Considering the patient's age
and the fact that the size of the kidney stones is larger than 2.5cm,
the director decided to perform PCNL,
percutaneous nephrolithotomy to shorten the operation time
and minimize the blood loss.
That's all from me. Thank you.
Thank you for your report, Dr. Wang.
Since the patient will undergo the operation in prone position,
Dr. Hsiao will advise us on the way we handle
the respiratory tract and anesthesia.
Dr. Hsiao.
I'm sorry.
After evaluating the patient's condition,
I've classified the patient under ASA class two
according to the Anesthetic Risk Assessment.
But due to the fact that patient's jaw bone is slightly shrunk
and she has a short neck,
it might be difficult to intubate her.
So just to be safe,
I'll use depolarizing muscle relaxant, SCC, to induce the anesthesia.
Then, a video-guided intubation system will be used to aid the intubation.
Is it confirmed that she doesn't have any history of adverse reaction to anesthesia?
Based on the information filled in by the patient
and reconfirmation with the patient's family,
she doesn't.
We'll use depolarizing muscle relaxants as usual.
Yes, sir.
-Dr. Wang. -Yes.
Before the surgery, confirm with Pharmacy and Anesthesiology Department again.
In case of an emergency,
the emergency medicine must be fully prepared.
Yes. Ms. Xu from the Anesthesiology Department will be in charge of this.
Yes, I've arranged it with the pharmacy department.
Everyone, performing the surgical demonstration
during the assessment period can showcase our clinical expertise.
All of you know it well
how high my expectation for the healthcare quality of our hospital is.
So every single step of the surgery must be completed without mishap.
Do you understand?
Yes.
Ma'am, what's your name?
Mei-man Lin Zeng.
Let me take a look at your bracelet.
What is your date of birth?
February 16th, 1937.
All right.
When did you start fasting?
-Since last night. -Since last night?
Are you allergic to any food or medicine?
-No. -No.
Don't worry. Have a seat.
It will take quite some time.
The anesthesiologist is on his way.
Just relax.
What time did you sleep last night?
Are the video-guided intubation system
-and the muscle relaxants ready? -Yes.
It's over there. Check them out yourself.
Hi, Mrs. Zeng. I'm your anesthesiologist, Dr. Hsiao.
-We met last night. -Yes.
You will undergo percutaneous nephrolithotomy today.
I'm preparing you for general anesthesia.
Okay.
You will inhale the oxygen.
You'll feel better after this.
-Breathe slowly and listen to me. -Okay.
Just like what I told you yesterday,
the medicines will be administered via intravenous drip to put you to sleep.
And anesthetic gas will be used to maintain the anesthesia.
Take a deep breath after you wake up.
Don't move. Remember what I told you.
Now, inhale slowly.
The surgery we're going to perform today is percutaneous nephrolithotomy.
The estimated operation duration is about one and a half hours.
Blood loss, minimum.
Begin the surgery.
Guo-zhang, Ms. Song.
-Mr. Yeh. -I bought you some food. Have you eaten?
No, thank you.
-Have some. -Please have some.
The surgery will take some time.
I have no appetite.
Really?
Then, would you like some drinks?
Ms. Song.
Thank you.
What about you, Guo-zhang?
Wait a minute.
Hey, the body temperature.
-Is the temperature transducer connected? -The oral temperature.
It's still increasing.
-Maximize the infusion rate. -All right.
-Measure the blood pressure once again. -All right.
Get the Arterial Line Insertion ready.
How's the patient doing?
I'm sorry, sir. I need to install the Arterial Line Insertion.
Why does she need that?
We need to measure her blood pressure now.
I want to do arterial blood gas analysis as well.
-Check the arterial blood gas. -All right.
Sir, the muscles have become stiff.
Muscle spasm.
How could this happen?
How could this happen to the patient?
Is there any way to eliminate it?
Sir, we need to stop the surgery.
The patient may suffer from malignant hyperthermia.
-I'll stop the anesthetics now. -How could this happen?
Didn't you confirm the clinical history before the surgery?
Are you sure it's malignant hyperthermia?
I only need the arterial blood gas result to confirm this.
The body temperature is increasing. ETCO2 is also increasing.
The heart rate is erratic.
PaCO2 75 lactate is approaching ten.
PH is only 7.2. Obviously, it's acidosis.
Malignant hyperthermia is confirmed. We need to use dantrolene.
Dantrolene?
Dantrolene.
Go get it now.
-We need 60mg. -Get 60mg.
Use cold saline to lower the temperature.
The body temperature is 38.8. It's still increasing.
Body temperature is still increasing. Dantrolene doesn't seem to work.
It's atrial fibrillation. She needs resuscitation.
Bring in the defibrillator.
Dress the wound. Get ready for resuscitation.
One, two, three.
Get ready for CPR.
Stop the resuscitation.
Send her to the ICU.
What?
Her heartbeat has stopped. Why are we sending her there?
No one has ever died on my surgical table.
Suture the wound.
Send her to the ICU.
Hey.
How is my mom?
-My mom... -You can't go in there.
-How is she? -We're now sending her to ICU.
Why does she need to be placed in ICU?
We must monitor her closely.
-She is... -No, tell me now.
How did my mom's surgery go?
-Now... -Tell me now.
She's quite unstable now. So we need to monitor her.
What do you mean by "unstable"? Can you clarify it?
Why did you send her there?
-To be honest... -Please explain to her family.
-Explain it to him. -The situation is far from optimistic.
-What do you mean by that? -What do you mean?
I will clarify with him.
Why are you sending her there?
Is the surgery a success or failure? You need to at least give us an answer.
We still need to monitor her closely.
Her family is over there. Explain to him.
-I want to see the director -Stop it.
Goodness.
What actually happened?
All I can say is that we've tried our best.
I'm sorry.
Dr. Wang.
Yes.
Everything was normal during the general anesthesia.
During the surgery, it was suspected that the patient had a complication
by malignant hyperthermia due to the depolarizing muscle relaxant.
Even after Dr. Hsiao administered 60mg of dantrolene to resuscitate her,
the malignant hyperthermia was not eliminated.
Even after admitting her into ICU,
she still failed to be resuscitated.
After listening to the director and Dr. Wang,
the surgeons did not do anything wrong during the surgery.
Does everyone agree with this?
Yes.
Now, let's discuss the reason that induced the complication.
Basically, the complication was caused by the anesthesia.
Sir, according to the surgical records,
although the malignant hyperthermia was caused by anesthesia,
Dr. Hsiao had ordered the use of dantrolene
to resuscitate the patient immediately.
With regard to the medication for resuscitation,
after the individual interviews,
it seems to be controversial.
Dr. Luo, please elaborate.
The other day, when I was assisting the surgery,
I was looking at Dr. Hsiao.
He looked lethargic and unfocused in front of the monitor.
I've confirmed it, Dr. Hsiao.
You've been suffering from insomnia, haven't you?
Yes, I do have insomnia.
Since you knew that you have rebound insomnia
and you were lethargic during the surgery because of it,
why did you not report to Dr. Liao immediately?
Why did you still enter the operation room anyway?
Because we are always tired.
Sir, there are only two anesthesiologists in our department.
There are 200 to 300 surgeries every month.
How can we not be lethargic?
But I think I was clear-headed enough to perform the surgery on that day.
Our job is to save lives.
There's no way we can compromise patients' lives due to lethargy.
According to the hospital regulations, Dr. Hsiao will be suspended from duty
until the medical board releases the investigation results.
That's all for the surgery post-mortem.
Everyone, dismiss.
Based on the testimonies of the medical personnel
and the operative reports,
the patient, Mei-man Lin Zeng,
had a complication by malignant hyperthermia
due to the anesthetics during the surgery.
But the anesthesiologist, Dr. Hsiao,
had caused the death of the patient
as he was unfocused and lethargic during the surgery.
According to the hospital regulations, Dr. Hsiao will be suspended from duty
until the medical board releases the investigation results.
Just watch. I'll definitely hold him responsible for this.
Dr. Hsiao.
Stop there!
Where do you think you're going?
How could you enter the room without getting enough sleep?
Are you insane?
-What's a patient's life to you? -Mr. Zeng.
-That's enough. -Bastard!
-What are you doing? -Bastard!
-Stop!
-Stop it. That's enough. -Stop it. Okay?
-Calm down. -Guo-zhang, stop it.
-Okay. -Stop it.
-Let go. -Why should I stop?
You killed my mom. Don't you know that?
Stop it.
Sir, what are you doing? I'll call the police.
-I'm sorry. Don't call the police. -It's fine.
Go ahead. He's a murderer.
-Go ahead. -We're sorry.
-Let's get out of here. -All right.
-What? -Let's go.
-Why are you staring at me? -Let's go.
-He wasn't staring. Let's go back. -I'll leave on my own.
Stop the bullshit.
I'm going to sue you.
Damn it, I'm going to sue you. Just wait and see.
Let's go, Guo-zhang. Stop it.
-Bastard! -Let's go back first.
Let's go.
It's okay.
I'm sorry. Guo-zhang didn't mean it.
-He's just not... -I understand.
So what actually happened during Mrs. Zeng's surgery?
Mrs. Zeng's cause of death
was due to her allergy to anesthetic which caused malignant hyperthermia.
That eventually led to multiple organ failures
and caused her death unfortunately.
Malignant hyperthermia
is a rare complication due to an allergy to anesthetics.
It's often hereditary.
But this wasn't stated in her clinical history.
Once I confirmed it was malignant hyperthermia,
I immediately ordered dantrolene. It's the remedy of malignant hyperthermia.
So you ordered the remedy once you found out?
-Yes. -But it did not work?
Now, we still don't know which part of the procedures went wrong.
I handled it according to the standard procedure.
But it didn't work.
You did take the necessary measures.
But why is the hospital blaming you?
I was...
I...
I wasn't at my best on that day.
The hospital needs someone to blame.
I've never...
I've never had any patient died under anesthesia.
Wait a minute.
Let's not think too much right now.
Now, we need to find out whether it's your fault or the hospital's.
You don't need to be upset about it
since we don't know if it actually was your fault.
Do you still play basketball?
Basketball?
Basketball.
I've stopped playing for quite a while.
I stopped once I entered medical school.
That's too bad.
You were quite good at it.
You still remember it.
Yes.
Of course.
Guo-zhang, this is the hospital. Calm down.
How could they handle it this way?
My mom is dead. They should bear the responsibility.
Yes, it's their fault. It's all their fault.
Go home first, okay?
Listen, I'll definitely hold them responsible for this.
Okay, let me handle this.
I'll help you sort it out. Let me investigate it.
Let's go.
-Good morning, Vina. -Good morning.
You're here early. Are you not hitting your sales target?
-Yes. Wait a minute. -Yes?
Well...
-Can I ask you something? -Okay.
Regarding Mrs. Zeng's surgery yesterday,
what actually happened?
I don't know. I did what I was supposed to do.
I'm busy. You should ask someone else.
Dr. Wang.
I'm sorry.
I need to disturb you for a bit.
Can I ask you something?
You insisted on performing the surgical demonstration.
Now that things have gone wrong,
you're putting the blame on us.
I wasn't going to ask you about that.
I know you've done your best for the surgery.
But could you please tell me
what actually happened
in the operating room?
We've explained it to the patient's family.
You're not her family member. So I don't need to explain it to you.
Hey.
I'm off.
Bye.
-Hey. -Yes?
During the meeting,
I didn't stand up for you.
I'm sorry.
Because the management said...
I know.
But I know for certain
that we were keeping an eye on the monitor.
You did respond to it immediately.
We're not at fault.
I don't think it was your fault.
Are you taking them all today?
No, I will come back and take them. I didn't drive today.
Can you register a Facebook account?
Why should I?
Everyone has a Facebook account now. You are outdated if you don't have one.
Just call me.
People no longer make phone calls.
All right, I've got to go.
See you again.
Bye.
Go there. What are you doing?
Stand properly. Can't you stand properly?
Be a watchman here. Do you understand?
Look there.
You'll be dead if someone comes over.
-Take off her pants. -What are you doing?
She is shy.
Take off her pants.
Will she fall for you? You are so outrageous.
Probably. Bring her home.
-Take her home! -Take her home!
Take off her pants.
What are you doing?
-She is crying. -Don't cry.
Let me see.
She is pathetic.
What are you doing?
Stop struggling.
-Don't struggle. -What are you doing?
I'm sorry. I fell asleep.
Thank you.
Just put it there.
How long was it?
About 20 minutes.
You are here to get a good sleep, aren't you?
Play it.
I'm sorry.
-I recorded this while you were asleep. -I'm sorry.
-Did you dream about the surgery? -I'm sorry.
No, I was dreaming...
I told you before about the dream when I was a junior high student.
Do you think this dream is related to your stress now?
Or could you tell me more about this dream?
There's nothing else I can say. It's just like what I told you.
I wake up at the same point of the dream every time.
Hey.
Focus.
Go back to the previous question.
Where were we before you fell asleep?
The surgery failed.
Someone died.
Then, you cried.
If your judgment didn't cause the surgery to fail,
why did you cry?
According to medical journals,
the success rate of using dantrolene to treat malignant hyperthermia
is more than 95 percent.
But apparently, this case is one of the five percent. Do you understand?
So you can't accept your own mistake?
No, it's because I had taken the necessary measures
and used the medicines in time.
So this shouldn't happen.
Doctors are also humans. Can't a doctor make mistakes?
As an anesthesiologist, we can't make mistakes.
As a psychiatrist, you only need to talk to your patients.
Nothing will go wrong if you say something wrong.
I can't inject the wrong vein. I can't make mistakes.
Mistakes are not allowed.
There's no room for mistakes.
Come here and sit down.
I want to clarify something.
Did you cry because of your failure at work
or because you've caused someone to die?
Now, you have two unresolved feelings in you.
I understand that you feel guilty.
But this is not the main source of your stress.
What is it then?
If the failure rate of the surgery is only five percent,
then why did it fail even when you had made the right judgment?
So what are you trying to say?
Logically,
you have to figure out the problems that cause the five percent of failures.
Would you like some hot tea?
So?
Okay, Guo-zhang.
All right, stop drinking.
Guo-zhang.
I'm sorry.
Ms. Song.
-Mr. Yeh. -Hello.
Why is Guo-zhang so drunk?
What happened was too sudden. Just let him drink.
Then, I will talk to him later.
Should I help you send him home?
I'm sorry, Mr. Yeh.
-Here. -Thank you.
I want to ask you...
The anesthesiologist was actually my classmate in junior high school.
He was?
What a coincidence.
Did he really cause the surgery's failure?
Actually, the reason why I asked Guo-zhang out today
is to tell him
that I don't think Mrs. Zeng's case
is that simple.
Sorry, but I don't understand.
Let me put it this way.
-After the incident, -Yes.
the hospital released the investigation report the very next day.
That is suspicious.
It was a surgical demonstration and the director was the main surgeon.
But the report only mentioned Dr. Hsiao.
Other details were not specified.
So I think what actually happened in the room was different
from what was stated in the report.
So it was not all Dr. Hsiao's fault, was it?
I won't say that it has nothing to do with him at all.
After all, he was in the operating room.
So he should know better about what happened in the room.
Goodness.
Guo-zhang.
Are you okay?
You've hurt yourself.
-Come on. -Sit down.
-Come on.
Are you injured?
-Mom died because of me! -No.
Mr. Yeh, I really don't know what to do.
I really need your help.
No matter what,
I'll try my best to investigate this.
Thank you.
All right, let's go.
-Let me help you. -Thank you.
Guo-zhang.
Come on, let's go.
Be careful.
Malignant hyperthermia
There's a kind of medicine used in the surgery.
It's called dantrolene.
Dantrolene?
Was the medicine used?
Yes.
An old lady died. Don't you know?
It's clearly stated in the report that dantrolene was used.
That medicine is rarely used.
How common is malignant hyperthermia? What genes are related to it?
Did you order it?
I'm not in charge of this.
I'm not sure.
Zhu, the patient wants to take the medicines.
-I need to get back to work. -Zhu.
Dantrolene importer
Look at this inventory.
Renxin Hospital hasn't been ordering dantrolene in the last two years.
You know dantrolene is rarely used.
You're lying, Jiang.
There was a surgical demonstration two days ago.
Dantrolene was used during the surgery.
Where did they get the medicine if you didn't sell it to them?
Wait a minute.
Look, this is our inventory.
It's all here.
Renxin Hospital hasn't ordered this medicine in the last two years.
It's true.
Zheng-xun Hsiao, Doctor
Depolarizing muscle relaxant
MEDICAL CENTER
Hey, Dr. Hsiao.
Hi.
Your pants are unzipped.
Are you leaving the hospital?
I don't need insurance.
Wait, you forgot your thermos. Here.
Thank you.
Do you know that your hospital
has not purchased dantrolene in the last two years?
That doesn't make sense.
I gave dantrolene once we confirmed that it was malignant hyperthermia.
If dantrolene was given in time, why did Mrs. Zeng die?
Dantrolene does not always work on hyperthermia.
I've done some homework.
It works 95 percent of the time.
You couldn't be so unlucky to fall within that five percent.
Then again,
if it's not a definitive cure
as you just said,
why didn't the hospital include that in the report and publicize it?
Why did the medical board put all the blame on a good doctor
before the judicial decision?
Someone is running away from the responsibility, isn't it?
It's not strange for them to blame it on the anesthesiologist.
Otherwise, who's going to take the blame? The director?
Sir, all your dishes are served.
-Please enjoy. -All right.
I would like to apologize to you, Mr. Speaker.
There was an emergent patient the other day.
The anesthesiologist needed to take care of that patient.
That's why we were unable to perform the painless delivery for your wife.
Mr. Speaker, please forgive us.
I'll drink this as a punishment.
Forget it.
You couldn't have had so many doctors involved with my wife's delivery.
It was an unreasonable request. Don't you think so?
No.
We should've accommodated the request.
It's just that we had some issues with the personnel deployment.
I hope you could give us another chance.
You are too humble.
I can easily persuade my wife.
But since we will be working together a lot in the future,
you should man up and be bold.
You have the authority to determine the rules, don't you?
Rules?
Rules must be in place
to regulate the situation.
Am I right?
Hey.
Of course.
That's why I said Mr. Speaker is generous.
He won't bother about these little things.
Here you go, Mr. Speaker.
Cheers.
But I heard that someone died
during the surgery you performed.
Although the result of the surgery won't affect the assessment,
how could I refer my friends to your hospital?
The surgery failed only because of the anesthesiologist.
It has nothing to do with our director.
This is just some misunderstanding. I hope it won't affect your trust in us.
The hospital should be held responsible for its physician's wrongdoings.
Before the public rebuilds their trust and confidence in your hospital,
I'm sure you know what to do to get what you want.
Mr. Speaker, have a drink.
This is totally personal.
It has nothing do with the business.
Yes.
-Sir, let's toast for Mr. Speaker. -Come on.
-Cheers. -Cheers.
Sir, regarding Mr. Speaker...
I know what you want to say.
I'm the director of the hospital.
I hope the hospital can pass the assessment more than anyone else,
but we need to hold on to our principles.
But not only is the speaker the committee of the board,
he also has control over the factions and profit distribution of the region.
It will be very difficult for us if we get on his bad side.
Of course, we can't disgruntle the villain.
But we also can't depend on him monetarily.
Renxin Hospital did make it
as the regional teaching hospital without his help last time.
Tzu-chiang.
I don't care how you are related to Mr. Speaker,
but I hope your personal matters
won't affect the hospital professionally.
The next milestone for the hospital is to become a medical institution.
In terms of budgets, manpower and infrastructure,
I need your help to rectify and reform them.
Remember this.
Serious problems are often monetary.
Dr. Hsiao.
My client died in your hospital due to medical malpractice.
I think I must investigate this.
I talked to the pharmaceutical company.
That's why I'm certain that your hospital hasn't purchased
dantrolene in last two years.
That's impossible.
But could you tell me honestly
what actually happened in the operating room?
I've told you. We took all the necessary measures.
I also gave her dantrolene.
Are you sure it was dantrolene?
What else would it be?
I don't know.
Are you saying that the hospital used counterfeit drugs?
You are the physician of the hospital.
What do you think?
That's impossible.
Do you have access to it?
To what?
Dantrolene.
"Medicines that will expire in less than a year
will be collected and disposed of by the manufacturer."
Let me introduce him. This is Mr. Gui-heng from the FDA.
Nice to meet you.
We need more than their purchase order record.
But your hospital did purchase dantrolene from them.
Now, every department has quotas for their expenses.
It's normal to purchase cheaper products.
I heard that Dr. Hsiao is still in the hospital,
asking around about the cost-cutting.
This hospital is sick.
If you can't change the system, then what are you trying to change?
NEXT EPISODE
I just want to be a good physician.
Subtitle translation by Gwen