Today's workout episode of #ER ("May Day", S6) has so many good ethics topics. If my wife were still alive, I would encourage her to write "Ethics of ER" to discuss them in detail. Today we've got: triage ethics (caring for shooter vs shot), informed consent, impaired physician.

today's episode ("Flight of Fancy", S7) dealt with disclosure of HIV status amongst other things.

Today (“a walk in the woods”, S7) we have vaccine refusal and a case of measles, physician competency.

Today, “The Longer You Stay”, S8, we have diagnostic error and disclosure of error.

Today Season 8, "Never Say Never" featured child with Trisomy 18 and palliative vs aggressive care, questions of futility. Pings some sadness for me for other reasons.

Season 8, Episode 9, "Quo Vadis?" features issues around organ donation and donation after cardiac death (DCD). A controversial issue, another for which Aviva would have an updated perspective

Observation: Dr. Romano was *almost* always an asshole. But this season, we saw him sign "Take care of your dad" to Benton's hearing impaired son when Benton wasn't looking, counseled Elizabeth about her husband's dying, and was truly saddened when Mark died. People are complex.

S8, E22, “”Lockdown” seems very timely. Infectious disease (?smallpox) in the ED. Isolation, N95s, and a lot of angry “inconvenienced” people

(later realizing that I am old enough that I had smallpox vaccine...)

Season 9, Episode 4, "Walk Like A Man", has a soldier that loses his sight from quinine. How timely.

S10, “out of Africa”, patient with macular degeneration and no treatment options. Who would have thought then that gene therapy would one day save sight?

S10, E6 "The Greater Good", decision making around limits of viability (then a 24 week preemie) and rights of mom to limit resuscitation.

S10, E7, “Death & Taxes”. Physician error. And “informed consent” (an issue very dear to Aviva)
Sam: “consent!”
Gallant “sign here!”
Parents: sign form

On today’s episode “NICU”, we again have limits of viability. But a resident named Matt Gillespie was a Peds resident. There is a real pediatric cardiologist by same name @ChildrensPhila !

S10,E13 "Get Carter". Kovach teaches parsimonious use of testing to uninterested students. Only much later did I learn that in US this primarily saves $ for the payor (more profits) and doesn't necessarily save $ for patient or "the system". #AnAmericanSickness #overtreated

other tidbit from this episode - patient with Wegener's Granulomatosis; we no longer use that eponym after it became known that he was a member of the Nazi party. See: Chest 2007 Dec;132(6):2064-5. Time Does Not Heal All Wounds: Medical Luminaries, National Socialism, & the ACCP

S10, E16, "Blood Relations". Big mistake.
Pratt: "Pulse ox measures oxygen dissolved in blood, not bound to hemoglobin. That's why it's normal in CO poisoning".
BUZZER!

S10, E16 "Forgive & Forget". The gruff, sometimes bigoted desk clerk has an MI, and during his treatment we learn that he dotes on his daughter with Trisomy 21 and at home speaks kindly of everyone at work. Reminds me of this amazing video

S10, E17 “the student”. Which happens to be how Aviva’s faculty referred to me. But this episode has misattributed paternity, risk of genetic counseling. Handled badly by Dr Kovac

Ibid.
Gallant: “this morning , in the bay, i was thinking of asking you out”
Neela: (crying) “I was thinking of saying yes”

Ibid. Elizabeth navigating looking for love after the loss of a spouse. Oy.

S10, E22, "Drive". Neela drives to Ann Arbor to start residency at @umichmedicine. Spent 9 years of my life there - fond memories.

(although she finds a parking spot a little too easily...)

S11,E2 “Damaged”. Relationship heartbreak . And gay bashing “they can’t kill you for kissing in the park”. #matthewshephard

S11, E9, “‘Twas the Night”. Social determinants of health (before we had that term), and Physician Assisted Suicide.

Also, Dr. Pratt ordered a BNP infusion which I had never heard of before. I've used BNP as marker of RA stretch and indirectly trying to look at RV function, but never as a therapeutic. @MKIttlesonMD educate me...

S11E19 "Ruby Redux", balancing risks & benefits, patient communication. and a frequent ER inaccuracy? Susan up for "tenure" which at most places is for people doing a lot more research. Mark Greene once demanded tenure too. Maybe they should just say "up for promotion"

S11,E21 “Carter est amoreux”. Neela caught between not assertive enough and too assertive. Women unfairly put there more often than their male counterparts.

S12, E1. New interns and their struggles. Most of episode spent with Sam & Luka driving cross country to look for runaway Alex. Recognizing that show was turning more to relationships/soap opera than medical stuff. Is this how shows jump the shark?

S12,E9 “I do”. Vaccine refusal (again), conspiracy theories against science/medicine. And racism in law enforcement. Residents sometimes know more than the attendings.

S12, E11, "If Not Now". Not sure if they were channeling Rabbi Hillel. Episode focused on decisions around termination (for teen raped whose parents expressed "everything happens for a reason") vs continuing pregnancy (for Abby/Luka). #plannedparenthood

and PS, basically every episode - why does no one wash their hands?!?

S12, E17, "Lost in America". Early use of eCPR (unsuccessfully) in a trauma.

S13, E1, "Bloodline". So much going on. Kidnap of Sam/Alex. Balancing of life of baby and life of mom. Picking a name for your unborn baby. And Jerry gets shot and visited by his mom (played by Estelle Harris/Estelle Costanza from Senifeld! and Mrs. Potato Head from Toy Story).

S13, E6 "The Heart of the Matter". Pratt discovers that the Black barbershop is a place with patients in need of care. Well before we had these kind of data: https://pubmed.ncbi.nlm.nih.gov/32180133/ 

S14, E6, "The Test". Kid with respiratory failure due to neuromuscular disease refuses intubation [autonomy, rights of teens?] (while playing catch with the ER doc and with pCO2 65). Dies later. Have they never heard of BiPAP??