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S01.E11: A Seat at the Table

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Reynolds confronts a difficult episode from his past; Max distracts himself from chemotherapy by taking on the case of a frequent-flyer patient; Frome helps a young man suffering from severe delusions; Sharpe worries about Bloom's attempt to detox.

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Bloom is so fortunate she is allowed to work at all; Sharpe and the hospital were obligated to suspend her without pay once they found out about her substance abuse. So she can lose the snippy attitude anytime that Sharpe is checking up on her.

Kapoor's son is going to manipulate and scam the nice coffee shop lady so he can get money from his father via her, right?

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1 hour ago, LexieLily said:

Kapoor's son is going to manipulate and scam the nice coffee shop lady so he can get money from his father via her, right?

That or they're setting up some kind of weird multi-generational love triangle. Please no.

I honestly forget what breed of Issues he and the son were originally estranged over, but if Kapoor didn't think it prudent to give him a wad of cash, I don't know why neither of them suggested he could pay for the studio directly instead.

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1 hour ago, Emma9 said:

if Kapoor didn't think it prudent to give him a wad of cash, I don't know why neither of them suggested he could pay for the studio directly instead.

Yes; how stupid of either of them not to suggest this. 

I thought the actress playing Bloom looked so different in this episode that I think it's a new actress. It probably isn't - but she just looked totally different and even sounded different.

I know nothing about chemo, having been fortunate enough not to need it during my cancer experience, but I wasn't aware there are types of chemo that require daily infusion. The people I know undergoing chemo, or who've had chemo, generally went once a week or once every two weeks, or something to that effect - I didn't realize there are regimes that are daily. 

I thought Iggy's story line was off kilter somehow. I would have appreciated more background or history. I feel like we got dropped into the young man's story 3/4 of the way through and I felt like I was missing something. I guess he'll never improve? So he'll continue to be terrorized by the wolf hallucinations if he's stressed out? I sort of got the impression that he was somewhat intellectually compromised as well; he was looking at the brochure and asked his dad, "I can draw there?" it sounded as if he was verbally challenged. Maybe from the surgery? When he was first telling Iggy about the most recent 'attack,' his use of language seemed more sophisticated.

Glad we didn't have to see Georgia and her awful hair.

Edited to add: I thought the cardiologist and the attorney had broken up at that big fundraising party a few episodes back? Yet in this episode, she said, "As your attorney, I'd do XYZ, but as your girlfriend, I'd say XYZ." Did she mean that literally, like, is she still his GF? 

Edited by Biggie B
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At this point I am just hate watching. I fast forward a lot...so what was the big secret that the cardiologist was trying to hide from his nephew?  I am over how this show depicts transplants and serious illnesses.  I am insulted by the whole treatment of Max's illness.  I guess he is just Superman!  Where is his wife?  On second thought I am glad she was not around , the same with Helen's new love interests that she also has no chemistry with.

 I had no idea Bloom and Helen were friends, or was this just thrown in so that she would have someone who knew her story and she could be mad at for checking on her?  What happened to the guy that complained about covering for her in the ER? 

I don't even know what happened with Kapoor and his son. I thought they had made up?  I am guessing that he asked his father for money at some point?  I missed the introduction...how did it happen in a way that there was romantic interest, or is he pretending to be interested in her because he think his father is interested in her?

I never really watch the Iggy? scenes, so I am sure I did not miss anything. 

I will say that my sister told me that in her town they conducted a study of how much money they were spending on homeless people coming to the ER. I believe it ended up at about 40 to 50K or slightly more a year.  A non profit identified 50 patients who had a variety of issues and built about 50 tiny homes for them. I believe they offer counseling and other services in the "community to help residents with mental illness and substance abuse.  It was supposed to cost about $15K to 20K to maintain per year, which was significantly less than what they were paying in there emergency visits.  I think it is somewhat of a success.  That formula, however, was a lot more believable than the whole Max gives the homeless man a home AND a job and solves all his problems!!!!  And in just two days!!   

I personally think the actor that plays Max overacts and he has some strange acting choices and facial expressions.  He also speaks indistinctly to me at times...is this showing doing well in the ratings? 

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Bloom is so fortunate she is allowed to work at all; Sharpe and the hospital were obligated to suspend her without pay once they found out about her substance abuse. So she can lose the snippy attitude anytime that Sharpe is checking up on her.

I can't believe for even a minute that the hospital would allow someone with her drug issues to continue working like nothing had happened.  Didn't she even say she was going cold turkey while working her shift?  That's just nuts. 

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I honestly forget what breed of Issues he and the son were originally estranged over, but if Kapoor didn't think it prudent to give him a wad of cash, I don't know why neither of them suggested he could pay for the studio directly instead.

I think his son had some kind of drug and/or alcohol problem, along with generalized daddy issues?  Wasn't he supposed to be in AA or NA?   

Edited by txhorns79
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10 hours ago, Biggie B said:

Yes; how stupid of either of them not to suggest this. 

I thought the actress playing Bloom looked so different in this episode that I think it's a new actress. It probably isn't - but she just looked totally different and even sounded different.

I know nothing about chemo, having been fortunate enough not to need it during my cancer experience, but I wasn't aware there are types of chemo that require daily infusion. The people I know undergoing chemo, or who've had chemo, generally went once a week or once every two weeks, or something to that effect - I didn't realize there are regimes that are daily. 

I thought Iggy's story line was off kilter somehow. I would have appreciated more background or history. I feel like we got dropped into the young man's story 3/4 of the way through and I felt like I was missing something. I guess he'll never improve? So he'll continue to be terrorized by the wolf hallucinations if he's stressed out? I sort of got the impression that he was somewhat intellectually compromised as well; he was looking at the brochure and asked his dad, "I can draw there?" it sounded as if he was verbally challenged. Maybe from the surgery? When he was first telling Iggy about the most recent 'attack,' his use of language seemed more sophisticated.

Glad we didn't have to see Georgia and her awful hair.

Edited to add: I thought the cardiologist and the attorney had broken up at that big fundraising party a few episodes back? Yet in this episode, she said, "As your attorney, I'd do XYZ, but as your girlfriend, I'd say XYZ." Did she mean that literally, like, is she still his GF? 

Yeah, there are chemos that are daily infusion - but usually they are inpatient.

So, no nurses at all in that infusion room? Why was it so tiny? Why did the doctor violate HIPAA and introduce Max to the patients? Where were the nurses in the infusion ward? Is cisplatin even used as a single chemotherapy agent with his cancer? They usually like to throw in a steroid. Why didn't they also have a bag of Zofran or something?

The first infusion is usually slower to make sure there are no side effects.

Why are they giving him the chemo direct into the arm vein? Why not do a port or a PICC?

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I had a community healthcare worker job at a hospital just a few years ago and we worked with the frequent fliers.  They would get flagged after 3 visits and we would try and connect with them and then provide them with resources so they weren't costing the hospital these high fees.  This story line was so absurdly unrealistic and I'm sure someone who did not do my job is even aware of this.  Housing is an absolute joke and there is no way anyone who was running the hospital would know about this one dude let alone rent an apartment for him.  There was only one client we got housing for and it was like pulling teeth, he only got bumped up because of his mental illness. He stayed in the place for about 2 days before he disappeared again. 

In the book did the doctor really run around doing chemo while attending to other tasks?

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3 hours ago, bros402 said:

Yeah, there are chemos that are daily infusion - but usually they are inpatient.

So, no nurses at all in that infusion room? Why was it so tiny? Why did the doctor violate HIPAA and introduce Max to the patients? Where were the nurses in the infusion ward? Is cisplatin even used as a single chemotherapy agent with his cancer? They usually like to throw in a steroid. Why didn't they also have a bag of Zofran or something?

The first infusion is usually slower to make sure there are no side effects.

Why are they giving him the chemo direct into the arm vein? Why not do a port or a PICC?

Because this show is totally ridiculous when it comes to the medicine.  In real life, he would've had a mediport or something similar inserted into a big vein in his chest.  Chemotherapy is caustic, it destroys small veins, causing them to be scarred and damaged and making repeated infusions through the same vein impossible.  Max' first stop would've been the OR where a general surgeon would've placed a port which takes just minutes and saves a lot of time and hassle.  His chemo could be given through it and also blood drawn from it both for convenience and comfort and to avoid destroying the veins in his arm and sparing him the pain that comes with poison running through small vessels.

A hospital as large as New Amsterdam would have a very busy outpatient chemotherapy unit which would be fully staffed with trained nurses and aides who do nothing but run chemo all day long.  Usually there are comfortable lounge chairs, TV's, blankets and other comforts as these infusions take hours.  As noted above, along with the chemo, Max would've received an anti nausea med like Zofran and probably some steroids to try to lessen the side effects.  There is absolutely no way a patient with chemotherapy running would be wandering the halls throughout thre hospital.  What if the IV disconnected?  What if it infiltrated?  As noted above, that stuff is highly poisonous, the nurses handle it with gloves and the empty bags are placed in specially sealed containers.  It burns the skin or any tissue that it hits, his arm would be messed up for weeks or longer if the infusion got under the skin instead of into the vein.

For squamous carcinomas of the throat that are not operable which it appears that Max has, chemo would usually be cis-platinum and 5 flourouricil; BUT, it would be done in conjunction with radiation therapy, because radiation is the most effective treatment and the chemo is an adjunct which makes the radiation more effective.  So, Max would be getting radiation therapy 5 days a week.  Cis-platinum is not one of the chemotherapies that is given daily, he'd be getting it maybe weekly. As noted above, daily chemo is very harsh and can be life threatening.  It is usually used in the initial stages of treatment for aggressive cancers like leukemias.  I don't think Max, in real life, would get Cis-platinum daily since it can cause kidney failure.

Because patients getting chemo are put on a specific schedule and spend hours on the unit each time, it is not uncommon for folks to be on the same schedule and to see one another often and sometimes become friends; but that is up to them; it was absolutely inappropriate for Helen to introduce them like it was a social gathering.  I am sure the oncology department has support groups for cancer patients, if Max wants to join one, he can do so, but forcing people to socialize in that circumstance is wrong.  Not everyone wants to be pals or get advice or whatever.  BTW, all the semi helpful advice Max got from the other patients should've been given to him by the medical staff in the form of a handbook given to all chemo patients.  There are a lot of tips and tricks for trying to manage the issues that arise; good oncology units give people that information right from the beginning.

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In the book did the doctor really run around doing chemo while attending to other tasks?

In the book, I believe the doctor didn't get chemo, only radiation.  He also took a leave of absence from the job that lasted a couple years while he dealt with the radiation and the very serious ongoing side effects that it caused.

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Because this show is totally ridiculous when it comes to the medicine. 

This show is totally ridiculous when it comes to a lot of things.  For example, Max being diagnosed with a debilitating disease, but having no plan in place for anyone to handle his job while he recovers.  And even now, while I like the character of Helen, my impression was that the Medical Director of such a large hospital would likely need years of experience serving in that type of position before being able to handle it.  It's not a job you can just step into, while simultaneously running your own oncology practice.  Though I guess it does say something about Max's abilities to do his job that his choices to be deputy were either Helen or Bloom, a drug addicted doctor whose issues rival Max's, and Helen seemed to take the job only to spare Max the dumpster fire Bloom would have been in that position.   

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14 hours ago, Biggie B said:

I thought Iggy's story line was off kilter somehow. I would have appreciated more background or history. I feel like we got dropped into the young man's story 3/4 of the way through and I felt like I was missing something. I guess he'll never improve? So he'll continue to be terrorized by the wolf hallucinations if he's stressed out? I sort of got the impression that he was somewhat intellectually compromised as well; he was looking at the brochure and asked his dad, "I can draw there?" it sounded as if he was verbally challenged. Maybe from the surgery? When he was first telling Iggy about the most recent 'attack,' his use of language seemed more sophisticated.

I wish they had given more information too. Maybe it got lost in editing. I didn't think he was intellectually disabled. People who have delusions and night terrors can become "fragile" - for lack of a better word. It can be exhausting and drains you of all will. Him asking his father if he could draw there was simply his fear of everything. For what I could gather from he incomplete information, is that he came to rely on his father - or his father came to be overprotective - so he needed reassurance that things would improve. I know people with similar things going on, and their confidence in themselves gets depleted really fast. It is a lot.

 

2 hours ago, IDreamofJoaquin said:

I had a community healthcare worker job at a hospital just a few years ago and we worked with the frequent fliers.  They would get flagged after 3 visits and we would try and connect with them and then provide them with resources so they weren't costing the hospital these high fees.  This story line was so absurdly unrealistic and I'm sure someone who did not do my job is even aware of this.  Housing is an absolute joke and there is no way anyone who was running the hospital would know about this one dude let alone rent an apartment for him.  There was only one client we got housing for and it was like pulling teeth, he only got bumped up because of his mental illness. He stayed in the place for about 2 days before he disappeared again. 

In the book did the doctor really run around doing chemo while attending to other tasks?

Really! Even in a public hospital it is more likely that a frequent flier would be left in the waiting area and forgotten there. This happens with people who have legitimate reasons to be in the ER, and that go there often. The guy apparently only liked the attention (most of the time at least)

 

17 hours ago, LexieLily said:

Bloom is so fortunate she is allowed to work at all; Sharpe and the hospital were obligated to suspend her without pay once they found out about her substance abuse. So she can lose the snippy attitude anytime that Sharpe is checking up on her.

Agree that she should be at least suspended but the way Sharpe dealt with it was not professional at all. Nobody has the right to go through people's stuff. Even if a place might have policies that allow random searches, no complaints were filed so that search was a violation. 

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21 minutes ago, txhorns79 said:

This show is totally ridiculous when it comes to a lot of things.  For example, Max being diagnosed with a debilitating disease, but having no plan in place for anyone to handle his job while he recovers.  And even now, while I like the character of Helen, my impression was that the Medical Director of such a large hospital would likely need years of experience serving in that type of position before being able to handle it.  It's not a job you can just step into, while simultaneously running your own oncology practice.  Though I guess it does say something about Max's abilities to do his job that his choices to be deputy were either Helen or Bloom, a drug addicted doctor whose issues rival Max's, and Helen seemed to take the job only to spare Max the dumpster fire Bloom would have been in that position.   

There's also the fact that Max is medical director, not king, and it is not his decision who replaces him when he is not able to work.  A hospital this size would have a huge administrative staff already in place as well as a chain of command that explicitly states who covers when someone is unable to work.  Since he is expected to be incapacitated for months, if not longer, it is likely the hospital's board of trustees would become involved in hiring someone with extensive administrative experience who could serve in the interim.  He might be asked for input in the decision but he would not have exclusive control.

Edited by doodlebug
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20 hours ago, doodlebug said:

Because this show is totally ridiculous when it comes to the medicine.  In real life, he would've had a mediport or something similar inserted into a big vein in his chest.  Chemotherapy is caustic, it destroys small veins, causing them to be scarred and damaged and making repeated infusions through the same vein impossible.  Max' first stop would've been the OR where a general surgeon would've placed a port which takes just minutes and saves a lot of time and hassle.  His chemo could be given through it and also blood drawn from it both for convenience and comfort and to avoid destroying the veins in his arm and sparing him the pain that comes with poison running through small vessels.

A hospital as large as New Amsterdam would have a very busy outpatient chemotherapy unit which would be fully staffed with trained nurses and aides who do nothing but run chemo all day long.  Usually there are comfortable lounge chairs, TV's, blankets and other comforts as these infusions take hours.  As noted above, along with the chemo, Max would've received an anti nausea med like Zofran and probably some steroids to try to lessen the side effects.  There is absolutely no way a patient with chemotherapy running would be wandering the halls throughout thre hospital.  What if the IV disconnected?  What if it infiltrated?  As noted above, that stuff is highly poisonous, the nurses handle it with gloves and the empty bags are placed in specially sealed containers.  It burns the skin or any tissue that it hits, his arm would be messed up for weeks or longer if the infusion got under the skin instead of into the vein.

For squamous carcinomas of the throat that are not operable which it appears that Max has, chemo would usually be cis-platinum and 5 flourouricil; BUT, it would be done in conjunction with radiation therapy, because radiation is the most effective treatment and the chemo is an adjunct which makes the radiation more effective.  So, Max would be getting radiation therapy 5 days a week.  Cis-platinum is not one of the chemotherapies that is given daily, he'd be getting it maybe weekly. As noted above, daily chemo is very harsh and can be life threatening.  It is usually used in the initial stages of treatment for aggressive cancers like leukemias.  I don't think Max, in real life, would get Cis-platinum daily since it can cause kidney failure.

Because patients getting chemo are put on a specific schedule and spend hours on the unit each time, it is not uncommon for folks to be on the same schedule and to see one another often and sometimes become friends; but that is up to them; it was absolutely inappropriate for Helen to introduce them like it was a social gathering.  I am sure the oncology department has support groups for cancer patients, if Max wants to join one, he can do so, but forcing people to socialize in that circumstance is wrong.  Not everyone wants to be pals or get advice or whatever.  BTW, all the semi helpful advice Max got from the other patients should've been given to him by the medical staff in the form of a handbook given to all chemo patients.  There are a lot of tips and tricks for trying to manage the issues that arise; good oncology units give people that information right from the beginning.

Yuuup - I have cancer, so I know about ports and PICCs (I don't have either because my cancer doesn't do IV chemo, but yeah). I could understand them not installing a port due to Max's recent issues - but then they would've put in a PICC line.

I went to Columbia in NYC for a bit - I went to their midtown location - all outpatient stuff, they had a pretty large infusion room - could fit like 10-12 people getting chemo, had like 5 nurses just for the infusion area. 

If anything happened, Max the Super Doctor would've fixed it, duh!

If Max is under 39 - then he would be a young adult, and would have even more in the way of support. That is one thing I *liked* about this episode - they had a young adult with cancer that wasn't the main character!

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I assume Sharpe took the Deputy Director job so she can order Bloom into rehab. Otherwise she’s an idiot at risk of getting sued and losing her license. And Bloom is the most unlikeable character.  I’d take a few more Georgia episodes over this mess.

The homeless guy didn’t “cost” the hospital $1.4 million. That’s just the total list price for all of his treatments. When a hospital charges you $5,000 for the pleasure of sitting in their ER for a few hours, there are zero costs involved. And I’m sure the $60 Tylenol they must have given him a few times didn’t affect their ability to treat other patients. 

Kapoor’s storyline is so boring and Iggys so pointless that they make for perfect bathroom breaks.

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On 1/17/2019 at 7:32 AM, alexvillage said:

Really! Even in a public hospital it is more likely that a frequent flier would be left in the waiting area and forgotten there.

I can't generalize to all public hospitals, but that has not been my experience at all.

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18 hours ago, Johnny Dollar said:

I assume Sharpe took the Deputy Director job so she can order Bloom into rehab. Otherwise she’s an idiot at risk of getting sued and losing her license. And Bloom is the most unlikeable character.  I’d take a few more Georgia episodes over this mess.

The homeless guy didn’t “cost” the hospital $1.4 million. That’s just the total list price for all of his treatments. When a hospital charges you $5,000 for the pleasure of sitting in their ER for a few hours, there are zero costs involved. And I’m sure the $60 Tylenol they must have given him a few times didn’t affect their ability to treat other patients. 

Kapoor’s storyline is so boring and Iggys so pointless that they make for perfect bathroom breaks.

Yeah, I was WTFing at them saying the homeless guy cost the hospital 1.4 million - unless he had some stuff go horribly wrong during his 3 (?) surgeries, yeaaah.

They said he got 10 EEGs, in my experience, they cost like $500 (Billed to insurance as that), then a couple hundred for interpretation. Let's be generous and say it costs $1000 for New Amsterdam to do and interpret an EEG, that's 10k. Three surgeries, let's say they were huge and cost 100k each. That's only 310k.

Edited by bros402
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9 hours ago, starri said:

I can't generalize to all public hospitals, but that has not been my experience at all.

I can tell you from witnessing that disabled people who also have chronic pain/disease and need the ER very often are left waiting and even told they are lying. Not one hospital in one place. This is across the board int his country.

But I get your point on generalizing. I haven't personally witnessed all the cases because it would require me to travel everywhere, and while at least in two cases the hospitals were public, I cannot say all of them were.

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My mom had oral caner twice (squamous cell carcinoma which is the most common oral cancer.)    She was told at the first hospital that she wasn't a candidate for surgery because of other health problems so didn't have it (but should have.   She had carboplaitin (cisplaitin light because she couldn't take cisplatin due to another medical issue).   That was once every three weeks concurrent with radiation.   It is just to help the radiation.  There is no curative chemotherapy for squamous cell carcinoma.    She did not have a port but she only had 3 chemo sessions.   

Recurrence after a year., much, much, much bigger tumor.    Different hospital (the one we should have gone the first time).  This time because of the size and location of the tumor they said she needed surgery a BIG ONE.  13 hours.  They did apparently worry she wasn't a great candidate because of other medical issues.  However, they did the surgery.  The surgery she woud have needed the first time would have been comparatively no big deal, NONE.   Alas.  Live.  Learn.   then more raidiation this time without chemo.    She is 3.5 years cancer free from the end of her second bout with oral cancer.  She is doing great.  She'd be doing a lot better if she'd had the surgery the first time.  Can't go backwards.   

But no, seriously, chemo and radiation is the gold standard and Max is healthy so he'd be getting the chemo.  Once every 2/3 weeks.  But radiation is the big gun.  Maybe proton therapy.  That isn't offered in as many places and it isn't offered if the tumor has spread but it is what a doctor with money/good insurance/options would absolutely pick if his tumor was a candidate for it.

There is no way he'd have daily chemo.  There would be people in his infusion center who were there every day.  And you do get to know the people on your chemo rotation.   Most chemo isn't inpatient although there absolutely is chemo that is either because of the type of chemo/cancer or because of concerns with the patient.   But chemo at say MD Anderson is done in an out patient clinic that is connected to the hospital proper.  So you absolutely could walk to chemo from patient rooms.   

But every time they say chemo it drives me crazy because seriously with head and neck SCC the radiation is the key.  It is the most important bit especially if surgery isn't an option, but radiation would still be very, very, very likely after surgery even with clean margins.  

I have the next episode lined on on my tivo but I'll wait to watch it but seriously he needs radiation and any google search would tell you that.    

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18 hours ago, bybrandy said:


Recurrence after a year., much, much, much bigger tumor.    Different hospital (the one we should have gone the first time).  This time because of the size and location of the tumor they said she needed surgery a BIG ONE.  13 hours.  They did apparently worry she wasn't a great candidate because of other medical issues.  However, they did the surgery.  The surgery she woud have needed the first time would have been comparatively no big deal, NONE.   Alas.  Live.  Learn.   then more raidiation this time without chemo.   

Going through radiation twice is also a big, red flag that things weren't done properly the first time. There is a life-time maximum of rads you can receive. They should have given her the maximum over six weeks during her first coarse of treatment. Having "extra" rads available for a second round of radiation shouldn't be possible if she had been given the full dose the first time around.

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On ‎1‎/‎17‎/‎2019 at 5:32 AM, alexvillage said:

Really! Even in a public hospital it is more likely that a frequent flier would be left in the waiting area and forgotten there. This happens with people who have legitimate reasons to be in the ER, and that go there often. The guy apparently only liked the attention (most of the time at least)

They did make a lame attempt at explaining this is the first episode. The head of the ER wanted to eliminate the waiting room altogether and admit patients directly into the treatment area. They never explained the logistics of exactly how they intended to accomplish this. In a hospital as busy as theirs, I don't know how it would be possible to have enough space or enough staff to make this happen. However, if it were achievable, it would prevent anyone (even a frequent flyer with non-issues) from being ignored in the waiting room.

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4 hours ago, eel2178 said:

Going through radiation twice is also a big, red flag that things weren't done properly the first time. There is a life-time maximum of rads you can receive. They should have given her the maximum over six weeks during her first coarse of treatment. Having "extra" rads available for a second round of radiation shouldn't be possible if she had been given the full dose the first time around.

No, she had her max the first time.  The thing is.  If your caner recurs even though they tell you and tell you your mouth can't be radiated twice.  If they decide to radiate your mouth twice they totally do it.  They don't even really blink about it.  I mean they do send you to like one of two radiologists but that is pretty much what those two doctors do, reradiation.

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