You're the first doc reactor I've seen who didn't immediately jump to "Leave it in!" You actually explained WHY it doesn't make much of a difference in the apocalypse.
Ironically, I actually saw this in practice. In college, during fall ball, (off season) we used wooden bats, one splintered and a segment embedded itself in the pitcher. ( A LOT smaller than the whole handle Joel takes.) Anyway, of course we all rushed to him and our first impulse was to pull it out and our athletic trainer literally started shoving people away and told them not to touch it. Paramedics arrived quickly and essentially said if we had removed the piece he more than likely would have died from blood loss.
Ellie knew if she left in that scene she was probably leaving Joel to die. The stabbing occurred on the campus of the Eastern University of Colorado in the state of Colorado. Tommy was 826 kilometers away in the state of Wyoming. It's about a day's worth of straight riding on horseback and a horse cannot go that long without taking breaks. So, it would probably take her a couple days to get back to Tommy. By the time they mount up a rescue team, and make it back, Joel would be long dead from blood loss from that open abdominal wound. That's why the scene is so emotional. Joel is basically asking Ellie to leave him to die in order to save herself.
You forgot the most important thing Joel rolled a d20 on his saving throw and he has a +6 luck modifier. There was no way that bat was going to do him in.
I'm curious: would there be any risk of leaving a foreign body inside a stab wound if you're about to make a hasty escape on horseback (lots of bouncing and movement)? Specifically, would there be a risk of incurring more damage/bleeding than if you'd removed it before moving? Also, in this case, Tommy was at least 5 days away (based on what they mentioned last week), so Joel wasn't telling Ellie to go get him help: he was telling her to go help *herself*, and leave him to die alone.
It really depends on the object. Rule of thumb is that you would like to try and secure anything that's sticking out before getting on your horse. Like, wrap a ton of gauze, a t-shirt, other fabric around the object and gently (!) try to somewhat limit movement of it. With a dagger for example, this would work reasonably well. It has a hilt, so technically it can't go in further unless you apply blunt force. Same with an arrow or anything that has a curved/flat bit on top. More difficult with splinters or the piece of the baseball bat here. Depending on how much is sticking out and where, there's a sheer likelihood you would hit the horse with it (not even the bouncy movement itself), so pulling it out, stuffing it/wrapping it up and applying pressure would probably be the better option (in a "no medical help anywhere near" setting that is!). With smaller penetrating objects (think blade broken off like Frodo in LotR, minus the ringwraith bit), it's a lucky guess without having medical imaging. There's loads of bullets or shrapnel bits being left in people even these days when there's no immediate danger to blood vessels/organs and the piece is somewhat blunt. Human tissue is super dense and the likelihood of it moving (let alone at a deadly pace) small. If the piece is small, the bouncy movement alone would probably not do much (unless it was already lodged in or very close to a blood vessel/organ). If it's larger or sticking out slightly, you would want to try and secure it/immobilise/isolate that area to your best ability and definitely avoid ANY further blunt force/pressure/jerking movements at all costs (so careful when dis-mounting a horse, leaning over, turning around... that sort of thing). In terms of bleeding, that would entirely depend on the wound itself. Major blood vessel/organ hit... we don't need to talk about that. In general, your heart would of course pump faster, thus speeding up blood loss if you are exerting yourself. But whether that would really that much of an impact in this situation is questionable. Also... unless you were trying to still win the Olympics in that state, you wouldn't really use your muscles THAT much if just escaping. Like... skip the standing up in stirrups bit, moving your body with the horse... just hold onto dear life and get out of there!
Something as jagged as that broken bat, and with the amount jostling that horseback riding causes, it could absolutely cause more damage after the original injury. What’s unclear is whether it would cause more damage than pulling it out.
I absolutely love your reactions! I've seen a few doctors react to this series but you actually try to look at this as realistic as possible while also taking into account that this is fiction. And you're the first one who said (thanks to your vast experience) that it IS possible to survive such a stab wound by just stitching it up... the chances are ridiculously low, sure... but it's nice to hear someone say it IS possible, instead of just laughing at how absolutely impossible it is. I've also seen reactions where they say you can't use a dirty rag 'cause of the infections... as if in this world, it's possible to easily find sterile equipment. Hearing you say things like "blood loss will kill you faster than infections'' is way more interesting to hear than "DON'T USE A DIRTY RAG"
Lmao all I'm thinking abt is Dr.Mike. I'm so glad Dr.Hope is seeing this from different angles too, it's much better that he's weighing the options of 'absolute vs likely' instead of jumping to everything being bad or futile. Bc yeah, this is literally an apocalypse situation and these characters don't have any other choices to survive.
Even though he said he watched the show, I’m pretty sure one of Dr. Mike’s people saw it for him, clipped out the relevant bits, gave him the cliff notes on the show, and then had him react, cause half the things he said made very little sense to what was happening on the screen.
Cutting your limbs off was tried in-universe, but we're not entirely sure if it works or not. In the DLC, that this episode was based on, there's actually a note from a group soldiers who tried just that with their comrade. The guy still doesn't make it, but they're not entirely sure if they were simply to late or if the guy simply got worse because of the severe blood loss.
The fungus needs a living body to control, if the body dies, then it cannot control. So I’d say it depends on how far the infection gets in the blood or tissue before the amputation, time is key.
In the first episode we see several amputees in the Boston QZ, which I took to imply that they had been bitten but were saved by a quick amputation. Of course it could have been for lots of other reasons. I didn't see a bone saw anywhere in that mall though, so that probably wasn't an option for Ellie and Riley. Though maybe a tourniquet could have bought enough time to get to surgery?
@@iwikal I think you’re right, and maybe a tourniquet would work, but I’m skeptical as it seems to also move through tissue, as you can see in an infected persons skin. But a tourniquet might squeeze hard enough to keep it from moving through the skin but I don’t know.
@@lgoamity no not for the horse. But remember that they traveled quite a lot. They moved out of the vicinity of the settlement (remember it had a reputation that would keep outsiders away). Then Ellie had some shooting lessons. Then they went to the university. Then they fled and rode to what looks like a suburb or at least less urban part of the city away from university. So yea Tommy had to be at least a day's ride away if not more. She may run into the attackers. She's not used to traveling long distance alone. Nightfall would soon come. The horse is also tired and needs rest.
@@iwatchwithnoads7480 ??!! Are we watching the same show/timeline? The University wasn't 5 days ride by Horse from Jackson? They weren't able to do everything we saw of that trip TO University in those 5 days? OK yes they had to "run" after the Attack... We don't have exact details if they "escaped" toward Jackson or not... But can we agree it certainly didn't seem like it was days on the run? With his injury, and horse vs people on foot... I'd suspect it could have been just minutes (lets just assume 1 hour to be "safe" that no one was following)... After falling off the horse we jump to them already "safe" in the suburbs. We don't see how she rigged up (I assume) a sled/stretch for Joel but again I don't see how they'd have shaved days or even hours off a normally 5 day (by Horse) trek? With the signs of blood loss to the house could she have afforded to have spent even 30 minutes travel time to shelter? I haven't played the game but starting with this episode I was "recommended" a RU-vid movie compilation of the Game's "Left Behind"... Which I watched before the HBO Episode aired. Was looking forward to seeing Ellie's adventures to a local mall for supplies. That didn't happen in the show but IMO could have... Basically they wouldn't have needed to ride too long to get into the "suburbs" and still be relatively near the University (and a Mall if Ellie or the Show wanted to explore the option).
REALLY appreciate these videos :) In the game, Ellie actually found a med kit from a military helicopter and found proper sutures (with a curved needle). Here, it looks like she just uses a straight (albeit slightly thicker than normal) sewing needle with regular, thick thread. I have to imagine that would present some challenges? I thought that for an uneven object like that shard from the baseball bat... Removing it would be better. Cuz if you're on a horse that's running away... That piece might move around and cause more damage. But yeah, I suppose it won't make too much of a difference in a situation like this. Also, Ellie put Joel on that sleeping bad/blanket, and dragged that via the horse
I love the fact that you brought up Mortal Kombat in the middle of all this. Picking out that scene. :) Even as a kid I didn't understand all the apparent femurs.
It's a memory limit for the early arcade machines and consoles. They couldn't add a bunch of different bones without removing other graphics. Duplicating the image however is basically free. So adding a well recognised bone a bunch of times gives the effect they were going for without costing too much in memory space.
Honestly, I just figured it was an animation limitation -- a ton of different bones would have been difficult and expensive to render (versus multiple standard "femur bone" shapes).
Remember that Tommy said the university was a 5 day horse ride away, and Ellie and Joel are currently near the university. So Ellie knows it will take too long to get to Tommy and back again with help.
9:45 It's funny you should mention that as in the game, Joel's injury is quite similar. Instead of a broken baseball bat, he actually falls onto some rubble and a piece of rebar impales him through the lower right abdomen.
I'm no expert, so this is pure speculation, but I think his injury in the game might've been easier to treat in some ways. The rebar had a much smaller and more even diameter, making the entry wound easier to close, though of course there's also an exit wound to contend with too. The baseball bat handle was sharp, but assuming the tip of the rebar was blunt or rounded, then it might've had a better chance of simply pushing between Joel's intestines, rather than cutting into them. And finally, a piece of inorganic iron might potentially have fewer dangerous bacteria than a bit of old wood that's been handled by unwashed human hands. Tetanus is often cited as a risk with rusty metal, but I recall that tetanus is anaerobic, so it's mainly a threat if the metal has been buried underground rather than exposed to the air. It's entirely possible I'm wrong, though, and I'd be happy to hear it from anyone better informed.
The problem with the game scene is that he fell from upper floor into a rebar and managed to survive... without even sustaining head injury from the fall lol...
Joel was asking her to leave him for dead to save herself. Tommy wasn't hospital distance away. they traveled quite a lot. They moved out of the vicinity of the settlement (remember it had a reputation that would keep outsiders away). Then Ellie had some shooting lessons. Then they went to the university. Then they fled and rode to what looks like a suburb or at least less urban part of the city away from university. So yea Tommy had to be at least a day's ride away if not more. She may run into the attackers. She's not used to traveling long distance alone. Nightfall would soon come. The horse is also tired and needs rest.
Ellie couldn't really go back to Tommy to get help. The previous episode we were told it would be five days ride, so by the time she got there and help made it to Joel I think he'd pretty definitely have died (over thirst if nothing else, as he's in no fit state to gather water) So the choice isn't between trying to save Joel alone and going to get more knowledgeable assistance, but between trying to save him alone when the attackers are potentially not too far away and letting him die (but getting yourself safety)
In regards to the amputation option. In the game, you can find a recording by someone who got their arm amputated after they were bitten. If I remember correctly, the guy survived for longer than it takes to turn but was agressive/paranoid. Though that could just be from getting an amputation in the dirty post apocalypse. He ripped his stitches in a fight and bled out. The person who did the amputation noted that she was worried that the amputation may have been too late. So presumably amputations do have a chance of success. The guy's body didn't have any noticeable Cordyceps growth.
I like that you acknowledge that they don't have access to a sterile environment or tools, and that they are doing the best they can with what limited resources they have. I've watched other doctors react to this episode, and all of them have criticized Ellie's use of a non-sterile rag and non-sterile thread, and don't even acknowledge that there's absolutely no way she could get ahold of sterile things. Also, in the game, Joel isn't stabbed by a baseball bat, but rather a piece of rebar that is sticking out of the floor (he falls onto it) And Ellie has no choice but to pull him off it, since it's stuck in the ground, and if they stay where they are they'll be killed by the hunters that are after them. So in the game it makes a whole lot more sense that the object is removed from Joel's body. Whereas the show just makes Joel look stupid for pulling it out without a plan for what to do after.
In the game we do come across notes telling the story of a case where one person was bit and then his partner refused to kill them so she instead cut off his arm. They both die in the end though before we can tell if this worked because the man got paranoid that his partner was going to kill him, so he killed her first then died from bleeding because his wound opened again.
Is it just an automatic response to remove an impaled object? (I heard Steve Irwin did that w/ the stingray barb, that there was a chance to save his life had he not done that.) Can't wait for your reaction to the next episode. It's by far the darkest ep. I'm not usually a fan of a moustache but combined with the British accent, it oddly works for me 😉😄
Probably- seeing an object in you that's not supposed to be there isn't normal, so our brain will naturally make us remove it. With Joel, his adrenaline rush from the fight likely made him not feel the pain of the bat in his body. And realizing he couldn't mount a horse with it still inside he took it out, probably realizing too late just how deep it really was.
@@beccazach One thing's for sure, whether in fiction or real life, there's no drug stronger than adrenaline. (And yes, before everyone swoops in to correct me, I k.ow it's actually a hormone.😉😄)
Thank you for talking about the benefits of leaving the bat fragment in and taking it out in an apocalyptic scenario 😂 honestly, given the lack of medical help anywhere and the fact that joel had to make his getaway on horseback, it probably would have better for him to just remove it.
The important thing to remember about the Zombies in the last of us! The fungus cannot control the dead, if the body dies, it cannot control the brain. No brain function, no beating heart, no moving or biting. If you shoot one enough, even without headshots, they’ll still die. They’re just harder to kill because it releases chemicals to give them adrenaline and other strength boosting and harder to kill, at least immediately. Also, some have fungus as armor, like clickers covering their heads and bodies.
Really late, but some in-game tidbits (from what I recall… correct me if I’m wrong): In the DLC of the game, there was an audio recording of a side character recording how someone to cut off their infected limb but others in their group were still afraid of them turning and it was a burden to care for them, so the group abandoned them (or died trying to get supplies… they didn’t come back) and that individual did survive the incubation/infection period but later died of blood loss. Also, regarding last episode with the bloater, I believe their in-game explanation was that the bloater was an infected that has been “infected for a long time”. So in the first game the stages were runner (recently infected) > stalker (less than a year, hides and stalks people to ensure infection festers) > clicker (blind, longer than a year, stronger) > bloater (several years, strong, infection serves to protect their body like an armor and they release spores… a difference the show removed). As you can see, there’s obvious gameplay advantages to these enemies! 😂
I always look forward to your videos -- you have so much humanity and humor, so it's been so much fun to see your reactions to "The Last of Us." I would echo others that Tommy and Jackson were 5 days' ride away, so Ellie staying by Joel and managing to try to treat the wound on its own was really Joel's only hope (beyond her going to try to find someone to help, which in this universe would seem like too big a risk to take). Cheers, and looking forward to the next video!
At the show's beginning, they showed several people with missing limbs in the QZ. I think it shows the harsh survival choices people had to make in order to live another day. Certain death due to infection or a high chance of death due to blood loss.
I always feel more medically enlightened after watching these. An interesting movie to see you breakdown in the future would be "world war z" which is another zombie movie. There's a good amount of interesting medical science in it. Not sure how accurate the science is but I think it's an interesting film
Thank you for clarifying this. I am reasonably skilled in first aid but ive never gotten a good reply to whether you should leave things in if the injured have to move. Im my mind it was always counterintuitive to leave a knife in someone who has to move around.
Amputation definitely works I think but its definitely not explored in the the season or game. But they showed hints of it in the very first episode, there were a few people who seemed like amputees when they were showing shots around the Boston QZ.
Question about leaving the bat in the wound: Would you still want to keep the bat in the wound while riding a horse? I'd imagine all the bouncing and movement would cause even more internal damage with the bat still in your stomach and would be a better call to remove it before riding the horse to safety.
I think it is smarter to leave it in if they didn't need to leave but since they need to escape I feel any large movements would have a high chance of breaking off wood and leaving chips of it stuck in his abdomen causing worse infection and not to mention causing further damage to any surrounding tissue,. they wouldn't be able to remove any chips since they have no tools to do so. I feel given the situation removing immediatly was the best move to avoid further complications
@4:52 why does Ellie get that close? Simple. She's born during the apocalypse, and has been safe behind Boston's walls for her entire life. She has no reason to fear infected, as all she's heard is from "stories".
I'm wondering if looking at premodern sources might shed more light on how to treat injuries like Joel's. Galen didn't have imaging and barbers and surgeons learned how to run bowel, stitch, and clean with turpentine. And surely abdominal injuries were common on the battlefield with spears and arrows. See Ambroise Pare.
As they stated, Tommy was a 5 day ride away. Anyone coming to Joel's aide would therefore be 10 days roundtrip for Ellie. Joel would be dead. Joel is not telling Ellie to go to Tommy's for help. He's telling her to forget about him and go there for her own safety.
Imo leaving the baseball bat in would've been worse, because he jumped on a horse right afterwards. A splintered piece of wood in your stomach WHILE you're riding a horse would do a LOT more damage than taking it out. Obviously, both situations are bad, in or out, but I think for the situation Joel found himself in, for that situation specifically it was the wiser choice to pull it out.
What happens to blood that has gone into the abdominal cavity and pelvic floor? Does it putrefy inside you? Or does your body have means to deal with it?
It just pools there. So if the bleeding continues you’d die from blood loss. If the bleeding somehow stopped the blood could be a source of infection particularly in this instance from that open wound. Otherwise the best scenario would be the bleeding is stopped and the blood that has collected there is probably reabsorbed over weeks
I love the fact that you had to pause to comment on the medical impossibility of Mortal Kombat fatalities. It never occurred to me that you'd even say anything about that. Hilarious. I'm never going to look at that game the same again.
I am curious what advice you would have? Like...how would doctors adapt their practices to the environment? Like, obviously, in ideal situations, there'd be a theatre, nurses, devices, etc, but how would a doctor be able to adapt to well operating on a dining room table, on a mat, and with limited tools and medicines?
Yeah this reminds me, I'd love to see Dr Hope react to medical scenes from the Outlander series. Claire is a trained surgeon albeit from the 40's to 70's and timetravels back 200 years, and struggles to help save lives, and continue practicing medicine.
I'm curious about the last scene: In that specific scenario, if suturing while there is still an internal puncture wound is not recommended due to internal bleeding, what should be done to deal with the wound before actually suturing it?
Not a lot of options in this scenario, but in some other survival movies I've seen them cauterized the bleeding with hot metal. Without medical experience and tools though it would still be super risky and might even do some more harm.
@@lkf8799 Burning is more versus infections and can stop small blood vessels from bleeding. But against bigger bleedings it is useless. Especially as the wound is quite deep and you have no clue what has been damaged....I don't see that this would be helpful.
Ideally you’d have imaging to see if there is internal bleeding. If so you’d get a trauma surgeon to open you up, find the source of the bleeding and cauterise the blood vessel with diathermy.
Another comment but I think the timeline orignally given for spread is biased to dispose of people as soon a bite is found. I remember them saying in the game they actually spent 2 days in the mall waiting for the infection instead of just 18-24 hours. In any case, I doubt the accuracy of the infection chart especially when you look at tess who was bitten near the neck and lasted for a couple of hours despite the poster claiming 10-15 minutes for a neck wound. Obviously not on the neck but still if it was accurate it should have been at most 30-40 min not hours.
The baseball bat being left in vs taken out isn't a simple decision, especially considering if he left it in and then fell off the horse anyway. He could have then unintentionally pushed it in deeper and therefore hitting something that would kill him. One of those damned if you do, damned if you don't kind of situations survivors tend to find themselves in.
Leaving the splintery piece inside, possibly the liver or bowels, would have it moving about while they make their way, which they have to, otherwise Ellie would be up against at least three grown men.
Hi Dr hope, completely unrelated but as a med student about to start as an fy1 in August, I was wondering if you would consider doing a video on the current situation of the NHS and why doctors are striking
It’s such a mess right now. I fully support the strikes but trying mainly just rely on the BMA representatives to do the media talking, I wouldn’t want to say something wrong that is used against us. Good luck with your finals, message me on Instagram if you have any questions about F1.
in the game, makes way more senso to remove the foreign object. the foreign object was a fixed pole the Joel fell on. that would be anote case to remove. obviously, if you don't have tools to cut it of
He would have bled out so fast in reality though with his wound from the game. Bleeding from both sides like that after ripping it out of him at that horrible angle? Yeah his insides are shredded he probably wouldn't have even made it to the horse let alone the basement.
The last of us DLC actually acknowledges the cutting arm off thing. There's a guy called Ellis who gets bit and he cuts his arm or leg off I don't remember which, and I believe it is implied that it worked but he died of blood loss, as you can find his rotted body but there aren't spores around him.
Next episode is the best ! Enjoy. Also about leaving the bat in, they took the horse right after, if it was still inside, Wouldn't it have done more damage ?
Ellie is nieve thats why she was so facinated with that dead guy... she's not stupid..but she hasn't lost anything yet either. And shes 14 so probably found it to be quite fun...oddly..but this is her childhood..not ours.. we had everything she never..she doesnt know much outside of what she knows..which at this point is nothing.
As far as pulling it out in a controlled situation, they were still on the run from the others. So jumping on a horse, riding, then falling off said horse. Probably best the thing was no long in there.
Well actually. If no one is on your side. No teachers or anyone. Then it doesn't matter if it's wrong. You would only fight as a defense meganism. But yeah don't fight someone if your mad. You need to fight if they they punch first or charge at you that's where you fight
I mean, in the most technical terms sure. But we already know that people can be infected, then lay motionless and seem to be "dead" for days, months, or years before reawakening. They can easily lay dormant for long stretches at a time. It does make sense that Ellie specifically, as a young person with no direct experience, doesn't totally grasp the concept yet, but there's a reason that they burn bodies and that later Ellie stabs the zombie in the cellar to make 100% certain it's dead (in addition to just plain old vengeance/anger). Any reasonable, experienced person in this world that sees a seemingly dead but fully intact body would want to stay well out of arm's reach, for good reason.
@@houktg They burn bodies because its easier than having mass graves, and less risk of any infection. Ellie kills the infected in the cellar that is STILL ALIVE because other than her one encounter with Riley she's never got to study and look at one up close. A
@@bakdpotato143 In your first comment you specifically said no one should have any worries about the dead infecting them, now you're saying they burn bodies because there's less risk of infection. You're contradicting yourself and agreeing with my point, my man.
If the Last of Us was real surely the military would develop a bite proof suit and just send in kill squads city by city and just wipe out all infected in a short space of time? Flame throwers, guns etc?
So in the "current time" USA is shown as fragmented and run by a military government. They also show shoot-to-kill policy in the initial response, and later bombing the infected-dense areas. They also indicate that at some point military/FEDRA lured and trapped a large number of infected underground. I think the implication is that your suggestion was tried but society broke down too soon