I'm not sure who was making this point in the "hospital" thread, but someone said it takes a mere three seconds to check whether someone is bleeding internally, probably through checking their capillary refill via the skin. And that it is hammered into every physician-in-training's mind to carefully assess a patient's condition by picking up obvious warning signs. They said John should have noticed Sherlock was bleeding internally and should have spared the three seconds, even over all the emotions he's been dealing with. (I hope I'm paraphrasing this right.)

While I personally don't agree with that statement, I think the viewpoint still has merit. It hurts just a little bit when we realize or have to admit that a character we love is flawed and might have made a grave mistake. That whole scene has me very conflicted, because I do see that John was acting a lot more coldly in the face of Sherlock's obvious pain and discomfort than I would have liked to see. But I can forgive that, because of all the shit that was crashing down on John in that very moment.

And I'm also loving the scene for what it is, because I think it's great that they're allowing the characters their flaws. It makes them human. Not a single one of us always behaves in an appropriate manner or the way they're expected. Why would we have to hold our beloved characters to something that would make them superhuman?

TeeJay wrote:

I'm not sure who was making this point in the "hospital" thread, but someone said it takes a mere three seconds to check whether someone is bleeding internally, probably through checking their capillary refill via the skin. And that it is hammered into every physician-in-training's mind to carefully assess a patient's condition by picking up obvious warning signs. They said John should have noticed Sherlock was bleeding internally and should have spared the three seconds, even over all the emotions he's been dealing with. (I hope I'm paraphrasing this right.)

While I personally don't agree with that statement, I think the viewpoint still has merit. It hurts just a little bit when we realize or have to admit that a character we love is flawed and might have made a grave mistake. That whole scene has me very conflicted, because I do see that John was acting a lot more coldly in the face of Sherlock's obvious pain and discomfort than I would have liked to see. But I can forgive that, because of all the shit that was crashing down on John in that very moment.

And I'm also loving the scene for what it is, because I think it's great that they're allowing the characters their flaws. It makes them human. Not a single one of us always behaves in an appropriate manner or the way they're expected. Why would we have to hold our beloved characters to something that would make them superhuman?

It's quite intresting. On one hand it's quite an easy diagnosis to make and on the other it's not. It does take few seconds to take cap refill and once you find it delayed internal bleeding is going to be on top of the differential under the circumstances. The decision to actively check the cap refill is what it comes down to. Things may be hammered into us in med schools and nursing schools but it doesn't change the fact that seriously ill people are missed all the time in hospitals for various reasons. After each crash call we do a couse analysis and quite fraquently it turns out that it was a 'failure to resque' and there were some obvious signs along the way that things were heading south and they were not picked up on.

People have written Phd thesis on clinical errors and why doctors make mistakes. Just becouse certain things are drilled into you in medical school it doesn't guarantee that you will act a certain way under any set of circumstances.

I think I want to defend John becouse a) I like his character and b) I have missed things for lesser reasons than my entire life crashing down around me. I don't know a single doctor who never made a stupid mistake.

From the dramatic point of view it's a great scene and I enjoyed watching it a great deal. I'm not sure if it would make such good TV if John has managed to park his emotions away and spring into the doctor mode to assess Sherlock properly. It's what we expect from doctors in real life (and what doctors try to deliver) but it doesn't make best enertainment.
 

Last edited by belis (February 16, 2014 11:55 am)

Apart from Mrs Hudson, there are three people in the room in that scene. Mary, who obviously thinks what she's done was absolutely right and the only possible way to act. Sherlock, who thinks what he and Mary did was absolutely right. And John, who probably thinks they've both gone insane.
That mutual understanding between Sherlock and Mary seems very strange to me if "she phoned the ambulance" is really the only explanation, that's why I came up with the "Mary saving Sherlock" theory in the other thread. There seems to be something John doesn't know, something they don't tell him, and perhaps he senses it. He has a long enough experience in dealing with exceptionally clever people who keep secrets from him. And he has always chosen to trust them more or less blindly because he sees the good in them that other people don't see. He is the one who calls Sherlock a hero again and again. After all, the reason why he "chose" Mary was perhaps not that she's dangerous, but that she's a good person, and he can see that even when nobody else can see it anymore?

Personally, I didn't understand the "you won't need morphine" line as a serious threat, more like a retaliation because of Sherlock's drug problem. If I'm not mistaken, Sherlock is taking far too much of that stuff. In the scene where they confront Mary, there are a glass bottle and a plastic box to see which probably contained pills. The bottle is already empty, and when they arrive at Baker Street Sherlock says he's run out.

When the ambulance arrives Sherlock says he's pretty sure he's bleeding internally, but he's not a doctor, so it might not be that dramatic after all.

I think I get what Willow is saying, but I don't necessarily agree. Apparently there are telltale signs of blood loss that John, as a doctor, should have spotted, even in his emotionally compromised state. That may very well be, but I can still forgive him that he didn't, because of his emotionally compromised state. No one is a doctor 100% of the time, and no one is infallible.

Willow wrote:

He was displaying unambiguous signs of major blood loss; I appreciate that it may seem odd but they use actors in medical schools, rehearse them, put makeup on them and then wheel the students in for this sort of thing. For example, Sherlock's voice and breathing problems started in Leinster Gardens, which is the first evidence of lack of oxygen caused by blood loss, and became obviously much worse as he tried to climb the stairs in Baker St.

It's hard climbing stairs when your oxygen saturations are going through the floor. If you listen to the way Sherlock is breathing and speaking once he finally makes it up the stairs then again, he's trying, and not succeeding, to get oxygen into himself.

His complexion is a beautiful piece of work by the make up artist, and again it's an unambiguous sign that he is in very deep trouble. I really like the fact that Benedict clearly understood the physical processes involved, and acted them so brilliantly.
 

I wouldn't say that signs of blood loss are unambiguous in this scene. The only truly unambiguous sign of massive heamorrhage is a lot of blood on the floor. Otherwise there are umpties things that can give you similar symptoms. I'm just being pedhantic here though.

I agree that he looks a bit crap. I think my TV is set for some sort of warm glow as I didn't think his complection was particularly bad initially. I had watched it again on my laptop and it was 10 times worse. lol I wouldn't say that it's obvious straight away that there is a serious problem there but there is enough going on to make you want put hands on this patient and check. John didn't becouse he was to preoccupied with other stuff. Not the best piece of doctoring and not how you would want a friend to act but at the same time quite an understandable reaction considering to the stress he was under. I bet he kicked himself later for not noticing.

Willow wrote:

Yes, I really did watch him waiting for him to collapse because he had already shown by his voice and his breathing at Leinster Gardens that he was struggling to get enough oxygen into him, and there's no good way back from that.

From that point onwards it was merely a question of when, not if...

In that case, that probably makes you a better doctor than John Watson.

Except when you watched, you hadn't just realized that your wife had been lying to you for months, has a secret identity and just shot your best friend. I really think you can only truly judge these things when you've been in the same or similar situation. (Which, I'm hoping, isn't terribly likely to happen. )

The human brain isn't always rationally analysable. When tragedy strikes or you're very emotionally affected by something, it's only normal that rational thinking and visual acuity for details takes a back seat. I am still of the steadfast opinion that John's brain was racing a mile a minute, all focused on Mary and himself, which blinded him to the physical signs Sherlock was prohibiting -- medical training or not.

You know, I think in the end it comes down to the fact that it's fiction, and TV entertainment. Moffat and Gatiss aren't doctors, and even though they most likely had this scene checked for medical accuracy, they were probably going for the drama rather than the authenticity.

TeeJay wrote:

I think I get what Willow is saying, but I don't necessarily agree. Apparently there are telltale signs of blood loss that John, as a doctor, should have spotted, even in his emotionally compromised state. That may very well be, but I can still forgive him that he didn't, because of his emotionally compromised state. No one is a doctor 100% of the time, and no one is infallible.

 
Off course, I entirely accept that John was in an emotionally compromised state, and that doctors make mistakes all of the time.

Perhaps it might help if you imagine what sort of reception John would be likely to get from the surgeons and intensivists who had done such a great job in hauling Sherlock back from the jaws of death in the first place. They get very picky about people messing up their masterpieces, and they would know from the paramedics that John had been in situ and apparently oblivious to the fact that Sherlock was bleeding out.

These are not the sort of circumstances in which said surgeons and intensivists are likely to take the 'we all make mistakes' line; admittedly, surgeons may not be the most self critical of individuals in the first place, which is why audit exists, but then John himself had been a trauma surgeon, and thus would be held to a higher standard than the average GP.

I certainly do not suggest that it's unforgivable, because Sherlock obviously forgives John, but in terms of plot lines next season it's a problem; Mycroft isn't the forgiving kind. He tolerated John's presence when he was an asset; someone to watch Sherlock's back, patch him up and, if all else fails, shoot someone threatening him. John is no longer an asset; he's a liability, and Mycroft, of all people, sees no reason to retain someone who has outlived his usefulness...

belis wrote:

Willow wrote:

He was displaying unambiguous signs of major blood loss; I appreciate that it may seem odd but they use actors in medical schools, rehearse them, put makeup on them and then wheel the students in for this sort of thing. For example, Sherlock's voice and breathing problems started in Leinster Gardens, which is the first evidence of lack of oxygen caused by blood loss, and became obviously much worse as he tried to climb the stairs in Baker St.

It's hard climbing stairs when your oxygen saturations are going through the floor. If you listen to the way Sherlock is breathing and speaking once he finally makes it up the stairs then again, he's trying, and not succeeding, to get oxygen into himself.

His complexion is a beautiful piece of work by the make up artist, and again it's an unambiguous sign that he is in very deep trouble. I really like the fact that Benedict clearly understood the physical processes involved, and acted them so brilliantly.
 

I wouldn't say that signs of blood loss are unambiguous in this scene. The only truly unambiguous sign of massive heamorrhage is a lot of blood on the floor. Otherwise there are umpties things that can give you similar symptoms. I'm just being pedhantic here though.

I agree that he looks a bit crap. I think my TV is set for some sort of warm glow as I didn't think his complection was particularly bad initially. I had watched it again on my laptop and it was 10 times worse. lol I wouldn't say that it's obvious straight away that there is a serious problem there but there is enough going on to make you want put hands on this patient and check. John didn't becouse he was to preoccupied with other stuff. Not the best piece of doctoring and not how you would want a friend to act but at the same time quite an understandable reaction considering to the stress he was under. I bet he kicked himself later for not noticing.

Well, I've already written about the likely reactions of the surgeons and intensivists; suffice it to say that John probably didn't need to kick himself because they would have already done so

Please be as pedantic as you like; it's a great asset to the discussion and fanfic writers everywhere. I do feel that the chances of Sherlock suddenly succumbing to an entirely coincidental respiratory disorder like asthma shortly after major surgery are somewhat slim; his voice and his breathing are pitch perfect for heavy duty blood loss, the cyanosis being icing on the cake.

I suppose postoperative pulmonary embolism might be a possibility, but this does not get John off the hook, as it were, since postoperative pulmonary embolisms do tend to kill people if left untreated. This is not the sort of information that Mycroft is likely to ignore, hence the implications for S4...



 

Willow wrote:

Please be as pedantic as you like; it's a great asset to the discussion and fanfic writers everywhere. I do feel that the chances of Sherlock suddenly succumbing to an entirely coincidental respiratory disorder like asthma shortly after major surgery are somewhat slim; his voice and his breathing are pitch perfect for heavy duty blood loss, the cyanosis being icing on the cake.
 

For him to develop asthma out of blue would be unlikely. But a touch of atelectasis or pneumonia would be quite plausible. PE would be unlucky but it's deffinitely possible. I would say the most likely explanation as to why he would look pale and struggle to climb a flight of stairs would be residual anaemia. He wouldn't be topped up back to normal Hb levels and it takes time to recover. He wouldn't need to be actively bleeding again for a missmatch to occour between his body's oxygen requirment and what can be delivered. Pain remains a very good explanation. It's really hard to breath adaquatly following abdominal or thorasic surgery without adequate analgesia on board. Loads of things to go wrong and that's why he shouldn't have left his hospital bed in a first place.

In my haed canon John has given him a good talking to and a once over when he first found him after the escape from hospital. That reassured him that he is likely to survive running around town for a bit. I'm a still a bit surprised though, to be hones,t that John agreed to it and that he didn't forcibly drag Sherlock back to hospital considering how he managed to escort him for a drug test.

So yes, I do agree that John makes some very stupid decisions and that his judgement gets seriously clouded at times. I wouldn't go as far as to say that he outlived his usefulness but there is deffinitely a scope for improvement.
 

Last edited by belis (February 16, 2014 4:47 pm)

I wonder if when they film the next episode, they'll include flashbacks to some of the things that did go on while Sherlock was in Hospital?
I feel like they deliberately "hid" things from us that may have happened during that time between John, Sherlock and Mycroft.