INTRO: This is The IV Drip, a podcast designed to give you the dish on health topics you need to know but didn’t know to ask. We are your host, Dr. Maleeha Mohiuddin and Dr. Dionne Ibekie. We’re both Harvard training anesthesiologist and besties. Join us as we explore hot topics that are rarely discussed but can have a huge impact on your life.

Dionne: Thanks for joining us. Today, Maleeha and I are going to start introducing “Bolus” episodes, basically a bonus episode where we share our immediate reactions on trending topics. I think it’s going to be fun because sometimes we are so excited by something we come across that we want to discuss it and share it with you guys right away. Like today, we have been dying to talk about the movie “13 Lives.”

Maleeha: Oh, my gosh, what an amazing movie. Please go see it, if you haven’t already. Actually, you don’t even need to go anywhere. You can just stream it on Amazon Prime Video. It’s an original, it’s really well done, and it’s directed by Ron Howard, and it actually has a very star studded cast.

Dionne: The movie is based on a true story about twelve young boys on a soccer team and their coach who got trapped in a cave in northern Thailand during monsoon season. Because of the location of the cave and the heavy flooding, the team was literally trapped for weeks looking for a way out. The rescue seemed impossible and required Herculean efforts from many experts from around the world.

Maleeha: Now, Dionne, I remember when this happened in 2018. It was the summer of 2018 because it was so sensational. It was all over the news. I remember we talked about it. Do you remember that?

Dionne: I do. We sure did. It was kind of personal for us.

Maleeha: Yeah, because one of the main rescuers, Dr. Harris, was an anesthesiologist from Australia, and we were all so geeked to see how instrumental he became in the rescue. So that definitely dialed up our interest in the whole cave.

Dionne: Absolutely. Quick warning for those of you who have not seen it, this is going to be a spoiler alert episode. So many props we have to give here. So many we don’t even know where to start. It was such a collaborative effort for this rescue.
Maleeha: Truly. And from what I read, because I did a little bit of a dive, a reading dive after watching a movie, the movie itself couldn’t show the entire team just from a logistical angle. However, there was a massive team involved in the rescue mission. They said over 100 people. That’s more than 100 rescue divers, hundreds of police officers, soldiers, engineers helping pump water out from the cave. It was just incredible, the concerted effort that everybody made.

Dionne: Yes, it was. So, for me, maybe I’m just emotional in general, but this movie had me on an emotional roller coaster. And even though I already knew the ending because we saw it on the news, I was still convinced that the boys and their coach were dead.
Maleeha: I know.
Dionne: Yeah. I literally teared up with joy when the two British divers, Rick Stanton and John Valentin, found them all alive on a raised section of dry land in the cave. Girl, I did a praise dance. Okay. When I saw those boys, I did a praise dance. I was so happy.

Maleeha: Yeah. I came off off the sofa. I was just so shocked to see them all huddled together. And they looked pretty okay. What took me also by surprise was it seemed like a mixed reaction of both relief and surprise to see them alive from the point of view of the divers. And it really did feel like Rick, one of the divers, had this immediate realization, like, you could see on his face that it would be nearly impossible to get them out alive.

Dionne: Definitely Debbie Downer vibes. Yeah, sure.

Maleeha: But enter Dr. Harris.

Dionne: He needs an intro. I’m sorry. He’s our man. He’s our guy.

Maleeha: That was very extra, though. But he’s definitely a favorite fan favorite. One of my favorite scenes from the movie was when Dr. Harris arrived at the cave, which is, like, a solid nine days after they’ve been trapped by the rising floodwaters. And you can see he’s starting to understand why he’s specifically been called upon for his expertise and when it clicks, why they want him there. His reaction to potentially sedating the kids is No, like, no, this is unethical. It’s illegal. Just that face.

Dionne: And we get it. I mean, it’s the whole do no harm thing, because we as physicians, we take an oath when we go into medical school, we take that oath to first do no harm. However, this was an emergency situation. And as you pointed out, Maleeha, Rick had already realized that there were no other feasible options for these kids. So in this case, doing nothing would be doing harm.

Maleeha: Yeah. And at this point, like you said, it’s an emergency and it’s a race against time. One, because the water level is rising rapidly every day in that cave system. And two, because the help of the kids is deteriorating with each additional day.

Dionne: Yes. So for this rescue, they use sedation, which was experimental, but necessary because they couldn’t allow the kids to panic on their way out. They would rip their masks off and potentially endanger not only themselves, but the divers in a panic attack. I know. I’ve panicked in the water, so I can only imagine what that would look like in a flooded cave. Okay. That would be frightening.

Maleeha: Yeah. And you saw that in the movie with another diver who had panicked earlier, right? Yeah. So, I mean, I’ve had some questions. I fielded questions from other friends who have watched the movie, and they specifically asked me, they wanted to know what meds were used and why, because that wasn’t really explained in the movie.

Dionne: So tell us what you dug up, Maleeha.

Maleeha: Okay, so from what I dug up in my little research, Dr. Harris estimated the kids to be roughly around 40 to 50. He needed the kids to be completely still for the divers. Okay, so from what I could tell and what I read, he used three drugs. The first drug was alprazolam, which was given orally, and I think we saw that in the movie as well. alprazolam is used for sedation. It’s fast acting, and the goal was to make it less stressful for the kids. The second drug was ketamine. That was given intramuscularly through the syringes, and it’s a shot that’s given in the thigh. It’s also effective for sedation, and it helps maintain respirations as well, so the kids will breathe. It has a predictable onset and duration, so that way they can time the next dose. Atropine was the third drug, also given intramuscularly in the thigh, and the goal of giving atropine was to minimize the oral secretions. So that’s what I found.

Dionne: Good job. Good job. Nice breakdown.

Maleeha: Yeah. And the reason why the weight is important is all of these drugs, most of the drugs we give are weight dependent.
Dionne: Yes. Especially for kids. Especially for kids. So I thought it was funny and cool how he taught the divers how to inject using water bottles. Yeah, but I guess they had to make do with what they had because none of them were medical personnel. They were divers.

Maleeha: Totally. That was such a MacGyver moment for me. But you got to work with what you got. And it’s important for them to learn this because it was critical to the success of the rescue that they knew how to give those shots.

Dionne: Yes, it was. And I also loved how Doctor Harris administered the medications. He sat each child on his lap and distracted them with World Cup news. He reassured them that they would be okay. Then he checked their respirations and mask seal underwater before handing off each child to a diver to embark on that entire two and a half kilometer trip, which was about four and a half hours. Four and a half hours with checkpoints along the way.

Maleeha: I agree. It was hands down one of my favorite moments, too, maybe because I saw myself in him to see this doctor and his bedside manner really soothing and being comforting and having that heart with the kids, it was just very relatable, very heartwarming to see.

Dionne: Yes, absolutely. It doesn’t matter the setting, that site manner is still important, but there’s a but. As a mom and doc, I had some concerns. Okay. So I’m going to be honest. I had some questions.
Maleeha: I know I did too.
Dionne: Yeah. So number one, getting the dosing right is tricky. And two, monitoring respirations and vital signs underwater with no monitors. Oh, my gosh. I was freaking out about that.

Maleeha: Okay. I agree. It was just basically a visual monitor for eyeballing. My big one, number three, was making the mask well sealed for that long. Making sure the mask was well sealed for that long. There was no leaking coming in from the sides of water, because that’s a huge risk for aspiration obstruction, asphyxiation very risky.

Dionne: Yes. My thing was number four, the kids having infections from cuts and scrapes, I mean, they were in the cave for weeks. I was really worried about that.

Maleeha: Yeah, I thought the same thing because I was like, oh, the skin might deteriorate in that condition, and there’s all this bacteria. And surprisingly, there were only a few infections in the feet, and apparently there were some minor chest infections that they saw on X ray, but they cleared up eventually in the ICU. It’s amazing.

Dionne: Yeah, it’s super amazing. The other thing related on that same vein was hypothermia. I was really concerned about that, too, but apparently all the kids and the coach defined and warmed up rather nicely in the ICU.

Maleeha: It’s a miracle. And after such an emotional rescue, I think the fact that everyone made it out alive was incredible. And I think it also shows how, just from a medical perspective, children’s bodies physiologically are able to handle a lot.

Dionne: Yes, they are resilient.

Maleeha: They are resilient, yes.

Dionne: None of the kids suffered long term physical ailments. Dr. Harris said, and I quote, “No one was more surprised than me that the outcome was successful.” His biggest fear was that he was about to do something reckless and irresponsible. He was expecting mortality.

Maleeha: I don’t blame him. Hindsight is 2020. But I would have expected the same thing if I was in the same situation. My heart would have been pounding. I can’t even imagine. I don’t even know if I would have the guts to even try.

Dionne: So, yes, major props, right.

Maleeha: With all those parents waiting for me on the outside. So, guys, that concludes our thoughts of “13 Lives.” If you haven’t watched this movie, we highly recommend it. It may dampen your interest to go spelunking.

Dionne: Aka exploring Caves

Maleeha: That’s a great word, spelunking. We would love to hear your thoughts and comments. If you have seen the movie, email us at info@ivydrip.co.

Dionne: Thanks for joining us for this Bolus episode. Don’t forget to subscribe to the podcast and check out our website website at the ivydrip.co