All language subtitles for The Pitt S01E09 - 3 00 P.M. (Awafim.tv)

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- Can you--can you just put him
on the phone for a second?

I just want to hear his voice.

There's my guy.

How you doing, buddy?

I would love to hear
your--your song.

[waves crashing]

- You should go home.

- Oh, that is the last place
I want to be.

- Are you sure
you shouldn't see your OB?

- I checked myself.

Uterus is empty,
barely spotting now.

I'm fine.

[sobbing]
- Oh, honey.

I'm so sorry.

- Oh, I shouldn't have bought
that fucking stroller.

- Oh.

Fuck that fucking stroller.

- Losing a kid
is hard on everybody.

- That's as hard as it gets.

We do these debriefs

to try to give
a sense of closure, meaning,

to difficult cases
so that they won't linger.

But trust me, the kids
you'll lose will linger.

So what do you do?

I did my residency
at Big Charity in New Orleans.

And day one, I got a kid,
five-year-old boy,

accidentally shot
by his brother

playing with Dad's gun,

worried he was gonna
get in trouble

right up until he coded
and died.

[exhales sharply]

That night,
I asked myself, like,

what do I do with this kid?

Where do I put this feeling?

And I found myself
walking all night.

I was walking
and walking and walking.

Then I found myself
back at the gates

of Big Charity Cemetery,
and I'm looking

at all those mausoleums
and those crypts

and I'm thinking to myself,
OK, that's what I need.

I just need a safe place where
I can put these feelings--

- Yo, we got patients
throwing punches in chairs.

- Uh, OK, everybody.
Let's get back to it.

Just remember,
the Employee Assistance Program

is available,
as are Kiara and myself,

if anybody needs to talk.

Where's McKay?
- In Central 11

with our UTI
accounting assistant

while we keep her boss on ice
in North 2.

- Robby, critical case
flying in--

possible MDMA overdose,
high temp,

en route from PittFest.
Five minutes out.

- Stay here. Set up for that.

Ahmad and I got chairs.
- Hey, hey.

Is everything all right
with Collins?

Something's bothering her.
I asked her about it.

She said she doesn't want
to talk to me about it.

- Oh. Imagine that.

She probably learned it
from you.

Seriously?
You just gave a speech titled

"How to Literally Bury
your Feelings."

Now, if you'll excuse me,
I gotta break up a fight.

[indistinct shouting]

- Yo, you need to control
your wife, man!

- Shut it, man!

[indistinct shouting]

- Hey, hey, Olsen!

Olsen, what the fuck, man?
- Took you long enough!

- Calm down.
- No.

Don't tell me to calm down.

How hard is it
to put a mask on your kid?

- He has allergies,
you fucking Fauci zombie.

- What?
- Allergies! Fuck you.

[screaming and shouting]

- You fucking bitch!
- Hey!

Hey! That's enough!

Jesus almighty, I don't believe
what I'm seeing.

Where do you people
think you are, huh?

This ain't Philly.

This is a hospital,
for Christ's sakes.

What's the matter with you?

You call yourselves adults?
Huh?

There are children in here.

You should be ashamed
of yourselves.

Olsen, you catch any shrapnel?

- Craziest shit I've seen since
I've been here, but I'm good.

I'm good, seriously.
- Jack-offs.

- Ladies, are we finished
with the craziness?

- [lisping]
This is fucking ridiculous.

All I did was offer
to put a mask on her child

who's been coughing
for over an hour.

And--and now I'm missing
half my goddamn tooth

and talking like this.

- First of all,
masks are bullshit.

- Oh, my God.
- And B, it's an allergy.

He's allergic to cat dander,
like I fucking told you.

My sister brought
her two Persians--

- Shut up.
Shut up right now, please.

And only answer
the questions I ask.

What happened to the tooth?
Did you swallow it?

- I don't think so.

- I think
it's still in my hand.

- It sure is.

I hope you both have
all your shots.

- What do you mean,
like, vaccines?

- Jesus,
please don't stir this pot.

Let's take these ladies back

and get them treated,
separately.

- Stick with me.
- Come on.

Ma'am, it's time to go.

- Guess that makes us a team.

- I guess it does.

Ma'am, come with Mateo and I--

Mateo and me.

Yes, with us both.

- OK, Earl,
let's take a look at you.

Oof, she really tagged you.

- Red's got a left hook
like Billy Conn.

- Well, let's get you
cleaned up.

Come on, baby.

Excuse me, sir.

You're not allowed back there.

- Unless, what,
I start a fight?

Become homeless?

Apparently,
that's what it takes.

- I understand
your frustration.

I promise you'll be seen

as soon as a provider
is available.

- But how can they
become available

if new people keep cutting
the fucking line?

- There's no line.

We see patients
by severity of need.

As soon as we have your tests
and labs, you will be seen.

- This place is
fucking unbelievable.

Runaround after runaround.

Hey. What's up, Erik Estrada?

Still keeping your eye on me?

- Always, my friend.

Always.

Who's Erik Estrada?
- Shame on you. "CHiPs."

Know your television history.

And thank you.
- Yeah.

- Crazy people.

- If you do get my tooth out,
I don't want it

after it's been inside
that woman.

- Reattachment
wouldn't be possible.

- A type two fracture
into the dentin.

Seal with dental cement.

Prescription for Pen VK,
soft diet.

Follow up with the dentist in
one to three days for a crown.

You handle Spinks
while I check on Ali.

- You got this.

Don't worry, partner.

- Yes.

I totally got this.

- How are we doing in here?

- You should write that bitch
a script for calcium

because I didn't even hit her
that hard.

Too much almond milk
in your soy lattes.

- That doesn't even make sense.

- You know, most commercial
almond and soy milks

are fortified with calcium,
so they end up having

a higher percentage of calcium
than cows' milk.

Prepped with Betadine
and draped.

- Very nice.

Let's have a closer look.

Dr. King,
can you please grab me

a 10 cc syringe,
a 20 gauge needle,

and some sterile saline,
please?

- Pluck it out, stitch me up,
and send me home.

I've got to get back out there
to my kid,

who is still waiting
to be seen, by the way.

- Afraid it's a little more
complicated than that.

You got yourself a fight bite,
which means a couple things.

First, we need to determine

if the bite extended
into the joint space.

If it did, you're gonna need
IV antibiotics

and a trip to the OR
to see a hand surgeon.

Pinprick and a little burning.
- An operation?

- Well, you were just shouting
a minute ago about infection,

and with good reason.

While I am sure you are in
the clear for rabies and HIV,

human mouths are filthy,
some more than others.

- How can you tell if it's bad?

- Good question. Dr. K?

- I'm sorry?

- I am going to inject
some sterile saline

into your knuckle joint,
which you won't feel

'cause of the anesthetic.

If it comes spraying back out
of the bite wound, we'll know.

Ready?
- I guess.

- There she blows.

- Ah, shit.

Are you serious?

You hear that,
you fucking bitch?

I've got to have surgery,
thanks to you.

- Good. You assaulted me!
- Damn right.

And I'll bet next time,
you keep your masks

and opinions to yourself.

- You OK?

- Yes.

- 3 grams Unasyn IV.
Call the OR.

Tell them we have a fight bite
that needs to be washed out.

Then go take 20 minutes
in the lounge.

I'll come find you
if I need you.

- I don't need a break.
- Yes, you do.

OK.

Oh, did you want me
to tell the surgeons

to go no masks for surgery?
- What?

- Well, those of us
who save lives for a living

believe strongly
that masks minimize risk

when it comes to spreading
disease and infection.

But I--I want to respect
your beliefs,

so what do you think?

With or without for surgery?
Without?

- Um...I want with.

- Good call.

- Helicopter's here.
Cafeteria send the ice?

- Yeah, everything they got.
- Hey.

I hear they're gonna start you

working on the Middle East
peace plan.

Not since the Dalai Lama
or Gandhi.

- They'd be fucking-A right to.

You should have seen me.

I was inspiring,
also terrifying,

and a little bit shaming.

- Holy Trinity
of crowd control.

Hey, can we pick it up
in here, please?

Overdose is here.

- PittFest OD.

- Keely Ralston,
brought to the first aid tent

at PittFest with altered
mental status and fever.

Temp too high
for a field thermometer.

Intubated en route.

- We got to cool
this lady down.

- Get some ice packs,
head, neck, groin.

Send off for a rainbow.
- On it.

- Heart rate 132,
BP 210 over 120.

- Jesus, that's high.
- Four of Ativan in the field.

- Pupils are dilated.
Definitely MDMA overdose.

Dr. Mohan, how do you want
to treat the BP?

- Beta blockers?
- No.

Unopposed alpha could kill her.

Four more of Ativan, please.

- Seriously?

- She might need another 40.

Hypertension and tachycardia
from MDMA

is centrally mediated.

Ativan is the drug of choice.
[thermometer beeps]

- Damn. Core temp, 107.3.

- OK, can we get
another hose in here

before she fries her brain,
please?

Let's go. Come on.
[monitors beeping]

- I'll be right back.

Hi. You look lost.

- No, it's my assistant

who actually seems
to have been misplaced.

I mean, how long
does a CT take?

Certainly not this long.

- They can get
pretty backed up.

Can I get you a cup
of bad coffee?

Dry sandwich?
- No, thank you.

- How about a cold LaCroix from
my secret stash in the lounge?

I'm going for one myself.
I'm freaking addicted.

- I'm good on drinks.
Can you take me to radiology?

- Yeah, right this way.
Right this way.

- Piper, while we still have
a few minutes,

there are some things
I want to say.

- Yeah, use protection.

I know. I'm sorry.
- Totally.

- It was a mistake.
- Totally.

I'm a part
of the street team here.

It's a group
of doctors and nurses

who go out into the community
and help people

who can't or won't ask
for help--

addicts, unhoused, runaways.

And I'll be honest
with you, Piper.

I think you need some help.

- What are you talking about?

- If you're in trouble,
we can help you.

- I'm not. OK?

And if we're done here,
I think I'd like to go.

- Will you at least
take a look at this?

There's a list of resources
on the back.

- I don't need that.

- I know
you don't have a phone,

but if you could just
take my number, OK?

You never know.

- Where's Laura?

- How about taking the pen?

If you ever feel unsafe
or in danger, call this number.

It's a national hotline.

There's somebody
on the other end 24/7,

a trained professional
who can help with anything.

- I have all the help I need.

I want to go. Now.

- OK, on my count.
One, two, three.

Gentle, gentle, gentle.

Houston, we have splashdown.

- Good luck.
See you on the next one.

- Yep.
- Temp's down to 107.1.

- How long does she need
to stay in the ice, Dr. Santos?

- My PB in the ice
is 13 minutes.

- Dr. Santos.
- Until her temp is normal.

- Wrong.
You pull her out at 102.

Otherwise we could overshoot
and cause hypothermia.

- Heart rate 120.
Pressure 198 over 116.

- More Ativan?
Another four, please.

- Why is she on the ice,
Dr. Santos?

- To bring her temp down.
- Wow, state the obvious,

yet still don't answer
the question.

- The quicker we bring it down,
the less of a chance

for permanent damage
to the brain,

liver, or kidneys.
- Exactly.

Was she sweating?
- Profusely.

- What if she wasn't,
Dr. Santos?

What if she was dry as a bone?

- Then we'd have to think
anticholinergic overdose,

not sympathetic.

- Very good.

- Hey.

I found you scrubs
that should fit.

- Oh.
[laughs]

Thank you. That's great.

I appreciate that.
- But they come with a catch.

- Mr. Krakozhia is asking
to see you.

- The guy who peed on me?

Why me?
- I didn't ask.

But maybe you should wait
to put these scrubs on

until after you've--

- That's a good idea.

- Oh, God.

[rat squeaking]

- Oh, man.
We got a load of the--

- Oh, my God.

- Whoa! Hey!

[rat squeaking]

- Yeah, I see you.

[rat squeaking]

Your days are numbered, buddy.

- Trauma to ER Two.
ETA now.

- That's another four
of Ativan.

- Rectal temp's down to 105.

- OK, moving
in the right direction.

We might get lucky here.

- Double trauma
at the back door.

Auto versus pedestrian before
hitting a telephone pole.

- You got this?
- Yep.

- Dr. Robby,
I finished with Dr. Ozeki,

the therapist upstairs.

- Yes, yes, yes.
How did that go?

- Well.
- Excellent.

Have you heard from David?

- No.

- Has David seen the therapist?

Do you think that he's still
gonna pick you up today?

- I think so.
- OK, well--

- Robby, here they come.
- OK.

Well, you're medically cleared,
so why don't you stay here

for a little while longer
in the hopes that he does?

I still would like him
to talk to somebody.

Perlah, this is Theresa.
She's a friend of mine,

so I expect concierge service,
yes?

- VIP treatment.
- Thank you.

You're in good hands.

Just let me know if David
shows up or if he calls.

- Good boy.
Good boy.

- Walter Pernell, 52,

walking his dog
in the crosswalk,

got struck by a Chevy Impala
at low velocity.

Ambulatory on scene, no KO,
no neck, chest, or belly pain.

Good vitals.
- Whoa. Major road rash.

- Yeah, the car didn't hit me
so much as throw me.

But I slid for a good 10 feet.

Of course,
this is the first day

I've worn shorts
all effin' year.

- No deformity
at the knee or ankle.

Distal pulse is intact.

Four of morphine so far.

- Yeah, feel free
to be more generous.

- Don't worry.
We will patch you up.

We will get you right.
Who's your friend?

- Oh, this is Crosby,

who thankfully barked
and warned me

so I had half a second
to try to move out of the way.

- Crosby, you're a hero.

Donahue, you think
you could find a Milk-Bone

for our little lifesaver here
in the doctor's lounge?

- Absolutely.
I'll take good care of him.

- Can't he stay with me?
He's a very good boy.

- No doubt.
Let's get you settled first.

You're going to South 20.
- Got it.

- Is that the driver?

- 28-year-old lady,
had her seat belt on.

Clipped the guy with the dog
and went

straight into a telephone pole.

Blood's from a scalp lac.

Also complained of chest pain.

Sleepy but arousable.

- What's your name?
- Paula.

- Heart rate's a bit tachy.
112. BP's fine.

- Paula, are you in
any pain right now?

- [sluggishly]
Yeah, I got hurt.

- Witnesses say she was driving
erratically before the crash.

No ETOH on her breath.
Maybe drugs?

- Core temp's 104.2.
- Heart rate 116.

BP 180 over 110.

- Better, but still too high.

- Another four of Ativan.

- That'll make 20.

- Good counting.

- Pedestrian in South 20
needs a doctor.

- You got this?
- Yep. Keep chilling.

- All hands on deck. You ready?
all: Ready.

- OK, here we go.
One, two, three.

[groans]

- [speaking Spanish]

I heard motor vehicle collision
with chest pain

and altered mental status.

Qué más?
- Meet Paula.

Restrained driver
versus telephone pole.

Altered before the crash.
Good BP, but tachy.

- Second line and run a liter
of LR wide open.

- Still tachy at 115.
BP's 180 over 72.

- Airway's patent.

- Good breath sounds
bilaterally.

- Pupils are equal
and reactive.

- Paula, do you know
what today's date is?

- It's, uh...

- Sats 94%.

- How about the city we're in?

- Pittsburgh?

- Bruising on the chest.

- [shouts]
- Possible sternal fracture.

Pericardium's clear.
- Good. Good.

- No marked tenderness.

- Nothing in Morrison's pouch.

- She's a little tachypneic.

- I don't think
she needs intubation.

Might just be concussed.

- I worry about her crumping
in the scanner.

- She's protecting her airway.
I see lung sliding.

No pneumo.
- With a head injury?

- You guys are supposed to be
the airway experts.

Stop fighting.
Make a decision.

Call me when she goes to CT.

- Paula, can you raise
your right arm for me?

- Good sign.
Follows commands.

You want to intubate
with a GCS of 13?

- OK.
We can hold off and monitor.

What's your plan?
- Pan scan, head to pelvis.

EKG, troponin.

Straight cath urine
for UA and tox screen.

- Agreed. [groans]
- I'm on it.

- Gotta bend those knees.
- I gotta quit showing off.

- Is that what you were doing?
- Always.

- It's a ten-day course
of doxycycline,

one pill twice a day.

- I'll make sure she takes it
on a full stomach.

- I can give you your first
dose now, Piper, if you like.

Get you started.
- That'd be great.

- Actually, I need Piper
to answer that one.

- Sure. That'd be great.

- OK.

- Hello, everyone.

Looks like
we're finishing up here.

I come bearing gifts.

Everything you always
wanted to know about STIs

but never wanted to read.

No gross pictures, I promise.

- I think we're good.

- You sure?
- Mm-hmm.

- Yeah.
I learned my lesson.

It won't happen again.

- I guess that's it, then.

- Well,
if you change your mind,

it comes with a free pen.

- Thank you both so much
for your help.

- Yeah.
- Thanks.

- OK.

Good luck to you both.

Fuck.

Fuck.

- That sums it up.

- She'll be back.

Only she'll have slipped
a little further.

- Sometimes it takes
a few visits.

- How can I keep her here?

You got anything?

- Maybe Kiara has
a social services card to play.

She was by Trauma One
last I saw her.

- Brilliant.
Brilliant. Thank you.

- That's why I'm here,
to be brilliant

and bring peace.

- Heart rate's 84.

BP 126 over 78.

Pulse ox, 99 on room air.

- Good news, Mr. Pernell.

Your heart, lungs,
and belly all look good.

- Yeah, just the leg.

- Whoo, this might be
a road rash record.

We might have to bust out
the tape.

- I'm getting a little worried
about Crosby.

- Who's Crosby?

- His dog.
- My dog.

- Where is Crosby?

- He's in the break room.
- Your break room, I think.

- I'm sure he's fine.

We got a lot of dog lovers
around here.

I'm the new owner of
a nine-week-old Goldendoodle.

- Oh, nice.

Crosby's a terrier.

- [sighs]
Great dogs.

Determined, courageous,
love to dig.

Who's he named for,
Sidney or David?

- David.

- Still my Sunday morning
soundtrack.

- Ow. Ow.
- Oh. Sorry.

Yeah, anyways, great name.

So the knee looks stable.

There's no laxity
to suggest a torn ligament.

I think the pain's probably
just from the road rash,

but let's get an X-ray
just to be sure.

- Some more morphine?

- You're a wonderful
human being.

- Let's start with LET,
no more than 30 cc's.

We're gonna try
a topical anesthetic

to numb the raw skin

before we start picking out
all the gravel.

- Well, my morning horoscope
didn't mention any of this.

- Well, hey,
look on the bright side.

Now you can tell people
that you got hit by a car.

Not a lot of people
can live to say that.

- Yeah, I hope whoever hit me
is rich and well insured.

- I'll let him know.
OK. Thanks.

Flag on the play.

Positive pregnancy test.

You still want a scan?

- Maybe she's bleeding
from an ectopic.

- No, she delivered
a healthy baby here

ten days ago.

Normal vaginal delivery,
no complications.

Pregnancy tests stay positive
for a few weeks.

- So are we good to go?
- Good to go.

We'll let the tech know.

- Oh, man.

She was seen here
this morning by Dr. McKay.

- For what?
- Urinary tract infection.

Discharged
with oral antibiotics.

- You think it has something
to do with the crash?

- Yes. No. Maybe.

Ask me again after I've had

the scans, labs,
and tox screen.

- [sighs]
No.

OK.

So I need to talk to you
about something.

- About what?
- Do me a favor.

Look at me,
and don't turn around

and just watch--
- [screams] Oh, hell no!

- I told you
not to turn around.

- I wish there was a way
to keep her,

but there just isn't.

- Well--well, then fuck it.

We'll just say that we need
another urine sample,

that the lab left
the last one out too long

and couldn't culture it.

- OK. Then what?

- I'll give Piper
the sample cup

and send her down the hall
to the bathroom.

I'll stay with Laura
in the room with some bullshit.

You wait for Piper
by the bathroom.

- To say what exactly?

- I don't know.

Just be another voice saying,
I see you in danger.

- There are limits
to what we can legally do,

but I can try to talk to her.

- Thank you.

Hi. It's Dr. McKay again.

Can I come in?

[sighs]
- Sorry.

- Yeah.

Well, it was
a long shot anyway.

- Hey.

I think Piper took a pen.

- Yeah.

- Temp is 103.2.

- Nice. Almost there.

- My God,
there are literally hundreds

of different MDMA pills.

And the milligram dosage range
is all over the place.

These names--BMW5,
Jurassic Park, Red Superman.

[water splashing]
[rapid beeping]

- Whoa. Why is she seizing?

- Febrile seizure?

- No, her temp is down.

- Maybe she needs more Ativan.

- No, she's had 20 already.

And her vitals are stabilizing.

- Another four of Ativan.

And prep a gram of Keppra.

- I don't think
this is a CNS problem.

She needs saline.

- We don't have
her labs back yet.

- At festivals,
you dance for hours.

You sweat,
you drink gallons of water,

but nobody thinks
to replenish their salts.

It's low sodium.
Hyponatremia.

She needs 100 cc's
of hot saline.

- We don't know
her sodium levels.

- Drop 100 cc's of 3%
and have it ready.

OK?

- Do it.
And prep a gram of Keppra now.

[rapid beeping]

[tense music]

♪ ♪

Start the Keppra, please.

- It's not gonna help.

[phone rings]
- Trauma One.

- What are you doing?

- Got it. Thanks.

It's hyponatremia.

Serum sodium is critical.

Only 112.

- Knew it.

- OK, I'll push
the other 50 cc's.

- What the hell?
- She's seizing.

- You think?
How long?

- About three minutes.

- Why did you not come get me?

Hello?
I was--I was across the hall.

I was 30 feet away.
What has she had already?

- It's hyponatremia.

We pushed 100 cc's
of 3% saline.

That did the trick.

- Again, why did you not
come get me?

- It was my fault.
Yeah, I want--

I wanted to keep going
with Ativan and Keppra,

but Dr. Mohan had
an excellent idea

to treat for hyponatremia
even before her labs came back.

- Temp's down to 102.4.

- Good call, Dr. Mohan.

Another minute,
and we'll de-ice her.

I am going to take that minute
to try to instill in Dr. Santos

a very clear understanding
of what her role is here

and how she is expected
to function.

- Dr. Langdon--
- Dr. Santos--

and I say doctor
in such a fashion

to draw attention
to the ridiculous fact

that you have enjoyed
that title for, what, 90 days?

So yeah, I'm confused.

Is it--is it hubris
or ignorance

that makes you think that you
know more than other residents

that have two to three years
more experience

and have helped
thousands more patients

in the emergency department
than you have?

Not to mention
the over 500 hours

of advanced training

with lectures
and simulation labs

with senior faculty
instruction.

It doesn't matter!

Stupid or arrogant,
you need to realize

that you are a beginner,
which means your job

is to shut up, listen,
and learn

because so far today,
the only thing you have been

successful at
is proving repeatedly

that you know nothing.

- Dr. Langdon.

Is the patient stable?

- Temp's 102.

Just about to take her
out of the ice.

- Proceed.
Dr. Langdon, a word, please.

[indistinct chatter]

- Look, I know
that sounded rough,

but you only caught the tail.
- Stop talking.

- I can give you a list
a mile--

- Stop talking.
- She was giving unsupervised--

- Knock it off.
Shut the fuck up!

[chatter stops]

Where does it say that shaming,
belittling, and insulting

are effective teaching tools?

Let me just tell you,

harassment has
zero educational value.

You're feeling upset?
She's getting under your skin?

Check yourself.
Take a break.

I've been watching you
ride her.

This kind of behavior
will not be tolerated.

I don't want to see it.

- I'm sorry.
It won't happen again.

- Where's your other one?
Where's Mel?

- She's taking a breather.
- Yeah.

Well, maybe go find her,
and see if you can

get her back in the game.
You are senior leadership here.

Step up and act like it.

- Wow. You came prepared.

- Better safe than sorry.
[chuckles]

- Sorry I took off like that.

I have a thing about rats.

And cows totally freak me out.

- Really?
[laughs]

Oh, there's plenty of both
where I come from.

They're--you know,
they're pretty harmless.

- Let's hope
Mr. Krakozhia is now too.

- Yeah, no kidding.

OK.

- [sniffs]

Is this the guy?

- Yes.

- Hey, man.

- It's Dennis Whitaker.

- I just wanted
to say sorry for earlier.

Heard I got you pretty good.

- Yeah.

- I kind of go out of my head
when I'm off my meds.

Then I guess I piss on people.

- I'm pretty sure
the meth doesn't help.

- I'm not using anymore.

I take antipsychotics
for the schizophrenia

I got from doing meth.

But I've been clean a year.

- Why aren't you
taking your meds?

- Why don't I take my meds?

Well, Doc, I'm kind of
in between houses right now

living in an encampment
on Liberty Avenue.

Meds cost money.

I don't have insurance.

Should I go on?
- No. No.

That's fine.

I'm sorry.

Life isn't always easy.

Have you talked
to a social worker yet?

- No.
- OK.

Do you think
you could go grab--

- Kiara?
- Kiara in here?

- Yeah.

- I really am sorry.

- It's OK, honestly.

Really, it's OK.

I appreciate the apology.

[door clicks]

- This must be Crosby.

[dog whines]

I've heard a lot
about you, buddy.

How's my least problematic
trainee?

Well, technically,
you're all pretty green,

but you're growing on me.

- Thank you.

- So how you doing?

- Um, good.

Better.

- Yeah?

- It's--I mean, it's just--

it's the--the little girl
and the sister's

too close to home.

- The things we do are hard.

- Yeah.

- You're sitting here
feeling like--

like maybe you're not up to it?

- Yeah.

- Been there.

We all been there.

Mel, you're a sensitive person.

This--this is a tough place
for sensitive people.

But we need them badly.

Now, if you're ready,
I need you.

It's a perfect job.

It's practically
a zen exercise.

I've got 1,000 pieces of gravel

that need to be plucked
out of a 2-foot-long road rash.

- 1,000?
- Yeah.

Give or take 100.

South 20.

Make sure you close the door
behind you.

Don't want Crosby getting out.
- Yeah.

Thank you. No problem.
I'll be right there.

[sighs]

That's a lot of gravel.
[chuckles]

- It looks clean to me.
You feel that, Earl?

- Feel what?

- That's a no.
- [laughs]

- All right.
Now just apply the Dermabond.

- Cool.

Can I ask you something?

- That's why I'm here.

- Yeah, I was just wondering

what the nurses do
after their shifts.

- In terms of what?

- You know, do they ever,
like, go out together,

like, hang out to decompress
after a shift or anything?

- Yeah, sometimes.

I mean, most of us
are just happy

to get the hell out of here.

Personally, I'm all about
a long, long, hot shower,

comfy sweats,

eating some takeout
in front of the TV,

ideally watching something
that makes me laugh, so...

- Yeah, I can see that.

I'm not imagining it
in my mind, of course.

I just mean that I can--
I can see the appeal.

I was just asking because--

you know,
since we work together,

maybe we could grab
a coffee together sometime.

And you could, like, help me
get the lay of the land,

so to speak?

- You asking him out?

- No. What? No. No.

It's just--I'm--I'm new here,
so I just thought--

- I--I don't date people
in the workplace.

It's nothing personal.
Just it's never a good idea.

- No. No, of course not.
No. No.

I just--no, it's not
a good--no, of course.

I just thought
that since you know

how everything operates here
and you, like, have everything

so dialed in, that you would
be, like, a valuable resource.

But no. No.

I should probably
just figure it out on my own.

- Mm-hmm.

- No shortcuts here.

- How are they
treating you, Earl?

Huh?

I see you wrangled yourself
another sandwich.

- I feel like
I'm watching a rom-com.

- [chuckles]

- Just came by to see
if I could take Dr. Javadi

on a reconnaissance
through chairs.

- Yes.

I mean, sorry,
if you think that's--

- Of course.
Of course.

I can finish up my man here.

- Great.

- Are you OK?

- I feel ridiculous.

I've spoken, like,
two complete sentences

in the last half hour.

And both of them
have made me sound

even more imbecilic
than the incomplete ones.

- And you attribute that to...

- It's like,
my parents once took me skiing

for Christmas in Utah,
and from the moment

I got off the plane,
I could not catch my breath.

No matter how hard I tried,
the altitude made me feel,

like, awkward
and uncoordinated.

I couldn't concentrate.
I couldn't get my bearings.

- Mm-hmm.
- And I'm a very good skier,

but I spent the whole vacation
just, like,

on my butt, dizzy and panting.

Mateo is like a human Utah.

- [laughs]

Oh, honey.

I've worked with a few Utahs.

I wish you many, many Utahs
in your life.

- Jesse, where are you going?

- Trauma Two.
- Stop. Stop. Stop.

Stop.
Not back in there.

I'm not even gonna
tell you why.

How's she doing?

- Still with some
pleuritic pain.

- Oh. Hey, Paula.
I'm Dr. Collins.

Your CT shows that you have
a broken sternum.

That's your breastbone
right here.

Probably from the shoulder belt
when you crashed your car.

- I crashed my car?

- Mm-hmm, and hit your head.

With a concussion,
sometimes you don't remember.

But your head CT doesn't show
anything serious.

So I saw in your chart
you're a new mom.

How's your baby doing?

- He's good.
He's with my mom.

- South 15's open.
Oh. Hey, Dr. McKay?

- Just get the bed out of 15.

- A patient you saw
this morning

came back as an MVC.

Sternal fracture.
Slightly concussed.

- Oh, no.
Paula, do you remember me?

- You look familiar.

- I was your doctor
this morning

for your bladder infection.
- Oh, yeah.

Sorry. I'm a little out of it.

- Still tachycardic, 115.

BP's 124 over 78.

- There's no bleeding
anywhere on the CT.

Chest and abdomen clear apart
from the sternal fracture.

- Well, probably still tachy
from the fracture pain.

- It hurts when I breathe.

- Let's try four of morphine.

Paula, we're gonna
give you some pain meds.

Let me know if it helps, OK?

- Mr. Pernell, you are in luck.

If I had to have gravel
meticulously picked out

of my leg,
this is the person I'd call,

Dr. Mel King,
detail specialist.

- Hello.
- Hi.

I love your dog.
- Crosby?

How is he?
- Oh, he's great.

- Here.
Something to help see up close.

- Hey, I don't want to be
one of those people

who say they need
an emotional support animal,

but is it possible
he could be with me?

We could tie his leash
to the bed.

He wouldn't be in any trouble.
I swear.

- What do you think?
- I'm happy to go get him.

- Any pain here?
- No.

- OK.

You go get the dog.
You get to work.

I'm gonna get
some more gauze from triage.

And just in case,
if anybody asks,

just say you need him
for anxiety.

- OK.

Thanks.

- I know you hear me.

You can pretend you don't,
but I know you do.

This glass
might be bulletproof,

but it ain't soundproof.

Huh?

Hello?

Can you hear me now?
Huh?

Hello!
- Whoa. Whoa. Whoa, sir.

Sir, what is the issue?

- Oh, same issue.

I've been here all day,

and you people have done
nothing to fucking help me.

- We're still waiting
on your second troponin.

We can't clear you medically
until it comes back.

For instance,
if it comes back elevated,

that could indicate
a silent heart attack.

And you'd need to be
admitted for monitoring

in a cardiology consult.

- That's all I'm asking for.

I'm afraid I've had
a silent heart attack.

I just want someone who knows
something about hearts

to tell me
what's happening to me.

You know,
unlike most of these losers,

I have insurance,
good insurance.

And I pay my taxes,
which pays for them

to not have any insurance.

- Sir, you've got
about five seconds

to change your whole attitude
before security

and the police get involved.

- Fuck it.

I'm leaving.

- Hey.

Hey!

You are absolutely free to go.

But if you do,
you will be leaving AMA,

against medical advice.

This form states that I have
advised you to stay

and complete your evaluation,
but you are choosing to leave,

understanding and accepting
all risks of heart attack,

stroke, disability, and death.

- Sounds like a CYA form

in case I drop dead
on the curb.

- That's exactly what it is.

- I just want
to be treated fairly.

- I assure you
that is our intention.

We are not back here
playing Go Fish.

- We're doing our best to help
some very sick people.

You will be seen, OK?

- Robby's gonna love that
patient satisfaction score.

- Crazy people.

[rapid beeping]
- What's going on?

- Car crash victim Paula
just went south.

BP's crashing.
84 over 62.

Much less responsive.

- Liter of LR wide open.

- Putting her
in a 100% non-rebreather.

- Paula, open your eyes.

Paula.

- Was it the morphine?

- She only got a small dose.

- Pulse ox is down to 89.

- Set up for intubation.

And, McKay, get Robby in here.

- I'll call ICU
and get her bumped

ahead of Joyce, our sickler.

She should get the next bed.

- Between the hyperthermia
and the seizure,

she's gonna be out of it
for a while.

A similar thing happened
to a friend of mine.

- Is that what made you
think of hyponatremia?

- Look, I know you value
evidence-based medicine.

But sometimes experience
counts for something.

- May I ask why you did that?
- What?

- Took the blame
for a delay in care

which didn't belong to you

and gave me credit for a save
that did belong to you?

- You know, I've been
on Langdon's shit list all day.

It seemed like he was gonna be
more upset about us

not calling him in than glad
that we stopped the seizure,

so no reason for him
to be pissed at both of us.

- Why have you been
on his shit list?

- Well, I think he made it
very clear

that he thinks I don't have
what it takes to make it here.

- Whether you do or do not,
it was completely inappropriate

for him to speak to you
that way.

- Eh, I've heard worse.

- Well, for what it's worth,
he's wrong.

You're very good at this.

- Thank you.

That's actually worth a lot.

- I thought
the CTs were normal.

- They were.
Systolic's down to 70.

Heart rate's up to 130.

- 100 of ketamine, 100 of rock.

- Could she have
delayed bleeding?

- It's not the chest.

Pericardium's still clear.

No tamponade, good EF.

Lungs are up.

- She feels warm.

- We'll check a temp.

Meds are on board.

- Belly's clear.
No bleeding here.

- She's loose.
- OK. Go for it.

- I see cords.

- Looks good.

- I'm in.

Connect the bag.
- Nice.

- Good breath sounds
bilaterally.

- Temp is 102.4.

- What?
Is this septic shock?

- OK, we need to assume
the worst here.

- Code sepsis.
Two sets of blood cultures,

lactate, 30 per kilo of LR

and for antibiotics,
ceftriaxone?

- No, no, she was just
in the hospital.

Pip-tazo and vanco.
- Got it.

- If this is sepsis,
where is it coming from?

What's the source?
- Her urinary tract infection.

- She doesn't have one.
- She did when I saw her.

- It's not a UTI.

We catheterized urine
a half an hour ago.

There's no nitrates, zero WBCs.

- Your specimen could have been
contaminated this morning.

- Is it pneumonia?
- Chest CT negative.

Abdominal CT negative
for an infectious source.

- She was altered.
Meningitis?

- She's postpartum.

- [sighs]
Endometritis.

The CT of the uterus shows
a thickened endometrium,

but that's normal postpartum.

No retained POCs.

- It still could be the source.

We'll do a pelvic
after she's stable.

- Mr. Krakozhia,
here's my obvious concern.

I write you a script
for 30 days' worth of pills.

Then what?

- What do you mean?
I'll take them.

- Well, you come back
for 30 more, right?

I mean, that's the question.

Even if I could give you
your dose

in a once-a-month shot,

you still have to come back
when the month is over.

- What if he didn't have to?

- Oh, no.
He has to.

If he doesn't, he--

well, he pees.

- We have a street team here.

Mr. Krakozhia,
are you pretty much

in one spot these days?

- Yeah, I'm over on Liberty
near the Benedum.

- The alley?

I know it well.

- So we could bring
the meds to him?

- Absolutely.

The once-a-month injection

sounds like the easier option.

We could just put you
on our schedule.

- I'd be interested
in joining that.

Maybe I can bring out
the medicine myself.

- That'd be amazing.

We could use
all the help we can get.

- Thanks, Doc.

- Yeah, purulent drainage
from the cervix.

Got the culture. Oof.
- [whistles]

- Looks like we have
our source.

The positive urine this morning
was contaminated.

- Maybe.

- Definitely.

Not-so-clean catch specimen.

- This infection's been brewing
for a while.

- So the car crash
was a coincidence.

- Not necessarily.

She was probably already septic
as the disease progressed,

dropped her BP,
and passed out while driving.

- She wasn't hypotensive
when she arrived.

- Adrenaline rush
from the car crash

and the sternal fracture
raised her BP

but not for long.
- Oh.

No history of fever.

- Bet she was taking Tylenol
for the pain.

- Let's call ICU for an admit.

Also want gyn to see her.

- She had mild
lower abdominal pain

and a positive urine dip.

No fever, no back pain
to indicate pyelonephritis.

She was alert,
walking, talking.

It just seemed
like a simple UTI.

I saw no reason to have her
wait eight hours

for a bed for a pelvic exam.

- McKay.

Every postpartum patient
needs a pelvic exam

to rule out endometritis.

- Wait, you're saying that
with 20/20 hindsight.

- Did you ask about Tylenol
or ibuprofen use?

Because that can mask a fever.

- There was no fever.

- Did you do
a careful abdominal exam?

- It was a quick chair exam,

and there was only mild
tenderness over the bladder.

- Perhaps there was something
about the patient

that made you overlook
proper treatment.

- Like what,

other than the obvious
health risk factors?

- Her size doesn't inherently
make her unhealthy.

- Are you saying I was biased
against the patient

because of her weight?

- I raise it as a possibility,
not as an accusation.

- Wow.

I mean, I really don't think
that's the case here,

but I will look out for it.

Yeah.

- You were good with him.

- Do you get a lot of homeless
in Pittsburgh?

- We call them unhoused.

It's not as bad
as Philly or D.C.,

but it's still pretty bad.
- Yeah.

- It really is great
that you want to help out.

The street team get
cool jackets.

- Yeah?
- Come find me end of shift,

and I'll give you
more information.

- Will do.

- You made it out
unscathed this time.

- Yeah.

I'm joining the street team.

Even get a jacket, so...

- Cool.

- Yeah. It is cool.

Very cool.

- Whose pooch?
- South 20's.

I'm taking him for a visit.

This is Crosby.

- Hello.

I'm going for a smoke.

If anyone asks,
he's an emotional--

- Support animal. I know.

I got it.

- [gasping]
[rat squeaking]

- Whoa!
[dog barking]

- Crosby!
Hey, hey, heads up.

- Crosby. Ow!

[rat squeaking]
Drop it. Drop it.

- Ugh!
- Whoa.

[indistinct chatter]

[rat squeaking]

[dog growling]

- Got you.
Come on.

- Crosby.
Crosby, come here, buddy.

Come here.
There you go.

[bones snap]
- Yeah.

[people gasping]

- Nice job!
- Hey.

- Good work!
- There you go.

[applause]

- You got a rat, didn't you?

Yeah.

He does that.
- Yeah.

- When did those cops get here?
- I don't know.

- Who called them?
- I don't know.

- Where's Dana?
- Again, I don't know.

- Thank you.
- Anytime.

- Hard at work?

[both grunt]

- [groans]

- I'll take my chances.

- [groaning]

[dramatic music]

♪ ♪

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