All language subtitles for The.Pitt.S01E11.WEB.H264-SuccessfulCrab+AMZN+MAX.en[sdh]

[distant indistinct chatter]

- Boop-bee-doop.
Boop-bee-doop.

Boop-bee-doop.

[gasps] Hey!

- Not now, Myrna.
- Aw.

Woman in labor.
10 minutes out.

What are you still doing here?

I have one hour left
on my shift.

If I get home before 6:00,
Benji will know something's up.

Pretty sure the black eye
is going to give you away.

Well, sadly,
it's not the first time

I've gone home with
a war wound from a patient.

Hey, Doc.

You got a sandwich?

Uh, you know what, Earl?
I can do you one better.

I'm going to order
Tagari's pizza.

I think we could all use
a morale boost around here.

No sandwich?

You could fold it in half,
New York style,

- just like a sandwich.
- Better not be pineapple...

No pineapple, I promise.
Not this time, okay?

We good?

I say this with all the love
and respect in my heart.

I honestly do.

- Get the hell out of here.
- You need me.

The CT came back normal.

Nasal bone just has
a hairline fracture.

I'm fine. Don't worry about me.
I don't like it.

You sound like me.
That's not a good thing.

- Just let me finish my day.
- Okay.

I'm not going to argue with you.

Yeah, all that knowledge
and still learning.

- It really is impressive.
- Yes.

Well, can you at least
keep a cold pack on it?

[sighs] No promises.

I've had so much coffee,
I've got to pee again.

Walk with me... I also need
to fill you in on something.

- What?
- So Langdon is gone.

- Gone? Where?
- Home.

I will handle his caseload.
It won't fall on anybody else.

And Dr. Ellis usually
comes in early.

I get punched in the face,
and he goes home early?

Nope. It's not like that.
Trust me.

You do not want to be
Langdon right now.

[sighs]

And I need a favor.

I need you to run
a pharmacy audit on Langdon

for the last three days.

I need a list of all
the patients he's treated

and all the medications
he's prescribed.

- Do I want to know why?
- No, you do not.

[sighs]

You sure you're
still good to stay?

- [elevator bell dings]
- Yeah. Are you?

Honestly, I'm beginning
to have my doubts.

Yeah, you feel like God's
trying to tell you something?

[sighs] We stopped
talking a long time ago.

[door closes]

[sighs]

[high-pitched ringing]

[breathing heavily]

[toilet flushes]

[both speaking Tagalog]

...2-0-2-2-8.

Yeah.
20 boxes ought to be enough.

10 cheese, 10 pepperoni.

God, no. No pineapple. No.

[distant telephone ringing]

[device beeps]

Okay.
Thank you very much.

Can I have a word?

With us?

With Dr. Santos.

Sure.

Let me just wrap this up.

Okay.

[speaking Tagalog]

I told you she was Filipina.

So the situation we discussed
earlier has been handled.

I sent Dr. Langdon home.

Well, I wanted to make
a big impression on my...

- Save it.
- Okay.

We're now down
a senior resident,

so it's all hands on deck.

- Got it?
- Got it.

And I trust you have not
mentioned this to anybody else.

Uh, no.

No, I don't know anyone.

Good.

Let's, um, keep it that way.

[indistinct announcement over PA]

[cell phone beeps]

Uh, Dr. Garcia?

This is Trinity Santos,
ED intern, day one.

Uh, I need to talk to you
about something.

So at your earliest convenience
would be great.

Thanks.

Oh, and there's pizza coming,
if you want to...

Yeah.
[sighs]

Dr. Robby!

Theresa,
did you hear from David?

No, but he posted this on
his Instagram 10 minutes ago.

"All I ever wanted was
to fit in and be loved,

"but they mocked me
and forced me into an existence

"of loneliness and pain.

It didn't need to be this way."
Wow.

They did this.
They did this.

[stammers] I think he's talking
about the girls on the list.

But the police said
it's not enough for a BOLA.

BOLO.
It means "Be On The Lookout."

Yeah, well, police are gone.

I heard Langdon left.

Theresa, why don't you
take a deep breath

and go have a seat
in the waiting room?

I will come and find you.

We will finish this
conversation, I promise.

- [sighs]
- Yes, Langdon left.

I will be covering for him.

There are two hours left
in this shift.

And if you need to go,

I will call somebody
to come in early.

Why would I want to go home?

[sighs]

You tell me.

- Okay.
- [door closes]

I'm only going to say this once.

I had a miscarriage.

Oh.

Oh, Heather, I'm so sorry.

- Um...
- I'm fine.

And, no,
I don't want to go home,

and, no, I don't want
to talk about it.

I was trying on my own with IVF.

I-I...
[sighs]

I don't know what...
what to say.

I'm ready to get back to work.

- Okay.
- Okay.

Hey, we need a doctor here!

Natalie Malone,
35-year-old G3P2,

39-week pregnancy,
in active labor after a SROM.

I'm fine, really.
It's not my first time.

All right, let's get her into
Trauma Two for a quick check,

and then we'll send her up
to Labor and Delivery.

Got it.

- I'm Dr. Heather Collins.
- Nice to meet you.

Justin should be here
any minute.

He was right behind me.

Any problems with the pregnancy?

Well, third time's a charm.

Justin's pretty nervous,
though... this is his first time.

BP's 112 over 72, heart rate 84.

- Mm-hmm.
- Um, Dr. Collins, can I join?

Sure.

Okay, when did
the contractions start?

Yesterday.

Really?

Well, my last two labors
were very long,

so I decided to wait it out
this time.

But then my water broke.

Natalie, I'm here.
Sorry, I got a little lost.

- Contraction!
- Curtain.

- Don't push. Just breathe.
- [exhales deeply]

Check her, Dr. King.

- [breathing deeply]
- Okay, good.

I see hair.

Baby's hair.

[breathing deeply, groaning]

Natalie, you're crowning.

You were right.
I waited too long.

I thought I had more time.

It's okay.
It's okay. Just breathe.

All right,
we can try and rush you

upstairs to OB,
but at the rate you're moving,

you may end up having
this baby in the elevator.

So what's my other option?

We deliver your baby here.

Grab a BOA kit
and get a baby warmer in here.

Call L and D, and tell them
this baby is coming now!

We're 20 behind in triage.

Mateo, treat 'em and street 'em.

See how many you can dispo.

I hear we're down
a senior resident.

- How can I help?
- Oh, yeah? What senior?

Langdon had to go home early
to deal with something.

Robby's covering.

You can follow Mateo to Chairs.

That's where
we could really use you.

Chairs is about to be my bitch.

So, D...

is... is this
all about the fight?

What fight?

Robby and Langdon got
into it at the lockers.

- Shit was flying.
- Literal shit.

That's enough from you two.
Not another word.

Keep it up!

You'll both be working
the holidays!

What have we got?

39 weeks, crowning after a SROM.

Hi, Mom.
I'm the attending.

I'm Dr. Robinavitch.

I'm Natalie,
but I'm not the mom.

What's happening?

You got here just in time.

Uh, we're the dads.

Natalie's my best friend
and surrogate.

We both teach fourth grade
and even share classrooms.

Same room, same womb.

We've been urging her
to stop saying that.

[laughter]

I've got the prenatal bag,

and let me pull up the birthing
playlist on my phone.

[chuckles] It's time.

Fuck Beyoncé. Fuck her.

I can take this.

No.

I got it.

Go, Dr. Collins.

Okay, Natalie.

Good chance we'll deliver
on the next contraction.

Bulb suction is ready.

[yelling]

Right.
Head is out!

Nice.
Take a break.

Catch your breath
before the next one.

All right.

I'm going to need
another big push from you.

You got this.

Three, two...

[groaning]

Who do we have in here?

Ivan Pugliesi, 55,
has experienced

a day of abdominal cramps,
vomiting, and diarrhea.

Afebrile, tachy at 124,
BP 192 over 100.

I'm Dr. Mohan.

I'm Student Doctor Whitaker.

Nice to meet you guys.

Um, I would have called my own
doctor, but I'm from New York.

You two kids ever
been out there?

Oh, I've never been to New York.

Coming to Pittsburgh was
my first time leaving Nebraska.

[chuckles]

- Uh, h-how long are you in town?
- Just till Monday.

My... my daughter's
getting married.

She's my baby and the only girl.

- Congratulations.
- Yeah, thanks.

Uh, you know, they say
you're not supposed

to have a favorite kid, but...

I'm an only child,
so I was born the favorite.

- [chuckles]
- Whitaker?

Oh, uh, youngest of four.

I'm just happy when
my parents remember my name.

No, I meant, do you have
any questions for the patient?

Oh, uh...

Hey, can I just get something
for the pain, you think?

As soon as we're done
with this assessment.

We just want to do
our due diligence.

Any intestinal disease
in your past?

Ulcers, gallstones?

General stomach ailments?
Surgeries?

No. No, nothing.

Good bowel sounds.

Thank you.

Abdomen's soft.

Nothing focal.

Anything else bothering you?

Uh, you know,
my back is killing me.

Four-hour car ride will do it.

I mean, the last time
I tweaked it,

I think they gave me, um...

they gave me morphine, and...
and that worked pretty good.

- Do you smoke?
- No.

- Drink alcohol?
- Uh, once, twice a month.

I'm not a big drinker.

Any recreational drugs,
either pills or by injection?

Tranquilizers, hallucinogens, painkillers?

Uh, all of the above.

Yeah. I'm kidding.

No, no drugs, never.

And what do you spend
your time doing?

I'm an actuary.
It's risk management, stats.

It's pretty much a desk job.

I pulled Zofran for the nausea.

Start with 4, repeat PRN.

What, and that's it?

For now, we're going to start
with some blood tests.

We'll be back soon
and check in on you.

All right. Fine.

What do you think
we should be looking at?

A big differential of pretty
serious stuff to rule out.

So what's your plan?

Besides Zofran, CBC, CMP,

IV fluids, morphine, maybe CT.

Good on labs and IV fluids,
but no morphine.

Treat his symptoms with
Clonidine and muscle relaxants.

What if he's...
[scoffs]

Look, I-I really can't lose
another patient today.

Remember how I said you get
good at spotting the fakers?

Yeah.

He's exhibiting every sign
of opiate withdrawal.

Eyes dilated, tearing,

skin has piloerection
and goosebumps.

Hypertension, tachycardia.

Agitation, restlessness, perspiration.

He's checking every box.

Right, but he said
he doesn't take drugs

and seldom drinks alcohol, so...

That's exactly what
he would want you to believe

if he was drug-seeking.

Wow.
You're good.

Thanks.

I am.

So how do we treat him?

By getting him to admit
his opiate usage.

Right. How do we do that?

By being smarter
than the patient.

Got it.

Another big one.

You said that
the last two times.

Shoulder dystocia.

[moaning]

The head's pulling back.

That's called the turtle sign.

Hey, Donahue,
can you call an L and D nurse

and ask her to bring down
a fetal monitor, please?

What's going on?

Baby's shoulder
might be a little

stuck on your pelvic bone.

It's nothing for you
to worry about.

We'll just try something
different on the next push.

Ready?

Why don't we all take
a deep breath, huh?

Everybody.
[all breathe deeply]

One more time. Dads too.
And in.

[all breathe deeply]

If you want him
for Halloween, just say it.

I want him for Halloween
and everything until then.

- Give me Thanksgiving.
- Fine.

You can celebrate
bringing smallpox

to wipe out
the Native Americans.

You know,
I'm the one who's hurt.

A little sympathy
wouldn't kill you.

You broke your ankle

doing something stupid
with our son.

I need surgery.

He wasn't wearing
a helmet, Chad.

What if he had fallen
and hit his head?

- He didn't.
- No, but he could have.

[whispering] Do you know what
it's like to watch a child die?

Oh, here we go.

You know how many kids
come in here

who are messed up because
of one stupid parental mistake?

You know I would never let
anything happen to our son.

Then act like it.

Be a grown-up.

You're his father,
not his friend.

Yeah, and you're his mother,
not my wife.

- Do you think...
- Chad!

- Oh, my God!
- Hey, babe.

[McKay scoffs]

Where's Harrison?

both: Staff lounge.

- Is he okay?
- both: He's fine.

I-I'm going to go
check on Harrison.

I'm pretty sure being
in the same room

with her violates
the restraining order, so...

I'll go.

I can take him home.

Uh, actually, Chloe,
since it'll be hard

for me to get around
after my surgery,

um, Harrison is going to stay
with Cassie for a little while.

- Right.
- No.

I'm here.

I can help take care of him
while you're recovering.

- Absolutely not.
- Babe, I don't mind.

I do.

Um, yeah, sure,
if you don't mind...

just till I'm back on my feet.

Wait... hold... hold on! I...

Dr. McKay,
sorry to interrupt!

We're moving Central 6
to Trauma One.

We need you.

We are not done here.

[indistinct chatter]

ICU boarder,
48-year-old cirrhotic,

here for hematemesis.

Intubated overnight and
after one unit pBRCs and FFP

- was supposedly stable.
- Not anymore. Weak carotid.

Javadi?
I need you on suction.

W-why is she bleeding
all of a sudden?

Most likely, bleeding is
from the esophageal varices.

With cirrhosis, you get
enlarged veins under pressure

at the entry of the stomach.

Varicose veins,
and they can burst.

What does that mean?

The cirrhosis from hepatitis B

caused a vein to burst

where the esophagus
meets the stomach,

and that's where
the blood is coming from.

In through the nose...

Mel, I'll have you help
with the McRoberts maneuver.

- Of course.
- Hey, Natalie...

we're going to lift your knees
up to your chest now.

Doing great.

Justin, is this the worst
you've ever seen me?

This is the most
I've ever seen of you.

You're beautiful.

All right, a little
suprapubic pressure here.

We got you.

You're going to feel me
pressing on your bladder.

Two minutes since head delivery.

Fetal heart rate looks good...
normal variability.

You're doing great, Nat.

Feel free to step in
and take over.

- Ah, another one's coming!
- Give me a big push!

Okay, Natalie. Here we go.
You got this.

[screaming in pain]

- You're almost there.
- Keep going.

- We love you.
- Go, Team Natalie.

- Late decel.
- [monitor beeping]

Okay, can you call Dr. Ingram
and tell him

to come down here, please,
from the NICU?

What's... what's happening?

The baby's heart rate
has slowed,

which could be
a sign of distress.

- So what do we do?
- We deliver this baby.

We got this.

We got this.

[monitor beeping]

Eusebio, can you page the OR

and tell them to prep
for a possible crash C-section?

BP's only 82 over 46.

Hey, Mom,
you're going to be okay.

Rapid infuser,
massive transfusion protocol,

octreotide bolus and drip,

80 pantoprazole and ceftriaxone.

Perlah, get Robby in here.

[monitor beeping rapidly]

Hey, Peggy.
Where's Robby?

Thank you.

Robby, MTP from bleeding
varices in Trauma One.

A little burning from the local.

Oh, fuck! That hurts.

If I can get my hand inside,

under the baby's head,

I can release that lower arm.

Three minutes
since head delivery.

- Dr. Robby.
- Yeah.

My hands are a little tied up
at the moment.

I'll need the Minnesota box.
Who's in there?

- Dr. McKay.
- Tell her to go ahead

and get set up...
she knows what to do.

- I'll be there as soon as I can.
- Yeah.

I'm Dr. Myers
with Obstetrics.

- both: Nice to meet you.
- And who's the father?

- both: We are.
- Oh.

And who's the mother?
both: We are.

Roger that.

OR is prepped and ready.
Do we need to go up?

Uh, not if I can rotate
this posterior shoulder.

- All right, there's the elbow.
- Make sure it's flexed.

It... it's flexed.
Good call.

We're getting closer.
Just stay with me, okay?

- I'm trying.
- Okay.

I've got control
of the hand and forearm.

Oh, that hurts!

Rotating posterior
shoulder up and out!

Fuck!

- Perfect.
- You're right there.

Give me one good push.

- [yelling]
- Yean, yeah, yeah, yeah.

Good! Hey!

We got a baby boy!

[laughs]

Uh, I've got a stubborn set
of twins upstairs.

Admit her to postpartum.

Congratulations, everyone.

[chuckles]

[monitor beeping]

Good job.

He's pretty quiet.

Sometimes
it takes them a minute.

Put the baby on a pulse ox
and a heart monitor.

Hey, Amy, swap out with me.

Mel, dry and stimulate
vigorously.

- On it.
- Very vigorously.

Shouldn't he be crying by now?

- Heart rate is 95.
- Too slow.

Dr. Collins, BVM.

[suction hissing]

Tiny volumes, once per second.

- This kid needs oxygen.
- Come on, baby.

Come on, let's breathe.

- Suction ready?
- Ready. Dr. Ingram?

I'm opening the intubation tray.

- Yep.
- One minute apgar is three.

Isn't apgar supposed
to be nine or ten?

- What does that mean?
- Come on, baby.

Breath, baby, breathe.

[baby choking]
There we go!

- We got him back.
- [baby crying]

That's good, right?

That is very good, very good.

- Okay, you got this?
- Yeah, go.

Looking much better.

Hemorrhagic shock from varices.

Failed medical therapy.

Suction stopped working.

Because your canister is full.

- I'm on it.
- Oh, my God.

- Someone please take her out.
- Mom!

Thank you very much.

By the way, that is not

how you raise
patient-satisfaction scores.

Okay, Dr. McKay, do you want
to explain to Javadi here

- all about the Minnesota?
- Yeah.

So best way to stop the
bleeding is direct pressure.

First balloon goes in
the stomach as an anchor.

Second runs the length
of the esophagus

for direct pressure
on the varices.

First, we want
to inflate the balloon

under water
like a bicycle inner tube

- to check for any air leaks.
- Yeah.

- Javadi, stopcock in the ports.
- Use the 50-cc syringe.

- Suction's good and running.
- I got it.

[suction hissing]

What did you give me?

Because I feel worse.

I told you that I got better
last time with morphine.

I have a morphine-like
drug called BUPE.

Works the same way and faster,
goes right under your tongue.

If this doesn't work,
we'll switch to morphine.

But let's try this first, okay?

[sighs]
I just want the pain to stop.

Open up.

Lift your tongue.

Leave it there,
and let it dissolve.

We'll be back in ten minutes.

[groans]

Just so I'm clear...

our plan is lying to patients?

I didn't lie.

BUPE is a morphine-like drug,
binds to the same receptor.

He said he isn't an addict,

so why give him
an opiate agonist

to treat
his withdrawal symptoms?

Because I don't believe him.
And I know this will work.

Then once he feels better,

we can get him to admit
to his addiction

and treat him long-term.

If you say so.

First do no harm.

Then do what's best
for the patient.

[sighs] Here you go, hon.

[suction hissing]

[sighs]
Langdon called the main line.

- You got to be kidding me.
- Princess answered.

Told him you were busy.
Just wanted you to know.

Okay, noted.
Thank you.

[monitor beeping]

- Can you see anything?
- I don't have to.

You just have to push
the tongue out of the way

in order to pass the tube.

Okay.
Here we go.

[suction hissing, bubbling]

Heart rate's 124.
BP's still only 84 over 42.

Bleeding is still brisk.

Get another unit
on that infuser, please.

- How far did you go?
- 50 centimeters.

Dr. Robby?

Did you say 50 centimeters?
Yes, that's plenty.

Inflate the gastric balloon.

Start with 50, and then
we'll check the placement

in the stomach with an X-ray.

[monitor beeping rapidly]

Apgar is now ten.

[monitor beeping]

Go on.

- Yeah?
- Yeah.

Okay, little one.

Okay.

[baby cooing]

All right, support his head
right over here.

- All right, come here.
- Right there.

There you go.

You're a natural.

[sniffles]

Whenever you're ready.

- We're gonna take him now.
- Okay.

Already miss your dad.

- I'll be up soon.
- Okay.

Can I put my legs down now?

As soon as your placenta's out.

- Oh.
- [groaning in pain]

Breathe.
Good, good.

Here it comes.

[gurgling]

Oh, wow.

- What?
- That is a lot of blood.

Starting a second line.
Spike a liter of saline.

- On it.
- What's going on?

This happens sometimes.

We have to help the uterus
clamp back down.

Starting uterine massage.
40 of oxytocin in the back.

800 mikes
of sublingual misoprostol

and 1,000 of TXA.

2 units from the blood bank,
just in case.

Call OB and get Robby!

- Why is Dana still here?
- She refuses to leave.

That's perfect placement.

- She wants to finish her shift.
- Of course she does.

I've never met a charge nurse
who wasn't a stubborn bitch.

McKay.

In an adorable way, of course.

I honestly don't know
what we'd do without her.

The mouth is filling up again.

It's like a fountain.

Dr. Robby, we need you
in Trauma Two.

Yeah, okay, I'll be right there.

She's still bleeding
higher up in the esophagus.

Natalie.
Keep your eyes open.

We got it.

- Perlah?
- Yeah.

She's not bleeding
in her stomach.

We have to inflate the second
balloon up in the esophagus.

- [cell phone vibrates]
- Dr. Robby, we need you!

Yes!
Fuck! I'm coming, I'm coming!

Fucking Langdon.

This port is in the esophagus.

With a ton of blood.

Mystery solved.

Pump up the esophageal balloon
to 30 millimeters mercury.

That's an insufflator
and a manometer?

Yep, just like
a fancy bike pump.

We are at 30,
and shut the stopcock.

Barely any blood coming
from the esophageal port.

The balloon
stopped the bleeding.

Tomorrow GI
can cauterize the veins.

That was awesome.

I learned from the best.

[monitor beeping]

Is she going to be okay?

We are doing
everything that we can.

Massive PPH on MTP
and all uterotonics.

Any rupture? Any inversion?
Any retained products?

Checked for all.
None present.

- This is all my fault.
- Second unit's going up.

Still tachy at 130.
Systolic's only 84.

Let's try carboprost,
0.25 milligrams IM.

And get a Bakri balloon
from Central.

You could talk to her.
Get in there.

Tell her some of your favorite
memories with her.

That'll help.
[elevator bell dings]

- [indistinct chatter]
- Thanks for coming down.

You said there was pizza.

Uh, do you remember
that thing I was worried about?

My foot is fine, but I'll
let you make it up to me

with a cocktail.

- No, about Langdon.
- What about him?

Uh, unfortunately, I was
right, and he's been dismissed.

- What do you mean "dismissed"?
- Dr. Robby sent him home.

Why?

You know, it's prob... best if
we don't talk about it anymore.

But if you could just keep a lid

on what I mentioned earlier,
that would be really great.

You called me down
to talk about it,

but you don't want
to talk about it?

- What is going on?
- He's been stealing meds.

Stop. I don't want to talk
about this.

- You just said...
- I said stop.

I don't want any part of this.

[scoffs] You're trouble.

[indistinct chatter]

[quietly] Fuck.

[sighs]

Bakri's here.

- Need a fresh saline bag.
- On it.

Third and fourth units
are coming up.

- FFP is also infusing.
- Keep going.

Keep talking to her.
More memories.

- It'll help.
- There was the time

that we got that,
um, glass table

off of Craigslist,
and we went to go pick it up,

and they mugged us,
and they stole it back from us?

Estimated blood loss?

About two liters, maybe three.

What's she had?

Oxytocin drip, TXA, carboprost,

massive transfusion protocol.

- Spike the saline.
- Balloon is past the cervix.

- How much should we put in?
- Up to 500.

If that doesn't work,
she'll need a hysterectomy.

- "Hysterectomy"?
- This is going to work.

Come on, keep talking.
More memories.

It's good for her.
It's good for all of us.

Uh, and the time we binged
"Game of Thrones"

two months before the finale
because of, uh, FOMO?

- [monitor beeping]
- Natalie! Hey, Natalie!

Natalie!
Stay with us!

How are you feeling,
Mr. Pugliesi?

Oh, I'm feeling a lot better.
Nausea's gone.

What about your stomachaches?
Muscle cramps?

[exhales sharply]
I mean, I'd say I'm 75% better.

Blood pressure and heart rate
are back to normal.

Incredible.

You sound surprised.

Oh, no, I'm just relieved
for you, so...

[scoffs]

Good news is you can have
another dose.

That should get you
back to 100%.

Tongue up.

I think we did it.

No more blood loss.

Thanks for your help.

I'll tell OR to stand down.

Nice save, Dr. Robinavitch,
Dr. Collins.

Pulse ox 99.

BP 102 over 68.

She doesn't need the mask.

Thank you for being my best
friend in the whole world.

We're family.

How long does this thing
need to stay in me?

12 to 24 hours.
We'll take it out tomorrow.

We're going to admit you
to the ICU

- for overnight monitoring.
- Thanks, Dr. Robby.

- Mm-hmm.
- Thank you, Dr. Collins.

Excuse me.

- [door opens, closes]
- BP's 98 over 70.

Heart rate's 104.

[indistinct chatter]

- So w-what happens next?
- [door closes]

Once, uh, she's stabilized,
the GI specialist

can do an endoscopy to try
to cauterize the bleeders.

Or they might put in a shunt

to take pressure
off the bleeding veins.

And she'll go to the top
of the transplant list

for a new liver.

"The top of the list"?
It's that serious?

It is, yeah, but, um...

once she gets her new liver,

she should be able to return
to normal life.

Okay.

I-I guess I always knew
that this day would come,

but... somewhere
in the back of my mind,

I hoped that maybe it wouldn't.

It's a lot for someone
your age to handle.

Is there anybody
we can call or...

Oh, no.

No, it's just us.

It's been that way
for a long time.

I'm sorry.
That's really hard.

Yeah, it's good she has you.

Yeah, I'm the same age
that she was

when she first got hep B.

I know it's hard to believe
when you look at her,

but she was a wild child

and an intravenous drug user.

But she got clean
the day that she found out

she was pregnant with me,
and she has been ever since.

She sounds like a good mom.

She's the best.

Are you close with your mom?

Um, sure, yeah.

- Like, proximity-wise?
- [chuckles]

Um, it's just not the first
word that comes to mind.

It's... it's complicated.

- Usually is, right?
- Yeah.

I mean, my mom
hasn't been perfect.

I mean, sometimes
I really hated her.

But I always loved her...

and I knew that she loved me.

Yeah, it's a long road ahead.

But it's a marathon,
not a sprint.

All you can do is take it
day by day.

We have a great social worker
here, Kiara Alfaro,

if you want to talk to her.

Maybe a-a little bit later.

I think I just want to be
with my mom right now.

Yeah.
Of course.

Yeah.

I know.

Dude, you got to stop
calling me, okay?

Yeah, okay.

I'll tell him.
I'll...

Whenever I see him next.

Okay.

Ah, sh...

Guess who that was.

God.

No. I told you. He never calls.

Well, Langdon's desperate
to get ahold of you.

- [phone vibrating]
- You don't say.

God damn it.

Hey, Jake.

Hey, man.
How's it going?

Everything okay with
the passes and the tickets?

Yeah, yeah, it's all good.

Want to say hi?

Hey, Jake.
Long time no see.

How's the festival?

It's really cool.

I mean, there's tons of people,

and there's a lot
of cool stuff going on.

Good. I'm glad you're having
a good time.

How's your friend?

Oh, she actually wanted
to thank you personally.

Hi, Dr. Robinavitch!

Just Robby.

Robby, I'm Leah, Jake's friend.

- Girlfriend.
- Stop!

You said you weren't
going to embarrass me.

I know you were supposed
to be here with Jake,

so thank you so much for
letting me use your tickets.

- We're having a blast.
- You're more than welcome.

All right, well,
we got to get out of here,

but thanks again
for the tickets, man.

Thank you!
Nice meeting you!

You too.

[call chimes]

Can I get you anything?

No.

I didn't even know
that you were trying.

I really didn't tell anyone.

It's not like
it's the first time, but...

It's probably the last.

Why do you say that?

[sighs]

Do you know how much IVF costs?

I should have gone into
reproduction endocrinology.

[chuckles]

Oh, those fertility doctors
are making a killing.

Even if my insurance would pay
for more rounds or I could...

pay out of pocket, I...

[crying] I'm, uh...

I'm not sure I could go
through this again.

Maybe it's just not meant to be.

I've never known you
to give up on anything.

Except maybe me.

[chuckling] Unbelievable.

- I had it coming.
- Mm.

Do you want me to go find Kiara?

- Do you want...
- No.

No, look, I know
you mean well, but I just...

I just want to be left alone.

Go home.

You sure?

Absolutely.

There's only an hour left
in the shift.

It's not like we're going
to get ahead of it.

We never do.
Maybe we never can.

So, yeah, go home.

Turn off your phone.
Turn off the TV.

Pour a glass of wine.
Have a bath.

Go to bed.

And if you need anything...

Thank you.

I got...

I got pregnant a few years ago.

Ah.

I wasn't ready to be a mom then.

I wasn't even sure
about the relationship.

I never told him.

I was afraid.

I was afraid of, um...

all of it.

But, mostly...

I was afraid he'd hate me
for being selfish.

Not selfish.

Heather...

not selfish.

[cries, breathes shakily]

Do you think
he'd forgive me if he knew?

[inhales deeply] Yes.

[exhales deeply]

And, more importantly,

I know he would want you
to forgive yourself.

[crying softly]

The mom had nine babies
on her back.

That's a big family.

Opossums are marsupials,

so they have a pouch
like a kangaroo.

- You're smart.
- Thanks.

I read a lot
when I was your age, too.

Hey, Victoria, do you
want to show Harrison

- how an ultrasound works?
- Sure, yeah.

You want to see
inside your guts?

- Always.
- [chuckles] Okay.

Bye, Mom.

See you in a sec.

[sighs]

This definitely violates
the restraining order.

I tried to warn you.

Chad was severely injured.

I wish.

Look, whatever's going on
between you and Chad,

it's not really
my business, okay?

He's yours.
Believe me.

But mind your place with my son.

Harrison loves living with us.

An 11-year-old needs stability.

I've been Harrison's mother
for 11 years, okay?

I made him.

And I've made a lot
of mistakes in my life,

but I am a damn good mom.

Look, Cassie, it's really
about what's best for Harrison.

Chloe, Harrison wants
to live with me.

I don't believe that.

That's because at your age,
your prefrontal cortex

hasn't really even fully formed.

I'll be 25 next month.

Congratulations.
You can rent a car.

If you really care
what's best for Harrison,

- you will back the fuck off.
- But...

And if I ever, so help me God,

see you in that shirt again...

Let's just say you will have
wished you hadn't, okay?

And he still hasn't admitted
to any opiate use?

No, but, again,
he exhibited every symptom,

- and now he's 100% better.
- [sighs]

And it feels like it was
just a few hours ago

I was asking you
why didn't you consult me first

and specifically telling you
never to do that again.

But instead, you went
behind my back and...

I did it again.

You did it again,
for fuck's sake.

Is anybody honest
about anything anymore?

Or are we all just bullshitting
our way through life?

- It's just a case of...
- That was rhetorical.

Why didn't you come and find me?

You were a little busy.

Really?

Do better, Dr. Mohan.

Yes, sir.

Using BUPE was unconventional,

and while it wasn't dangerous,

it could be subject
for scrutiny,

which I really don't need any
more of right now from Gloria.

I expect a level of this
from medical students.

I expect more from an R3.

And don't forget your vows.
You know what?

Just... just, uh, give 'em
to Cindy, have her hold 'em,

and then you don't
got to think about it.

Because I'm your father,
that's why.

Listen, the doctors are back.
I got to go.

I'll talk to you later.
Yes, I love you.

Bye.

How you feeling,
Mr. Pugliesi?

Oh, so much better.
Thank you.

You guys think that I could have

a little bit more
of that medicine,

just for the few days
that I'm out here?

I just want to be able
to walk my daughter

down the aisle
without shitting myself.

The medication we gave you
wasn't morphine.

It was something called
buprenorphine, or BUPE.

Yeah, no, she said that.

I mean, whatever you call it,
Doc, it worked great.

It's a medicine
specifically targeted

to treat opioid withdrawal.

That's why it worked.

Wait, I-I don't...
I don't understand.

All indicators are that
you have been using opioids.

That would include
pain medication

like hydrocodone, oxycodone.

I told them I don't do drugs.

Wow.

- You lied to me.
- I didn't lie.

I said I was giving you
a morphine-like drug

that got rid of your cravings.

Well, you know what?
This is bullshit.

I mean, you know,
I could sue all of you.

You hear me?

I'm not some junkie
on the street.

Look, look, I-I got a family.
I got a job.

I make good money.

I... you know,
I return my shopping carts.

I pay my taxes.

That sound like
a drug addict to you?

Yes, because anybody
can be an addict.

You are proof of that.

These pills
that you were taking,

they're not helping you
with your pain.

They are keeping you
stuck in it.

A lot of really good people
struggle with addiction.

It is a brain disease.

But social environment
and personal choice

- are also factors.
- I don't have a problem.

The good news is that
the brain is highly dynamic,

as is the environment.

But you need to stop now before
the damage is irreparable.

No, screw this hospital, okay?

- And screw you.
- Hey.

Doctor Mohan...
Doctor Mohan will advise you

on our proposed action plan.

You can either choose
to follow it or not.

That is entirely up to you.

I wish you luck, Mr. Pugliesi.

We're giving you
a seven-day supply

of a drug called Suboxone.

We can set you up
with a medic...

Fuck off. I'm not interested.

My father passed away
when I was young.

I don't know if I'll ever
get married, but if I do,

it'll be without him
walking me down the aisle.

I'm glad your daughter has you
there on her wedding day.

I hope she gets
to have you there

for all of her other big days
to come, too.

Dr. Mohan.

I, uh... I don't always know
the exact right thing to say,

but I am sorry about your dad.

It was a long time ago,
but thank you.

Dr. Robby.

I've been waiting in the lobby
for almost an hour.

You said you'd be right there.

Theresa, oh, I am so sorry.

Uh, we are
a little understaffed.

And, truthfully,
my head has been

in a million different places...
can you forgive me?

I'm here now.
Please. What's going on?

The psychologist spoke to me
about becoming a petitioner

to place David on
a involuntary psychiatric hold.

- Yes.
- But can that be anonymous?

No.

To call a 302
in the state of Pennsylvania,

the petitioner needs to admit
to having witnessed

the concerning behavior,

and you need a physician

and a social worker to sign off,

which both Kiara and I can do.

What if I'm wrong?

Then you apologize.

And we will help you explain

that this came
from concern for his safety.

What if you're right?

But if I become a petitioner,
what am I doing to my son?

You...

are trying to get him the help
that it sounds like he needs.

David lost his father.
That would affect anyone.

But we are failing young men,

because we don't teach them
how to express their emotions.

We just tell them to man up,
and then we let them

get their lessons in manhood
from toxic podcasts.

And these young men

then feel isolated
from themselves and society,

and they find community
and comfort

in all the wrong places.

David needs help.

We don't want to fail him, too.

You have kids?

I sort of have a stepson, yeah.

His mom and I dated for a while.

But, um, Jake and I have
a great relationship.

Jake's lucky.

Oh, I think
I'm the lucky one there.

I'm going to check in
with the psychologist...

and tell her I want to become
a petitioner.

Great, and then come find me,

and I will sign off
on that paperwork.

[telephone rings,
indistinct chatter]

[sighs]

- Knock, knock.
- [chuckles]

To what do I owe this pleasure?

I found these.

You must have dropped them.
Got to be more careful.

You don't want these ending up
in the wrong hands.

Ah, you can keep 'em.

You ever think about quitting?

[chuckles]

I'm not a quitter.

Oh, I know
you're a happy drunk today.

But one day,
when your liver fails...

and believe me, it will fail...

you won't be so happy.

It's not a nice way to go.

I'm digging my own grave.

Let me.

[softly] I don't have
to give you the shovel.

- [indistinct chatter]
- [sighs]

Um, have you seen
Dr. Langdon?

Uh, he left for the day.

He didn't say goodbye.
That's...

Um, I really wanted to tell him
about this delivery.

It was really cool.

I mean, the dads
were so happy, and, um...

Great stuff.

Dr. Robby?
I...

I just wanted to apologize
for what happened with Langdon.

Apology accepted.

I just... if I hadn't said
anything, he would still be...

Nobody's fault but Langdon's.
Now, if you'll excuse me...

Well, it doesn't feel that way.

Some people might have turned
a blind eye, but you didn't.

It took a strong moral compass
to do what you did...

on your first day, nonetheless.

I just wonder if...

You did the right thing,
Dr. Santos.

Thanks, Dr. Robinavitch.

Have you seen Dana?

Yeah, she was headed
to the ambulance bay.

Keep your distance.
I'm already in a bad mood.

- I'm just getting some air.
- [scoffs] Yeah, right.

You're a terrible liar.

Hope you're better at security.

Hey, now you're just being mean.

You realize that
this is the second person

to accuse you of that today.

- You starting to see a pattern?
- No.

But I am starting
to see why Gloria's unhappy

with your
patient-satisfaction scores.

- [laughs]
- You need something?

Or you just here to ruin
one of the few things

that still brings me
a little joy in life?

I sent Collins home.

You don't want to work
with anybody today.

You must be in a mood.

- She's had a rough day.
- [scoffs, chuckles]

It's going around.

You should leave, too.

[chuckling] Yeah.

You're good.

You're not that good.

You know I was born
at this hospital?

I even volunteered here
in high school.

I've been punched,
kicked, spit at,

pissed on,
had feces thrown at me.

I talked to Gloria.

I told her, listen,

we got to do something
to beef up security.

- This can't happen again.
- It will.

It will.

Maybe not to me,
but to somebody.

World's changed.
People are angry.

Our tempers are shorter.

And we're still just
trying to help.

You do help.

You do make a difference.

One asshole doesn't get
to change that.

I think I'm done.

[sighs]

Yeah.

I know that one.

And I don't blame you.

I, uh...

[sighs] I-I-I-I don't know.

I don't know. Maybe what I want
and what the patients need

isn't what's best
for you anymore.

Yeah.

I just honestly don't know

what I'm going to do
without you.

You'll figure it out.

You always do.

You're a good man, Robinavitch.

Don't let this place
take that from you.

[distant siren wailing]

Okay?

[cell phone ringing,
cell phone chiming]

God.
[phone beeps]

Yeah?

Code triage.

[sirens approaching]

Multiple GSWs.

There's an active shooter
at Pittfest.

Jake and his girlfriend
are there.

[sirens approaching]