1 00:00:25,525 --> 00:00:30,280 Can you... can you just put him on the phone for a second? 2 00:00:30,363 --> 00:00:33,575 I just want to hear his voice. 3 00:00:33,616 --> 00:00:36,703 There's my guy. 4 00:00:36,786 --> 00:00:39,456 How you doing, buddy? 5 00:00:39,539 --> 00:00:42,459 I would love to hear your... your song. 6 00:00:49,340 --> 00:00:52,385 [waves crashing] 7 00:01:00,143 --> 00:01:02,479 You should go home. 8 00:01:02,520 --> 00:01:04,647 Oh, that is the last place I want to be. 9 00:01:04,730 --> 00:01:07,067 Are you sure you shouldn't see your OB? 10 00:01:07,150 --> 00:01:09,652 I checked myself. 11 00:01:09,736 --> 00:01:11,780 Uterus is empty, barely spotting now. 12 00:01:11,821 --> 00:01:13,198 I'm fine. 13 00:01:13,281 --> 00:01:15,492 - [sobbing] - Oh, honey. 14 00:01:15,533 --> 00:01:17,786 I'm so sorry. 15 00:01:17,827 --> 00:01:20,789 Oh, I shouldn't have bought that fucking stroller. 16 00:01:20,830 --> 00:01:22,164 Oh. 17 00:01:22,207 --> 00:01:24,000 Fuck that fucking stroller. 18 00:01:30,048 --> 00:01:33,718 Losing a kid is hard on everybody. 19 00:01:45,604 --> 00:01:47,357 That's as hard as it gets. 20 00:01:47,398 --> 00:01:49,484 We do these debriefs 21 00:01:49,526 --> 00:01:53,696 to try to give a sense of closure, meaning, 22 00:01:53,738 --> 00:01:56,533 to difficult cases so that they won't linger. 23 00:01:56,574 --> 00:02:01,329 But trust me, the kids you'll lose will linger. 24 00:02:01,371 --> 00:02:04,040 So what do you do? 25 00:02:04,124 --> 00:02:07,127 I did my residency at Big Charity in New Orleans. 26 00:02:07,210 --> 00:02:11,172 And day one, I got a kid, five-year-old boy, 27 00:02:11,214 --> 00:02:12,674 accidentally shot by his brother 28 00:02:12,715 --> 00:02:14,884 playing with Dad's gun, 29 00:02:14,968 --> 00:02:17,679 worried he was gonna get in trouble 30 00:02:17,720 --> 00:02:19,597 right up until he coded and died. 31 00:02:19,681 --> 00:02:23,351 [exhales sharply] 32 00:02:23,393 --> 00:02:26,603 That night, I asked myself, like, 33 00:02:26,688 --> 00:02:29,065 what do I do with this kid? 34 00:02:29,107 --> 00:02:31,151 Where do I put this feeling? 35 00:02:31,234 --> 00:02:32,902 And I found myself walking all night. 36 00:02:32,986 --> 00:02:34,320 I was walking and walking and walking. 37 00:02:34,404 --> 00:02:35,738 Then I found myself back at the gates 38 00:02:35,780 --> 00:02:37,198 of Big Charity Cemetery, and I'm looking 39 00:02:37,240 --> 00:02:38,908 at all those mausoleums and those crypts 40 00:02:38,992 --> 00:02:40,743 and I'm thinking to myself, OK, that's what I need. 41 00:02:40,827 --> 00:02:42,871 I just need a safe place where I can put these feelings... 42 00:02:42,912 --> 00:02:44,747 Yo, we got patients throwing punches in chairs. 43 00:02:46,749 --> 00:02:48,751 Uh, OK, everybody. Let's get back to it. 44 00:02:48,835 --> 00:02:50,753 Just remember, the Employee Assistance Program 45 00:02:50,795 --> 00:02:52,589 is available, as are Kiara and myself, 46 00:02:52,672 --> 00:02:54,591 if anybody needs to talk. 47 00:02:54,674 --> 00:02:56,134 - Where's McKay? - In Central 11 48 00:02:56,216 --> 00:02:58,052 with our UTI accounting assistant 49 00:02:58,094 --> 00:03:00,388 while we keep her boss on ice in North 2. 50 00:03:00,430 --> 00:03:02,182 Robby, critical case flying in... 51 00:03:02,265 --> 00:03:04,184 possible MDMA overdose, high temp, 52 00:03:04,267 --> 00:03:05,894 en route from PittFest. Five minutes out. 53 00:03:05,935 --> 00:03:07,270 Stay here. Set up for that. 54 00:03:07,353 --> 00:03:08,730 - Ahmad and I got chairs. - Hey, hey. 55 00:03:08,771 --> 00:03:10,273 Is everything all right with Collins? 56 00:03:10,356 --> 00:03:11,858 Something's bothering her. I asked her about it. 57 00:03:11,941 --> 00:03:13,193 She said she doesn't want to talk to me about it. 58 00:03:13,276 --> 00:03:14,527 Oh. Imagine that. 59 00:03:14,611 --> 00:03:16,112 She probably learned it from you. 60 00:03:16,196 --> 00:03:18,448 Seriously? You just gave a speech titled 61 00:03:18,489 --> 00:03:20,116 "How to Literally Bury your Feelings." 62 00:03:20,158 --> 00:03:23,244 Now, if you'll excuse me, I gotta break up a fight. 63 00:03:23,286 --> 00:03:24,662 [indistinct shouting] 64 00:03:24,746 --> 00:03:25,914 Yo, you need to control your wife, man! 65 00:03:25,954 --> 00:03:27,123 Shut it, man! 66 00:03:27,165 --> 00:03:28,291 [indistinct shouting] 67 00:03:28,333 --> 00:03:30,126 Hey, hey, Olsen! 68 00:03:30,210 --> 00:03:31,961 - Olsen, what the fuck, man? - Took you long enough! 69 00:03:32,045 --> 00:03:33,087 - Calm down. - No. 70 00:03:33,129 --> 00:03:34,589 Don't tell me to calm down. 71 00:03:34,631 --> 00:03:36,132 How hard is it to put a mask on your kid? 72 00:03:36,216 --> 00:03:38,593 He has allergies, you fucking Fauci zombie. 73 00:03:38,635 --> 00:03:40,762 - What? - Allergies! Fuck you. 74 00:03:40,803 --> 00:03:42,138 [screaming and shouting] 75 00:03:42,222 --> 00:03:43,223 - You fucking bitch! - Hey! 76 00:03:43,305 --> 00:03:44,974 Hey! That's enough! 77 00:03:45,058 --> 00:03:47,477 Jesus almighty, I don't believe what I'm seeing. 78 00:03:47,560 --> 00:03:49,978 Where do you people think you are, huh? 79 00:03:50,063 --> 00:03:51,481 This ain't Philly. 80 00:03:51,564 --> 00:03:53,316 This is a hospital, for Christ's sakes. 81 00:03:53,358 --> 00:03:55,985 What's the matter with you? 82 00:03:56,027 --> 00:03:58,488 You call yourselves adults? Huh? 83 00:03:58,529 --> 00:04:00,323 There are children in here. 84 00:04:00,365 --> 00:04:03,326 You should be ashamed of yourselves. 85 00:04:03,409 --> 00:04:05,828 Olsen, you catch any shrapnel? 86 00:04:05,912 --> 00:04:08,831 Craziest shit I've seen since I've been here, but I'm good. 87 00:04:08,873 --> 00:04:10,667 - I'm good, seriously. - Jack-offs. 88 00:04:10,750 --> 00:04:14,671 Ladies, are we finished with the craziness? 89 00:04:14,754 --> 00:04:16,255 [lisping] This is fucking ridiculous. 90 00:04:16,339 --> 00:04:18,216 All I did was offer to put a mask on her child 91 00:04:18,298 --> 00:04:19,968 who's been coughing for over an hour. 92 00:04:20,009 --> 00:04:21,678 And... and now I'm missing half my goddamn tooth 93 00:04:21,761 --> 00:04:23,137 and talking like this. 94 00:04:23,179 --> 00:04:24,514 First of all, masks are bullshit. 95 00:04:24,597 --> 00:04:26,307 - Oh, my God. - And B, it's an allergy. 96 00:04:26,349 --> 00:04:28,685 He's allergic to cat dander, like I fucking told you. 97 00:04:28,768 --> 00:04:30,228 My sister brought her two Persians... 98 00:04:30,311 --> 00:04:32,313 Shut up. Shut up right now, please. 99 00:04:32,355 --> 00:04:34,524 And only answer the questions I ask. 100 00:04:34,607 --> 00:04:37,652 What happened to the tooth? Did you swallow it? 101 00:04:37,694 --> 00:04:38,861 I don't think so. 102 00:04:38,945 --> 00:04:39,988 I think it's still in my hand. 103 00:04:40,029 --> 00:04:41,364 It sure is. 104 00:04:41,447 --> 00:04:42,949 I hope you both have all your shots. 105 00:04:43,032 --> 00:04:44,492 What do you mean, like, vaccines? 106 00:04:44,534 --> 00:04:46,119 Jesus, please don't stir this pot. 107 00:04:46,202 --> 00:04:47,370 Let's take these ladies back 108 00:04:47,453 --> 00:04:48,871 and get them treated, separately. 109 00:04:48,913 --> 00:04:50,665 - Stick with me. - Come on. 110 00:04:50,707 --> 00:04:51,832 Ma'am, it's time to go. 111 00:04:51,874 --> 00:04:54,210 Guess that makes us a team. 112 00:04:54,252 --> 00:04:55,878 I guess it does. 113 00:04:55,920 --> 00:04:58,548 Ma'am, come with Mateo and I... 114 00:04:58,631 --> 00:05:00,008 Mateo and me. 115 00:05:00,049 --> 00:05:01,718 Yes, with us both. 116 00:05:01,801 --> 00:05:03,428 OK, Earl, let's take a look at you. 117 00:05:03,511 --> 00:05:04,887 Oof, she really tagged you. 118 00:05:04,971 --> 00:05:07,515 Red's got a left hook like Billy Conn. 119 00:05:07,557 --> 00:05:08,725 Well, let's get you cleaned up. 120 00:05:08,766 --> 00:05:11,686 Come on, baby. 121 00:05:11,728 --> 00:05:12,854 Excuse me, sir. 122 00:05:12,895 --> 00:05:15,148 You're not allowed back there. 123 00:05:15,231 --> 00:05:17,400 Unless, what, I start a fight? 124 00:05:17,483 --> 00:05:18,818 Become homeless? 125 00:05:18,901 --> 00:05:19,944 Apparently, that's what it takes. 126 00:05:20,028 --> 00:05:21,070 I understand your frustration. 127 00:05:21,112 --> 00:05:22,405 I promise you'll be seen 128 00:05:22,447 --> 00:05:23,906 as soon as a provider is available. 129 00:05:23,990 --> 00:05:25,616 But how can they become available 130 00:05:25,700 --> 00:05:27,368 if new people keep cutting the fucking line? 131 00:05:27,410 --> 00:05:28,703 There's no line. 132 00:05:28,745 --> 00:05:30,455 We see patients by severity of need. 133 00:05:30,538 --> 00:05:33,416 As soon as we have your tests and labs, you will be seen. 134 00:05:33,457 --> 00:05:35,585 This place is fucking unbelievable. 135 00:05:35,668 --> 00:05:38,212 Runaround after runaround. 136 00:05:38,254 --> 00:05:40,381 Hey. What's up, Erik Estrada? 137 00:05:40,423 --> 00:05:41,758 Still keeping your eye on me? 138 00:05:41,841 --> 00:05:43,718 Always, my friend. 139 00:05:43,760 --> 00:05:45,386 Always. 140 00:05:45,428 --> 00:05:48,056 - Who's Erik Estrada? - Shame on you. "CHiPs." 141 00:05:48,097 --> 00:05:49,349 Know your television history. 142 00:05:49,432 --> 00:05:50,933 - And thank you. - Yeah. 143 00:05:53,061 --> 00:05:54,937 Crazy people. 144 00:05:55,021 --> 00:05:56,606 If you do get my tooth out, I don't want it 145 00:05:56,689 --> 00:05:58,649 after it's been inside that woman. 146 00:05:58,733 --> 00:06:00,485 Reattachment wouldn't be possible. 147 00:06:00,568 --> 00:06:02,236 A type two fracture into the dentin. 148 00:06:02,278 --> 00:06:03,488 Seal with dental cement. 149 00:06:03,571 --> 00:06:05,448 Prescription for Pen VK, soft diet. 150 00:06:05,490 --> 00:06:07,575 Follow up with the dentist in one to three days for a crown. 151 00:06:07,617 --> 00:06:10,912 You handle Spinks while I check on Ali. 152 00:06:10,953 --> 00:06:11,954 You got this. 153 00:06:11,996 --> 00:06:13,873 Don't worry, partner. 154 00:06:13,956 --> 00:06:15,416 Yes. 155 00:06:15,458 --> 00:06:16,918 I totally got this. 156 00:06:20,213 --> 00:06:21,881 How are we doing in here? 157 00:06:21,964 --> 00:06:23,633 You should write that bitch a script for calcium 158 00:06:23,716 --> 00:06:25,510 because I didn't even hit her that hard. 159 00:06:25,593 --> 00:06:28,971 Too much almond milk in your soy lattes. 160 00:06:29,013 --> 00:06:30,807 That doesn't even make sense. 161 00:06:30,848 --> 00:06:33,142 You know, most commercial almond and soy milks 162 00:06:33,183 --> 00:06:35,186 are fortified with calcium, so they end up having 163 00:06:35,269 --> 00:06:37,814 a higher percentage of calcium than cows' milk. 164 00:06:37,855 --> 00:06:39,649 Prepped with Betadine and draped. 165 00:06:39,732 --> 00:06:40,817 Very nice. 166 00:06:40,858 --> 00:06:42,151 Let's have a closer look. 167 00:06:42,235 --> 00:06:44,070 Dr. King, can you please grab me 168 00:06:44,153 --> 00:06:46,656 a 10 cc syringe, a 20 gauge needle, 169 00:06:46,697 --> 00:06:48,241 and some sterile saline, please? 170 00:06:48,324 --> 00:06:50,159 Pluck it out, stitch me up, and send me home. 171 00:06:50,243 --> 00:06:51,786 I've got to get back out there to my kid, 172 00:06:51,828 --> 00:06:53,663 who is still waiting to be seen, by the way. 173 00:06:53,704 --> 00:06:55,498 Afraid it's a little more complicated than that. 174 00:06:55,581 --> 00:06:58,167 You got yourself a fight bite, which means a couple things. 175 00:06:58,251 --> 00:06:59,710 First, we need to determine 176 00:06:59,794 --> 00:07:01,671 if the bite extended into the joint space. 177 00:07:01,712 --> 00:07:03,548 If it did, you're gonna need IV antibiotics 178 00:07:03,631 --> 00:07:05,633 and a trip to the OR to see a hand surgeon. 179 00:07:05,675 --> 00:07:08,511 - Pinprick and a little burning. - An operation? 180 00:07:08,553 --> 00:07:11,139 Well, you were just shouting a minute ago about infection, 181 00:07:11,180 --> 00:07:13,015 and with good reason. 182 00:07:13,057 --> 00:07:16,769 While I am sure you are in the clear for rabies and HIV, 183 00:07:16,853 --> 00:07:19,522 human mouths are filthy, some more than others. 184 00:07:19,564 --> 00:07:20,857 How can you tell if it's bad? 185 00:07:20,940 --> 00:07:22,608 Good question. Dr. K? 186 00:07:24,110 --> 00:07:25,570 I'm sorry? 187 00:07:25,653 --> 00:07:28,531 I am going to inject some sterile saline 188 00:07:28,614 --> 00:07:30,032 into your knuckle joint, which you won't feel 189 00:07:30,116 --> 00:07:31,868 'cause of the anesthetic. 190 00:07:31,951 --> 00:07:33,703 If it comes spraying back out of the bite wound, we'll know. 191 00:07:33,744 --> 00:07:35,121 - Ready? - I guess. 192 00:07:37,457 --> 00:07:38,832 There she blows. 193 00:07:38,875 --> 00:07:40,376 Ah, shit. 194 00:07:40,418 --> 00:07:41,711 Are you serious? 195 00:07:41,794 --> 00:07:43,838 You hear that, you fucking bitch? 196 00:07:43,880 --> 00:07:46,048 I've got to have surgery, thanks to you. 197 00:07:46,132 --> 00:07:49,886 - Good. You assaulted me! - Damn right. 198 00:07:49,927 --> 00:07:51,804 And I'll bet next time, you keep your masks 199 00:07:51,888 --> 00:07:54,015 and opinions to yourself. 200 00:07:54,056 --> 00:07:55,349 You OK? 201 00:07:55,391 --> 00:07:56,726 Yes. 202 00:07:56,808 --> 00:08:00,021 3 grams Unasyn IV. Call the OR. 203 00:08:00,062 --> 00:08:02,398 Tell them we have a fight bite that needs to be washed out. 204 00:08:02,482 --> 00:08:03,733 Then go take 20 minutes in the lounge. 205 00:08:03,816 --> 00:08:05,234 I'll come find you if I need you. 206 00:08:05,276 --> 00:08:07,153 - I don't need a break. - Yes, you do. 207 00:08:09,572 --> 00:08:10,990 OK. 208 00:08:11,073 --> 00:08:13,993 Oh, did you want me to tell the surgeons 209 00:08:14,076 --> 00:08:16,829 - to go no masks for surgery? - What? 210 00:08:16,913 --> 00:08:19,040 Well, those of us who save lives for a living 211 00:08:19,081 --> 00:08:21,417 believe strongly that masks minimize risk 212 00:08:21,459 --> 00:08:23,169 when it comes to spreading disease and infection. 213 00:08:23,252 --> 00:08:25,338 But I... I want to respect your beliefs, 214 00:08:25,421 --> 00:08:27,215 so what do you think? 215 00:08:27,256 --> 00:08:28,758 With or without for surgery? Without? 216 00:08:28,841 --> 00:08:32,595 Um... I want with. 217 00:08:32,678 --> 00:08:35,640 Good call. 218 00:08:35,722 --> 00:08:37,558 Helicopter's here. Cafeteria send the ice? 219 00:08:37,600 --> 00:08:39,268 - Yeah, everything they got. - Hey. 220 00:08:39,309 --> 00:08:40,727 I hear they're gonna start you 221 00:08:40,770 --> 00:08:42,104 working on the Middle East peace plan. 222 00:08:42,145 --> 00:08:43,898 Not since the Dalai Lama or Gandhi. 223 00:08:43,940 --> 00:08:45,066 They'd be fucking-A right to. 224 00:08:45,107 --> 00:08:46,275 You should have seen me. 225 00:08:46,317 --> 00:08:47,985 I was inspiring, also terrifying, 226 00:08:48,069 --> 00:08:49,278 and a little bit shaming. 227 00:08:49,320 --> 00:08:50,905 Holy Trinity of crowd control. 228 00:08:50,947 --> 00:08:52,240 Hey, can we pick it up in here, please? 229 00:08:52,281 --> 00:08:55,117 Overdose is here. 230 00:08:55,201 --> 00:08:56,744 PittFest OD. 231 00:08:56,786 --> 00:08:58,287 Keely Ralston, brought to the first aid tent 232 00:08:58,371 --> 00:09:00,581 at PittFest with altered mental status and fever. 233 00:09:00,623 --> 00:09:02,124 Temp too high for a field thermometer. 234 00:09:02,208 --> 00:09:03,417 Intubated en route. 235 00:09:03,459 --> 00:09:04,919 We got to cool this lady down. 236 00:09:04,961 --> 00:09:06,420 Get some ice packs, head, neck, groin. 237 00:09:06,462 --> 00:09:08,881 - Send off for a rainbow. - On it. 238 00:09:08,965 --> 00:09:11,467 Heart rate 132, BP 210 over 120. 239 00:09:11,509 --> 00:09:14,053 - Jesus, that's high. - Four of Ativan in the field. 240 00:09:14,136 --> 00:09:16,222 Pupils are dilated. Definitely MDMA overdose. 241 00:09:16,305 --> 00:09:17,974 Dr. Mohan, how do you want to treat the BP? 242 00:09:18,057 --> 00:09:19,392 - Beta blockers? - No. 243 00:09:19,475 --> 00:09:20,476 Unopposed alpha could kill her. 244 00:09:20,518 --> 00:09:21,477 Four more of Ativan, please. 245 00:09:21,561 --> 00:09:22,895 Seriously? 246 00:09:22,979 --> 00:09:24,480 She might need another 40. 247 00:09:24,564 --> 00:09:26,399 Hypertension and tachycardia from MDMA 248 00:09:26,482 --> 00:09:27,984 is centrally mediated. 249 00:09:28,067 --> 00:09:29,110 Ativan is the drug of choice. [thermometer beeps] 250 00:09:29,151 --> 00:09:31,153 Damn. Core temp, 107.3. 251 00:09:31,237 --> 00:09:32,613 OK, can we get another hose in here 252 00:09:32,655 --> 00:09:33,948 before she fries her brain, please? 253 00:09:33,990 --> 00:09:36,158 Let's go. Come on. [monitors beeping] 254 00:09:39,120 --> 00:09:40,997 I'll be right back. 255 00:09:41,080 --> 00:09:43,499 Hi. You look lost. 256 00:09:43,583 --> 00:09:45,001 No, it's my assistant 257 00:09:45,042 --> 00:09:46,502 who actually seems to have been misplaced. 258 00:09:46,544 --> 00:09:48,337 I mean, how long does a CT take? 259 00:09:48,421 --> 00:09:49,630 Certainly not this long. 260 00:09:49,672 --> 00:09:51,007 They can get pretty backed up. 261 00:09:51,048 --> 00:09:52,174 Can I get you a cup of bad coffee? 262 00:09:52,258 --> 00:09:54,176 - Dry sandwich? - No, thank you. 263 00:09:54,218 --> 00:09:55,845 How about a cold LaCroix from my secret stash in the lounge? 264 00:09:55,928 --> 00:09:57,638 I'm going for one myself. I'm freaking addicted. 265 00:09:57,680 --> 00:09:59,849 I'm good on drinks. Can you take me to radiology? 266 00:09:59,932 --> 00:10:02,268 Yeah, right this way. Right this way. 267 00:10:07,023 --> 00:10:09,108 Piper, while we still have a few minutes, 268 00:10:09,191 --> 00:10:10,526 there are some things I want to say. 269 00:10:10,610 --> 00:10:12,278 Yeah, use protection. 270 00:10:12,361 --> 00:10:14,363 - I know. I'm sorry. - Totally. 271 00:10:14,447 --> 00:10:17,116 - It was a mistake. - Totally. 272 00:10:17,199 --> 00:10:19,368 I'm a part of the street team here. 273 00:10:19,452 --> 00:10:21,370 It's a group of doctors and nurses 274 00:10:21,412 --> 00:10:24,040 who go out into the community and help people 275 00:10:24,123 --> 00:10:27,001 who can't or won't ask for help... 276 00:10:27,043 --> 00:10:30,713 addicts, unhoused, runaways. 277 00:10:30,796 --> 00:10:32,882 And I'll be honest with you, Piper. 278 00:10:32,965 --> 00:10:35,843 I think you need some help. 279 00:10:35,885 --> 00:10:37,720 What are you talking about? 280 00:10:37,803 --> 00:10:40,222 If you're in trouble, we can help you. 281 00:10:40,306 --> 00:10:43,059 I'm not. OK? 282 00:10:43,142 --> 00:10:46,729 And if we're done here, I think I'd like to go. 283 00:10:46,812 --> 00:10:51,275 Will you at least take a look at this? 284 00:10:51,359 --> 00:10:53,110 There's a list of resources on the back. 285 00:10:53,194 --> 00:10:55,404 I don't need that. 286 00:10:55,488 --> 00:10:57,907 I know you don't have a phone, 287 00:10:57,948 --> 00:11:02,203 but if you could just take my number, OK? 288 00:11:02,244 --> 00:11:04,080 You never know. 289 00:11:04,163 --> 00:11:06,332 Where's Laura? 290 00:11:06,415 --> 00:11:08,167 How about taking the pen? 291 00:11:08,250 --> 00:11:11,212 If you ever feel unsafe or in danger, call this number. 292 00:11:11,253 --> 00:11:12,755 It's a national hotline. 293 00:11:12,797 --> 00:11:15,174 There's somebody on the other end 24/7, 294 00:11:15,257 --> 00:11:17,093 a trained professional who can help with anything. 295 00:11:17,176 --> 00:11:18,427 I have all the help I need. 296 00:11:18,469 --> 00:11:20,763 I want to go. Now. 297 00:11:20,846 --> 00:11:23,057 OK, on my count. One, two, three. 298 00:11:23,099 --> 00:11:24,767 Gentle, gentle, gentle. 299 00:11:24,850 --> 00:11:26,936 Houston, we have splashdown. 300 00:11:26,977 --> 00:11:28,229 Good luck. See you on the next one. 301 00:11:28,270 --> 00:11:30,272 - Yep. - Temp's down to 107.1. 302 00:11:30,314 --> 00:11:32,066 How long does she need to stay in the ice, Dr. Santos? 303 00:11:32,108 --> 00:11:33,609 My PB in the ice is 13 minutes. 304 00:11:33,651 --> 00:11:35,569 - Dr. Santos. - Until her temp is normal. 305 00:11:35,611 --> 00:11:37,154 Wrong. You pull her out at 102. 306 00:11:37,238 --> 00:11:39,281 Otherwise we could overshoot and cause hypothermia. 307 00:11:39,323 --> 00:11:41,992 Heart rate 120. Pressure 198 over 116. 308 00:11:42,076 --> 00:11:44,120 More Ativan? Another four, please. 309 00:11:44,203 --> 00:11:45,788 Why is she on the ice, Dr. Santos? 310 00:11:45,830 --> 00:11:47,456 - To bring her temp down. - Wow, state the obvious, 311 00:11:47,498 --> 00:11:49,165 yet still don't answer the question. 312 00:11:49,250 --> 00:11:50,668 The quicker we bring it down, the less of a chance 313 00:11:50,751 --> 00:11:51,961 for permanent damage to the brain, 314 00:11:52,044 --> 00:11:53,462 - liver, or kidneys. - Exactly. 315 00:11:53,546 --> 00:11:55,423 - Was she sweating? - Profusely. 316 00:11:55,464 --> 00:11:56,632 What if she wasn't, Dr. Santos? 317 00:11:56,716 --> 00:11:58,259 What if she was dry as a bone? 318 00:11:58,300 --> 00:11:59,844 Then we'd have to think anticholinergic overdose, 319 00:11:59,927 --> 00:12:01,011 not sympathetic. 320 00:12:04,223 --> 00:12:05,433 Very good. 321 00:12:12,690 --> 00:12:14,734 Hey. 322 00:12:14,817 --> 00:12:17,153 I found you scrubs that should fit. 323 00:12:17,194 --> 00:12:18,487 Oh. [laughs] 324 00:12:18,529 --> 00:12:20,156 Thank you. That's great. 325 00:12:20,239 --> 00:12:23,492 - I appreciate that. - But they come with a catch. 326 00:12:23,576 --> 00:12:25,578 Mr. Krakozhia is asking to see you. 327 00:12:25,661 --> 00:12:27,621 The guy who peed on me? 328 00:12:27,663 --> 00:12:29,665 - Why me? - I didn't ask. 329 00:12:29,707 --> 00:12:31,917 But maybe you should wait to put these scrubs on 330 00:12:32,001 --> 00:12:33,794 until after you've... 331 00:12:33,836 --> 00:12:34,920 That's a good idea. 332 00:12:35,004 --> 00:12:36,338 Oh, God. 333 00:12:36,422 --> 00:12:38,340 [rat squeaking] 334 00:12:38,424 --> 00:12:40,301 Oh, man. We got a load of the... 335 00:12:40,342 --> 00:12:42,344 Oh, my God. 336 00:12:42,386 --> 00:12:43,512 Whoa! Hey! 337 00:12:43,554 --> 00:12:46,432 [rat squeaking] 338 00:12:48,017 --> 00:12:49,685 Yeah, I see you. 339 00:12:50,728 --> 00:12:52,062 [rat squeaking] 340 00:12:52,146 --> 00:12:53,564 Your days are numbered, buddy. 341 00:12:53,647 --> 00:12:55,024 Trauma to ER Two. ETA now. 342 00:12:55,107 --> 00:12:56,567 That's another four of Ativan. 343 00:12:56,650 --> 00:12:58,194 Rectal temp's down to 105. 344 00:12:58,235 --> 00:12:59,361 OK, moving in the right direction. 345 00:12:59,403 --> 00:13:00,696 We might get lucky here. 346 00:13:00,738 --> 00:13:02,364 Double trauma at the back door. 347 00:13:02,406 --> 00:13:04,366 Auto versus pedestrian before hitting a telephone pole. 348 00:13:04,408 --> 00:13:06,368 - You got this? - Yep. 349 00:13:06,452 --> 00:13:08,454 Dr. Robby, I finished with Dr. Ozeki, 350 00:13:08,537 --> 00:13:09,538 the therapist upstairs. 351 00:13:09,580 --> 00:13:11,165 Yes, yes, yes. How did that go? 352 00:13:11,207 --> 00:13:13,000 - Well. - Excellent. 353 00:13:16,045 --> 00:13:17,379 Have you heard from David? 354 00:13:17,421 --> 00:13:18,714 No. 355 00:13:18,756 --> 00:13:20,216 Has David seen the therapist? 356 00:13:26,222 --> 00:13:27,973 Do you think that he's still gonna pick you up today? 357 00:13:28,057 --> 00:13:29,558 - I think so. - OK, well... 358 00:13:29,642 --> 00:13:31,644 - Robby, here they come. - OK. 359 00:13:31,727 --> 00:13:33,687 Well, you're medically cleared, so why don't you stay here 360 00:13:33,729 --> 00:13:36,190 for a little while longer in the hopes that he does? 361 00:13:36,232 --> 00:13:37,733 I still would like him to talk to somebody. 362 00:13:37,775 --> 00:13:39,568 Perlah, this is Theresa. She's a friend of mine, 363 00:13:39,610 --> 00:13:41,570 so I expect concierge service, yes? 364 00:13:41,612 --> 00:13:42,780 - VIP treatment. - Thank you. 365 00:13:42,863 --> 00:13:44,240 You're in good hands. 366 00:13:44,323 --> 00:13:46,367 Just let me know if David shows up or if he calls. 367 00:13:46,408 --> 00:13:48,536 Good boy. Good boy. 368 00:13:48,577 --> 00:13:50,120 Walter Pernell, 52, 369 00:13:50,204 --> 00:13:51,622 walking his dog in the crosswalk, 370 00:13:51,705 --> 00:13:53,749 got struck by a Chevy Impala at low velocity. 371 00:13:53,833 --> 00:13:57,086 Ambulatory on scene, no KO, no neck, chest, or belly pain. 372 00:13:57,169 --> 00:13:59,630 - Good vitals. - Whoa. Major road rash. 373 00:13:59,713 --> 00:14:02,299 Yeah, the car didn't hit me so much as throw me. 374 00:14:02,383 --> 00:14:04,426 But I slid for a good 10 feet. 375 00:14:04,468 --> 00:14:05,636 Of course, this is the first day 376 00:14:05,719 --> 00:14:07,263 I've worn shorts all effin' year. 377 00:14:07,304 --> 00:14:09,139 No deformity at the knee or ankle. 378 00:14:09,223 --> 00:14:10,599 Distal pulse is intact. 379 00:14:10,641 --> 00:14:11,934 Four of morphine so far. 380 00:14:11,976 --> 00:14:13,352 Yeah, feel free to be more generous. 381 00:14:13,435 --> 00:14:14,770 Don't worry. We will patch you up. 382 00:14:14,812 --> 00:14:16,230 We will get you right. Who's your friend? 383 00:14:16,272 --> 00:14:17,565 Oh, this is Crosby, 384 00:14:17,606 --> 00:14:19,441 who thankfully barked and warned me 385 00:14:19,525 --> 00:14:21,402 so I had half a second to try to move out of the way. 386 00:14:21,443 --> 00:14:22,945 Crosby, you're a hero. 387 00:14:22,987 --> 00:14:24,613 Donahue, you think you could find a Milk-Bone 388 00:14:24,697 --> 00:14:26,532 for our little lifesaver here in the doctor's lounge? 389 00:14:26,615 --> 00:14:28,242 Absolutely. I'll take good care of him. 390 00:14:28,284 --> 00:14:29,952 Can't he stay with me? He's a very good boy. 391 00:14:29,994 --> 00:14:31,412 No doubt. Let's get you settled first. 392 00:14:31,453 --> 00:14:32,788 - You're going to South 20. - Got it. 393 00:14:32,872 --> 00:14:34,290 Is that the driver? 394 00:14:34,331 --> 00:14:35,790 28-year-old lady, had her seat belt on. 395 00:14:35,875 --> 00:14:37,084 Clipped the guy with the dog and went 396 00:14:37,126 --> 00:14:38,586 straight into a telephone pole. 397 00:14:38,627 --> 00:14:39,879 Blood's from a scalp lac. 398 00:14:39,962 --> 00:14:41,088 Also complained of chest pain. 399 00:14:41,130 --> 00:14:42,298 Sleepy but arousable. 400 00:14:42,381 --> 00:14:44,008 - What's your name? - Paula. 401 00:14:44,091 --> 00:14:46,677 Heart rate's a bit tachy. 112. BP's fine. 402 00:14:46,760 --> 00:14:48,345 Paula, are you in any pain right now? 403 00:14:48,429 --> 00:14:50,264 [sluggishly] Yeah, I got hurt. 404 00:14:50,306 --> 00:14:52,641 Witnesses say she was driving erratically before the crash. 405 00:14:52,725 --> 00:14:55,644 No ETOH on her breath. Maybe drugs? 406 00:14:55,686 --> 00:14:58,314 - Core temp's 104.2. - Heart rate 116. 407 00:14:58,397 --> 00:15:00,316 BP 180 over 110. 408 00:15:00,357 --> 00:15:01,692 Better, but still too high. 409 00:15:01,775 --> 00:15:02,985 Another four of Ativan. 410 00:15:03,027 --> 00:15:04,028 That'll make 20. 411 00:15:04,111 --> 00:15:05,362 Good counting. 412 00:15:05,446 --> 00:15:06,822 Pedestrian in South 20 needs a doctor. 413 00:15:06,864 --> 00:15:08,949 - You got this? - Yep. Keep chilling. 414 00:15:08,991 --> 00:15:10,993 - All hands on deck. You ready? - all: Ready. 415 00:15:11,035 --> 00:15:13,287 OK, here we go. One, two, three. 416 00:15:13,329 --> 00:15:16,081 [groans] 417 00:15:16,165 --> 00:15:17,666 [speaking Spanish] 418 00:15:17,750 --> 00:15:19,585 I heard motor vehicle collision with chest pain 419 00:15:19,668 --> 00:15:20,669 and altered mental status. 420 00:15:20,753 --> 00:15:22,004 - Qué más? - Meet Paula. 421 00:15:22,087 --> 00:15:24,340 Restrained driver versus telephone pole. 422 00:15:24,423 --> 00:15:26,800 Altered before the crash. Good BP, but tachy. 423 00:15:26,842 --> 00:15:28,761 Second line and run a liter of LR wide open. 424 00:15:28,844 --> 00:15:31,513 Still tachy at 115. BP's 180 over 72. 425 00:15:31,597 --> 00:15:32,806 Airway's patent. 426 00:15:32,848 --> 00:15:34,099 Good breath sounds bilaterally. 427 00:15:34,183 --> 00:15:35,768 Pupils are equal and reactive. 428 00:15:35,851 --> 00:15:37,519 Paula, do you know what today's date is? 429 00:15:37,603 --> 00:15:39,438 It's, uh... 430 00:15:39,521 --> 00:15:40,814 Sats 94%. 431 00:15:40,856 --> 00:15:42,107 How about the city we're in? 432 00:15:42,191 --> 00:15:43,317 Pittsburgh? 433 00:15:43,359 --> 00:15:44,860 Bruising on the chest. 434 00:15:44,902 --> 00:15:47,071 - [shouts] - Possible sternal fracture. 435 00:15:47,154 --> 00:15:48,822 - Pericardium's clear. - Good. Good. 436 00:15:48,864 --> 00:15:50,574 No marked tenderness. 437 00:15:50,658 --> 00:15:52,868 Nothing in Morrison's pouch. 438 00:15:52,910 --> 00:15:54,370 She's a little tachypneic. 439 00:15:54,411 --> 00:15:55,746 I don't think she needs intubation. 440 00:15:55,829 --> 00:15:57,247 Might just be concussed. 441 00:15:57,331 --> 00:15:58,874 I worry about her crumping in the scanner. 442 00:15:58,958 --> 00:16:00,876 She's protecting her airway. I see lung sliding. 443 00:16:00,918 --> 00:16:02,503 - No pneumo. - With a head injury? 444 00:16:02,544 --> 00:16:04,088 You guys are supposed to be the airway experts. 445 00:16:04,171 --> 00:16:05,923 Stop fighting. Make a decision. 446 00:16:06,006 --> 00:16:07,549 Call me when she goes to CT. 447 00:16:07,633 --> 00:16:10,219 Paula, can you raise your right arm for me? 448 00:16:10,260 --> 00:16:12,429 Good sign. Follows commands. 449 00:16:12,513 --> 00:16:14,390 You want to intubate with a GCS of 13? 450 00:16:14,473 --> 00:16:15,891 OK. We can hold off and monitor. 451 00:16:15,933 --> 00:16:18,060 - What's your plan? - Pan scan, head to pelvis. 452 00:16:18,102 --> 00:16:19,728 EKG, troponin. 453 00:16:19,812 --> 00:16:21,897 Straight cath urine for UA and tox screen. 454 00:16:21,939 --> 00:16:24,566 - Agreed. [groans] - I'm on it. 455 00:16:24,650 --> 00:16:26,902 - Gotta bend those knees. - I gotta quit showing off. 456 00:16:26,944 --> 00:16:29,571 - Is that what you were doing? - Always. 457 00:16:30,990 --> 00:16:33,158 It's a ten-day course of doxycycline, 458 00:16:33,242 --> 00:16:35,035 one pill twice a day. 459 00:16:35,077 --> 00:16:38,664 I'll make sure she takes it on a full stomach. 460 00:16:38,747 --> 00:16:41,417 I can give you your first dose now, Piper, if you like. 461 00:16:41,458 --> 00:16:42,876 - Get you started. - That'd be great. 462 00:16:42,918 --> 00:16:46,088 Actually, I need Piper to answer that one. 463 00:16:46,130 --> 00:16:47,881 Sure. That'd be great. 464 00:16:47,923 --> 00:16:49,758 OK. 465 00:16:50,759 --> 00:16:51,927 Hello, everyone. 466 00:16:51,969 --> 00:16:53,637 Looks like we're finishing up here. 467 00:16:53,721 --> 00:16:55,139 I come bearing gifts. 468 00:16:55,222 --> 00:16:56,765 Everything you always wanted to know about STIs 469 00:16:56,849 --> 00:16:58,100 but never wanted to read. 470 00:16:58,142 --> 00:17:00,102 No gross pictures, I promise. 471 00:17:00,144 --> 00:17:01,311 I think we're good. 472 00:17:01,395 --> 00:17:03,480 - You sure? - Mm-hmm. 473 00:17:03,564 --> 00:17:05,273 Yeah. I learned my lesson. 474 00:17:05,357 --> 00:17:06,900 It won't happen again. 475 00:17:09,403 --> 00:17:12,948 I guess that's it, then. 476 00:17:13,031 --> 00:17:14,950 Well, if you change your mind, 477 00:17:15,034 --> 00:17:17,578 it comes with a free pen. 478 00:17:17,618 --> 00:17:19,538 Thank you both so much for your help. 479 00:17:19,621 --> 00:17:21,330 - Yeah. - Thanks. 480 00:17:23,959 --> 00:17:25,294 OK. 481 00:17:25,335 --> 00:17:27,046 Good luck to you both. 482 00:17:31,550 --> 00:17:32,676 Fuck. 483 00:17:34,678 --> 00:17:35,721 Fuck. 484 00:17:35,804 --> 00:17:38,140 That sums it up. 485 00:17:38,223 --> 00:17:39,641 She'll be back. 486 00:17:39,725 --> 00:17:41,435 Only she'll have slipped a little further. 487 00:17:41,477 --> 00:17:44,146 Sometimes it takes a few visits. 488 00:17:44,229 --> 00:17:45,564 How can I keep her here? 489 00:17:45,647 --> 00:17:47,107 You got anything? 490 00:17:47,149 --> 00:17:49,693 Maybe Kiara has a social services card to play. 491 00:17:49,777 --> 00:17:51,487 She was by Trauma One last I saw her. 492 00:17:51,528 --> 00:17:53,655 Brilliant. Brilliant. Thank you. 493 00:17:53,739 --> 00:17:56,784 That's why I'm here, to be brilliant 494 00:17:56,825 --> 00:17:58,660 and bring peace. 495 00:17:58,702 --> 00:17:59,828 Heart rate's 84. 496 00:17:59,870 --> 00:18:01,789 BP 126 over 78. 497 00:18:01,830 --> 00:18:03,791 Pulse ox, 99 on room air. 498 00:18:03,832 --> 00:18:05,167 Good news, Mr. Pernell. 499 00:18:05,250 --> 00:18:07,544 Your heart, lungs, and belly all look good. 500 00:18:07,628 --> 00:18:09,838 Yeah, just the leg. 501 00:18:09,880 --> 00:18:11,673 Whoo, this might be a road rash record. 502 00:18:11,715 --> 00:18:13,175 We might have to bust out the tape. 503 00:18:13,217 --> 00:18:14,968 I'm getting a little worried about Crosby. 504 00:18:15,010 --> 00:18:16,011 Who's Crosby? 505 00:18:16,095 --> 00:18:17,179 - His dog. - My dog. 506 00:18:17,262 --> 00:18:18,847 Where is Crosby? 507 00:18:18,889 --> 00:18:21,016 - He's in the break room. - Your break room, I think. 508 00:18:21,058 --> 00:18:22,351 I'm sure he's fine. 509 00:18:22,434 --> 00:18:24,311 We got a lot of dog lovers around here. 510 00:18:24,353 --> 00:18:26,313 I'm the new owner of a nine-week-old Goldendoodle. 511 00:18:26,355 --> 00:18:27,689 Oh, nice. 512 00:18:27,773 --> 00:18:28,857 Crosby's a terrier. 513 00:18:28,941 --> 00:18:31,151 [sighs] Great dogs. 514 00:18:31,193 --> 00:18:33,278 Determined, courageous, love to dig. 515 00:18:33,362 --> 00:18:35,030 Who's he named for, Sidney or David? 516 00:18:35,114 --> 00:18:36,365 David. 517 00:18:36,406 --> 00:18:37,366 Still my Sunday morning soundtrack. 518 00:18:37,449 --> 00:18:39,368 - Ow. Ow. - Oh. Sorry. 519 00:18:39,409 --> 00:18:41,036 Yeah, anyways, great name. 520 00:18:41,120 --> 00:18:42,830 So the knee looks stable. 521 00:18:42,871 --> 00:18:45,374 There's no laxity to suggest a torn ligament. 522 00:18:45,457 --> 00:18:47,626 I think the pain's probably just from the road rash, 523 00:18:47,709 --> 00:18:49,002 but let's get an X-ray just to be sure. 524 00:18:49,044 --> 00:18:50,379 Some more morphine? 525 00:18:50,462 --> 00:18:52,005 You're a wonderful human being. 526 00:18:52,047 --> 00:18:53,549 Let's start with LET, no more than 30 cc's. 527 00:18:53,632 --> 00:18:56,093 We're gonna try a topical anesthetic 528 00:18:56,176 --> 00:18:57,845 to numb the raw skin 529 00:18:57,886 --> 00:18:59,721 before we start picking out all the gravel. 530 00:18:59,763 --> 00:19:02,224 Well, my morning horoscope didn't mention any of this. 531 00:19:02,307 --> 00:19:04,017 Well, hey, look on the bright side. 532 00:19:04,059 --> 00:19:05,561 Now you can tell people that you got hit by a car. 533 00:19:05,644 --> 00:19:07,229 Not a lot of people can live to say that. 534 00:19:07,312 --> 00:19:11,441 Yeah, I hope whoever hit me is rich and well insured. 535 00:19:11,525 --> 00:19:14,570 I'll let him know. OK. Thanks. 536 00:19:14,611 --> 00:19:15,904 Flag on the play. 537 00:19:15,946 --> 00:19:17,781 Positive pregnancy test. 538 00:19:17,865 --> 00:19:19,241 You still want a scan? 539 00:19:19,283 --> 00:19:21,535 Maybe she's bleeding from an ectopic. 540 00:19:21,577 --> 00:19:23,412 No, she delivered a healthy baby here 541 00:19:23,495 --> 00:19:24,746 ten days ago. 542 00:19:24,788 --> 00:19:28,333 Normal vaginal delivery, no complications. 543 00:19:28,417 --> 00:19:30,335 Pregnancy tests stay positive for a few weeks. 544 00:19:30,419 --> 00:19:31,920 - So are we good to go? - Good to go. 545 00:19:31,962 --> 00:19:33,213 We'll let the tech know. 546 00:19:38,594 --> 00:19:40,095 Oh, man. 547 00:19:40,179 --> 00:19:42,264 She was seen here this morning by Dr. McKay. 548 00:19:42,347 --> 00:19:44,683 - For what? - Urinary tract infection. 549 00:19:44,766 --> 00:19:47,769 Discharged with oral antibiotics. 550 00:19:47,811 --> 00:19:49,605 You think it has something to do with the crash? 551 00:19:49,688 --> 00:19:51,023 Yes. No. Maybe. 552 00:19:51,106 --> 00:19:52,774 Ask me again after I've had 553 00:19:52,858 --> 00:19:56,612 the scans, labs, and tox screen. 554 00:19:56,695 --> 00:19:58,614 [sighs] No. 555 00:19:58,655 --> 00:20:00,115 OK. 556 00:20:00,199 --> 00:20:03,285 So I need to talk to you about something. 557 00:20:03,368 --> 00:20:05,120 - About what? - Do me a favor. 558 00:20:05,162 --> 00:20:07,497 Look at me, and don't turn around 559 00:20:07,581 --> 00:20:08,999 - and just watch... - [screams] Oh, hell no! 560 00:20:09,082 --> 00:20:11,877 I told you not to turn around. 561 00:20:15,130 --> 00:20:16,632 I wish there was a way to keep her, 562 00:20:16,715 --> 00:20:18,300 but there just isn't. 563 00:20:18,383 --> 00:20:19,968 Well... well, then fuck it. 564 00:20:20,010 --> 00:20:21,637 We'll just say that we need another urine sample, 565 00:20:21,720 --> 00:20:23,180 that the lab left the last one out too long 566 00:20:23,263 --> 00:20:24,556 and couldn't culture it. 567 00:20:24,640 --> 00:20:26,058 OK. Then what? 568 00:20:26,141 --> 00:20:27,476 I'll give Piper the sample cup 569 00:20:27,559 --> 00:20:29,436 and send her down the hall to the bathroom. 570 00:20:29,478 --> 00:20:31,313 I'll stay with Laura in the room with some bullshit. 571 00:20:31,396 --> 00:20:32,773 You wait for Piper by the bathroom. 572 00:20:32,814 --> 00:20:34,733 To say what exactly? 573 00:20:34,816 --> 00:20:36,485 I don't know. 574 00:20:36,526 --> 00:20:39,321 Just be another voice saying, I see you in danger. 575 00:20:39,404 --> 00:20:41,740 There are limits to what we can legally do, 576 00:20:41,823 --> 00:20:43,659 but I can try to talk to her. 577 00:20:43,742 --> 00:20:45,994 Thank you. 578 00:20:46,036 --> 00:20:48,163 Hi. It's Dr. McKay again. 579 00:20:48,205 --> 00:20:49,331 Can I come in? 580 00:20:51,750 --> 00:20:54,461 - [sighs] - Sorry. 581 00:20:54,503 --> 00:20:56,713 Yeah. 582 00:20:56,797 --> 00:21:00,008 Well, it was a long shot anyway. 583 00:21:00,092 --> 00:21:01,510 Hey. 584 00:21:01,551 --> 00:21:03,720 I think Piper took a pen. 585 00:21:03,804 --> 00:21:05,055 Yeah. 586 00:21:11,478 --> 00:21:12,854 Temp is 103.2. 587 00:21:12,938 --> 00:21:15,732 Nice. Almost there. 588 00:21:15,816 --> 00:21:17,693 My God, there are literally hundreds 589 00:21:17,734 --> 00:21:19,861 of different MDMA pills. 590 00:21:19,903 --> 00:21:22,531 And the milligram dosage range is all over the place. 591 00:21:22,572 --> 00:21:26,618 These names... BMW5, Jurassic Park, Red Superman. 592 00:21:26,702 --> 00:21:27,786 [water splashing] [rapid beeping] 593 00:21:27,869 --> 00:21:29,204 Whoa. Why is she seizing? 594 00:21:29,288 --> 00:21:30,372 Febrile seizure? 595 00:21:30,455 --> 00:21:31,665 No, her temp is down. 596 00:21:31,707 --> 00:21:32,666 Maybe she needs more Ativan. 597 00:21:32,708 --> 00:21:33,709 No, she's had 20 already. 598 00:21:33,792 --> 00:21:34,710 And her vitals are stabilizing. 599 00:21:34,793 --> 00:21:35,877 Another four of Ativan. 600 00:21:35,919 --> 00:21:37,212 And prep a gram of Keppra. 601 00:21:37,296 --> 00:21:40,132 I don't think this is a CNS problem. 602 00:21:40,215 --> 00:21:42,050 She needs saline. 603 00:21:42,134 --> 00:21:43,552 We don't have her labs back yet. 604 00:21:43,593 --> 00:21:45,137 At festivals, you dance for hours. 605 00:21:45,220 --> 00:21:47,347 You sweat, you drink gallons of water, 606 00:21:47,389 --> 00:21:49,182 but nobody thinks to replenish their salts. 607 00:21:49,224 --> 00:21:50,892 It's low sodium. Hyponatremia. 608 00:21:50,976 --> 00:21:52,644 She needs 100 cc's of hot saline. 609 00:21:52,728 --> 00:21:54,479 We don't know her sodium levels. 610 00:21:54,563 --> 00:21:56,690 Drop 100 cc's of 3% and have it ready. 611 00:21:56,732 --> 00:21:57,941 OK? 612 00:21:58,025 --> 00:22:00,277 Do it. And prep a gram of Keppra now. 613 00:22:00,360 --> 00:22:01,403 [rapid beeping] 614 00:22:01,486 --> 00:22:04,406 [tense music] 615 00:22:04,489 --> 00:22:11,538 ♪ ♪ 616 00:22:14,082 --> 00:22:15,417 Start the Keppra, please. 617 00:22:15,500 --> 00:22:16,585 It's not gonna help. 618 00:22:16,668 --> 00:22:18,128 - [phone rings] - Trauma One. 619 00:22:18,211 --> 00:22:20,547 What are you doing? 620 00:22:20,589 --> 00:22:21,965 Got it. Thanks. 621 00:22:22,049 --> 00:22:23,133 It's hyponatremia. 622 00:22:23,216 --> 00:22:24,259 Serum sodium is critical. 623 00:22:24,343 --> 00:22:25,260 Only 112. 624 00:22:25,344 --> 00:22:26,595 Knew it. 625 00:22:26,636 --> 00:22:28,722 OK, I'll push the other 50 cc's. 626 00:22:28,764 --> 00:22:30,766 - What the hell? - She's seizing. 627 00:22:30,849 --> 00:22:32,100 You think? How long? 628 00:22:32,184 --> 00:22:33,435 About three minutes. 629 00:22:33,518 --> 00:22:34,770 Why did you not come get me? 630 00:22:34,853 --> 00:22:36,730 Hello? I was... I was across the hall. 631 00:22:36,772 --> 00:22:38,523 I was 30 feet away. What has she had already? 632 00:22:40,317 --> 00:22:41,777 It's hyponatremia. 633 00:22:41,860 --> 00:22:43,528 We pushed 100 cc's of 3% saline. 634 00:22:43,612 --> 00:22:44,863 That did the trick. 635 00:22:44,946 --> 00:22:47,616 Again, why did you not come get me? 636 00:22:47,699 --> 00:22:49,618 It was my fault. Yeah, I want... 637 00:22:49,659 --> 00:22:52,120 I wanted to keep going with Ativan and Keppra, 638 00:22:52,162 --> 00:22:54,289 but Dr. Mohan had an excellent idea 639 00:22:54,373 --> 00:22:58,293 to treat for hyponatremia even before her labs came back. 640 00:22:58,377 --> 00:23:00,796 Temp's down to 102.4. 641 00:23:00,879 --> 00:23:02,255 Good call, Dr. Mohan. 642 00:23:02,297 --> 00:23:04,132 Another minute, and we'll de-ice her. 643 00:23:04,174 --> 00:23:08,428 I am going to take that minute to try to instill in Dr. Santos 644 00:23:08,470 --> 00:23:11,473 a very clear understanding of what her role is here 645 00:23:11,556 --> 00:23:13,308 and how she is expected to function. 646 00:23:13,350 --> 00:23:15,977 - Dr. Langdon... - Dr. Santos... 647 00:23:16,019 --> 00:23:18,313 and I say doctor in such a fashion 648 00:23:18,355 --> 00:23:20,982 to draw attention to the ridiculous fact 649 00:23:21,066 --> 00:23:24,486 that you have enjoyed that title for, what, 90 days? 650 00:23:24,528 --> 00:23:26,446 So yeah, I'm confused. 651 00:23:26,488 --> 00:23:28,949 Is it... is it hubris or ignorance 652 00:23:28,990 --> 00:23:31,743 that makes you think that you know more than other residents 653 00:23:31,827 --> 00:23:33,995 that have two to three years more experience 654 00:23:34,037 --> 00:23:36,123 and have helped thousands more patients 655 00:23:36,164 --> 00:23:37,749 in the emergency department than you have? 656 00:23:37,833 --> 00:23:40,752 Not to mention the over 500 hours 657 00:23:40,836 --> 00:23:42,087 of advanced training 658 00:23:42,170 --> 00:23:44,256 with lectures and simulation labs 659 00:23:44,339 --> 00:23:45,674 with senior faculty instruction. 660 00:23:45,715 --> 00:23:47,342 It doesn't matter! 661 00:23:47,384 --> 00:23:49,469 Stupid or arrogant, you need to realize 662 00:23:49,511 --> 00:23:52,013 that you are a beginner, which means your job 663 00:23:52,097 --> 00:23:53,682 is to shut up, listen, and learn 664 00:23:53,723 --> 00:23:55,308 because so far today, the only thing you have been 665 00:23:55,350 --> 00:23:57,352 successful at is proving repeatedly 666 00:23:57,436 --> 00:23:58,520 that you know nothing. 667 00:23:58,603 --> 00:23:59,688 Dr. Langdon. 668 00:24:01,690 --> 00:24:04,484 Is the patient stable? 669 00:24:04,526 --> 00:24:05,861 Temp's 102. 670 00:24:05,902 --> 00:24:07,195 Just about to take her out of the ice. 671 00:24:07,279 --> 00:24:09,823 Proceed. Dr. Langdon, a word, please. 672 00:24:15,287 --> 00:24:16,538 [indistinct chatter] 673 00:24:16,580 --> 00:24:18,039 Look, I know that sounded rough, 674 00:24:18,123 --> 00:24:19,374 - but you only caught the tail. - Stop talking. 675 00:24:19,458 --> 00:24:21,001 I can give you a list a mile... 676 00:24:21,042 --> 00:24:22,544 - Stop talking. - She was giving unsupervised... 677 00:24:22,627 --> 00:24:23,920 Knock it off. Shut the fuck up! 678 00:24:24,004 --> 00:24:25,672 [chatter stops] 679 00:24:25,714 --> 00:24:28,383 Where does it say that shaming, belittling, and insulting 680 00:24:28,467 --> 00:24:29,593 are effective teaching tools? 681 00:24:29,676 --> 00:24:31,219 Let me just tell you, 682 00:24:31,261 --> 00:24:32,888 harassment has zero educational value. 683 00:24:32,971 --> 00:24:35,223 You're feeling upset? She's getting under your skin? 684 00:24:35,307 --> 00:24:36,725 Check yourself. Take a break. 685 00:24:36,808 --> 00:24:38,393 I've been watching you ride her. 686 00:24:38,435 --> 00:24:41,146 This kind of behavior will not be tolerated. 687 00:24:41,229 --> 00:24:43,064 I don't want to see it. 688 00:24:43,106 --> 00:24:44,983 I'm sorry. It won't happen again. 689 00:24:45,066 --> 00:24:47,194 Where's your other one? Where's Mel? 690 00:24:47,235 --> 00:24:48,570 - She's taking a breather. - Yeah. 691 00:24:48,612 --> 00:24:50,238 Well, maybe go find her, and see if you can 692 00:24:50,322 --> 00:24:53,909 get her back in the game. You are senior leadership here. 693 00:24:53,950 --> 00:24:55,952 Step up and act like it. 694 00:25:06,963 --> 00:25:09,424 Wow. You came prepared. 695 00:25:09,466 --> 00:25:12,552 Better safe than sorry. [chuckles] 696 00:25:12,594 --> 00:25:14,095 Sorry I took off like that. 697 00:25:14,179 --> 00:25:15,472 I have a thing about rats. 698 00:25:15,555 --> 00:25:17,766 And cows totally freak me out. 699 00:25:17,849 --> 00:25:19,434 Really? [laughs] 700 00:25:19,476 --> 00:25:21,770 Oh, there's plenty of both where I come from. 701 00:25:21,853 --> 00:25:23,980 They're... you know, they're pretty harmless. 702 00:25:24,064 --> 00:25:25,899 Let's hope Mr. Krakozhia is now too. 703 00:25:25,941 --> 00:25:27,901 Yeah, no kidding. 704 00:25:27,943 --> 00:25:29,444 OK. 705 00:25:32,030 --> 00:25:34,074 [sniffs] 706 00:25:37,369 --> 00:25:38,537 Is this the guy? 707 00:25:38,620 --> 00:25:40,455 Yes. 708 00:25:40,497 --> 00:25:41,581 Hey, man. 709 00:25:41,623 --> 00:25:43,124 It's Dennis Whitaker. 710 00:25:43,208 --> 00:25:45,794 I just wanted to say sorry for earlier. 711 00:25:45,835 --> 00:25:48,421 Heard I got you pretty good. 712 00:25:48,463 --> 00:25:50,131 Yeah. 713 00:25:50,173 --> 00:25:53,426 I kind of go out of my head when I'm off my meds. 714 00:25:53,468 --> 00:25:56,137 Then I guess I piss on people. 715 00:25:56,221 --> 00:25:58,807 I'm pretty sure the meth doesn't help. 716 00:25:58,848 --> 00:26:00,976 I'm not using anymore. 717 00:26:01,059 --> 00:26:03,395 I take antipsychotics for the schizophrenia 718 00:26:03,478 --> 00:26:05,272 I got from doing meth. 719 00:26:05,313 --> 00:26:08,483 But I've been clean a year. 720 00:26:09,776 --> 00:26:11,486 Why aren't you taking your meds? 721 00:26:11,528 --> 00:26:13,113 Why don't I take my meds? 722 00:26:13,154 --> 00:26:15,699 Well, Doc, I'm kind of in between houses right now 723 00:26:15,782 --> 00:26:19,286 living in an encampment on Liberty Avenue. 724 00:26:19,327 --> 00:26:20,453 Meds cost money. 725 00:26:20,495 --> 00:26:22,831 I don't have insurance. 726 00:26:22,872 --> 00:26:24,332 - Should I go on? - No. No. 727 00:26:24,374 --> 00:26:26,626 That's fine. 728 00:26:26,668 --> 00:26:27,961 I'm sorry. 729 00:26:31,840 --> 00:26:34,926 Life isn't always easy. 730 00:26:37,178 --> 00:26:39,014 Have you talked to a social worker yet? 731 00:26:39,055 --> 00:26:40,515 - No. - OK. 732 00:26:40,599 --> 00:26:42,517 Do you think you could go grab... 733 00:26:42,559 --> 00:26:43,810 - Kiara? - Kiara in here? 734 00:26:43,852 --> 00:26:45,103 Yeah. 735 00:26:47,564 --> 00:26:49,149 I really am sorry. 736 00:26:49,190 --> 00:26:50,692 It's OK, honestly. 737 00:26:50,775 --> 00:26:53,486 Really, it's OK. 738 00:26:53,528 --> 00:26:55,655 I appreciate the apology. 739 00:26:56,948 --> 00:26:58,617 [door clicks] 740 00:27:02,704 --> 00:27:04,372 This must be Crosby. 741 00:27:04,414 --> 00:27:05,790 [dog whines] 742 00:27:05,874 --> 00:27:08,710 I've heard a lot about you, buddy. 743 00:27:08,752 --> 00:27:10,920 How's my least problematic trainee? 744 00:27:11,004 --> 00:27:13,673 Well, technically, you're all pretty green, 745 00:27:13,715 --> 00:27:15,216 but you're growing on me. 746 00:27:15,258 --> 00:27:16,926 Thank you. 747 00:27:17,010 --> 00:27:19,137 So how you doing? 748 00:27:20,430 --> 00:27:22,432 Um, good. 749 00:27:22,515 --> 00:27:23,767 Better. 750 00:27:23,850 --> 00:27:25,560 Yeah? 751 00:27:25,602 --> 00:27:28,438 It's... I mean, it's just... 752 00:27:28,521 --> 00:27:32,359 it's the... the little girl and the sister's 753 00:27:32,400 --> 00:27:33,902 too close to home. 754 00:27:33,943 --> 00:27:36,196 The things we do are hard. 755 00:27:36,237 --> 00:27:37,906 Yeah. 756 00:27:37,947 --> 00:27:43,662 You're sitting here feeling like... 757 00:27:43,745 --> 00:27:46,414 like maybe you're not up to it? 758 00:27:46,498 --> 00:27:48,541 Yeah. 759 00:27:48,583 --> 00:27:50,502 Been there. 760 00:27:50,585 --> 00:27:53,380 We all been there. 761 00:27:53,421 --> 00:27:57,050 Mel, you're a sensitive person. 762 00:27:57,092 --> 00:28:02,514 This... this is a tough place for sensitive people. 763 00:28:02,597 --> 00:28:05,350 But we need them badly. 764 00:28:07,769 --> 00:28:12,774 Now, if you're ready, I need you. 765 00:28:12,857 --> 00:28:14,234 It's a perfect job. 766 00:28:14,275 --> 00:28:16,277 It's practically a zen exercise. 767 00:28:16,319 --> 00:28:19,406 I've got 1,000 pieces of gravel 768 00:28:19,447 --> 00:28:23,118 that need to be plucked out of a 2-foot-long road rash. 769 00:28:23,201 --> 00:28:25,286 - 1,000? - Yeah. 770 00:28:25,370 --> 00:28:27,622 Give or take 100. 771 00:28:27,706 --> 00:28:29,290 South 20. 772 00:28:29,374 --> 00:28:31,793 Make sure you close the door behind you. 773 00:28:31,876 --> 00:28:33,962 - Don't want Crosby getting out. - Yeah. 774 00:28:34,045 --> 00:28:37,465 Thank you. No problem. I'll be right there. 775 00:28:37,507 --> 00:28:38,758 [sighs] 776 00:28:38,800 --> 00:28:40,802 That's a lot of gravel. [chuckles] 777 00:28:40,885 --> 00:28:42,804 It looks clean to me. You feel that, Earl? 778 00:28:42,846 --> 00:28:43,888 Feel what? 779 00:28:43,972 --> 00:28:45,306 - That's a no. - [laughs] 780 00:28:45,390 --> 00:28:46,891 All right. Now just apply the Dermabond. 781 00:28:46,975 --> 00:28:49,811 Cool. 782 00:28:49,894 --> 00:28:52,147 Can I ask you something? 783 00:28:52,188 --> 00:28:53,815 That's why I'm here. 784 00:28:53,857 --> 00:28:55,150 Yeah, I was just wondering 785 00:28:55,233 --> 00:28:58,111 what the nurses do after their shifts. 786 00:28:58,153 --> 00:28:59,988 In terms of what? 787 00:29:00,029 --> 00:29:02,407 You know, do they ever, like, go out together, 788 00:29:02,490 --> 00:29:05,577 like, hang out to decompress after a shift or anything? 789 00:29:05,660 --> 00:29:07,120 Yeah, sometimes. 790 00:29:07,162 --> 00:29:08,288 I mean, most of us are just happy 791 00:29:08,329 --> 00:29:09,789 to get the hell out of here. 792 00:29:09,831 --> 00:29:14,836 Personally, I'm all about a long, long, hot shower, 793 00:29:14,919 --> 00:29:16,504 comfy sweats, 794 00:29:16,588 --> 00:29:18,214 eating some takeout in front of the TV, 795 00:29:18,298 --> 00:29:21,885 ideally watching something that makes me laugh, so... 796 00:29:21,968 --> 00:29:23,970 Yeah, I can see that. 797 00:29:24,012 --> 00:29:25,513 I'm not imagining it in my mind, of course. 798 00:29:25,597 --> 00:29:29,309 I just mean that I can... I can see the appeal. 799 00:29:29,350 --> 00:29:31,019 I was just asking because... 800 00:29:31,060 --> 00:29:32,562 you know, since we work together, 801 00:29:32,645 --> 00:29:36,691 maybe we could grab a coffee together sometime. 802 00:29:36,775 --> 00:29:39,694 And you could, like, help me get the lay of the land, 803 00:29:39,736 --> 00:29:41,529 so to speak? 804 00:29:41,571 --> 00:29:43,573 You asking him out? 805 00:29:43,656 --> 00:29:45,366 No. What? No. No. 806 00:29:45,408 --> 00:29:48,119 It's just... I'm... I'm new here, so I just thought... 807 00:29:48,203 --> 00:29:50,622 I... I don't date people in the workplace. 808 00:29:50,705 --> 00:29:54,626 It's nothing personal. Just it's never a good idea. 809 00:29:54,709 --> 00:29:56,795 No. No, of course not. No. No. 810 00:29:56,878 --> 00:29:59,172 I just... no, it's not a good... no, of course. 811 00:29:59,214 --> 00:30:00,965 I just thought that since you know 812 00:30:01,049 --> 00:30:02,717 how everything operates here and you, like, have everything 813 00:30:02,801 --> 00:30:04,552 so dialed in, that you would be, like, a valuable resource. 814 00:30:04,636 --> 00:30:06,888 But no. No. 815 00:30:06,930 --> 00:30:09,891 I should probably just figure it out on my own. 816 00:30:09,974 --> 00:30:11,810 Mm-hmm. 817 00:30:11,893 --> 00:30:14,729 No shortcuts here. 818 00:30:14,771 --> 00:30:16,731 How are they treating you, Earl? 819 00:30:16,815 --> 00:30:18,233 Huh? 820 00:30:18,274 --> 00:30:19,901 I see you wrangled yourself another sandwich. 821 00:30:19,943 --> 00:30:21,945 I feel like I'm watching a rom-com. 822 00:30:22,028 --> 00:30:23,571 [chuckles] 823 00:30:23,613 --> 00:30:24,906 Just came by to see if I could take Dr. Javadi 824 00:30:24,948 --> 00:30:26,199 on a reconnaissance through chairs. 825 00:30:26,241 --> 00:30:27,534 Yes. 826 00:30:27,575 --> 00:30:28,785 I mean, sorry, if you think that's... 827 00:30:28,868 --> 00:30:30,286 Of course. Of course. 828 00:30:30,370 --> 00:30:31,913 I can finish up my man here. 829 00:30:31,996 --> 00:30:33,081 Great. 830 00:30:40,672 --> 00:30:41,923 Are you OK? 831 00:30:42,006 --> 00:30:44,092 I feel ridiculous. 832 00:30:44,175 --> 00:30:47,762 I've spoken, like, two complete sentences 833 00:30:47,804 --> 00:30:49,055 in the last half hour. 834 00:30:49,097 --> 00:30:50,515 And both of them have made me sound 835 00:30:50,598 --> 00:30:53,685 even more imbecilic than the incomplete ones. 836 00:30:53,768 --> 00:30:56,229 And you attribute that to... 837 00:30:56,271 --> 00:30:58,356 It's like, my parents once took me skiing 838 00:30:58,439 --> 00:31:00,108 for Christmas in Utah, and from the moment 839 00:31:00,191 --> 00:31:03,111 I got off the plane, I could not catch my breath. 840 00:31:03,152 --> 00:31:05,613 No matter how hard I tried, the altitude made me feel, 841 00:31:05,655 --> 00:31:08,032 like, awkward and uncoordinated. 842 00:31:08,116 --> 00:31:09,784 I couldn't concentrate. I couldn't get my bearings. 843 00:31:09,826 --> 00:31:12,078 - Mm-hmm. - And I'm a very good skier, 844 00:31:12,120 --> 00:31:13,288 but I spent the whole vacation just, like, 845 00:31:13,371 --> 00:31:18,042 on my butt, dizzy and panting. 846 00:31:18,126 --> 00:31:20,169 Mateo is like a human Utah. 847 00:31:20,253 --> 00:31:21,671 [laughs] 848 00:31:21,754 --> 00:31:23,464 Oh, honey. 849 00:31:23,548 --> 00:31:25,341 I've worked with a few Utahs. 850 00:31:25,425 --> 00:31:28,303 I wish you many, many Utahs in your life. 851 00:31:30,263 --> 00:31:31,639 Jesse, where are you going? 852 00:31:31,723 --> 00:31:33,141 - Trauma Two. - Stop. Stop. Stop. 853 00:31:33,224 --> 00:31:35,018 Stop. Not back in there. 854 00:31:35,101 --> 00:31:37,186 I'm not even gonna tell you why. 855 00:31:37,270 --> 00:31:38,438 How's she doing? 856 00:31:38,479 --> 00:31:39,647 Still with some pleuritic pain. 857 00:31:39,731 --> 00:31:41,983 Oh. Hey, Paula. I'm Dr. Collins. 858 00:31:42,066 --> 00:31:44,485 Your CT shows that you have a broken sternum. 859 00:31:44,527 --> 00:31:46,362 That's your breastbone right here. 860 00:31:46,446 --> 00:31:48,656 Probably from the shoulder belt when you crashed your car. 861 00:31:48,740 --> 00:31:49,949 I crashed my car? 862 00:31:49,991 --> 00:31:51,492 Mm-hmm, and hit your head. 863 00:31:51,576 --> 00:31:53,661 With a concussion, sometimes you don't remember. 864 00:31:53,703 --> 00:31:56,915 But your head CT doesn't show anything serious. 865 00:31:56,998 --> 00:32:00,501 So I saw in your chart you're a new mom. 866 00:32:00,585 --> 00:32:02,503 How's your baby doing? 867 00:32:02,545 --> 00:32:05,256 He's good. He's with my mom. 868 00:32:05,340 --> 00:32:07,675 South 15's open. Oh. Hey, Dr. McKay? 869 00:32:07,717 --> 00:32:08,927 Just get the bed out of 15. 870 00:32:09,010 --> 00:32:10,261 A patient you saw this morning 871 00:32:10,345 --> 00:32:11,930 came back as an MVC. 872 00:32:12,013 --> 00:32:13,848 Sternal fracture. Slightly concussed. 873 00:32:13,932 --> 00:32:15,516 Oh, no. Paula, do you remember me? 874 00:32:15,600 --> 00:32:16,809 You look familiar. 875 00:32:16,851 --> 00:32:18,186 I was your doctor this morning 876 00:32:18,269 --> 00:32:19,646 - for your bladder infection. - Oh, yeah. 877 00:32:19,687 --> 00:32:21,689 Sorry. I'm a little out of it. 878 00:32:21,731 --> 00:32:23,191 Still tachycardic, 115. 879 00:32:23,274 --> 00:32:25,485 BP's 124 over 78. 880 00:32:25,526 --> 00:32:27,236 There's no bleeding anywhere on the CT. 881 00:32:27,320 --> 00:32:29,864 Chest and abdomen clear apart from the sternal fracture. 882 00:32:29,948 --> 00:32:32,075 Well, probably still tachy from the fracture pain. 883 00:32:32,158 --> 00:32:33,534 It hurts when I breathe. 884 00:32:33,576 --> 00:32:35,078 Let's try four of morphine. 885 00:32:35,161 --> 00:32:37,246 Paula, we're gonna give you some pain meds. 886 00:32:37,330 --> 00:32:39,832 Let me know if it helps, OK? 887 00:32:39,874 --> 00:32:41,709 Mr. Pernell, you are in luck. 888 00:32:41,793 --> 00:32:44,087 If I had to have gravel meticulously picked out 889 00:32:44,170 --> 00:32:46,547 of my leg, this is the person I'd call, 890 00:32:46,589 --> 00:32:48,341 Dr. Mel King, detail specialist. 891 00:32:48,383 --> 00:32:49,384 - Hello. - Hi. 892 00:32:49,425 --> 00:32:50,760 - I love your dog. - Crosby? 893 00:32:50,843 --> 00:32:52,512 - How is he? - Oh, he's great. 894 00:32:52,553 --> 00:32:54,347 Here. Something to help see up close. 895 00:32:54,389 --> 00:32:56,724 Hey, I don't want to be one of those people 896 00:32:56,808 --> 00:32:59,352 who say they need an emotional support animal, 897 00:32:59,394 --> 00:33:01,396 but is it possible he could be with me? 898 00:33:01,479 --> 00:33:03,147 We could tie his leash to the bed. 899 00:33:03,231 --> 00:33:04,732 He wouldn't be in any trouble. I swear. 900 00:33:04,774 --> 00:33:06,901 - What do you think? - I'm happy to go get him. 901 00:33:06,943 --> 00:33:08,569 - Any pain here? - No. 902 00:33:08,611 --> 00:33:09,821 OK. 903 00:33:09,904 --> 00:33:11,990 You go get the dog. You get to work. 904 00:33:12,073 --> 00:33:14,075 I'm gonna get some more gauze from triage. 905 00:33:14,158 --> 00:33:15,910 And just in case, if anybody asks, 906 00:33:15,994 --> 00:33:18,246 just say you need him for anxiety. 907 00:33:18,287 --> 00:33:19,414 OK. 908 00:33:19,455 --> 00:33:20,999 Thanks. 909 00:33:21,082 --> 00:33:23,251 I know you hear me. 910 00:33:23,334 --> 00:33:27,088 You can pretend you don't, but I know you do. 911 00:33:27,171 --> 00:33:28,589 This glass might be bulletproof, 912 00:33:28,673 --> 00:33:29,882 but it ain't soundproof. 913 00:33:29,924 --> 00:33:31,050 Huh? 914 00:33:31,092 --> 00:33:32,218 Hello? 915 00:33:32,260 --> 00:33:33,761 Can you hear me now? Huh? 916 00:33:33,845 --> 00:33:35,888 - Hello! - Whoa. Whoa. Whoa, sir. 917 00:33:35,930 --> 00:33:37,306 Sir, what is the issue? 918 00:33:37,390 --> 00:33:38,391 Oh, same issue. 919 00:33:38,433 --> 00:33:39,976 I've been here all day, 920 00:33:40,059 --> 00:33:41,936 and you people have done nothing to fucking help me. 921 00:33:41,978 --> 00:33:43,604 We're still waiting on your second troponin. 922 00:33:43,646 --> 00:33:45,773 We can't clear you medically until it comes back. 923 00:33:45,815 --> 00:33:47,567 For instance, if it comes back elevated, 924 00:33:47,608 --> 00:33:49,610 that could indicate a silent heart attack. 925 00:33:49,652 --> 00:33:50,987 And you'd need to be admitted for monitoring 926 00:33:51,070 --> 00:33:52,405 in a cardiology consult. 927 00:33:52,447 --> 00:33:54,115 That's all I'm asking for. 928 00:33:54,157 --> 00:33:56,784 I'm afraid I've had a silent heart attack. 929 00:33:56,868 --> 00:33:59,120 I just want someone who knows something about hearts 930 00:33:59,162 --> 00:34:00,455 to tell me what's happening to me. 931 00:34:00,496 --> 00:34:02,457 You know, unlike most of these losers, 932 00:34:02,498 --> 00:34:04,625 I have insurance, good insurance. 933 00:34:04,667 --> 00:34:06,627 And I pay my taxes, which pays for them 934 00:34:06,711 --> 00:34:07,962 to not have any insurance. 935 00:34:08,045 --> 00:34:09,547 Sir, you've got about five seconds 936 00:34:09,630 --> 00:34:11,299 to change your whole attitude before security 937 00:34:11,340 --> 00:34:12,884 and the police get involved. 938 00:34:12,967 --> 00:34:14,552 Fuck it. 939 00:34:14,635 --> 00:34:16,971 I'm leaving. 940 00:34:17,054 --> 00:34:18,097 Hey. 941 00:34:18,139 --> 00:34:19,431 Hey! 942 00:34:19,474 --> 00:34:20,975 You are absolutely free to go. 943 00:34:21,016 --> 00:34:23,478 But if you do, you will be leaving AMA, 944 00:34:23,518 --> 00:34:25,063 against medical advice. 945 00:34:25,146 --> 00:34:27,648 This form states that I have advised you to stay 946 00:34:27,732 --> 00:34:30,777 and complete your evaluation, but you are choosing to leave, 947 00:34:30,818 --> 00:34:33,487 understanding and accepting all risks of heart attack, 948 00:34:33,529 --> 00:34:35,239 stroke, disability, and death. 949 00:34:40,578 --> 00:34:41,788 Sounds like a CYA form 950 00:34:41,829 --> 00:34:43,331 in case I drop dead on the curb. 951 00:34:43,414 --> 00:34:46,333 That's exactly what it is. 952 00:34:46,417 --> 00:34:49,378 I just want to be treated fairly. 953 00:34:49,462 --> 00:34:51,880 I assure you that is our intention. 954 00:34:51,964 --> 00:34:53,716 We are not back here playing Go Fish. 955 00:34:53,800 --> 00:34:56,135 We're doing our best to help some very sick people. 956 00:34:56,177 --> 00:34:57,845 You will be seen, OK? 957 00:35:03,851 --> 00:35:06,646 Robby's gonna love that patient satisfaction score. 958 00:35:06,687 --> 00:35:08,481 Crazy people. 959 00:35:11,943 --> 00:35:14,320 - [rapid beeping] - What's going on? 960 00:35:14,362 --> 00:35:15,863 Car crash victim Paula just went south. 961 00:35:15,905 --> 00:35:18,116 BP's crashing. 84 over 62. 962 00:35:18,199 --> 00:35:19,117 Much less responsive. 963 00:35:19,200 --> 00:35:20,451 Liter of LR wide open. 964 00:35:20,535 --> 00:35:21,786 Putting her in a 100% non-rebreather. 965 00:35:21,869 --> 00:35:23,162 Paula, open your eyes. 966 00:35:23,204 --> 00:35:24,497 Paula. 967 00:35:24,539 --> 00:35:25,790 Was it the morphine? 968 00:35:25,873 --> 00:35:26,833 She only got a small dose. 969 00:35:26,874 --> 00:35:28,709 Pulse ox is down to 89. 970 00:35:28,793 --> 00:35:29,877 Set up for intubation. 971 00:35:29,961 --> 00:35:33,339 And, McKay, get Robby in here. 972 00:35:33,381 --> 00:35:34,590 I'll call ICU and get her bumped 973 00:35:34,674 --> 00:35:36,551 ahead of Joyce, our sickler. 974 00:35:36,634 --> 00:35:38,094 She should get the next bed. 975 00:35:38,177 --> 00:35:39,846 Between the hyperthermia and the seizure, 976 00:35:39,887 --> 00:35:41,389 she's gonna be out of it for a while. 977 00:35:41,472 --> 00:35:43,558 A similar thing happened to a friend of mine. 978 00:35:43,641 --> 00:35:45,726 Is that what made you think of hyponatremia? 979 00:35:45,768 --> 00:35:47,728 Look, I know you value evidence-based medicine. 980 00:35:47,812 --> 00:35:51,107 But sometimes experience counts for something. 981 00:35:54,360 --> 00:35:57,613 - May I ask why you did that? - What? 982 00:35:57,697 --> 00:35:59,824 Took the blame for a delay in care 983 00:35:59,907 --> 00:36:01,993 which didn't belong to you 984 00:36:02,076 --> 00:36:04,745 and gave me credit for a save that did belong to you? 985 00:36:04,829 --> 00:36:08,249 You know, I've been on Langdon's shit list all day. 986 00:36:08,291 --> 00:36:10,084 It seemed like he was gonna be more upset about us 987 00:36:10,126 --> 00:36:12,712 not calling him in than glad that we stopped the seizure, 988 00:36:12,753 --> 00:36:16,215 so no reason for him to be pissed at both of us. 989 00:36:16,257 --> 00:36:18,593 Why have you been on his shit list? 990 00:36:18,634 --> 00:36:20,845 Well, I think he made it very clear 991 00:36:20,928 --> 00:36:23,890 that he thinks I don't have what it takes to make it here. 992 00:36:23,931 --> 00:36:26,392 Whether you do or do not, it was completely inappropriate 993 00:36:26,434 --> 00:36:28,102 for him to speak to you that way. 994 00:36:28,186 --> 00:36:29,937 Eh, I've heard worse. 995 00:36:29,979 --> 00:36:32,190 Well, for what it's worth, he's wrong. 996 00:36:33,482 --> 00:36:35,193 You're very good at this. 997 00:36:36,611 --> 00:36:38,613 Thank you. 998 00:36:38,654 --> 00:36:41,490 That's actually worth a lot. 999 00:36:41,574 --> 00:36:43,284 I thought the CTs were normal. 1000 00:36:43,326 --> 00:36:44,619 They were. Systolic's down to 70. 1001 00:36:44,702 --> 00:36:45,912 Heart rate's up to 130. 1002 00:36:45,953 --> 00:36:47,121 100 of ketamine, 100 of rock. 1003 00:36:47,163 --> 00:36:48,122 Could she have delayed bleeding? 1004 00:36:48,206 --> 00:36:49,123 It's not the chest. 1005 00:36:49,207 --> 00:36:50,291 Pericardium's still clear. 1006 00:36:50,333 --> 00:36:51,459 No tamponade, good EF. 1007 00:36:51,542 --> 00:36:52,501 Lungs are up. 1008 00:36:52,585 --> 00:36:53,628 She feels warm. 1009 00:36:53,669 --> 00:36:54,754 We'll check a temp. 1010 00:36:54,795 --> 00:36:56,130 Meds are on board. 1011 00:36:56,214 --> 00:36:57,798 Belly's clear. No bleeding here. 1012 00:36:57,840 --> 00:36:59,884 - She's loose. - OK. Go for it. 1013 00:37:03,221 --> 00:37:04,639 I see cords. 1014 00:37:04,680 --> 00:37:05,806 Looks good. 1015 00:37:05,890 --> 00:37:06,974 I'm in. 1016 00:37:07,016 --> 00:37:09,977 - Connect the bag. - Nice. 1017 00:37:10,061 --> 00:37:11,729 Good breath sounds bilaterally. 1018 00:37:11,812 --> 00:37:13,105 Temp is 102.4. 1019 00:37:13,147 --> 00:37:14,649 What? Is this septic shock? 1020 00:37:14,690 --> 00:37:16,108 OK, we need to assume the worst here. 1021 00:37:16,150 --> 00:37:17,818 Code sepsis. Two sets of blood cultures, 1022 00:37:17,902 --> 00:37:19,654 lactate, 30 per kilo of LR 1023 00:37:19,737 --> 00:37:21,489 and for antibiotics, ceftriaxone? 1024 00:37:21,530 --> 00:37:22,990 No, no, she was just in the hospital. 1025 00:37:23,032 --> 00:37:24,450 - Pip-tazo and vanco. - Got it. 1026 00:37:24,492 --> 00:37:26,827 If this is sepsis, where is it coming from? 1027 00:37:26,869 --> 00:37:28,412 - What's the source? - Her urinary tract infection. 1028 00:37:28,496 --> 00:37:29,997 - She doesn't have one. - She did when I saw her. 1029 00:37:30,039 --> 00:37:31,457 It's not a UTI. 1030 00:37:31,499 --> 00:37:32,667 We catheterized urine a half an hour ago. 1031 00:37:32,750 --> 00:37:35,336 There's no nitrates, zero WBCs. 1032 00:37:35,419 --> 00:37:37,505 Your specimen could have been contaminated this morning. 1033 00:37:37,588 --> 00:37:39,840 - Is it pneumonia? - Chest CT negative. 1034 00:37:39,924 --> 00:37:42,885 Abdominal CT negative for an infectious source. 1035 00:37:42,969 --> 00:37:44,470 She was altered. Meningitis? 1036 00:37:44,512 --> 00:37:45,513 She's postpartum. 1037 00:37:45,554 --> 00:37:47,682 [sighs] Endometritis. 1038 00:37:47,765 --> 00:37:50,643 The CT of the uterus shows a thickened endometrium, 1039 00:37:50,685 --> 00:37:52,186 but that's normal postpartum. 1040 00:37:52,228 --> 00:37:53,229 No retained POCs. 1041 00:37:53,312 --> 00:37:54,522 It still could be the source. 1042 00:37:54,605 --> 00:37:57,525 We'll do a pelvic after she's stable. 1043 00:37:57,608 --> 00:38:00,194 Mr. Krakozhia, here's my obvious concern. 1044 00:38:00,236 --> 00:38:04,782 I write you a script for 30 days' worth of pills. 1045 00:38:04,865 --> 00:38:06,117 Then what? 1046 00:38:06,200 --> 00:38:07,827 What do you mean? I'll take them. 1047 00:38:07,868 --> 00:38:10,204 Well, you come back for 30 more, right? 1048 00:38:10,288 --> 00:38:11,706 I mean, that's the question. 1049 00:38:11,747 --> 00:38:13,833 Even if I could give you your dose 1050 00:38:13,874 --> 00:38:15,501 in a once-a-month shot, 1051 00:38:15,543 --> 00:38:18,379 you still have to come back when the month is over. 1052 00:38:18,421 --> 00:38:19,797 What if he didn't have to? 1053 00:38:19,880 --> 00:38:21,007 Oh, no. He has to. 1054 00:38:21,048 --> 00:38:22,675 If he doesn't, he... 1055 00:38:22,717 --> 00:38:24,051 well, he pees. 1056 00:38:24,093 --> 00:38:25,845 We have a street team here. 1057 00:38:25,886 --> 00:38:27,179 Mr. Krakozhia, are you pretty much 1058 00:38:27,221 --> 00:38:28,889 in one spot these days? 1059 00:38:28,931 --> 00:38:31,559 Yeah, I'm over on Liberty near the Benedum. 1060 00:38:31,600 --> 00:38:32,560 The alley? 1061 00:38:32,643 --> 00:38:33,978 I know it well. 1062 00:38:34,061 --> 00:38:35,896 So we could bring the meds to him? 1063 00:38:35,938 --> 00:38:37,023 Absolutely. 1064 00:38:37,064 --> 00:38:38,399 The once-a-month injection 1065 00:38:38,482 --> 00:38:39,775 sounds like the easier option. 1066 00:38:39,859 --> 00:38:42,403 We could just put you on our schedule. 1067 00:38:42,445 --> 00:38:45,364 I'd be interested in joining that. 1068 00:38:45,406 --> 00:38:47,283 Maybe I can bring out the medicine myself. 1069 00:38:47,366 --> 00:38:48,576 That'd be amazing. 1070 00:38:48,617 --> 00:38:50,703 We could use all the help we can get. 1071 00:38:50,745 --> 00:38:52,371 Thanks, Doc. 1072 00:38:54,123 --> 00:38:57,960 Yeah, purulent drainage from the cervix. 1073 00:38:58,044 --> 00:38:59,920 - Got the culture. Oof. - [whistles] 1074 00:39:00,004 --> 00:39:01,922 Looks like we have our source. 1075 00:39:02,006 --> 00:39:05,217 The positive urine this morning was contaminated. 1076 00:39:05,259 --> 00:39:06,427 Maybe. 1077 00:39:06,469 --> 00:39:08,512 Definitely. 1078 00:39:08,596 --> 00:39:11,390 Not-so-clean catch specimen. 1079 00:39:11,432 --> 00:39:13,768 This infection's been brewing for a while. 1080 00:39:13,809 --> 00:39:15,519 So the car crash was a coincidence. 1081 00:39:15,603 --> 00:39:17,271 Not necessarily. 1082 00:39:17,355 --> 00:39:19,607 She was probably already septic as the disease progressed, 1083 00:39:19,648 --> 00:39:21,233 dropped her BP, and passed out while driving. 1084 00:39:21,275 --> 00:39:22,777 She wasn't hypotensive when she arrived. 1085 00:39:22,818 --> 00:39:24,195 Adrenaline rush from the car crash 1086 00:39:24,278 --> 00:39:25,738 and the sternal fracture raised her BP 1087 00:39:25,780 --> 00:39:27,073 - but not for long. - Oh. 1088 00:39:27,114 --> 00:39:28,949 No history of fever. 1089 00:39:29,033 --> 00:39:31,118 Bet she was taking Tylenol for the pain. 1090 00:39:31,202 --> 00:39:32,578 Let's call ICU for an admit. 1091 00:39:32,620 --> 00:39:34,121 Also want gyn to see her. 1092 00:39:37,124 --> 00:39:39,794 She had mild lower abdominal pain 1093 00:39:39,877 --> 00:39:41,670 and a positive urine dip. 1094 00:39:41,754 --> 00:39:45,674 No fever, no back pain to indicate pyelonephritis. 1095 00:39:45,758 --> 00:39:47,843 She was alert, walking, talking. 1096 00:39:47,927 --> 00:39:50,096 It just seemed like a simple UTI. 1097 00:39:50,137 --> 00:39:51,931 I saw no reason to have her wait eight hours 1098 00:39:51,972 --> 00:39:54,225 for a bed for a pelvic exam. 1099 00:39:58,646 --> 00:39:59,939 McKay. 1100 00:40:03,943 --> 00:40:06,445 Every postpartum patient needs a pelvic exam 1101 00:40:06,487 --> 00:40:08,781 to rule out endometritis. 1102 00:40:08,823 --> 00:40:11,826 Wait, you're saying that with 20/20 hindsight. 1103 00:40:11,867 --> 00:40:15,329 Did you ask about Tylenol or ibuprofen use? 1104 00:40:15,371 --> 00:40:16,747 Because that can mask a fever. 1105 00:40:16,831 --> 00:40:18,165 There was no fever. 1106 00:40:18,207 --> 00:40:20,292 Did you do a careful abdominal exam? 1107 00:40:20,334 --> 00:40:21,961 It was a quick chair exam, 1108 00:40:22,002 --> 00:40:24,505 and there was only mild tenderness over the bladder. 1109 00:40:24,547 --> 00:40:27,633 Perhaps there was something about the patient 1110 00:40:27,675 --> 00:40:30,261 that made you overlook proper treatment. 1111 00:40:31,762 --> 00:40:34,515 Like what, 1112 00:40:34,598 --> 00:40:36,934 other than the obvious health risk factors? 1113 00:40:37,017 --> 00:40:40,146 Her size doesn't inherently make her unhealthy. 1114 00:40:40,187 --> 00:40:42,356 Are you saying I was biased against the patient 1115 00:40:42,440 --> 00:40:44,024 because of her weight? 1116 00:40:44,108 --> 00:40:47,027 I raise it as a possibility, not as an accusation. 1117 00:40:47,111 --> 00:40:49,029 Wow. 1118 00:40:49,113 --> 00:40:52,158 I mean, I really don't think that's the case here, 1119 00:40:52,199 --> 00:40:55,369 but I will look out for it. 1120 00:40:55,411 --> 00:40:57,371 Yeah. 1121 00:40:57,413 --> 00:40:59,081 You were good with him. 1122 00:40:59,165 --> 00:41:01,041 Do you get a lot of homeless in Pittsburgh? 1123 00:41:01,083 --> 00:41:02,334 We call them unhoused. 1124 00:41:02,376 --> 00:41:03,836 It's not as bad as Philly or D.C., 1125 00:41:03,878 --> 00:41:05,588 - but it's still pretty bad. - Yeah. 1126 00:41:05,671 --> 00:41:07,673 It really is great that you want to help out. 1127 00:41:07,715 --> 00:41:09,550 The street team get cool jackets. 1128 00:41:09,592 --> 00:41:11,552 - Yeah? - Come find me end of shift, 1129 00:41:11,594 --> 00:41:12,970 and I'll give you more information. 1130 00:41:13,053 --> 00:41:15,222 Will do. 1131 00:41:15,306 --> 00:41:17,057 You made it out unscathed this time. 1132 00:41:17,141 --> 00:41:18,225 Yeah. 1133 00:41:18,267 --> 00:41:20,186 I'm joining the street team. 1134 00:41:20,227 --> 00:41:22,396 Even get a jacket, so... 1135 00:41:22,480 --> 00:41:25,524 Cool. 1136 00:41:25,566 --> 00:41:27,526 Yeah. It is cool. 1137 00:41:27,568 --> 00:41:29,195 Very cool. 1138 00:41:33,574 --> 00:41:35,242 - Whose pooch? - South 20's. 1139 00:41:35,326 --> 00:41:36,827 I'm taking him for a visit. 1140 00:41:36,911 --> 00:41:38,245 This is Crosby. 1141 00:41:38,329 --> 00:41:39,663 Hello. 1142 00:41:39,747 --> 00:41:40,998 I'm going for a smoke. 1143 00:41:41,081 --> 00:41:42,124 If anyone asks, he's an emotional... 1144 00:41:42,208 --> 00:41:44,084 Support animal. I know. 1145 00:41:44,126 --> 00:41:45,586 I got it. 1146 00:41:47,004 --> 00:41:48,964 [gasping] [rat squeaking] 1147 00:41:49,048 --> 00:41:50,424 Whoa! [dog barking] 1148 00:41:50,508 --> 00:41:52,426 Crosby! Hey, hey, heads up. 1149 00:41:52,468 --> 00:41:54,261 Crosby. Ow! 1150 00:41:54,345 --> 00:41:56,055 [rat squeaking] Drop it. Drop it. 1151 00:41:56,096 --> 00:41:58,265 - Ugh! - Whoa. 1152 00:41:58,307 --> 00:42:00,976 [indistinct chatter] 1153 00:42:01,060 --> 00:42:03,479 [rat squeaking] 1154 00:42:03,562 --> 00:42:05,606 [dog growling] 1155 00:42:05,648 --> 00:42:08,108 Got you. Come on. 1156 00:42:08,192 --> 00:42:10,277 Crosby. Crosby, come here, buddy. 1157 00:42:10,319 --> 00:42:12,071 Come here. There you go. 1158 00:42:12,112 --> 00:42:13,614 - [bones snap] - Yeah. 1159 00:42:13,697 --> 00:42:15,950 [people gasping] 1160 00:42:15,991 --> 00:42:18,452 - Nice job! - Hey. 1161 00:42:18,494 --> 00:42:20,287 - Good work! - There you go. 1162 00:42:20,329 --> 00:42:23,165 [applause] 1163 00:42:28,128 --> 00:42:29,964 You got a rat, didn't you? 1164 00:42:30,005 --> 00:42:31,465 Yeah. 1165 00:42:31,549 --> 00:42:33,968 - He does that. - Yeah. 1166 00:42:34,009 --> 00:42:36,971 - When did those cops get here? - I don't know. 1167 00:42:37,012 --> 00:42:38,597 - Who called them? - I don't know. 1168 00:42:38,639 --> 00:42:40,474 - Where's Dana? - Again, I don't know. 1169 00:42:40,558 --> 00:42:41,767 - Thank you. - Anytime. 1170 00:42:49,817 --> 00:42:51,110 Hard at work? 1171 00:42:51,151 --> 00:42:52,861 [both grunt] 1172 00:42:52,945 --> 00:42:54,154 [groans] 1173 00:42:54,196 --> 00:42:55,739 I'll take my chances. 1174 00:42:59,159 --> 00:43:02,454 [groaning] 1175 00:43:02,496 --> 00:43:05,457 [dramatic music] 1176 00:43:05,499 --> 00:43:11,547 ♪ ♪