All language subtitles for The.pitt.S02E06

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I'm in.

Bag him.

Defib pads are in place.

OK, holding compressions.

Good square line on the End-Tidal CO2.

V-fib, charge to 200.

Charged.

Clear.

Stand by with epi.

Suction that tube.

You're not in the esophagus, are you?

Definitely not.

I passed right through the cords.

Good breath sounds.
End-Tidal CO2 confirmed.

His lungs are filling up with blood.

I know.

OK, rhythm check.

Asystole. Push the epi.

Fuck.

Patients with lunch trays
have been admitted.

They're boarders.

They're waiting for a bed
to open upstairs.

- And what about the others?
- Non-admitted patients.

They can have sandwiches or juice boxes.

Just make sure they're not NPO.

That's "nil per os."

It's Latin for "nothing by mouth."

NPOs are waiting for surgery.

They'll beg, spit, and curse for food,

but you got to stay strong.

Hey, I've been waiting for an hour.

When am I gonna see a fucking doctor?

Excuse me!

Perhaps you didn't see this,
which is strange,

because they're all over the place.

Aggressive behavior toward
healthcare workers is a felony.

$2,000 fine, possible jail time.

Got it?

OK. I was just asking.

We're busy today.

It's a holiday weekend.

We see the sickest patients first,

so be happy you're still waiting.

Jag-off.

PTMC charge nurse.

Go ahead, Medic Command.

OK. Got it.

Incoming trauma.

Come on.

Three minutes since the last epi.

Hold compressions.

Asystole.

Resume CPR. Another amp of epi.

Needs more suction.

Pulmonary hemorrhage from liver failure.

Is he going to make it?

Should we give PCC?

Too late for that.

And he's not an ECMO candidate.

Nothing else we can do?

No, I think we're done.

Louie.

12:07.

Should we do a debrief?

We've got another
motorcycle injury coming in,

ETA 10 minutes.

Why don't we get Louie cleaned up,

- move him to the viewing room?
- Yeah.

Anybody that wants to pay their
respects can join us in there.

Thank you, everyone.

I'll clean him up.

Why don't you take five first?

Or ten. Yeah?

Yep.

This is Dr. Jefferson from psychiatry.

Why do I need to see a psychiatrist?

Jada, why do I need
to see a psychiatrist?

It's gonna be OK, Jackson.

Dr. Jefferson says he can help.

Do you know how you got here?

The medics brought me.

I don't really remember.
I... I was in the library.

What were you doing there?

I was... I was studying.

I was trying to study.

But then they wouldn't stop talking.

Who wouldn't stop talking?

They don't want me to pass the bar.

Who doesn't want you to pass the bar?

- That's what they told me.
- Hey, hey.

Hey, look at me. Look at me.

Who doesn't want you to pass the bar?

Let's give them some privacy.

Dr. Jefferson will let us know
when he's done.

They don't want me to pass the bar.

I'll be right outside, OK?

I'll be right outside, Jackson.

Why don't they want you
to pass the bar, Jackson?

They're afraid of me becoming a lawyer.

They're afraid of you becoming a lawyer?

He must have been studying
with his law school friends.

They... they should know what happened.

I'm gonna call them.

If you need anything, let me know.

- OK, thank you.
- Mm-hmm.

Louie.

Pulmonary hemorrhage.

That was quick.

I'm gonna go clean him up.

I'll help.

Go, go.

Everything OK, Roxie?

I can't get off the bedpan.

Oh, that's what I'm here for.

Your husband seems like a saint.

How long you been married?

Too long.

Almost 20 years.

- OK, put your arm around me.
- Mm-hmm.

And I'll pull the bedpan on three.

OK.

One, two, three.

One more.

- Great.
- Mm.

20? Wow.

Yeah.

He's been by my side
through all of this.

I've watched the light go out of him.

So have the kids.

That's what happened to my auntie

when my Uncle Gerald got sick.

But your husband does it
because he loves you.

Mm.

I don't know how you do it,

care for people day after day.

I'll tell you my secret.

I go home at the end of every shift,

leave this all behind,

and escape to "Love Island."

How's it going in here?

The higher-demand dose
of morphine helped a little,

- but she's still in pain.
- OK.

I got your order. 0.1 per kilo.

- Thanks.
- Mm-hmm.

This is a very low sub-dissociative dose

of ketamine.

You might feel a little weird,

but I think it's gonna help
with the pain.

Is my husband still in the cafeteria?

I think so. Want me to get him?

No, no.

It's good for us to have
a little time apart.

I'll get you another blanket.

Here. I'm headed that way.

Thank you.

Back here for good?

Officially out of triage.

They need extra hands with
all the Westbridge hullabaloo.

How many cups have you had today?

- Don't judge me.
- Just asking.

You're judging.

Did you hear about Louie?

No.

Pulmonary hemorrhage. Didn't make it.

- Shit.
- Mm.

He's been here a hundred times.

I know.

Debrief in the viewing room later.

On a happier note,
Perlah and I are planning

a birthday party for Javadi.

She's turning 21.

You two are thick as thieves.

I don't have much
of a social life these days,

but I'll be sure to keep
an eye out for the Partiful.

Let's discuss
our incarcerated patient Gus.

Prison infirmaries
tend to be short-staffed,

so we need to be thorough.

What's in the differential
diagnosis for malnutrition?

Inadequate intake, methamphetamine use,

severe alcoholism, ADHD medication.

What else?

Cancer of the oropharynx,
esophageal strictures,

prior strokes, malabsorption,
inflammatory bowel disease,

none of which were
in his medical record.

What about psychosocial causes?

Could be an intentional hunger strike.

Or refusing food
to get to the infirmary.

Could also be abuse or neglect.

Let's start with a nutrition
history once he's back from CT.

Do you have a second
to talk about Westbridge?

Mm-hmm.

Hey, we need to start moving
some patients out of here.

These walls are starting
to fill up with gurneys.

Santos, Ogilvie, and King

all have patients on the launching pad.

I'll check in with them.

How many patients have we
had rerouted from Westbridge?

Ten, and God knows how many
more in the waiting room.

Ambulance will be here in a few minutes

with the accident victim;
I'll stick him in Trauma Two.

What is the story with
your incarcerated patient?

Gus Varney, three rib fractures

with normal O2 sats currently,
waiting on CT results.

OK, if he's stable at the two-hour mark,

I'd say he's good to go.

Let's get the ball rolling on discharge.

Let's wait on the CT results.

We can move him out
of Trauma One, at least.

Yes, we can. What's open?

13 and 14 will be discharged soon,

15 once we move Louie
to the viewing room

and get it cleaned up.

Our paracentesis patient,
Mr. Cloverfield?

V-fib arrest.

We'll do a debrief when
we know how many patients

we're getting from Westbridge.

So Gus goes to 13, 14, or 15?

I kind of want to keep him
in plain sight.

- What about BH-2?
- Sold.

Why not give him some privacy?

Everyone can see him in BH-2
like he's a monkey at the zoo.

Because he came in
with an orange jumpsuit,

and we need to think
about patient and staff safety.

Safety first. BH-2 beats a prison cell.

Not by much.

Did you guys hear about Louie?

- Yeah.
- Yeah, chronic alcoholic.

Go figure.

Hey, fent OD in South 20
is ready for discharge,

but could you get Lupe
to call him a ride?

I need to check on Louie.

- Uh, actually, Whitaker...
- He croaked.

- What?
- Five minutes ago.

Robby called it.

I'm sorry, man.

We didn't have time to find you.

What happened?

He was apneic and pulseless.

We started CPR and intubated him.

He had a massive pulmonary hemorrhage.

Robby called it.

Found this with his stuff.

Guess he was married at some point.

Never knew that.

Oh, didn't miss this part of the job.

Yeah.

Perlah, did Louie ever mention
anything about a wife and kids?

Not as far as I know.

He only had eyes for Rita Moreno.

Well, this is not Rita Moreno.

No, it's not.

Can we check to see if
there's an emergency contact?

Yeah, there's a number listed.

You were his primary. Do you want to...

No.

PTMC charge nurse.

Langdon? Where are you?

Makes sense that we'd be
his emergency contact.

Sorry to get your hopes up.

Our social worker's
gonna do their thing.

If Louie had any family left,
they'll find them.

OK?

Guess it's good it happened
here, not out on the street.

You're off the hook with Louie.

I'ma teach Emma here
how to clean a dead body.

I'm sorry, but they need me in L&D.

You might want to call
for another interpreter.

Busy day.

Shit, that's the girl in 12?

Yeah, she's been waiting for five hours.

Didn't hear her name called
the first time.

You check on her?

Need to brush up on my ASL.

You know sign language too?

Princess here knows six languages.

- I know French.
- OK, it's not a contest.

Ah!

No shit talking in front of me.

I get enough of that
from her and Perlah.

Guess I'll call for backup.

Yo, Donnie, did you discharge
your butt abscess?

Not yet!

What the hell?

Your good friends upstairs
sent doughnuts.

Special thank-you
for working the holiday.

You got to be kidding me.

What were you expecting,
tacos and tequila?

Every single one of them
can forget about extra shifts.

- Won't hire more nurses.
- Won't pay us a decent wage.

Won't hire security that can actually

protect us from patients.

But absolutely, send doughnuts.

Sure you want to go
into this line of work?

Want me get you one?

Of course I do, but I'm not
taking admin's blood pastries.

Et tu, Donnie?

OK, move it or lose it.

Meet me in South 15
with gowns and gloves.

Looks like happy hour in here.

Don't ask. What's up with Evel Knievel?

Brandon Li, 52,
fell off a motorcycle pyramid

at 25 miles per hour.

Motorcycle pyramid? You recruiting?

Got a fellow rider in your midst.

- No kidding.
- How high up were you?

On top of a three, two, one.

But the bottom guys are sitting
down driving the choppers.

I'm fine. I don't need all this.

- Were you wearing a helmet?
- Of course.

Oh, what do you know?
They're still in style.

Good vitals, tender right
wrist, and big left knee lac.

Hey, Joy, Perlah, Trauma Two.

Who else can I have?

Santos and Whitaker are in with Louie.

Yeah, give me Whitaker.
He could use a distraction.

And Santos has been
ducking traumas all day.

Well, she's behind in her charting.

Who isn't?

OK, even when it's not your fault,

sometimes it's worse knowing

that there was nothing you could do.

Uh-huh.

Are you...

Robby needs you both in Trauma Two,

and I need you to discharge
sweet Patty in 13

as soon as you're done.

Can't catch a break.

I push you 'cause
I know you can take it.

You ever clean a dead body?

Probably never seen one either.

No one tells you what it
looks, feels, or smells like,

but you get used to it over time.

You pull off the gown.
You wipe him down with towels.

Then we'll roll him on his side,

clean his back,
stuff the sheet under him,

wipe down the bed,
roll him the other way,

pull out the sheet, and repeat.

Just follow my lead.

Usually, you leave the ET tube
in for the coroner,

but Louie's a chronic alcoholic
with end-stage liver disease.

Not a coroner's case.

- Did he have family?
- Everyone has family.

The social worker always
tries to find them.

Sometimes the family loved them,

tried to get them to come home.

Other times, the family wants
nothing to do with them.

- That's sad.
- That's life.

What happens if no one claims his body?

He'll be cremated.

Where would his ashes go?

They'll keep him for a few months.

Then he gets buried in a mass grave

with all the other unclaimed bodies.

OK, now we roll him.

Ready.

Go.

Oh, my God, is he still alive?

No, that happens.

These frequent fliers.

They can be a real
pain in the ass, but...

you miss them when they're gone.

I've been at every
Millvale Fourth of July parade

since '08.

World record is 40 men
on seven motorcycles.

I plan to beat that someday.

Good lung sliding bilaterally.

Pupils equal and reactive.

- What do you ride?
- The Bullet.

Oh, Royal Enfield. Ankle breaker.

- Thumper.
- BP 138 over 80.

Pulse 94. Pulse ox 98.

All your vitals sound
really good, Brandon.

They call it an ankle breaker 'cause

you got to kick over
a big, fat single cylinder

to get it started,
sometimes five or six kicks.

Yeah, especially on a cold day.

Um, does anyone have
any trauma scissors?

- I'll check the knee.
- Uh, not yet.

- Why not?
- Dr. Santos.

Primary survey means
rule out the life threats.

Don't get distracted
by lacerations or fractures.

No free fluid in the belly.

Airway, breathing, circulation are fine.

OK, that's ABC.
That just leaves two letters.

Tell her about D, Dr. Santos.

Disability. Wiggle your toes, sir.

Any pain in your arms or legs?

Not really.

Does it hurt when I push here?

- No.
- OK, no midline tenderness.

Nexus negative.

With no obvious brain injury
or spinal cord injury.

That just leaves E. Joy.

Can I buy another vowel?

- Dr. Whitaker.
- Exposure.

AKA strip and flip.

Cut off his clothes,
and we'll log roll him.

What do we have?

Helmeted motorcycle acrobat.

8-foot fall standing
on top of five riders.

Primary survey normal, E-FAST negative.

Another motorcycle accident.

Hello, sir. I'm Dr. Garcia from surgery.

Hello.

OK, we will roll him in three, two, one.

Well, I grew up a block from Carrick,

but my mom was a teacher at
Brashear, so I had to go there.

- The Bullets?
- That's right.

They were the Bullets when I was there.

They changed to the Bulls when I left.

Oh.

Hey, you think I could
get something to eat?

Gus here is wondering
if he's clear to eat.

As long as it's a liquid diet.

We have the results of your CT scan.

Your jaw should heal without
surgery, which is good news,

but it will be a few weeks.

Before I can eat?

Solid foods, yes.

Or you can have food pureed
with liquid in a blender.

I don't have a blender.

Right.

Sorry.

We have a calorie-rich
supplement drink called Ensure.

Comes in chocolate,
vanilla, or strawberry.

Chocolate, please.

- Good choice.
- How many can I have?

Two a day is recommended.

I'll get it for you.

You have an appetite. That's good.

Mr. Varney, your blood tests indicate

low levels of protein and vitamins.

Can we ask you a few questions
about your diet?

How many meals or snacks do you
have in a 24-hour period?

I don't know.

Don't count.

Pretty sure it's three trays a day.

OK.

How often do you eat cereals,
fruits, or vegetables?

Not many fruits
and vegetables in prison.

Slow and steady.

What year is your Bonneville?

'69.

Rescued it from a motor graveyard.

Brought it back to life
with a buddy of mine,

who's supposed to be coming in today.

How often do you ride?

I ride it in to work every day.

Good for you.

Don't encourage him.

CT's ready for Brandon.

As soon as we take a look at this knee.

- Whoa.
- Through the deep fascia.

How's it look?

Definitely gonna need stitches.

- How many?
- A lot.

It could be an open joint.

We'll do a saline load after CT.

OK.

Lever sign negative. ACL intact.

OK, ready to roll.

Are you still coming over tonight?

I think Whitaker is gonna be playing

farm boy again this weekend,
so he's not gonna be around.

I may need a rain check.

Hey, do you have an update
on that nec fasc patient?

Last I heard, Miller was doing

an above-the-knee amputation with ortho.

Langdon's waitress with the cellulitis?

Yeah.

- Man, that took a turn.
- Sure did.

Hey, did you hear about Louie?

- Yeah.
- You OK?

Um,

one of my uncles drank himself to death.

I barely recognized him at the end.

At least Louie always seemed happy.

I'm here if you want to talk.

Should've known I'd find you in here.

You steal anyone's lunch,
it's a $20 fine.

Made a lot of changes
while you were gone.

I can see that.

Look, I'll let you hide out
a little bit longer,

but then I need you
to pick up more patients.

You're not as fast as you used to be.

Damn doughnuts!

Ouch.

First day back,
I get kicked in the nuts.

One dead, one septic bounce-back.

Both of those not your fault.

You expecting a party?

No, not really.

Didn't hear from anyone
while I was gone.

Sorry.

They ever, uh, arrest
that guy who punched you?

Yeah.

Wanted to know if I wanted
to press charges,

but didn't want to go through all that.

Thought I was done, really did, but...

I got bored at home,
so only lasted a few weeks.

You?

10 months is a long time
to be alone with your thoughts.

I almost lost everything.

I know a lot of women who would
have taken the kids and left,

- but Abby stayed.
- 'Cause she's a good woman.

'Cause you deserve a second chance.

I'm not sure everyone agrees with you.

Give it time.

Look, I...

I, um...

I've been working the 12 steps,
trying to make amends.

I was really selfish.

I lied to myself, and I lied to you.

I'm really sorry.

You can check me off your list, kid.

We're good.

- OK.
- Yeah.

Got a lovely patient for you in Two.

Let's get you back on the horse.

Really need to talk with Robby.

I don't know if today's
the best day for that.

He leaves on vacation tomorrow.

Let him get through the day in peace.

He's supposed to be gone
for three months?

So he says. I give him one.

Go get 'em, kid.

Dr. Langdon, this is Rocky.

Great name.

What brings you in, Rocky?

Very sick.

When did it start?

An hour ago.

After he won a hot dog eating contest.

A hot dog eating contest?
How many you eat?

351 hot dogs?

36.

Still a lot.

- I pulled eight of Zofran.
- Go for it.

All right, this should help.

Stick it under your tongue.
Let it dissolve.

OK, are you taking any prescription...

Oh, thank you.

Thanks.

Santos, what's up
with your ileus patient?

Admitted to medicine,
and before you ask,

13 has been discharged.

Great. 12 needs a doctor.

No, don't make me go back there.

That disimpaction left a smell
and stunk up the whole hallway.

So grab some coffee grounds
from the lounge.

We need to admit
our incarcerated patient, Gus.

What did the CT show?

Moderate pulmonary contusion,
three rib fractures,

no intra-abdominal bleeding,
and oblique fracture

in the body of the mandible
anterior to the angle.

All favorable for healing.
What's the treatment plan?

- A pain med...
- Security.

People are trying to sleep.

Pain medication,
antibiotics, liquid diet,

um, a pulse ox a few times a day,

and then also dressing changes
for the laceration.

Which he can get
at his correctional facility.

Or he stays here for a few days,

and we get him
on the right track to healing.

Why don't you two
go check on your patients?

- Got it.
- Sure thing.

What am I missing?

He's not getting enough to eat

at his correctional facility.

The portions are tiny.

Too many carbs, not enough
fruits or vegetables.

He's lucky he hasn't developed
a chronic illness.

We don't have any inpatient beds.

He would board down here for three days.

We're still getting runs
from Westbridge,

and we cannot tie up
Behavioral for that long.

Dr. Al-Hashimi,
Dr. Jefferson wants to talk

to you about our tasered kid.

Why don't I call the prison doctor

and find out what they're
working with over there?

- Thank you.
- My pleasure.

Dr. Jefferson seems to have
a good rapport with Jackson.

That's excellent.

How's the sister doing?

Still pretty upset.

She's never seen him like this.

It's a lot to process.

- How's he doing?
- He's scared.

Droperidol had a positive effect,

but he doesn't understand
what's going on.

He's been experiencing
auditory hallucinations

and paranoid delusions.

Voices are telling him he isn't safe.

This has been going on for months.

- Months?
- Yeah.

Turns out, his sister
hasn't seen him in a while.

Family history of mental illness?

Not that we know of.

I'm gonna give him a break and
then continue the conversation.

Parents are on their way.

We'll let you know when they get here.

Yes. Do.

OK, hospital bed, wheelchair,

and shower chair have all been ordered.

What do you say, kid?

Ready to go home?

How's your pain, Mrs. Hamler?

The same.

We're gonna write you
a script for Keppra.

You'll take that to prevent seizures

once a day, starting tomorrow.

Between your broken leg and
the bruises from your seizure,

the pain will probably
get a little worse.

Yeah, the most important thing is

to let others help you.

You'll need assistance showering

and getting to the bathroom.

Yeah, no problem.
I won't leave her side.

Paul, you need a break.

You're... you're taking care
of me, the kids, the house.

It's too much for one person.

I'm not the one battling cancer.

Paul.

Hey, you're in pain every day,

fighting for your life.

I'm happy to do this for you.

You're my wife.

Now, let's go home and forget
this day ever happened.

I'll call the transpo ambulance.

Thanks, Princess.

Hey.

Hmm?

Why don't you go ahead?

- What?
- Yeah.

You can get the house ready.

I'll be right behind you.

- No.
- Mm-hmm.

No, I'm... I'm riding
in the back with you.

You know what? I'll stay with her.

Are you sure?

- Mm-hmm.
- Yeah.

OK.

Um, call me if you need me to come back.

Mm-hmm.

When will the ambulance get here?

It shouldn't be long.

Mr. Francis, short of breath?

Yeah, I was worried the clot in my leg

could have gone up to my lungs, so...

You're on Eliquis.
That shouldn't happen.

- Yeah, I know, but...
- Hey, Donnie, I got this.

Don't worry, Mr. Francis.

I'll order the D-dimer.
I'll be back to see you.

Thank you, Dr. Mohan.

You know I'm an NP now.

I can pick up a patient with dyspnea.

I'm sorry.

I've seen him before,
and he's asked for me.

Why even order the test?
He's on Eliquis.

Mr. Francis comes in every month

and always asks for a D-dimer.

Just... he's worried,
and it puts his mind at ease.

- Why not?
- Yeah, OK.

Donnie's the best.
You'll learn a lot from him.

That's right.

All right, fill me in.

This is Harlow Graham.
She was seen in triage.

CBC and CMP came back normal.

IT was supposed to bring the
VRI down, but they're slammed.

I know a bit of sign language.

Harlow, this is Dr. Santos.

Hi, Harlow. How are you feeling?

She has a headache.

OK. What else?

What is she saying?

I think she had a stomachache,

and she might have passed out.

I'm not 100% sure.

OK, we're just gonna need
to wait for an interpreter,

'cause I need to ask
a million questions,

and I can't do it this way.

So just call me when IT comes down.

CT head, neck, chest,
abdomen, pelvis all negative.

It means we can get this collar off.

Thank you.

Roll to your side.

We'll get you off this board.

How long is your trip?

2,000 miles, all the way
from here to Alberta.

Couple stops along the way.

Got the whole thing mapped out.

- Sounds like heaven.
- Let's sit you up.

Sorry, I got stuck with a patient.

You know the old saying,
four wheels move the body,

two wheels move the soul.

You're gonna be living the dream.

Thank you, Brandon.

Not everybody down here feels that way.

- OK, Whitaker, what's next?
- Ortho assessment.

Palpate all long bones,
starting with the clavicle.

Got it.

I'll take the lower extremities.

Distal radius tender. No deformities.

Needs an X-ray.

No bony tenderness down here.

No laxity of the knee.

Are you concerned about that knee lac?

If it's an open joint,
he'll need a washout in the OR.

We could try a fluorescein injection.

OK, we'll need a...

Wood's lamp, 1% lido with epi,

sterile saline, sterile basin,
sterile fluoro-strip,

18- and 27-gauge needles,
5- and 60-cc syringes.

How does she know all that?

She just does.

How are you feeling, Rocky?

Oh, much better.

He's had eight migs of ondansetron.

Any pain in the belly?

No, but my mouth is really dry.

No doubt from consuming mass
quantities of salty hot dogs.

Could I have another sip of water?

Sure. A little sip.

Take it slow.

- Here you go.
- Thank you.

Just enough to wet your whistle.

So how'd you get your start
as a competitive eater?

Any pain here, Mr. Li?

- Can't feel a thing.
- Great.

Where is Santos?

Probably catching up on her charting.

- Right.
- Lights out.

Wood's lamp on.

OK.

I might want to use
some of that on Halloween.

That is 250 ccs of sterile saline

with one small touch
of a sterile fluoro-strip.

OK.

We're going to inject this
fluid into your knee, Brandon,

and if there's anything
glowing in your wound,

we know we have a leak.

- Feeling some pressure.
- Yeah, it's normal.

As soon as I finish the test,
I'll pull off the fluid.

That looks good.

Laceration did not enter
into the joint space.

Surgery not needed.

Excellent. I can get back to the parade.

No, we'll still need to

stitch you up and splint your wrist.

Hanging a gram of Ancef.

Wait, he has a penicillin allergy.

No, PEN-FAST was negative. We're OK.

My mom said I got a rash with
amoxicillin when I was two.

Yeah, probably not a true allergy.

Go ahead and give it, Kim.

But have epi and Benadryl
standing by, right?

Yes, to be on the safe side.

Most people who think
they have a penicillin allergy

actually don't.

Always listen to the nurses.
They run the ER.

We just try and stay out of their way.

Now we can really clean him up.

Didn't we already do that?

Dried blood on the face, neck, hands.

If anyone comes, they shouldn't
have to see that.

Sometimes the local unhoused
folks will pay a visit,

but we always make them presentable

in case anyone comes.

That's the last thing
we can do for them.

Didn't get to do that during COVID.

Once he's spotless, we'll
tuck him in nice and tight,

but we always leave one arm
outside the sheet.

Because?

So loved ones can hold their hand.

- Here you go.
- Thanks.

Yeah.

We're ready to discharge
our cancer mom, Roxie.

Ambulance is on the way; we just need

- to reconcile her home meds.
- Sounds good.

Hey, I thought I saw another
charge nurse around here.

Oh, yeah. We travel in packs.

Aren't you sick of this place yet?

Oh, someone is ready for his sabbatical.

Guilty as charged.

Hey, I just got word
that the at-home morphine pump

is gonna be delayed.

Hospital pharmacy has to mix it

and then deliver it later today.

Well, should we keep her here
until it's ready?

No, you can give her

a 200-milligram tablet of MS Contin.

- 200 milligrams?
- Biggest pill they make.

Releases over 12 hours for
patients with opiate tolerance.

Got it.

Hey, do you want
to stick around a little bit?

Westbridge is closed
to internal disaster.

- We're getting all their runs.
- Yeah, I heard.

I put 20 bucks on a plumbing issue.

I just watched that
poop cruise documentary.

Oh, I cannot stop thinking about it.

That sounds like something
I will absolutely never watch.

Dr. Robby,

you gave us a clozapine ileus
about an hour ago.

Your resident reported
no surgical history,

but the chart says
they've had an appendectomy.

We're not admitting the patient
without a surgery consult.

- Who called it in?
- A Dr. Trinity Santos.

Dr. Santos, you had an ileus patient.

You neglected to mention
a history of appendectomy.

There was no history of appendectomy.

It was in your note.

I may have forgotten to proof check it.

I was using the app
that Dr. Al-Hashimi suggested

to catch up on my charting.

Wonderful.

- Ah, Dr. Al-Hashimi.
- Yes?

Dr. Santos was just using
your AI tool for her charting,

and it hallucinated
a history of appendicitis.

As I mentioned to Dr. Santos,
generative AI is not perfect.

We still need to proofread
every chart it creates.

Mm-hmm, the patient also has
a history of headache,

followed by Dr. Park from Urology.

That should probably be Neurology.

Unless urologists
are now treating migraines.

Another example
that should have been caught

by proofreading.

AI's 2% error rate
is still better than dictation.

Yeah, I don't really
give a shit whether or not

you want to use robots down here.

I need accurate information
in the medical record.

- Understood.
- OK.

Dr. Santos.

Dr. Santos!

Yup. Won't happen again.

Hoy.

Thanks, Perlah.

Six hours to go. You got this.

When a wound is gaping like this,

you want to use sub-Q
to bring the edges together.

A lot of meat to close.

What would happen if we just
did a simple wound closure?

You take the stitches out in ten days,

the wound opens, dehisces.

Exactly.

So what suture do we use under the skin?

Vicryl provides support for a month.

It takes two months to dissolve.

Mm-hmm. So 5-0 nylon on the skin.

4-0 vicryl under the skin.

I'd go with a 3-0 vicryl.

- You think?
- Most definitely.

Donnie is the master of wound closure.

I do at least ten lacs
a day out at triage, so...

Can we see your sub-Q?

Be my guest.

If you insist.

So...

The secret is to be sure
your entry point

and exit point
on both sides of the wound

matches the depth on the other side.

S...

Start deep.

Come up at the dermis.

Big bites help the tissue close.

It's a mirror image on the other side.

Superficial to deep.

- So you bury the knot.
- Bingo.

Avoids bumps on the scar line.

Three ties, not four.

Yeah, that's beautiful.

And then you cut it short.

Not too short.

I like to slide my scissors

down on the knot,

then rotate up 45 degrees before I cut.

Could use two more sub-Qs,

one above, one below.

Have at it.

Interesting ink. Do they mean anything?

This, this is "death and chaos,"

and this is "miracles and blessings."

Got this one after
the PittFest shooting,

and I got this after
my daughter was born.

Put the head of the gurney up

so people can see him, but not so high

that his head flops to the side.

What do you think?

He looks peaceful.

What's the hardest part of this job?

It's pretty thankless,
and that can be tough.

You've seen burnout rates.

I'm sure they teach you that in school.

All my closest friends left after COVID.

Some during.

But I don't blame them.

They needed to do what was best
for their mental health.

A lot of people broke.

Why do you keep coming back?

Why don't you, um,

just finish up here and then
go help Perlah for a bit?

Great. Thank you.

No, that is exactly
what I needed to know.

OK.

I just got off the phone
with the physician assistant

at the prison; they've got
a 16-hour-a-day infirmary

with NP and PA coverage
giving everything that we need,

and they've got an RN for overnights.

Even so, he's here because

they're ignoring his basic needs.

He's here because somebody
kicked the shit out of him.

I think you're missing the point.

We have more to offer.

Robby, we've got
four more coming our way.

OK, got it.

What you're trying to do is very noble.

We don't have the resources to spare.

OK, then why admit
the unhoused man, Digby?

Why not send him back to the street

with antibiotics and a roll of gauze?

Because Digby lives on the street,

and your incarcerated patient
has a mid-level provider

and a nurse looking after him.

We both know the quality
of care is not the same.

Sorry, are you waiting for me?

No.

Dr. Al-Hashimi,
for the patient in Seven.

A few days here could
make a world of difference

for Gus' health.

We are a safety net,
but nets have holes.

We are not admitting him

'cause this is not about social justice.

Everything I've done in my career

is an effort to improve the system.

Just because you know it's broken

doesn't mean you stop trying.

Excuse me.

I talked to Jackson's girlfriend.

OK.

She told me a lot of stuff.

Um, she wants to come see him,

but I just don't think
that's a good idea.

And my... my parents are asking
a lot of questions.

Can I just take him home?

I'm so sorry.

Your... your brother is on
an involuntary psych hold.

He can't leave.

It could take us weeks to figure out

what's wrong with him.

What's wrong with him?

I'm so sorry.
I did not mean it like that.

What's...

Why don't we go somewhere quiet, yeah?

What's wrong with him?

- Let's go over here.
- What's wrong with him?

What's wrong with him?

What's wrong with him?

How's she doing?

She took three ounces of formula

without vomiting or distress.

Excellent.

Dr. Wolke from Pedes
should be down shortly.

Yeah. I think I saw her smile.

A true social smile
where the baby is awake, alert,

and responding to facial expressions

usually doesn't happen
until six weeks or older.

It was likely
a reflex smile that happens

while they're sleeping.

But some parents
have reported their babies

smiled socially as early as four weeks,

so who knows?

- Jesse.
- Hmm?

North 4 needs a blood draw
when you have a sec.

Got it.

How we doing in here?

Almost ready to head out.

Looking good.

Heart rate 91.

BP is 115 over 82.

Oxygen sat's 95%.

Great.

I'm sending him home
with some nonstick dressing

in case they don't stock them.

Grab some burn net too.

He's a good guy. He's a local.

Yeah? You're from Pittsburgh?

Yes, ma'am. Born and raised.

Whereabouts?

Bloomfield, Liberty Ave.

Bloomfield?

You know Sonny's Tavern?

Worked there through high school.

- No kidding.
- You know Sonny's?

Had my first kiss there.

Hey, Donnie, my buddy Duke
hasn't checked in yet?

Nah, I told Lupe to keep an eye out.

- Thank you.
- Yep.

Right, left.
Right, left. Yeah. That's it.

You back to check our work?

Nope. I need a silastic loop drain.

That looks great.

It's thanks to your fine instruction.

OK, he's going to need
Kerlix and Xeroform.

You should throw
a neoprene sleeve on him.

Limits the range of motion at the knee

- so the sutures don't pull out.
- That's a good idea.

Must be fun to work here.

Oh, sure is. First week for these two.

How are you guys liking the Pitt?

I feel like I was born to do this.

Hard pass.

I'm shooting for pathology.

I like medical mysteries,

but I don't really
deal well with people.

You have an interesting energy.

What's that for?

Splint starts at the knuckles,

comes up and around the elbow,

and back down to the palm.

It needs to be smaller.
I can't ride with a splint.

Well, no, you shouldn't
be riding at all.

Right now, that's
a non-displaced fracture.

If you fall on it again, you're
gonna need to go to the OR.

No worries, Doc. I won't fall again.

Uh-huh.

Robby, pulse ox just dropped.

What happened?

I don't know.
I stepped out for a minute.

It's down to 85%.

Are you having some trouble breathing?

A little.

Start him on 2 liters oxygen,
nasal cannula.

Titrate to 5.

Keep the pulse ox at 92 or higher

and have a rebreather
standing by just in case.

He's gonna have to stay.

For how long?

Not sure.

Sorry, boss, I only
stepped out for a second.

Let me know if anything changes.

You were in the room
when his pulse ox dropped?

- I was.
- What were you doing?

D, still can't get a hold of Ortho.

Leave them to me.

- Feeling better?
- Oh, so much better.

Well, I wrote you a script
for Zofran, just in case.

Thanks. I think I cleared it all out.

- So no more hot dogs, right?
- Oh, not today.

But I'll be back next year.

- Got to defend my title!
- Yo.

OK, well, best of luck to you.

They got a Wiener World truck outside.

You want one?

I think I'm good on hot dogs
for the rest of my life.

Wait, didn't I just see you
eating a doughnut?

Don't judge.

Stay here for a sec.

- Transport ambulance is here.
- Thanks, Princess.

This is a 200-milligram MS Contin.

This will give you 12 hours of relief.

- OK.
- Mm.

Yes.

Whenever you're ready, Rox.

Hey, guys, this is Roxie Hamler.

Hello, ma'am.

- Easy on the transfer, guys.
- Yeah.

OK, on my count.

No, no, no. This isn't gonna work out.

I'm sorry.

I can't... I can't...

I can't... I can't do this.

- It's OK.
- I want to stay.

Please.

It's OK.

Can I assume that you've
already called upstairs

to get Gus Varney a bed?

Do you want to tell me what you did?

I don't know what you're talking about.

His pulse ox was steady.
We were about to discharge him.

Did Dr. Al-Hashimi put you up to that?

Al-Hashimi? No.

You know he's gonna go back to prison

after they discharge him upstairs.

I thought you didn't
go the extra distance

for your patients anymore.

- It's Emma, right?
- Yeah.

How's your first day going?

Good, I think.

Haven't killed anyone yet.

- I'm sorry. I...
- It's OK.

I guess time will tell
if I'm cut out for this.

Well, when in doubt,
stick with her, kid.

She scares me.

No, that's just a...
it's a tough exterior.

She's warm and gooey on the inside.

Looks like they're doing
the debrief for Louie.

- You coming?
- I paid my respects.

Besides, who's gonna hold down the fort?

Remember the day you found
him passed out in the park?

Sure do.

I had to drag his ass over here.

Came in soaked to the bone.

You saved his life.

How about last summer when
we didn't see him for months?

He said he finally quit drinking,

- so he didn't need to come in.
- Mm-hmm.

How many times did he say
he was gonna quit drinking?

Mm-hmm.

He always asked about Harrison.

- Always said thank you.
- Mm-hmm.

Found this with his stuff.

Who knew he was married?

Hmm.

That's Rhonda, Louie's wife.

High school sweetheart.

About five years ago,
I was covering a night shift.

He came in feeling talkative.

Born and raised in Pittsburgh.

Lifelong Steelers fan.

Groundskeeper at Three Rivers Stadium

until 1998.

He never really wanted kids,

but Rhonda wore him down,

and when she finally got pregnant,

he changed his tune, he got excited.

And then about a month
before the baby was due,

Rhonda and the baby
were killed in a car crash.

Louie never really came back from that.

May his memory be a blessing.

- Amen.
- May his memory be a blessing.

Yep.

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