1 00:00:23,523 --> 00:00:25,442 Robby. 2 00:00:28,778 --> 00:00:30,280 Robby. 3 00:00:30,363 --> 00:00:31,906 College kid in respiratory distress is here. 4 00:00:31,990 --> 00:00:33,324 - All right. - You OK? 5 00:00:33,408 --> 00:00:35,076 Yep. 6 00:00:35,160 --> 00:00:37,120 I wanted to talk to the patient in Central 12's son, 7 00:00:37,203 --> 00:00:38,329 but he took off. 8 00:00:38,413 --> 00:00:39,414 Is there a problem? 9 00:00:39,497 --> 00:00:40,749 Uh, according to Mom, 10 00:00:40,832 --> 00:00:41,833 she found a list of high school girls 11 00:00:41,916 --> 00:00:44,878 that he'd like to eliminate. 12 00:00:44,961 --> 00:00:47,005 What's wrong with kids these days? 13 00:00:47,088 --> 00:00:48,923 Uh, you mean besides social media 14 00:00:49,007 --> 00:00:51,676 and the worldwide pandemic and the environmental crisis? 15 00:00:51,760 --> 00:00:53,470 - Yeah, yeah, yeah. - And gun violence? 16 00:00:53,553 --> 00:00:55,180 You're a fucking fountain of hope today, aren't you? 17 00:00:55,263 --> 00:00:57,932 Nick Bradley, 19, found unresponsive by parents. 18 00:00:58,016 --> 00:00:59,351 No meds, no allergies. 19 00:00:59,434 --> 00:01:00,935 On arrival, he was barely breathing 20 00:01:01,019 --> 00:01:03,271 with pinpoint pupils, bradycardic at 38. 21 00:01:03,355 --> 00:01:04,981 Pupils responded to Narcan, 22 00:01:05,065 --> 00:01:07,567 but we tubed him when his respirations didn't pick up. 23 00:01:07,650 --> 00:01:09,569 Any drugs or alcohol on the scene? 24 00:01:09,652 --> 00:01:11,112 - No. - Signs of trauma? 25 00:01:11,196 --> 00:01:12,364 Nothing. 26 00:01:12,447 --> 00:01:14,032 OK. Open your eyes, Nick. 27 00:01:14,115 --> 00:01:16,493 On three. One, two, three. 28 00:01:18,411 --> 00:01:21,664 - Where was he found? - In bed by his mom. 29 00:01:21,748 --> 00:01:26,169 Pupils are 6 millimeters, non-reactive. 30 00:01:26,252 --> 00:01:28,672 Heart rate's 64. BP is cycling. 31 00:01:28,755 --> 00:01:31,466 No response to pain. GCS 3. 32 00:01:31,549 --> 00:01:34,010 - Does that fit any toxidrome? - No. 33 00:01:34,094 --> 00:01:36,471 If it was just opiates with Narcan, 34 00:01:36,554 --> 00:01:38,807 he'd be breathing on his own. 35 00:01:38,890 --> 00:01:41,017 Uh, beta blockers shouldn't get pinpoint pupils. 36 00:01:41,101 --> 00:01:42,519 Maybe parents had some 37 00:01:42,602 --> 00:01:43,603 prescription meds in their bathroom. 38 00:01:43,687 --> 00:01:45,271 They're on their way. 39 00:01:45,355 --> 00:01:47,399 Code trauma, tier 1, ETA five minutes. 40 00:01:47,482 --> 00:01:49,734 That's a stand-up scooter rider versus car door. 41 00:01:49,818 --> 00:01:51,986 - No helmet. - No blood in the belly. 42 00:01:52,070 --> 00:01:57,117 No pericardial effusion, and lungs are up. 43 00:01:57,200 --> 00:01:58,993 Hemocue's good, 15. 44 00:01:59,077 --> 00:02:01,830 - BP 84 over 58. - OK. 45 00:02:01,913 --> 00:02:03,790 What's your plan, Dr. Collins? 46 00:02:03,873 --> 00:02:07,752 Um, push dose epi, 0.1 milligram. 47 00:02:07,836 --> 00:02:10,171 Foley for urine, stabilize for CT, 48 00:02:10,255 --> 00:02:13,425 and throw a wide net. 49 00:02:17,554 --> 00:02:18,847 Where-- where are we going now? 50 00:02:18,930 --> 00:02:20,682 We need the room for someone else, 51 00:02:20,765 --> 00:02:23,685 but you can rest in the hall till we get your labs back. 52 00:02:25,353 --> 00:02:27,856 Your parents must be proud. 53 00:02:27,939 --> 00:02:30,066 Having a son for a doctor. 54 00:02:30,150 --> 00:02:32,736 Yeah, I guess. 55 00:02:32,819 --> 00:02:34,446 Um, you know, 56 00:02:34,529 --> 00:02:38,533 I was the first one in my family to go to college. 57 00:02:38,616 --> 00:02:42,370 You know, they sacrificed a lot to get me here. 58 00:02:42,454 --> 00:02:43,955 How's your pain, Mr. Milton? 59 00:02:44,039 --> 00:02:45,415 Uh, I'm fine. 60 00:02:45,498 --> 00:02:47,000 Could use a latte, though. 61 00:02:47,083 --> 00:02:49,252 That could bring back the gallstone pain. 62 00:02:49,336 --> 00:02:50,754 How about a bourbon? 63 00:02:50,837 --> 00:02:52,464 It's barely 8:00. 64 00:02:52,547 --> 00:02:54,799 Uh, how about some ice chips? 65 00:02:54,883 --> 00:02:56,801 No, thanks. 66 00:02:56,885 --> 00:02:58,595 I prefer my whiskey neat. 67 00:02:58,678 --> 00:03:00,013 Yeah, that's not happening. 68 00:03:04,768 --> 00:03:07,479 Systolic back down to 90. 69 00:03:07,562 --> 00:03:09,481 Another 0.1 of epi. 70 00:03:09,564 --> 00:03:13,234 Flaccid paralysis of all four extremities. 71 00:03:13,318 --> 00:03:16,112 No eye movement with ice water. 72 00:03:16,196 --> 00:03:17,697 So no brainstem function. 73 00:03:17,781 --> 00:03:19,074 Due to? 74 00:03:19,157 --> 00:03:21,534 Hypoxic injury, massive hemorrhage. 75 00:03:21,618 --> 00:03:23,745 Samira, escort him to CT. 76 00:03:23,828 --> 00:03:25,789 Take the drug box with you. 77 00:03:25,872 --> 00:03:27,332 Call me if you need me. 78 00:03:27,415 --> 00:03:29,876 Hey, are you OK? 79 00:03:29,959 --> 00:03:31,628 - Yep. - Are you sure? 80 00:03:31,711 --> 00:03:33,922 Have you ever had to worry about me? 81 00:03:34,005 --> 00:03:36,257 No, but it never hurts to check in. 82 00:03:36,341 --> 00:03:38,093 It's part of my job. 83 00:03:38,176 --> 00:03:40,428 Consider yourself checked in. 84 00:03:40,512 --> 00:03:41,930 OK. 85 00:03:42,972 --> 00:03:45,308 Ah, ah, ah, ah, ah. 86 00:03:45,392 --> 00:03:46,601 Got something? 87 00:03:46,685 --> 00:03:48,228 Oh, I had a case for Dr. Collins. 88 00:03:48,311 --> 00:03:50,605 - May I see? - Yeah. 89 00:03:50,689 --> 00:03:53,900 A 68-year-old male, history of hypertension, 90 00:03:53,983 --> 00:03:55,610 one hour of right upper quadrant pain 91 00:03:55,694 --> 00:03:57,862 after eating a fatty meal, now resolved. 92 00:03:57,946 --> 00:03:59,280 Afebrile, non-tender. 93 00:03:59,364 --> 00:04:01,199 There was a gallstone present on POCUS. 94 00:04:01,282 --> 00:04:03,702 EKG shows no acute ischemic changes, 95 00:04:03,785 --> 00:04:05,995 but I'm still waiting on LFTs and lipase. 96 00:04:06,079 --> 00:04:08,498 Why did you order the EKG? 97 00:04:08,581 --> 00:04:11,751 The nurse suggested it to rule out any cardiac issues. 98 00:04:11,835 --> 00:04:14,295 Well, good call on both your parts. 99 00:04:14,379 --> 00:04:15,630 Nurses know what they're doing. 100 00:04:15,714 --> 00:04:17,090 Never hesitate to listen to them. 101 00:04:17,173 --> 00:04:18,675 Come find me when those labs are back. 102 00:04:18,758 --> 00:04:20,135 - Hey, how's that finger? - Oh, it's nothing. 103 00:04:20,218 --> 00:04:21,594 - Dr. Robby? - Yep? 104 00:04:21,678 --> 00:04:23,013 The son and daughter of Mr. Spencer 105 00:04:23,096 --> 00:04:24,597 from assisted living, they're here. 106 00:04:24,681 --> 00:04:26,850 OK. I'll be right there. 107 00:04:33,732 --> 00:04:36,860 Your father has pneumonia and a condition called sepsis. 108 00:04:36,943 --> 00:04:38,778 What is-- what is that exactly? 109 00:04:38,862 --> 00:04:41,114 It means that the bacteria has spread from his lung 110 00:04:41,197 --> 00:04:42,699 to his bloodstream. 111 00:04:42,782 --> 00:04:45,243 So far, he's been responding well to treatment. 112 00:04:45,326 --> 00:04:47,662 Hey, Pop. 113 00:04:47,746 --> 00:04:49,956 It's Helen and Jereme. 114 00:04:51,833 --> 00:04:54,169 Jereme... 115 00:04:54,252 --> 00:04:56,004 Hillary... 116 00:04:56,087 --> 00:04:57,213 Boob... 117 00:04:57,297 --> 00:04:58,923 Fud. 118 00:05:00,925 --> 00:05:03,803 It's the "Nowhere Man" from "Yellow Submarine." 119 00:05:03,887 --> 00:05:06,139 It's what he used to call me when I didn't do my homework. 120 00:05:06,222 --> 00:05:07,932 Is this his baseline? 121 00:05:08,016 --> 00:05:10,143 He has good days and bad days. 122 00:05:11,686 --> 00:05:13,855 Why don't we step out for one more second? 123 00:05:18,485 --> 00:05:20,653 So your father came in with low blood pressure, 124 00:05:20,737 --> 00:05:21,988 which is improving. 125 00:05:22,072 --> 00:05:23,615 Can he go back to assisted living? 126 00:05:23,698 --> 00:05:25,450 Eventually, we hope so. 127 00:05:25,533 --> 00:05:27,243 Your dad has an advanced directive 128 00:05:27,327 --> 00:05:28,953 expressing his wishes, which says that 129 00:05:29,037 --> 00:05:31,289 IV fluids and medications are OK, 130 00:05:31,373 --> 00:05:33,750 but no artificial life support, no CPR. 131 00:05:33,833 --> 00:05:36,544 He doesn't want a bunch of machines keeping him alive. 132 00:05:36,628 --> 00:05:38,213 OK. 133 00:05:38,296 --> 00:05:40,006 Then we will continue with oxygen 134 00:05:40,090 --> 00:05:42,509 and IV fluids and antibiotics, 135 00:05:42,592 --> 00:05:44,177 but if his lungs stop working, 136 00:05:44,260 --> 00:05:45,637 we're not going to place a tube in his windpipe 137 00:05:45,720 --> 00:05:46,763 for a breathing machine. 138 00:05:46,846 --> 00:05:49,224 But pneumonia is treatable? 139 00:05:49,307 --> 00:05:51,976 Most of the time, it is. 140 00:05:52,060 --> 00:05:53,019 But if he can get better in a week, 141 00:05:53,103 --> 00:05:54,270 then put him on a machine. 142 00:05:54,354 --> 00:05:56,106 That's not what he wanted. 143 00:05:56,189 --> 00:05:58,108 Do either of you have durable power of attorney 144 00:05:58,191 --> 00:05:59,693 for health care? 145 00:05:59,776 --> 00:06:00,944 - Yes. - We both do. 146 00:06:01,027 --> 00:06:02,112 OK. 147 00:06:02,195 --> 00:06:03,613 Well, this is a decision 148 00:06:03,697 --> 00:06:04,989 that does not need to be made right now. 149 00:06:05,073 --> 00:06:06,533 Why don't you think about it? 150 00:06:06,616 --> 00:06:08,076 Talk about it. 151 00:06:08,159 --> 00:06:11,955 If things get worse, sometimes allowing 152 00:06:12,038 --> 00:06:15,000 for a comfortable natural death can be the most humane path. 153 00:06:18,420 --> 00:06:21,256 No routine cases until we assess the tier 1. 154 00:06:21,339 --> 00:06:22,257 Thanks. 155 00:06:22,340 --> 00:06:24,843 Dr. Langdon? 156 00:06:24,926 --> 00:06:27,971 So, uh, how was the VA? 157 00:06:28,054 --> 00:06:30,724 Yeah, it was, uh good, uh, you know, challenging. 158 00:06:30,807 --> 00:06:33,351 I learned a ton. I just think it-- 159 00:06:33,435 --> 00:06:34,686 maybe it should be mandatory 160 00:06:34,769 --> 00:06:35,729 that all doctors spend time there, 161 00:06:35,812 --> 00:06:37,230 like, on a regular basis 162 00:06:37,313 --> 00:06:39,232 because of all they've sacrificed for us. 163 00:06:39,315 --> 00:06:41,985 That's a nice thought. Why'd you choose the Pitt? 164 00:06:42,068 --> 00:06:43,445 Oh, I have a sister with special needs 165 00:06:43,528 --> 00:06:45,071 and she got into this really great facility 166 00:06:45,155 --> 00:06:46,448 here in Pittsburgh. 167 00:06:46,531 --> 00:06:48,158 And PTMC has such a great reputation, 168 00:06:48,241 --> 00:06:49,993 I thought, you know, it'd be a good fit. 169 00:06:50,076 --> 00:06:51,077 Can I present my headache to you? 170 00:06:51,161 --> 00:06:52,620 Uh, yeah, what do you got? 171 00:06:52,704 --> 00:06:54,497 A 36-year-old woman with severe headache 172 00:06:54,581 --> 00:06:56,332 due to paracervical trigger point. 173 00:06:56,416 --> 00:06:59,044 Her pain went from 11 to zero after 2 ccs of IM Marcaine 174 00:06:59,127 --> 00:07:00,337 - to the-- - Wait, wait, wait. 175 00:07:00,420 --> 00:07:01,838 You did a trigger point injection 176 00:07:01,921 --> 00:07:03,548 - before presenting the case? - Yeah. I-- 177 00:07:03,631 --> 00:07:05,800 Interns always present first. 178 00:07:05,884 --> 00:07:07,093 I spent a month at the pain clinic at Hopkins. 179 00:07:07,177 --> 00:07:08,845 - No, it's not OK. - Incoming! 180 00:07:08,928 --> 00:07:10,805 - I'm very comfortable with-- - It's definitely not OK. 181 00:07:10,889 --> 00:07:12,599 23-year-old Ben Kemper, no helmet, 182 00:07:12,682 --> 00:07:14,434 got doored riding an e-scooter. 183 00:07:14,517 --> 00:07:16,436 Neck versus handlebar then face-planted to the pavement. 184 00:07:16,519 --> 00:07:18,021 Obvious facial fractures, 185 00:07:18,104 --> 00:07:19,981 but alert and oriented with good vitals. 186 00:07:22,359 --> 00:07:23,693 Here we go. 187 00:07:25,320 --> 00:07:27,530 One, two, three. 188 00:07:29,949 --> 00:07:31,242 How are we doing, Ben? 189 00:07:31,326 --> 00:07:33,620 Blood, back in my throat. 190 00:07:33,703 --> 00:07:35,413 That's probably from the nosebleed. 191 00:07:35,497 --> 00:07:37,290 Short Rapid Rhino, please. 192 00:07:37,374 --> 00:07:40,502 Tachy at 120, pulse ox borderline at 90. 193 00:07:40,585 --> 00:07:41,878 Blow by at 15 liters for now. 194 00:07:41,961 --> 00:07:43,463 - Neck contusion. - BP 138 over 84. 195 00:07:43,546 --> 00:07:45,131 Larynx shifted to the right, no crepitance. 196 00:07:45,215 --> 00:07:47,133 4 of morphine. 197 00:07:47,217 --> 00:07:51,638 I'm going to stick something in your nose to stop the bleeding. 198 00:07:51,721 --> 00:07:53,348 No hemotympanum. 199 00:07:53,431 --> 00:07:56,226 Inflate the balloon. 200 00:07:56,309 --> 00:07:58,687 How about now, Ben? 201 00:07:58,770 --> 00:08:01,189 - Better. - What's up? 202 00:08:01,272 --> 00:08:04,401 Good vitals, A and O, let's have a look. 203 00:08:08,279 --> 00:08:09,614 Ouch. 204 00:08:09,698 --> 00:08:12,325 - Floating face. - Le Fort III fracture. 205 00:08:12,409 --> 00:08:14,744 You don't see that every day. OK, let's prep for airway. 206 00:08:14,828 --> 00:08:17,038 Double setup just in case. 207 00:08:30,885 --> 00:08:34,097 - Nice work. - Thanks. 208 00:08:34,180 --> 00:08:36,182 All right, Mr. Tagari, you are good to go. 209 00:08:36,266 --> 00:08:37,851 Oh, thank you. 210 00:08:37,934 --> 00:08:42,188 Remember, 10% off for doctors and nurses. 211 00:08:42,272 --> 00:08:43,606 I'm a student doctor. 212 00:08:43,690 --> 00:08:45,650 Oh, right. Sorry. 213 00:08:45,734 --> 00:08:48,028 - I hit my head, remember? - Well, my son loves pizza, 214 00:08:48,111 --> 00:08:49,612 so I will take you up on it for sure, OK? 215 00:08:49,696 --> 00:08:50,864 - Thank you. Thank you. - Thank you. 216 00:08:50,947 --> 00:08:52,615 - Wait for a nurse. - OK, thanks. 217 00:08:52,699 --> 00:08:54,576 Hi. 218 00:08:54,659 --> 00:08:57,162 I just realized it sounds like I always feed my kid junk food. 219 00:08:57,245 --> 00:08:58,371 - Oh. - You know? 220 00:08:58,455 --> 00:08:59,914 Pizza, s'mores. 221 00:08:59,998 --> 00:09:02,792 No, no, please. I--I like pizza and s'mores. 222 00:09:02,876 --> 00:09:05,628 - Who doesn't? - Mm. 223 00:09:05,712 --> 00:09:09,174 - How many kids do you have? - Just one, Harrison. 224 00:09:09,257 --> 00:09:11,593 He's 11 now. 225 00:09:11,676 --> 00:09:12,969 What does your husband do? 226 00:09:13,053 --> 00:09:14,929 No husband, just me and my son. 227 00:09:15,013 --> 00:09:16,389 I take it you don't have kids? 228 00:09:16,473 --> 00:09:18,767 I--I don't mean on account of your age. 229 00:09:18,850 --> 00:09:20,393 Or maybe I do. 230 00:09:20,477 --> 00:09:22,354 I mean, most medical students don't have kids. 231 00:09:22,437 --> 00:09:25,940 Oh, yeah, no, no. Um, no kids. 232 00:09:26,024 --> 00:09:29,235 Just not even a boyfriend. Uh, it's just school for now. 233 00:09:29,319 --> 00:09:31,237 Yeah. That'll keep you pretty busy. 234 00:09:31,321 --> 00:09:33,573 I do not miss it. 235 00:09:33,656 --> 00:09:35,867 Must have been difficult as a young mother. 236 00:09:35,950 --> 00:09:37,369 It had its moments, 237 00:09:37,452 --> 00:09:39,079 but my life has been full of challenges, 238 00:09:39,162 --> 00:09:42,374 and med school was not one of the hardest, by far. 239 00:09:42,457 --> 00:09:44,709 It was one of the most rewarding, though. 240 00:09:44,793 --> 00:09:48,463 - Other than having my son. - Hey. 241 00:09:48,546 --> 00:09:50,924 Facial lash with possible foreign object in the eye, 242 00:09:51,007 --> 00:09:54,344 which is always a solid 7 on the WMMV Scale. 243 00:09:54,427 --> 00:09:56,054 What Makes Mateo Vomit. 244 00:09:59,307 --> 00:10:01,976 - You OK? - Yeah. 245 00:10:02,060 --> 00:10:05,563 Yeah. Um, he's funny, the... 246 00:10:05,647 --> 00:10:06,981 - the nurse. - Oh, Mateo. 247 00:10:07,065 --> 00:10:08,692 You can say his name. 248 00:10:09,984 --> 00:10:12,320 Um, yeah, uh... 249 00:10:12,404 --> 00:10:15,490 a foreign object in the eye could be really serious. 250 00:10:22,330 --> 00:10:25,458 Hey, Fruitcake. 251 00:10:25,542 --> 00:10:26,876 Hey, I'm talking to you, Fruitcake. 252 00:10:26,960 --> 00:10:28,628 Myrna, I told you a hundred times 253 00:10:28,712 --> 00:10:31,047 my name is Dr. Robby. 254 00:10:31,131 --> 00:10:33,174 You want to see my vagina? 255 00:10:33,258 --> 00:10:35,260 I have already seen it. 256 00:10:35,343 --> 00:10:38,138 And once was enough, thank you. 257 00:10:38,221 --> 00:10:40,181 Robby, parents of Nick Bradley, 258 00:10:40,265 --> 00:10:42,976 - the OD teen, are here. - OK, park them in Trauma 1. 259 00:10:43,059 --> 00:10:44,769 He's not back from CT yet. 260 00:10:44,853 --> 00:10:46,021 I'll be right there in a minute. 261 00:10:46,104 --> 00:10:47,355 Got it. Behaving yourself, Myrna? 262 00:10:47,439 --> 00:10:49,274 Oh, yes, ma'am. 263 00:10:52,986 --> 00:10:53,987 How we doing? 264 00:10:54,070 --> 00:10:55,071 Ketamine and sux on board. 265 00:10:55,155 --> 00:10:56,781 Pulse ox holding at 94. 266 00:10:56,865 --> 00:10:58,158 Prepping the neck just in case. 267 00:10:58,241 --> 00:10:59,200 Let's have a look. 268 00:11:01,494 --> 00:11:03,455 A little deeper. 269 00:11:03,538 --> 00:11:05,040 Lots of swelling. I can't see the cords. 270 00:11:05,123 --> 00:11:07,584 To the right. The left. 271 00:11:07,667 --> 00:11:09,127 Yeah, it really distorted from the trauma, 272 00:11:09,210 --> 00:11:10,295 and the edema's only going to get worse. 273 00:11:10,378 --> 00:11:11,713 Which is why we should crike. 274 00:11:11,796 --> 00:11:13,506 You don't crike a laryngeal fracture. 275 00:11:13,590 --> 00:11:14,758 Don't listen to Edwina Scissorhands here. 276 00:11:14,841 --> 00:11:16,176 If they can't cut it, 277 00:11:16,259 --> 00:11:17,802 surgery doesn't know how to fix it. 278 00:11:17,886 --> 00:11:19,471 The contusion is high at the thyroid cartilage, 279 00:11:19,554 --> 00:11:21,097 so you just stand there looking pretty, ER Ken, 280 00:11:21,181 --> 00:11:23,558 and let me fix this. 281 00:11:23,641 --> 00:11:24,976 - We're down to 85. - All right, pull out. 282 00:11:25,060 --> 00:11:27,228 - I-gel, bag and crike. - I-gel, please. 283 00:11:27,312 --> 00:11:28,521 Turn off the alarm. 284 00:11:28,605 --> 00:11:29,606 I've never done a crike before. 285 00:11:29,689 --> 00:11:30,982 No. Mel will do the crike. 286 00:11:31,066 --> 00:11:32,108 You've already had a busy morning. 287 00:11:32,192 --> 00:11:33,485 Glove up, Mel. 288 00:11:33,568 --> 00:11:34,986 No, I'm doing the crike, doctor. 289 00:11:35,070 --> 00:11:35,987 You would be doing it, doctor, 290 00:11:36,071 --> 00:11:37,447 if it wasn't an odd day. 291 00:11:37,530 --> 00:11:38,698 Surgery gets even days, ED gets odd days. 292 00:11:38,782 --> 00:11:40,408 You know this. For crikes' sake. 293 00:11:40,492 --> 00:11:42,077 That's because you're all fucking odd down here. 294 00:11:42,160 --> 00:11:43,870 OK, team work, please. Let's focus on the patient. 295 00:11:43,953 --> 00:11:45,872 I so appreciate your gracious understanding. 296 00:11:45,955 --> 00:11:47,582 I'll assist in case she screws up. 297 00:11:47,665 --> 00:11:49,668 Yolanda, play nice. 298 00:11:49,751 --> 00:11:51,211 Sats are up with the I-gel. 299 00:11:51,294 --> 00:11:53,630 You ready? Hello? 300 00:11:53,713 --> 00:11:55,423 Oh, uh, hello. 301 00:11:55,507 --> 00:11:56,925 You've done this? 302 00:11:57,008 --> 00:12:00,470 Yes, in the cadaver lab. 303 00:12:00,553 --> 00:12:03,515 Let's hope that's not where this poor soul ends up. 304 00:12:03,598 --> 00:12:05,392 We'll do an open technique since we have a minute. 305 00:12:05,475 --> 00:12:07,560 OK. 306 00:12:07,644 --> 00:12:09,604 OK, you're going to be making a vertical incision 307 00:12:09,688 --> 00:12:12,190 to avoid the jugulars in the carotids. 308 00:12:13,692 --> 00:12:15,402 Mm-hmm, good. 309 00:12:15,485 --> 00:12:17,070 If this was a crike that needed to happen in seconds, 310 00:12:17,153 --> 00:12:20,073 you could use a 10 blade, your finger, and a bougie. 311 00:12:23,493 --> 00:12:24,994 This is called a Weitlaner. 312 00:12:25,078 --> 00:12:27,455 And this is your trake hook. 313 00:12:27,539 --> 00:12:31,334 C-spine, head CT, OMF. Start a propofol drip. 314 00:12:31,418 --> 00:12:33,044 OK, now we're going to make a horizontal incision 315 00:12:33,128 --> 00:12:35,130 across the cricothyroid membrane. 316 00:12:37,549 --> 00:12:39,676 Yeah. 317 00:12:39,759 --> 00:12:41,678 4.0 Shiley next. 318 00:12:41,761 --> 00:12:42,929 Get ready to bag the crike. 319 00:12:44,764 --> 00:12:46,850 Yeah, yeah, yeah, good. 320 00:12:54,149 --> 00:12:55,066 Oh, excuse me. 321 00:12:55,150 --> 00:12:57,235 No worries. 322 00:12:57,318 --> 00:12:58,528 End tidal CO2 is yellow. 323 00:12:58,611 --> 00:13:00,113 Yellow is yes. Nicely done. 324 00:13:00,196 --> 00:13:03,158 Sew it in. OK, I will be next-door. 325 00:13:04,909 --> 00:13:06,161 Does your resident know how to suture, 326 00:13:06,244 --> 00:13:07,579 or do I need to teach? 327 00:13:07,662 --> 00:13:10,623 - You're all class, Yoyo. - I know, thanks. 328 00:13:10,707 --> 00:13:13,084 That means a lot of nothing coming from you. 329 00:13:13,168 --> 00:13:15,587 - Mel, you OK? - If you're done fighting. 330 00:13:15,670 --> 00:13:17,088 We're not fighting. This is playing. 331 00:13:17,172 --> 00:13:18,882 Langdon's too soft to fight. 332 00:13:18,965 --> 00:13:20,884 Oh, yeah, I have nothing but respect for Dr. Garcia. 333 00:13:20,967 --> 00:13:22,344 In fact, I think she would 334 00:13:22,427 --> 00:13:24,220 make a wonderful hostess at Applebee's. 335 00:13:24,304 --> 00:13:25,722 Later, Odds. 336 00:13:28,058 --> 00:13:29,851 Let's go. 337 00:13:29,934 --> 00:13:31,519 OK, thanks. 338 00:13:31,603 --> 00:13:33,980 Just received word your son's head CT is normal, 339 00:13:34,064 --> 00:13:35,815 and he's maintaining a good heart rate. 340 00:13:35,899 --> 00:13:38,026 - You got him back. - Thank you. Thank God. 341 00:13:38,109 --> 00:13:39,486 Right now, he's unconscious 342 00:13:39,569 --> 00:13:42,739 with a tube in his throat for oxygen. 343 00:13:42,822 --> 00:13:44,240 Why don't we step out for a minute while they 344 00:13:44,324 --> 00:13:45,825 get him settled, and then you can come back? 345 00:13:45,909 --> 00:13:48,286 You can sit with him as long as you want. 346 00:13:48,370 --> 00:13:50,747 Nicky, it's Mama. I'm here, baby. 347 00:13:50,830 --> 00:13:53,208 You're doing great, son. 348 00:13:53,291 --> 00:13:56,086 Blown. 349 00:13:56,169 --> 00:13:59,506 - OK, let's step outside. - OK. 350 00:14:05,679 --> 00:14:07,555 So we don't know 351 00:14:07,639 --> 00:14:09,599 how long he was at home without breathing. 352 00:14:09,683 --> 00:14:12,811 - He's breathing now. - Not on his own. 353 00:14:12,894 --> 00:14:14,104 But he's going to wake up. 354 00:14:14,187 --> 00:14:15,855 We certainly hope so. 355 00:14:15,939 --> 00:14:17,148 We're going to know better after 356 00:14:17,232 --> 00:14:18,608 we get some more test results back. 357 00:14:18,692 --> 00:14:21,361 Are you sure that he didn't take anything 358 00:14:21,444 --> 00:14:22,445 that could have caused this? 359 00:14:22,529 --> 00:14:24,197 No, no, he's a good kid. 360 00:14:24,280 --> 00:14:26,449 He's in college, he has a part-time job. 361 00:14:26,533 --> 00:14:29,744 He even chose to live at home so he could focus on school. 362 00:14:29,828 --> 00:14:31,621 Dr. Robby. From the urine. 363 00:14:31,705 --> 00:14:34,124 What's that? 364 00:14:34,207 --> 00:14:35,458 It's a drug test. 365 00:14:35,542 --> 00:14:38,086 And it is positive for fentanyl. 366 00:14:38,169 --> 00:14:40,839 No, that is impossible. Nick doesn't do drugs. 367 00:14:40,922 --> 00:14:43,174 There are a lot of pills that are sold illegally 368 00:14:43,258 --> 00:14:45,385 that have fentanyl, not just painkillers. 369 00:14:45,468 --> 00:14:47,095 Xanax, Ativan. 370 00:14:47,178 --> 00:14:49,597 - No, not our son. - Uh-- 371 00:14:49,681 --> 00:14:51,224 Well, maybe he didn't know that he took something 372 00:14:51,307 --> 00:14:52,767 with fentanyl, I don't know. 373 00:14:52,851 --> 00:14:55,020 The hows and the whys don't really matter. 374 00:14:55,103 --> 00:14:56,980 What matters is spending time with Nick. 375 00:14:57,063 --> 00:14:58,356 We've got some more tests to run. 376 00:14:58,440 --> 00:14:59,441 We'll know our options after that, 377 00:14:59,524 --> 00:15:00,817 but in the meantime, 378 00:15:00,900 --> 00:15:02,736 why don't you take a seat and talk to him? 379 00:15:05,280 --> 00:15:06,531 Can he hear us? 380 00:15:06,614 --> 00:15:07,866 You know, we're never really sure, 381 00:15:07,949 --> 00:15:09,826 so we should assume that he can. 382 00:15:09,909 --> 00:15:12,203 And we'll come find you as soon as we know more, OK? 383 00:15:12,287 --> 00:15:13,204 OK. 384 00:15:19,794 --> 00:15:21,921 Can we move Nick Bradley to a private room? 385 00:15:22,005 --> 00:15:23,465 The kid going to make it? 386 00:15:24,966 --> 00:15:26,760 Didn't he respond to Narcan? 387 00:15:26,843 --> 00:15:28,803 I think his pinpoint pupils just grew into blown pupils 388 00:15:28,887 --> 00:15:29,929 from brainstem death. 389 00:15:30,013 --> 00:15:33,266 - Shit. - Yeah. 390 00:15:33,350 --> 00:15:35,810 Not much older than Jake. 391 00:15:35,894 --> 00:15:37,145 Don't go there. 392 00:15:38,646 --> 00:15:41,232 Hard not to sometimes. 393 00:15:41,316 --> 00:15:43,401 Mr. Spencer's room. 394 00:15:43,485 --> 00:15:45,195 Hey, Robby, 395 00:15:45,278 --> 00:15:47,405 Theresa, the mother of the young man David who bolted, 396 00:15:47,489 --> 00:15:48,740 she's asking for her son. 397 00:15:48,823 --> 00:15:50,241 OK. I'll be there in a minute. 398 00:15:50,325 --> 00:15:51,701 What is happening? 399 00:15:51,785 --> 00:15:54,537 Uh, his oxygen levels are dropping. 400 00:15:54,621 --> 00:15:56,831 Mr. Spencer, how are you feeling? 401 00:15:56,915 --> 00:15:59,376 I don't remember where I parked. 402 00:15:59,459 --> 00:16:01,336 Mr. Spencer, do you know where you are? 403 00:16:01,419 --> 00:16:03,755 It's so loud in here. 404 00:16:03,838 --> 00:16:06,257 Dad? Do you know where you are? 405 00:16:06,341 --> 00:16:08,677 Dad, look at me. What's my name? 406 00:16:08,760 --> 00:16:12,806 I don't know where my car is. 407 00:16:12,889 --> 00:16:14,516 BiPAP, 15 over 5. 408 00:16:14,599 --> 00:16:15,850 Let's step out. 409 00:16:20,188 --> 00:16:21,981 What's a BiPAP? 410 00:16:22,065 --> 00:16:25,318 It is a pressurized air mask that can improve his oxygen. 411 00:16:25,402 --> 00:16:26,778 Either his pneumonia is getting worse 412 00:16:26,861 --> 00:16:28,780 or his heart couldn't handle the fluids 413 00:16:28,863 --> 00:16:30,573 that we gave him to treat the sepsis. 414 00:16:30,657 --> 00:16:32,075 His lungs are filling up with fluid. 415 00:16:32,158 --> 00:16:33,535 Can't you take the fluid away? 416 00:16:33,618 --> 00:16:35,370 Not without his blood pressure crashing 417 00:16:35,453 --> 00:16:36,663 with very bad consequences, 418 00:16:36,746 --> 00:16:38,790 so let's just hope the BiPAP works. 419 00:16:38,873 --> 00:16:40,792 And if it doesn't? 420 00:16:40,875 --> 00:16:43,211 Then I would need to know your decision 421 00:16:43,294 --> 00:16:44,629 about using a breathing machine. 422 00:16:44,713 --> 00:16:46,631 We're still talking about it. 423 00:16:46,715 --> 00:16:48,925 Well, we know he expressed his wishes. 424 00:16:49,009 --> 00:16:51,011 In writing. "Do not intubate." 425 00:16:51,094 --> 00:16:54,097 We're thinking try it for a week. 426 00:16:54,180 --> 00:16:57,392 That would be a very painful week. 427 00:16:57,475 --> 00:17:00,145 He wouldn't get a lot of rest with all the monitors 428 00:17:00,228 --> 00:17:02,355 and all the blood tests. He might need to be sedated. 429 00:17:02,439 --> 00:17:03,857 He might need to be restrained 430 00:17:03,940 --> 00:17:05,942 because he'd be in an unfamiliar place 431 00:17:06,026 --> 00:17:08,570 with a very uncomfortable tube down his throat. 432 00:17:08,653 --> 00:17:10,905 And he wouldn't really know what was happening. 433 00:17:10,989 --> 00:17:14,409 Elderly patients can often develop psychosis. 434 00:17:14,492 --> 00:17:17,704 - But he might get better. - Or he might get worse. 435 00:17:17,787 --> 00:17:19,956 What would you do? 436 00:17:20,040 --> 00:17:21,708 I really can't answer that for you. 437 00:17:21,791 --> 00:17:23,251 This is your father. It's your decision to make. 438 00:17:23,335 --> 00:17:24,919 I can guarantee you 439 00:17:25,003 --> 00:17:26,755 that we will keep him as comfortable as possible 440 00:17:26,838 --> 00:17:28,590 if a natural death is what you choose. 441 00:17:28,673 --> 00:17:30,342 But he's not your father. 442 00:17:30,425 --> 00:17:32,093 And he can recover from this. 443 00:17:32,177 --> 00:17:33,803 What my sister means 444 00:17:33,887 --> 00:17:35,847 is that we're still deciding the best thing to do. 445 00:17:38,892 --> 00:17:40,977 Well, the sooner you decide, the better. 446 00:17:41,061 --> 00:17:42,354 I'm really sorry. 447 00:17:42,437 --> 00:17:44,314 I wish there was more that I could do. 448 00:17:44,397 --> 00:17:46,691 I'm not sure that he has that much time left. 449 00:17:53,073 --> 00:17:55,241 Dr. Robby. 450 00:18:01,623 --> 00:18:03,208 You were right. 451 00:18:03,291 --> 00:18:04,834 She can't say whether she was bumped by accident 452 00:18:04,918 --> 00:18:06,670 - or shoved on purpose. - No other witnesses? 453 00:18:06,753 --> 00:18:09,255 No, not really. 454 00:18:09,339 --> 00:18:11,216 We pulled security footage. Maybe we'll find something. 455 00:18:11,299 --> 00:18:13,468 Hopefully she tripped. 456 00:18:13,551 --> 00:18:14,928 I don't mean I hope she tripped. 457 00:18:15,011 --> 00:18:17,430 I mean I hope she wasn't pushed on purpose. 458 00:18:17,514 --> 00:18:19,349 That would this a hate crime. 459 00:18:19,432 --> 00:18:21,893 Yes, ma'am. 460 00:18:21,976 --> 00:18:24,062 - Ma'am? - Doctor. 461 00:18:24,145 --> 00:18:26,231 Sorry. I'm--I'm sorry. 462 00:18:27,399 --> 00:18:28,483 No harm, no foul. 463 00:18:28,566 --> 00:18:32,862 Will you let me know if she says anything else? 464 00:18:34,280 --> 00:18:35,907 Will do. 465 00:18:38,576 --> 00:18:39,869 At the risk of seeming-- 466 00:18:39,953 --> 00:18:41,079 Then you probably shouldn't. 467 00:18:41,162 --> 00:18:43,415 - I just-- - No, trust me. 468 00:18:43,498 --> 00:18:45,166 - How do you know-- - I just know. 469 00:18:45,250 --> 00:18:48,128 - I just wanted-- - I know. 470 00:18:48,211 --> 00:18:51,047 Look, I'll let you know if she says anything else 471 00:18:51,131 --> 00:18:53,800 that could be important to your investigation. 472 00:18:57,429 --> 00:18:59,305 Thank you. 473 00:18:59,389 --> 00:19:02,267 - You know, for the record-- - Nope. 474 00:19:12,318 --> 00:19:15,238 Any luck getting our psych boarders upstairs? 475 00:19:15,321 --> 00:19:18,575 Yeah, right, at least the Kraken's still sleeping. 476 00:19:20,076 --> 00:19:21,202 Is it me or was that officer-- 477 00:19:21,286 --> 00:19:23,246 - No. - What? 478 00:19:23,329 --> 00:19:26,541 - You don't even know what I-- - What you were going to say? 479 00:19:26,624 --> 00:19:29,586 Maybe you do. 480 00:19:29,669 --> 00:19:31,546 - He seemed nice. - Absolutely not. 481 00:19:31,629 --> 00:19:33,423 Mm-mm. 482 00:19:33,506 --> 00:19:34,966 There is no possible scenario 483 00:19:35,050 --> 00:19:37,385 in which you and I have this conversation. 484 00:19:37,469 --> 00:19:39,262 You of all people should know better. 485 00:19:39,346 --> 00:19:42,015 - I was-- - No. 486 00:19:42,098 --> 00:19:43,641 Just walk away. 487 00:19:43,725 --> 00:19:46,811 Best possible scenario. Just keep on walking. 488 00:19:46,895 --> 00:19:48,646 Mm-hmm. 489 00:19:48,730 --> 00:19:51,566 You got to lay off mixing Adderall and energy drinks. 490 00:19:51,649 --> 00:19:52,901 Trust me, I will. 491 00:19:52,984 --> 00:19:55,028 All right. Thanks. 492 00:19:56,363 --> 00:19:57,781 That's the thing about emergency medicine. 493 00:19:57,864 --> 00:19:59,282 You never know what you're going to get. 494 00:19:59,366 --> 00:20:01,201 And we get everything. 495 00:20:01,284 --> 00:20:02,452 Is that why you chose it? 496 00:20:02,535 --> 00:20:04,162 Maybe a little. 497 00:20:04,245 --> 00:20:05,663 I also get to pick my shifts, 498 00:20:05,747 --> 00:20:08,333 which, for a single mother, is amazing. 499 00:20:08,416 --> 00:20:11,044 But mostly, I just like the people, you know? 500 00:20:11,127 --> 00:20:12,712 They're always there when you need them. 501 00:20:12,796 --> 00:20:14,339 Who wouldn't want to be a part of that, you know? 502 00:20:17,092 --> 00:20:18,968 Fuck off. 503 00:20:25,266 --> 00:20:27,102 This is the monitoring center. 504 00:20:27,185 --> 00:20:29,020 We see that you are not in your inclusion zone. 505 00:20:29,104 --> 00:20:31,064 Do you have permission to be outside this area? 506 00:20:31,147 --> 00:20:33,608 Yes, I am at work. 507 00:20:33,692 --> 00:20:37,445 Just like last time and the time before that. 508 00:20:39,030 --> 00:20:40,156 I'll be right back. 509 00:20:42,283 --> 00:20:44,661 What is the point of this fucking thing 510 00:20:44,744 --> 00:20:46,287 if it doesn't even work? 511 00:20:54,045 --> 00:20:55,422 Sorry. 512 00:20:55,505 --> 00:20:57,424 You're doing great. Take your time. 513 00:20:57,507 --> 00:20:58,466 You OK? 514 00:20:58,550 --> 00:20:59,968 I am--yeah. 515 00:21:00,051 --> 00:21:01,386 I get frustrated when I can't do things, 516 00:21:01,469 --> 00:21:02,887 or at least it looks like it. 517 00:21:02,971 --> 00:21:05,098 Yeah, you and me both. 518 00:21:05,181 --> 00:21:08,435 Thanks, but my frustration manifests itself emotionally, 519 00:21:08,518 --> 00:21:10,311 and then, uh, I get upset, 520 00:21:10,395 --> 00:21:12,147 and then it looks like I can't handle things, 521 00:21:12,230 --> 00:21:14,315 and, you know, then I can't cry in front of the patient 522 00:21:14,399 --> 00:21:15,525 because no one wants to see their doctor cry. 523 00:21:15,608 --> 00:21:17,277 That's just a big red flag. 524 00:21:17,360 --> 00:21:20,530 You just did a perfect crike. You're doing great. 525 00:21:23,700 --> 00:21:25,660 Hey, you! Pasty white! 526 00:21:25,744 --> 00:21:27,120 How about a sandwich? 527 00:21:27,203 --> 00:21:30,415 Uh, what brings you here today, sir? 528 00:21:30,498 --> 00:21:33,293 I'm here for a fucking sandwich. 529 00:21:33,376 --> 00:21:35,045 OK. 530 00:21:35,128 --> 00:21:37,964 OK, uh, excuse me... 531 00:21:38,048 --> 00:21:39,382 - Perlah. - Perlah. 532 00:21:39,466 --> 00:21:41,259 Can this patient get a sandwich? 533 00:21:41,343 --> 00:21:42,719 I already gave you a sandwich, Earl. 534 00:21:42,802 --> 00:21:45,638 I ain't ate this whole week. 535 00:21:45,722 --> 00:21:47,307 Sure. 536 00:21:47,390 --> 00:21:49,142 Give him another sandwich. They're on the food cart. 537 00:21:49,225 --> 00:21:50,352 Just make sure it's not egg salad, 538 00:21:50,435 --> 00:21:51,895 or he'll throw it on the floor. 539 00:21:51,978 --> 00:21:53,772 OK. Good to know. Thanks. 540 00:22:08,328 --> 00:22:09,954 Any quick ones up here? 541 00:22:10,038 --> 00:22:11,748 It's only 8:30, and Robby's already on my case 542 00:22:11,831 --> 00:22:13,708 for being too slow. 543 00:22:13,792 --> 00:22:14,834 I can usually at least make it to lunch 544 00:22:14,918 --> 00:22:16,461 before he starts hounding me. 545 00:22:16,544 --> 00:22:18,338 Cut him a little slack today, OK? 546 00:22:18,421 --> 00:22:20,924 It's the anniversary of Dr. Adamson's death. 547 00:22:21,007 --> 00:22:23,551 That's sad. 548 00:22:23,635 --> 00:22:26,221 But it's still no reason to take it out on me. 549 00:22:26,304 --> 00:22:27,931 I'm just saying. 550 00:22:28,014 --> 00:22:30,475 - Dr. Mohan? - Samira, please. 551 00:22:30,558 --> 00:22:32,477 I just wanted to apologize. 552 00:22:32,560 --> 00:22:35,522 When my phone went off earlier, that was really unprofessional. 553 00:22:35,605 --> 00:22:36,898 Don't sweat it. Trust me. 554 00:22:36,981 --> 00:22:38,274 We need to laugh. 555 00:22:38,358 --> 00:22:39,818 Otherwise, we'd never stop crying. 556 00:22:39,901 --> 00:22:41,152 Thank you. 557 00:22:41,236 --> 00:22:42,570 Besides, with all the craziness 558 00:22:42,654 --> 00:22:43,905 that comes through here every hour, 559 00:22:43,988 --> 00:22:45,699 nobody cares or notices. 560 00:22:45,782 --> 00:22:48,076 Got an unresponsive unhoused man coming in. 561 00:22:48,159 --> 00:22:52,163 Might be a good teaching case, Funky Music. 562 00:22:54,290 --> 00:22:55,625 Let's go. 563 00:22:55,709 --> 00:22:57,002 Caucasian male, 564 00:22:57,085 --> 00:22:58,628 approximately 60 to 70 years old, 565 00:22:58,712 --> 00:23:01,965 found unresponsive. No signs of trauma, no ID. 566 00:23:03,425 --> 00:23:05,093 On three. 567 00:23:05,176 --> 00:23:07,387 One, two, three. 568 00:23:09,681 --> 00:23:12,100 Oof. Did you take anything? 569 00:23:12,183 --> 00:23:13,601 I smell the alcohol from here. 570 00:23:13,685 --> 00:23:14,811 This guy's wearing the spring, summer, 571 00:23:14,894 --> 00:23:15,979 and fall collection. 572 00:23:17,188 --> 00:23:18,356 Oh! Whoa! 573 00:23:18,440 --> 00:23:20,108 - Jesus, uh-- - Oh, oh, oh! 574 00:23:20,191 --> 00:23:21,192 What the-- 575 00:23:21,276 --> 00:23:22,527 Oh! 576 00:23:22,610 --> 00:23:25,196 Uh, what's wrong? What's going on? 577 00:23:25,280 --> 00:23:28,158 Patient tested positive for rats. 578 00:23:28,241 --> 00:23:29,576 No. 579 00:23:29,659 --> 00:23:33,121 If it matters, I only counted three. 580 00:23:33,204 --> 00:23:34,622 Oh, there goes one. 581 00:23:39,169 --> 00:23:41,254 Because your son tested positive for THC, 582 00:23:41,338 --> 00:23:43,423 the psychoactive ingredient in cannabis, 583 00:23:43,506 --> 00:23:45,091 we're going to have to admit him for overnight 584 00:23:45,175 --> 00:23:47,093 observation and monitoring. 585 00:23:47,177 --> 00:23:49,179 And what about his brain? 586 00:23:49,262 --> 00:23:51,598 Is there a chance that much pot is going to do some damage? 587 00:23:51,681 --> 00:23:53,016 He's only four. 588 00:23:53,099 --> 00:23:54,684 The honest answer is we don't know. 589 00:23:54,768 --> 00:23:56,269 There haven't been any long-term studies, 590 00:23:56,353 --> 00:23:58,021 but the fact that this is a one-time occurrence 591 00:23:58,104 --> 00:24:00,231 suggests that there should be no long-term effects. 592 00:24:00,315 --> 00:24:01,941 But you don't know. 593 00:24:02,025 --> 00:24:04,110 So my son could end up with learning disabilities, 594 00:24:04,194 --> 00:24:06,613 psychiatric problems, or even autism because of this. 595 00:24:06,696 --> 00:24:08,406 There's no evidence to suggest any of that. 596 00:24:08,490 --> 00:24:11,159 Hello. I'm Kiara Alfaro. 597 00:24:11,242 --> 00:24:13,078 I'm the department social worker. 598 00:24:13,161 --> 00:24:15,997 Kiara will help you navigate the next steps. 599 00:24:16,081 --> 00:24:17,290 What steps? 600 00:24:17,374 --> 00:24:18,833 Well, a case like this 601 00:24:18,917 --> 00:24:21,878 requires mandatory reporting to child services 602 00:24:21,961 --> 00:24:23,963 - and sometimes law enforcement. - No. 603 00:24:24,047 --> 00:24:25,131 Why--why do you have to involve the police? 604 00:24:25,215 --> 00:24:26,466 It's a controlled substance. 605 00:24:26,549 --> 00:24:28,134 They're not taking my kid away. 606 00:24:28,218 --> 00:24:30,011 - They were pot gummies. - No one's suggesting that. 607 00:24:30,095 --> 00:24:32,138 Well, fuck your suggestions! No one is touching my child! 608 00:24:32,222 --> 00:24:33,640 In fact, we're leaving. 609 00:24:33,723 --> 00:24:35,141 Well you-- no, you can't take your son. 610 00:24:35,225 --> 00:24:36,726 He could stop breathing. He could have a seizure. 611 00:24:36,810 --> 00:24:38,311 - I will observe him at home. - Amanda, please. 612 00:24:38,395 --> 00:24:39,979 - Fuck off, Drew. - Get security. 613 00:24:40,063 --> 00:24:41,356 If you can't cooperate, 614 00:24:41,439 --> 00:24:42,774 I'm going to have to ask you to leave. 615 00:24:42,857 --> 00:24:44,234 Amanda, please. He needs to stay here. 616 00:24:44,317 --> 00:24:45,985 And you need to get a fucking hotel. 617 00:24:46,069 --> 00:24:47,278 Your son can't leave the hospital, 618 00:24:47,362 --> 00:24:48,613 but I can have you removed. 619 00:24:48,697 --> 00:24:49,948 Don't you dare touch me. 620 00:24:50,031 --> 00:24:51,574 Get out! All of you! 621 00:24:51,658 --> 00:24:53,743 Mrs. Jones, I know this is scary and stressful. 622 00:24:53,827 --> 00:24:55,912 Oh, fuck you! Fuck you! This is my son. 623 00:24:55,995 --> 00:24:57,247 My son! And nobody is touching him! 624 00:24:57,330 --> 00:24:58,915 Whoa, whoa, whoa. What's going on? 625 00:24:58,998 --> 00:25:00,333 - How can I help you? - By backing the fuck off! 626 00:25:00,417 --> 00:25:01,918 Mom's worried about a CYF investigation. 627 00:25:02,002 --> 00:25:03,920 - Amanda, just calm down! - OK, OK, OK, enough! 628 00:25:04,004 --> 00:25:05,338 This is a hospital. 629 00:25:05,422 --> 00:25:06,965 This isn't "The Jerry Springer Show." 630 00:25:07,048 --> 00:25:09,426 Ma'am, nobody's trying to take your child, 631 00:25:09,509 --> 00:25:11,136 so why don't you stay here with him 632 00:25:11,219 --> 00:25:12,887 while your husband talks to our social worker outside 633 00:25:12,971 --> 00:25:14,556 and straightens all this out? 634 00:25:14,639 --> 00:25:16,933 Well, I don't want him speaking for me and my son. 635 00:25:17,017 --> 00:25:18,893 Well, it is either you or him. 636 00:25:18,977 --> 00:25:21,896 Your son is not leaving, but you can be escorted out 637 00:25:21,980 --> 00:25:23,982 and even arrested if you refuse to cooperate. 638 00:25:24,065 --> 00:25:25,483 Nobody wants that. 639 00:25:25,567 --> 00:25:27,485 So you tell us. What do you want to do? 640 00:25:30,488 --> 00:25:33,241 - I'm staying with my son. - OK, great. 641 00:25:33,324 --> 00:25:35,076 You do that. 642 00:25:35,160 --> 00:25:37,454 We all on the same page here? 643 00:25:37,537 --> 00:25:38,872 Thank you, Olsen. 644 00:25:38,955 --> 00:25:39,873 - You know where to find me. - You OK? 645 00:25:39,956 --> 00:25:41,666 Yeah, we got this. 646 00:25:41,750 --> 00:25:43,460 - All good. - It's all yours. 647 00:25:43,543 --> 00:25:45,211 Mrs. Jones, we just have a couple things. 648 00:25:48,590 --> 00:25:49,841 Everything all right out there? 649 00:25:49,924 --> 00:25:52,177 Yeah, just another day in paradise. 650 00:25:52,260 --> 00:25:54,095 - How are you feeling? - Better. 651 00:25:54,179 --> 00:25:56,639 - Where's David? - He left. 652 00:25:56,723 --> 00:25:59,517 He said he had to get back to school. 653 00:25:59,601 --> 00:26:01,102 Oh. 654 00:26:01,186 --> 00:26:02,896 Um, maybe you could try calling him, 655 00:26:02,979 --> 00:26:04,105 get him to come back. 656 00:26:06,858 --> 00:26:09,736 What's going to happen to him if I do? 657 00:26:09,819 --> 00:26:11,988 Hopefully he'll be willing to talk to somebody. 658 00:26:12,072 --> 00:26:14,616 - Will you talk to him? - I can try. 659 00:26:14,699 --> 00:26:17,369 I don't think he wanted to talk to me. 660 00:26:17,452 --> 00:26:19,704 Have you shared with anyone 661 00:26:19,788 --> 00:26:21,790 about the writings of his you found? 662 00:26:21,873 --> 00:26:23,583 No. 663 00:26:23,667 --> 00:26:25,293 I didn't know who to tell. 664 00:26:25,377 --> 00:26:27,545 I just don't want to see him get hurt. 665 00:26:27,629 --> 00:26:29,381 Neither do we. 666 00:26:38,765 --> 00:26:40,100 It's just going straight to voicemail. 667 00:26:40,183 --> 00:26:42,185 Maybe if you can text him. 668 00:26:54,531 --> 00:26:56,616 He's not texting back. 669 00:26:56,700 --> 00:26:58,201 Oh, I'm sorry about all this. 670 00:26:58,284 --> 00:26:59,744 It's OK, it's OK. 671 00:26:59,828 --> 00:27:02,956 What are you doing for David is very brave. 672 00:27:03,039 --> 00:27:04,207 I'm his mother. 673 00:27:04,290 --> 00:27:06,334 I'll do anything to protect him. 674 00:27:08,336 --> 00:27:09,587 Do you think he would hurt anyone? 675 00:27:09,671 --> 00:27:11,256 No. 676 00:27:12,966 --> 00:27:16,970 But... 677 00:27:17,053 --> 00:27:20,724 I'm sure a lot of parents felt that way 678 00:27:20,807 --> 00:27:23,685 before their children did unspeakable things. 679 00:27:26,354 --> 00:27:27,772 Does he have any history of violence? 680 00:27:27,856 --> 00:27:29,190 Has he ever been in any trouble? 681 00:27:29,274 --> 00:27:30,650 No, never. 682 00:27:30,734 --> 00:27:33,069 He's very quiet. 683 00:27:33,153 --> 00:27:35,488 And he takes great care of me. 684 00:27:35,572 --> 00:27:40,994 He--he's struggled with his father's death. 685 00:27:41,077 --> 00:27:42,954 We both have. 686 00:27:43,038 --> 00:27:45,248 Flight is ten minutes out with an electrocution. 687 00:27:45,331 --> 00:27:48,335 OK, grab Collins. I'll be right there. 688 00:27:48,418 --> 00:27:49,753 Keep trying to reach him. 689 00:27:49,836 --> 00:27:51,379 If you do, have someone come find me. 690 00:27:51,463 --> 00:27:53,757 - OK? - OK. 691 00:27:53,840 --> 00:27:55,884 - Thank you. - Of course. 692 00:27:55,967 --> 00:27:58,053 - You got some good news for me? - I sure do. 693 00:27:58,136 --> 00:27:59,679 There are two rooms in ICU being cleaned. 694 00:27:59,763 --> 00:28:01,431 - They'll be ready by now. - Great. 695 00:28:01,514 --> 00:28:02,557 And I got bagels in the lounge. 696 00:28:02,640 --> 00:28:04,100 Nice job. Thank you. 697 00:28:06,603 --> 00:28:09,064 - Is it true? - You have to be more specific. 698 00:28:09,147 --> 00:28:10,690 Are there rats in the ED? 699 00:28:10,774 --> 00:28:13,026 Uh, apparently, if somebody already snitched. 700 00:28:13,109 --> 00:28:15,487 Do you know how bad this looks? 701 00:28:15,570 --> 00:28:17,489 One more reason to shutter this place. 702 00:28:17,572 --> 00:28:19,699 Only the emergency department admits rats. 703 00:28:19,783 --> 00:28:21,284 Emergency department would never admit rats, 704 00:28:21,368 --> 00:28:22,869 unless they had the right insurance. 705 00:28:22,952 --> 00:28:24,245 Did you catch any of them? 706 00:28:24,329 --> 00:28:26,039 One, and I charged him for a full visit. 707 00:28:26,122 --> 00:28:27,582 I'm glad you think this is funny. 708 00:28:27,665 --> 00:28:28,750 I'm sorry that you don't. 709 00:28:28,833 --> 00:28:30,543 Did you call an exterminator? 710 00:28:30,627 --> 00:28:32,337 He's waiting on a second opinion. 711 00:28:33,755 --> 00:28:35,548 You're pushing your luck today. 712 00:28:35,632 --> 00:28:36,841 Don't worry. Last I heard, 713 00:28:36,925 --> 00:28:38,218 they were headed for the cafeteria, 714 00:28:38,301 --> 00:28:39,386 so they should be dead within the hour. 715 00:28:39,469 --> 00:28:40,845 OK. 716 00:28:40,929 --> 00:28:43,723 - I'll be here all week. - Or maybe not. 717 00:28:47,435 --> 00:28:49,604 Drug-seeking woman kicked off the city bus 718 00:28:49,688 --> 00:28:50,980 for disrupting and disturbing passengers. 719 00:28:51,064 --> 00:28:52,565 I called 911! 720 00:28:52,649 --> 00:28:54,359 She's been screaming for narcotics nonstop. 721 00:28:54,442 --> 00:28:55,944 We found an empty Percocet bottle filled five days ago. 722 00:28:56,027 --> 00:28:57,112 What are you doing? What are you doing? 723 00:28:57,195 --> 00:28:58,571 She's been uncooperative 724 00:28:58,655 --> 00:28:59,781 and combative since we picked her up. 725 00:28:59,864 --> 00:29:01,199 Get off her. Let her go. 726 00:29:01,282 --> 00:29:02,742 Stop fighting. 727 00:29:02,826 --> 00:29:04,577 Calm the fuck down, or I'm calling the cops. 728 00:29:04,661 --> 00:29:06,287 My meds at home aren't working! 729 00:29:06,371 --> 00:29:08,498 Please, I have sickle cell! 730 00:29:08,581 --> 00:29:10,291 OK, stop. Everybody stop. 731 00:29:10,375 --> 00:29:11,960 Stop! 732 00:29:12,669 --> 00:29:14,295 What's your name? 733 00:29:14,379 --> 00:29:16,548 It's Joyce. It's Joyce St. Claire. 734 00:29:16,631 --> 00:29:18,758 Joyce, is this your sickle cell pain? 735 00:29:18,842 --> 00:29:21,052 - Yes! - 10 milligrams of IV morphine. 736 00:29:21,136 --> 00:29:22,387 - You really want 10? - Yes. 737 00:29:22,470 --> 00:29:23,513 Repeat it in five minutes if needed. 738 00:29:23,596 --> 00:29:24,889 And she needs a Dilaudid drip. 739 00:29:24,973 --> 00:29:25,974 This is a vaso-occlusive crisis! 740 00:29:26,057 --> 00:29:27,142 I'm so sorry this happened. 741 00:29:27,225 --> 00:29:28,768 You're going to be OK now. 742 00:29:28,852 --> 00:29:30,061 You're safe here. 743 00:29:30,145 --> 00:29:31,354 Come on. 744 00:29:31,438 --> 00:29:33,023 You're going to be safe here. I promise. 745 00:29:33,106 --> 00:29:34,858 Just breathe. OK? 746 00:30:00,258 --> 00:30:01,801 Live wire hit his left forearm, 747 00:30:01,885 --> 00:30:03,511 shocked him once for v-fib. 748 00:30:03,595 --> 00:30:05,555 - Was there a power pole down? - No, abandoned factory. 749 00:30:05,638 --> 00:30:06,639 We found bolt cutters at his side. 750 00:30:06,723 --> 00:30:07,891 Got electrocuted. 751 00:30:07,974 --> 00:30:08,933 Was he trying to steal copper? 752 00:30:09,017 --> 00:30:09,934 Most likely. 753 00:30:10,018 --> 00:30:11,811 Powerline fried his arm, 754 00:30:11,895 --> 00:30:14,689 and the current through his whole body stopped his heart. 755 00:30:14,773 --> 00:30:17,359 Ready? 756 00:30:17,442 --> 00:30:19,527 Steady, lift. 757 00:30:21,279 --> 00:30:24,074 Add a myoglobin and a CK to the labs. 758 00:30:24,157 --> 00:30:26,117 Two liters normal saline wide open. 759 00:30:26,201 --> 00:30:27,869 Dr. Santos, what are we worried about? 760 00:30:27,952 --> 00:30:30,830 Um, rhabdomyolysis from tissue damage 761 00:30:30,914 --> 00:30:33,792 can kill the kidneys, ongoing risk of cardiac irritability. 762 00:30:33,875 --> 00:30:35,377 - Excellent. - AP pads in place. 763 00:30:35,460 --> 00:30:37,087 Guy fell off a telephone pole? 764 00:30:37,170 --> 00:30:39,464 - No, he was on a platform. - Boring. 765 00:30:39,547 --> 00:30:42,008 Cut into a live wire. 766 00:30:42,092 --> 00:30:43,677 Tense ventral compartment. 767 00:30:43,760 --> 00:30:45,095 Set up the STIC pressure monitor. 768 00:30:45,178 --> 00:30:46,596 V-fib. 769 00:30:46,680 --> 00:30:48,056 - All right, charge to 300. - Charge to 300. 770 00:30:48,139 --> 00:30:49,265 Am I running this or are you? 771 00:30:49,349 --> 00:30:51,393 - Sorry, reflex response. - Clear. 772 00:30:52,352 --> 00:30:54,145 Ah, fuck! 773 00:30:54,229 --> 00:30:55,605 Sorry. 774 00:30:55,689 --> 00:30:57,107 Sorry. 775 00:30:57,190 --> 00:30:59,693 So what--what happened? 776 00:30:59,776 --> 00:31:02,237 I bought it for my girlfriend's dog. 777 00:31:02,320 --> 00:31:06,282 I work nights, and he yaps all day long. 778 00:31:06,366 --> 00:31:08,993 And when I woke up, I was wearing it. 779 00:31:09,077 --> 00:31:10,537 Stupid bitch! 780 00:31:11,996 --> 00:31:14,916 Sorry, sorry. 781 00:31:15,000 --> 00:31:17,419 I think she must have used Krazy Glue. 782 00:31:17,502 --> 00:31:20,755 Yeah, it, um, it looks that way. 783 00:31:20,839 --> 00:31:22,507 Have you tried removing the batteries? 784 00:31:22,590 --> 00:31:26,511 Of course. She glued the case shut. 785 00:31:26,594 --> 00:31:29,389 All right, I think we have a couple options, Gary. 786 00:31:29,472 --> 00:31:32,434 Um, we can try to find a solvent that will dissolve 787 00:31:32,517 --> 00:31:34,894 or at least soften the glue enough for you to peel it off 788 00:31:34,978 --> 00:31:36,980 without taking your skin with it. 789 00:31:37,063 --> 00:31:39,232 Or, um... 790 00:31:39,315 --> 00:31:41,776 - Dr. Javadi? - Um... 791 00:31:41,860 --> 00:31:44,863 I--I guess your skin cells on your neck will naturally 792 00:31:44,946 --> 00:31:48,366 slough off and you should just be able to remove it in time. 793 00:31:48,450 --> 00:31:51,411 - How much time? - Um, couple of weeks, maybe. 794 00:31:51,494 --> 00:31:52,746 Couple weeks? 795 00:31:52,829 --> 00:31:54,372 I think this guy's got scurvy. 796 00:31:54,456 --> 00:31:55,498 What is he, a pirate? 797 00:31:55,582 --> 00:31:57,208 No, he's an unhoused man 798 00:31:57,292 --> 00:31:59,753 who lives almost exclusively on dollar store ramen. 799 00:31:59,836 --> 00:32:02,339 There's perifollicular hemorrhage, gingivitis, 800 00:32:02,422 --> 00:32:04,716 bleeding gums, and, um, yeah, 801 00:32:04,799 --> 00:32:06,134 no fruit or vegetables in his diet. 802 00:32:06,217 --> 00:32:07,427 I suppose that could do it 803 00:32:07,510 --> 00:32:09,262 as long as you've ruled out piracy. 804 00:32:09,346 --> 00:32:12,390 No parrot, no peg leg, doesn't reek of sweat and rum? 805 00:32:12,474 --> 00:32:14,309 Well, now that you mention it, there was a smell. 806 00:32:14,392 --> 00:32:17,312 Probably a pirate. 807 00:32:17,395 --> 00:32:18,730 Tell him to pick up some vitamin C 808 00:32:18,813 --> 00:32:20,190 next time he docks at a dollar store. 809 00:32:22,567 --> 00:32:24,235 I can't tell if you're joking. 810 00:32:24,319 --> 00:32:26,571 No, Captain Scurvy's got a vitamin C deficiency. 811 00:32:26,654 --> 00:32:29,032 Cheapest way to fix it is with a daily supplement. 812 00:32:29,115 --> 00:32:30,867 Captain Scurvy is another joke. 813 00:32:30,950 --> 00:32:32,869 - I'd like to think so. - It's a good one. 814 00:32:32,952 --> 00:32:34,954 Dr. Langdon, Dr. King, this is Arthur Carlson 815 00:32:35,038 --> 00:32:36,664 from Children, Youth, and Families. 816 00:32:36,748 --> 00:32:38,541 He'd like to speak to the parents of Tyler Jones. 817 00:32:38,625 --> 00:32:40,460 Right, right. 818 00:32:40,543 --> 00:32:42,962 Uh, Mel, would you mind showing him to Kiara and the family? 819 00:32:43,046 --> 00:32:44,422 Mm. Yeah, right this way. 820 00:32:49,344 --> 00:32:51,096 - Beto? - Hello, Doctor. 821 00:32:51,179 --> 00:32:54,474 - What are you doing here? - I'm working day shifts now. 822 00:32:54,557 --> 00:32:56,393 Didn't you retire a couple of years ago? 823 00:32:56,476 --> 00:32:57,894 No. 824 00:32:57,977 --> 00:33:01,106 - I have to work today. - Right. 825 00:33:01,189 --> 00:33:02,649 Right. Just stay right here, OK? 826 00:33:02,732 --> 00:33:04,567 I--I have a lot of cleaning to do. 827 00:33:04,651 --> 00:33:06,528 Yeah, no, I'll be just one second. 828 00:33:06,611 --> 00:33:08,863 Hey, Doc, Doc! How about a sandwich? 829 00:33:08,947 --> 00:33:10,657 Sure, Earl. Turkey, no egg salad. 830 00:33:10,740 --> 00:33:12,909 I got you. Just give me one minute. 831 00:33:15,078 --> 00:33:16,830 So Beto said he's working here? 832 00:33:16,913 --> 00:33:18,373 Yeah, he just started wandering. 833 00:33:18,456 --> 00:33:20,542 Fortunately, he always winds up back here. 834 00:33:20,625 --> 00:33:22,252 He thinks he still works in the ED. 835 00:33:22,335 --> 00:33:23,753 I called his family. 836 00:33:23,837 --> 00:33:25,046 They usually pick him up after a few hours. 837 00:33:25,130 --> 00:33:26,172 Really? 838 00:33:26,256 --> 00:33:27,632 Yeah. It gives them a break. 839 00:33:27,716 --> 00:33:29,092 And look at him. He's talking to people, 840 00:33:29,175 --> 00:33:31,511 feeling useful, getting some exercise. 841 00:33:31,594 --> 00:33:33,138 Hell, I wish I was that happy. 842 00:33:33,221 --> 00:33:34,764 You think he's any good at catching rats? 843 00:33:34,848 --> 00:33:37,434 - Stop. - Oh, Earl wants a sandwich. 844 00:33:37,517 --> 00:33:39,394 He always wants a sandwich. 845 00:33:39,477 --> 00:33:40,854 Hey, check it out. 846 00:33:40,937 --> 00:33:42,397 I got my kids a puppy. 847 00:33:42,480 --> 00:33:44,566 Cute. Hope that wasn't your idea. 848 00:33:44,649 --> 00:33:46,359 - Why? - Seriously? 849 00:33:46,443 --> 00:33:47,694 You really think your wife 850 00:33:47,777 --> 00:33:49,112 needs anything else to take care of? 851 00:33:49,195 --> 00:33:51,239 - Abby loves dogs. - I love penguins. 852 00:33:51,322 --> 00:33:52,824 It doesn't mean I want to take care of one. 853 00:33:52,907 --> 00:33:54,367 I'm pretty sure it's illegal to own a penguin. 854 00:33:54,451 --> 00:33:55,869 Pretty sure you're missing the point. 855 00:33:55,952 --> 00:33:57,328 The point is Tanner promised 856 00:33:57,412 --> 00:33:58,580 he would take care of it. 857 00:33:58,663 --> 00:34:01,666 A four-year-old? Yeah, OK. 858 00:34:06,921 --> 00:34:08,548 How's she doing? 859 00:34:08,631 --> 00:34:11,593 Still breathing after 20 of morphine. 860 00:34:13,803 --> 00:34:15,138 How's the pain, Joyce? 861 00:34:16,306 --> 00:34:17,849 A little better. 862 00:34:17,932 --> 00:34:19,893 We've ordered an exchange transfusion. 863 00:34:19,976 --> 00:34:22,395 Mm. Figured I needed that. 864 00:34:22,479 --> 00:34:24,939 What's your normal regimen at home? 865 00:34:25,023 --> 00:34:28,860 90 of extended-release morphine every 12 hours 866 00:34:28,943 --> 00:34:31,196 and oxycodone for breakthrough pain, 867 00:34:31,279 --> 00:34:33,698 but it wasn't working. 868 00:34:33,782 --> 00:34:36,826 Starting IV Dilaudid of four an hour. 869 00:34:36,910 --> 00:34:39,204 You can press this button if you need a little extra. 870 00:34:39,287 --> 00:34:42,832 That only works once an hour, though, so don't go crazy. 871 00:34:42,916 --> 00:34:45,752 - Could I confer with you? - Yeah. 872 00:34:54,511 --> 00:34:57,055 You seem surprised by the opioid dosage. 873 00:34:57,138 --> 00:34:59,599 - It seemed a little high. - So was her pain. 874 00:34:59,683 --> 00:35:01,184 How do you know she's not drug-seeking? 875 00:35:01,267 --> 00:35:03,061 You can't fake a hemoglobin of 6. 876 00:35:03,144 --> 00:35:05,105 Do you know what sickle cell crisis does to the body? 877 00:35:05,188 --> 00:35:06,648 Blood cells get caught and plug up your capillaries 878 00:35:06,731 --> 00:35:08,358 and deprive all your cells of oxygen. 879 00:35:08,441 --> 00:35:11,194 It's been described as an electrical stabbing pain 880 00:35:11,277 --> 00:35:12,696 that feels like it's breaking your bones 881 00:35:12,779 --> 00:35:15,448 and flushing glass through your body. 882 00:35:15,532 --> 00:35:17,283 I never thought of it like that. 883 00:35:17,367 --> 00:35:18,660 Little empathy goes a long way 884 00:35:18,743 --> 00:35:20,412 with those suffering in real pain. 885 00:35:22,539 --> 00:35:23,957 - Yeah. - Don't worry. 886 00:35:24,040 --> 00:35:25,458 You'll get good at spotting the fakers, 887 00:35:25,542 --> 00:35:27,335 and half the time, all those people need 888 00:35:27,419 --> 00:35:29,921 is someone to really listen to them and hear their story. 889 00:35:31,464 --> 00:35:33,008 Mm-hmm. 890 00:35:33,091 --> 00:35:36,886 Interior compartment pressure is 49. 891 00:35:36,970 --> 00:35:38,638 Burn caused massive swelling. 892 00:35:38,722 --> 00:35:40,515 What does he need, Dr. Santos? 893 00:35:40,598 --> 00:35:43,476 Fasciotomy, but he still has a radial pulse. 894 00:35:43,560 --> 00:35:45,520 Pressure would have to be over 100 to lose the pulse, 895 00:35:45,603 --> 00:35:47,188 and at that point, he'd lose the arm. 896 00:35:47,272 --> 00:35:49,232 49 is enough to destroy all the nerves and muscles 897 00:35:49,315 --> 00:35:51,109 in a matter of hours. 898 00:35:51,192 --> 00:35:52,819 - Compartment pressure's 49? - Yeah. 899 00:35:52,902 --> 00:35:54,779 I'm going to make the initial incision down here. 900 00:35:54,863 --> 00:35:56,489 Ortho can finish it up in the OR. 901 00:35:56,573 --> 00:35:58,324 Good plan. I'll let them know. 902 00:35:58,408 --> 00:36:00,076 - Hey, Robby. - Always good to see you, Fred. 903 00:36:00,160 --> 00:36:01,369 - How do you like my rock star? - She's pretty good. 904 00:36:01,453 --> 00:36:03,955 She has a great teacher. 905 00:36:04,039 --> 00:36:05,915 Sterile gloves for Dr. Santos. 906 00:36:05,999 --> 00:36:09,210 Oh, we don't teach forearm fasciotomies to our residents. 907 00:36:09,294 --> 00:36:11,171 What if she's all alone somewhere someday 908 00:36:11,254 --> 00:36:13,381 with no backup? 909 00:36:15,467 --> 00:36:18,595 This is the path to avoid the median nerve 910 00:36:18,678 --> 00:36:20,805 and all major vessels. 911 00:36:20,889 --> 00:36:23,099 Maybe just watch the first time. 912 00:36:23,183 --> 00:36:25,518 She'll hold the blade, I'll cut. 913 00:36:25,602 --> 00:36:27,062 10 blade to Dr. Santos. 914 00:36:30,690 --> 00:36:33,068 We'll start proximal. 915 00:36:33,151 --> 00:36:34,527 How much pressure? 916 00:36:34,611 --> 00:36:37,655 Just about this much. 917 00:36:41,910 --> 00:36:43,286 Mm-hmm. 918 00:36:45,997 --> 00:36:48,541 Through the skin and sub-Q. 919 00:36:53,046 --> 00:36:54,422 Good. 920 00:36:58,677 --> 00:37:00,553 How they making out? 921 00:37:00,637 --> 00:37:02,263 They're still talking. 922 00:37:03,765 --> 00:37:05,767 - You OK? - Yeah, for sure. 923 00:37:05,850 --> 00:37:07,936 I just--I hate seeing families torn apart. 924 00:37:08,019 --> 00:37:09,521 Oh, they'll be fine. 925 00:37:09,604 --> 00:37:11,981 - How can you be sure? - They're white. 926 00:37:12,065 --> 00:37:14,275 Probably get off with a slap on the wrist. 927 00:37:14,359 --> 00:37:16,778 If they weren't, she'd probably lose her child 928 00:37:16,861 --> 00:37:20,407 and he'd end up going to jail, but... 929 00:37:20,490 --> 00:37:23,368 Sorry, I did a fellowship in cynicism. 930 00:37:23,451 --> 00:37:24,869 You sure you're OK? 931 00:37:24,953 --> 00:37:26,955 100%. I'm just going to get some air. 932 00:37:32,836 --> 00:37:35,672 I am a savage, classy, bougie, 933 00:37:35,755 --> 00:37:38,550 ratchet, sassy, moody, nasty. 934 00:37:38,633 --> 00:37:40,510 I am a savage... 935 00:37:41,469 --> 00:37:42,887 I need help! 936 00:37:42,971 --> 00:37:44,014 I got shot. 937 00:37:44,097 --> 00:37:45,265 Can you guys help? 938 00:37:46,141 --> 00:37:47,475 What's your name? 939 00:37:47,559 --> 00:37:48,643 Alex. 940 00:37:48,727 --> 00:37:50,854 OK, Alex, let me take a look. 941 00:37:50,937 --> 00:37:52,230 It fucking hurts. 942 00:37:52,313 --> 00:37:54,190 Oh, I know. All right. 943 00:37:54,274 --> 00:37:55,400 We're going to take good care of you. 944 00:37:55,483 --> 00:37:57,068 - Yeah. - You guys got it? 945 00:37:57,152 --> 00:37:59,279 Let me get you up here, Alex. 946 00:37:59,362 --> 00:38:00,989 I got you. 947 00:38:01,072 --> 00:38:02,365 I have an abdominal GSW 948 00:38:02,449 --> 00:38:05,160 in the ambulance bay, code trauma now. 949 00:38:05,243 --> 00:38:07,787 GSW just got dumped by a homeboy ambulance. 950 00:38:07,871 --> 00:38:10,832 - You got this? - Yeah, go. 951 00:38:10,915 --> 00:38:14,169 2 grams of Ancef. Ortho's on their way. 952 00:38:17,964 --> 00:38:20,592 Systolic's only 80. 14 gauge left AC. 953 00:38:20,675 --> 00:38:21,718 We got two units of whole blood 954 00:38:21,801 --> 00:38:23,053 going on the rapid infuser. 955 00:38:23,136 --> 00:38:24,387 Call the OR. We'll be right up. 956 00:38:24,471 --> 00:38:25,722 Lungs up. 957 00:38:25,805 --> 00:38:26,931 Do you take medications every day? 958 00:38:27,015 --> 00:38:28,850 - Any allergies? - No. 959 00:38:28,933 --> 00:38:30,310 Morrison's is full of blood. You see that? 960 00:38:30,393 --> 00:38:32,187 - Yeah. - Tore up his liver. 961 00:38:32,270 --> 00:38:33,605 - What's his name? - Alex. 962 00:38:33,688 --> 00:38:34,981 Alex, you've lost a lot of blood. 963 00:38:35,065 --> 00:38:36,316 You need to go to surgery right away. 964 00:38:36,399 --> 00:38:37,317 Am I going to die? 965 00:38:37,400 --> 00:38:38,818 Not now that I'm here. 966 00:38:38,902 --> 00:38:40,111 Spoken with the humility of a surgeon. 967 00:38:40,195 --> 00:38:41,446 OR's ready. How's he doing? 968 00:38:41,529 --> 00:38:43,156 - BP is coming up a bit. - Let's go. 969 00:38:43,239 --> 00:38:44,949 - Can you call my mom? - Yep. 970 00:38:45,033 --> 00:38:47,577 - She's the "ICE" on my cell. - Of course, of course. 971 00:38:47,660 --> 00:38:50,163 So he didn't have to wait for an OR? 972 00:38:50,246 --> 00:38:51,998 No, we're a trauma center. 973 00:38:52,082 --> 00:38:54,417 We always keep one OR stocked and ready to go. 974 00:38:54,501 --> 00:38:58,088 Well, that's awesome! 975 00:38:58,171 --> 00:39:01,091 What--what happens if there are multiple traumas needing OR? 976 00:39:01,174 --> 00:39:02,717 We get a lot busier. 977 00:39:04,636 --> 00:39:06,137 Mr. Milton, I'm sorry. 978 00:39:06,221 --> 00:39:07,847 We had to move you into the hall. 979 00:39:07,931 --> 00:39:09,808 I know it gets pretty chaotic and noisy out here. 980 00:39:09,891 --> 00:39:12,310 Mr. Milton? 981 00:39:12,394 --> 00:39:14,771 Hey, hey, Bennet, wake up for me. 982 00:39:17,190 --> 00:39:19,984 Oh, shit, shit, shit. Um, I need a little help here! 983 00:39:21,194 --> 00:39:22,445 Help! 984 00:39:22,529 --> 00:39:24,030 When did you check on him last? 985 00:39:24,114 --> 00:39:25,657 I don't know, around half an hour ago at most. 986 00:39:25,740 --> 00:39:27,158 - I was waiting on labs. - What's going on? 987 00:39:27,242 --> 00:39:28,827 It's my gallstone guy. You saw his EKGs. 988 00:39:28,910 --> 00:39:31,496 Unknown downtime. He was sleeping in the hall. 989 00:39:31,579 --> 00:39:33,498 Crash cart, let's go! 990 00:39:36,584 --> 00:39:38,420 I got it. 991 00:39:40,964 --> 00:39:42,507 Hold compressions. 992 00:39:44,676 --> 00:39:46,219 Asystole. 993 00:39:46,302 --> 00:39:49,973 Resume compressions, amp of epi. 994 00:39:50,056 --> 00:39:51,433 Slower, slower tempo, slower tempo. 995 00:39:51,516 --> 00:39:53,393 - Should I intubate? - No. Drop an LMA. 996 00:39:53,476 --> 00:39:56,062 We don't want to hold compressions. 997 00:39:56,146 --> 00:39:58,148 Pupils are fixed and dilated. 998 00:39:58,231 --> 00:39:59,607 He's been down a long time. 999 00:40:11,661 --> 00:40:12,996 How we doing in here? 1000 00:40:13,079 --> 00:40:14,539 So much better. 1001 00:40:14,622 --> 00:40:17,125 Dr. Mohan, this is my wife, Ondine. 1002 00:40:17,208 --> 00:40:19,753 Dr. Samira Mohan. Nice to meet you, Ondine. 1003 00:40:19,836 --> 00:40:21,921 - Thank you for helping her. - Of course. 1004 00:40:22,005 --> 00:40:24,716 And, again, I'm so sorry about how you were treated 1005 00:40:24,799 --> 00:40:26,384 when you first arrived. 1006 00:40:26,468 --> 00:40:27,761 Not everyone who works here 1007 00:40:27,844 --> 00:40:29,679 is accustomed to dealing with sickle cell. 1008 00:40:29,763 --> 00:40:31,139 We will be doing everything possible 1009 00:40:31,222 --> 00:40:33,808 from here on in to manage Joyce's crisis. 1010 00:40:33,892 --> 00:40:35,685 In the meantime, can I get you anything? 1011 00:40:35,769 --> 00:40:36,728 I'm fine. 1012 00:40:36,811 --> 00:40:38,229 - Ondine? - No, thank you. 1013 00:40:38,313 --> 00:40:39,647 OK. Well, have the nurses come find me 1014 00:40:39,731 --> 00:40:40,815 if you need anything. 1015 00:40:43,568 --> 00:40:45,945 Take slow, deep breaths for me, Ian. 1016 00:40:46,029 --> 00:40:48,948 They ordered a neb, 5 albuterol, 125 solumedrol. 1017 00:40:49,032 --> 00:40:50,575 All right. 1018 00:40:50,658 --> 00:40:52,243 Keep an eye on him and present to Dr. Langdon. 1019 00:40:52,327 --> 00:40:54,329 - OK. - OK, great. 1020 00:40:54,412 --> 00:40:56,539 I'll see you back in triage once he settles down. 1021 00:40:56,623 --> 00:40:58,458 Yeah. 1022 00:40:58,541 --> 00:40:59,584 OK, let's take this off. 1023 00:40:59,668 --> 00:41:01,002 All right, hang in there, Ian. 1024 00:41:01,086 --> 00:41:02,837 This should really help your asthma. 1025 00:41:12,806 --> 00:41:13,932 How can I help you, hon? 1026 00:41:14,015 --> 00:41:15,308 Um, I'm looking for Dr. Langdon. 1027 00:41:15,392 --> 00:41:17,143 Yeah, let me see where he is. 1028 00:41:20,689 --> 00:41:22,482 Dr. Langdon, we have a med student 1029 00:41:22,565 --> 00:41:24,109 at Central looking for you. 1030 00:41:25,694 --> 00:41:27,404 Copy that. He's headed this way. 1031 00:41:27,487 --> 00:41:28,571 Thanks. 1032 00:41:29,864 --> 00:41:31,116 Hey, Crash. 1033 00:41:31,199 --> 00:41:33,618 You missed a pretty cool fasciotomy. 1034 00:41:33,702 --> 00:41:34,911 I'm not sure I'd be describing 1035 00:41:34,994 --> 00:41:36,496 a fasciotomy as cool. 1036 00:41:36,579 --> 00:41:39,207 You would if you were the one who did it. 1037 00:41:39,290 --> 00:41:42,335 How's it going out in the arrivals lounge? 1038 00:41:44,337 --> 00:41:47,257 Do you know anything about Dr. McKay? 1039 00:41:47,340 --> 00:41:49,592 I've been here for less than two hours. 1040 00:41:49,676 --> 00:41:52,804 I don't know anybody, including you. 1041 00:41:52,887 --> 00:41:55,682 I thought you were some kind of kid genius. 1042 00:41:55,765 --> 00:41:58,101 I'm like any other third-year med student. 1043 00:41:58,184 --> 00:42:01,021 Clearly. 1044 00:42:01,104 --> 00:42:02,480 Hey, I'm just trying to break the ice. 1045 00:42:02,564 --> 00:42:04,524 I'm not trying to annoy you. 1046 00:42:04,607 --> 00:42:06,443 And yet, you're still calling me Crash 1047 00:42:06,526 --> 00:42:07,861 when I asked you not to. 1048 00:42:07,944 --> 00:42:09,654 Really? You're still on that? 1049 00:42:09,738 --> 00:42:11,031 Still on that. 1050 00:42:12,365 --> 00:42:15,243 Yep. OK, sorry. 1051 00:42:15,326 --> 00:42:20,206 I had no idea genius was so sensitive. 1052 00:42:20,290 --> 00:42:23,293 But I get it. Big brain, big feelings. 1053 00:42:23,376 --> 00:42:24,753 Makes total sense. 1054 00:42:24,836 --> 00:42:26,671 I'll try to be softer. 1055 00:42:50,653 --> 00:42:51,946 We switch out every few minutes. 1056 00:42:52,030 --> 00:42:53,615 - You can take a break. - I'm fine. 1057 00:42:53,698 --> 00:42:54,908 Hold compressions. 1058 00:42:56,910 --> 00:42:58,495 Still in asystole. 1059 00:42:58,578 --> 00:43:00,997 Resume compressions. 1060 00:43:01,081 --> 00:43:02,374 Should we shock him? 1061 00:43:02,457 --> 00:43:03,792 You don't shock asystole. 1062 00:43:03,875 --> 00:43:05,085 It could be fine v-fib. 1063 00:43:05,168 --> 00:43:07,754 - Not a chance. - OK. 1064 00:43:07,837 --> 00:43:08,963 Uh, when was his last epi? 1065 00:43:09,047 --> 00:43:10,674 - Three minutes ago. - OK. 1066 00:43:10,757 --> 00:43:12,092 Well, ACLS says every three to five minute, right? 1067 00:43:12,175 --> 00:43:14,678 - So let's push another round. - Fine. 1068 00:43:14,761 --> 00:43:17,514 Robby, Mr. Spencer's adult children are asking for you. 1069 00:43:17,597 --> 00:43:19,432 And the parents of Nick Bradley, 1070 00:43:19,516 --> 00:43:21,393 the fentanyl overdose, also want to speak with you. 1071 00:43:21,476 --> 00:43:22,769 OK. 1072 00:43:22,852 --> 00:43:25,980 Three rounds of epi and then call it. 1073 00:43:26,064 --> 00:43:28,525 Mr. Spencer's maxed out on BiPAP, 25 on 10. 1074 00:43:28,608 --> 00:43:31,528 - Sats? - Not great, High 80s. 1075 00:43:34,489 --> 00:43:36,116 Hi. I heard you wanted to talk to me. 1076 00:43:36,199 --> 00:43:37,951 Yeah. That alarm kept going off. 1077 00:43:38,034 --> 00:43:40,954 Yeah. Why don't we step outside? 1078 00:43:41,663 --> 00:43:43,289 The alarm is for low oxygen. 1079 00:43:43,373 --> 00:43:45,583 Does he need more of that, um, BiPAP? 1080 00:43:45,667 --> 00:43:47,627 I'm afraid that's as high as we go. 1081 00:43:47,711 --> 00:43:49,421 So the decision at this point is-- 1082 00:43:49,504 --> 00:43:52,382 We want you to put our father on the breathing machine. 1083 00:43:54,217 --> 00:43:55,885 Even though that goes against his desires 1084 00:43:55,969 --> 00:43:58,221 to not be intubated? 1085 00:43:58,304 --> 00:44:00,724 We're not ready to let go yet. 1086 00:44:00,807 --> 00:44:03,810 And if your father is? 1087 00:44:05,353 --> 00:44:06,813 He was a stubborn son of a bitch 1088 00:44:06,896 --> 00:44:09,357 who would never have given up on either of us. 1089 00:44:09,441 --> 00:44:12,152 We're not giving up on him. 1090 00:44:12,235 --> 00:44:14,154 You're absolutely certain you want 1091 00:44:14,237 --> 00:44:16,239 to put your father through this after everything I've told you? 1092 00:44:20,869 --> 00:44:24,914 I may have to honor his advanced directive. 1093 00:44:24,998 --> 00:44:29,044 No, you have to honor our durable power for health care. 1094 00:44:29,127 --> 00:44:32,505 If not, we can talk to your hospital attorney. 1095 00:44:35,050 --> 00:44:37,302 Jereme, you're on board with this? 1096 00:44:37,385 --> 00:44:39,512 Yeah, I guess so. 1097 00:44:41,222 --> 00:44:43,892 OK. You can sit with him until we're ready. 1098 00:44:43,975 --> 00:44:46,061 - And when will that be? - Momentarily. 1099 00:44:57,697 --> 00:44:59,032 Please don't tell me 1100 00:44:59,115 --> 00:45:00,367 you're going to intubate that poor man. 1101 00:45:00,450 --> 00:45:02,077 It's what the family wants. 1102 00:45:02,160 --> 00:45:03,828 So what? They want to torture him? 1103 00:45:03,912 --> 00:45:06,331 I explained all that. 1104 00:45:06,414 --> 00:45:10,293 If I co-sign, you can override their durable power. 1105 00:45:10,377 --> 00:45:12,128 They're threatening to go to the hospital attorney. 1106 00:45:12,212 --> 00:45:13,588 Let them. Call the Ethics Committee. 1107 00:45:13,672 --> 00:45:14,839 They'll agree with us. 1108 00:45:14,923 --> 00:45:16,174 No, no, you're probably right. 1109 00:45:16,257 --> 00:45:17,676 But we don't have that kind of time. 1110 00:45:17,759 --> 00:45:19,427 We are stuck. 1111 00:45:19,511 --> 00:45:22,514 - What are you talking about? - Shit. 1112 00:45:24,766 --> 00:45:26,142 What? 1113 00:45:26,226 --> 00:45:27,560 I got to go tell those parents 1114 00:45:27,644 --> 00:45:30,063 their 18-year-old son is brain-dead. 1115 00:45:30,146 --> 00:45:32,691 - Want me to come with you? - No, It's OK. 1116 00:45:32,774 --> 00:45:34,025 What are you going to say? 1117 00:45:34,109 --> 00:45:35,443 I'm going to say that it's likely, 1118 00:45:35,527 --> 00:45:36,986 but we still need to do an apnea test 1119 00:45:37,070 --> 00:45:40,073 and a cerebral perfusion study. 1120 00:45:40,156 --> 00:45:41,783 There's no cranial nerve activity. 1121 00:45:41,866 --> 00:45:45,620 - Those people need some hope. - False hope. 1122 00:45:45,704 --> 00:45:47,747 - Hope is hope. - Is it? 1123 00:45:47,831 --> 00:45:51,334 What, are we praying for miracles today? 1124 00:45:51,418 --> 00:45:52,877 They need time to process 1125 00:45:52,961 --> 00:45:55,880 before they can accept what's happening. 1126 00:45:55,964 --> 00:45:59,300 You ever consider taking that advice? 1127 00:45:59,384 --> 00:46:02,429 Physician, heal thyself. 1128 00:46:02,512 --> 00:46:04,014 Don't you have patients? 1129 00:46:26,619 --> 00:46:29,289 No, no, no, no, no, no. People wake up from comas. 1130 00:46:29,372 --> 00:46:31,416 You can wake him up. 1131 00:46:31,499 --> 00:46:33,668 You can do that. You can--you can shock-- 1132 00:46:33,752 --> 00:46:36,254 you can-- you can shock him back. 1133 00:46:41,760 --> 00:46:44,679 Nick. 1134 00:46:52,312 --> 00:46:53,813 Hey, hey, hey. 1135 00:46:53,897 --> 00:46:55,565 Hey, hey, hey, hey, hey. 1136 00:46:55,648 --> 00:46:57,567 Nick. 1137 00:46:59,819 --> 00:47:03,531 Please, no! 1138 00:48:09,014 --> 00:48:10,974 No change. 1139 00:48:11,057 --> 00:48:12,475 No pericardial effusion, 1140 00:48:12,559 --> 00:48:16,438 no tension pneumothorax, no cardiac activity. 1141 00:48:16,521 --> 00:48:18,690 Try calcium. Could be hyperkalemia. 1142 00:48:18,773 --> 00:48:20,734 No, his potassium was normal. 1143 00:48:20,817 --> 00:48:23,278 - Ready to call this? - Not yet. 1144 00:48:23,361 --> 00:48:25,280 Dr. Robby said three rounds of epi. 1145 00:48:25,363 --> 00:48:26,865 It's time. Let's push another amp. 1146 00:48:26,948 --> 00:48:28,450 This one could do it. 1147 00:48:31,077 --> 00:48:32,203 OK.