1 00:00:15,640 --> 00:00:17,057 - You know this guy? - Orlando Diaz. 2 00:00:17,058 --> 00:00:18,809 {\an8}We were treating him for DKA when he eloped. 3 00:00:18,810 --> 00:00:20,394 {\an8}- How far did he fall? - 20 feet or so. 4 00:00:20,395 --> 00:00:22,229 {\an8}- Anyone see him pass out? - No. 5 00:00:22,230 --> 00:00:24,356 {\an8}They went looking for him after he didn't answer his radio. 6 00:00:24,357 --> 00:00:25,566 Pupils equal but sluggish. 7 00:00:25,567 --> 00:00:26,942 He left against medical advice. 8 00:00:26,943 --> 00:00:29,654 On my count, three, two, one. 9 00:00:30,905 --> 00:00:33,115 Dr. Ellis on the case. Day shift, we got this. 10 00:00:33,116 --> 00:00:35,492 - I'm staying. - Continuity of care. 11 00:00:35,493 --> 00:00:36,869 Dr. Al-Hashimi, why don't you go cover 12 00:00:36,870 --> 00:00:38,162 sign-out rounds with Dr. Abbot? 13 00:00:38,163 --> 00:00:39,496 - Shen, you too. - Got it. 14 00:00:39,497 --> 00:00:41,582 OK, let me know if you need anything. 15 00:00:41,583 --> 00:00:44,168 - Lungs are up bilaterally. - Pelvis is stable. 16 00:00:44,169 --> 00:00:48,047 Right tib-fib hematoma, deformed right forearm. 17 00:00:48,048 --> 00:00:50,049 Ruptured TM on the left with sero-sanguinous fluid. 18 00:00:50,050 --> 00:00:51,842 That means basilar skull fracture. 19 00:00:51,843 --> 00:00:53,636 We've got a diabetic patient, 20-foot fall. 20 00:00:53,637 --> 00:00:55,971 BP 204 over 98, pulse 56. 21 00:00:55,972 --> 00:00:57,640 Dr. Mohan, what do those numbers indicate? 22 00:00:57,641 --> 00:00:59,433 I'm trying to treat the patient. 23 00:00:59,434 --> 00:01:00,726 It's the Cushing's reflex. 24 00:01:00,727 --> 00:01:02,853 From increased intracranial pressure. 25 00:01:02,854 --> 00:01:05,189 Yeah, we need to get him to CT right away. 26 00:01:05,190 --> 00:01:06,857 No free fluid in the belly. 27 00:01:06,858 --> 00:01:10,194 - Any family to notify? - Wife and three kids. 28 00:01:10,195 --> 00:01:12,279 Is there a card to sign for Robby? 29 00:01:12,280 --> 00:01:14,323 No, he said no card, no presents. 30 00:01:14,324 --> 00:01:15,741 Oh. Was there a cake? 31 00:01:15,742 --> 00:01:17,326 Oh, he didn't want that either. 32 00:01:17,327 --> 00:01:19,286 That sucks. I need some cake. 33 00:01:19,287 --> 00:01:21,497 Patient was injured when they raided a restaurant. 34 00:01:21,498 --> 00:01:23,290 And they actually arrested the nurse? 35 00:01:23,291 --> 00:01:25,834 - With a takedown and zip ties. - Damn. 36 00:01:25,835 --> 00:01:27,961 Crus, you, uh, know the computer downtime drill? 37 00:01:27,962 --> 00:01:29,421 Yeah, no biggie. 38 00:01:29,422 --> 00:01:31,090 I prefer to treat 'em without labs and X-rays. 39 00:01:31,091 --> 00:01:32,591 Welcome back. 40 00:01:32,592 --> 00:01:34,468 If you do have orders for labs and X-rays, 41 00:01:34,469 --> 00:01:36,553 clipboards go here. 42 00:01:36,554 --> 00:01:39,306 If it's just nursing orders, here. 43 00:01:39,307 --> 00:01:41,100 Please write neatly, for God's sake. 44 00:01:41,101 --> 00:01:43,644 Oh, Monica, this is Nazely, new intern. 45 00:01:43,645 --> 00:01:46,523 - I don't need to know that. - So nice to meet you. 46 00:01:47,691 --> 00:01:49,316 Looks like you and me, Jack. 47 00:01:49,317 --> 00:01:50,776 Yeah, who's our senior? 48 00:01:50,777 --> 00:01:53,904 - Dr. Henderson. - Excellent. 49 00:01:53,905 --> 00:01:55,781 Night shift's on Crus control. 50 00:01:55,782 --> 00:01:57,908 You hear ICE brought us a patient? 51 00:01:57,909 --> 00:01:59,702 Oh, yeah? How'd that go? 52 00:01:59,703 --> 00:02:00,828 There was some collateral damage. 53 00:02:00,829 --> 00:02:02,329 They arrested Jesse. 54 00:02:02,330 --> 00:02:04,331 - For what? - Assaulting a federal officer. 55 00:02:04,332 --> 00:02:05,874 Are you fucking kidding me? 56 00:02:05,875 --> 00:02:07,251 Oh, Dr. Al-Hashimi, 57 00:02:07,252 --> 00:02:09,546 this is Nazely Toomarian... new intern. 58 00:02:16,344 --> 00:02:18,178 OK, everybody, let's huddle up. 59 00:02:18,179 --> 00:02:19,513 Before we start, 60 00:02:19,514 --> 00:02:21,140 let me address the elephant in the room. 61 00:02:21,141 --> 00:02:22,933 For those of you who don't know, 62 00:02:22,934 --> 00:02:24,393 Jesse tried to intervene 63 00:02:24,394 --> 00:02:26,186 when a federal agent was handling his patient, 64 00:02:26,187 --> 00:02:28,564 and both he and the patient were taken away by ICE. 65 00:02:28,565 --> 00:02:30,232 - Did he punch the guy? - No. 66 00:02:30,233 --> 00:02:32,651 He put out a hand to stop him, made physical contact. 67 00:02:32,652 --> 00:02:34,236 It was a little bit more than that. 68 00:02:34,237 --> 00:02:35,821 The hospital lawyers are on the case, 69 00:02:35,822 --> 00:02:38,157 and we will brief the staff every 12 hours 70 00:02:38,158 --> 00:02:39,908 at sign-out rounds with an official update. 71 00:02:39,909 --> 00:02:42,411 In the meantime, don't feed the rumor mill. 72 00:02:42,412 --> 00:02:44,747 You may have also heard that new grad nurse Emma here 73 00:02:44,748 --> 00:02:47,249 - was assaulted by a patient. - I... I'm fine. 74 00:02:47,250 --> 00:02:48,876 Please don't forget "code hula hoop," 75 00:02:48,877 --> 00:02:50,210 and with risky patients, 76 00:02:50,211 --> 00:02:52,546 always keep a path to the door clear. 77 00:02:52,547 --> 00:02:54,214 Sounds like one hell of a day. 78 00:02:54,215 --> 00:02:56,049 And we're still dealing with downtime, 79 00:02:56,050 --> 00:02:58,218 so day shift should brief night residents 80 00:02:58,219 --> 00:02:59,553 about the protocol... 81 00:02:59,554 --> 00:03:00,512 Hey! 82 00:03:00,513 --> 00:03:02,181 Oh, all right! 83 00:03:02,182 --> 00:03:04,391 Oh, thank God. 84 00:03:04,392 --> 00:03:05,768 Yeah, not so fast. 85 00:03:05,769 --> 00:03:07,644 Every chart from the last five hours 86 00:03:07,645 --> 00:03:09,980 needs to be scanned into the Electronic Health Record 87 00:03:09,981 --> 00:03:12,024 and checked for accuracy... 88 00:03:12,025 --> 00:03:14,193 - Um, whose job is that? - Day shift. 89 00:03:14,194 --> 00:03:16,153 With a completed and signed T-sheet. 90 00:03:16,154 --> 00:03:17,863 - Are you kidding me? - That's gonna take forever. 91 00:03:17,864 --> 00:03:19,615 We will set up stations for scanning. 92 00:03:19,616 --> 00:03:21,408 OK, everybody, let's get moving. 93 00:03:21,409 --> 00:03:23,577 Triage is 20 behind. Gotta help 'em clean up. 94 00:03:23,578 --> 00:03:24,828 I'm skipping rounds. 95 00:03:24,829 --> 00:03:26,663 Consider yourself lucky. 96 00:03:26,664 --> 00:03:27,916 Should we join them? 97 00:03:29,334 --> 00:03:30,959 Might as well witness the magic. 98 00:03:30,960 --> 00:03:33,212 It's like changing of the guard at Buckingham Palace. 99 00:03:33,213 --> 00:03:35,088 Except we're allowed to smile. 100 00:03:35,089 --> 00:03:37,383 "Smile though your heart is aching." 101 00:03:38,551 --> 00:03:39,551 Plain films, right tib-fib 102 00:03:39,552 --> 00:03:41,512 and right forearm after CT. 103 00:03:41,513 --> 00:03:43,514 Got the chem-8. Blood sugar's 284. 104 00:03:43,515 --> 00:03:46,141 That's not too bad. Potassium looks good. 105 00:03:46,142 --> 00:03:48,393 Mm-hmm. Anion gap's up at 14. 106 00:03:48,394 --> 00:03:49,645 It was 24 this morning. 107 00:03:49,646 --> 00:03:51,313 He's definitely improving. 108 00:03:51,314 --> 00:03:52,689 The DKA is resolving. 109 00:03:52,690 --> 00:03:54,316 So what made him pass out? 110 00:03:54,317 --> 00:03:56,151 It's hot as hell out there. 111 00:03:56,152 --> 00:03:58,320 He could have been dehydrated from sweating. 112 00:03:58,321 --> 00:04:01,782 Or he could have had an N-STEMI or a posterior CVA. 113 00:04:01,783 --> 00:04:03,326 Ready to roll. 114 00:04:05,078 --> 00:04:07,704 - I can babysit him at CT. - Thank you. 115 00:04:07,705 --> 00:04:09,999 I'll stay in case he needs the OR. 116 00:04:11,835 --> 00:04:13,710 Hey, we're back up. 117 00:04:13,711 --> 00:04:15,712 It's about time. 118 00:04:15,713 --> 00:04:17,172 - Ooh, Robby. - Yeah. 119 00:04:17,173 --> 00:04:19,383 I got intel on where ICE has taken Jesse. 120 00:04:19,384 --> 00:04:20,634 Intel from who? 121 00:04:20,635 --> 00:04:22,511 Uh, my brother-in-law's a cop. 122 00:04:22,512 --> 00:04:24,847 So he'll be processed at DHS Southside 123 00:04:24,848 --> 00:04:27,349 and then transferred to ICE detention in Clearfield. 124 00:04:27,350 --> 00:04:28,642 Clearfield? That's two hours away. 125 00:04:28,643 --> 00:04:30,143 Mm-hmm. 126 00:04:30,144 --> 00:04:32,271 OK, I'll let the hospital attorneys know. 127 00:04:32,272 --> 00:04:34,189 - How are you doing, Oliver? - Alive and kicking. 128 00:04:34,190 --> 00:04:35,566 Uh, Mr. Haas. 129 00:04:35,567 --> 00:04:37,860 Pulmonary edema after missed dialysis, 130 00:04:37,861 --> 00:04:40,445 now stable with his son Mason at the bedside. 131 00:04:40,446 --> 00:04:42,072 - Hello. - I'm Dr. Shen. 132 00:04:42,073 --> 00:04:43,282 I'll be back. 133 00:04:43,283 --> 00:04:44,324 Dialysis tech says 134 00:04:44,325 --> 00:04:46,118 I'm off the machine at 10:42. 135 00:04:46,119 --> 00:04:48,245 Hit the call light, and I'll come running. 136 00:04:48,246 --> 00:04:50,415 South 21 next... 137 00:04:52,375 --> 00:04:54,126 Mr. Digby. 138 00:04:54,127 --> 00:04:55,711 J-just Digby. 139 00:04:55,712 --> 00:04:57,379 Dr. Mohan's patient. 140 00:04:57,380 --> 00:04:59,590 Forearm cellulitis, admit med-surge. 141 00:04:59,591 --> 00:05:01,174 - Awaiting a bed. - I can take him. 142 00:05:01,175 --> 00:05:03,010 Sold to Dr. Toomarian. 143 00:05:03,011 --> 00:05:05,429 Moving right along. 144 00:05:05,430 --> 00:05:07,222 Get enough to eat? 145 00:05:07,223 --> 00:05:09,558 We'll be back. 146 00:05:09,559 --> 00:05:12,978 Lillian Stegman. Tweaked her knee water-skiing. 147 00:05:12,979 --> 00:05:15,022 Doing a 360 off a 5-foot ramp. 148 00:05:15,023 --> 00:05:16,481 Ooh, respect. 149 00:05:16,482 --> 00:05:17,816 X-rays ordered in triage. 150 00:05:17,817 --> 00:05:19,109 That was hours ago. 151 00:05:19,110 --> 00:05:21,320 Ma'am, I'm Dr. Crus Henderson. 152 00:05:21,321 --> 00:05:23,572 Let's get you home real fast. 153 00:05:23,573 --> 00:05:25,324 - That would be wonderful. - OK, heading to North. 154 00:05:25,325 --> 00:05:27,034 Thank you. 155 00:05:27,035 --> 00:05:29,578 Looks like our first scanning station is almost ready. 156 00:05:29,579 --> 00:05:32,331 Whitaker, Santos, after rounds, this will be your post. 157 00:05:32,332 --> 00:05:35,000 - Seriously? - For... how long? 158 00:05:35,001 --> 00:05:37,127 Till we mop up this mess. 159 00:05:37,128 --> 00:05:38,795 And away we go. 160 00:05:38,796 --> 00:05:40,964 All right, now you know everything 161 00:05:40,965 --> 00:05:42,174 there is to know about rounds. 162 00:05:42,175 --> 00:05:43,342 Fascinating, right? 163 00:05:43,343 --> 00:05:45,510 Uh... yeah. 164 00:05:45,511 --> 00:05:47,805 Here, I got something better for you. 165 00:05:49,599 --> 00:05:52,392 So, Digby, we're gonna find you some new clothes, 166 00:05:52,393 --> 00:05:54,186 but my friend Emma and I wondered if you'd like 167 00:05:54,187 --> 00:05:56,813 to get cleaned up a bit first. 168 00:05:56,814 --> 00:05:58,565 I already had a shower. 169 00:05:58,566 --> 00:06:00,192 I know, and you look good. 170 00:06:00,193 --> 00:06:02,277 But the offer also comes with a shave and a haircut, 171 00:06:02,278 --> 00:06:03,528 if you're interested. 172 00:06:03,529 --> 00:06:04,738 No pressure... like I said, 173 00:06:04,739 --> 00:06:05,990 you already look great. 174 00:06:07,408 --> 00:06:10,327 - Sure, I guess. - Fantastic. 175 00:06:10,328 --> 00:06:12,329 All right, kid, fill that basin with some warm water 176 00:06:12,330 --> 00:06:14,040 and lather him up. 177 00:06:16,960 --> 00:06:19,378 - Hey, stay safe out there. - Back at you in here. 178 00:06:19,379 --> 00:06:21,380 Hey, Cary. 179 00:06:21,381 --> 00:06:23,507 You were on scene with Orlando, right? 180 00:06:23,508 --> 00:06:25,926 Did you notice anything about his fall? 181 00:06:25,927 --> 00:06:27,427 Like what? 182 00:06:27,428 --> 00:06:30,597 Like, um, if there was a break in the railing 183 00:06:30,598 --> 00:06:33,600 or if there were security cameras? 184 00:06:33,601 --> 00:06:35,185 Too busy working on the guy... 185 00:06:35,186 --> 00:06:37,646 IV, intubation, backboard, splint. 186 00:06:37,647 --> 00:06:38,814 Thanks. 187 00:06:38,815 --> 00:06:40,440 Oh, two names is a start. 188 00:06:40,441 --> 00:06:42,192 Pretty soon, we'll retire the clipboards. 189 00:06:42,193 --> 00:06:43,527 Baby Jane Doe in Pedes? 190 00:06:43,528 --> 00:06:45,404 Uh, yeah, abandoned 191 00:06:45,405 --> 00:06:48,156 in the waiting room bathroom at 7:30 a.m. 192 00:06:48,157 --> 00:06:50,617 - Safe haven drop-off? - No, she's too old for that. 193 00:06:50,618 --> 00:06:52,452 - At least two months. - I'll take her. 194 00:06:52,453 --> 00:06:54,621 Awaiting foster placement by CYF. 195 00:06:54,622 --> 00:06:56,957 - What if the mom comes back? - Call the cops. 196 00:06:56,958 --> 00:06:58,417 Day shift, get to work scanning. 197 00:06:58,418 --> 00:06:59,960 Night shift, the room numbers 198 00:06:59,961 --> 00:07:02,129 on top of the dry-erase board need a doctor. 199 00:07:02,130 --> 00:07:05,048 - Who's in BH-1? - Psych hold, danger to self. 200 00:07:05,049 --> 00:07:06,508 What's the story? 201 00:07:06,509 --> 00:07:08,385 Doctors King and Langdon were on the case. 202 00:07:08,386 --> 00:07:10,637 It's a sad story... she says her 5-year-old 203 00:07:10,638 --> 00:07:12,514 snuck into the back seat of the car to take a nap. 204 00:07:12,515 --> 00:07:14,182 Heat stroke. 205 00:07:14,183 --> 00:07:16,560 Mom was extremely distraught. Walked out into traffic. 206 00:07:16,561 --> 00:07:18,103 Grady Barnhill, wheezing 207 00:07:18,104 --> 00:07:19,730 and not responding to albuterol. 208 00:07:19,731 --> 00:07:21,606 Pulse ox 87. His mother, Naomi. 209 00:07:21,607 --> 00:07:23,817 - OK, Trauma Two's open. - On our way. 210 00:07:23,818 --> 00:07:26,319 - Uh, Mom, history of asthma? - His whole life. 211 00:07:26,320 --> 00:07:28,447 - Never this bad. - Barely moving air. 212 00:07:28,448 --> 00:07:31,074 Using all his accessory muscles. 213 00:07:31,075 --> 00:07:32,534 Call RT! 214 00:07:32,535 --> 00:07:35,287 Uh, continuous nebs, 20 milligrams an hour. 215 00:07:35,288 --> 00:07:36,788 We have a home nebulizer. 216 00:07:36,789 --> 00:07:39,666 I've been giving him albuterol every hour. 217 00:07:39,667 --> 00:07:40,792 Ready? 218 00:07:40,793 --> 00:07:43,712 On my count, one, two, three. 219 00:07:43,713 --> 00:07:45,172 Does he take any other medications? 220 00:07:45,173 --> 00:07:46,673 Just the albuterol. 221 00:07:46,674 --> 00:07:48,216 He used to be on montelukast and Symbicort. 222 00:07:48,217 --> 00:07:49,801 Why did you stop that? 223 00:07:49,802 --> 00:07:51,845 Because he lost his Medicaid two months ago. 224 00:07:51,846 --> 00:07:53,680 He's so tight, nothing's getting through. 225 00:07:53,681 --> 00:07:55,265 - Mel, EpiPen. - On it. 226 00:07:55,266 --> 00:07:56,767 0.3 milligrams. 227 00:07:56,768 --> 00:07:59,895 That may open his lungs so the nebs can work. 228 00:07:59,896 --> 00:08:01,981 All right, Grady, shot in the thigh. 229 00:08:07,028 --> 00:08:08,779 Hey. 230 00:08:08,780 --> 00:08:10,238 Something to scan? 231 00:08:10,239 --> 00:08:11,782 Critical labs on North Three. 232 00:08:11,783 --> 00:08:13,366 Oh, it's, uh... it's not my patient. 233 00:08:13,367 --> 00:08:14,702 She's about to be. 234 00:08:16,621 --> 00:08:18,872 I'm, uh... I'm off the clock, so... 235 00:08:18,873 --> 00:08:21,541 These were ordered three hours ago from triage, 236 00:08:21,542 --> 00:08:24,002 so, technically, she is a day-shift patient. 237 00:08:24,003 --> 00:08:25,295 Just get the intern started. 238 00:08:25,296 --> 00:08:26,838 I got a meeting upstairs with admin 239 00:08:26,839 --> 00:08:28,840 to get things back on track. 240 00:08:28,841 --> 00:08:30,592 Sorry. Everyone else is tied up. 241 00:08:30,593 --> 00:08:31,968 That's OK. 242 00:08:31,969 --> 00:08:33,178 How'd you get stuck on night shift 243 00:08:33,179 --> 00:08:34,346 for your first rotation? 244 00:08:34,347 --> 00:08:35,806 Just lucky, I guess. 245 00:08:35,807 --> 00:08:37,350 Yeah, if you like a good horror movie. 246 00:08:38,768 --> 00:08:40,644 - Where was med school? - Uh, UC Irvine. 247 00:08:40,645 --> 00:08:42,437 - California, right? - Yep. 248 00:08:42,438 --> 00:08:43,688 Pittsburgh's a little different. 249 00:08:43,689 --> 00:08:44,898 Yeah, a lot more humidity. 250 00:08:44,899 --> 00:08:45,982 Yeah, that'll go away 251 00:08:45,983 --> 00:08:47,901 with your first foot of snow. 252 00:08:47,902 --> 00:08:50,695 Uh, hi, Mrs. Davis. 253 00:08:50,696 --> 00:08:52,739 I am Dr. McKay. This is Doctor... 254 00:08:52,740 --> 00:08:54,991 - Toomarian. - Hello. 255 00:08:54,992 --> 00:08:58,120 Uh, your labs show a lot of inflammation in your liver. 256 00:08:58,121 --> 00:09:01,498 - Is that why I'm so nauseated? - Definitely, yeah. 257 00:09:01,499 --> 00:09:04,584 Have you, um, noticed a change in your skin coloration? 258 00:09:04,585 --> 00:09:06,628 I've been using this bronzing cream 259 00:09:06,629 --> 00:09:09,297 so I don't look like a ghost in my bathing suit. 260 00:09:09,298 --> 00:09:11,258 Do you remember the name of the bronzer? 261 00:09:11,259 --> 00:09:12,801 It could have a chemical that can cause... 262 00:09:12,802 --> 00:09:14,845 Oh, no, no, it's 100% natural. 263 00:09:14,846 --> 00:09:18,098 - It's DHA from sugar beets. - OK. 264 00:09:18,099 --> 00:09:20,267 Why would my liver be inflamed? 265 00:09:20,268 --> 00:09:22,227 Uh, there's a lot of possibilities. 266 00:09:22,228 --> 00:09:24,062 Are you taking any prescription medications? 267 00:09:24,063 --> 00:09:25,063 Not a single one. 268 00:09:25,064 --> 00:09:26,648 - Tylenol? - God, no. 269 00:09:26,649 --> 00:09:28,859 We have to ask everybody about injection drug use. 270 00:09:28,860 --> 00:09:29,985 Never. 271 00:09:29,986 --> 00:09:31,653 Raw clams or oysters? 272 00:09:31,654 --> 00:09:33,488 I'm a vegan. 273 00:09:33,489 --> 00:09:35,699 One step at a time, OK? 274 00:09:35,700 --> 00:09:36,868 We'll be back. 275 00:09:38,286 --> 00:09:40,120 Digby, Haas, now on the big board. 276 00:09:40,121 --> 00:09:41,121 Progress. 277 00:09:41,122 --> 00:09:42,122 So he's just been waiting 278 00:09:42,123 --> 00:09:43,790 in the hall the whole time? 279 00:09:43,791 --> 00:09:46,752 OK, well, can you maybe get to him next? 280 00:09:48,045 --> 00:09:49,088 Thank you. 281 00:09:50,214 --> 00:09:51,798 Duke goes to CT, and they bump him. 282 00:09:51,799 --> 00:09:54,301 Yeah, he may end up waiting for hours over there. 283 00:09:54,302 --> 00:09:56,803 Oh, look at that. 7:15 already. 284 00:09:56,804 --> 00:09:58,763 Just a few more loose ends to tie up. 285 00:09:58,764 --> 00:10:01,975 You got more loose ends than a macramé wall hanging. 286 00:10:01,976 --> 00:10:04,269 My mom had one. Took up the whole goddamn wall. 287 00:10:04,270 --> 00:10:05,979 Seriously, you should think about signing out 288 00:10:05,980 --> 00:10:07,772 - and hitting the road. - Yeah, maybe you should too. 289 00:10:07,773 --> 00:10:09,524 Oh, that's right, you sent Lena home. 290 00:10:09,525 --> 00:10:11,401 Are you planning on calling in a replacement, 291 00:10:11,402 --> 00:10:13,195 or are you just gonna work till sunrise? 292 00:10:13,196 --> 00:10:14,613 If I have to. 293 00:10:14,614 --> 00:10:16,698 Oh, so you get to go the extra mile, 294 00:10:16,699 --> 00:10:19,201 and the rest of us just get accused of being martyrs. 295 00:10:19,202 --> 00:10:20,578 - Robby. - Excuse me. 296 00:10:22,622 --> 00:10:24,497 - What's the word? - No subdural, no epidural. 297 00:10:24,498 --> 00:10:26,499 Diffuse brain swelling with effacement 298 00:10:26,500 --> 00:10:28,210 and compression of the ventricles. 299 00:10:28,211 --> 00:10:30,420 C-spine? Chest-abdomen-pelvis? 300 00:10:30,421 --> 00:10:32,714 Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 301 00:10:32,715 --> 00:10:33,882 Which means I'm off the hook. 302 00:10:33,883 --> 00:10:35,342 I'll send Neurosurgery down. 303 00:10:35,343 --> 00:10:37,886 If he doesn't need the OR, why Neurosurgery? 304 00:10:37,887 --> 00:10:39,304 - Wait and see. - Let's get busy. 305 00:10:39,305 --> 00:10:40,555 CVP and an art line. 306 00:10:40,556 --> 00:10:43,726 Orlando. Orlando, squeeze my hand. 307 00:10:44,894 --> 00:10:46,102 Open your eyes. 308 00:10:46,103 --> 00:10:48,647 We already know his GCS is going to be three. 309 00:10:48,648 --> 00:10:50,649 Hey, Javadi, anti-seizure prophylaxis? 310 00:10:50,650 --> 00:10:52,651 - Keppra, 20 migs per kilo. - Mixing it now. 311 00:10:52,652 --> 00:10:54,319 Gotta get this brain swelling down, Samira. 312 00:10:54,320 --> 00:10:55,488 How we gonna do that? 313 00:10:56,781 --> 00:10:58,281 - Samira? - What? 314 00:10:58,282 --> 00:11:01,493 We have to lower the intracranial pressure. 315 00:11:01,494 --> 00:11:03,203 - Mannitol. - Not the best. 316 00:11:03,204 --> 00:11:04,537 Can cause diuresis and hypotension. 317 00:11:04,538 --> 00:11:05,914 Then hypertonic saline. 318 00:11:05,915 --> 00:11:08,417 23%. 50 cc's through a central line. 319 00:11:10,336 --> 00:11:11,836 Still tight as a drum. 320 00:11:11,837 --> 00:11:12,963 Five minutes since the epi. 321 00:11:12,964 --> 00:11:14,339 He can have one more EpiPen. 322 00:11:14,340 --> 00:11:16,091 Sats are borderline, 87. 323 00:11:16,092 --> 00:11:17,509 How about BiPap? 10 over 5. 324 00:11:17,510 --> 00:11:19,678 Yes, with in-line nebs. 325 00:11:19,679 --> 00:11:21,513 All right, Grady, shot number two. 326 00:11:21,514 --> 00:11:23,723 Might as well throw in some magnesium, 50 per kilo. 327 00:11:23,724 --> 00:11:25,058 I'm sorry. He's not ventilating. 328 00:11:25,059 --> 00:11:26,434 We should be ready to intubate. 329 00:11:26,435 --> 00:11:27,811 With an asthma patient? 330 00:11:27,812 --> 00:11:29,729 There's a high risk of cardiac arrest. 331 00:11:29,730 --> 00:11:31,982 Naomi, has he ever been put on a breathing machine before? 332 00:11:31,983 --> 00:11:33,650 - Never. - Hospitalized? 333 00:11:33,651 --> 00:11:35,568 No, we could always break him with the Symbicort. 334 00:11:35,569 --> 00:11:37,028 We're gonna give the current treatment 335 00:11:37,029 --> 00:11:39,156 a few more minutes to help him turn the corner. 336 00:11:42,326 --> 00:11:44,160 I could probably do this myself 337 00:11:44,161 --> 00:11:45,578 now that my cast is off. 338 00:11:45,579 --> 00:11:47,497 Oh, that's OK. 339 00:11:47,498 --> 00:11:49,208 I don't mind. 340 00:11:53,129 --> 00:11:55,006 How long have you been a nurse? 341 00:11:56,424 --> 00:11:58,092 This is my first day. 342 00:12:00,803 --> 00:12:02,805 You're doing really good. 343 00:12:04,765 --> 00:12:06,309 Thank you. 344 00:12:10,313 --> 00:12:12,022 - Oh, shit, you OK? - Yeah. 345 00:12:12,023 --> 00:12:13,523 There's water on the floor. 346 00:12:13,524 --> 00:12:15,025 Sorry! I... I might have spilled. 347 00:12:15,026 --> 00:12:16,443 Yeah, no worries. 348 00:12:16,444 --> 00:12:18,486 We're gonna have to sort these all by patient 349 00:12:18,487 --> 00:12:20,280 before we scan them. 350 00:12:20,281 --> 00:12:22,949 Is, uh, Joy still around? 351 00:12:22,950 --> 00:12:25,618 I heard she left at 6:59. 352 00:12:25,619 --> 00:12:27,620 - Smart girl. - Mm-hmm. 353 00:12:27,621 --> 00:12:29,789 You know what? Find Ogilvie. He's such an ass-kisser. 354 00:12:29,790 --> 00:12:31,458 He might stay and scan all the charts himself. 355 00:12:31,459 --> 00:12:33,626 Oh, he, uh, scrubbed in in the OR, 356 00:12:33,627 --> 00:12:35,545 scrubbed in on the ruptured triple-A. 357 00:12:35,546 --> 00:12:37,255 Oh, the kidney stone that wasn't. 358 00:12:37,256 --> 00:12:39,133 That'll be four hours at least. 359 00:12:41,093 --> 00:12:44,429 So are you still going to Amy's after work? 360 00:12:44,430 --> 00:12:46,348 Yeah, maybe just for tonight, 361 00:12:46,349 --> 00:12:48,726 after Robby briefs me on all the house stuff. 362 00:12:49,852 --> 00:12:51,270 Sounds fun. 363 00:12:52,688 --> 00:12:54,606 When he asked, it was hard to say no. 364 00:12:54,607 --> 00:12:56,025 Sure. 365 00:12:58,277 --> 00:13:00,445 It's gonna be very weird without him here. 366 00:13:00,446 --> 00:13:01,863 Yeah. 367 00:13:01,864 --> 00:13:04,407 You think Dr. Al-Hashimi can handle it? 368 00:13:04,408 --> 00:13:05,950 In a word, no. 369 00:13:05,951 --> 00:13:07,369 She's smart. 370 00:13:07,370 --> 00:13:08,661 It takes more than that. 371 00:13:08,662 --> 00:13:10,288 Yeah, well, at least 372 00:13:10,289 --> 00:13:11,664 it's only three months. 373 00:13:11,665 --> 00:13:13,792 Yeah, three long months. 374 00:13:13,793 --> 00:13:15,503 Then you need to find a new home. 375 00:13:16,462 --> 00:13:17,837 Not necessarily. 376 00:13:17,838 --> 00:13:19,923 I mean, if I wanted, I could just check on 377 00:13:19,924 --> 00:13:23,009 Robby's house once or twice a day, you know. 378 00:13:23,010 --> 00:13:24,762 Why would you do that? 379 00:13:26,138 --> 00:13:28,265 I don't know. Why not? 380 00:13:31,352 --> 00:13:32,727 Hypertonic's in. 381 00:13:32,728 --> 00:13:34,854 Maintenance LR in the AC. 382 00:13:34,855 --> 00:13:36,648 Looks like a halo sign. 383 00:13:36,649 --> 00:13:39,234 Cerebrospinal fluid from a basilar skull fracture. 384 00:13:39,235 --> 00:13:43,238 The halo sign is neither sensitive nor specific for CSF. 385 00:13:43,239 --> 00:13:45,532 Saline, tap water, and runny noses 386 00:13:45,533 --> 00:13:46,741 all separate from blood. 387 00:13:46,742 --> 00:13:48,243 - Hello, Linda. - Robby. 388 00:13:48,244 --> 00:13:50,703 Division chief working on a holiday weekend. 389 00:13:50,704 --> 00:13:52,831 Well, somebody's got to. 390 00:13:52,832 --> 00:13:55,625 Saw the scans. This guy needs an EVD. 391 00:13:55,626 --> 00:13:57,919 External ventricular drain to take down the pressure. 392 00:13:57,920 --> 00:14:01,172 Because CPP equals "MAP" minus ICP. 393 00:14:01,173 --> 00:14:03,842 Cerebral perfusion pressure in the brain 394 00:14:03,843 --> 00:14:05,760 equals mean arterial blood pressure 395 00:14:05,761 --> 00:14:07,262 minus the pressure in the skull. 396 00:14:07,263 --> 00:14:08,972 ICP less than 22 397 00:14:08,973 --> 00:14:11,516 predicts survival and favorable outcome. 398 00:14:11,517 --> 00:14:15,895 CPP from 60 to 70 reduces morbidity and mortality. 399 00:14:15,896 --> 00:14:17,313 Can somebody assist? 400 00:14:17,314 --> 00:14:18,481 Dr. Mohan? 401 00:14:18,482 --> 00:14:19,650 I'm good. 402 00:14:20,776 --> 00:14:22,277 Samira, you should lend a hand. 403 00:14:22,278 --> 00:14:24,028 I said I'm good. 404 00:14:24,029 --> 00:14:26,906 - Javadi? - I don't think so. 405 00:14:26,907 --> 00:14:28,450 Javadi? 406 00:14:28,451 --> 00:14:31,870 As in, daughter of Raymond and Eileen? 407 00:14:31,871 --> 00:14:34,330 I was at your mother's baby shower. 408 00:14:34,331 --> 00:14:35,290 She was a resident. 409 00:14:35,291 --> 00:14:36,750 You were in utero. 410 00:14:38,252 --> 00:14:39,294 I don't know how she got through 411 00:14:39,295 --> 00:14:41,087 motherhood and training. 412 00:14:41,088 --> 00:14:42,672 Feel free to join me. 413 00:14:42,673 --> 00:14:44,549 Oh, my... my shift was over a while ago. 414 00:14:44,550 --> 00:14:46,009 OK. 415 00:14:46,010 --> 00:14:48,052 Masks all around. Two sterile gowns. 416 00:14:48,053 --> 00:14:50,680 We brought the surgical towels. Just need some Betadine. 417 00:14:50,681 --> 00:14:52,349 This is kind of an amazing opportunity. 418 00:14:53,517 --> 00:14:54,726 I'm exhausted. 419 00:14:54,727 --> 00:14:56,686 The Chief of Neurosurgery is here. 420 00:14:56,687 --> 00:14:58,146 She's kind of a legend. 421 00:14:58,147 --> 00:15:00,190 Maybe one of the night residents can do it. 422 00:15:00,191 --> 00:15:02,442 Is this about the volvulus case from earlier? 423 00:15:02,443 --> 00:15:04,027 'Cause if it is, you made a mistake. 424 00:15:04,028 --> 00:15:05,945 You need to move on. 425 00:15:05,946 --> 00:15:07,614 I do not want to come back here and find that 426 00:15:07,615 --> 00:15:10,825 you've applied for a residency in derm. 427 00:15:10,826 --> 00:15:13,495 Step up to the plate. Do it. 428 00:15:13,496 --> 00:15:14,704 Javadi will assist. 429 00:15:14,705 --> 00:15:16,372 Excellent. 430 00:15:16,373 --> 00:15:18,124 You know, I think Eileen did her first EVD with me 431 00:15:18,125 --> 00:15:20,669 back when I was a brand-new assistant professor. 432 00:15:22,087 --> 00:15:23,506 Time flies. 433 00:15:26,467 --> 00:15:27,509 How you doing, Grady? 434 00:15:27,510 --> 00:15:28,968 Still retracting. 435 00:15:28,969 --> 00:15:30,678 - Any improvement? - Not really. 436 00:15:30,679 --> 00:15:31,805 You feeling tired? 437 00:15:33,682 --> 00:15:36,184 - Do we have Aerogen in the ED? - Just in the unit. 438 00:15:36,185 --> 00:15:37,810 How fast can you get back? 439 00:15:37,811 --> 00:15:38,978 Two minutes if I take the stairs. 440 00:15:38,979 --> 00:15:40,021 Go. 441 00:15:40,022 --> 00:15:41,356 Uh, Aerogen? 442 00:15:41,357 --> 00:15:43,316 It has a 5-millimeter mesh 443 00:15:43,317 --> 00:15:46,570 that vibrates over 120,000 times per second. 444 00:15:51,742 --> 00:15:53,077 Dr. Al-Hashimi? 445 00:15:57,414 --> 00:15:58,832 You OK? 446 00:16:01,293 --> 00:16:03,295 Uh, you were telling us about Aerogen. 447 00:16:04,463 --> 00:16:05,798 Dr. Shen can explain. 448 00:16:07,216 --> 00:16:10,093 It produces droplets in the 2-to 5-micron range 449 00:16:10,094 --> 00:16:12,096 for medication delivery. 450 00:16:19,395 --> 00:16:21,854 - How's it going? - Just about to start. 451 00:16:21,855 --> 00:16:23,064 Securing the art line here. 452 00:16:23,065 --> 00:16:25,316 Measure twice, cut once. 453 00:16:25,317 --> 00:16:29,112 We enter 11 centimeters back from the nasion, 454 00:16:29,113 --> 00:16:30,738 3 centimeters lateral. 455 00:16:30,739 --> 00:16:32,323 Without any direct imaging? 456 00:16:32,324 --> 00:16:35,368 No, straight shot into the lateral ventricle... 457 00:16:35,369 --> 00:16:38,955 tried and true since 1890. 458 00:16:38,956 --> 00:16:41,333 OK, go ahead with the incision. 459 00:16:42,876 --> 00:16:45,003 Hey, you worked with Dr. Al-Hashimi at the VA. 460 00:16:45,004 --> 00:16:46,129 I did. 461 00:16:46,130 --> 00:16:47,630 For how long? 462 00:16:47,631 --> 00:16:49,591 During my R2 rotation 463 00:16:49,592 --> 00:16:51,802 and then one again last year. 464 00:16:55,222 --> 00:16:58,308 OK. Hand drill's all set. 465 00:16:58,309 --> 00:16:59,726 Maybe you should do this part. 466 00:16:59,727 --> 00:17:01,102 No, no, there's a safety stop here. 467 00:17:01,103 --> 00:17:02,604 You can't go too deep. 468 00:17:02,605 --> 00:17:04,648 It's not brain surgery. 469 00:17:06,900 --> 00:17:08,110 OK. 470 00:17:11,322 --> 00:17:13,072 - Stay perpendicular. - OK. 471 00:17:13,073 --> 00:17:15,033 Good. 472 00:17:15,034 --> 00:17:16,784 All right, now, four turns 473 00:17:16,785 --> 00:17:17,994 to get through the outer table... 474 00:17:17,995 --> 00:17:19,287 - Yep. - Then half turns 475 00:17:19,288 --> 00:17:20,956 till you penetrate the skull. 476 00:17:31,800 --> 00:17:35,386 Three, four. 477 00:17:35,387 --> 00:17:36,722 One... 478 00:17:38,724 --> 00:17:40,308 Holy smoke! 479 00:17:40,309 --> 00:17:43,728 I thought it was Tom Cruise for a second over here. 480 00:17:43,729 --> 00:17:46,773 Nice job. How's that feel, Digby? 481 00:17:46,774 --> 00:17:48,358 - Pretty good. - I bet. 482 00:17:48,359 --> 00:17:49,651 What do you say we trim up 483 00:17:49,652 --> 00:17:51,445 those gorgeous locks of yours now? 484 00:17:53,155 --> 00:17:55,114 I don't like having my hair cut. 485 00:17:55,115 --> 00:17:58,451 I get it, Rapunzel, but you need your ears lowered. 486 00:17:58,452 --> 00:18:00,578 You'll feel better with a fresh summer look 487 00:18:00,579 --> 00:18:02,665 that won't go unnoticed by the ladies. 488 00:18:04,583 --> 00:18:06,876 - Maybe just a trim? - Great. 489 00:18:06,877 --> 00:18:09,087 I'm thinking a pixie cut. 490 00:18:09,088 --> 00:18:10,880 - What? - I'm kidding. 491 00:18:10,881 --> 00:18:12,674 I cut my husband Benji's hair all the time. 492 00:18:12,675 --> 00:18:14,175 Trust me, you're gonna look fabulous. 493 00:18:14,176 --> 00:18:15,844 When's the last time you had a haircut? 494 00:18:17,471 --> 00:18:20,682 Maybe my daughter's wedding a few years ago. 495 00:18:20,683 --> 00:18:22,016 Where? 496 00:18:22,017 --> 00:18:23,226 St. Sebastian, 497 00:18:23,227 --> 00:18:25,228 Our Lady of Mount Carmel Parish. 498 00:18:25,229 --> 00:18:27,855 Does your daughter know where you are? 499 00:18:27,856 --> 00:18:31,025 Of course. We all live in Pittsburgh. 500 00:18:31,026 --> 00:18:33,320 In fact, they live in my old house. 501 00:18:35,948 --> 00:18:38,199 Your daughter lives in your house? 502 00:18:38,200 --> 00:18:40,076 Yep. 503 00:18:40,077 --> 00:18:42,620 Where do you live? 504 00:18:42,621 --> 00:18:44,873 Wherever I want. 505 00:18:46,667 --> 00:18:48,710 You're gonna pass it 5 to 6 centimeters 506 00:18:48,711 --> 00:18:51,296 from the inner table of the skull, OK? 507 00:18:53,257 --> 00:18:55,341 Centered... 508 00:18:55,342 --> 00:18:57,176 perpendicular... 509 00:18:57,177 --> 00:18:59,054 aiming for the medial canthus. 510 00:19:00,222 --> 00:19:01,806 All yours. 511 00:19:01,807 --> 00:19:03,141 A-and just keep going? 512 00:19:03,142 --> 00:19:04,600 You'll feel a pop when you pass 513 00:19:04,601 --> 00:19:07,186 the ependymal lining. 514 00:19:07,187 --> 00:19:08,980 Art line is calibrated. Good to go. 515 00:19:08,981 --> 00:19:12,900 Titrate the nicardipine to a MAP of 85, please. 516 00:19:12,901 --> 00:19:14,318 And if we can get the intracranial pressure 517 00:19:14,319 --> 00:19:16,155 down to 20? 518 00:19:17,614 --> 00:19:18,990 Dr. Mohan? 519 00:19:18,991 --> 00:19:20,450 I'm sorry. 520 00:19:20,451 --> 00:19:22,744 MAP of 85, ICP of 20? 521 00:19:22,745 --> 00:19:25,747 Um, cerebral perfusion pressure 65. 522 00:19:25,748 --> 00:19:28,499 Which gives him the best shot at survival. 523 00:19:28,500 --> 00:19:30,001 A third of patients like this die. 524 00:19:30,002 --> 00:19:32,587 Half have long-term disability. 525 00:19:32,588 --> 00:19:34,547 We'll know in two weeks if there's a possibility 526 00:19:34,548 --> 00:19:36,883 for a good prognosis. 527 00:19:36,884 --> 00:19:38,092 Felt a pop. 528 00:19:38,093 --> 00:19:39,762 Remove the stylet. 529 00:19:42,306 --> 00:19:45,058 OK, let it drain a bit. 530 00:19:47,019 --> 00:19:49,229 And now pinch it shut. 531 00:19:50,731 --> 00:19:51,647 Perfect. 532 00:19:51,648 --> 00:19:53,524 BP is down, 190 over 88. 533 00:19:53,525 --> 00:19:54,943 Heart rate's 67. 534 00:19:59,072 --> 00:20:00,948 How are you guys doing? 535 00:20:00,949 --> 00:20:02,867 Yeah, making some progress. 536 00:20:02,868 --> 00:20:04,202 You seen Abbot? 537 00:20:04,203 --> 00:20:05,995 Not since rounds. 538 00:20:05,996 --> 00:20:08,706 He asked me to see a patient with the night intern. 539 00:20:08,707 --> 00:20:10,333 And you said yes? 540 00:20:10,334 --> 00:20:13,211 48-year-old woman, new onset jaundice, 541 00:20:13,212 --> 00:20:16,297 elevated liver enzymes, no history of alcohol use. 542 00:20:16,298 --> 00:20:17,632 Take your pick... 543 00:20:17,633 --> 00:20:20,343 hepatitis A, B, C, D, or E. 544 00:20:20,344 --> 00:20:23,221 - No risk factors, no fever. - Tylenol? 545 00:20:23,222 --> 00:20:25,097 Never, and no prescription meds. 546 00:20:25,098 --> 00:20:27,392 Does she eat polar bear liver? 547 00:20:28,602 --> 00:20:30,813 It can cause vitamin A toxicity. 548 00:20:31,772 --> 00:20:32,772 - No. - Yeah. 549 00:20:32,773 --> 00:20:34,023 She, uh, doesn't eat meat, 550 00:20:34,024 --> 00:20:35,650 kind of a health nut. 551 00:20:35,651 --> 00:20:37,068 Well, maybe she's gulping down 552 00:20:37,069 --> 00:20:38,694 cod liver oil to prevent measles. 553 00:20:38,695 --> 00:20:40,905 No. Vegan, no fish. 554 00:20:40,906 --> 00:20:43,033 Would you, uh, mind laying eyes on her? 555 00:20:43,826 --> 00:20:44,742 Seriously? 556 00:20:44,743 --> 00:20:46,911 You have a way of figuring out the weird stuff. 557 00:20:46,912 --> 00:20:48,455 Take the compliment. 558 00:20:49,873 --> 00:20:51,207 OK, fine. 559 00:20:51,208 --> 00:20:53,501 Five minutes at the bedside... that's it. 560 00:20:53,502 --> 00:20:55,461 I'm already gonna be here for hours as it is. 561 00:20:55,462 --> 00:20:57,713 Thank you. 562 00:20:57,714 --> 00:20:59,341 What am I doing... 563 00:21:02,553 --> 00:21:04,846 - Definitely improving. - Tidal volume's up. 564 00:21:04,847 --> 00:21:07,348 Wheezes now expiratory only. 565 00:21:07,349 --> 00:21:08,933 Oh, making some progress. 566 00:21:08,934 --> 00:21:11,060 You feeling better, baby? 567 00:21:11,061 --> 00:21:14,313 - You scared the shit out of me. - Language! 568 00:21:14,314 --> 00:21:16,691 Does he have a primary-care doctor? 569 00:21:16,692 --> 00:21:18,067 Not anymore. 570 00:21:18,068 --> 00:21:20,653 How do you get his prescriptions renewed? 571 00:21:20,654 --> 00:21:22,864 Neighborhood clinic. We pay cash. 572 00:21:22,865 --> 00:21:24,657 - Albuterol's cheap. - Symbicort? 573 00:21:24,658 --> 00:21:27,618 Without Medicaid, 400 bucks a month. 574 00:21:27,619 --> 00:21:29,121 Just for a little inhaler? 575 00:21:31,290 --> 00:21:32,791 Trocar is on the tube. 576 00:21:33,876 --> 00:21:37,086 I tunnel underneath the scalp about 5 centimeters 577 00:21:37,087 --> 00:21:38,588 and poke through. 578 00:21:38,589 --> 00:21:40,340 - To prevent infection? - Mm-hmm, exactly. 579 00:21:41,925 --> 00:21:44,469 Now you hold the knuckle steady while I pull it through. 580 00:21:47,848 --> 00:21:49,975 And you can staple the wound shut. 581 00:21:51,476 --> 00:21:53,519 That looks like something from Home Depot. 582 00:21:53,520 --> 00:21:55,354 Yeah, big Fourth of July sale. 583 00:21:55,355 --> 00:21:56,689 The brain pressure is measured by 584 00:21:56,690 --> 00:21:58,566 the height of the fluid column. 585 00:21:58,567 --> 00:22:01,110 We need to calibrate it to zero at the level of the tragus. 586 00:22:01,111 --> 00:22:03,154 Stopcock's on, ready to attach. 587 00:22:03,155 --> 00:22:04,530 First troponin's normal, 588 00:22:04,531 --> 00:22:06,991 but you need a second to rule out MI. 589 00:22:06,992 --> 00:22:08,869 Hey, can you step out for a second? 590 00:22:15,042 --> 00:22:16,417 I really did do everything I could 591 00:22:16,418 --> 00:22:18,002 to try to make Orlando stay. 592 00:22:18,003 --> 00:22:19,003 Yeah, I don't doubt it. 593 00:22:19,004 --> 00:22:20,004 I wanted to ask you about 594 00:22:20,005 --> 00:22:22,214 Dr. Al-Hashimi at the VA. 595 00:22:22,215 --> 00:22:24,926 Did you ever notice anything unusual about her behavior? 596 00:22:24,927 --> 00:22:26,928 Um, like what? 597 00:22:26,929 --> 00:22:29,555 Lapses in focus, attention? 598 00:22:29,556 --> 00:22:32,142 No, she was always on top of her game. 599 00:22:35,145 --> 00:22:38,773 But this morning when she was checking labs on Baby Jane Doe, 600 00:22:38,774 --> 00:22:41,193 it was like she zoned out for a few seconds. 601 00:22:42,694 --> 00:22:44,446 Maybe she was just tired. 602 00:22:51,495 --> 00:22:53,746 No congestion, nodules, 603 00:22:53,747 --> 00:22:55,206 or cirrhosis. 604 00:22:55,207 --> 00:22:56,874 Good-looking liver. 605 00:22:56,875 --> 00:22:58,751 I should not be sick. 606 00:22:58,752 --> 00:23:01,379 I work so hard to stay healthy... 607 00:23:01,380 --> 00:23:04,298 diet, exercise, eight hours of sleep. 608 00:23:04,299 --> 00:23:08,135 I can't remember the last time I got eight hours. 609 00:23:08,136 --> 00:23:10,137 Maybe you should try sleepmaxxing. 610 00:23:10,138 --> 00:23:12,056 Oh, you definitely should. 611 00:23:12,057 --> 00:23:14,976 Yeah, cold room, white noise, eye shades. 612 00:23:14,977 --> 00:23:18,813 Kiwis before bedtime, lettuce water, mouth taping. 613 00:23:18,814 --> 00:23:20,481 Who do you follow for health? 614 00:23:20,482 --> 00:23:22,817 A few naturopaths and some functional healers. 615 00:23:22,818 --> 00:23:24,777 Do you... do you buy vitamins from them? 616 00:23:24,778 --> 00:23:26,612 Oh, no, no, I don't take vitamins. 617 00:23:26,613 --> 00:23:29,407 Food is the best medicine... kale, blueberries, 618 00:23:29,408 --> 00:23:31,993 - kidney beans, turmeric. - Turmeric? 619 00:23:31,994 --> 00:23:33,703 Uh, how long have you been taking that? 620 00:23:33,704 --> 00:23:36,247 For a few months. It's an anti-inflammatory. 621 00:23:36,248 --> 00:23:38,791 It detoxes the body, and it can prevent Alzheimer's. 622 00:23:38,792 --> 00:23:40,251 How much do you take? 623 00:23:40,252 --> 00:23:42,253 500 milligram capsules, 624 00:23:42,254 --> 00:23:43,547 but I take five a day. 625 00:23:45,298 --> 00:23:46,799 What? 626 00:23:46,800 --> 00:23:48,634 With doses that large of turmeric, 627 00:23:48,635 --> 00:23:51,262 there have been cases of liver failure. 628 00:23:51,263 --> 00:23:52,972 From eating a spice? 629 00:23:52,973 --> 00:23:55,641 All right, Digby, I think you're good to go. 630 00:23:55,642 --> 00:23:57,811 Mm-hmm. Would you like to see? 631 00:24:10,449 --> 00:24:12,825 I haven't looked like this in a long time. 632 00:24:12,826 --> 00:24:15,328 Your family won't recognize you. 633 00:24:17,247 --> 00:24:19,331 Then how will they find me? 634 00:24:19,332 --> 00:24:21,333 They... they won't know what I look like. 635 00:24:21,334 --> 00:24:22,418 They won't know this is me. 636 00:24:22,419 --> 00:24:23,544 Of course they will. 637 00:24:23,545 --> 00:24:24,795 They know your voice. 638 00:24:24,796 --> 00:24:26,630 They know where you hang out. 639 00:24:26,631 --> 00:24:30,468 They even remember that you used to look like this. 640 00:24:30,469 --> 00:24:32,554 They remember the wedding. 641 00:24:35,515 --> 00:24:37,683 Did you dance with your daughter 642 00:24:37,684 --> 00:24:39,186 at her wedding? 643 00:24:40,604 --> 00:24:42,730 I did. 644 00:24:42,731 --> 00:24:45,817 Then she will always remember you. 645 00:24:48,570 --> 00:24:50,113 - Yeah. - OK. 646 00:24:51,615 --> 00:24:53,157 Hey, I was just looking for you. 647 00:24:53,158 --> 00:24:54,492 - What's up? - You tell me. 648 00:24:54,493 --> 00:24:56,827 - The, uh, asthma patient. - What about him? 649 00:24:56,828 --> 00:24:58,204 Seemed like you were hesitating 650 00:24:58,205 --> 00:24:59,872 talking about using Aerogen. 651 00:24:59,873 --> 00:25:01,582 I was wondering if you were having second thoughts. 652 00:25:01,583 --> 00:25:03,334 No. Just thinking. 653 00:25:03,335 --> 00:25:04,627 About? 654 00:25:04,628 --> 00:25:06,629 The best treatment plan for the patient. 655 00:25:06,630 --> 00:25:08,714 And I think he's on it. 656 00:25:08,715 --> 00:25:10,216 - Anything else? - I don't know. 657 00:25:10,217 --> 00:25:12,802 You tell me. Anything else I need to know? 658 00:25:12,803 --> 00:25:14,137 I don't think so. 659 00:25:15,806 --> 00:25:17,264 This is Dr. Robby in the ED. 660 00:25:17,265 --> 00:25:18,974 I'm checking on a patient, Ekins. 661 00:25:18,975 --> 00:25:21,519 We can take Larson and Stevens off the dry-erase. 662 00:25:21,520 --> 00:25:22,561 Consider it done. 663 00:25:22,562 --> 00:25:23,771 He's in the scanner now? 664 00:25:23,772 --> 00:25:25,231 Oh, great. 665 00:25:25,232 --> 00:25:26,315 No, I was just calling to confirm. 666 00:25:26,316 --> 00:25:27,608 Thank you. 667 00:25:27,609 --> 00:25:29,401 Any new information from upstairs? 668 00:25:29,402 --> 00:25:30,861 Nothing we don't already know. 669 00:25:30,862 --> 00:25:32,530 Same old story, huh? 670 00:25:32,531 --> 00:25:33,948 You think we should take up a collection 671 00:25:33,949 --> 00:25:35,741 for Jesse for... for bail money? 672 00:25:35,742 --> 00:25:37,326 They don't usually set bail 673 00:25:37,327 --> 00:25:39,120 until after you've appeared in front of a judge. 674 00:25:39,121 --> 00:25:40,996 With the holiday, it's not likely to happen till Monday. 675 00:25:40,997 --> 00:25:43,165 So he's gonna be locked up all weekend? 676 00:25:43,166 --> 00:25:44,875 That sucks. 677 00:25:44,876 --> 00:25:46,877 It does suck. 678 00:25:46,878 --> 00:25:49,922 Dr. Langdon, Grady's worse... much worse. 679 00:25:49,923 --> 00:25:52,716 - Need an attending? - Uh, no, we have Shen. 680 00:25:52,717 --> 00:25:54,135 Sat's down to 83. 681 00:25:54,136 --> 00:25:56,220 - What's happening? - Give us a minute. 682 00:25:56,221 --> 00:25:57,721 He's tiring out. 683 00:25:57,722 --> 00:25:59,765 Ketamine and rock. It's time to intubate. 684 00:25:59,766 --> 00:26:00,975 I'll call Volk. 685 00:26:00,976 --> 00:26:02,726 Ma'am, we have to put a tube 686 00:26:02,727 --> 00:26:03,978 down your son's windpipe 687 00:26:03,979 --> 00:26:05,437 so a machine can breathe for him. 688 00:26:05,438 --> 00:26:06,772 Oh, my God. 689 00:26:06,773 --> 00:26:08,315 Hold on, hold on. 690 00:26:08,316 --> 00:26:09,525 No lung sliding on the right. 691 00:26:09,526 --> 00:26:11,026 Pneumothorax. 692 00:26:11,027 --> 00:26:13,070 No need to intubate. 693 00:26:13,071 --> 00:26:14,363 What's going on? 694 00:26:14,364 --> 00:26:16,323 He has a collapsed lung. 695 00:26:16,324 --> 00:26:18,242 There was no history of trauma 696 00:26:18,243 --> 00:26:19,743 that would have caused pneumothorax. 697 00:26:19,744 --> 00:26:21,787 Glove up, Dr. King. 698 00:26:21,788 --> 00:26:24,123 In asthma, you can get "air trapping." 699 00:26:24,124 --> 00:26:25,875 When the lungs can't fully exhale, 700 00:26:25,876 --> 00:26:27,251 eventually they overinflate, 701 00:26:27,252 --> 00:26:29,170 causing some of the tiny air sacs to burst. 702 00:26:29,171 --> 00:26:30,422 How do you fix it? 703 00:26:36,344 --> 00:26:37,262 Like that. 704 00:26:42,976 --> 00:26:45,519 It's a good thing Dr. Conley was here. 705 00:26:45,520 --> 00:26:46,812 - Yeah. - We should probably try 706 00:26:46,813 --> 00:26:48,355 to find him a Neuro-Critical ICU bed. 707 00:26:48,356 --> 00:26:49,940 We don't want to board a patient like this. 708 00:26:49,941 --> 00:26:51,609 - Mm-hmm. - Hey, Robby. 709 00:26:51,610 --> 00:26:54,195 - Hey, how did the scan go? - Fine. 710 00:26:54,196 --> 00:26:55,654 It is probably gonna take a little while 711 00:26:55,655 --> 00:26:57,114 to get the results from the radiologist. 712 00:26:57,115 --> 00:26:58,574 Well, that's not a problem. 713 00:26:58,575 --> 00:27:00,784 Nurse Vivi and I need a little time 714 00:27:00,785 --> 00:27:03,370 to coordinate our schedules over the next few months. 715 00:27:03,371 --> 00:27:04,371 - Really? - Yeah. 716 00:27:04,372 --> 00:27:05,372 I've always wanted to learn 717 00:27:05,373 --> 00:27:06,415 how to ride a motorcycle, 718 00:27:06,416 --> 00:27:07,917 and Duke offered to teach me. 719 00:27:07,918 --> 00:27:10,211 Well, nobody knows motorcycles like Duke. 720 00:27:10,212 --> 00:27:12,630 He's giving me the health care worker discount. 721 00:27:12,631 --> 00:27:13,964 He's quite the gentleman. 722 00:27:13,965 --> 00:27:15,758 Let's get him back to his room. 723 00:27:15,759 --> 00:27:18,552 How would next Saturday be for you, Vivi? 724 00:27:18,553 --> 00:27:21,889 Uh, maybe we could have some dinner after. 725 00:27:21,890 --> 00:27:23,515 Dr. Mohan, Lorrie Diaz is here. 726 00:27:23,516 --> 00:27:25,267 She wants to see her husband. She's heading back. 727 00:27:25,268 --> 00:27:26,853 OK, I'm on my way. 728 00:27:29,022 --> 00:27:30,940 - Mrs. Diaz? - Hi. 729 00:27:30,941 --> 00:27:33,817 Did Orlando go up to his room yet? 730 00:27:33,818 --> 00:27:35,319 No. Um... 731 00:27:35,320 --> 00:27:37,446 I brought him some dinner from Burgatory. 732 00:27:37,447 --> 00:27:38,822 It's a chicken burger... 733 00:27:38,823 --> 00:27:40,449 no bun, just lettuce. 734 00:27:40,450 --> 00:27:43,161 Figured it would be better than hospital food. 735 00:27:46,498 --> 00:27:50,668 He's being treated by our top brain-injury specialists. 736 00:27:50,669 --> 00:27:52,169 Will he wake up? 737 00:27:52,170 --> 00:27:54,088 We won't know for several weeks. 738 00:27:54,089 --> 00:27:56,674 And then he could be back to normal? 739 00:27:56,675 --> 00:27:59,802 Best-case scenario, it would take about a year 740 00:27:59,803 --> 00:28:02,429 before he could be independent at home. 741 00:28:02,430 --> 00:28:04,098 And the worst case? 742 00:28:04,099 --> 00:28:07,602 Round-the-clock nursing care for severe disability. 743 00:28:11,231 --> 00:28:13,357 You let him leave? 744 00:28:13,358 --> 00:28:17,361 He insisted on leaving to work at his second job. 745 00:28:17,362 --> 00:28:19,571 You couldn't make him stay? 746 00:28:19,572 --> 00:28:22,574 He was competent. He knew the risks. 747 00:28:22,575 --> 00:28:24,576 We honored his decision to leave. 748 00:28:24,577 --> 00:28:26,370 Even if it was a stupid one? 749 00:28:26,371 --> 00:28:27,871 I tried to stop him. 750 00:28:27,872 --> 00:28:29,498 Offered to get him all the supplies he'd need 751 00:28:29,499 --> 00:28:31,000 to take care of himself at home. 752 00:28:31,001 --> 00:28:33,544 But he left before I could give them to him. 753 00:28:33,545 --> 00:28:36,047 He said he couldn't afford to lose a paycheck. 754 00:28:43,596 --> 00:28:45,765 Dr. Langdon. 755 00:28:48,018 --> 00:28:49,685 Are you OK? 756 00:28:49,686 --> 00:28:52,813 Yeah. I'm just kind of, uh... 757 00:28:52,814 --> 00:28:55,274 wondering if I'm really ready to be back here. 758 00:28:55,275 --> 00:28:57,568 Well, of course you are. 759 00:28:57,569 --> 00:28:59,695 Ten months is a long time. 760 00:28:59,696 --> 00:29:02,948 I almost killed that kid with an intubation. 761 00:29:02,949 --> 00:29:06,243 Didn't even occur to me to check for pneumothorax. 762 00:29:06,244 --> 00:29:07,953 There wasn't any trauma to indicate... 763 00:29:07,954 --> 00:29:09,164 - I should have caught it. - OK. 764 00:29:15,920 --> 00:29:17,213 You know, I, um... 765 00:29:19,132 --> 00:29:21,967 I had a deposition today, 766 00:29:21,968 --> 00:29:25,429 and all the lawyer's questions made me feel like 767 00:29:25,430 --> 00:29:27,807 I was a really, really bad doctor. 768 00:29:30,185 --> 00:29:33,646 We don't always get everything right the first time. 769 00:29:34,814 --> 00:29:37,274 You would have caught the collapsed lung. 770 00:29:37,275 --> 00:29:39,986 And it may have taken a minute, but you would have saved him. 771 00:29:41,237 --> 00:29:43,572 I'm not sure Robby would agree with you. 772 00:29:43,573 --> 00:29:46,283 He's been riding me all day. 773 00:29:46,284 --> 00:29:48,160 Well, Robby's leaving for three months. 774 00:29:48,161 --> 00:29:50,996 And, you know, with Robby gone... 775 00:29:50,997 --> 00:29:53,041 I really don't want you to leave either. 776 00:29:56,628 --> 00:29:59,171 That which does not kill me makes me stronger. 777 00:29:59,172 --> 00:30:02,466 Wow, Friedrich Nietzsche. 778 00:30:02,467 --> 00:30:05,677 Yeah, Nietzsche, yeah... 779 00:30:05,678 --> 00:30:08,056 not Kelly Clarkson. 780 00:30:10,058 --> 00:30:11,975 Hey, that's a thick one. 781 00:30:11,976 --> 00:30:14,896 Yeah, Austin Green. Ogilvie's triple-A. 782 00:30:17,941 --> 00:30:20,484 Uh, G-R-E-E-N? 783 00:30:20,485 --> 00:30:21,902 Yeah. Why? What are you doing? 784 00:30:21,903 --> 00:30:23,362 Checking to see when we'll get Ogilvie 785 00:30:23,363 --> 00:30:25,280 back from the OR. 786 00:30:25,281 --> 00:30:27,324 - Oh, shit. - What? 787 00:30:27,325 --> 00:30:29,076 The guy didn't make it. 788 00:30:29,077 --> 00:30:31,370 He died on the table about 40 minutes ago. 789 00:30:31,371 --> 00:30:33,539 Then where's Ogilvie? 790 00:30:33,540 --> 00:30:35,499 Oh, man. 791 00:30:35,500 --> 00:30:38,127 His patient had a CT a year and a half ago 792 00:30:38,128 --> 00:30:40,421 that showed a 4-centimeter triple-A. 793 00:30:40,422 --> 00:30:42,089 That's too small for surgery. 794 00:30:42,090 --> 00:30:43,424 He was supposed to come back 795 00:30:43,425 --> 00:30:45,175 every six months for a repeat ultrasound, 796 00:30:45,176 --> 00:30:46,885 but looks like he didn't. 797 00:30:46,886 --> 00:30:49,555 We would've seen that if the computers were working. 798 00:30:49,556 --> 00:30:51,223 Why wouldn't he tell Ogilvie? 799 00:30:51,224 --> 00:30:53,100 I don't know. Maybe he forgot all about it. 800 00:30:53,101 --> 00:30:55,145 Or Ogilvie didn't ask the right questions. 801 00:30:56,271 --> 00:30:58,230 Dennis, hey, got a minute? 802 00:30:58,231 --> 00:31:00,774 Uh, sure. What do you need? 803 00:31:00,775 --> 00:31:02,443 Teenager with jewelry magnets 804 00:31:02,444 --> 00:31:04,445 stuck to both sides of her nasal septum. 805 00:31:04,446 --> 00:31:06,447 I tried to move them with a plastic curette. 806 00:31:06,448 --> 00:31:08,282 Too much pain, and then there was bleeding. 807 00:31:08,283 --> 00:31:10,576 Those need to come off before they cause permanent damage. 808 00:31:10,577 --> 00:31:12,161 Yeah, you think, uh, you could find, like, 809 00:31:12,162 --> 00:31:14,079 a senior or an attending? 810 00:31:14,080 --> 00:31:15,956 We're really trying to get off the clock here. 811 00:31:15,957 --> 00:31:17,125 They're all busy. 812 00:31:19,878 --> 00:31:21,420 I already took one for the team. 813 00:31:21,421 --> 00:31:23,380 Yeah, fine. 814 00:31:23,381 --> 00:31:26,925 Uh, labs on your yellow lady. 815 00:31:26,926 --> 00:31:29,386 INR is elevated, 2.2. 816 00:31:29,387 --> 00:31:31,346 Liver's in trouble but not dead yet. 817 00:31:31,347 --> 00:31:32,931 Tell her to skip the turmeric. 818 00:31:32,932 --> 00:31:35,100 Admit for monitoring, and follow the LFTs. 819 00:31:35,101 --> 00:31:36,310 - Got it. - Mm-hmm. 820 00:31:36,311 --> 00:31:37,812 - Central 10? - Yeah. 821 00:31:42,192 --> 00:31:44,276 "Sleepmaxxing"? Really? 822 00:31:44,277 --> 00:31:45,861 I track the online trends. 823 00:31:45,862 --> 00:31:48,238 Is that your secret for the tough ones? 824 00:31:48,239 --> 00:31:49,948 I just think, 825 00:31:49,949 --> 00:31:52,326 what's the stupidest thing this person could have done? 826 00:31:52,327 --> 00:31:53,578 Then assume they did it. 827 00:31:55,038 --> 00:31:57,164 Well, I mean, she was trying to be healthy. 828 00:31:57,165 --> 00:31:59,500 Yeah, by taking advice from fools. 829 00:31:59,501 --> 00:32:01,710 Turmeric is recommended by a lot of doctors. 830 00:32:01,711 --> 00:32:03,712 Yeah, then ask your doctor for the dose 831 00:32:03,713 --> 00:32:06,298 or check someplace reputable, like the CDC. 832 00:32:06,299 --> 00:32:09,593 Oh, right, I forgot, it's now a medical toxic waste site. 833 00:32:09,594 --> 00:32:12,638 I mean, she's in pretty bad shape. 834 00:32:12,639 --> 00:32:14,932 If things get worse, she could need a liver transplant. 835 00:32:14,933 --> 00:32:17,060 Yeah, 'cause she's a big fucking idiot. 836 00:32:18,645 --> 00:32:20,395 Wow. 837 00:32:20,396 --> 00:32:22,648 No, I actually appreciate her. 838 00:32:22,649 --> 00:32:25,401 Our job security depends on all these big fucking idiots. 839 00:32:27,862 --> 00:32:29,072 OK. 840 00:32:31,407 --> 00:32:34,785 Uh, good night, Perlah, Monica. 841 00:32:34,786 --> 00:32:37,538 - Good night, Dr. Robby. - Good night. 842 00:32:37,539 --> 00:32:39,122 Bye, Emma. 843 00:32:39,123 --> 00:32:40,582 You could stay to pitch in. 844 00:32:40,583 --> 00:32:42,543 Mm, Dana told me to go and get some rest 845 00:32:42,544 --> 00:32:43,961 before tomorrow's shift. 846 00:32:43,962 --> 00:32:45,629 Yeah, you had quite a day. 847 00:32:45,630 --> 00:32:47,006 Wasn't so bad. 848 00:32:49,050 --> 00:32:50,801 Why can't I find Duke's results? 849 00:32:50,802 --> 00:32:53,554 Oh, new patient, no EHR yet. 850 00:32:53,555 --> 00:32:56,348 I can run over to Radiology, get a printout. 851 00:32:56,349 --> 00:32:57,809 Thank you, Monica. 852 00:33:00,353 --> 00:33:02,271 Ready to pick up a few more. 853 00:33:02,272 --> 00:33:03,689 Orlando's all tucked in for now. 854 00:33:03,690 --> 00:33:05,315 - How's he doing? - Numbers are good. 855 00:33:05,316 --> 00:33:07,150 CPP 22. 856 00:33:07,151 --> 00:33:09,778 OK, so he's got a shot at a decent outcome at least. 857 00:33:09,779 --> 00:33:11,405 You think he has a chance? 858 00:33:11,406 --> 00:33:13,615 Oh, I don't know that survival was 859 00:33:13,616 --> 00:33:15,617 the outcome he was hoping for. 860 00:33:15,618 --> 00:33:17,244 What? 861 00:33:17,245 --> 00:33:19,454 He told Samira he's got $100,000 in medical debt, 862 00:33:19,455 --> 00:33:21,958 - that his life is probably... - Mrs. Diaz! 863 00:33:24,294 --> 00:33:26,712 - How can we help you? - The bathroom? 864 00:33:26,713 --> 00:33:29,424 Uh, yeah. Perlah can show you the way. 865 00:33:31,217 --> 00:33:33,552 Not a great idea to have a private conversation 866 00:33:33,553 --> 00:33:34,803 about a patient in a public area. 867 00:33:34,804 --> 00:33:36,805 I know. I know. 868 00:33:36,806 --> 00:33:38,181 You were about to start yapping... 869 00:33:38,182 --> 00:33:39,767 But I didn't! 870 00:33:42,312 --> 00:33:45,188 OK. 871 00:33:45,189 --> 00:33:47,524 And how long have they been in there? 872 00:33:47,525 --> 00:33:48,984 At least two hours. 873 00:33:48,985 --> 00:33:51,403 - How did it happen? - With my earring. 874 00:33:51,404 --> 00:33:54,323 It was supposed to be, uh, red, white, and blue 875 00:33:54,324 --> 00:33:56,116 to look cool at the fireworks. 876 00:33:56,117 --> 00:33:57,826 I told her for the nose, one side only, 877 00:33:57,827 --> 00:33:59,077 but she never listens. 878 00:33:59,078 --> 00:34:00,329 This can be pretty serious. 879 00:34:00,330 --> 00:34:01,622 If we don't get them out quickly, 880 00:34:01,623 --> 00:34:03,040 it can cut off the blood supply 881 00:34:03,041 --> 00:34:04,958 and cause the septum to collapse. 882 00:34:04,959 --> 00:34:08,546 Like, my nose could be deformed? 883 00:34:10,840 --> 00:34:13,342 - Oh, my God, get them off. - Yeah, that's the plan. 884 00:34:13,343 --> 00:34:15,052 Yeah, she tried already. It hurt like crazy. 885 00:34:15,053 --> 00:34:16,219 Because they're stuck together 886 00:34:16,220 --> 00:34:18,347 by a very strong magnetic force. 887 00:34:18,348 --> 00:34:20,265 - Yeah. - No, no, no. 888 00:34:20,266 --> 00:34:22,017 Oh, uh, I'm not gonna use the tips. 889 00:34:22,018 --> 00:34:25,062 I'm gonna flip it around and use the handle. 890 00:34:25,063 --> 00:34:26,688 It's still gonna hurt. 891 00:34:26,689 --> 00:34:27,898 Probably not. 892 00:34:27,899 --> 00:34:29,317 Just, uh, hold still. 893 00:34:31,861 --> 00:34:33,279 OK. 894 00:34:37,533 --> 00:34:38,742 Voilà. 895 00:34:38,743 --> 00:34:41,453 - Really? - That was amazing. 896 00:34:41,454 --> 00:34:43,288 I think another half hour, 897 00:34:43,289 --> 00:34:44,998 we can send this dry-erase board back to storage. 898 00:34:44,999 --> 00:34:46,208 With pleasure. 899 00:34:46,209 --> 00:34:47,584 - Dr. Robinavitch? - Yep. 900 00:34:47,585 --> 00:34:49,087 Results on your friend. 901 00:34:53,758 --> 00:34:55,885 - Fuck. - Duke? 902 00:34:59,889 --> 00:35:01,515 Are you gonna tell him? 903 00:35:01,516 --> 00:35:03,141 I want to talk to a surgeon first. 904 00:35:03,142 --> 00:35:05,185 Uh, Dr. Robby, I have an update on the patient. 905 00:35:05,186 --> 00:35:06,603 Now is not a great time. 906 00:35:06,604 --> 00:35:08,021 Oh, I thought you were going home. 907 00:35:08,022 --> 00:35:09,231 Uh, I was. 908 00:35:09,232 --> 00:35:10,982 Dr. Ogilvie is just sitting 909 00:35:10,983 --> 00:35:12,734 out in the ambulance bay covered in blood. 910 00:35:12,735 --> 00:35:14,361 Sorry, what... what's he doing out there? 911 00:35:14,362 --> 00:35:16,321 Kind of, uh, staring off into space. 912 00:35:16,322 --> 00:35:17,614 I tried to talk to him, but it was like 913 00:35:17,615 --> 00:35:19,074 - he couldn't hear me. - Monica, 914 00:35:19,075 --> 00:35:20,659 can you stat page CardioThoracic? 915 00:35:20,660 --> 00:35:22,870 - I'll go check on Ogilvie. - Please. 916 00:35:25,206 --> 00:35:26,416 Oh. 917 00:35:37,844 --> 00:35:39,971 Hey, Ogilvie. 918 00:35:42,598 --> 00:35:44,516 Ogilvie... 919 00:35:44,517 --> 00:35:46,436 y-you OK, man? 920 00:35:51,524 --> 00:35:53,567 99 on 2 liters. 921 00:35:53,568 --> 00:35:55,902 Scattered end expiratory wheezes. 922 00:35:55,903 --> 00:35:58,113 He is so much better. 923 00:35:58,114 --> 00:36:00,157 The steroids should kick in soon. 924 00:36:00,158 --> 00:36:02,534 So he'll keep improving. 925 00:36:02,535 --> 00:36:04,870 Um, when can I go home? 926 00:36:04,871 --> 00:36:06,538 In a day or two. 927 00:36:06,539 --> 00:36:09,833 And we will, uh, discharge you with a Symbicort inhaler. 928 00:36:09,834 --> 00:36:12,002 That should last about a month. 929 00:36:12,003 --> 00:36:14,546 Hopefully we'll be back on Medicaid by then. 930 00:36:14,547 --> 00:36:16,590 How'd you lose it? 931 00:36:16,591 --> 00:36:20,093 They sent a redetermination letter to our old apartment. 932 00:36:20,094 --> 00:36:22,637 It didn't get forwarded. 933 00:36:22,638 --> 00:36:24,681 When I went to pick up his prescription, 934 00:36:24,682 --> 00:36:28,518 pharmacist told me we were no longer covered. 935 00:36:28,519 --> 00:36:30,771 And you haven't been able to get it back since? 936 00:36:30,772 --> 00:36:33,106 I've been trying for months. 937 00:36:33,107 --> 00:36:35,567 To get re-enrolled, you need tax returns, 938 00:36:35,568 --> 00:36:36,985 pay stubs. 939 00:36:36,986 --> 00:36:39,905 I cut hair. My income fluctuates. 940 00:36:39,906 --> 00:36:42,365 A lot of my regulars are struggling, 941 00:36:42,366 --> 00:36:45,494 so it's been tough. 942 00:36:45,495 --> 00:36:47,412 Well, if you run out of Symbicort 943 00:36:47,413 --> 00:36:49,790 before your Medicaid kicks in, you can come back, 944 00:36:49,791 --> 00:36:52,709 and we'll, uh, set you up with another one. 945 00:36:52,710 --> 00:36:54,711 Oh, is there a patient in here? 946 00:36:54,712 --> 00:36:57,798 'Cause everyone in this room looks extremely healthy to me. 947 00:36:57,799 --> 00:37:00,258 Dr. Shen and I will be with Grady all night long. 948 00:37:00,259 --> 00:37:02,219 Yeah. Day shift, we got this. 949 00:37:02,220 --> 00:37:04,179 We're leaving you in good hands. 950 00:37:04,180 --> 00:37:06,014 Um... 951 00:37:06,015 --> 00:37:08,433 I was really scared. 952 00:37:08,434 --> 00:37:09,644 Thank you. 953 00:37:11,354 --> 00:37:13,356 You're very welcome. 954 00:37:17,276 --> 00:37:19,862 Due to his injury, things have changed. 955 00:37:21,322 --> 00:37:23,532 I was looking for Dr. Abbot. 956 00:37:23,533 --> 00:37:26,368 I haven't seen him for a while. 957 00:37:26,369 --> 00:37:27,703 Excuse me. 958 00:37:30,748 --> 00:37:32,666 So now, with a long-term disability, 959 00:37:32,667 --> 00:37:35,377 things may be easier. 960 00:37:35,378 --> 00:37:36,545 "Easier"? 961 00:37:36,546 --> 00:37:38,046 His condition will qualify him 962 00:37:38,047 --> 00:37:39,548 for Medicare and Medicaid. 963 00:37:39,549 --> 00:37:42,050 So, moving forward, costs should be covered, 964 00:37:42,051 --> 00:37:43,844 including home health care. 965 00:37:43,845 --> 00:37:45,178 OK. 966 00:37:45,179 --> 00:37:46,638 Perhaps this isn't the best time... 967 00:37:46,639 --> 00:37:48,014 I just wanted to reassure you 968 00:37:48,015 --> 00:37:49,892 about future costs. 969 00:37:58,150 --> 00:37:59,484 Robby. 970 00:37:59,485 --> 00:38:01,653 Noelle. 971 00:38:01,654 --> 00:38:03,280 You're still here. 972 00:38:03,281 --> 00:38:05,615 It's not the best day to try to get out on time. 973 00:38:05,616 --> 00:38:07,284 Mm. 974 00:38:07,285 --> 00:38:08,743 So I guess this is it for a while. 975 00:38:08,744 --> 00:38:10,245 Unless you want to come with me. 976 00:38:10,246 --> 00:38:12,622 No, but thank you, 977 00:38:12,623 --> 00:38:14,666 even if it isn't a legitimate offer. 978 00:38:14,667 --> 00:38:16,167 - What do you mean? - Oh, please. 979 00:38:16,168 --> 00:38:18,044 I know well enough not to get in between 980 00:38:18,045 --> 00:38:20,172 a man and his vision quest. 981 00:38:21,591 --> 00:38:22,841 "Vision quest." 982 00:38:22,842 --> 00:38:26,012 That is my nice way of putting it. 983 00:38:27,263 --> 00:38:28,555 I probably don't want to hear 984 00:38:28,556 --> 00:38:30,432 your not-so-nice way of putting it. 985 00:38:30,433 --> 00:38:31,851 No, probably not. 986 00:38:33,603 --> 00:38:37,147 I-I hope that this is not, um... 987 00:38:37,148 --> 00:38:38,523 about you running away from me. 988 00:38:38,524 --> 00:38:39,774 I'm a big girl. 989 00:38:39,775 --> 00:38:41,443 You can tell me just to get lost. 990 00:38:41,444 --> 00:38:43,278 This has nothing to do with you. 991 00:38:43,279 --> 00:38:44,571 Oh, right. 992 00:38:44,572 --> 00:38:47,366 It's the old, uh, "it's not you, it's me"? 993 00:38:48,868 --> 00:38:51,037 In this case, it's actually true. 994 00:38:57,251 --> 00:38:58,878 Excuse me. 995 00:39:04,967 --> 00:39:06,259 I'll see you next week? 996 00:39:06,260 --> 00:39:07,594 It's a three-month sabbatical. 997 00:39:07,595 --> 00:39:09,639 Like I said, I will see you next week. 998 00:39:16,312 --> 00:39:19,522 My first day here as a med student... 999 00:39:19,523 --> 00:39:21,233 there was a patient. 1000 00:39:23,069 --> 00:39:24,736 He was a real nice guy, 1001 00:39:24,737 --> 00:39:27,572 came in with belly pain. 1002 00:39:27,573 --> 00:39:31,201 I saw a gall stone on the ultrasound, 1003 00:39:31,202 --> 00:39:33,370 normal EKG, troponin. 1004 00:39:33,371 --> 00:39:36,748 The pain resolved, and he was in the hall 1005 00:39:36,749 --> 00:39:38,709 when he had a cardiac arrest. 1006 00:39:41,504 --> 00:39:42,838 I couldn't save him. 1007 00:39:44,465 --> 00:39:45,883 People die. 1008 00:39:47,343 --> 00:39:50,804 And we do the best we can... 1009 00:39:50,805 --> 00:39:53,224 but people die. 1010 00:39:54,475 --> 00:39:56,435 You ever get used to it? 1011 00:39:58,229 --> 00:39:59,313 No. 1012 00:40:00,982 --> 00:40:03,733 No, you... 1013 00:40:03,734 --> 00:40:05,695 you try to accept it. 1014 00:40:07,697 --> 00:40:09,448 You try to find balance. 1015 00:40:14,912 --> 00:40:17,790 I don't know if I can take another day like today. 1016 00:40:19,333 --> 00:40:22,627 Primary care specialty sounds way better. 1017 00:40:22,628 --> 00:40:24,421 Pedes, maybe. 1018 00:40:24,422 --> 00:40:26,048 Yeah, maybe. 1019 00:40:27,591 --> 00:40:30,678 I know I'd be bored out of my fucking mind. 1020 00:40:32,013 --> 00:40:36,016 Seriously, I like the challenge of undiagnosed illness, 1021 00:40:36,017 --> 00:40:41,021 of quick decisions, of life-saving procedures. 1022 00:40:41,022 --> 00:40:43,440 And I like being here for people 1023 00:40:43,441 --> 00:40:45,901 on the worst days of their lives. 1024 00:40:54,076 --> 00:40:56,036 {\an8}You know what I think? 1025 00:40:56,037 --> 00:40:57,746 What? 1026 00:40:57,747 --> 00:41:00,081 I think you should go home. 1027 00:41:00,082 --> 00:41:01,499 I think you should sleep on it. 1028 00:41:01,500 --> 00:41:03,001 And I think you should at least wait 1029 00:41:03,002 --> 00:41:04,252 till the morning to decide 1030 00:41:04,253 --> 00:41:05,755 if you want to come back. 1031 00:41:08,758 --> 00:41:11,051 I don't really want to... 1032 00:41:11,052 --> 00:41:13,678 go back in there and see anybody. 1033 00:41:13,679 --> 00:41:14,889 Yeah. 1034 00:41:16,432 --> 00:41:18,933 OK, pull off your gown. I'll take it in. 1035 00:41:18,934 --> 00:41:21,394 Shift is over. 1036 00:41:21,395 --> 00:41:22,938 Go home. 1037 00:41:35,826 --> 00:41:37,035 - Oh! - Oh, God. 1038 00:41:37,036 --> 00:41:38,119 - No, I'm... I'm... - Sorry. 1039 00:41:38,120 --> 00:41:39,537 I'm good. I'm good. I'm good. 1040 00:41:39,538 --> 00:41:41,247 There's a dummy in a wheelchair. 1041 00:41:41,248 --> 00:41:43,209 Uh, yeah, he moves around. 1042 00:41:46,295 --> 00:41:48,421 I see I've been replaced. 1043 00:41:48,422 --> 00:41:49,964 Oh, did I take your spot? 1044 00:41:49,965 --> 00:41:51,633 - Not really, no. - Are you sure? 1045 00:41:51,634 --> 00:41:53,093 Where the hell have you been? 1046 00:41:53,094 --> 00:41:54,719 I found Ogilvie. 1047 00:41:54,720 --> 00:41:56,012 And? 1048 00:41:56,013 --> 00:41:58,348 And he's going home. 1049 00:41:58,349 --> 00:41:59,557 That's it? 1050 00:41:59,558 --> 00:42:00,892 It's a long story. 1051 00:42:00,893 --> 00:42:02,352 Well, I got nothing but time. 1052 00:42:02,353 --> 00:42:04,521 I need to respect his privacy. 1053 00:42:04,522 --> 00:42:06,106 Where's the fun in that? 1054 00:42:06,107 --> 00:42:08,150 - Beep. Beep, beep. - Sorry. 1055 00:42:16,742 --> 00:42:18,076 Um, the shredder jammed. 1056 00:42:18,077 --> 00:42:21,122 Yeah, uh, try putting it in reverse. 1057 00:42:23,499 --> 00:42:24,666 Perfect. 1058 00:42:24,667 --> 00:42:26,751 Just give it a little love tap. 1059 00:42:26,752 --> 00:42:28,337 - OK. - Kick it. 1060 00:42:29,505 --> 00:42:31,048 Jesus Christ. 1061 00:42:33,050 --> 00:42:35,135 Guess Mr. Digby got a room upstairs. 1062 00:42:35,136 --> 00:42:36,594 In your dreams. 1063 00:42:36,595 --> 00:42:38,596 He's not in South 21. 1064 00:42:38,597 --> 00:42:40,014 Yeah, he is. 1065 00:42:40,015 --> 00:42:42,350 There's a new guy in the bed. 1066 00:42:42,351 --> 00:42:44,352 Short hair, clean-shaved? 1067 00:42:44,353 --> 00:42:46,771 I'll take care of it. 1068 00:42:46,772 --> 00:42:48,481 Scout film showed obvious pathology, 1069 00:42:48,482 --> 00:42:50,024 so we ordered the CT angiogram. 1070 00:42:50,025 --> 00:42:51,693 Textbook ascending aortic aneurysm. 1071 00:42:51,694 --> 00:42:53,528 Eight centimeters. 1072 00:42:53,529 --> 00:42:55,405 50% one-year mortality. 1073 00:42:55,406 --> 00:42:56,698 So he definitely needs surgery. 1074 00:42:56,699 --> 00:42:57,699 If he wants to live. 1075 00:42:57,700 --> 00:42:58,741 OK, well, he's a friend, 1076 00:42:58,742 --> 00:43:00,034 so I will talk to him. 1077 00:43:00,035 --> 00:43:01,202 I'll get him admitted to your service. 1078 00:43:01,203 --> 00:43:03,329 - Not today. - Why not? 1079 00:43:03,330 --> 00:43:05,165 He needs to see Cardiology and Pulmonary first 1080 00:43:05,166 --> 00:43:06,416 to be cleared for the OR. 1081 00:43:06,417 --> 00:43:08,334 They can do a stress echo, PFTs. 1082 00:43:08,335 --> 00:43:10,587 He needs to be admitted and evaluated as an inpatient. 1083 00:43:10,588 --> 00:43:12,255 Nothing ever gets done over a holiday weekend. 1084 00:43:12,256 --> 00:43:13,339 He can take it easy at home. 1085 00:43:13,340 --> 00:43:14,757 He's a ticking time bomb. 1086 00:43:14,758 --> 00:43:16,092 He's probably been that way for years. 1087 00:43:16,093 --> 00:43:17,385 We can get him in early next week 1088 00:43:17,386 --> 00:43:18,970 with a specialist to get his testing done. 1089 00:43:18,971 --> 00:43:20,930 All goes well, he's on the OR schedule in a week. 1090 00:43:20,931 --> 00:43:22,557 What happens if it ruptures before then? 1091 00:43:22,558 --> 00:43:24,392 Call 911. 1092 00:43:24,393 --> 00:43:26,060 Sorry, Robby. Best we can do. 1093 00:43:26,061 --> 00:43:28,063 Text me his number. I'll have my office coordinate. 1094 00:43:30,274 --> 00:43:31,816 - Fuck! - Hey! 1095 00:43:31,817 --> 00:43:33,569 Take a walk. Come on! 1096 00:43:37,907 --> 00:43:38,823 Two for discharge. 1097 00:43:38,824 --> 00:43:40,325 Yeah, please don't ring the bell. 1098 00:43:40,326 --> 00:43:41,951 The computers are back up and running. 1099 00:43:41,952 --> 00:43:43,494 Not for these two. 1100 00:43:43,495 --> 00:43:44,913 They don't have electronic health records yet. 1101 00:43:44,914 --> 00:43:46,289 Wait, hold up. 1102 00:43:46,290 --> 00:43:48,541 This kid had a wrist X-ray ordered. 1103 00:43:48,542 --> 00:43:49,792 Ugh, it never happened. 1104 00:43:49,793 --> 00:43:51,127 And water-skiing lady's 1105 00:43:51,128 --> 00:43:52,462 still waiting on a knee series. 1106 00:43:52,463 --> 00:43:53,713 I canceled the X-rays. 1107 00:43:53,714 --> 00:43:56,049 Diagnosed them both with ultrasound. 1108 00:43:56,050 --> 00:43:57,300 Really? 1109 00:43:57,301 --> 00:43:59,052 Yeah. 1110 00:43:59,053 --> 00:44:01,512 The, uh, little boy had a simple buckle fracture. 1111 00:44:01,513 --> 00:44:04,140 Distal radius. He got a Velcro splint. 1112 00:44:04,141 --> 00:44:06,851 And Mrs. Stegman had a small medial meniscus tear. 1113 00:44:06,852 --> 00:44:09,270 Knee immobilizer, crutches, and a follow up with ortho. 1114 00:44:09,271 --> 00:44:11,606 Could have used you on the day shift today. 1115 00:44:11,607 --> 00:44:14,025 They don't teach us a lot of musculoskeletal ultrasound. 1116 00:44:14,026 --> 00:44:15,568 I know. 1117 00:44:15,569 --> 00:44:18,196 That's why I did electives at Harvard and Highland. 1118 00:44:18,197 --> 00:44:21,032 Are you applying for an ultrasound fellowship here? 1119 00:44:21,033 --> 00:44:23,826 I am, but it is so competitive. 1120 00:44:23,827 --> 00:44:26,079 - That's what I hear. - Kind of a long shot. 1121 00:44:26,080 --> 00:44:27,497 I only have one publication, 1122 00:44:27,498 --> 00:44:29,415 but it's a series of case reports diagnosing 1123 00:44:29,416 --> 00:44:31,960 shoulder dislocations with ultrasound only. 1124 00:44:31,961 --> 00:44:33,962 If you want to learn some MSK, you can tag along. 1125 00:44:33,963 --> 00:44:35,463 I got three more to scan. 1126 00:44:35,464 --> 00:44:37,465 Maybe some other time. 1127 00:44:37,466 --> 00:44:39,885 Cool. 1128 00:44:42,304 --> 00:44:44,222 Hey, don't jam the shredder. 1129 00:44:44,223 --> 00:44:45,765 What is that, two charts? 1130 00:44:45,766 --> 00:44:48,352 No, it's my ultrasound fellowship application. 1131 00:44:50,187 --> 00:44:51,729 Hey. 1132 00:44:51,730 --> 00:44:54,732 Uh, sorry about your patient. 1133 00:44:54,733 --> 00:44:57,735 Yeah, Orlando's in pretty bad shape. 1134 00:44:57,736 --> 00:44:59,654 Oh, no, I... I was talking about 1135 00:44:59,655 --> 00:45:03,325 the triple-A guy you worked on with Ogilvie. 1136 00:45:05,953 --> 00:45:08,496 He didn't make it through surgery. 1137 00:45:08,497 --> 00:45:10,039 I tried to talk to Robby about it, 1138 00:45:10,040 --> 00:45:12,041 but I think he's busy. 1139 00:45:12,042 --> 00:45:13,752 Excuse me. 1140 00:45:16,130 --> 00:45:17,881 Oh, shit. 1141 00:45:22,136 --> 00:45:23,553 You think I'm on edge? 1142 00:45:23,554 --> 00:45:25,346 First you're shaming Samira, then McKay... 1143 00:45:25,347 --> 00:45:26,681 They both needed to be called out 1144 00:45:26,682 --> 00:45:28,016 - for unacceptable behavior. - Yeah? 1145 00:45:28,017 --> 00:45:29,309 Yeah, well, you do that in private. 1146 00:45:29,310 --> 00:45:30,727 Same place you share your thoughts 1147 00:45:30,728 --> 00:45:31,936 about a patient's possible suicide. 1148 00:45:31,937 --> 00:45:33,396 And slamming stuff? Please. 1149 00:45:33,397 --> 00:45:34,605 Sign out all the shit that's bugging you 1150 00:45:34,606 --> 00:45:35,773 and get out of here. 1151 00:45:35,774 --> 00:45:37,608 - I can't. - Yes, you can. 1152 00:45:37,609 --> 00:45:38,943 When either of my kids was acting like this, 1153 00:45:38,944 --> 00:45:40,403 I gave them a time-out in their room. 1154 00:45:40,404 --> 00:45:41,571 Whoa, whoa, whoa, you're not my mother. 1155 00:45:41,572 --> 00:45:42,780 Yeah? Well, too bad. 1156 00:45:42,781 --> 00:45:43,990 - You need one. - No, I had one. 1157 00:45:43,991 --> 00:45:45,700 She left. I don't need another one. 1158 00:45:45,701 --> 00:45:47,035 What I need is someone who can actually run this place 1159 00:45:47,036 --> 00:45:48,953 - while I'm gone. - OK, I'm sorry. 1160 00:45:48,954 --> 00:45:50,288 - I didn't know. - Nobody knows. 1161 00:45:50,289 --> 00:45:52,582 Who needs to know? Who gives a fuck? 1162 00:45:52,583 --> 00:45:53,916 I think you need a break. 1163 00:45:53,917 --> 00:45:55,501 That is what the sabbatical is for. 1164 00:45:55,502 --> 00:45:57,045 Then start it now. Walk away. 1165 00:45:57,046 --> 00:45:58,296 I have too much to do. 1166 00:45:58,297 --> 00:46:00,006 Let someone else talk to Duke. 1167 00:46:00,007 --> 00:46:01,758 No, that needs to come from me. 1168 00:46:01,759 --> 00:46:03,092 Why? 1169 00:46:03,093 --> 00:46:04,677 Because I owe him that. 1170 00:46:04,678 --> 00:46:06,512 It needs to come from a friend, not a stranger, 1171 00:46:06,513 --> 00:46:08,556 otherwise he's gonna bail and drop dead while I'm gone. 1172 00:46:08,557 --> 00:46:11,434 OK, wrap that up and then leave. 1173 00:46:11,435 --> 00:46:13,061 It's not just Duke. 1174 00:46:13,062 --> 00:46:14,812 I'm not sure that Al-Hashimi is fit to run this place. 1175 00:46:14,813 --> 00:46:16,022 - What's that supposed to mean? - I'm not sure. 1176 00:46:16,023 --> 00:46:17,648 I'm trying to figure that out. 1177 00:46:17,649 --> 00:46:18,900 Did you know that she wants to have two attendings 1178 00:46:18,901 --> 00:46:20,526 - on at all times? - No. 1179 00:46:20,527 --> 00:46:22,028 Is that something she's worked out with Gloria? 1180 00:46:22,029 --> 00:46:23,571 - I don't know. - I also don't know 1181 00:46:23,572 --> 00:46:24,906 if Langdon is going to relapse. 1182 00:46:24,907 --> 00:46:25,907 I don't know if Whitaker's gonna be able 1183 00:46:25,908 --> 00:46:27,283 to take care of my shit. 1184 00:46:27,284 --> 00:46:28,868 I don't know if Javadi's gonna give up on 1185 00:46:28,869 --> 00:46:30,745 what she's good at or if Samira's gonna flame out 1186 00:46:30,746 --> 00:46:32,163 because of some bullshit with her mother. 1187 00:46:32,164 --> 00:46:34,582 - Is there anything else? - Yeah, you. 1188 00:46:34,583 --> 00:46:36,793 I don't know about you running around 1189 00:46:36,794 --> 00:46:38,586 with a full syringe of Versed in your pocket. 1190 00:46:38,587 --> 00:46:40,963 I'm worried about the people that I care about. 1191 00:46:40,964 --> 00:46:43,383 We'll all manage until you come back. 1192 00:46:43,384 --> 00:46:44,550 We always do. 1193 00:46:44,551 --> 00:46:46,387 Yeah? What if I don't come back?