Original subtitles

Robbie. Robbie.

Coler skin respiratory distress is here. Right.

You okay? Yep.

I wanted to talk to the patient in Central 12th Summit, but he took off.

Is there a problem?

According to Mom, she found a list of high school girls that he'd like to

eliminate.

What's wrong with kids these days?

Uh, you mean besides social media and the worldwide pandemic and the

environmental crisis?

Yeah, yeah, you're about to help today, aren't you?

Nick Bradley, 19, found unresponsive by parents. No meds, no allergies. On

arrival, he was barely breathing with pinpoint pupils bradycardic at 38.

Pupils responded in Narcan, but we tubed him when his respirations didn't pick

up. Any drugs or alcohol I'm seeing?

No. Signs of trauma?

Nothing. Okay, open your eyes, Nick.

On three. One, two, three.

Where was he found? In bed by his mom.

Pupils are six millimeters non -reactive.

Heart rate 64.

BP is cycling.

No response to pain.

GCS3. Does that fit any toxidrome?

No. If it was just opiates with Narcan, he'd be breathing on his own.

A beta blocker shouldn't give pinpoint pupils.

Maybe parents have some prescription meds in their bathroom.

We're on our way.

That's a stand -up scooter rider versus car door.

No helmet. No blood in the belly. No pericardial effusion.

And lungs are up.

Hemo Q's good. 15.

BP 84 over 58.

Okay.

What's your plan, Dr. Collins?

Push dose epi. 0 .1 milligram.

Foley for urine. Stabilized for CT.

And throw a wide net.

Where are we going now? We need the room for someone else. But you can rest in

the hall till we get your labs back.

Your parents must be proud.

Having a son who's a doctor.

Yeah, I guess.

You know, I was the first one in my family to go to college.

Now they sacrificed a lot to get me here.

How's your pain, Mr. Milton?

I'm fine.

I could use a latte, though.

That could bring back the gallstone pain.

How about a bourbon?

It's barely 8 o 'clock.

How about some ice chips?

No, thanks.

I prefer my whiskey neat.

Yeah, that's not happening.

Systolic back down to 90.

Another .1 of epi.

Lack of paralysis of all four extremities.

No eye movement with ice water. So no brainstem function.

Due to?

Hypoxic injury, massive hemorrhage.

Samira, escort him to CT.

Take the drug box with you.

Call me if you need me.

Hey, are you okay?

Yep. You sure?

Have you ever had to worry about me?

No, but never heard to check in. It's part of my job.

Consider yourself checked in.

Okay.

Uh, uh, uh, uh, uh.

Got something?

Oh, I had a case for Dr. Collins.

May I see it?

Yeah. Uh, 68 -year -old male, history of hypertension, one hour of right upper

quadrant pain after eating a fatty meal, now resolved, afebrile, non -tender.

There was a gallstone present on POCUS.

EKG shows no acute ischemic changes, but I'm still waiting on LFTs and lipase.

Why did you order the EKG?

The nurse suggested it to rule out any cardiac issues.

Well, good call on both your parts.

Nurses know what they're doing. Never hesitate to listen to them. Come find me

when those labs are back. Hey, how's that figure?

Oh, it's nothing. Dr. Robbie?

Yep. The son and daughter of Mr. Spencer from assisted living? They're here.

Okay, I'll be right there.

Your father has pneumonia.

And a condition called sepsis. What is that exactly? It means that the bacteria

has spread from his lung to his bloodstream.

So far, he's been responding well to treatment.

Hey, Pop.

It's Helen and Jeremy.

Jeremy.

Hillary.

Boom.

Fuck.

David. It's the nowhere man from Yellow Submarine. It's what he used to call me

when I didn't do my homework.

Is this his baseline?

He has good days and bad days.

Why don't we step out for one more second?

So your father came in with low blood pressure, which is improving.

Can he go back to assisted living?

Eventually, we hope so.

Your dad has an advanced directive expressing his wishes, which says that

fluids and medications are okay.

But no artificial life support, no CPR.

He doesn't want a bunch of machines keeping him alive?

Okay.

Then we will continue with oxygen and IV fluids and antibiotics.

But if his lungs stop working, we're not going to place a tube in his windpipe

for a breathing machine. But pneumonia is treatable?

Most of the time it is.

But if he can get better in a week, then put him on a machine. That's not what

he wanted.

Do either of you have durable power of attorney for health care?

Yes. We both do.

Okay. Well, this is a decision that does not need to be made right now.

Why don't you think about it?

Talk about it.

If things get worse, sometimes allowing for a comfortable natural death can be

the most humane path.

No routine cases until we assess the Tier 1.

Thanks. Dr. Langdon?

So, uh, how's the VA?

Yeah. It's good.

You know, challenging.

I learned a ton.

I just think it... Maybe it should be mandatory that all doctors spend time

there, like, on a regular basis, because of all they've sacrificed for us.

That's a nice thought.

How'd you choose the pit?

Oh, I have a sister with special needs, and she got into a really great facility

here in Pittsburgh.

And PTMC has such a great reputation, I thought, you know, I'd be a good fit.

Can I put that in my headache, please? Uh, yeah. What do you got?

A 36 -year -old woman with severe headache due to parasophical trigger

Her pain went from 11 to 0 after two cc's of IMR cane. Wait, wait, wait. You

a trigger point injection before presenting the case?

Yeah. Interns always present first.

I spent a month at the pain clinic. No, it's not okay. It's very comfortable.

It's definitely not okay.

23 -year -old Ben Kemper, no helmet, got doored riding an e -scooter. Neck

versus handlebar, then face planted to the pavement.

Obvious facial fractures, but alert and oriented with good vitals.

Here we go.

One, two, three.

How we doing, Ben?

Come on.

Back in my throat.

That's probably from the nose bleed.

Short rapid rhino, please.

Tachy at 120.

Pulse ox borderline at 90.

We'll buy it 15 liters for now.

Neck confusion.

Larynx shifted to the right. No crepitant.

Four morphine.

I'm going to stick something in your nose to stop the bleeding.

No hemotymphin.

Inflate the balloon.

How about now, Ben?

Better. What's up?

Good vitals.

A &O. Let's have a look.

Ouch.

Floating face.

Fourth refracture.

You don't see that every day. Okay, let's prep for an airway. Double setup

in case.

Nice work.

Thanks.

All right, Mr. Tagare, you are good to go.

Oh, thank you.

Remember, 10 % off for doctors and nurses.

I'm a student doctor.

All right, sorry.

I hit my head, remember?

Well, my son loves pizza, so I will take you up on it for sure. Thank you. Thank

you. Wait for a nurse. Okay, thanks.

I just realized it sounds like I always feed my kid junk food.

Oh. No.

Pizza? S'mores?

No, no, please.

I like pizza and s'mores.

Who doesn't?

How many kids do you have? Just one.

Harrison? He's 11 now.

What does your husband do?

No husband.

Just me and my son.

I take it you don't have kids?

I don't mean on account of your age.

Or, I don't know, maybe I do. I mean, most medical students don't have kids.

Yeah, no, no.

No kids.

Just... I'm not even a boyfriend.

It's just school for now.

Yeah. It'll keep you pretty busy. I do not miss it.

Less than difficult as a young mother.

It had its moments.

But my life has been full of challenges.

Med school was not one of the hardest by far.

It was one of the most rewarding, though.

Other than having my son.

Hey.

Facial lack with a possible foreign object in the eye, which is always a

seven on the WMMD scale.

What makes Mateo vomit?

You okay?

Yeah.

Yeah, um, he's funny. The nurse.

Mateo, you can say his name.

Um, yeah, uh, for an object in the eye, I could be really serious.

Hey, fruitcake.

Hey, I'm talking to you, fruitcake. Myrna, I've told you a hundred times, my

name is Dr. Robbie.

You want to see my vagina?

I have already seen it.

And once was enough.

Thank you.

Robbie, parents of Nick Bradley, the OD team, are here.

Okay, Parkerman trauma one. He's not back from CT yet, but I'll be right

in a minute.

Behaving yourself, Myrna?

Oh, yes, ma 'am.

How we doing?

Ketamine is stuck on board. Pulse ox holding at 94.

Prep in the neck just in case.

Let's have a look.

A little deeper.

Lots of swelling. I can't see the cords. To the right.

The left.

Yeah, really distorted from the trauma and the edema is only going to get

Which is why we should crike. You don't crike a laryngeal fracture. Don't listen

to Edwina Scissorhands here. If they can't cut it, surgery doesn't know how

fix it. The contusion is high at the thyroid cartilage. So you just stand

looking pretty, ER Ken, and let me fix this.

We're down to 85.

All right, pull out eye gel, bag and crike.

Eye gel, please.

I've never done a crike before.

No, Mel will do the crike. You've already had a busy morning. Glove up,

No, I'm doing the crike, doctor.

You would be doing it, doctor, if it wasn't an odd day. Surgery gets even

ED gets odd days. You know this, for crike's sake.

Because you're all fucking odd down here. Okay, same word, please. Let's

on the patient. I so appreciate your gracious understanding.

I'll assist in case she screws up. So long, Mel. Play nice.

Sasser up with the eye gel.

You ready?

Hello. Oh, hello.

You've done this?

Yes, in the cadaver lab.

Let's hope that's not where this poor soul ends up.

We'll do an open technique since we have a minute.

Okay.

Okay, you're going to be making a vertical incision to avoid the jugulars

the carotids.

Good. If this was a crack that needed to happen in seconds, you could use a ten

blade, your finger, and a bougie.

This is called a wheat lanter, and this is your trade cook.

T -spine, head C, T, OMF, start a propofol drip.

Okay, now we're going to make a horizontal incision across the

membrane.

4 -0 Shiley next.

Get ready to bag the crack.

Yeah, yeah, yeah, good.

Excuse me. No worries.

Entitled CO2 is yellow. Yellow is yes. Nicely done. Throw it in. Okay.

I will be next door.

Does your resident know how to suture, or do I need to teach?

You're all class, yo -yo.

I know.

Thanks. That means a lot of nothing coming from you.

Mel, you okay?

If you're done fighting.

We're not fighting. This is playing.

Langdon's too soft to fight.

Oh, yeah. I have nothing but respect for Dr. Garcia. In fact, I think she would

make a wonderful hostess at Applebee's.

Later, Og.

Let's go.

Okay, thanks.

Just received word your son's head CT is normal. And he's maintaining a good

heart rate. You got him back.

Thank you, thank you. Right now, he's unconscious with a tube in his throat

oxygen.

Why don't we step out for a minute while they get him settled, and then you can

come back and sit with him as long as you want.

Nikki, it's Mama. I'm here, babe.

You're doing great, son.

Boom.

Okay, this is the bedtime.

So, we don't know how long he was at home

without breathing.

He's breathing now?

Not on his own.

But he's going to wake up. We certainly hope so.

We're going to know better after we get some more test results back.

Are you sure that he didn't take anything that could have caused this?

No, he's a good kid. He's in college. He has a part -time job.

He even chose to live at home so he could focus on school.

Dr. Robbie, from the urine.

What's that?

It's a drug test.

And it is positive for fentanyl.

No, that is impossible.

Nick doesn't do drugs.

There are a lot of pills that are sold illegally that have fentanyl, not just

painkillers. Xanax, Ativan.

No, not our son.

Well, maybe he didn't know that he took something with fentanyl. I don't know.

The hows and the whys don't really matter.

What matters is spending time with Nick.

We've got some more tests to run. We'll know our options after that. But in the

meantime, why don't you take a seat and talk to him?

Can he hear us?

You know, we're never really sure, so we should just assume that he can.

And we'll come find you as soon as we know more, okay? Okay.

Can we move Nick Bradley to a private room?

Like you're going to make it?

Can you respond to Narcan?

I think his pinpoint pupils just grew into blown pupils from brain stem death.

Shit.

Yeah, not much older than Jake.

Don't go there.

Hard not to sometimes.

Mr. Spencer's room.

Hey, Robbie.

Teresa, the mother of the young man David who bolted. She's asking for her

Okay, I'll be there in a minute.

What is happening?

His oxygen levels are dropping.

Mr. Spencer, how are you feeling?

I don't remember where I parked.

Mr. Spencer, do you know where you are? It's so loud in here.

Dad, do you know where you are? Dad, look at me. What's my name?

I don't know where my car is.

I've had this number five. Step out.

What's BiPAP?

It is a pressurized air mask that can improve his oxygen.

Either his pneumonia is getting worse or his heart couldn't handle the fluids

that we gave him to treat the sepsis. His lungs are filling up with fluid. Can

you take the fluid away?

Not without his blood pressure crashing with very bad consequences.

So let's just hope the BiPAP works.

And if it doesn't?

Then I would need to know your decision about using a breathing machine.

We're still talking about it.

Well, we know he expressed his wishes in writing.

Do not intubate.

We're thinking try it for a week.

That would be a very painful week.

He wouldn't get a lot of rest with all the monitors and all the blood tests.

He might need to be sedated. He might need to be restrained because he'd be in

an unfamiliar place with a very uncomfortable tube down his throat.

And he wouldn't really know what was happening.

Elderly patients can often develop psychosis.

But he might get better.

Or he might get worse.

What would you do?

I really can't answer that for you. This is your father. That's your decision to

make. I can guarantee you that we will keep him as comfortable as possible if a

natural death is what you choose.

But he's not your father, and he can't recover from it.

What my sister means is that we're still deciding the best thing to do.

Well, the sooner you decide, the better.

I'm really sorry. I wish there was more that I could do.

I'm not sure that he has that much time left.

Dr. Robbie?

You were right.

She can't say whether she was bumped by accident or shoved on purpose.

No other witnesses?

No, not really.

Pull security footage, maybe we'll find something. Hopefully she tripped.

I mean, I hope she tripped. I mean, I hope she wasn't pushed on purpose.

That would make this a hate crime.

Yes, ma 'am.

Doctor. Sorry.

I'm sorry.

No harm, no foul.

Will you let me know if she says anything else?

Will do.

At the risk of seeming... Then you probably shouldn't. No, trust me.

How do you know? I just know.

I just wanted... I know.

Look.

I'll let you know if she says anything else that could be important to your

investigation.

Thank you.

No, for the record.

Nope.

Any

luck

getting our psych workers upstairs?

Yeah, right.

At least the Kraken's still sleeping.

Is it me or was that opposite? No.

What? You don't even know what I... What you were going to say?

Maybe you do.

You seem nice.

Absolutely not.

There is no possible scenario in which you and I have this conversation.

You, of all people, should know better.

I was... No.

Just walk away.

Best possible scenario, just keep on walking.

You got to lay off mixing Adderall and energy drinks.

Trust me, I will.

All right.

Thanks.

That's the thing about emergency medicine. You never know what you're

get. And we get everything.

Is that why you chose it?

Maybe a little.

I also get to pick my ship, which for a single mother is amazing.

But mostly, I just like the people, you know?

They're always there when you need them.

You wouldn't want to be a part of that, you know?

I am at work, just like last time and the time before that.

I'll be right back.

What is the point of this fucking thing if it doesn't even work?

Sorry. You're doing great. Take your time.

You okay?

I am.

I get frustrated when I can't do things, or at least it looks like it.

Yeah, you and me both.

Thanks, but my frustration manifests itself emotionally, and then I get

and then it looks like I can't handle things, and, you know, then I can't cry

front of the patient because no one wants to see their doctor cry. That's

big red flag.

You just did a perfect crike.

You're doing great.

Hey, you, pasty white.

How about a sandwich?

Uh...

What brings you here today, sir?

I'm here for a fucking sandwich.

Okay.

Okay, uh, excuse me.

Perla? Perla, can this patient get a sandwich?

I already gave you a sandwich, Ro.

I ate this all week.

Sure,

give him another sandwich. They're on the food cart. Just make sure it's not

salad or he'll throw it on the floor.

Okay, good to know. Thanks.

Any quick ones up here?

It's only 8 .30 and Robbie's already on my case for being too slow.

I can usually at least make it a lunch before he starts hounding me.

Got a little slack today, okay? It's the anniversary of Dr. Adamson's death.

That's sad.

There's still no reason to take it out on me.

I'm just saying.

Dr. Mohan?

Samira, please.

I just wanted to apologize.

When my phone went off earlier, that was really unprofessional.

Don't sweat it.

Trust me, we'd need to laugh, otherwise we'd never stop crying.

Thank you.

Besides, with all the craziness that comes through here every hour, nobody

about us.

Got an unresponsive, unhoused man coming in. Might be a good teaching case,

funky music.

Let's go.

Caucasian male, approximately 60 to 70 years old, found unresponsive, no signs

of trauma, no ID.

On three.

One, two, three.

Did you take anything?

Smelly alcohol from here. This guy's wearing the spring, summer, and fall

collection.

What's wrong?

Patient tested positive for rats.

No.

If it matters, I only counted three.

Oh, there goes one.

Because your son tested positive for THC, the psychoactive ingredient in

cannabis, we're going to have to admit him for overnight observation and

monitoring. What about his brain?

Is there a chance that much pot is going to do some damage? I mean, he's only

four. The honest answer is we don't know. There haven't been any long -term

studies, but the fact that this is a one -time occurrence suggests that there

should be no long -term effects.

But you don't know.

So my son could end up with learning disabilities, psychiatric problems, or

autism because there's no evidence to suggest any of that. Hello, I'm Kiara

Alfaro. I'm the department's social worker.

Kiara will help you navigate the next steps.

What steps?

Well, a case like this requires mandatory reporting to child services

sometimes law enforcement.

No. Why do you have to involve the police? It's a controlled substance.

They're not taking my kid away. They're doing pot gummies. Well, fuck your

suggestions. No one is touching my child.

In fact, we're leaving.

No, you can't take your son. He can stop breathing. I'll observe him at home.

Amanda, please. Fuck off, Drew. Get security.

If you can't cooperate, I'm going to have to ask you to leave. Amanda,

He needs to stay here. And you need to get a fucking hotel. Your son can't

the hospital, but I can have you removed. Don't you dare touch me. Get

here. Mrs. Jones, I know this is scary and stressful. Oh, fuck you, fuck you!

This is my son, my son, and nobody is touching him! Whoa, whoa, whoa, what's

going on? I was worried about a CYF. Man, stop it! Okay, okay, enough!

This is a hospital. It's in the Jerry Springer show.

Ma 'am, nobody's trying to take your child, so why don't you stay here with

while your husband talks to our social worker outside and straightens all this

out? Well, I don't want him speaking for me and my son.

Well, it is either you or him.

Your son is not leaving. But you can be escorted out and even arrested if you

refuse to cooperate.

Nobody wants that.

So you tell us. What do you want to do?

I'm staying with my son.

Okay, great.

You do that.

We're all on the same page here.

Thank you, Olsen. You okay?

Yeah, we got this.

It's all yours.

Is everything all right out there? Yeah, just another day in paradise. How are

you feeling? Better.

Where's David?

He left.

He said he had to get back to school.

What?

Maybe you could try calling him. Get him to come back.

What's going to happen to him if I do?

Hopefully he'll be willing to talk to somebody.

Will you talk to him?

I can try. I don't think he wanted to talk to me.

Have you shared with anyone about the writings of his you found? No.

I didn't know who to tell. I just don't want to see him get hurt.

Neither do we.

No, it's just my straight devotion. Maybe if you can text him.

He's not texting back.

Oh, I'm sorry about all this. It's okay.

What you're doing for David is very brave.

I'm his mother.

I'll do anything to protect him.

Do you think he would hurt anyone?

No.

But... I'm sure a lot of parents felt that way

before their children did unspeakable things.

Does he have any history of violence? Has he ever been in any trouble? No,

never. He's very quiet.

And he takes great care of me.

He's struggled with his father's death.

We both have.

The flight is ten minutes out with an electrocution.

Okay, grab Collins. I'll be right there.

Keep trying to reach him. If you do, have someone come find me.

Okay.

Thank you.

Of course.

You got some good news for me? I sure do.

There are two rooms in ICU being cleaned. They'll be ready by now. Great.

And I got bagels in the lounge. Nice job. Thank you.

Is it true? You have to be more specific.

Are there rats in the ED?

Apparently, if somebody already snitched.

Do you know how bad this looks?

One more reason to shut it, it's clear.

Only the emergency department admits rats. The emergency department would

admit rats.

Unless they have the right insurance.

Did you catch any of them?

One, and I charge him for a full visit.

I'm glad you think this is funny. I'm sorry that you don't. Did you call an

exterminator? He's waiting on a second opinion.

You were pushing your luck today.

Don't worry. Last I heard, they were headed for the cafeteria, so they should

dead within the hour.

I'll be here all week. Well, maybe not.

Drug -seeking woman kicked off a city bus for disrupting and disturbing

passengers.

She's been screaming for narcotics non -stop. What the hell are you doing?

Why can't you call this? She's been uncooperative and combative. Let her go.

Stop fighting. Come the fuck down or I'm calling the cops.

My meds at home aren't working. Please, I have to call the cops. Okay, stop.

Everybody stop.

Stop!

What's your name?

It's Joyce.

It's Joyce.

Joyce, is this your sickle cell pain?

Yes. 10 milligrams of ibuprofen.

You really want 10? Yes, repeat it in five minutes if needed. And she needs a

dilaudid drip. This is a vaso -occlusive crisis.

I'm so sorry this happened.

We're going to be okay now.

We're safe here.

Come on.

We're going to be safe here. I promise.

Great.

Live wire hit his left floral.

Shocked him once for V -tips. Was there a power pole down? No. Abandoned

factory. Two elbow cutters hit his side. Got electrocuted. Did he try to still

cover? Most likely.

Power line fried his arm and the current through his whole body stopped his

fire.

Ready?

Steady lift.

Atomyoglobin and a CK to the lab.

Two liters normal saline wide open. Dr. Santos, what are we worried about?

Oh. Raptor myelosis from tissue damage can kill the kidneys.

Ongoing risk of cardiac irritability. Text me. AP pad in place. That fell off

telephone pole?

No, he was on a platform.

Boring. Cut into a live wire.

Tense ventral compartment.

Set up a stick pressure monitor.

V -fib. Charge at 300.

Am I running this or are you? Sorry, reflex response.

Clear.

Ah, fuck.

Sorry.

Sorry.

So, what happened?

I bought it for my girlfriend's dog.

I work nights and he yaps all day long. And when I woke up, I was wearing it.

Stupid bitch!

Sorry.

Sorry. I think she might have used crazy glue. Yeah, it looks that way.

Have you tried removing the batteries?

Of course.

All right, I think we have a couple options, Gary.

We can try to find a solvent that will dissolve or at least soften the glue

enough for you to peel it off without taking your skin with it.

Or, um, that's your buddy.

Um, I guess your skin cells on your neck will naturally slough off, and you

should just be able to remove it in time.

How much time?

Um, a couple weeks, maybe.

A couple weeks?

I think this guy's got scurvy.

Is he a pirate?

No, he's an unhoused man. Lives almost exclusively on Dollar Store ramen.

There's parafollicular hemorrhage, gingivitis, bleeding gums, and, yeah, no

fruit or vegetables in his diet. I suppose that could do it as long as he

out piracy. No parrot, no peg leg, doesn't reek of sweat and rum.

Well, I think you mentioned it. There was a smell.

Probably a pirate.

Tell him to pick up some vitamin C next time he docks at a Dollar Store.

I can't tell if you're joking.

No. Captain Scurvy's got a vitamin C deficiency.

Cheapest way to fix it is with a daily supplement.

Captain Scurvy's another joke.

I'd like to think so. That's a good one.

Dr. Langdon, Dr. King, this is Arthur Carlson from Children, Youth, and

Families. He'd like to speak to the parents of Tyler Jones.

Right. Right.

Mel, would you mind showing him to Kiara and the family? Yeah. Right this way.

Beto? Hello, Doctor.

What are you doing here?

I'm working day shifts now.

Didn't you retire a couple years ago?

No.

I have to work today.

Right. Right, just stay right here, okay? I have a lot of cleaning to do.

no, I'll be just one second.

Hey, Doc.

Doc, how about a sandwich? Sure, Earl, turkey, no egg salad. I got you. Just

give me one minute.

So, Bader said he's working here?

Yeah, he just started wandering. Fortunately, he always winds up back

Thinks he still works in the E .D.

I called his family. They usually pick him up after a few hours.

Really?

Yeah, give them a break and look at him. He's talking to people, feeling

youthful, getting some exercise.

Hell, I wish I was that happy.

Think he's any good at catching rats?

Stop.

Oh, Earl wants a sandwich. Earl always wants a sandwich.

Hey, check it out.

I got my kids a puppy.

Cute. Hope that wasn't your idea.

Why?

Seriously? You really think your wife needs anything else to take care of?

loves dogs.

Oh, look, penguins. Doesn't mean I want to take care of one.

Well, I'm pretty sure it's illegal to own a penguin. Pretty sure you're

the point.

The point is, Tanner promised you he'd take care of it.

A four -year -old.

Yeah, okay.

How's she doing?

Still breathing after 20 of morphine.

How's the pain, Joyce?

Oh, a little better.

You've ordered an exchange transfusion.

I figured I needed that.

What's your normal regimen at home?

90 of extended release morphine every 12 hours and oxycodone for breakthrough

pain, but it wasn't working.

Starting IV dilaudid for an hour.

You can press this button if you need a lecture.

That only works once an hour, though, so don't go crazy.

Could I confer with you?

Yeah.

You seem surprised by the opiate dosage.

Seems a little high. So was her pain.

How do you know she's not drug -seeking? You can't fake a hemoglobin of six.

Do you know what sickle cell crisis does to the body?

Lots of people get caught and plug up your capillaries and deprive all your

cells of oxygen.

It's been described as an electrical stabbing pain that feels like it's

your bones and flushing glass through your body.

I never thought of it like that. Little empathy goes a long way with those

suffering in real pain.

Yeah. Don't worry, you'll get good at spotting the fakers, and half the time

those people need is someone to really listen to them and hear their story.

Mm -hmm.

Interior compartment pressure is... 49.

Burn caused massive swelling.

What does he need, Dr. Santos?

A fasciotomy, but he still has a radial pulse.

It's pressured out to be over 100 to lose the pulse, and at that point, he'd

lose the arm.

49's enough to destroy all the nerves and muscles in a matter of hours.

Compartment pressure is 49. Yeah, I'm going to make the initial incision down

here. Ortho can finish up in the OR.

Good plan. I'll let him know.

Hey, Robbie. Always good to see you, Fred. Hey, like my rock star. She's

good. She's a great teacher.

Show of gloves for Dr. Santos.

Oh, we don't teach forearm fasciatomy to our residents.

He's all alone somewhere someday with no backup.

This is the path to avoid the median nerve and all major vessels.

Maybe just watch the first time.

She'll hold the blade. I'll cut.

Template of Dr. Cantor.

We'll start proximal.

How much pressure?

Just about this much.

Mm -hmm.

Through the skin and sub -Q.

How are they making out?

They're still talking.

You okay?

Yeah, for sure. I just hate seeing families torn apart.

Oh, they'll be fine.

How can you be sure?

They're white.

Probably get off with a slap on the wrist.

If they weren't, she'd probably lose her child and he'd end up going to jail.

Sorry, I did a fellowship in cynicism.

You sure you okay?

100%. I'm just going to get some air.

I am a savage.

I am a savage.

I am a savage.

I need help.

I got stuff.

Do you need any help?

What's your name?

Alex. Okay, Alex, let me take a look.

This fucking hurts.

Oh, I know.

All right.

We're going to take good care of you. You guys got it? We got you up here,

We got you.

I have an abdominal GSW in the ambulance. Say code trauma now.

GSW just got dumped by homeboy ambulance.

Okay, you got this?

Yeah, go.

Two grams of Ansep. Ortho's on their way.

It's only 80, 14 gauge.

Left AC.

We got two units of whole blood going on the rapid diffuser. Call the OR. We'll

be right up. Lungs up. Do you take medications every day?

Any allergies? No.

More than the full blood. Yeah.

Torp is liver.

What's his name?

Alex. Alex, you've lost a lot of blood. You need to go to surgery right away.

We're going to die.

Not now that I'm here.

Oh, it was humility.

It was surgery. Oh, it's ready. How's he doing?

He's coming up a bit. Let's go.

Can you call my mom? Yep. Of course. Of course.

So he didn't have to wait for OR?

Nope. We're a trauma center. We always keep one OR stocked and ready to go.

Well, he's awesome.

What happens if there are multiple traumas needing OR?

We get a lot busier.

Mr. Milton, I'm sorry we had to move you into the hall. I know it gets pretty

chaotic and noisy out here.

Mr. Milton?

Hey. Hey, Bennett. Wake up for me.

Oh, shit, shit, shit. Um, I need a little help here.

Yeah.

Help! When did you check on him last?

I don't know, around half an hour ago at most. I was waiting on the lab. What's

going on? It's my Goldstone guy. You saw his EKG. Unknown downtime. He was

sleeping in the hall.

Crash guard, let's go!

I got it.

Full compression?

Asystole. Resume compression.

Amp of epi.

Slow temp is slow temp. Should I intubate?

No. Drop it down one minute. We don't want a whole compression.

She blew her fix and dilated.

She's been down a long time.

How are we doing in here?

So much better.

Dr. Mohan, this is my wife, Andeen.

Dr. Samira Mohan, nice to meet you, Andeen.

Thank you for helping her. Of course. And, again, I'm so sorry about how you

were treated when you first arrived.

Not everyone who works here is accustomed to dealing with sickle cell.

We will be doing everything possible from here on in to manage Royce's

In the meantime, can I get you anything?

I'm fine.

Andeen? No, thank you.

Okay, well, have the nurses come find me if you need anything.

deep breaths for me, Ian.

Keep an eye on him and present to Dr. Langdon.

Okay. Okay, great.

I'll see you back in triage once he settles down.

Yeah.

Just take this off. Hang in there, Ian. This should really help with your

asthma.

How can I help you, hon?

I'm looking for Dr. Langdon. Yeah, let me see where you are.

Dr. Langdon, we have a med student at Central looking for you.

Copy that. He's headed this way.

Thanks.

Hey, Crash.

You missed a pretty cool fasciotomy.

I'm not sure I'd be describing a fasciotomy as cool. You would if you

one who did it.

How's it going out in the arrivals lounge?

Do you know anything about Dr. McKay?

I've been here for less than two hours. I don't know anybody, including you.

I thought you were some kind of kid genius.

I'm like any other third -year med student.

Clearly.

Hey, I'm just trying to break the ice. I'm not trying to annoy you.

And yet, you're still calling me Crash when I asked you not to.

Really? Still on that?

Still on that.

Yeah. Okay.

Sorry.

I had no idea genius was so sensitive.

But I get it.

Big brain, big feelings. Makes total sense.

I'll try to be softer.

We switch out every few minutes. You can take a break. I'm fine.

Cold compressions.

Still in aces, Billy.

Resume compressions.

Should we shock him?

You don't shock aces, Billy. We could be fine via fib. Not a chance.

Okay, uh, when was the last epi? Three minutes ago. Okay, well, ACLS does every

three to five minutes, right? So let's push another round.

Fine. Robbie.

Mr. Spencer's adult children are asking for you, and the parents of Nick

Bradley, the fentanyl overdose, also want to speak with you.

Three rounds of epi and then call it.

Mr. Spencer's maxed out on BiPAP, 25 on 10.

Is that?

Not great, high 80s.

Hi.

I heard you wanted to talk to me. Yeah, that alarm kept going off. Yeah, why

don't we step outside?

The alarm is for low oxygen.

Does he need more of that BiPAP?

I'm afraid that's as high as we go.

So it's a decision at this point. We want you to put our father on the

machine.

Even though that goes against his desires to not be intubated?

We're not ready to let go yet.

And if your father is?

He was a stubborn son of a bitch. He would never have given up on either of

We're not giving up on him.

You're absolutely certain you want to put your father through this after

everything I've told you?

I may have to honor his advance directive.

No, you have to honor our durable power for health care.

If not, we can talk to your hospital attorney.

Jeremy, you're on board with this?

Yeah, I guess so.

Okay. You can sit with him until we're ready.

When will that be?

Momentarily.

Please don't tell me you're going to intubate that poor man. It's what the

family wants. So what? They want to torture him?

I explained all that.

If I co -sign, we can override their durable power.

They're threatening to go to the hospital, attorney.

Let them. Call the ethics committee. They'll agree with us. No, you're

right, but we don't have that kind of time.

We are stuck.

What are you talking about?

What?

I gotta go tell those parents their 18 -year -old son is brain dead.

You want me to come with you? Nope.

It's okay.

What are you gonna say?

I'm going to say that it's likely, but we still need to do an apnea test and a

cerebral perfusion test.

There's no cranial nerve activity.

Those people need some hope.

False hope.

Hope is hope. Is it?

What are we praying for miracles today?

They need time to process before they can accept what's happening.

You ever consider taking that advice?

Physician, heal thyself.

Don't you have patience?

No change.

No pericardial effusion, no tension, pneumothorax, no cardiac activity.

Let's try calcium.

Could be hyperkalemia. No, his potassium was normal.

You ready to call this?

Not yet.

Dr. Robbie said three rounds of epi.

It's time. Let's push another amp. This one could do it.