1 00:00:12,679 --> 00:00:15,015 - Baran, is this you? 2 00:00:20,521 --> 00:00:23,232 - It began after a bad case of viral meningitis 3 00:00:23,315 --> 00:00:24,983 when I was five. 4 00:00:25,067 --> 00:00:27,319 They tried every anti-seizure medication, 5 00:00:27,402 --> 00:00:31,281 but I still had episodes every few months or so. 6 00:00:31,365 --> 00:00:32,533 No one's ever noticed before. 7 00:00:32,616 --> 00:00:34,076 They just think I'm thoughtful. 8 00:00:36,119 --> 00:00:37,454 - Are you driving? 9 00:00:37,538 --> 00:00:40,582 - I couldn't until laser ablation 10 00:00:40,666 --> 00:00:43,919 to my left temporal lobe 12 years ago. 11 00:00:44,002 --> 00:00:46,755 Between that and the Keppra, I've been seizure-free, 12 00:00:46,797 --> 00:00:50,467 cleared by Neurology to drive and to work as an attending. 13 00:00:52,261 --> 00:00:54,471 - How long, uh, between the seizure 14 00:00:54,555 --> 00:00:56,348 you had today and the last one? 15 00:00:56,431 --> 00:00:59,685 - It's been well over a year. 16 00:01:01,853 --> 00:01:03,355 But I had two today. 17 00:01:07,985 --> 00:01:09,444 I don't know why. 18 00:01:09,528 --> 00:01:12,656 It could be sleep deprivation, new job stress. 19 00:01:12,739 --> 00:01:15,951 I--I haven't had to deal with Peds cases 20 00:01:16,033 --> 00:01:17,494 since Afghanistan. 21 00:01:17,536 --> 00:01:19,204 - What are your options now? 22 00:01:19,288 --> 00:01:21,331 - Um... 23 00:01:21,414 --> 00:01:24,876 up my Keppra or maybe try 24 00:01:24,960 --> 00:01:26,503 one of the newer anti-seizure meds. 25 00:01:26,587 --> 00:01:29,339 But if that doesn't work, I'm left with two choices-- 26 00:01:29,423 --> 00:01:33,801 um, a temporal lobectomy, which could impair my speech, 27 00:01:33,884 --> 00:01:36,263 or get a neuromodulation device, 28 00:01:36,346 --> 00:01:38,015 which can sense and stop the seizures 29 00:01:38,056 --> 00:01:39,850 almost immediately. 30 00:01:39,890 --> 00:01:41,685 - You need to disclose this. 31 00:01:41,727 --> 00:01:43,687 - I know. I have a plan. 32 00:01:43,770 --> 00:01:44,813 - Hey, Robby, Dana's looking for you. 33 00:01:44,896 --> 00:01:46,023 She's in Peds. 34 00:01:46,106 --> 00:01:47,357 - Yeah, OK, I'll be right there. 35 00:01:47,441 --> 00:01:48,734 [door closes] 36 00:01:48,817 --> 00:01:49,985 - Sounds like you're needed in Peds, 37 00:01:50,068 --> 00:01:52,070 and I have patients to see. 38 00:01:52,154 --> 00:01:54,031 - Robby, pregnant woman with severe headache 39 00:01:54,072 --> 00:01:55,699 on her way in by ambulance. 40 00:01:55,782 --> 00:01:58,285 - Find Abbot or a night shift resident. 41 00:02:04,875 --> 00:02:07,919 [indistinct chatter] 42 00:02:13,300 --> 00:02:15,177 - Need you to turn out your pockets. 43 00:02:21,433 --> 00:02:23,310 OK. Show me your hands. 44 00:02:43,454 --> 00:02:44,956 - [sighs] 45 00:02:47,834 --> 00:02:51,213 [urine trickling] 46 00:02:51,296 --> 00:02:52,631 Come here often? 47 00:02:56,343 --> 00:02:58,095 [baby crying] 48 00:02:58,136 --> 00:02:59,638 - [clears throat] 49 00:03:01,390 --> 00:03:02,808 What's going on? 50 00:03:02,891 --> 00:03:04,601 - Oh, sorry--false alarm. 51 00:03:04,643 --> 00:03:06,770 We thought she spiked a fever, but it was the wrong chart 52 00:03:06,853 --> 00:03:09,231 from our analog hell. 53 00:03:09,314 --> 00:03:11,775 You know anybody who might consider kinship adoption? 54 00:03:11,858 --> 00:03:13,568 Doctors and nurses qualify. 55 00:03:13,652 --> 00:03:15,195 - Don't look at me. 56 00:03:15,278 --> 00:03:17,280 Hey, can your staff keep an eye on Dr. Al-Hashimi 57 00:03:17,364 --> 00:03:18,365 until she leaves? 58 00:03:18,448 --> 00:03:20,784 - Why? 59 00:03:20,867 --> 00:03:22,953 - Uh, because I think she's tired, 60 00:03:23,036 --> 00:03:24,579 and I don't want her to make any mistakes. 61 00:03:24,621 --> 00:03:26,623 - Oh, great advice. Maybe you should take it. 62 00:03:26,707 --> 00:03:27,916 - Yeah. 63 00:03:27,999 --> 00:03:29,334 I'm gonna go get some fresh air. 64 00:03:29,418 --> 00:03:30,919 - Grab some for me while you're out there. 65 00:03:30,961 --> 00:03:32,003 - Your lungs wouldn't know what to do with it. 66 00:03:32,087 --> 00:03:33,088 - Screw you! 67 00:03:33,171 --> 00:03:34,715 - In front of the baby? Nice. 68 00:03:34,798 --> 00:03:37,591 [baby crying] 69 00:03:37,676 --> 00:03:39,219 - Yeah. 70 00:03:39,302 --> 00:03:41,096 - We are the night crawlers. 71 00:03:41,138 --> 00:03:44,057 We deal with the weirdest and the wildest because... 72 00:03:44,141 --> 00:03:46,601 all: We are the weirdest and the wildest of them all. 73 00:03:46,685 --> 00:03:47,728 - That is right, and tonight, 74 00:03:47,811 --> 00:03:49,062 they are really gonna be crawling. 75 00:03:49,146 --> 00:03:50,439 Now go get some! 76 00:03:50,522 --> 00:03:51,481 all: Hooah! 77 00:03:51,523 --> 00:03:52,607 - [claps] 78 00:03:54,401 --> 00:03:55,861 - [clears throat] 79 00:03:55,944 --> 00:03:57,487 - Sorry to wake you. 80 00:03:57,529 --> 00:03:59,030 - I--I was thinking. 81 00:04:02,409 --> 00:04:04,119 [yawns] Doubt PTX. 82 00:04:04,202 --> 00:04:06,329 - You're supposed to be leaving. 83 00:04:06,413 --> 00:04:07,539 - I am. 84 00:04:09,833 --> 00:04:11,334 - You know, this spirit quest of yours 85 00:04:11,376 --> 00:04:13,170 has a lot of people up in arms around here. 86 00:04:13,253 --> 00:04:14,671 - Everyone's gonna be fine without me, 87 00:04:14,713 --> 00:04:16,298 and it's hardly a spirit quest. 88 00:04:16,380 --> 00:04:18,007 - Whatever it is, it seems you've given people 89 00:04:18,048 --> 00:04:19,259 the impression you might not be coming back. 90 00:04:19,341 --> 00:04:20,677 - Well, who knows 91 00:04:20,761 --> 00:04:22,179 what the future has in store for any of us? 92 00:04:22,220 --> 00:04:23,513 - Yeah, saying shit like that right there 93 00:04:23,597 --> 00:04:24,556 isn't helping. 94 00:04:24,639 --> 00:04:26,016 People are worried about you. 95 00:04:26,057 --> 00:04:27,893 - Dr. Abbot, the patient in South 21, 96 00:04:27,976 --> 00:04:29,352 Digby, he's missing again. 97 00:04:29,436 --> 00:04:30,729 - Sounds like a day shift problem. 98 00:04:30,812 --> 00:04:33,064 - Not if he was handed off already. 99 00:04:37,235 --> 00:04:38,820 - Best I can do under the circumstances. 100 00:04:38,904 --> 00:04:40,113 - Thank you. 101 00:04:40,197 --> 00:04:41,615 Hey, don't leave before I get back, yeah? 102 00:04:41,698 --> 00:04:43,450 - Hell, I feel like I live here now. 103 00:04:46,870 --> 00:04:48,121 - Your friend fixing your bike? 104 00:04:48,205 --> 00:04:49,372 - Ambulance clipped it 105 00:04:49,414 --> 00:04:51,207 while it was just parked here today. 106 00:04:51,291 --> 00:04:53,418 - Jesus Christ. 107 00:04:53,502 --> 00:04:55,045 That's a sign if I've ever seen one. 108 00:04:55,086 --> 00:04:56,588 [siren chirps] 109 00:04:56,671 --> 00:04:58,423 Yeah, here's the thing-- when people worry about you, 110 00:04:58,507 --> 00:05:00,217 it makes me think that I should be worried about you, 111 00:05:00,258 --> 00:05:01,885 and I don't like worrying about things. 112 00:05:01,927 --> 00:05:03,053 - Ooh. Now you're a shrink? 113 00:05:03,136 --> 00:05:04,179 - No, I'm trying to be your friend. 114 00:05:04,262 --> 00:05:05,347 You got--you got Dana convinced 115 00:05:05,430 --> 00:05:07,098 that you're gonna hurt yourself. 116 00:05:07,182 --> 00:05:08,683 - Dana's got her own issues. - That sounds like projection. 117 00:05:08,767 --> 00:05:10,018 - Are you seriously trying to have this fucking 118 00:05:10,101 --> 00:05:11,561 conversation with me right now, man? 119 00:05:11,645 --> 00:05:13,188 I--I'm not the one 120 00:05:13,271 --> 00:05:15,565 who spends his free time getting shot at. 121 00:05:15,607 --> 00:05:17,150 Hooah! 122 00:05:17,234 --> 00:05:19,486 - Hey, Dr. Robby, this is Judith Lastrade-- 123 00:05:19,569 --> 00:05:21,738 36 weeks pregnant with two days of headache, 124 00:05:21,780 --> 00:05:24,241 now a 10 out of 10 with blurred vision. 125 00:05:24,282 --> 00:05:27,410 BP 174/120, heart rate 92. 126 00:05:27,494 --> 00:05:29,538 No relief with fentanyl. - Judith, I'm Dr. Abbot. 127 00:05:29,621 --> 00:05:30,914 Any weakness in your arms or legs? 128 00:05:30,997 --> 00:05:32,457 - No, no. Is this a stroke? 129 00:05:32,541 --> 00:05:33,875 - We need to check for everything. 130 00:05:33,959 --> 00:05:36,586 - Pitting edema with severe preeclampsia. 131 00:05:36,670 --> 00:05:38,547 Where are you doing your prenatal care? 132 00:05:38,630 --> 00:05:39,756 - Nowhere. 133 00:05:39,840 --> 00:05:41,258 It's a wild pregnancy. 134 00:05:41,341 --> 00:05:43,301 I want a free birth. 135 00:05:45,428 --> 00:05:48,765 - This 81-year-old nun presents with red, itchy eyes 136 00:05:48,807 --> 00:05:51,935 with secretions for the past two days. 137 00:05:51,977 --> 00:05:54,437 Patient complains of no URI symptoms, 138 00:05:54,479 --> 00:05:55,981 no contact with any chemical... - Hey. 139 00:05:56,064 --> 00:05:57,399 - Agents, no known exposures-- 140 00:05:57,482 --> 00:05:58,942 - Want half a Monster? 141 00:05:58,984 --> 00:06:00,610 - Oh, no, thanks. 142 00:06:00,652 --> 00:06:02,112 I--I don't really want to stay awake 143 00:06:02,153 --> 00:06:04,239 any longer than I have to. 144 00:06:04,322 --> 00:06:05,782 - Yeah, I hear you. 145 00:06:07,325 --> 00:06:09,286 - Did you find your ID badge? 146 00:06:09,369 --> 00:06:10,871 - Uh, no. 147 00:06:10,954 --> 00:06:13,123 You any closer to deciding what's next for you? 148 00:06:13,206 --> 00:06:15,083 - Uh, yeah, I'm seriously considering law school. 149 00:06:15,166 --> 00:06:16,585 - What? What are you talking about? 150 00:06:16,668 --> 00:06:18,545 You're gonna be a great doctor. 151 00:06:20,005 --> 00:06:23,216 - I mean, no offense, but look what this place does to you. 152 00:06:23,300 --> 00:06:24,885 Langdon's an addict. 153 00:06:24,968 --> 00:06:27,596 - Is a person with a substance use disorder. 154 00:06:27,679 --> 00:06:29,514 - McKay was on house arrest. 155 00:06:29,598 --> 00:06:31,016 Dana's a time bomb. 156 00:06:31,099 --> 00:06:32,767 Santos is one of the angriest people 157 00:06:32,851 --> 00:06:34,269 you are ever going to meet. 158 00:06:34,352 --> 00:06:35,770 - Sarcastic, yes. Cynical, definitely. 159 00:06:35,854 --> 00:06:37,314 I don't know if she's, you know-- 160 00:06:37,355 --> 00:06:38,732 - Mel? 161 00:06:39,774 --> 00:06:42,736 Samira has no life. 162 00:06:42,819 --> 00:06:45,947 Abbot's an adrenaline junkie who gets shot at for fun. 163 00:06:46,031 --> 00:06:48,825 Robby's got, like, PTSD or something way fucking worse. 164 00:06:48,867 --> 00:06:50,076 - OK, well, I--I mean, 165 00:06:50,159 --> 00:06:52,203 I'd hate to know what you think about me. 166 00:06:53,747 --> 00:06:55,332 - I don't know, I just-- 167 00:06:55,415 --> 00:06:58,001 the more time I spend here, 168 00:06:58,043 --> 00:06:59,210 the more I realize the importance 169 00:06:59,294 --> 00:07:01,963 of my mental health. 170 00:07:03,048 --> 00:07:04,049 - Mm. 171 00:07:04,132 --> 00:07:05,342 - For patients and for us. 172 00:07:05,425 --> 00:07:07,969 And this is... 173 00:07:08,053 --> 00:07:09,137 - Yeah. 174 00:07:09,220 --> 00:07:10,388 Well, you know, 175 00:07:10,472 --> 00:07:13,308 maybe that's what you should focus on. 176 00:07:14,392 --> 00:07:16,603 - What? - Mental health. 177 00:07:16,686 --> 00:07:18,855 Clearly, you have a passion for it, right? 178 00:07:18,939 --> 00:07:20,440 I mean, that's--that's great. 179 00:07:20,523 --> 00:07:21,524 - I don't know if I'd call it a passion. 180 00:07:21,566 --> 00:07:23,735 I would call it, like, a... 181 00:07:26,613 --> 00:07:28,239 Oh, my God. 182 00:07:30,116 --> 00:07:32,284 You might be right. 183 00:07:33,828 --> 00:07:35,372 Oh, you're a genius, Whitaker. 184 00:07:35,455 --> 00:07:36,581 - Oh, OK. 185 00:07:36,665 --> 00:07:38,207 [laughs] 186 00:07:38,291 --> 00:07:40,210 - CTG is on. 187 00:07:40,293 --> 00:07:42,545 - CTG? - Cardiotocography. 188 00:07:42,587 --> 00:07:45,966 Measures the baby's heart rate and checks for contractions. 189 00:07:46,049 --> 00:07:47,550 - Fetal heart rate 128. 190 00:07:47,592 --> 00:07:49,052 Normal range, Nazely? 191 00:07:49,135 --> 00:07:50,971 - 110 to 160. 192 00:07:51,054 --> 00:07:52,847 - So the baby's OK? 193 00:07:52,931 --> 00:07:54,057 - Right now, yes. 194 00:07:54,099 --> 00:07:55,475 128 is reassuring. 195 00:07:55,558 --> 00:07:57,686 - BP's 170/119. 196 00:07:57,769 --> 00:07:59,437 6 grams of magnesium running in. 197 00:07:59,521 --> 00:08:01,064 - Your next move, Crus? 198 00:08:01,106 --> 00:08:03,692 - 20 of labetalol, IV push over two minutes. 199 00:08:03,775 --> 00:08:05,235 - Uh, what's happening? 200 00:08:05,276 --> 00:08:07,237 - Uh, you have a condition called preeclampsia. 201 00:08:07,320 --> 00:08:08,530 - And how did it happen? 202 00:08:08,613 --> 00:08:10,740 - Uh, nobody really knows, actually. 203 00:08:10,824 --> 00:08:13,076 It affects about 10% of the pregnancies. 204 00:08:13,159 --> 00:08:14,577 High blood pressure, headaches, 205 00:08:14,619 --> 00:08:17,038 protein in the urine, and swollen ankles. 206 00:08:17,122 --> 00:08:19,332 - OK, well, it's a wild pregnancy, 207 00:08:19,416 --> 00:08:21,543 so that means no medical care. 208 00:08:21,626 --> 00:08:23,586 - Then why are you here? 209 00:08:23,628 --> 00:08:25,046 - [crying] 210 00:08:25,130 --> 00:08:27,382 I just need to get rid of this headache. 211 00:08:29,509 --> 00:08:32,470 - Well, if we don't lower your blood pressure 212 00:08:32,554 --> 00:08:35,432 and treat with magnesium, there can be problems. 213 00:08:35,472 --> 00:08:36,640 - Like what? 214 00:08:36,725 --> 00:08:38,268 - Seizures, bleeding, 215 00:08:38,351 --> 00:08:40,395 even death, for you and the baby. 216 00:08:40,477 --> 00:08:42,230 - [crying] Oh, my God. 217 00:08:42,313 --> 00:08:43,940 - Robby, your VIP's ready to go. 218 00:08:43,982 --> 00:08:45,984 - OK, I'll be right there. 219 00:08:46,067 --> 00:08:47,610 You good? - Yeah, I'm good. 220 00:08:47,694 --> 00:08:50,321 I got it. With my eyes closed. 221 00:08:50,405 --> 00:08:51,656 But I won't. Maybe one eye. 222 00:08:51,740 --> 00:08:52,991 [clicks tongue] 223 00:08:53,074 --> 00:08:54,117 Hey-- [door closes] 224 00:08:54,159 --> 00:08:56,161 [machines beeping] 225 00:08:57,537 --> 00:08:58,913 - Hey, Becca. How you feeling? 226 00:08:58,997 --> 00:09:01,207 - I'm better. Thanks. 227 00:09:02,709 --> 00:09:04,044 - Where are you? 228 00:09:04,127 --> 00:09:05,962 - I'm at Adam's house. 229 00:09:06,004 --> 00:09:07,714 Can I call you later? We're watching a movie. 230 00:09:07,797 --> 00:09:08,965 - Oh, sure. I just--I thought 231 00:09:09,007 --> 00:09:10,467 you were gonna see the fireworks. 232 00:09:10,550 --> 00:09:13,094 - Nope, we decided to watch "Elf" instead. 233 00:09:13,178 --> 00:09:14,429 - Ah. 234 00:09:14,512 --> 00:09:16,431 Of course you did. - OK. 235 00:09:16,514 --> 00:09:18,141 I'll call you tomorrow! - Tomorrow? Wait. 236 00:09:18,183 --> 00:09:20,435 Uh, are--are you spending the night? 237 00:09:20,518 --> 00:09:22,312 - Um, uh, yes. 238 00:09:22,353 --> 00:09:24,064 His parents invited me. 239 00:09:24,147 --> 00:09:25,565 - They--they need to ask me that. 240 00:09:25,648 --> 00:09:27,984 - Are--are you staying here too? 241 00:09:28,068 --> 00:09:32,072 - No, they--they needed to ask if it was OK if you stayed. 242 00:09:32,155 --> 00:09:33,448 - Why? 243 00:09:33,531 --> 00:09:38,119 - Be--because, uh, it's polite. 244 00:09:38,161 --> 00:09:40,371 It's the right-- it's the right thing to do. 245 00:09:40,455 --> 00:09:43,500 Um, I need to talk to them. 246 00:09:43,540 --> 00:09:46,169 - Um, they're not here. They're at a barbecue. 247 00:09:46,252 --> 00:09:48,338 - OK, um, can you have them call me 248 00:09:48,379 --> 00:09:49,672 as soon as they get home? 249 00:09:49,714 --> 00:09:51,508 - Yes. - Can you promise? 250 00:09:51,591 --> 00:09:53,384 - I promise. OK, bye, Mel! 251 00:09:53,468 --> 00:09:54,886 [phone chimes] - Bye. Have fun-- 252 00:09:56,262 --> 00:09:57,806 - Thanks for fixing my bike. 253 00:09:57,889 --> 00:10:00,058 - Well, you keep me running, I'll keep her going. 254 00:10:01,935 --> 00:10:05,438 You know, the Cree don't have a word for goodbye. 255 00:10:05,522 --> 00:10:06,606 - You know a lot of Cree? 256 00:10:06,689 --> 00:10:08,358 - [chuckles] A bit. 257 00:10:08,441 --> 00:10:09,526 I got around, man. 258 00:10:09,567 --> 00:10:10,902 - I don't doubt it. 259 00:10:13,404 --> 00:10:15,824 - Look, I'll come back for all this other shit... 260 00:10:15,907 --> 00:10:17,200 - Great. 261 00:10:17,242 --> 00:10:18,660 - If you promise to come back 262 00:10:18,743 --> 00:10:20,537 and let me take the Bonnie for a ride. 263 00:10:20,578 --> 00:10:21,704 - Uh, I don't know. 264 00:10:21,788 --> 00:10:23,123 I've seen you ride, old man. 265 00:10:23,206 --> 00:10:24,541 - Fuck you. 266 00:10:24,624 --> 00:10:26,501 I mean it. 267 00:10:26,584 --> 00:10:27,794 We got a deal? 268 00:10:30,880 --> 00:10:32,757 - I'll think about it. 269 00:10:45,854 --> 00:10:47,856 This looks like an ambush. 270 00:10:47,939 --> 00:10:49,524 - We got a slight hiccup in chairs. 271 00:10:49,607 --> 00:10:50,567 - ICE is back? 272 00:10:50,650 --> 00:10:52,569 - No, we got a dead body. 273 00:10:52,652 --> 00:10:54,237 - Somebody died out there? - Yeah. 274 00:10:54,279 --> 00:10:56,030 - Poor devil checked in at 5:00 this morning. 275 00:10:56,114 --> 00:10:57,532 He was a DNR. - [groans] 276 00:10:57,574 --> 00:10:58,700 What was his chief complaint? - Hemorrhoids 277 00:10:58,783 --> 00:11:00,243 and constipation. - No shit. 278 00:11:00,285 --> 00:11:02,579 - Hence the constipation. - [laughs] 279 00:11:02,620 --> 00:11:04,289 - Throw me a slow one, I'm gonna hit it. 280 00:11:04,372 --> 00:11:05,957 - Tell the night shift. I'm saying that's when he died. 281 00:11:06,040 --> 00:11:07,250 We all in agreement on that? 282 00:11:07,292 --> 00:11:08,585 - To the grave. 283 00:11:08,668 --> 00:11:10,378 Just like poor Jasper. 284 00:11:10,461 --> 00:11:11,880 - You're on fire. 285 00:11:11,963 --> 00:11:13,381 - Just getting my second wind. 286 00:11:14,674 --> 00:11:15,884 - How's the headache? 287 00:11:15,967 --> 00:11:17,218 - Still a 10. 288 00:11:17,302 --> 00:11:18,720 - More fentanyl? 289 00:11:18,803 --> 00:11:21,097 - Yep. - BP's good. Another 50. 290 00:11:21,181 --> 00:11:22,599 - Hey, Abbot. 291 00:11:22,640 --> 00:11:24,559 Attending and resident are stuck in the OR. 292 00:11:24,642 --> 00:11:26,394 - Oh, you're the next best thing. 293 00:11:26,477 --> 00:11:27,770 - Better, some would say. 294 00:11:27,812 --> 00:11:29,105 - Mm. 295 00:11:29,147 --> 00:11:30,607 - What do you got? - This is Judith. 296 00:11:30,690 --> 00:11:33,109 G1, P0 with no prenatal care. 297 00:11:33,151 --> 00:11:35,195 Preeclampsia with severe hypertension. 298 00:11:35,278 --> 00:11:37,614 - Hi, Judith. Nurse Garvin from OB. 299 00:11:37,697 --> 00:11:39,073 - Some jelly on the belly. 300 00:11:39,157 --> 00:11:40,617 Gonna take a quick look with ultrasound. 301 00:11:40,700 --> 00:11:42,577 - No, no, no. Ultrasound can harm the baby. 302 00:11:42,660 --> 00:11:44,579 - Not true. - Not doing the ultrasound 303 00:11:44,662 --> 00:11:46,748 could end up harming you and the baby. 304 00:11:47,999 --> 00:11:49,125 - [sighs] OK. 305 00:11:49,167 --> 00:11:51,628 Just do it as fast as you can. 306 00:11:51,711 --> 00:11:54,172 - Why no prenatal care, Judith? 307 00:11:55,215 --> 00:11:57,592 - I wanted a free birth-- 308 00:11:57,675 --> 00:11:59,761 no doctors, no hospital, no medicine. 309 00:11:59,844 --> 00:12:02,597 - Mm. You have a midwife? 310 00:12:02,680 --> 00:12:03,640 A birth doula? 311 00:12:03,723 --> 00:12:06,100 - No, I don't need one. 312 00:12:06,142 --> 00:12:07,352 Women have been having children on their own 313 00:12:07,435 --> 00:12:08,645 for thousands of years. 314 00:12:08,686 --> 00:12:10,146 - Yeah, with an infant mortality rate 315 00:12:10,230 --> 00:12:13,066 of 30% for most of those thousands of years. 316 00:12:13,149 --> 00:12:15,318 - Femur length 7 centimeters. - 37 weeks. 317 00:12:15,401 --> 00:12:17,320 They'll probably induce. 318 00:12:17,362 --> 00:12:19,239 - What? No. 319 00:12:19,322 --> 00:12:20,615 No, no, no, no. Absolutely not. 320 00:12:20,698 --> 00:12:22,158 - At 37 weeks, 321 00:12:22,200 --> 00:12:24,327 the cure for preeclampsia is to deliver the baby. 322 00:12:24,410 --> 00:12:26,162 We need to get you upstairs so the OB doctors 323 00:12:26,204 --> 00:12:28,915 can induce labor to save you and your baby. 324 00:12:28,998 --> 00:12:31,417 - No. No, no, no, no. Mm-mm. 325 00:12:33,753 --> 00:12:35,421 - Yep, that's definitely Jasper. 326 00:12:35,505 --> 00:12:36,673 He was alive and kicking 327 00:12:36,756 --> 00:12:38,091 when my shift ended this morning. 328 00:12:38,174 --> 00:12:39,467 This is definitely a day shift patient. 329 00:12:39,550 --> 00:12:40,802 - Now he's not a patient. 330 00:12:40,885 --> 00:12:42,345 He's a DB that we gotta deal with. 331 00:12:42,387 --> 00:12:43,554 - [sighs] 332 00:12:44,889 --> 00:12:46,057 - Is this dude dead? 333 00:12:46,140 --> 00:12:47,558 both: Nope. 334 00:12:47,642 --> 00:12:49,394 - All right, Mr. Reed, time to take you back 335 00:12:49,477 --> 00:12:50,853 and get you checked out, OK? 336 00:12:50,937 --> 00:12:52,313 - He sure looks dead. - Are you a doctor? 337 00:12:52,397 --> 00:12:54,649 - No, but he-- - Has hypernarcolepsy. 338 00:12:54,732 --> 00:12:56,359 It's no joke. - Mm-hmm. 339 00:12:56,442 --> 00:12:58,653 - Excuse me. - [clears throat] 340 00:12:58,736 --> 00:13:00,571 - Oh, sometimes I hate nights. 341 00:13:00,655 --> 00:13:01,864 - Yep. - Oof. 342 00:13:01,906 --> 00:13:02,949 [grunts] 343 00:13:08,246 --> 00:13:11,291 [fireworks whistling, popping] 344 00:13:12,792 --> 00:13:14,127 - Wow. 345 00:13:14,210 --> 00:13:17,338 Crazy how muggy it still is out here. 346 00:13:17,422 --> 00:13:20,049 You, uh--you seen Robby? 347 00:13:20,091 --> 00:13:22,218 - Uh, not for a bit. 348 00:13:22,260 --> 00:13:23,553 - You catch up on your charts 349 00:13:23,594 --> 00:13:25,054 from the beginning of the shift? 350 00:13:25,096 --> 00:13:26,306 - Yeah. 351 00:13:26,389 --> 00:13:27,390 - What are you still doing here? 352 00:13:27,432 --> 00:13:29,183 - Uh, just gonna... 353 00:13:29,267 --> 00:13:31,561 - You staying for the fireworks? 354 00:13:31,644 --> 00:13:32,979 - Yeah. 355 00:13:33,062 --> 00:13:34,397 I was supposed to see them with Becca, 356 00:13:34,439 --> 00:13:38,401 but she is at her boyfriend Adam's 357 00:13:38,443 --> 00:13:40,320 family's house instead. 358 00:13:44,615 --> 00:13:50,747 - Your sister seems like she's, uh, pretty put-together. 359 00:13:50,830 --> 00:13:52,081 - Yeah. 360 00:13:52,123 --> 00:13:54,876 Uh, a lot more than I realized. 361 00:13:56,794 --> 00:13:58,212 - How was your day? 362 00:14:00,048 --> 00:14:02,467 - I've had better. 363 00:14:02,550 --> 00:14:03,676 You? 364 00:14:06,554 --> 00:14:08,931 - Yeah. 365 00:14:08,973 --> 00:14:12,226 But then again, I've had a lot worse. 366 00:14:12,310 --> 00:14:14,771 Hell, I did a closed cervical reduction, like, an hour ago. 367 00:14:14,812 --> 00:14:17,065 - Oh, I heard. That must have been so intense. 368 00:14:18,775 --> 00:14:20,902 - My hands are still shaking. 369 00:14:20,943 --> 00:14:22,945 - Hey, um, do you think you could teach me 370 00:14:22,987 --> 00:14:25,073 how to do that sometime? 371 00:14:25,156 --> 00:14:26,532 - Uh, yeah. 372 00:14:26,616 --> 00:14:27,742 - Yeah? - Yeah, sure. I mean, 373 00:14:27,825 --> 00:14:29,285 I hope you never have to use it. 374 00:14:29,369 --> 00:14:31,287 I could have paralyzed that guy. 375 00:14:31,329 --> 00:14:33,956 - Yeah, but you didn't. 376 00:14:34,040 --> 00:14:37,293 - No, I didn't. 377 00:14:37,335 --> 00:14:39,712 Thank you... 378 00:14:39,796 --> 00:14:41,798 by the way, for... 379 00:14:41,881 --> 00:14:44,550 talking me down earlier. 380 00:14:44,634 --> 00:14:46,511 I'm sorry I snapped. 381 00:14:48,012 --> 00:14:49,347 - It's OK. 382 00:14:57,522 --> 00:15:00,108 - Dr. Mohan, you ever heard of kinship fostering? 383 00:15:00,191 --> 00:15:01,818 It's where a nurse or doctor can 384 00:15:01,901 --> 00:15:03,319 become an emergency foster-- - Oh, no. 385 00:15:03,403 --> 00:15:04,821 I don't need any kids. 386 00:15:04,904 --> 00:15:06,989 I need to find a job first. 387 00:15:07,073 --> 00:15:09,450 Candice O'Grady is an 82-year-old female 388 00:15:09,534 --> 00:15:11,994 brought in by her son for intractable vomiting. 389 00:15:12,036 --> 00:15:14,997 No fever, no chills, no abdominal pain, no rash. 390 00:15:16,082 --> 00:15:18,000 - Beep. 391 00:15:18,084 --> 00:15:21,421 - Oh, I've already got one I can barely keep up with. 392 00:15:21,504 --> 00:15:23,339 - What about Sleeping Beauty over here? 393 00:15:23,381 --> 00:15:25,341 - She's already babysitting Whitaker. 394 00:15:25,425 --> 00:15:27,427 - Well, if you know anyone who'd like to help us out 395 00:15:27,510 --> 00:15:29,345 with Baby Jane Doe, have them call the main desk. 396 00:15:29,429 --> 00:15:31,013 - Sure thing. 397 00:15:31,055 --> 00:15:34,225 - I'd take her myself, but Benji'd kill me. 398 00:15:35,601 --> 00:15:37,353 - BP's 164/114. 399 00:15:37,395 --> 00:15:38,688 - Another 40 of labetalol. 400 00:15:38,771 --> 00:15:39,856 - Mag bolus is in. 401 00:15:39,897 --> 00:15:41,524 Now infusing 2 grams an hour. 402 00:15:41,566 --> 00:15:42,775 - Labs are coming back. 403 00:15:42,859 --> 00:15:45,027 Hemoglobin 7.5, platelets 40. 404 00:15:45,111 --> 00:15:47,029 LFTs are sky high. 405 00:15:47,113 --> 00:15:48,823 - HELLP syndrome. - Hemolytic anemia, 406 00:15:48,906 --> 00:15:51,200 elevated liver enzymes, and low platelets. 407 00:15:51,242 --> 00:15:52,535 - They're cleaning a room. 408 00:15:52,618 --> 00:15:54,495 We can bring her up in ten minutes. 409 00:15:54,579 --> 00:15:55,788 - How you doing, Judith? 410 00:15:57,790 --> 00:16:00,251 - I--I-- 411 00:16:00,334 --> 00:16:01,919 [machine beeping] - Oh, she's seizing. 412 00:16:02,003 --> 00:16:03,588 - Oh, shit. 413 00:16:03,671 --> 00:16:06,174 10 of IV diazepam. Have another 10 ready. 414 00:16:06,257 --> 00:16:08,176 - With all the movement, we can't get a fetal heartbeat. 415 00:16:08,217 --> 00:16:10,428 - Putting on 15 liters by mask. Should we intubate? 416 00:16:10,511 --> 00:16:12,430 - Hold intubation. Let's try to break this. 417 00:16:12,513 --> 00:16:14,390 We don't want to mask seizures with paralysis 418 00:16:14,432 --> 00:16:15,933 unless we have to. 419 00:16:16,017 --> 00:16:17,518 OK, um... 420 00:16:17,602 --> 00:16:19,979 [rapid beeping] 421 00:16:20,062 --> 00:16:21,731 Crus, CTG isn't reading. 422 00:16:21,814 --> 00:16:23,232 Check with ultrasound. - On it. 423 00:16:23,274 --> 00:16:24,817 - Nazely, what's the diagnosis? 424 00:16:24,901 --> 00:16:27,945 - Um, with the seizure, now it's eclampsia. 425 00:16:29,113 --> 00:16:31,073 - Fetal heart rate is about 90. - Way too low. 426 00:16:31,157 --> 00:16:32,366 - Mom's sats are going down. 427 00:16:32,450 --> 00:16:33,826 - Time to tube her? 428 00:16:33,910 --> 00:16:35,495 - Set up for it, but wait. 429 00:16:35,578 --> 00:16:36,829 Another 10 of diazepam. 430 00:16:36,913 --> 00:16:39,373 Push 4 grams of Keppra. 431 00:16:40,583 --> 00:16:42,084 [baby fussing] 432 00:16:42,126 --> 00:16:43,586 - History of hypertension 433 00:16:43,628 --> 00:16:44,921 presents to the emergency department 434 00:16:44,962 --> 00:16:47,256 with a chief complaint of dizziness 435 00:16:47,298 --> 00:16:49,425 after inadvertently ingesting 80 milligrams-- 436 00:16:49,509 --> 00:16:50,760 - Hey, how are you guys making out? 437 00:16:50,801 --> 00:16:51,802 - Yeah, we're getting there. 438 00:16:51,886 --> 00:16:53,596 - Have you seen Dr. Al-Hashimi? 439 00:16:53,638 --> 00:16:55,473 - No. - Can I talk to you for a sec? 440 00:17:01,020 --> 00:17:02,271 So I just wanted to let you know that I've been 441 00:17:02,355 --> 00:17:03,564 checking out some of your online posts-- 442 00:17:03,648 --> 00:17:04,773 - Look, I was just trying to help 443 00:17:04,815 --> 00:17:06,317 get some health messages out there, 444 00:17:06,400 --> 00:17:07,902 especially for young people. - I think they're great. 445 00:17:07,984 --> 00:17:09,904 Really good. 446 00:17:09,987 --> 00:17:11,906 - You do? - Yeah. 447 00:17:11,989 --> 00:17:14,116 Yeah, um, keep it up. 448 00:17:14,200 --> 00:17:15,576 - OK. 449 00:17:15,660 --> 00:17:17,912 - As long as you follow the HIPAA laws. 450 00:17:17,994 --> 00:17:19,288 - I do. 451 00:17:19,372 --> 00:17:20,873 - And wait until you're done charting. 452 00:17:20,957 --> 00:17:22,583 - [scoffs] Sure. 453 00:17:24,794 --> 00:17:29,048 Actually, Dr. Robby--sorry, um, can I ask you a question? 454 00:17:29,131 --> 00:17:30,258 - Shoot. 455 00:17:30,341 --> 00:17:31,759 - Um, I--I may be 456 00:17:31,801 --> 00:17:34,595 considering emergency psychiatry. 457 00:17:35,846 --> 00:17:37,974 - Very cool. 458 00:17:38,057 --> 00:17:39,850 - Think I could do it? 459 00:17:42,019 --> 00:17:43,479 - I think that you could do 460 00:17:43,521 --> 00:17:46,107 anything that you put your mind to, Victoria. 461 00:17:50,194 --> 00:17:51,571 - OK. 462 00:17:51,654 --> 00:17:53,281 - Pulse ox is 88. 463 00:17:53,364 --> 00:17:54,490 [rapid beeping] 464 00:17:54,532 --> 00:17:56,492 - Dr. Abbot? 465 00:17:56,576 --> 00:17:58,661 Intubate? - Let's do it. 466 00:17:58,744 --> 00:18:01,998 Nazely, what do you suggest for rapid sequence induction? 467 00:18:02,081 --> 00:18:03,207 - Etomidate and roc. 468 00:18:03,291 --> 00:18:04,375 - Mm, not quite. 469 00:18:04,458 --> 00:18:05,501 120 of propofol, 470 00:18:05,585 --> 00:18:06,502 60 of succinylcholine. 471 00:18:06,586 --> 00:18:08,004 Why is that, Crus? 472 00:18:08,045 --> 00:18:09,672 - Propofol for the anti-seizure effect, 473 00:18:09,755 --> 00:18:11,340 sux to avoid prolonged paralysis 474 00:18:11,382 --> 00:18:13,384 so we can check her neuro exam. - Exactly. 475 00:18:13,467 --> 00:18:14,719 - Pushing the propofol. 476 00:18:14,802 --> 00:18:16,220 - Once she's flat for intubation, 477 00:18:16,304 --> 00:18:17,847 we need to displace the uterus to the left. 478 00:18:17,888 --> 00:18:19,473 - Nazely, that's you. Big hug, both arms. 479 00:18:19,515 --> 00:18:21,809 Get the baby off the vena cava. - Sux is on board. 480 00:18:21,851 --> 00:18:24,520 - But after she's paralyzed, the seizing stops, right? 481 00:18:24,604 --> 00:18:26,022 - It might look like that, 482 00:18:26,105 --> 00:18:28,107 but an ongoing seizure will still fry the brain. 483 00:18:28,190 --> 00:18:29,942 We monitor with EEG. 484 00:18:30,026 --> 00:18:31,902 - Is there time for that? - Wait and see. 485 00:18:33,029 --> 00:18:34,196 - Paralytics kicked in. 486 00:18:34,280 --> 00:18:35,823 - Let's go. Roll her to her back. 487 00:18:36,866 --> 00:18:38,492 - Intubate, then EEG 488 00:18:38,576 --> 00:18:41,037 to see if her brain is still seizing. 489 00:18:41,078 --> 00:18:42,538 I need first pass success. 490 00:18:42,622 --> 00:18:43,789 - You and me both. 491 00:18:43,873 --> 00:18:46,917 [machinery beeping] 492 00:18:50,087 --> 00:18:51,547 [indistinct chatter] 493 00:18:51,589 --> 00:18:54,050 - [sighs] Have you seen Dr. Al-Hashimi? 494 00:18:54,133 --> 00:18:55,259 - No. 495 00:18:55,343 --> 00:18:57,678 - Have you seen Dr. Al-Hashimi? 496 00:18:57,762 --> 00:18:59,430 Al-Hashimi? 497 00:18:59,513 --> 00:19:02,058 - With how this day's going, she probably quit. 498 00:19:02,099 --> 00:19:05,269 - Last I saw her, she was in Peds with Baby Jane Doe. 499 00:19:05,353 --> 00:19:07,730 - Nope, I was just in there. 500 00:19:07,772 --> 00:19:08,731 - Want me to page her? 501 00:19:08,773 --> 00:19:10,524 - Uh, no, that's OK. 502 00:19:10,608 --> 00:19:11,901 I will find her. 503 00:19:16,489 --> 00:19:17,740 Hello. 504 00:19:20,534 --> 00:19:22,912 Hey, how did our people do at the deposition? 505 00:19:22,953 --> 00:19:25,414 - Oh, well, Dr. Ellis is a pit bull. 506 00:19:25,498 --> 00:19:27,541 Dr. King is a petunia. 507 00:19:27,625 --> 00:19:28,876 They were pretty brutal with her. 508 00:19:28,959 --> 00:19:30,753 - She's sensitive. - Very. 509 00:19:30,795 --> 00:19:32,338 And I'm afraid it isn't over. 510 00:19:32,421 --> 00:19:33,506 They want to call her back. 511 00:19:33,589 --> 00:19:35,341 - Oh, that's unfortunate. 512 00:19:35,424 --> 00:19:36,592 Maybe I should go with you 513 00:19:36,634 --> 00:19:38,260 to break that news to her, actually. 514 00:19:38,302 --> 00:19:40,096 - Misery loves company. - Um, hey, while I have you, 515 00:19:40,137 --> 00:19:42,848 can I pose a hypothetical to you? 516 00:19:42,932 --> 00:19:44,850 If a doctor suspects another physician 517 00:19:44,934 --> 00:19:47,103 of having a medical condition that could negatively 518 00:19:47,186 --> 00:19:49,271 affect the way they would treat a patient, 519 00:19:49,313 --> 00:19:50,940 where would disclosing that fall 520 00:19:51,023 --> 00:19:53,025 on the HIPAA violation scale? 521 00:19:54,026 --> 00:19:56,028 - First, do no harm. 522 00:19:58,489 --> 00:20:00,908 Dr. King, do you have a second? 523 00:20:03,494 --> 00:20:06,288 - Mm... 524 00:20:08,082 --> 00:20:10,084 - Good lung sliding bilaterally. 525 00:20:10,167 --> 00:20:12,169 - Fetal heart rate borderline at 98. 526 00:20:13,671 --> 00:20:15,798 - Roll her to the left again. That can help. 527 00:20:15,840 --> 00:20:18,968 - One, two, three. - [grunts] 528 00:20:19,009 --> 00:20:22,430 OK, all set here. 529 00:20:22,513 --> 00:20:23,931 - EEG monitor's good to go. 530 00:20:24,014 --> 00:20:25,683 - That was fast. 531 00:20:25,766 --> 00:20:27,143 - Still seizing while paralyzed. 532 00:20:27,226 --> 00:20:29,729 It's nonconvulsive status. 533 00:20:29,812 --> 00:20:31,105 - What's she had so far? 534 00:20:31,188 --> 00:20:32,773 - 30 of diazepam, a full load of mag, 535 00:20:32,857 --> 00:20:33,983 Keppra, and propofol. 536 00:20:34,024 --> 00:20:35,317 - Damn. What's your next step? 537 00:20:35,401 --> 00:20:36,569 - Any ideas? 538 00:20:36,652 --> 00:20:38,821 Hmm? Nazely? 539 00:20:38,863 --> 00:20:40,740 - Dilantin? Valproate? 540 00:20:40,823 --> 00:20:42,074 - Mm, infusion is too long. 541 00:20:42,158 --> 00:20:43,617 So is onset of action. 542 00:20:43,701 --> 00:20:45,077 Push 100 of ketamine. 543 00:20:45,161 --> 00:20:47,329 That's had results with refractory status. 544 00:20:47,371 --> 00:20:49,623 - She also has HELLP syndrome-- hemoglobin only 7, 545 00:20:49,665 --> 00:20:52,501 platelets down to 30. - Two units whole blood? 546 00:20:52,585 --> 00:20:54,962 - O-neg is going up on the rapid infuser as we speak. 547 00:20:55,045 --> 00:20:57,006 - Uh, put the AP pads on, just in case. 548 00:20:57,089 --> 00:20:59,842 - And 10 of Decadron IV push for the inflammatory storm. 549 00:20:59,884 --> 00:21:01,969 - Fetal heart rate up to 104. - Hmm. 550 00:21:02,052 --> 00:21:03,304 - Little better. - Yeah. 551 00:21:03,387 --> 00:21:05,681 She should be upstairs with OB. 552 00:21:05,723 --> 00:21:09,393 - She will be after we break this seizure. 553 00:21:09,477 --> 00:21:12,646 - There was a delay in history-taking 554 00:21:12,688 --> 00:21:15,733 due to a malfunctioning VRI interpretation device. 555 00:21:15,816 --> 00:21:18,360 During this time, there was a normal CBC 556 00:21:18,402 --> 00:21:20,029 and comprehensive metabolic panel 557 00:21:20,070 --> 00:21:21,781 that came back from the lab. 558 00:21:23,240 --> 00:21:25,075 What's wrong with you, Malfeasance? 559 00:21:25,159 --> 00:21:28,078 - I have to do another deposition. 560 00:21:28,162 --> 00:21:30,039 - Oh, that sucks. 561 00:21:30,122 --> 00:21:32,082 You must have really messed up. [chuckles] 562 00:21:33,125 --> 00:21:34,794 Dude, I'm joking. 563 00:21:34,877 --> 00:21:35,878 You gotta lighten up. 564 00:21:35,920 --> 00:21:37,588 It's all just bullshit. 565 00:21:39,089 --> 00:21:41,467 [sighs] God, you know what? Fuck all this. 566 00:21:41,550 --> 00:21:42,927 Do you want to go get a drink? 567 00:21:44,053 --> 00:21:45,012 - Me? 568 00:21:45,095 --> 00:21:46,680 - Yes, you. 569 00:21:46,764 --> 00:21:49,016 You--you do go out, don't you? 570 00:21:49,099 --> 00:21:51,227 - Well, I'm usually with Becca. 571 00:21:51,268 --> 00:21:52,520 - Well, bring her along. 572 00:21:52,603 --> 00:21:53,854 Can she drive? 573 00:21:53,938 --> 00:21:56,190 - No, and she's with her boyfriend. 574 00:21:57,149 --> 00:21:58,609 - OK, Becca. 575 00:22:00,277 --> 00:22:02,238 So it's just you and me. 576 00:22:04,365 --> 00:22:06,742 Do you like karaoke? 577 00:22:06,784 --> 00:22:08,577 - You do karaoke? 578 00:22:08,661 --> 00:22:12,957 - Well, what I do is more like primal scream therapy. 579 00:22:13,040 --> 00:22:14,708 There's nothing like getting wasted 580 00:22:14,792 --> 00:22:16,210 and just absolutely wailing 581 00:22:16,293 --> 00:22:18,963 to shake off a shit show like today. 582 00:22:19,046 --> 00:22:20,923 - I could use a fun night. 583 00:22:22,299 --> 00:22:24,093 - You and me both, sister. 584 00:22:24,176 --> 00:22:25,886 - There's been no improvement. 585 00:22:25,970 --> 00:22:27,429 Still seizing on the EEG. 586 00:22:27,513 --> 00:22:29,139 Neurology has been called. - OK. Got it. 587 00:22:29,223 --> 00:22:31,100 OB says send her up. They have an OR ready. 588 00:22:31,183 --> 00:22:32,601 - About time. 589 00:22:32,643 --> 00:22:34,270 - Baby's been bradying down a bit more. 590 00:22:34,353 --> 00:22:35,855 - This one looks like it took a turn for the worse. 591 00:22:35,938 --> 00:22:37,690 - Eclampsia, refractory seizures, 592 00:22:37,773 --> 00:22:39,942 HELLP syndrome with anemia and thrombocytopenia. 593 00:22:40,025 --> 00:22:41,402 - Yeah, about as bad as it gets. 594 00:22:41,485 --> 00:22:43,904 [alarm blaring] - V-fib! 595 00:22:43,988 --> 00:22:45,948 - Chest compressions, Nazely. 596 00:22:45,990 --> 00:22:48,701 Charge to 200. 597 00:22:48,784 --> 00:22:50,119 - Prep the belly. 598 00:22:50,202 --> 00:22:51,453 Get a baby warmer. 599 00:22:51,537 --> 00:22:53,122 Call the NICU. Start a timer. 600 00:22:53,205 --> 00:22:54,957 - Charged. 601 00:22:55,040 --> 00:22:56,250 Clear. 602 00:22:56,333 --> 00:22:58,085 [tense music] 603 00:22:58,168 --> 00:22:59,420 - Continue compressions. 604 00:22:59,503 --> 00:23:01,797 We'll check a rhythm in a minute. 605 00:23:01,881 --> 00:23:03,132 - Gown up. 606 00:23:03,173 --> 00:23:04,466 Robby, it's you and me. 607 00:23:04,508 --> 00:23:06,468 - Nazely, what's the four-minute rule? 608 00:23:06,510 --> 00:23:08,679 - Uh, not sure. 609 00:23:08,762 --> 00:23:10,472 - Pregnant patient with a viable fetus, 610 00:23:10,556 --> 00:23:12,141 you have four minutes after cardiac arrest 611 00:23:12,182 --> 00:23:14,435 to save the baby. - And the mom. 612 00:23:14,476 --> 00:23:16,687 We don't call it a postmortem C-section anymore. 613 00:23:16,770 --> 00:23:17,980 It's a resuscitative hysterotomy 614 00:23:18,022 --> 00:23:19,481 to try to save them both. 615 00:23:19,523 --> 00:23:20,774 - But she doesn't want any medical intervention. 616 00:23:20,858 --> 00:23:22,151 - That doesn't matter. 617 00:23:22,234 --> 00:23:23,652 Mom and baby are both dead if we do nothing. 618 00:23:23,736 --> 00:23:25,487 OK, charge to 200. 619 00:23:25,529 --> 00:23:27,573 One more rhythm check and then Abbot and I are gonna cut. 620 00:23:28,866 --> 00:23:31,368 Ellis, you and Crus on Mom resuscitation. 621 00:23:31,452 --> 00:23:32,828 Shen, you and Nazely take the baby. 622 00:23:32,912 --> 00:23:34,330 OK, hold compressions. 623 00:23:34,413 --> 00:23:35,998 ♪ ♪ 624 00:23:36,081 --> 00:23:37,625 - Still V-fib. 625 00:23:37,708 --> 00:23:38,792 - Clear. 626 00:23:38,876 --> 00:23:40,669 [thud] - No change. 627 00:23:40,711 --> 00:23:42,671 Resume compression, amp of epi. - OK, showtime. 628 00:23:42,755 --> 00:23:44,340 - We need to get this baby out right now. 629 00:23:44,423 --> 00:23:45,549 - OK, take a break. 630 00:23:48,093 --> 00:23:51,513 - OK, 10 blade. Good. 631 00:23:51,597 --> 00:23:53,766 First incision is from the xiphoid 632 00:23:53,849 --> 00:23:55,517 to the pubic symphysis 633 00:23:55,559 --> 00:23:58,479 through the skin to the linea alba. 634 00:23:58,562 --> 00:24:00,648 - Units three and four on the infuser. 635 00:24:00,689 --> 00:24:03,484 - Second incision goes through the peritoneum, 636 00:24:03,567 --> 00:24:05,277 exposing the uterus. 637 00:24:05,361 --> 00:24:06,987 - Where do you need me? 638 00:24:07,071 --> 00:24:09,198 - You're with the baby. Nazely's got the bag mask. 639 00:24:09,281 --> 00:24:11,408 You're on suction. Stand by for intubation. 640 00:24:11,492 --> 00:24:12,910 - Bladder retractors. 641 00:24:12,993 --> 00:24:14,578 - Neonatal monitor and pulse ox ready to go. 642 00:24:14,662 --> 00:24:17,039 - Ellis, gentle traction. 643 00:24:17,081 --> 00:24:19,083 OK, making a small vertical incision 644 00:24:19,166 --> 00:24:22,711 through the lower uterus so as not to cut the baby. 645 00:24:22,795 --> 00:24:24,546 - Mm-hmm. 646 00:24:24,588 --> 00:24:26,048 - Got it? - Yep, I got it. 647 00:24:26,131 --> 00:24:27,508 - OK. - OK. 648 00:24:27,591 --> 00:24:30,678 Using scissors to extend superiorly. 649 00:24:30,719 --> 00:24:32,096 ♪ ♪ 650 00:24:32,179 --> 00:24:34,223 - Ellis, hand retract the uterus with me. 651 00:24:34,264 --> 00:24:36,100 - Amniotic fluid looks good. 652 00:24:36,183 --> 00:24:37,726 ♪ ♪ 653 00:24:37,810 --> 00:24:39,478 - Give me some fundal pressure. 654 00:24:39,561 --> 00:24:40,896 - Breech position. 655 00:24:40,980 --> 00:24:43,315 ♪ ♪ 656 00:24:43,399 --> 00:24:46,485 - OK, baby's out. 657 00:24:46,568 --> 00:24:48,320 It's a girl. - All right. 658 00:24:48,404 --> 00:24:49,989 ♪ ♪ 659 00:24:50,072 --> 00:24:52,992 Milking the cord. 660 00:24:53,075 --> 00:24:55,494 - Clamping. 661 00:24:55,577 --> 00:24:57,496 - Cutting. 662 00:24:57,579 --> 00:24:59,081 - OK, blue and flaccid. Coming to you, Shen. 663 00:24:59,164 --> 00:25:00,249 You ready? - Yeah, you got her. 664 00:25:00,290 --> 00:25:02,251 - I got it, yep. 665 00:25:02,334 --> 00:25:03,669 OK. 666 00:25:03,752 --> 00:25:07,256 [rapid beeping] 667 00:25:07,339 --> 00:25:09,717 Poor tone, no movement. 668 00:25:09,800 --> 00:25:12,386 - Keep the blow-by closer. 669 00:25:12,469 --> 00:25:13,762 - She's really blue. 670 00:25:13,846 --> 00:25:16,598 - Some blue is normal, but not this much. 671 00:25:16,682 --> 00:25:18,559 - Do we need to intubate? - Not yet, no. 672 00:25:18,642 --> 00:25:21,270 They usually pink up with stimulation and blow-by. 673 00:25:21,353 --> 00:25:23,105 - OK, removing the placenta. 674 00:25:23,147 --> 00:25:25,441 - Sweeping to the left, trying to get it in one piece. 675 00:25:25,524 --> 00:25:27,276 ♪ ♪ 676 00:25:27,359 --> 00:25:28,610 - Looks intact. - Yeah. 677 00:25:28,652 --> 00:25:30,738 - Nicely done. 678 00:25:30,821 --> 00:25:32,740 - 10 of IV Pitocin to contract the uterus. 679 00:25:32,823 --> 00:25:34,950 - And lots of massage. 680 00:25:34,992 --> 00:25:36,577 - Heart rate 76. 681 00:25:36,660 --> 00:25:38,162 - Less than 100 means we need to bag. 682 00:25:38,245 --> 00:25:39,371 Suction first. 683 00:25:39,455 --> 00:25:40,539 - OK. 684 00:25:40,622 --> 00:25:42,458 ♪ ♪ 685 00:25:42,541 --> 00:25:43,917 - Hey, Jord, charge to 200. 686 00:25:44,001 --> 00:25:46,795 Stand by for the next rhythm check. 687 00:25:46,837 --> 00:25:48,464 - She grimaced. Good sign. 688 00:25:48,547 --> 00:25:49,548 - Bagging. 689 00:25:49,631 --> 00:25:51,550 - Pulse ox 45%. 690 00:25:51,633 --> 00:25:53,135 - Oh, I've never seen it that low. 691 00:25:53,218 --> 00:25:54,970 - It's not as bad as it sounds. 692 00:25:55,012 --> 00:25:56,972 I'm more worried about the heart rate. 693 00:25:57,056 --> 00:25:59,141 McKay, get ready with an IO in case we need epi. 694 00:25:59,224 --> 00:26:00,601 - OK. 695 00:26:00,684 --> 00:26:02,436 [whirring] 696 00:26:02,519 --> 00:26:04,938 - Rhythm check. Hold compressions. 697 00:26:05,022 --> 00:26:05,981 - Still V-fib. 698 00:26:06,065 --> 00:26:07,483 OK, shock it. - Clear. 699 00:26:07,566 --> 00:26:08,484 [thud] 700 00:26:08,567 --> 00:26:09,985 Resume compressions. 701 00:26:10,069 --> 00:26:11,487 - Shen, how's she doing over there? 702 00:26:11,570 --> 00:26:12,821 - Heart rate's up to 104. 703 00:26:12,863 --> 00:26:14,031 - Uh, at one minute, 704 00:26:14,114 --> 00:26:16,366 she's 0 for color, 2 for heart rate, 705 00:26:16,450 --> 00:26:17,701 1 for reflex, tone, breathing. 706 00:26:17,785 --> 00:26:19,328 APGAR of 5. 707 00:26:19,411 --> 00:26:21,288 - 5 out of 10. Not great. 708 00:26:21,371 --> 00:26:22,998 - Pulse ox 58%. 709 00:26:23,040 --> 00:26:24,875 - Intubation? - Uh, not yet. 710 00:26:24,958 --> 00:26:27,002 O2 sat in the 60s is normal at one minute. 711 00:26:27,044 --> 00:26:29,838 - Her heart rate and pulse ox are trending higher. 712 00:26:29,922 --> 00:26:31,298 - Let's keep doing what we're doing. 713 00:26:31,381 --> 00:26:32,841 A little tincture of time. 714 00:26:32,883 --> 00:26:34,510 - Hold compressions. 715 00:26:34,551 --> 00:26:36,553 - Looks like sinus. 716 00:26:36,637 --> 00:26:38,222 - Can't feel a carotid. 717 00:26:38,305 --> 00:26:39,640 - No. 718 00:26:39,723 --> 00:26:41,642 - Heart's barely pumping. It's PEA. 719 00:26:41,725 --> 00:26:42,935 - Back on compressions. 720 00:26:43,018 --> 00:26:44,436 - Transfuse two more units. 721 00:26:44,520 --> 00:26:45,854 She needs more red cells and platelets. 722 00:26:45,896 --> 00:26:47,523 - Ongoing blood loss from the uterus. 723 00:26:47,606 --> 00:26:49,108 Give me all the lap pads we got, please. 724 00:26:49,191 --> 00:26:52,111 [rapid beeping] 725 00:26:52,194 --> 00:26:56,532 ♪ ♪ 726 00:26:56,615 --> 00:26:57,866 - Yeah. 727 00:26:57,950 --> 00:26:58,992 OK, yeah, thanks. 728 00:26:59,076 --> 00:27:00,452 I appreciate it, honey. 729 00:27:00,536 --> 00:27:02,371 Oh, gotta go. 730 00:27:02,412 --> 00:27:03,705 Whoa, whoa, whoa! 731 00:27:03,747 --> 00:27:04,706 Hold up. 732 00:27:04,748 --> 00:27:06,208 - Is there a problem here? 733 00:27:06,250 --> 00:27:08,293 - Yeah, you two aren't leaving empty-handed. 734 00:27:08,377 --> 00:27:09,419 - What? 735 00:27:10,587 --> 00:27:12,131 - One of you follow me. 736 00:27:13,799 --> 00:27:15,551 Rape kits are supposed to be picked up 737 00:27:15,634 --> 00:27:18,512 within 72 hours of collecting 'em. 738 00:27:18,595 --> 00:27:21,223 This one's been here for over two weeks. 739 00:27:21,306 --> 00:27:22,933 - That's not on us. 740 00:27:23,016 --> 00:27:24,560 - Well, it's on somebody. 741 00:27:24,601 --> 00:27:26,061 It's not bad enough these poor women 742 00:27:26,103 --> 00:27:27,604 go through an assault, plus the indignity 743 00:27:27,688 --> 00:27:29,273 of the whole collection process, 744 00:27:29,356 --> 00:27:31,066 but nobody from the police department 745 00:27:31,108 --> 00:27:33,610 even has the human decency to come get these things? 746 00:27:33,694 --> 00:27:34,736 Like nobody there gives a flying fuck? 747 00:27:34,820 --> 00:27:36,363 - OK, we got it. 748 00:27:36,446 --> 00:27:38,282 We'll see that these get put into evidence properly. 749 00:27:38,365 --> 00:27:39,575 - Thank you. 750 00:27:41,702 --> 00:27:42,953 How hard was that? 751 00:27:45,497 --> 00:27:46,707 [rapid beeping] 752 00:27:46,790 --> 00:27:47,916 - Units five and six are in. 753 00:27:47,958 --> 00:27:49,334 - Down to a slow ooze here. 754 00:27:49,418 --> 00:27:50,752 - Hold compressions. 755 00:27:50,794 --> 00:27:54,256 [machinery beeping] 756 00:27:54,339 --> 00:27:56,341 - Looks like sinus. 757 00:27:56,425 --> 00:27:57,759 And I got a weak carotid. - OK. 758 00:27:57,801 --> 00:27:59,261 Cycle the BP. 759 00:27:59,303 --> 00:28:01,346 - Better filling, better squeeze. 760 00:28:01,430 --> 00:28:02,931 - No seizure activity on the EEG. 761 00:28:03,015 --> 00:28:04,433 - That's progress. That's progress. 762 00:28:04,516 --> 00:28:05,517 - We're at five minutes. 763 00:28:05,601 --> 00:28:07,436 - Uh, heart rate is 132. 764 00:28:07,519 --> 00:28:09,104 Uh, pulse ox 79%. 765 00:28:09,188 --> 00:28:11,023 Nazely, the APGAR? 766 00:28:11,106 --> 00:28:12,608 - Um... 767 00:28:12,649 --> 00:28:14,735 1 off for color, 1 off for tone, 768 00:28:14,818 --> 00:28:17,279 1 off for respiration with hypoxia, total of 7. 769 00:28:17,362 --> 00:28:18,655 - Respiration score is for observed breathing, 770 00:28:18,739 --> 00:28:20,115 not pulse ox. 771 00:28:20,157 --> 00:28:21,617 - Sat of 80 is normal at five minutes. 772 00:28:21,700 --> 00:28:23,118 With no crying, she still gets 1 off. 773 00:28:23,160 --> 00:28:24,203 - Yeah. 774 00:28:26,580 --> 00:28:27,998 [baby crying] - Ah! 775 00:28:28,081 --> 00:28:29,958 She just scored the winning point! 776 00:28:30,042 --> 00:28:32,377 APGAR of 8 is pretty normal. 777 00:28:35,672 --> 00:28:37,925 - Holy shit. What did I miss? 778 00:28:38,008 --> 00:28:40,636 - Eclampsia with status, HELLP syndrome, 779 00:28:40,719 --> 00:28:43,805 cardiac arrest, resuscitative hysterotomy. 780 00:28:43,889 --> 00:28:46,141 - I was in the OR with a septic twin C-section. 781 00:28:46,225 --> 00:28:47,434 Got your text 12 minutes ago. 782 00:28:47,517 --> 00:28:48,977 - Shit happens fast down here. 783 00:28:49,019 --> 00:28:51,480 - Resuscitative hysterotomy in 36 seconds. 784 00:28:51,563 --> 00:28:53,815 - Impressive. - BP's 102/64. 785 00:28:53,857 --> 00:28:54,983 Hemoglobin is up to 9. 786 00:28:55,067 --> 00:28:57,069 - That'll do. 787 00:28:57,152 --> 00:28:58,487 - NICU's sending a team down. 788 00:28:58,528 --> 00:29:00,822 - We can take Mom. You guys are rock stars. 789 00:29:00,864 --> 00:29:03,367 - We like to be referred to as crawlers of the night. 790 00:29:04,993 --> 00:29:06,495 - [sighs] 791 00:29:06,536 --> 00:29:07,829 If you're not careful, 792 00:29:07,913 --> 00:29:09,414 you're gonna get stuck here all night. 793 00:29:09,498 --> 00:29:11,917 - Nah, Henny said she'd be here in 30 minutes. 794 00:29:12,000 --> 00:29:14,503 How's Mom and baby? - Whew. 795 00:29:14,544 --> 00:29:16,463 They're both gonna go upstairs. 796 00:29:16,546 --> 00:29:18,632 - Good. You leaving now? 797 00:29:18,715 --> 00:29:20,300 - Yeah, pretty soon. 798 00:29:20,384 --> 00:29:23,387 I gotta find Whitaker, I gotta find Al-Hashimi, 799 00:29:23,470 --> 00:29:25,681 and I gotta find Langdon before I leave. 800 00:29:25,722 --> 00:29:28,225 - You missed Langdon. He just checked out. 801 00:29:30,644 --> 00:29:32,688 - [sighs] Shit. 802 00:29:56,128 --> 00:29:57,504 - Can I help you? 803 00:29:57,546 --> 00:30:01,049 - Uh, yeah, I'm Dr. Langdon from the ED. 804 00:30:01,091 --> 00:30:03,969 I was just, uh, checking in on the status 805 00:30:04,052 --> 00:30:06,638 of someone we sent up here earlier. 806 00:30:06,722 --> 00:30:09,224 Patient's name is, uh, Cohen. 807 00:30:09,308 --> 00:30:10,517 - Let me check. 808 00:30:10,600 --> 00:30:11,810 What was she up here for? 809 00:30:11,893 --> 00:30:13,645 - Uh, clean out a nasty neck fash. 810 00:30:13,729 --> 00:30:16,315 [keys clacking] 811 00:30:16,398 --> 00:30:17,983 - Oh, yeah, she's good. 812 00:30:18,066 --> 00:30:21,069 She's in 4202, recovering nicely. 813 00:30:21,153 --> 00:30:23,697 - Great, great. 814 00:30:23,739 --> 00:30:26,575 I mean, she was--she was in not-great shape earlier. 815 00:30:26,658 --> 00:30:28,744 - It was a good catch. 816 00:30:28,785 --> 00:30:32,748 Saved her life, even if we couldn't save her leg. 817 00:30:32,789 --> 00:30:35,709 - Uh, was it below the knee? 818 00:30:35,792 --> 00:30:37,627 - Unfortunately, it was above. 819 00:30:54,519 --> 00:30:57,606 - My cell phone and the building manager's. 820 00:30:57,647 --> 00:30:59,524 He can help if there's any emergencies. 821 00:30:59,608 --> 00:31:01,610 - Yeah, what kind of emergencies? 822 00:31:01,693 --> 00:31:03,028 - Whatever. 823 00:31:03,111 --> 00:31:04,029 And follow up with Duke 824 00:31:04,112 --> 00:31:05,030 in a couple days, yeah? 825 00:31:05,113 --> 00:31:06,073 - Yeah. 826 00:31:06,156 --> 00:31:08,450 You, um--you sure about this? 827 00:31:08,533 --> 00:31:10,285 - I trust you, Whitaker. 828 00:31:10,369 --> 00:31:12,079 - Great. 829 00:31:12,162 --> 00:31:13,538 - Any questions? 830 00:31:13,622 --> 00:31:16,625 - Uh, when are you back, exactly? 831 00:31:16,666 --> 00:31:18,085 - You know, I'll text you. 832 00:31:18,168 --> 00:31:20,003 I'm trying to keep my dates kind of fluid. 833 00:31:21,380 --> 00:31:23,465 I think this is your ride. 834 00:31:23,507 --> 00:31:25,467 - Yeah, uh, yes. 835 00:31:25,550 --> 00:31:28,011 I--I promise I'll check in on your house tomorrow. 836 00:31:28,095 --> 00:31:29,596 - Sounds good. 837 00:31:30,722 --> 00:31:32,349 - Hey. - Hey. 838 00:31:32,432 --> 00:31:35,477 - OK. Hey, Theo. 839 00:31:35,519 --> 00:31:37,312 You're up late, huh? 840 00:31:37,354 --> 00:31:40,023 What you got there? [chuckles] 841 00:31:41,566 --> 00:31:43,944 OK. 842 00:31:44,027 --> 00:31:45,612 - He's been fussy all day. 843 00:31:45,695 --> 00:31:47,781 I think he's got another tooth coming in. 844 00:31:47,864 --> 00:31:49,491 - Aw, right on, big guy. 845 00:31:49,533 --> 00:31:52,869 Are you ready to get funky? 846 00:31:52,953 --> 00:31:54,663 Yeah? - [chuckles] 847 00:31:54,746 --> 00:31:56,957 - ♪ Ain't we funkin' now ♪ 848 00:31:56,998 --> 00:31:58,834 [The Brothers Johnson's "Ain't We Funkin' Now"] 849 00:31:58,875 --> 00:32:00,794 ♪ Ain't we funkin' now ♪ 850 00:32:00,877 --> 00:32:06,883 ♪ ♪ 851 00:32:13,849 --> 00:32:15,183 - Hey. 852 00:32:15,225 --> 00:32:17,227 Any luck picking an elective? 853 00:32:18,687 --> 00:32:21,440 - Don't know. [sighs] 854 00:32:21,523 --> 00:32:23,733 Maybe I will go into geriatrics. 855 00:32:25,235 --> 00:32:27,195 - It's a smart choice. 856 00:32:30,907 --> 00:32:32,492 I know that life can be challenging, 857 00:32:32,576 --> 00:32:33,869 especially when it doesn't work out 858 00:32:33,910 --> 00:32:35,203 the way you expected. 859 00:32:35,245 --> 00:32:36,455 - OK. 860 00:32:41,293 --> 00:32:42,711 - I thought I would be married 861 00:32:42,752 --> 00:32:44,838 with two kids in college by now. 862 00:32:46,131 --> 00:32:48,842 Maybe have some property with a pond, 863 00:32:48,925 --> 00:32:51,052 and we could play hockey on it in the wintertime. 864 00:32:51,136 --> 00:32:53,180 [siren wailing] 865 00:32:53,263 --> 00:32:54,389 And yet look at me now. 866 00:32:54,473 --> 00:32:58,602 No wife, no kids, no pond. 867 00:33:02,063 --> 00:33:04,191 - It's never too late. 868 00:33:04,274 --> 00:33:06,693 - Do you really believe that? 869 00:33:06,776 --> 00:33:08,069 - Yeah. 870 00:33:08,111 --> 00:33:09,738 - Only for me, or for you too? 871 00:33:09,821 --> 00:33:11,406 - OK. [siren chirps] 872 00:33:11,448 --> 00:33:13,033 I see what you did there. 873 00:33:14,242 --> 00:33:16,912 Was that true, or something you just said to make a point? 874 00:33:16,953 --> 00:33:18,330 [vehicle door opens] 875 00:33:23,084 --> 00:33:25,837 - Have you worked things out with your mom? 876 00:33:28,048 --> 00:33:29,633 - We're not talking. 877 00:33:32,886 --> 00:33:37,224 I am sorry that, um, I let it distract me. 878 00:33:38,725 --> 00:33:40,310 She was treating me like a child, 879 00:33:40,393 --> 00:33:41,811 and I was letting her. 880 00:33:46,983 --> 00:33:48,485 Have a good trip. 881 00:33:49,653 --> 00:33:50,820 Please be safe. 882 00:33:52,739 --> 00:33:55,116 We need you here. 883 00:33:55,158 --> 00:33:57,327 Even if you can be a dick sometimes. 884 00:34:00,163 --> 00:34:01,373 Good luck. 885 00:34:02,707 --> 00:34:04,084 - You too. 886 00:34:09,839 --> 00:34:10,799 [loud bang] 887 00:34:10,840 --> 00:34:12,425 [car alarm blaring] 888 00:34:13,176 --> 00:34:15,262 Hey, I didn't think you were still here. 889 00:34:15,344 --> 00:34:17,764 - I was just talking to the neurologist on call. 890 00:34:19,181 --> 00:34:20,891 - And? 891 00:34:20,976 --> 00:34:24,228 - We had a nice chat. 892 00:34:24,312 --> 00:34:26,898 She agrees I can work with double coverage. 893 00:34:26,982 --> 00:34:29,317 - That's not her call to make. 894 00:34:29,359 --> 00:34:30,652 You can't do anything critical 895 00:34:30,735 --> 00:34:32,152 where a five-second lapse in consciousness 896 00:34:32,237 --> 00:34:34,030 could potentially kill a patient. 897 00:34:35,864 --> 00:34:37,074 - I agree. 898 00:34:39,202 --> 00:34:40,495 - [sighs] 899 00:34:40,536 --> 00:34:41,788 - But 90% of our patients 900 00:34:41,830 --> 00:34:43,039 don't require critical procedures. 901 00:34:43,123 --> 00:34:45,208 - And the ones that do? 902 00:34:45,292 --> 00:34:47,627 - Will be handled by whomever is working with me. 903 00:34:47,710 --> 00:34:49,504 - Unless they're also tied up with a critical patient. 904 00:34:49,588 --> 00:34:50,880 What if it's a double or triple trauma? 905 00:34:50,964 --> 00:34:52,882 - Robby, I can handle it. - No, you can't. 906 00:34:52,966 --> 00:34:54,342 And I can't let you. 907 00:34:54,384 --> 00:34:55,719 - I am fully capable of handling-- 908 00:34:55,802 --> 00:34:57,345 - No, you are not fully capable, 909 00:34:57,387 --> 00:34:58,847 and you know it. 910 00:35:02,559 --> 00:35:03,977 - What do you want from me? 911 00:35:04,060 --> 00:35:05,103 - I want what's best for this department-- 912 00:35:05,186 --> 00:35:06,521 patients and staff. 913 00:35:06,605 --> 00:35:08,815 Best-case scenario, you get a handle on this, 914 00:35:08,898 --> 00:35:10,358 you're seizure-free for six months, 915 00:35:10,442 --> 00:35:11,610 you get your driver's license back, 916 00:35:11,693 --> 00:35:12,861 you are cleared to work. 917 00:35:12,944 --> 00:35:15,196 - I am cleared for my driver's license. 918 00:35:15,280 --> 00:35:17,365 - You shouldn't be driving at all like this. 919 00:35:17,449 --> 00:35:19,868 If you were a patient, we would have to report you. 920 00:35:19,909 --> 00:35:21,453 - I am not your fucking patient. 921 00:35:21,536 --> 00:35:22,537 - No, but I cannot let you work 922 00:35:22,621 --> 00:35:23,955 in my emergency department 923 00:35:24,039 --> 00:35:25,790 until you're fully capable of doing so. 924 00:35:25,874 --> 00:35:27,500 - That is not your fucking call! 925 00:35:27,584 --> 00:35:29,044 - You're fucking-A right, that's my call! 926 00:35:29,085 --> 00:35:31,004 I'm trying to protect you and my patients, 927 00:35:31,087 --> 00:35:32,339 and you know I'm right about this. 928 00:35:32,422 --> 00:35:34,049 - Oh, "my department," "my patients." 929 00:35:34,132 --> 00:35:35,550 All you fucking think about is yourself! 930 00:35:35,634 --> 00:35:36,885 Do you hear yourself? 931 00:35:36,926 --> 00:35:37,886 You didn't rat out Langdon 932 00:35:37,969 --> 00:35:39,429 for stealing fucking drugs. 933 00:35:39,512 --> 00:35:41,056 - No, but I kicked him out of this department 934 00:35:41,097 --> 00:35:42,932 until he got the appropriate help that he needs, 935 00:35:43,016 --> 00:35:44,851 and the same goes for you. 936 00:35:44,934 --> 00:35:46,436 You've got until Monday to let the administration know, 937 00:35:46,519 --> 00:35:47,687 or I will. 938 00:35:53,526 --> 00:35:54,694 [bell dinging] 939 00:35:54,778 --> 00:35:56,571 - I am finished. 940 00:35:56,613 --> 00:35:58,406 Last chart. 941 00:35:58,448 --> 00:35:59,449 [bell dings] 942 00:35:59,532 --> 00:36:00,950 - You and me both. - Really? 943 00:36:01,034 --> 00:36:02,535 - Is this a thing? I finished a while ago. 944 00:36:02,619 --> 00:36:03,995 [bell dings] 945 00:36:04,079 --> 00:36:05,872 - I never want to hear that fucking bell again. 946 00:36:10,460 --> 00:36:11,878 - Where's Dana? - Not sure. 947 00:36:11,961 --> 00:36:13,421 A bunch of day shift just headed to the roof 948 00:36:13,463 --> 00:36:14,589 to watch the fireworks. 949 00:36:14,673 --> 00:36:15,924 You want me to call her? 950 00:36:15,965 --> 00:36:17,467 - No, that's OK. 951 00:36:19,344 --> 00:36:20,762 - Yo. 952 00:36:20,845 --> 00:36:22,555 Thanks for your help in there. 953 00:36:24,474 --> 00:36:26,685 Almost out? - Yep, just about. 954 00:36:28,978 --> 00:36:30,605 Is this where you try to talk me out of going? 955 00:36:30,689 --> 00:36:31,606 - Me? 956 00:36:31,690 --> 00:36:33,441 No, not a chance. 957 00:36:33,483 --> 00:36:34,609 Why, are you having second thoughts? 958 00:36:34,693 --> 00:36:35,610 - Nope. - No? 959 00:36:35,694 --> 00:36:37,278 - Nope. 960 00:36:37,320 --> 00:36:39,280 - Don't have to convince me. 961 00:36:39,322 --> 00:36:40,615 I mean, it is a little strange the only place 962 00:36:40,657 --> 00:36:42,117 you talked about going is somewhere 963 00:36:42,200 --> 00:36:43,451 they used to drive buffalo off a cliff to die. 964 00:36:43,493 --> 00:36:44,744 - Here it comes. - I looked it up, 965 00:36:44,828 --> 00:36:46,454 and as far as summer vacations go, 966 00:36:46,496 --> 00:36:48,164 it's not exactly a holiday hotspot. 967 00:36:48,248 --> 00:36:51,292 I mean, what's in the fucking gift shop, man? 968 00:36:51,376 --> 00:36:52,502 - It's just one place I'm going. 969 00:36:52,585 --> 00:36:54,129 - As long as it's not the last. 970 00:36:54,170 --> 00:36:56,297 Don't be pulling a "Thelma and Louise" out there. 971 00:36:56,339 --> 00:36:58,466 - I am minutes from taking a three-month vacation. 972 00:36:58,550 --> 00:37:00,009 When's the last time you took any time off, Jack? 973 00:37:00,093 --> 00:37:01,970 - Yeah, but I've dealt with my demons. 974 00:37:03,263 --> 00:37:05,807 It's a process. 975 00:37:05,890 --> 00:37:08,560 You want to know why I never killed myself? 976 00:37:08,643 --> 00:37:11,980 After what I saw, lived through? 977 00:37:12,021 --> 00:37:15,608 Losing my leg, losing my wife? 978 00:37:16,860 --> 00:37:18,987 Because it comes for all of us, man. 979 00:37:19,028 --> 00:37:20,155 You and I know it more than most. 980 00:37:20,238 --> 00:37:21,906 We see it every shift, 981 00:37:21,990 --> 00:37:24,117 but we can't let ourselves succumb to it. 982 00:37:25,201 --> 00:37:27,036 Yes, life can suck. 983 00:37:28,371 --> 00:37:30,331 It can be unbearable 984 00:37:30,373 --> 00:37:32,167 and--and brutal 985 00:37:32,208 --> 00:37:34,836 and ugly and heartbreaking. 986 00:37:34,919 --> 00:37:39,007 But it's also beautiful-- and hilarious. 987 00:37:39,090 --> 00:37:41,342 And that woman today... 988 00:37:44,387 --> 00:37:45,889 Her baby, they'd both be in the morgue 989 00:37:45,972 --> 00:37:47,849 if you hadn't been here. 990 00:37:47,891 --> 00:37:49,684 That's us. That's you and me. 991 00:37:49,726 --> 00:37:52,645 That's what we're here for. 992 00:37:52,729 --> 00:37:55,231 - The most important things I've ever done in my life 993 00:37:55,315 --> 00:37:57,901 have been in this hospital. 994 00:37:57,984 --> 00:38:00,361 Nothing will ever matter more than what I've done 995 00:38:00,445 --> 00:38:03,406 in this hospital, but it is killing me. 996 00:38:05,033 --> 00:38:07,076 You know how they say that a part of you dies 997 00:38:07,160 --> 00:38:08,703 when you lose someone you love? 998 00:38:08,787 --> 00:38:11,122 I'm not convinced that a part of you doesn't die 999 00:38:11,206 --> 00:38:13,291 every time you see a fellow human pass. 1000 00:38:13,374 --> 00:38:17,796 And I've seen so many people die 1001 00:38:17,879 --> 00:38:20,924 that I feel like it's leaching something from my soul. 1002 00:38:22,592 --> 00:38:24,594 - Go on a cruise, man. 1003 00:38:26,971 --> 00:38:29,724 Knock off this helmetless motorcycle shit. 1004 00:38:29,808 --> 00:38:31,851 Yeah, people talk. 1005 00:38:31,893 --> 00:38:33,228 That's death-wish behavior. 1006 00:38:33,269 --> 00:38:34,687 - I'm tired of being a role model. 1007 00:38:34,729 --> 00:38:36,564 I'm tired of feeling like you can't get ahead. 1008 00:38:36,648 --> 00:38:38,358 I'm tired of feeling like I'm drowning every day. 1009 00:38:38,441 --> 00:38:39,609 I'm tired of all of it. 1010 00:38:39,692 --> 00:38:40,860 - You need to get away for a while, 1011 00:38:40,944 --> 00:38:42,237 and you need to get some help. 1012 00:38:42,320 --> 00:38:45,782 You need this place as much as it needs you. 1013 00:38:46,950 --> 00:38:50,078 - [breathes deeply] 1014 00:38:50,161 --> 00:38:52,205 Am I fucked up? 1015 00:38:52,288 --> 00:38:53,873 - 100%. 1016 00:38:57,377 --> 00:38:59,546 But nobody works here as long as you and me 1017 00:38:59,629 --> 00:39:00,713 and doesn't get screwed up. 1018 00:39:00,797 --> 00:39:03,883 You--you gotta find somebody 1019 00:39:03,967 --> 00:39:06,594 to help you dance through the darkness. 1020 00:39:06,678 --> 00:39:10,598 - [breathes deeply] 1021 00:39:10,682 --> 00:39:12,392 Did you just make that up? 1022 00:39:14,602 --> 00:39:15,937 - Maybe it's a song lyric. - [laughs] 1023 00:39:15,979 --> 00:39:17,689 - I don't-- maybe my therapist said it. 1024 00:39:17,772 --> 00:39:19,691 I don't know. 1025 00:39:19,774 --> 00:39:22,443 - [sighs] 1026 00:39:22,485 --> 00:39:23,862 - Some dude just pulled up. 1027 00:39:23,945 --> 00:39:25,989 Looks like he blew half his face off. 1028 00:39:28,825 --> 00:39:30,660 - How can you not love this place? 1029 00:39:33,037 --> 00:39:36,416 Look, don't make me look stupid. 1030 00:39:36,499 --> 00:39:38,918 You come back to us in one piece. 1031 00:39:42,255 --> 00:39:43,631 I'm still your emergency contact, 1032 00:39:43,715 --> 00:39:46,092 and I do not want to be contacted. 1033 00:39:48,428 --> 00:39:49,596 All right, night crawlers, 1034 00:39:49,679 --> 00:39:50,805 what the hell's going on out here? 1035 00:39:50,889 --> 00:39:53,933 [indistinct chatter] 1036 00:39:56,436 --> 00:39:57,687 - 25-year-old man-- 1037 00:39:57,770 --> 00:39:58,980 [indistinct] history, 1038 00:39:59,063 --> 00:40:00,315 no meds, no allergies. 1039 00:40:00,398 --> 00:40:03,443 [continues speaking indistinctly] 1040 00:40:28,384 --> 00:40:29,385 [lock chirps] 1041 00:40:54,285 --> 00:40:57,038 [engine starts] 1042 00:40:57,080 --> 00:40:58,748 [chiming] 1043 00:41:15,598 --> 00:41:18,601 [sobbing] 1044 00:41:26,776 --> 00:41:28,653 - More than 2,000 years ago, 1045 00:41:28,736 --> 00:41:30,822 the Chinese were throwing bamboo into fire 1046 00:41:30,905 --> 00:41:32,824 to make explosions. 1047 00:41:32,907 --> 00:41:34,367 They went on to invent gunpowder. 1048 00:41:34,450 --> 00:41:36,619 And boom! The rest is history. 1049 00:41:38,246 --> 00:41:41,249 They had chemicals to get the different colors, you know? 1050 00:41:41,332 --> 00:41:44,043 Sodium gives you yellow, strontium gives you red, 1051 00:41:44,127 --> 00:41:47,088 and barium is green. 1052 00:41:47,171 --> 00:41:50,717 Who knew chemistry could be so damn pretty? 1053 00:41:50,758 --> 00:41:52,260 [booming] 1054 00:41:52,301 --> 00:41:54,053 [chatter, laughter] 1055 00:41:54,137 --> 00:41:57,056 [fireworks popping] 1056 00:41:57,140 --> 00:42:00,059 ["America the Beautiful" playing] 1057 00:42:00,143 --> 00:42:07,025 ♪ ♪ 1058 00:42:59,702 --> 00:43:01,370 - Hey. - Hey. 1059 00:43:01,454 --> 00:43:03,831 - I thought you'd left already. - On my way out. 1060 00:43:03,873 --> 00:43:07,794 - Hey, I'm sorry that I didn't find the time today 1061 00:43:07,877 --> 00:43:08,961 to have that conversation. 1062 00:43:09,045 --> 00:43:10,296 - Yeah, that's all right. 1063 00:43:10,379 --> 00:43:12,173 Seems like you didn't really want to. 1064 00:43:12,256 --> 00:43:14,383 - I didn't. [sighs] 1065 00:43:16,552 --> 00:43:17,887 Did you? 1066 00:43:17,970 --> 00:43:20,264 - Uh... 1067 00:43:20,348 --> 00:43:23,017 yeah, actually. 1068 00:43:23,101 --> 00:43:26,145 Look, I'm doing the work. 1069 00:43:26,229 --> 00:43:28,606 I'm--I've been sober 186 days. 1070 00:43:28,689 --> 00:43:30,858 I'm going to meetings. I'm taking the drug tests. 1071 00:43:30,900 --> 00:43:33,152 - That's good. - And you're still riding me. 1072 00:43:36,197 --> 00:43:39,534 What would have happened if I'd paralyzed that guy? 1073 00:43:39,575 --> 00:43:41,202 - I don't know. 1074 00:43:41,244 --> 00:43:42,787 What would have happened if I hadn't been here today? 1075 00:43:42,870 --> 00:43:44,497 You'd still be questioning yourself. 1076 00:43:44,539 --> 00:43:46,207 Now you know you can do it. You're welcome. 1077 00:43:46,290 --> 00:43:47,834 - Oh, so that's-- that's how you teach now? 1078 00:43:47,917 --> 00:43:49,794 - Sometimes. 1079 00:43:49,877 --> 00:43:52,088 - You know who I saw in rehab? 1080 00:43:52,171 --> 00:43:54,757 I saw a bunch of guys just like you. 1081 00:43:54,841 --> 00:43:56,050 The only difference is, 1082 00:43:56,134 --> 00:43:59,220 they've accepted that they need help. 1083 00:43:59,262 --> 00:44:01,222 I think you're afraid to admit that 1084 00:44:01,305 --> 00:44:03,891 the mighty Dr. Robinavitch isn't perfect. 1085 00:44:03,975 --> 00:44:05,935 - Oh, I never claimed to be perfect. 1086 00:44:06,018 --> 00:44:09,230 - No, but you expect it of yourself, 1087 00:44:09,272 --> 00:44:11,691 and it's not realistic, man. 1088 00:44:11,774 --> 00:44:14,026 How can any of us live up to your standards 1089 00:44:14,110 --> 00:44:15,820 if you can't even do it? 1090 00:44:17,196 --> 00:44:20,074 You need help, Robby. 1091 00:44:20,158 --> 00:44:21,868 You need help. 1092 00:44:21,951 --> 00:44:24,704 [baby crying] 1093 00:44:24,787 --> 00:44:25,955 - Finished? 1094 00:44:27,123 --> 00:44:29,417 - You don't gotta be honest with me, man. 1095 00:44:29,500 --> 00:44:31,502 At least be honest with yourself. 1096 00:44:31,586 --> 00:44:34,630 [baby crying] 1097 00:44:47,018 --> 00:44:49,353 - She is due for a new bottle. 1098 00:44:49,437 --> 00:44:52,190 I was hoping to get her some formula before I clocked out. 1099 00:44:53,858 --> 00:44:56,152 - I'll stay with her. 1100 00:44:56,235 --> 00:44:57,486 - Thanks. 1101 00:44:59,739 --> 00:45:01,908 - Why are you--will you hit those lights on your way out? 1102 00:45:01,991 --> 00:45:04,952 - Yep. - Why are you crying? 1103 00:45:04,994 --> 00:45:07,496 Why are you crying, little one? 1104 00:45:07,580 --> 00:45:10,124 You're OK. You're safe. 1105 00:45:10,166 --> 00:45:12,418 Yeah, you're not alone. 1106 00:45:12,501 --> 00:45:15,504 [baby crying] 1107 00:45:19,342 --> 00:45:21,802 Yeah, you're OK. 1108 00:45:21,886 --> 00:45:25,139 Do you need to be swaddled again? 1109 00:45:25,181 --> 00:45:26,891 Is that it? 1110 00:45:26,974 --> 00:45:28,809 I can do that. Look. 1111 00:45:28,893 --> 00:45:31,437 Aww. 1112 00:45:31,520 --> 00:45:35,149 I wish somebody would swaddle me. 1113 00:45:35,233 --> 00:45:37,610 Yes, I do. 1114 00:45:37,693 --> 00:45:39,654 Oh. 1115 00:45:39,737 --> 00:45:42,073 [Rosie Carney's "Thousand"] 1116 00:45:42,156 --> 00:45:45,117 You got off to kind of a rough start, 1117 00:45:45,201 --> 00:45:48,246 didn't you, little one? 1118 00:45:48,329 --> 00:45:50,331 Yeah, you did. 1119 00:45:50,414 --> 00:45:52,667 - ♪ She is left stuck on her own ♪ 1120 00:45:52,708 --> 00:45:55,336 - Well, that makes two of us. 1121 00:45:55,378 --> 00:45:57,672 - ♪ Dust grows ♪ 1122 00:45:57,755 --> 00:45:58,881 - [sighs] 1123 00:45:58,965 --> 00:46:00,967 I got abandoned too. 1124 00:46:01,050 --> 00:46:04,303 - ♪ Can't move, can't grow ♪ 1125 00:46:04,387 --> 00:46:06,681 - When I was eight. 1126 00:46:06,722 --> 00:46:10,184 - ♪ When you've fallen on your knees ♪ 1127 00:46:10,268 --> 00:46:15,690 - But I got through all of that, and so will you. 1128 00:46:15,731 --> 00:46:19,694 I got a good feeling that you're gonna be just fine. 1129 00:46:19,735 --> 00:46:23,197 Everything's gonna be just fine. 1130 00:46:23,239 --> 00:46:26,117 You got so many wonderful things to see 1131 00:46:26,200 --> 00:46:29,328 and so many people to love ahead of you. 1132 00:46:29,412 --> 00:46:31,497 ♪ ♪ 1133 00:46:31,580 --> 00:46:36,544 So many wonderful things to see, 1134 00:46:36,585 --> 00:46:38,671 people to love ahead of you. 1135 00:46:38,754 --> 00:46:41,882 - ♪ To show they really care ♪ 1136 00:46:41,966 --> 00:46:44,218 ♪ Love, please surround me ♪ 1137 00:46:44,260 --> 00:46:47,138 [baby fussing] - Shh. 1138 00:46:47,221 --> 00:46:51,892 It's OK. It's gonna be OK. 1139 00:46:51,976 --> 00:46:54,478 It's OK. 1140 00:46:54,562 --> 00:46:59,191 - ♪ But a thousand more to live ♪ 1141 00:46:59,275 --> 00:47:03,029 ♪ Will it be this way tomorrow ♪ 1142 00:47:03,112 --> 00:47:04,572 ♪ I don't know ♪ 1143 00:47:04,613 --> 00:47:10,786 ♪ But I won't fade ♪ 1144 00:47:19,962 --> 00:47:24,050 both: ♪ I want you to know ♪ 1145 00:47:24,133 --> 00:47:28,846 ♪ That I'm happy for you ♪ 1146 00:47:28,929 --> 00:47:32,892 ♪ I wish nothing but ♪ 1147 00:47:32,975 --> 00:47:37,396 ♪ The best for you both ♪ 1148 00:47:37,438 --> 00:47:39,607 ♪ An older version of me ♪ 1149 00:47:39,648 --> 00:47:41,776 ♪ Is she perverted like me ♪ 1150 00:47:41,859 --> 00:47:46,364 ♪ Would she go down on you in a theater ♪ 1151 00:47:46,447 --> 00:47:48,699 ♪ Does she speak eloquently ♪ 1152 00:47:48,783 --> 00:47:50,910 ♪ And would she have your baby ♪ 1153 00:47:50,993 --> 00:47:56,082 ♪ I'm sure she'd make a really excellent mother ♪ 1154 00:47:56,165 --> 00:47:57,958 ♪ 'Cause the love that you gave that we made ♪ 1155 00:47:58,042 --> 00:47:59,794 ♪ Wasn't able to make it enough ♪ 1156 00:47:59,835 --> 00:48:02,963 ♪ For you to be open wide ♪ 1157 00:48:03,047 --> 00:48:05,299 ♪ No ♪ 1158 00:48:05,341 --> 00:48:07,635 ♪ And every time you speak her name ♪ 1159 00:48:07,718 --> 00:48:08,969 ♪ Does she know how you told me ♪ 1160 00:48:09,011 --> 00:48:10,805 ♪ You'd hold me until you died ♪ 1161 00:48:10,888 --> 00:48:13,933 ♪ Till you died, but you're still alive ♪ 1162 00:48:14,016 --> 00:48:18,437 ♪ And I'm here to remind you ♪ 1163 00:48:18,521 --> 00:48:20,773 ♪ Of the mess that you left ♪ 1164 00:48:20,856 --> 00:48:22,983 ♪ When you went away ♪ 1165 00:48:23,025 --> 00:48:27,613 ♪ It's not fair to deny me ♪ 1166 00:48:27,696 --> 00:48:31,617 ♪ Of the cross I bear that you gave to me ♪ 1167 00:48:31,700 --> 00:48:35,579 ♪ You, you, you oughta know ♪ 1168 00:48:35,663 --> 00:48:38,582 [Alanis Morissette's "You Oughta Know" playing] 1169 00:48:38,666 --> 00:48:45,714 ♪ ♪