1 00:00:28,080 --> 00:00:29,080 Robbie. Robbie. 2 00:00:30,160 --> 00:00:32,320 Coler skin respiratory distress is here. Right. 3 00:00:32,680 --> 00:00:33,680 You okay? Yep. 4 00:00:34,440 --> 00:00:38,120 I wanted to talk to the patient in Central 12th Summit, but he took off. 5 00:00:38,340 --> 00:00:39,340 Is there a problem? 6 00:00:39,700 --> 00:00:42,820 According to Mom, she found a list of high school girls that he'd like to 7 00:00:42,820 --> 00:00:43,820 eliminate. 8 00:00:44,800 --> 00:00:46,540 What's wrong with kids these days? 9 00:00:47,020 --> 00:00:50,700 Uh, you mean besides social media and the worldwide pandemic and the 10 00:00:50,700 --> 00:00:51,760 environmental crisis? 11 00:00:52,100 --> 00:00:54,140 Yeah, yeah, you're about to help today, aren't you? 12 00:00:54,880 --> 00:00:59,720 Nick Bradley, 19, found unresponsive by parents. No meds, no allergies. On 13 00:00:59,720 --> 00:01:03,180 arrival, he was barely breathing with pinpoint pupils bradycardic at 38. 14 00:01:03,420 --> 00:01:06,640 Pupils responded in Narcan, but we tubed him when his respirations didn't pick 15 00:01:06,640 --> 00:01:09,460 up. Any drugs or alcohol I'm seeing? 16 00:01:09,720 --> 00:01:10,980 No. Signs of trauma? 17 00:01:11,300 --> 00:01:13,200 Nothing. Okay, open your eyes, Nick. 18 00:01:13,860 --> 00:01:16,120 On three. One, two, three. 19 00:01:18,220 --> 00:01:20,200 Where was he found? In bed by his mom. 20 00:01:21,720 --> 00:01:25,320 Pupils are six millimeters non -reactive. 21 00:01:26,040 --> 00:01:27,160 Heart rate 64. 22 00:01:27,440 --> 00:01:28,440 BP is cycling. 23 00:01:28,600 --> 00:01:29,880 No response to pain. 24 00:01:30,360 --> 00:01:32,820 GCS3. Does that fit any toxidrome? 25 00:01:33,060 --> 00:01:37,760 No. If it was just opiates with Narcan, he'd be breathing on his own. 26 00:01:38,620 --> 00:01:41,040 A beta blocker shouldn't give pinpoint pupils. 27 00:01:41,380 --> 00:01:43,440 Maybe parents have some prescription meds in their bathroom. 28 00:01:43,700 --> 00:01:44,700 We're on our way. 29 00:01:47,580 --> 00:01:49,720 That's a stand -up scooter rider versus car door. 30 00:01:49,920 --> 00:01:53,600 No helmet. No blood in the belly. No pericardial effusion. 31 00:01:53,880 --> 00:01:56,640 And lungs are up. 32 00:01:57,020 --> 00:01:58,540 Hemo Q's good. 15. 33 00:01:58,840 --> 00:02:00,500 BP 84 over 58. 34 00:02:00,820 --> 00:02:01,820 Okay. 35 00:02:01,860 --> 00:02:03,100 What's your plan, Dr. Collins? 36 00:02:04,360 --> 00:02:06,780 Push dose epi. 0 .1 milligram. 37 00:02:07,680 --> 00:02:09,680 Foley for urine. Stabilized for CT. 38 00:02:10,100 --> 00:02:11,520 And throw a wide net. 39 00:02:17,519 --> 00:02:21,460 Where are we going now? We need the room for someone else. But you can rest in 40 00:02:21,460 --> 00:02:23,100 the hall till we get your labs back. 41 00:02:25,120 --> 00:02:26,500 Your parents must be proud. 42 00:02:27,600 --> 00:02:28,920 Having a son who's a doctor. 43 00:02:30,220 --> 00:02:31,240 Yeah, I guess. 44 00:02:34,080 --> 00:02:36,660 You know, I was the first one in my family to go to college. 45 00:02:38,620 --> 00:02:40,460 Now they sacrificed a lot to get me here. 46 00:02:42,400 --> 00:02:43,560 How's your pain, Mr. Milton? 47 00:02:44,140 --> 00:02:45,140 I'm fine. 48 00:02:45,420 --> 00:02:46,900 I could use a latte, though. 49 00:02:47,400 --> 00:02:48,980 That could bring back the gallstone pain. 50 00:02:49,300 --> 00:02:50,420 How about a bourbon? 51 00:02:50,760 --> 00:02:52,140 It's barely 8 o 'clock. 52 00:02:52,720 --> 00:02:54,360 How about some ice chips? 53 00:02:54,720 --> 00:02:56,080 No, thanks. 54 00:02:56,640 --> 00:02:58,200 I prefer my whiskey neat. 55 00:02:58,640 --> 00:03:00,000 Yeah, that's not happening. 56 00:03:05,120 --> 00:03:06,500 Systolic back down to 90. 57 00:03:07,480 --> 00:03:08,920 Another .1 of epi. 58 00:03:09,440 --> 00:03:11,740 Lack of paralysis of all four extremities. 59 00:03:14,570 --> 00:03:17,250 No eye movement with ice water. So no brainstem function. 60 00:03:17,730 --> 00:03:18,730 Due to? 61 00:03:18,990 --> 00:03:20,930 Hypoxic injury, massive hemorrhage. 62 00:03:21,690 --> 00:03:23,150 Samira, escort him to CT. 63 00:03:23,710 --> 00:03:25,190 Take the drug box with you. 64 00:03:25,830 --> 00:03:26,830 Call me if you need me. 65 00:03:27,730 --> 00:03:28,730 Hey, are you okay? 66 00:03:29,890 --> 00:03:30,910 Yep. You sure? 67 00:03:31,550 --> 00:03:32,990 Have you ever had to worry about me? 68 00:03:33,890 --> 00:03:37,090 No, but never heard to check in. It's part of my job. 69 00:03:38,210 --> 00:03:39,390 Consider yourself checked in. 70 00:03:40,570 --> 00:03:41,570 Okay. 71 00:03:42,820 --> 00:03:44,420 Uh, uh, uh, uh, uh. 72 00:03:45,180 --> 00:03:46,180 Got something? 73 00:03:46,400 --> 00:03:47,860 Oh, I had a case for Dr. Collins. 74 00:03:48,180 --> 00:03:49,180 May I see it? 75 00:03:49,620 --> 00:03:55,000 Yeah. Uh, 68 -year -old male, history of hypertension, one hour of right upper 76 00:03:55,000 --> 00:03:59,380 quadrant pain after eating a fatty meal, now resolved, afebrile, non -tender. 77 00:03:59,460 --> 00:04:00,960 There was a gallstone present on POCUS. 78 00:04:01,420 --> 00:04:06,140 EKG shows no acute ischemic changes, but I'm still waiting on LFTs and lipase. 79 00:04:06,180 --> 00:04:07,380 Why did you order the EKG? 80 00:04:08,739 --> 00:04:11,680 The nurse suggested it to rule out any cardiac issues. 81 00:04:11,900 --> 00:04:13,760 Well, good call on both your parts. 82 00:04:14,560 --> 00:04:17,760 Nurses know what they're doing. Never hesitate to listen to them. Come find me 83 00:04:17,760 --> 00:04:19,459 when those labs are back. Hey, how's that figure? 84 00:04:19,760 --> 00:04:20,760 Oh, it's nothing. Dr. Robbie? 85 00:04:21,220 --> 00:04:24,460 Yep. The son and daughter of Mr. Spencer from assisted living? They're here. 86 00:04:24,620 --> 00:04:25,780 Okay, I'll be right there. 87 00:04:33,480 --> 00:04:34,620 Your father has pneumonia. 88 00:04:35,240 --> 00:04:39,760 And a condition called sepsis. What is that exactly? It means that the bacteria 89 00:04:39,760 --> 00:04:42,020 has spread from his lung to his bloodstream. 90 00:04:42,300 --> 00:04:44,400 So far, he's been responding well to treatment. 91 00:04:45,160 --> 00:04:46,160 Hey, Pop. 92 00:04:47,640 --> 00:04:48,920 It's Helen and Jeremy. 93 00:04:51,540 --> 00:04:52,540 Jeremy. 94 00:04:54,000 --> 00:04:55,000 Hillary. 95 00:04:55,700 --> 00:04:56,700 Boom. 96 00:04:57,440 --> 00:04:58,440 Fuck. 97 00:05:00,880 --> 00:05:04,740 David. It's the nowhere man from Yellow Submarine. It's what he used to call me 98 00:05:04,740 --> 00:05:05,740 when I didn't do my homework. 99 00:05:06,340 --> 00:05:07,560 Is this his baseline? 100 00:05:08,220 --> 00:05:09,720 He has good days and bad days. 101 00:05:11,560 --> 00:05:13,080 Why don't we step out for one more second? 102 00:05:18,420 --> 00:05:21,700 So your father came in with low blood pressure, which is improving. 103 00:05:22,000 --> 00:05:23,460 Can he go back to assisted living? 104 00:05:23,760 --> 00:05:24,800 Eventually, we hope so. 105 00:05:25,280 --> 00:05:29,360 Your dad has an advanced directive expressing his wishes, which says that 106 00:05:29,360 --> 00:05:30,920 fluids and medications are okay. 107 00:05:31,400 --> 00:05:33,460 But no artificial life support, no CPR. 108 00:05:33,760 --> 00:05:35,960 He doesn't want a bunch of machines keeping him alive? 109 00:05:36,820 --> 00:05:37,820 Okay. 110 00:05:38,060 --> 00:05:41,660 Then we will continue with oxygen and IV fluids and antibiotics. 111 00:05:42,440 --> 00:05:45,860 But if his lungs stop working, we're not going to place a tube in his windpipe 112 00:05:45,860 --> 00:05:48,240 for a breathing machine. But pneumonia is treatable? 113 00:05:49,740 --> 00:05:50,860 Most of the time it is. 114 00:05:52,000 --> 00:05:54,840 But if he can get better in a week, then put him on a machine. That's not what 115 00:05:54,840 --> 00:05:55,840 he wanted. 116 00:05:56,000 --> 00:05:58,840 Do either of you have durable power of attorney for health care? 117 00:05:59,680 --> 00:06:00,680 Yes. We both do. 118 00:06:01,080 --> 00:06:04,880 Okay. Well, this is a decision that does not need to be made right now. 119 00:06:05,200 --> 00:06:06,440 Why don't you think about it? 120 00:06:06,800 --> 00:06:07,800 Talk about it. 121 00:06:08,480 --> 00:06:14,020 If things get worse, sometimes allowing for a comfortable natural death can be 122 00:06:14,020 --> 00:06:15,020 the most humane path. 123 00:06:18,160 --> 00:06:21,000 No routine cases until we assess the Tier 1. 124 00:06:21,540 --> 00:06:23,240 Thanks. Dr. Langdon? 125 00:06:24,840 --> 00:06:27,560 So, uh, how's the VA? 126 00:06:27,920 --> 00:06:29,280 Yeah. It's good. 127 00:06:29,600 --> 00:06:30,600 You know, challenging. 128 00:06:30,720 --> 00:06:31,720 I learned a ton. 129 00:06:32,300 --> 00:06:35,980 I just think it... Maybe it should be mandatory that all doctors spend time 130 00:06:35,980 --> 00:06:39,260 there, like, on a regular basis, because of all they've sacrificed for us. 131 00:06:39,480 --> 00:06:40,480 That's a nice thought. 132 00:06:40,520 --> 00:06:41,520 How'd you choose the pit? 133 00:06:41,800 --> 00:06:45,040 Oh, I have a sister with special needs, and she got into a really great facility 134 00:06:45,040 --> 00:06:46,040 here in Pittsburgh. 135 00:06:46,220 --> 00:06:50,080 And PTMC has such a great reputation, I thought, you know, I'd be a good fit. 136 00:06:50,080 --> 00:06:51,960 Can I put that in my headache, please? Uh, yeah. What do you got? 137 00:06:52,400 --> 00:06:56,060 A 36 -year -old woman with severe headache due to parasophical trigger 138 00:06:56,160 --> 00:07:00,600 Her pain went from 11 to 0 after two cc's of IMR cane. Wait, wait, wait. You 139 00:07:00,600 --> 00:07:02,300 a trigger point injection before presenting the case? 140 00:07:03,060 --> 00:07:05,340 Yeah. Interns always present first. 141 00:07:05,700 --> 00:07:08,980 I spent a month at the pain clinic. No, it's not okay. It's very comfortable. 142 00:07:08,980 --> 00:07:10,600 It's definitely not okay. 143 00:07:10,900 --> 00:07:14,420 23 -year -old Ben Kemper, no helmet, got doored riding an e -scooter. Neck 144 00:07:14,420 --> 00:07:16,280 versus handlebar, then face planted to the pavement. 145 00:07:16,540 --> 00:07:19,460 Obvious facial fractures, but alert and oriented with good vitals. 146 00:07:22,220 --> 00:07:23,220 Here we go. 147 00:07:25,220 --> 00:07:26,600 One, two, three. 148 00:07:29,640 --> 00:07:30,640 How we doing, Ben? 149 00:07:31,280 --> 00:07:32,280 Come on. 150 00:07:32,420 --> 00:07:33,560 Back in my throat. 151 00:07:33,780 --> 00:07:35,240 That's probably from the nose bleed. 152 00:07:35,700 --> 00:07:37,140 Short rapid rhino, please. 153 00:07:37,560 --> 00:07:38,560 Tachy at 120. 154 00:07:38,720 --> 00:07:40,140 Pulse ox borderline at 90. 155 00:07:40,440 --> 00:07:41,800 We'll buy it 15 liters for now. 156 00:07:42,040 --> 00:07:43,040 Neck confusion. 157 00:07:43,120 --> 00:07:44,920 Larynx shifted to the right. No crepitant. 158 00:07:45,320 --> 00:07:46,440 Four morphine. 159 00:07:46,680 --> 00:07:49,640 I'm going to stick something in your nose to stop the bleeding. 160 00:07:51,989 --> 00:07:52,989 No hemotymphin. 161 00:07:53,650 --> 00:07:54,650 Inflate the balloon. 162 00:07:55,990 --> 00:07:56,990 How about now, Ben? 163 00:07:58,810 --> 00:08:00,290 Better. What's up? 164 00:08:00,950 --> 00:08:01,950 Good vitals. 165 00:08:02,230 --> 00:08:04,030 A andO. Let's have a look. 166 00:08:08,050 --> 00:08:09,050 Ouch. 167 00:08:09,950 --> 00:08:10,849 Floating face. 168 00:08:10,850 --> 00:08:11,850 Fourth refracture. 169 00:08:12,110 --> 00:08:15,450 You don't see that every day. Okay, let's prep for an airway. Double setup 170 00:08:15,450 --> 00:08:16,450 in case. 171 00:08:31,020 --> 00:08:32,020 Nice work. 172 00:08:32,860 --> 00:08:33,860 Thanks. 173 00:08:34,000 --> 00:08:36,220 All right, Mr. Tagare, you are good to go. 174 00:08:36,460 --> 00:08:37,640 Oh, thank you. 175 00:08:37,880 --> 00:08:41,340 Remember, 10 % off for doctors and nurses. 176 00:08:42,240 --> 00:08:43,240 I'm a student doctor. 177 00:08:43,700 --> 00:08:44,700 All right, sorry. 178 00:08:45,260 --> 00:08:46,460 I hit my head, remember? 179 00:08:46,700 --> 00:08:50,460 Well, my son loves pizza, so I will take you up on it for sure. Thank you. Thank 180 00:08:50,460 --> 00:08:52,560 you. Wait for a nurse. Okay, thanks. 181 00:08:54,160 --> 00:08:57,140 I just realized it sounds like I always feed my kid junk food. 182 00:08:57,380 --> 00:08:58,380 Oh. No. 183 00:08:58,560 --> 00:08:59,560 Pizza? S'mores? 184 00:08:59,760 --> 00:09:00,760 No, no, please. 185 00:09:00,840 --> 00:09:02,160 I like pizza and s'mores. 186 00:09:02,700 --> 00:09:03,700 Who doesn't? 187 00:09:04,700 --> 00:09:07,540 How many kids do you have? Just one. 188 00:09:08,280 --> 00:09:10,180 Harrison? He's 11 now. 189 00:09:11,440 --> 00:09:12,440 What does your husband do? 190 00:09:12,680 --> 00:09:13,539 No husband. 191 00:09:13,540 --> 00:09:14,540 Just me and my son. 192 00:09:14,840 --> 00:09:15,880 I take it you don't have kids? 193 00:09:16,160 --> 00:09:17,900 I don't mean on account of your age. 194 00:09:18,840 --> 00:09:22,300 Or, I don't know, maybe I do. I mean, most medical students don't have kids. 195 00:09:22,540 --> 00:09:23,840 Yeah, no, no. 196 00:09:24,480 --> 00:09:25,540 No kids. 197 00:09:26,260 --> 00:09:27,500 Just... I'm not even a boyfriend. 198 00:09:28,000 --> 00:09:29,120 It's just school for now. 199 00:09:29,320 --> 00:09:32,960 Yeah. It'll keep you pretty busy. I do not miss it. 200 00:09:33,500 --> 00:09:35,260 Less than difficult as a young mother. 201 00:09:35,660 --> 00:09:36,820 It had its moments. 202 00:09:37,080 --> 00:09:38,680 But my life has been full of challenges. 203 00:09:39,060 --> 00:09:41,580 Med school was not one of the hardest by far. 204 00:09:42,400 --> 00:09:44,020 It was one of the most rewarding, though. 205 00:09:44,760 --> 00:09:46,100 Other than having my son. 206 00:09:47,360 --> 00:09:48,360 Hey. 207 00:09:48,600 --> 00:09:52,060 Facial lack with a possible foreign object in the eye, which is always a 208 00:09:52,060 --> 00:09:54,060 seven on the WMMD scale. 209 00:09:54,380 --> 00:09:55,740 What makes Mateo vomit? 210 00:09:59,050 --> 00:10:00,050 You okay? 211 00:10:00,970 --> 00:10:01,970 Yeah. 212 00:10:02,130 --> 00:10:05,930 Yeah, um, he's funny. The nurse. 213 00:10:06,610 --> 00:10:07,810 Mateo, you can say his name. 214 00:10:09,930 --> 00:10:13,970 Um, yeah, uh, for an object in the eye, I could be really serious. 215 00:10:17,250 --> 00:10:23,150 Hey, fruitcake. 216 00:10:25,420 --> 00:10:29,040 Hey, I'm talking to you, fruitcake. Myrna, I've told you a hundred times, my 217 00:10:29,040 --> 00:10:30,040 name is Dr. Robbie. 218 00:10:30,920 --> 00:10:32,280 You want to see my vagina? 219 00:10:33,140 --> 00:10:34,860 I have already seen it. 220 00:10:35,300 --> 00:10:37,000 And once was enough. 221 00:10:37,200 --> 00:10:38,200 Thank you. 222 00:10:38,220 --> 00:10:41,260 Robbie, parents of Nick Bradley, the OD team, are here. 223 00:10:41,500 --> 00:10:45,280 Okay, Parkerman trauma one. He's not back from CT yet, but I'll be right 224 00:10:45,280 --> 00:10:46,179 in a minute. 225 00:10:46,180 --> 00:10:47,180 Behaving yourself, Myrna? 226 00:10:47,340 --> 00:10:48,500 Oh, yes, ma 'am. 227 00:10:52,480 --> 00:10:53,620 How we doing? 228 00:10:54,030 --> 00:10:56,570 Ketamine is stuck on board. Pulse ox holding at 94. 229 00:10:56,990 --> 00:10:58,110 Prep in the neck just in case. 230 00:10:58,330 --> 00:10:59,330 Let's have a look. 231 00:11:01,250 --> 00:11:02,250 A little deeper. 232 00:11:03,470 --> 00:11:05,530 Lots of swelling. I can't see the cords. To the right. 233 00:11:06,290 --> 00:11:07,290 The left. 234 00:11:07,730 --> 00:11:10,270 Yeah, really distorted from the trauma and the edema is only going to get 235 00:11:10,410 --> 00:11:13,910 Which is why we should crike. You don't crike a laryngeal fracture. Don't listen 236 00:11:13,910 --> 00:11:16,370 to Edwina Scissorhands here. If they can't cut it, surgery doesn't know how 237 00:11:16,370 --> 00:11:19,970 fix it. The contusion is high at the thyroid cartilage. So you just stand 238 00:11:19,970 --> 00:11:22,430 looking pretty, ER Ken, and let me fix this. 239 00:11:23,660 --> 00:11:24,660 We're down to 85. 240 00:11:24,700 --> 00:11:26,380 All right, pull out eye gel, bag and crike. 241 00:11:26,580 --> 00:11:27,580 Eye gel, please. 242 00:11:27,940 --> 00:11:29,360 I've never done a crike before. 243 00:11:29,640 --> 00:11:32,760 No, Mel will do the crike. You've already had a busy morning. Glove up, 244 00:11:33,020 --> 00:11:34,540 No, I'm doing the crike, doctor. 245 00:11:34,820 --> 00:11:38,080 You would be doing it, doctor, if it wasn't an odd day. Surgery gets even 246 00:11:38,120 --> 00:11:40,160 ED gets odd days. You know this, for crike's sake. 247 00:11:40,400 --> 00:11:43,320 Because you're all fucking odd down here. Okay, same word, please. Let's 248 00:11:43,320 --> 00:11:45,580 on the patient. I so appreciate your gracious understanding. 249 00:11:46,020 --> 00:11:48,960 I'll assist in case she screws up. So long, Mel. Play nice. 250 00:11:49,880 --> 00:11:50,940 Sasser up with the eye gel. 251 00:11:51,380 --> 00:11:52,380 You ready? 252 00:11:53,439 --> 00:11:54,580 Hello. Oh, hello. 253 00:11:55,540 --> 00:11:56,540 You've done this? 254 00:11:57,040 --> 00:11:59,080 Yes, in the cadaver lab. 255 00:12:00,500 --> 00:12:02,360 Let's hope that's not where this poor soul ends up. 256 00:12:03,340 --> 00:12:05,160 We'll do an open technique since we have a minute. 257 00:12:05,400 --> 00:12:06,400 Okay. 258 00:12:07,680 --> 00:12:11,380 Okay, you're going to be making a vertical incision to avoid the jugulars 259 00:12:11,380 --> 00:12:12,380 the carotids. 260 00:12:14,420 --> 00:12:17,540 Good. If this was a crack that needed to happen in seconds, you could use a ten 261 00:12:17,540 --> 00:12:18,760 blade, your finger, and a bougie. 262 00:12:23,660 --> 00:12:26,980 This is called a wheat lanter, and this is your trade cook. 263 00:12:27,320 --> 00:12:31,160 T -spine, head C, T, OMF, start a propofol drip. 264 00:12:31,360 --> 00:12:34,340 Okay, now we're going to make a horizontal incision across the 265 00:12:34,340 --> 00:12:35,340 membrane. 266 00:12:39,500 --> 00:12:40,700 4 -0 Shiley next. 267 00:12:41,780 --> 00:12:42,840 Get ready to bag the crack. 268 00:12:45,020 --> 00:12:46,200 Yeah, yeah, yeah, good. 269 00:12:54,540 --> 00:12:55,940 Excuse me. No worries. 270 00:12:57,520 --> 00:13:01,000 Entitled CO2 is yellow. Yellow is yes. Nicely done. Throw it in. Okay. 271 00:13:01,700 --> 00:13:03,020 I will be next door. 272 00:13:04,840 --> 00:13:07,160 Does your resident know how to suture, or do I need to teach? 273 00:13:07,600 --> 00:13:08,820 You're all class, yo -yo. 274 00:13:09,180 --> 00:13:09,939 I know. 275 00:13:09,940 --> 00:13:12,960 Thanks. That means a lot of nothing coming from you. 276 00:13:13,260 --> 00:13:14,260 Mel, you okay? 277 00:13:14,320 --> 00:13:15,320 If you're done fighting. 278 00:13:15,600 --> 00:13:17,040 We're not fighting. This is playing. 279 00:13:17,560 --> 00:13:18,620 Langdon's too soft to fight. 280 00:13:18,860 --> 00:13:22,240 Oh, yeah. I have nothing but respect for Dr. Garcia. In fact, I think she would 281 00:13:22,240 --> 00:13:23,680 make a wonderful hostess at Applebee's. 282 00:13:24,319 --> 00:13:25,319 Later, Og. 283 00:13:28,100 --> 00:13:29,100 Let's go. 284 00:13:30,060 --> 00:13:31,060 Okay, thanks. 285 00:13:31,440 --> 00:13:35,260 Just received word your son's head CT is normal. And he's maintaining a good 286 00:13:35,260 --> 00:13:36,500 heart rate. You got him back. 287 00:13:36,720 --> 00:13:40,880 Thank you, thank you. Right now, he's unconscious with a tube in his throat 288 00:13:40,880 --> 00:13:41,880 oxygen. 289 00:13:42,720 --> 00:13:45,180 Why don't we step out for a minute while they get him settled, and then you can 290 00:13:45,180 --> 00:13:46,760 come back and sit with him as long as you want. 291 00:13:48,660 --> 00:13:50,340 Nikki, it's Mama. I'm here, babe. 292 00:13:50,580 --> 00:13:51,580 You're doing great, son. 293 00:13:53,220 --> 00:13:54,220 Boom. 294 00:13:56,780 --> 00:13:57,780 Okay, this is the bedtime. 295 00:14:01,940 --> 00:14:08,880 So, we don't know how long he was at home 296 00:14:08,880 --> 00:14:09,759 without breathing. 297 00:14:09,760 --> 00:14:10,760 He's breathing now? 298 00:14:11,360 --> 00:14:12,360 Not on his own. 299 00:14:12,920 --> 00:14:15,040 But he's going to wake up. We certainly hope so. 300 00:14:15,940 --> 00:14:18,280 We're going to know better after we get some more test results back. 301 00:14:18,680 --> 00:14:22,880 Are you sure that he didn't take anything that could have caused this? 302 00:14:23,360 --> 00:14:26,400 No, he's a good kid. He's in college. He has a part -time job. 303 00:14:26,620 --> 00:14:29,280 He even chose to live at home so he could focus on school. 304 00:14:29,800 --> 00:14:31,300 Dr. Robbie, from the urine. 305 00:14:31,640 --> 00:14:32,640 What's that? 306 00:14:34,100 --> 00:14:35,100 It's a drug test. 307 00:14:35,360 --> 00:14:37,140 And it is positive for fentanyl. 308 00:14:38,040 --> 00:14:39,120 No, that is impossible. 309 00:14:39,360 --> 00:14:40,360 Nick doesn't do drugs. 310 00:14:40,760 --> 00:14:44,600 There are a lot of pills that are sold illegally that have fentanyl, not just 311 00:14:44,600 --> 00:14:46,780 painkillers. Xanax, Ativan. 312 00:14:47,200 --> 00:14:48,340 No, not our son. 313 00:14:49,220 --> 00:14:52,660 Well, maybe he didn't know that he took something with fentanyl. I don't know. 314 00:14:53,320 --> 00:14:54,800 The hows and the whys don't really matter. 315 00:14:55,020 --> 00:14:56,740 What matters is spending time with Nick. 316 00:14:56,960 --> 00:14:59,940 We've got some more tests to run. We'll know our options after that. But in the 317 00:14:59,940 --> 00:15:01,880 meantime, why don't you take a seat and talk to him? 318 00:15:05,120 --> 00:15:06,120 Can he hear us? 319 00:15:06,460 --> 00:15:09,580 You know, we're never really sure, so we should just assume that he can. 320 00:15:09,820 --> 00:15:12,560 And we'll come find you as soon as we know more, okay? Okay. 321 00:15:19,560 --> 00:15:21,520 Can we move Nick Bradley to a private room? 322 00:15:22,010 --> 00:15:23,010 Like you're going to make it? 323 00:15:24,770 --> 00:15:26,110 Can you respond to Narcan? 324 00:15:26,470 --> 00:15:29,770 I think his pinpoint pupils just grew into blown pupils from brain stem death. 325 00:15:30,270 --> 00:15:31,270 Shit. 326 00:15:32,290 --> 00:15:34,310 Yeah, not much older than Jake. 327 00:15:35,790 --> 00:15:36,790 Don't go there. 328 00:15:38,450 --> 00:15:39,470 Hard not to sometimes. 329 00:15:41,230 --> 00:15:42,370 Mr. Spencer's room. 330 00:15:44,030 --> 00:15:45,030 Hey, Robbie. 331 00:15:45,050 --> 00:15:48,610 Teresa, the mother of the young man David who bolted. She's asking for her 332 00:15:48,790 --> 00:15:49,930 Okay, I'll be there in a minute. 333 00:15:50,510 --> 00:15:51,510 What is happening? 334 00:15:51,570 --> 00:15:53,870 His oxygen levels are dropping. 335 00:15:54,590 --> 00:15:56,270 Mr. Spencer, how are you feeling? 336 00:15:56,850 --> 00:15:58,830 I don't remember where I parked. 337 00:15:59,410 --> 00:16:02,610 Mr. Spencer, do you know where you are? It's so loud in here. 338 00:16:04,030 --> 00:16:08,030 Dad, do you know where you are? Dad, look at me. What's my name? 339 00:16:08,730 --> 00:16:11,310 I don't know where my car is. 340 00:16:12,790 --> 00:16:15,270 I've had this number five. Step out. 341 00:16:20,270 --> 00:16:21,209 What's BiPAP? 342 00:16:21,210 --> 00:16:24,570 It is a pressurized air mask that can improve his oxygen. 343 00:16:25,110 --> 00:16:28,950 Either his pneumonia is getting worse or his heart couldn't handle the fluids 344 00:16:28,950 --> 00:16:32,450 that we gave him to treat the sepsis. His lungs are filling up with fluid. Can 345 00:16:32,450 --> 00:16:33,450 you take the fluid away? 346 00:16:33,750 --> 00:16:36,690 Not without his blood pressure crashing with very bad consequences. 347 00:16:36,990 --> 00:16:38,670 So let's just hope the BiPAP works. 348 00:16:39,010 --> 00:16:40,010 And if it doesn't? 349 00:16:40,730 --> 00:16:44,490 Then I would need to know your decision about using a breathing machine. 350 00:16:44,690 --> 00:16:46,030 We're still talking about it. 351 00:16:46,470 --> 00:16:49,450 Well, we know he expressed his wishes in writing. 352 00:16:49,950 --> 00:16:50,950 Do not intubate. 353 00:16:51,190 --> 00:16:52,730 We're thinking try it for a week. 354 00:16:54,090 --> 00:16:56,430 That would be a very painful week. 355 00:16:57,250 --> 00:17:01,210 He wouldn't get a lot of rest with all the monitors and all the blood tests. 356 00:17:01,490 --> 00:17:04,530 He might need to be sedated. He might need to be restrained because he'd be in 357 00:17:04,530 --> 00:17:07,890 an unfamiliar place with a very uncomfortable tube down his throat. 358 00:17:08,550 --> 00:17:10,170 And he wouldn't really know what was happening. 359 00:17:11,210 --> 00:17:13,390 Elderly patients can often develop psychosis. 360 00:17:13,890 --> 00:17:15,450 But he might get better. 361 00:17:15,670 --> 00:17:16,730 Or he might get worse. 362 00:17:17,910 --> 00:17:18,910 What would you do? 363 00:17:20,109 --> 00:17:23,569 I really can't answer that for you. This is your father. That's your decision to 364 00:17:23,569 --> 00:17:27,329 make. I can guarantee you that we will keep him as comfortable as possible if a 365 00:17:27,329 --> 00:17:28,550 natural death is what you choose. 366 00:17:28,750 --> 00:17:31,890 But he's not your father, and he can't recover from it. 367 00:17:32,390 --> 00:17:35,530 What my sister means is that we're still deciding the best thing to do. 368 00:17:38,650 --> 00:17:40,550 Well, the sooner you decide, the better. 369 00:17:41,030 --> 00:17:43,110 I'm really sorry. I wish there was more that I could do. 370 00:17:44,270 --> 00:17:46,110 I'm not sure that he has that much time left. 371 00:17:53,040 --> 00:17:54,040 Dr. Robbie? 372 00:18:01,420 --> 00:18:02,420 You were right. 373 00:18:02,940 --> 00:18:05,680 She can't say whether she was bumped by accident or shoved on purpose. 374 00:18:05,960 --> 00:18:06,960 No other witnesses? 375 00:18:07,100 --> 00:18:08,740 No, not really. 376 00:18:09,180 --> 00:18:12,280 Pull security footage, maybe we'll find something. Hopefully she tripped. 377 00:18:13,380 --> 00:18:16,340 I mean, I hope she tripped. I mean, I hope she wasn't pushed on purpose. 378 00:18:17,260 --> 00:18:18,740 That would make this a hate crime. 379 00:18:19,400 --> 00:18:20,400 Yes, ma 'am. 380 00:18:23,140 --> 00:18:24,700 Doctor. Sorry. 381 00:18:24,940 --> 00:18:25,980 I'm sorry. 382 00:18:26,620 --> 00:18:27,940 No harm, no foul. 383 00:18:28,280 --> 00:18:31,160 Will you let me know if she says anything else? 384 00:18:33,780 --> 00:18:34,780 Will do. 385 00:18:38,540 --> 00:18:42,840 At the risk of seeming... Then you probably shouldn't. No, trust me. 386 00:18:43,380 --> 00:18:45,000 How do you know? I just know. 387 00:18:45,200 --> 00:18:47,040 I just wanted... I know. 388 00:18:47,980 --> 00:18:48,980 Look. 389 00:18:49,580 --> 00:18:52,200 I'll let you know if she says anything else that could be important to your 390 00:18:52,200 --> 00:18:53,200 investigation. 391 00:18:57,300 --> 00:18:58,300 Thank you. 392 00:18:59,300 --> 00:19:00,300 No, for the record. 393 00:19:00,480 --> 00:19:01,480 Nope. 394 00:19:05,540 --> 00:19:05,960 Any 395 00:19:05,960 --> 00:19:13,020 luck 396 00:19:13,020 --> 00:19:14,460 getting our psych workers upstairs? 397 00:19:15,180 --> 00:19:16,179 Yeah, right. 398 00:19:16,180 --> 00:19:17,860 At least the Kraken's still sleeping. 399 00:19:19,980 --> 00:19:21,700 Is it me or was that opposite? No. 400 00:19:22,420 --> 00:19:24,960 What? You don't even know what I... What you were going to say? 401 00:19:26,740 --> 00:19:27,740 Maybe you do. 402 00:19:29,660 --> 00:19:30,660 You seem nice. 403 00:19:30,700 --> 00:19:31,700 Absolutely not. 404 00:19:32,500 --> 00:19:36,980 There is no possible scenario in which you and I have this conversation. 405 00:19:37,360 --> 00:19:39,120 You, of all people, should know better. 406 00:19:39,560 --> 00:19:40,560 I was... No. 407 00:19:42,220 --> 00:19:43,220 Just walk away. 408 00:19:43,860 --> 00:19:46,180 Best possible scenario, just keep on walking. 409 00:19:48,680 --> 00:19:50,980 You got to lay off mixing Adderall and energy drinks. 410 00:19:51,480 --> 00:19:52,560 Trust me, I will. 411 00:19:53,140 --> 00:19:54,140 All right. 412 00:19:54,160 --> 00:19:55,160 Thanks. 413 00:19:56,400 --> 00:19:58,980 That's the thing about emergency medicine. You never know what you're 414 00:19:58,980 --> 00:20:00,400 get. And we get everything. 415 00:20:00,980 --> 00:20:02,180 Is that why you chose it? 416 00:20:02,840 --> 00:20:03,840 Maybe a little. 417 00:20:03,980 --> 00:20:07,460 I also get to pick my ship, which for a single mother is amazing. 418 00:20:08,260 --> 00:20:10,760 But mostly, I just like the people, you know? 419 00:20:11,060 --> 00:20:12,280 They're always there when you need them. 420 00:20:12,480 --> 00:20:14,300 You wouldn't want to be a part of that, you know? 421 00:20:32,240 --> 00:20:36,200 I am at work, just like last time and the time before that. 422 00:20:38,660 --> 00:20:39,660 I'll be right back. 423 00:20:42,120 --> 00:20:45,720 What is the point of this fucking thing if it doesn't even work? 424 00:20:54,060 --> 00:20:56,800 Sorry. You're doing great. Take your time. 425 00:20:57,300 --> 00:20:58,239 You okay? 426 00:20:58,240 --> 00:20:59,240 I am. 427 00:20:59,790 --> 00:21:02,570 I get frustrated when I can't do things, or at least it looks like it. 428 00:21:02,950 --> 00:21:04,150 Yeah, you and me both. 429 00:21:05,190 --> 00:21:10,350 Thanks, but my frustration manifests itself emotionally, and then I get 430 00:21:10,470 --> 00:21:14,010 and then it looks like I can't handle things, and, you know, then I can't cry 431 00:21:14,010 --> 00:21:16,350 front of the patient because no one wants to see their doctor cry. That's 432 00:21:16,350 --> 00:21:17,129 big red flag. 433 00:21:17,130 --> 00:21:18,830 You just did a perfect crike. 434 00:21:19,370 --> 00:21:20,370 You're doing great. 435 00:21:23,650 --> 00:21:25,330 Hey, you, pasty white. 436 00:21:25,950 --> 00:21:26,950 How about a sandwich? 437 00:21:27,490 --> 00:21:28,490 Uh... 438 00:21:28,580 --> 00:21:29,980 What brings you here today, sir? 439 00:21:30,560 --> 00:21:32,820 I'm here for a fucking sandwich. 440 00:21:33,580 --> 00:21:34,580 Okay. 441 00:21:35,400 --> 00:21:36,760 Okay, uh, excuse me. 442 00:21:38,120 --> 00:21:40,760 Perla? Perla, can this patient get a sandwich? 443 00:21:41,080 --> 00:21:42,480 I already gave you a sandwich, Ro. 444 00:21:42,820 --> 00:21:44,560 I ate this all week. 445 00:21:45,900 --> 00:21:46,900 Sure, 446 00:21:47,060 --> 00:21:50,240 give him another sandwich. They're on the food cart. Just make sure it's not 447 00:21:50,240 --> 00:21:51,640 salad or he'll throw it on the floor. 448 00:21:51,900 --> 00:21:53,180 Okay, good to know. Thanks. 449 00:22:08,560 --> 00:22:09,560 Any quick ones up here? 450 00:22:10,040 --> 00:22:12,760 It's only 8 .30 and Robbie's already on my case for being too slow. 451 00:22:13,480 --> 00:22:16,000 I can usually at least make it a lunch before he starts hounding me. 452 00:22:16,340 --> 00:22:19,780 Got a little slack today, okay? It's the anniversary of Dr. Adamson's death. 453 00:22:20,920 --> 00:22:21,920 That's sad. 454 00:22:23,600 --> 00:22:25,260 There's still no reason to take it out on me. 455 00:22:26,560 --> 00:22:27,560 I'm just saying. 456 00:22:28,060 --> 00:22:29,060 Dr. Mohan? 457 00:22:29,160 --> 00:22:30,160 Samira, please. 458 00:22:30,480 --> 00:22:31,740 I just wanted to apologize. 459 00:22:32,440 --> 00:22:35,400 When my phone went off earlier, that was really unprofessional. 460 00:22:35,640 --> 00:22:36,640 Don't sweat it. 461 00:22:36,730 --> 00:22:39,310 Trust me, we'd need to laugh, otherwise we'd never stop crying. 462 00:22:39,890 --> 00:22:40,890 Thank you. 463 00:22:41,330 --> 00:22:44,730 Besides, with all the craziness that comes through here every hour, nobody 464 00:22:44,730 --> 00:22:45,529 about us. 465 00:22:45,530 --> 00:22:49,730 Got an unresponsive, unhoused man coming in. Might be a good teaching case, 466 00:22:49,790 --> 00:22:50,790 funky music. 467 00:22:54,470 --> 00:22:55,470 Let's go. 468 00:22:55,990 --> 00:23:00,290 Caucasian male, approximately 60 to 70 years old, found unresponsive, no signs 469 00:23:00,290 --> 00:23:01,290 of trauma, no ID. 470 00:23:03,250 --> 00:23:04,250 On three. 471 00:23:05,110 --> 00:23:06,770 One, two, three. 472 00:23:09,610 --> 00:23:12,050 Did you take anything? 473 00:23:12,430 --> 00:23:15,410 Smelly alcohol from here. This guy's wearing the spring, summer, and fall 474 00:23:15,410 --> 00:23:16,410 collection. 475 00:23:20,970 --> 00:23:23,490 What's wrong? 476 00:23:24,050 --> 00:23:27,430 Patient tested positive for rats. 477 00:23:28,370 --> 00:23:29,370 No. 478 00:23:29,910 --> 00:23:31,630 If it matters, I only counted three. 479 00:23:33,050 --> 00:23:34,050 Oh, there goes one. 480 00:23:38,939 --> 00:23:42,840 Because your son tested positive for THC, the psychoactive ingredient in 481 00:23:42,840 --> 00:23:45,960 cannabis, we're going to have to admit him for overnight observation and 482 00:23:45,960 --> 00:23:48,120 monitoring. What about his brain? 483 00:23:49,080 --> 00:23:52,400 Is there a chance that much pot is going to do some damage? I mean, he's only 484 00:23:52,400 --> 00:23:55,760 four. The honest answer is we don't know. There haven't been any long -term 485 00:23:55,760 --> 00:23:58,780 studies, but the fact that this is a one -time occurrence suggests that there 486 00:23:58,780 --> 00:24:00,120 should be no long -term effects. 487 00:24:00,440 --> 00:24:01,440 But you don't know. 488 00:24:01,740 --> 00:24:05,460 So my son could end up with learning disabilities, psychiatric problems, or 489 00:24:05,460 --> 00:24:10,020 autism because there's no evidence to suggest any of that. Hello, I'm Kiara 490 00:24:10,020 --> 00:24:12,820 Alfaro. I'm the department's social worker. 491 00:24:13,080 --> 00:24:14,840 Kiara will help you navigate the next steps. 492 00:24:15,940 --> 00:24:16,940 What steps? 493 00:24:17,160 --> 00:24:21,860 Well, a case like this requires mandatory reporting to child services 494 00:24:21,860 --> 00:24:23,120 sometimes law enforcement. 495 00:24:23,610 --> 00:24:26,330 No. Why do you have to involve the police? It's a controlled substance. 496 00:24:26,590 --> 00:24:29,790 They're not taking my kid away. They're doing pot gummies. Well, fuck your 497 00:24:29,790 --> 00:24:32,130 suggestions. No one is touching my child. 498 00:24:32,430 --> 00:24:33,430 In fact, we're leaving. 499 00:24:33,630 --> 00:24:37,450 No, you can't take your son. He can stop breathing. I'll observe him at home. 500 00:24:37,770 --> 00:24:39,870 Amanda, please. Fuck off, Drew. Get security. 501 00:24:40,110 --> 00:24:42,770 If you can't cooperate, I'm going to have to ask you to leave. Amanda, 502 00:24:42,990 --> 00:24:47,010 He needs to stay here. And you need to get a fucking hotel. Your son can't 503 00:24:47,010 --> 00:24:50,650 the hospital, but I can have you removed. Don't you dare touch me. Get 504 00:24:50,650 --> 00:24:55,200 here. Mrs. Jones, I know this is scary and stressful. Oh, fuck you, fuck you! 505 00:24:55,260 --> 00:24:58,980 This is my son, my son, and nobody is touching him! Whoa, whoa, whoa, what's 506 00:24:58,980 --> 00:25:02,580 going on? I was worried about a CYF. Man, stop it! Okay, okay, enough! 507 00:25:03,920 --> 00:25:06,380 This is a hospital. It's in the Jerry Springer show. 508 00:25:06,840 --> 00:25:11,000 Ma 'am, nobody's trying to take your child, so why don't you stay here with 509 00:25:11,000 --> 00:25:13,740 while your husband talks to our social worker outside and straightens all this 510 00:25:13,740 --> 00:25:17,100 out? Well, I don't want him speaking for me and my son. 511 00:25:17,340 --> 00:25:18,860 Well, it is either you or him. 512 00:25:19,390 --> 00:25:22,930 Your son is not leaving. But you can be escorted out and even arrested if you 513 00:25:22,930 --> 00:25:23,930 refuse to cooperate. 514 00:25:24,130 --> 00:25:25,130 Nobody wants that. 515 00:25:25,270 --> 00:25:27,370 So you tell us. What do you want to do? 516 00:25:30,370 --> 00:25:31,650 I'm staying with my son. 517 00:25:32,090 --> 00:25:33,090 Okay, great. 518 00:25:33,230 --> 00:25:34,230 You do that. 519 00:25:34,990 --> 00:25:36,470 We're all on the same page here. 520 00:25:37,410 --> 00:25:39,230 Thank you, Olsen. You okay? 521 00:25:39,530 --> 00:25:40,530 Yeah, we got this. 522 00:25:42,050 --> 00:25:43,050 It's all yours. 523 00:25:48,460 --> 00:25:52,540 Is everything all right out there? Yeah, just another day in paradise. How are 524 00:25:52,540 --> 00:25:53,540 you feeling? Better. 525 00:25:54,220 --> 00:25:55,220 Where's David? 526 00:25:55,460 --> 00:25:56,460 He left. 527 00:25:56,740 --> 00:25:59,400 He said he had to get back to school. 528 00:25:59,720 --> 00:26:00,699 What? 529 00:26:00,700 --> 00:26:03,620 Maybe you could try calling him. Get him to come back. 530 00:26:07,440 --> 00:26:08,960 What's going to happen to him if I do? 531 00:26:10,120 --> 00:26:11,940 Hopefully he'll be willing to talk to somebody. 532 00:26:12,500 --> 00:26:13,500 Will you talk to him? 533 00:26:13,860 --> 00:26:16,100 I can try. I don't think he wanted to talk to me. 534 00:26:17,770 --> 00:26:22,210 Have you shared with anyone about the writings of his you found? No. 535 00:26:23,370 --> 00:26:26,890 I didn't know who to tell. I just don't want to see him get hurt. 536 00:26:28,050 --> 00:26:29,050 Neither do we. 537 00:26:37,890 --> 00:26:41,090 No, it's just my straight devotion. Maybe if you can text him. 538 00:26:54,440 --> 00:26:55,480 He's not texting back. 539 00:26:56,140 --> 00:26:58,640 Oh, I'm sorry about all this. It's okay. 540 00:26:59,360 --> 00:27:01,580 What you're doing for David is very brave. 541 00:27:02,860 --> 00:27:03,860 I'm his mother. 542 00:27:04,020 --> 00:27:05,680 I'll do anything to protect him. 543 00:27:08,060 --> 00:27:09,500 Do you think he would hurt anyone? 544 00:27:09,820 --> 00:27:10,820 No. 545 00:27:12,900 --> 00:27:18,860 But... I'm sure a lot of parents felt that way 546 00:27:18,860 --> 00:27:22,620 before their children did unspeakable things. 547 00:27:26,250 --> 00:27:29,590 Does he have any history of violence? Has he ever been in any trouble? No, 548 00:27:29,590 --> 00:27:31,750 never. He's very quiet. 549 00:27:32,850 --> 00:27:34,490 And he takes great care of me. 550 00:27:36,010 --> 00:27:39,910 He's struggled with his father's death. 551 00:27:40,950 --> 00:27:41,950 We both have. 552 00:27:42,430 --> 00:27:45,110 The flight is ten minutes out with an electrocution. 553 00:27:45,390 --> 00:27:46,830 Okay, grab Collins. I'll be right there. 554 00:27:48,270 --> 00:27:51,210 Keep trying to reach him. If you do, have someone come find me. 555 00:27:51,670 --> 00:27:52,670 Okay. 556 00:27:53,590 --> 00:27:54,590 Thank you. 557 00:27:54,870 --> 00:27:55,870 Of course. 558 00:27:56,080 --> 00:27:57,640 You got some good news for me? I sure do. 559 00:27:57,860 --> 00:28:01,160 There are two rooms in ICU being cleaned. They'll be ready by now. Great. 560 00:28:01,380 --> 00:28:03,580 And I got bagels in the lounge. Nice job. Thank you. 561 00:28:06,880 --> 00:28:08,580 Is it true? You have to be more specific. 562 00:28:09,220 --> 00:28:10,600 Are there rats in the ED? 563 00:28:11,120 --> 00:28:12,860 Apparently, if somebody already snitched. 564 00:28:13,100 --> 00:28:15,040 Do you know how bad this looks? 565 00:28:15,500 --> 00:28:17,220 One more reason to shut it, it's clear. 566 00:28:17,560 --> 00:28:20,580 Only the emergency department admits rats. The emergency department would 567 00:28:20,580 --> 00:28:21,459 admit rats. 568 00:28:21,460 --> 00:28:22,600 Unless they have the right insurance. 569 00:28:23,000 --> 00:28:24,000 Did you catch any of them? 570 00:28:24,280 --> 00:28:25,880 One, and I charge him for a full visit. 571 00:28:26,200 --> 00:28:29,440 I'm glad you think this is funny. I'm sorry that you don't. Did you call an 572 00:28:29,440 --> 00:28:31,900 exterminator? He's waiting on a second opinion. 573 00:28:32,740 --> 00:28:35,380 You were pushing your luck today. 574 00:28:35,820 --> 00:28:38,900 Don't worry. Last I heard, they were headed for the cafeteria, so they should 575 00:28:38,900 --> 00:28:39,900 dead within the hour. 576 00:28:40,440 --> 00:28:42,240 I'll be here all week. Well, maybe not. 577 00:28:47,720 --> 00:28:50,640 Drug -seeking woman kicked off a city bus for disrupting and disturbing 578 00:28:50,640 --> 00:28:51,640 passengers. 579 00:28:51,920 --> 00:28:55,580 She's been screaming for narcotics non -stop. What the hell are you doing? 580 00:28:56,220 --> 00:29:00,640 Why can't you call this? She's been uncooperative and combative. Let her go. 581 00:29:01,420 --> 00:29:04,440 Stop fighting. Come the fuck down or I'm calling the cops. 582 00:29:04,760 --> 00:29:08,880 My meds at home aren't working. Please, I have to call the cops. Okay, stop. 583 00:29:09,060 --> 00:29:10,060 Everybody stop. 584 00:29:10,380 --> 00:29:11,380 Stop! 585 00:29:13,060 --> 00:29:14,060 What's your name? 586 00:29:14,200 --> 00:29:15,139 It's Joyce. 587 00:29:15,140 --> 00:29:16,140 It's Joyce. 588 00:29:16,380 --> 00:29:18,160 Joyce, is this your sickle cell pain? 589 00:29:18,940 --> 00:29:21,000 Yes. 10 milligrams of ibuprofen. 590 00:29:21,470 --> 00:29:24,170 You really want 10? Yes, repeat it in five minutes if needed. And she needs a 591 00:29:24,170 --> 00:29:25,770 dilaudid drip. This is a vaso -occlusive crisis. 592 00:29:25,970 --> 00:29:26,970 I'm so sorry this happened. 593 00:29:27,130 --> 00:29:28,130 We're going to be okay now. 594 00:29:28,450 --> 00:29:29,450 We're safe here. 595 00:29:30,070 --> 00:29:31,070 Come on. 596 00:29:31,330 --> 00:29:32,710 We're going to be safe here. I promise. 597 00:29:33,370 --> 00:29:34,370 Great. 598 00:30:00,459 --> 00:30:02,220 Live wire hit his left floral. 599 00:30:02,460 --> 00:30:05,320 Shocked him once for V -tips. Was there a power pole down? No. Abandoned 600 00:30:05,320 --> 00:30:08,460 factory. Two elbow cutters hit his side. Got electrocuted. Did he try to still 601 00:30:08,460 --> 00:30:09,460 cover? Most likely. 602 00:30:09,740 --> 00:30:12,580 Power line fried his arm and the current through his whole body stopped his 603 00:30:12,580 --> 00:30:13,580 fire. 604 00:30:14,860 --> 00:30:15,860 Ready? 605 00:30:17,920 --> 00:30:18,920 Steady lift. 606 00:30:21,800 --> 00:30:23,540 Atomyoglobin and a CK to the lab. 607 00:30:23,900 --> 00:30:27,660 Two liters normal saline wide open. Dr. Santos, what are we worried about? 608 00:30:27,980 --> 00:30:31,590 Oh. Raptor myelosis from tissue damage can kill the kidneys. 609 00:30:32,130 --> 00:30:36,070 Ongoing risk of cardiac irritability. Text me. AP pad in place. That fell off 610 00:30:36,070 --> 00:30:37,009 telephone pole? 611 00:30:37,010 --> 00:30:38,250 No, he was on a platform. 612 00:30:38,790 --> 00:30:40,610 Boring. Cut into a live wire. 613 00:30:42,130 --> 00:30:43,290 Tense ventral compartment. 614 00:30:43,650 --> 00:30:44,930 Set up a stick pressure monitor. 615 00:30:45,990 --> 00:30:47,570 V -fib. Charge at 300. 616 00:30:47,890 --> 00:30:50,170 Am I running this or are you? Sorry, reflex response. 617 00:30:50,570 --> 00:30:51,570 Clear. 618 00:30:52,030 --> 00:30:53,110 Ah, fuck. 619 00:30:54,030 --> 00:30:55,030 Sorry. 620 00:30:55,590 --> 00:30:56,590 Sorry. 621 00:30:57,450 --> 00:30:58,450 So, what happened? 622 00:30:59,450 --> 00:31:01,570 I bought it for my girlfriend's dog. 623 00:31:01,910 --> 00:31:08,750 I work nights and he yaps all day long. And when I woke up, I was wearing it. 624 00:31:09,170 --> 00:31:10,170 Stupid bitch! 625 00:31:10,570 --> 00:31:11,570 Sorry. 626 00:31:12,650 --> 00:31:19,290 Sorry. I think she might have used crazy glue. Yeah, it looks that way. 627 00:31:20,430 --> 00:31:22,230 Have you tried removing the batteries? 628 00:31:22,610 --> 00:31:23,610 Of course. 629 00:31:26,540 --> 00:31:29,100 All right, I think we have a couple options, Gary. 630 00:31:29,780 --> 00:31:33,880 We can try to find a solvent that will dissolve or at least soften the glue 631 00:31:33,880 --> 00:31:36,280 enough for you to peel it off without taking your skin with it. 632 00:31:37,060 --> 00:31:39,860 Or, um, that's your buddy. 633 00:31:40,480 --> 00:31:46,120 Um, I guess your skin cells on your neck will naturally slough off, and you 634 00:31:46,120 --> 00:31:47,480 should just be able to remove it in time. 635 00:31:48,340 --> 00:31:49,340 How much time? 636 00:31:49,780 --> 00:31:51,440 Um, a couple weeks, maybe. 637 00:31:51,640 --> 00:31:52,539 A couple weeks? 638 00:31:52,540 --> 00:31:54,180 I think this guy's got scurvy. 639 00:31:54,420 --> 00:31:55,420 Is he a pirate? 640 00:31:55,750 --> 00:31:59,290 No, he's an unhoused man. Lives almost exclusively on Dollar Store ramen. 641 00:31:59,710 --> 00:32:05,090 There's parafollicular hemorrhage, gingivitis, bleeding gums, and, yeah, no 642 00:32:05,090 --> 00:32:07,750 fruit or vegetables in his diet. I suppose that could do it as long as he 643 00:32:07,750 --> 00:32:11,130 out piracy. No parrot, no peg leg, doesn't reek of sweat and rum. 644 00:32:12,470 --> 00:32:14,210 Well, I think you mentioned it. There was a smell. 645 00:32:14,650 --> 00:32:15,650 Probably a pirate. 646 00:32:17,350 --> 00:32:19,810 Tell him to pick up some vitamin C next time he docks at a Dollar Store. 647 00:32:22,410 --> 00:32:23,770 I can't tell if you're joking. 648 00:32:24,350 --> 00:32:26,450 No. Captain Scurvy's got a vitamin C deficiency. 649 00:32:26,650 --> 00:32:28,350 Cheapest way to fix it is with a daily supplement. 650 00:32:29,090 --> 00:32:30,310 Captain Scurvy's another joke. 651 00:32:30,910 --> 00:32:32,490 I'd like to think so. That's a good one. 652 00:32:32,830 --> 00:32:36,170 Dr. Langdon, Dr. King, this is Arthur Carlson from Children, Youth, and 653 00:32:36,170 --> 00:32:38,330 Families. He'd like to speak to the parents of Tyler Jones. 654 00:32:38,750 --> 00:32:40,090 Right. Right. 655 00:32:40,390 --> 00:32:44,090 Mel, would you mind showing him to Kiara and the family? Yeah. Right this way. 656 00:32:49,650 --> 00:32:50,850 Beto? Hello, Doctor. 657 00:32:51,370 --> 00:32:52,370 What are you doing here? 658 00:32:52,640 --> 00:32:54,240 I'm working day shifts now. 659 00:32:54,500 --> 00:32:56,320 Didn't you retire a couple years ago? 660 00:32:56,540 --> 00:32:57,540 No. 661 00:32:57,800 --> 00:32:59,060 I have to work today. 662 00:32:59,840 --> 00:33:04,980 Right. Right, just stay right here, okay? I have a lot of cleaning to do. 663 00:33:05,000 --> 00:33:06,560 no, I'll be just one second. 664 00:33:06,760 --> 00:33:07,499 Hey, Doc. 665 00:33:07,500 --> 00:33:11,560 Doc, how about a sandwich? Sure, Earl, turkey, no egg salad. I got you. Just 666 00:33:11,560 --> 00:33:12,560 give me one minute. 667 00:33:14,860 --> 00:33:16,640 So, Bader said he's working here? 668 00:33:16,860 --> 00:33:20,220 Yeah, he just started wandering. Fortunately, he always winds up back 669 00:33:20,560 --> 00:33:21,920 Thinks he still works in the E .D. 670 00:33:22,460 --> 00:33:24,800 I called his family. They usually pick him up after a few hours. 671 00:33:25,040 --> 00:33:26,040 Really? 672 00:33:26,280 --> 00:33:29,340 Yeah, give them a break and look at him. He's talking to people, feeling 673 00:33:29,340 --> 00:33:30,840 youthful, getting some exercise. 674 00:33:31,460 --> 00:33:32,900 Hell, I wish I was that happy. 675 00:33:33,160 --> 00:33:34,760 Think he's any good at catching rats? 676 00:33:34,960 --> 00:33:35,960 Stop. 677 00:33:36,060 --> 00:33:38,800 Oh, Earl wants a sandwich. Earl always wants a sandwich. 678 00:33:39,320 --> 00:33:40,320 Hey, check it out. 679 00:33:40,740 --> 00:33:41,840 I got my kids a puppy. 680 00:33:42,300 --> 00:33:44,080 Cute. Hope that wasn't your idea. 681 00:33:44,540 --> 00:33:45,540 Why? 682 00:33:45,700 --> 00:33:49,680 Seriously? You really think your wife needs anything else to take care of? 683 00:33:49,680 --> 00:33:50,519 loves dogs. 684 00:33:50,520 --> 00:33:52,540 Oh, look, penguins. Doesn't mean I want to take care of one. 685 00:33:52,820 --> 00:33:55,160 Well, I'm pretty sure it's illegal to own a penguin. Pretty sure you're 686 00:33:55,160 --> 00:33:55,899 the point. 687 00:33:55,900 --> 00:33:58,300 The point is, Tanner promised you he'd take care of it. 688 00:33:58,500 --> 00:33:59,500 A four -year -old. 689 00:33:59,980 --> 00:34:00,980 Yeah, okay. 690 00:34:06,780 --> 00:34:07,780 How's she doing? 691 00:34:08,800 --> 00:34:11,219 Still breathing after 20 of morphine. 692 00:34:13,860 --> 00:34:14,860 How's the pain, Joyce? 693 00:34:15,179 --> 00:34:17,060 Oh, a little better. 694 00:34:17,840 --> 00:34:19,340 You've ordered an exchange transfusion. 695 00:34:19,870 --> 00:34:21,210 I figured I needed that. 696 00:34:22,270 --> 00:34:23,949 What's your normal regimen at home? 697 00:34:24,929 --> 00:34:30,830 90 of extended release morphine every 12 hours and oxycodone for breakthrough 698 00:34:30,830 --> 00:34:32,949 pain, but it wasn't working. 699 00:34:33,530 --> 00:34:35,889 Starting IV dilaudid for an hour. 700 00:34:36,610 --> 00:34:38,750 You can press this button if you need a lecture. 701 00:34:39,010 --> 00:34:42,050 That only works once an hour, though, so don't go crazy. 702 00:34:42,690 --> 00:34:43,889 Could I confer with you? 703 00:34:44,469 --> 00:34:45,469 Yeah. 704 00:34:54,409 --> 00:34:56,030 You seem surprised by the opiate dosage. 705 00:34:57,170 --> 00:34:58,830 Seems a little high. So was her pain. 706 00:34:59,850 --> 00:35:02,630 How do you know she's not drug -seeking? You can't fake a hemoglobin of six. 707 00:35:02,970 --> 00:35:04,830 Do you know what sickle cell crisis does to the body? 708 00:35:05,230 --> 00:35:07,650 Lots of people get caught and plug up your capillaries and deprive all your 709 00:35:07,650 --> 00:35:08,549 cells of oxygen. 710 00:35:08,550 --> 00:35:12,250 It's been described as an electrical stabbing pain that feels like it's 711 00:35:12,250 --> 00:35:14,250 your bones and flushing glass through your body. 712 00:35:15,090 --> 00:35:18,610 I never thought of it like that. Little empathy goes a long way with those 713 00:35:18,610 --> 00:35:19,610 suffering in real pain. 714 00:35:23,240 --> 00:35:26,080 Yeah. Don't worry, you'll get good at spotting the fakers, and half the time 715 00:35:26,080 --> 00:35:28,980 those people need is someone to really listen to them and hear their story. 716 00:35:31,320 --> 00:35:32,320 Mm -hmm. 717 00:35:33,080 --> 00:35:36,620 Interior compartment pressure is... 49. 718 00:35:37,140 --> 00:35:38,440 Burn caused massive swelling. 719 00:35:38,680 --> 00:35:39,740 What does he need, Dr. Santos? 720 00:35:40,480 --> 00:35:43,140 A fasciotomy, but he still has a radial pulse. 721 00:35:43,500 --> 00:35:46,580 It's pressured out to be over 100 to lose the pulse, and at that point, he'd 722 00:35:46,580 --> 00:35:47,439 lose the arm. 723 00:35:47,440 --> 00:35:50,380 49's enough to destroy all the nerves and muscles in a matter of hours. 724 00:35:51,100 --> 00:35:53,980 Compartment pressure is 49. Yeah, I'm going to make the initial incision down 725 00:35:53,980 --> 00:35:56,060 here. Ortho can finish up in the OR. 726 00:35:56,500 --> 00:35:57,680 Good plan. I'll let him know. 727 00:35:58,180 --> 00:36:01,000 Hey, Robbie. Always good to see you, Fred. Hey, like my rock star. She's 728 00:36:01,000 --> 00:36:02,420 good. She's a great teacher. 729 00:36:03,920 --> 00:36:05,480 Show of gloves for Dr. Santos. 730 00:36:05,960 --> 00:36:09,080 Oh, we don't teach forearm fasciatomy to our residents. 731 00:36:09,460 --> 00:36:12,020 He's all alone somewhere someday with no backup. 732 00:36:15,280 --> 00:36:20,360 This is the path to avoid the median nerve and all major vessels. 733 00:36:20,860 --> 00:36:22,620 Maybe just watch the first time. 734 00:36:22,960 --> 00:36:24,440 She'll hold the blade. I'll cut. 735 00:36:25,500 --> 00:36:26,620 Template of Dr. Cantor. 736 00:36:30,420 --> 00:36:31,520 We'll start proximal. 737 00:36:32,880 --> 00:36:33,920 How much pressure? 738 00:36:34,440 --> 00:36:36,600 Just about this much. 739 00:36:41,740 --> 00:36:42,740 Mm -hmm. 740 00:36:45,640 --> 00:36:47,620 Through the skin and sub -Q. 741 00:36:56,570 --> 00:36:59,510 How are they making out? 742 00:37:00,610 --> 00:37:01,610 They're still talking. 743 00:37:03,550 --> 00:37:04,550 You okay? 744 00:37:04,650 --> 00:37:07,490 Yeah, for sure. I just hate seeing families torn apart. 745 00:37:07,930 --> 00:37:08,950 Oh, they'll be fine. 746 00:37:09,430 --> 00:37:10,430 How can you be sure? 747 00:37:10,730 --> 00:37:11,730 They're white. 748 00:37:12,070 --> 00:37:13,670 Probably get off with a slap on the wrist. 749 00:37:14,050 --> 00:37:18,010 If they weren't, she'd probably lose her child and he'd end up going to jail. 750 00:37:20,410 --> 00:37:22,390 Sorry, I did a fellowship in cynicism. 751 00:37:23,310 --> 00:37:24,310 You sure you okay? 752 00:37:24,850 --> 00:37:26,130 100%. I'm just going to get some air. 753 00:37:32,610 --> 00:37:33,730 I am a savage. 754 00:37:34,070 --> 00:37:36,130 I am a savage. 755 00:37:39,030 --> 00:37:40,310 I am a savage. 756 00:37:40,510 --> 00:37:41,990 I need help. 757 00:37:42,810 --> 00:37:43,810 I got stuff. 758 00:37:43,950 --> 00:37:44,950 Do you need any help? 759 00:37:46,070 --> 00:37:47,070 What's your name? 760 00:37:47,510 --> 00:37:49,980 Alex. Okay, Alex, let me take a look. 761 00:37:50,980 --> 00:37:51,980 This fucking hurts. 762 00:37:52,300 --> 00:37:53,300 Oh, I know. 763 00:37:53,500 --> 00:37:54,419 All right. 764 00:37:54,420 --> 00:37:56,600 We're going to take good care of you. You guys got it? We got you up here, 765 00:37:58,460 --> 00:37:59,800 We got you. 766 00:38:00,060 --> 00:38:03,740 I have an abdominal GSW in the ambulance. Say code trauma now. 767 00:38:05,580 --> 00:38:07,600 GSW just got dumped by homeboy ambulance. 768 00:38:07,880 --> 00:38:08,880 Okay, you got this? 769 00:38:09,040 --> 00:38:10,040 Yeah, go. 770 00:38:10,540 --> 00:38:12,320 Two grams of Ansep. Ortho's on their way. 771 00:38:18,250 --> 00:38:19,990 It's only 80, 14 gauge. 772 00:38:20,190 --> 00:38:20,908 Left AC. 773 00:38:20,910 --> 00:38:23,890 We got two units of whole blood going on the rapid diffuser. Call the OR. We'll 774 00:38:23,890 --> 00:38:26,370 be right up. Lungs up. Do you take medications every day? 775 00:38:26,790 --> 00:38:27,850 Any allergies? No. 776 00:38:28,810 --> 00:38:30,150 More than the full blood. Yeah. 777 00:38:31,030 --> 00:38:32,030 Torp is liver. 778 00:38:32,150 --> 00:38:33,150 What's his name? 779 00:38:33,230 --> 00:38:36,230 Alex. Alex, you've lost a lot of blood. You need to go to surgery right away. 780 00:38:36,490 --> 00:38:37,269 We're going to die. 781 00:38:37,270 --> 00:38:38,270 Not now that I'm here. 782 00:38:38,650 --> 00:38:39,650 Oh, it was humility. 783 00:38:39,710 --> 00:38:41,050 It was surgery. Oh, it's ready. How's he doing? 784 00:38:41,370 --> 00:38:42,690 He's coming up a bit. Let's go. 785 00:38:42,950 --> 00:38:45,410 Can you call my mom? Yep. Of course. Of course. 786 00:38:47,630 --> 00:38:49,910 So he didn't have to wait for OR? 787 00:38:50,230 --> 00:38:54,270 Nope. We're a trauma center. We always keep one OR stocked and ready to go. 788 00:38:54,770 --> 00:38:55,770 Well, he's awesome. 789 00:38:58,070 --> 00:39:00,930 What happens if there are multiple traumas needing OR? 790 00:39:01,130 --> 00:39:02,130 We get a lot busier. 791 00:39:04,570 --> 00:39:08,150 Mr. Milton, I'm sorry we had to move you into the hall. I know it gets pretty 792 00:39:08,150 --> 00:39:09,330 chaotic and noisy out here. 793 00:39:09,950 --> 00:39:10,950 Mr. Milton? 794 00:39:12,170 --> 00:39:14,350 Hey. Hey, Bennett. Wake up for me. 795 00:39:17,450 --> 00:39:19,730 Oh, shit, shit, shit. Um, I need a little help here. 796 00:39:20,390 --> 00:39:21,390 Yeah. 797 00:39:21,570 --> 00:39:23,690 Help! When did you check on him last? 798 00:39:23,910 --> 00:39:26,910 I don't know, around half an hour ago at most. I was waiting on the lab. What's 799 00:39:26,910 --> 00:39:29,910 going on? It's my Goldstone guy. You saw his EKG. Unknown downtime. He was 800 00:39:29,910 --> 00:39:30,910 sleeping in the hall. 801 00:39:31,610 --> 00:39:32,610 Crash guard, let's go! 802 00:39:37,090 --> 00:39:38,090 I got it. 803 00:39:40,930 --> 00:39:41,930 Full compression? 804 00:39:45,530 --> 00:39:47,080 Asystole. Resume compression. 805 00:39:48,040 --> 00:39:49,040 Amp of epi. 806 00:39:50,140 --> 00:39:52,060 Slow temp is slow temp. Should I intubate? 807 00:39:52,280 --> 00:39:54,200 No. Drop it down one minute. We don't want a whole compression. 808 00:39:56,100 --> 00:39:57,760 She blew her fix and dilated. 809 00:39:58,080 --> 00:39:59,100 She's been down a long time. 810 00:40:10,040 --> 00:40:12,460 How are we doing in here? 811 00:40:13,200 --> 00:40:14,200 So much better. 812 00:40:14,710 --> 00:40:16,950 Dr. Mohan, this is my wife, Andeen. 813 00:40:17,230 --> 00:40:19,490 Dr. Samira Mohan, nice to meet you, Andeen. 814 00:40:19,810 --> 00:40:24,730 Thank you for helping her. Of course. And, again, I'm so sorry about how you 815 00:40:24,730 --> 00:40:25,770 were treated when you first arrived. 816 00:40:26,330 --> 00:40:29,290 Not everyone who works here is accustomed to dealing with sickle cell. 817 00:40:29,570 --> 00:40:33,010 We will be doing everything possible from here on in to manage Royce's 818 00:40:33,770 --> 00:40:35,310 In the meantime, can I get you anything? 819 00:40:35,870 --> 00:40:36,589 I'm fine. 820 00:40:36,590 --> 00:40:37,890 Andeen? No, thank you. 821 00:40:38,190 --> 00:40:40,390 Okay, well, have the nurses come find me if you need anything. 822 00:40:44,520 --> 00:40:45,720 deep breaths for me, Ian. 823 00:40:46,540 --> 00:40:52,080 Keep an eye on him and present to Dr. Langdon. 824 00:40:52,340 --> 00:40:53,600 Okay. Okay, great. 825 00:40:54,320 --> 00:40:56,300 I'll see you back in triage once he settles down. 826 00:40:56,760 --> 00:40:57,760 Yeah. 827 00:40:58,460 --> 00:41:01,760 Just take this off. Hang in there, Ian. This should really help with your 828 00:41:01,760 --> 00:41:02,760 asthma. 829 00:41:08,340 --> 00:41:13,660 How can I help you, hon? 830 00:41:13,930 --> 00:41:16,550 I'm looking for Dr. Langdon. Yeah, let me see where you are. 831 00:41:20,610 --> 00:41:23,550 Dr. Langdon, we have a med student at Central looking for you. 832 00:41:25,710 --> 00:41:27,030 Copy that. He's headed this way. 833 00:41:27,630 --> 00:41:28,630 Thanks. 834 00:41:29,890 --> 00:41:30,788 Hey, Crash. 835 00:41:30,790 --> 00:41:32,530 You missed a pretty cool fasciotomy. 836 00:41:33,750 --> 00:41:37,590 I'm not sure I'd be describing a fasciotomy as cool. You would if you 837 00:41:37,590 --> 00:41:38,590 one who did it. 838 00:41:39,190 --> 00:41:41,490 How's it going out in the arrivals lounge? 839 00:41:44,140 --> 00:41:45,800 Do you know anything about Dr. McKay? 840 00:41:47,480 --> 00:41:52,260 I've been here for less than two hours. I don't know anybody, including you. 841 00:41:52,840 --> 00:41:55,000 I thought you were some kind of kid genius. 842 00:41:55,660 --> 00:41:57,500 I'm like any other third -year med student. 843 00:41:58,080 --> 00:41:59,080 Clearly. 844 00:42:00,960 --> 00:42:03,720 Hey, I'm just trying to break the ice. I'm not trying to annoy you. 845 00:42:04,360 --> 00:42:07,540 And yet, you're still calling me Crash when I asked you not to. 846 00:42:07,880 --> 00:42:09,220 Really? Still on that? 847 00:42:09,640 --> 00:42:10,640 Still on that. 848 00:42:12,540 --> 00:42:13,700 Yeah. Okay. 849 00:42:13,980 --> 00:42:14,980 Sorry. 850 00:42:15,360 --> 00:42:17,940 I had no idea genius was so sensitive. 851 00:42:20,020 --> 00:42:21,020 But I get it. 852 00:42:21,240 --> 00:42:24,240 Big brain, big feelings. Makes total sense. 853 00:42:24,700 --> 00:42:25,900 I'll try to be softer. 854 00:42:50,620 --> 00:42:53,240 We switch out every few minutes. You can take a break. I'm fine. 855 00:42:53,520 --> 00:42:54,520 Cold compressions. 856 00:42:56,880 --> 00:42:57,920 Still in aces, Billy. 857 00:42:58,600 --> 00:42:59,620 Resume compressions. 858 00:43:01,000 --> 00:43:02,000 Should we shock him? 859 00:43:02,240 --> 00:43:05,820 You don't shock aces, Billy. We could be fine via fib. Not a chance. 860 00:43:06,980 --> 00:43:11,260 Okay, uh, when was the last epi? Three minutes ago. Okay, well, ACLS does every 861 00:43:11,260 --> 00:43:12,960 three to five minutes, right? So let's push another round. 862 00:43:14,080 --> 00:43:15,080 Fine. Robbie. 863 00:43:15,630 --> 00:43:18,870 Mr. Spencer's adult children are asking for you, and the parents of Nick 864 00:43:18,870 --> 00:43:21,670 Bradley, the fentanyl overdose, also want to speak with you. 865 00:43:22,250 --> 00:43:24,890 Three rounds of epi and then call it. 866 00:43:25,770 --> 00:43:28,590 Mr. Spencer's maxed out on BiPAP, 25 on 10. 867 00:43:28,810 --> 00:43:29,348 Is that? 868 00:43:29,350 --> 00:43:30,770 Not great, high 80s. 869 00:43:33,710 --> 00:43:34,710 Hi. 870 00:43:34,950 --> 00:43:38,410 I heard you wanted to talk to me. Yeah, that alarm kept going off. Yeah, why 871 00:43:38,410 --> 00:43:39,410 don't we step outside? 872 00:43:41,030 --> 00:43:42,830 The alarm is for low oxygen. 873 00:43:43,390 --> 00:43:45,130 Does he need more of that BiPAP? 874 00:43:45,650 --> 00:43:47,430 I'm afraid that's as high as we go. 875 00:43:47,750 --> 00:43:50,970 So it's a decision at this point. We want you to put our father on the 876 00:43:50,970 --> 00:43:51,970 machine. 877 00:43:54,150 --> 00:43:56,990 Even though that goes against his desires to not be intubated? 878 00:43:58,230 --> 00:43:59,530 We're not ready to let go yet. 879 00:44:00,910 --> 00:44:03,110 And if your father is? 880 00:44:05,290 --> 00:44:09,130 He was a stubborn son of a bitch. He would never have given up on either of 881 00:44:09,250 --> 00:44:10,610 We're not giving up on him. 882 00:44:12,140 --> 00:44:14,860 You're absolutely certain you want to put your father through this after 883 00:44:14,860 --> 00:44:15,860 everything I've told you? 884 00:44:20,100 --> 00:44:23,200 I may have to honor his advance directive. 885 00:44:25,140 --> 00:44:28,420 No, you have to honor our durable power for health care. 886 00:44:29,060 --> 00:44:31,880 If not, we can talk to your hospital attorney. 887 00:44:34,980 --> 00:44:36,200 Jeremy, you're on board with this? 888 00:44:37,620 --> 00:44:39,000 Yeah, I guess so. 889 00:44:41,200 --> 00:44:43,320 Okay. You can sit with him until we're ready. 890 00:44:43,780 --> 00:44:44,780 When will that be? 891 00:44:44,940 --> 00:44:45,940 Momentarily. 892 00:44:57,740 --> 00:45:01,140 Please don't tell me you're going to intubate that poor man. It's what the 893 00:45:01,140 --> 00:45:03,680 family wants. So what? They want to torture him? 894 00:45:03,920 --> 00:45:05,000 I explained all that. 895 00:45:06,700 --> 00:45:09,860 If I co -sign, we can override their durable power. 896 00:45:10,330 --> 00:45:12,030 They're threatening to go to the hospital, attorney. 897 00:45:12,250 --> 00:45:15,710 Let them. Call the ethics committee. They'll agree with us. No, you're 898 00:45:15,710 --> 00:45:17,130 right, but we don't have that kind of time. 899 00:45:17,630 --> 00:45:18,630 We are stuck. 900 00:45:19,570 --> 00:45:20,570 What are you talking about? 901 00:45:22,070 --> 00:45:23,070 What? 902 00:45:25,990 --> 00:45:28,670 I gotta go tell those parents their 18 -year -old son is brain dead. 903 00:45:29,970 --> 00:45:31,350 You want me to come with you? Nope. 904 00:45:31,750 --> 00:45:32,750 It's okay. 905 00:45:32,790 --> 00:45:33,788 What are you gonna say? 906 00:45:33,790 --> 00:45:37,490 I'm going to say that it's likely, but we still need to do an apnea test and a 907 00:45:37,490 --> 00:45:38,490 cerebral perfusion test. 908 00:45:39,940 --> 00:45:41,840 There's no cranial nerve activity. 909 00:45:42,140 --> 00:45:43,140 Those people need some hope. 910 00:45:43,820 --> 00:45:44,820 False hope. 911 00:45:45,500 --> 00:45:47,060 Hope is hope. Is it? 912 00:45:47,500 --> 00:45:49,380 What are we praying for miracles today? 913 00:45:51,360 --> 00:45:54,220 They need time to process before they can accept what's happening. 914 00:45:55,740 --> 00:45:58,480 You ever consider taking that advice? 915 00:45:59,800 --> 00:46:01,020 Physician, heal thyself. 916 00:46:02,400 --> 00:46:03,460 Don't you have patience? 917 00:48:08,830 --> 00:48:09,830 No change. 918 00:48:10,790 --> 00:48:15,610 No pericardial effusion, no tension, pneumothorax, no cardiac activity. 919 00:48:16,370 --> 00:48:17,370 Let's try calcium. 920 00:48:17,490 --> 00:48:20,290 Could be hyperkalemia. No, his potassium was normal. 921 00:48:20,830 --> 00:48:21,850 You ready to call this? 922 00:48:22,090 --> 00:48:23,090 Not yet. 923 00:48:23,170 --> 00:48:24,870 Dr. Robbie said three rounds of epi. 924 00:48:25,150 --> 00:48:27,590 It's time. Let's push another amp. This one could do it.