1 00:00:15,590 --> 00:00:18,410 Baby, it's all right. 2 00:00:19,930 --> 00:00:24,930 Maybe you stay here tonight. 3 00:00:26,710 --> 00:00:31,290 Baby, it's all right. 4 00:00:33,010 --> 00:00:37,850 Maybe you can stay here tonight. 5 00:00:40,350 --> 00:00:42,010 Out on the street. 6 00:00:47,400 --> 00:00:48,400 You're going to want. 7 00:01:38,440 --> 00:01:42,660 True. Timmy told Hector that Dr. Durangian said the hospital was up for 8 00:01:42,840 --> 00:01:45,420 They might turn into an ortho center with no ER. 9 00:01:45,680 --> 00:01:48,280 Oh, they're always threatening to shut us down, but they never do. 10 00:01:52,140 --> 00:01:57,300 Gloria is looking for you. 11 00:01:57,680 --> 00:01:59,100 No guts, no Gloria. 12 00:01:59,320 --> 00:02:00,880 Must be time for my weekly spanking. 13 00:02:01,100 --> 00:02:02,180 That'd be nice for all I think. 14 00:02:03,320 --> 00:02:04,760 You sure you're cool being here today? 15 00:02:06,080 --> 00:02:07,520 Yeah, why wouldn't I be? 16 00:02:09,289 --> 00:02:10,289 Well, if you need to talk. 17 00:02:10,530 --> 00:02:11,930 Yeah, I won't, but thanks. 18 00:02:14,170 --> 00:02:15,170 Where's Abbott? 19 00:02:16,970 --> 00:02:17,970 Getting some air. 20 00:02:40,040 --> 00:02:43,260 I like to say it goes away, but I had morning sickness for six months with my 21 00:02:43,260 --> 00:02:44,260 second daughter. 22 00:02:44,520 --> 00:02:45,740 No, no, I'm kidding. 23 00:02:46,060 --> 00:02:47,380 I was so worried they'd say. 24 00:02:49,760 --> 00:02:51,540 Thanks. It's worth it. 25 00:02:52,780 --> 00:02:54,080 You tell anybody yet? 26 00:02:55,060 --> 00:02:56,060 Oh, no. 27 00:02:57,340 --> 00:02:59,800 Not until I pass 12 weeks. Not this time. 28 00:03:00,320 --> 00:03:01,460 Nothing but good vibes. 29 00:03:02,380 --> 00:03:04,360 But just so you know, Robbie's working today. 30 00:03:05,420 --> 00:03:08,140 Today's the day Doc Adamson died. He hasn't worked here in four years. 31 00:03:11,420 --> 00:03:12,420 So why is he here? 32 00:03:13,200 --> 00:03:16,900 All I know is he still blames himself for Adamson's death. But if he's a 33 00:03:16,900 --> 00:03:19,400 prickly today, give him a pass, okay? 34 00:03:21,260 --> 00:03:22,440 Great. Thank you. 35 00:03:23,480 --> 00:03:24,480 Hang in there, kid. 36 00:03:25,680 --> 00:03:26,100 Good 37 00:03:26,100 --> 00:03:36,640 morning, 38 00:03:36,700 --> 00:03:37,700 Jack. 39 00:03:40,010 --> 00:03:41,230 What are you doing here? 40 00:03:42,630 --> 00:03:43,630 I'm working. 41 00:03:44,250 --> 00:03:45,250 And you? 42 00:03:47,790 --> 00:03:48,790 Well, I don't know. 43 00:03:49,710 --> 00:03:54,370 Had a guy come in, hit by a drunk driver in a crosswalk. 44 00:03:55,110 --> 00:03:56,250 39 -year -old vet. 45 00:03:57,610 --> 00:03:59,350 Survived three tours without a scratch. 46 00:04:02,350 --> 00:04:04,850 I spent the last two hours coding him. 47 00:04:06,890 --> 00:04:08,810 That's always a rough way to end the night. 48 00:04:09,540 --> 00:04:15,580 Must have had a reason at one time to keep coming back, but I can't think of 49 00:04:15,580 --> 00:04:16,580 right now. 50 00:04:17,959 --> 00:04:20,220 Because this is the job that keeps on giving. 51 00:04:21,420 --> 00:04:22,420 Nightmares. 52 00:04:22,980 --> 00:04:23,980 Ulcers. 53 00:04:25,260 --> 00:04:26,260 Suicidal tendencies. 54 00:04:29,760 --> 00:04:33,520 Besides, if you jump on my shift, that's just rude, man. 55 00:04:42,700 --> 00:04:44,220 Hope I'm never one of your patients. 56 00:04:45,580 --> 00:04:47,220 That makes two of us, my friend. 57 00:04:49,280 --> 00:04:52,260 I got a pregnant teen coming back today for a mifepristone. 58 00:04:53,080 --> 00:04:56,740 And a small bowel obstruction waiting on surgery for the last three hours. 59 00:04:57,820 --> 00:05:03,120 Oh, and unfortunately, the Kraken is still boarding a VH. Phil? 60 00:05:03,640 --> 00:05:05,700 Guy's been here for a week waiting on a psych, man. 61 00:05:06,100 --> 00:05:07,680 Yep, he's only getting worse. 62 00:05:08,720 --> 00:05:12,340 He's catching some Zyprex disease at the moment, but when he wakes up, God help 63 00:05:12,340 --> 00:05:13,340 you all. 64 00:05:16,300 --> 00:05:19,160 I wrote a note for the family of my dead vet, if anyone shows. 65 00:05:21,300 --> 00:05:26,100 Oh, and you got the med students and new interns starting today, so good luck 66 00:05:26,100 --> 00:05:27,100 with that. Like you like me. 67 00:05:28,140 --> 00:05:30,360 Sir, come back here! No more needles! 68 00:05:30,800 --> 00:05:32,100 Sir! No more needles! 69 00:05:32,440 --> 00:05:33,440 Stop! 70 00:05:33,980 --> 00:05:35,280 Sure you want to work today, huh? 71 00:05:35,480 --> 00:05:36,480 They're going to hurt me! 72 00:05:37,160 --> 00:05:38,740 I promise nobody's going to hurt you. 73 00:05:41,020 --> 00:05:42,020 Sir? 74 00:05:45,260 --> 00:05:46,680 You left this mess. 75 00:05:47,340 --> 00:05:48,440 You had a rough night. 76 00:05:50,640 --> 00:05:51,640 Good morning, sunshine. 77 00:05:52,180 --> 00:05:53,760 You obviously haven't seen this board. 78 00:05:54,400 --> 00:05:55,560 Oh, we've seen worse. 79 00:05:56,000 --> 00:05:58,840 Nothing like a little challenge every now and then to keep everybody on their 80 00:05:58,840 --> 00:06:00,300 toes. Dr. Rabinovich? 81 00:06:01,140 --> 00:06:02,039 Melissa King. 82 00:06:02,040 --> 00:06:05,980 I will be joining you today. I just came from two months in the VA. Hey, welcome 83 00:06:05,980 --> 00:06:06,649 to the pit. 84 00:06:06,650 --> 00:06:07,670 This is Dr. Jack Abbott. 85 00:06:08,070 --> 00:06:09,070 Nice to meet you. 86 00:06:09,490 --> 00:06:13,970 I can't take how excited I am to be here today, so... Talk to me at the end of 87 00:06:13,970 --> 00:06:14,970 the day. 88 00:06:15,230 --> 00:06:16,890 Ignore him. He had a rough night. 89 00:06:17,570 --> 00:06:20,470 And is having an ongoing existential crisis. 90 00:06:20,730 --> 00:06:21,369 Don't worry. 91 00:06:21,370 --> 00:06:22,650 You'll get there soon enough. 92 00:06:23,330 --> 00:06:26,610 I married my second husband, Everett, in 1964. 93 00:06:27,590 --> 00:06:33,530 He unfortunately passed in 1976 from a heart attack while we were vacationing 94 00:06:33,530 --> 00:06:36,420 Kissimmee, Florida. It was... Awful. Good morning. 95 00:06:36,820 --> 00:06:38,000 Wait around, Dr. Moyan. 96 00:06:39,940 --> 00:06:40,939 Excuse me, Estelle. 97 00:06:40,940 --> 00:06:41,940 We'll be right back. 98 00:06:44,080 --> 00:06:47,900 So, you know we track every resident's patient for an hour. I was just taking 99 00:06:47,900 --> 00:06:50,960 her history. A brief backstory about what brought them in, not an 100 00:06:51,000 --> 00:06:53,160 I was almost done. You hadn't even made it to this century. 101 00:06:55,680 --> 00:06:57,880 Patients, they check in for registration here. 102 00:06:58,240 --> 00:07:00,600 A nurse eyeballs them, makes sure they're not dying. 103 00:07:01,450 --> 00:07:04,730 If not, they're moved to one of two triage rooms for vitals and a quick 104 00:07:04,730 --> 00:07:08,490 exam where you can go to the labs and your x -rays. And then they come back to 105 00:07:08,490 --> 00:07:12,030 the waiting room until the bed opens up. For how long? 106 00:07:12,630 --> 00:07:15,290 Eight hours if they're lucky. A lot of times 12. 107 00:07:15,850 --> 00:07:18,130 Uh, is it always this busy? 108 00:07:18,490 --> 00:07:19,490 Uh, no. 109 00:07:19,930 --> 00:07:21,330 It gets a lot busier. 110 00:07:24,690 --> 00:07:25,690 Take this. 111 00:07:26,150 --> 00:07:27,170 Hey, Mateo. 112 00:07:27,390 --> 00:07:28,390 Morning, Kath. 113 00:07:28,470 --> 00:07:29,690 This is Sherry. 114 00:07:31,549 --> 00:07:35,670 Hi. Sherry, I'm Dr. McKay. I have some student doctors with me today. Do you 115 00:07:35,670 --> 00:07:36,670 mind if they observe? 116 00:07:36,730 --> 00:07:37,890 Sure. Okay. 117 00:07:39,550 --> 00:07:40,710 What's going on, Sherry? 118 00:07:41,570 --> 00:07:47,530 I burned my hand on a sterno. What were you doing with a sterno? 119 00:07:48,230 --> 00:07:50,610 Cooking. You were cooking with a sterno? 120 00:07:50,910 --> 00:07:52,630 Yeah. We were making s'mores. 121 00:07:54,590 --> 00:07:56,450 Sweet. It's on the board. 122 00:07:58,830 --> 00:08:02,980 We... I've been here for hours, and I have to get them to school. Do you know 123 00:08:02,980 --> 00:08:04,460 how much longer this will take? 124 00:08:04,840 --> 00:08:05,940 Uh, yeah. 125 00:08:06,820 --> 00:08:07,820 Let's see. 126 00:08:07,900 --> 00:08:09,180 You take anything for the pain? 127 00:08:09,600 --> 00:08:10,359 Not yet. 128 00:08:10,360 --> 00:08:13,760 A thousand of Tylenol, 400 ibuprofen, and saline dressing? Yes, please. 129 00:08:14,720 --> 00:08:16,260 Okay, we'll go around. 130 00:08:16,620 --> 00:08:18,040 And the fun begins. 131 00:08:18,800 --> 00:08:21,560 All right, Sherry, we're going to patch you up and get you out of here as soon 132 00:08:21,560 --> 00:08:22,560 as possible, okay? 133 00:08:23,000 --> 00:08:24,000 I'll be back. 134 00:08:24,660 --> 00:08:29,100 As you can see... 135 00:08:29,450 --> 00:08:32,450 We have some new faces with us this morning. Good morning, good morning. 136 00:08:32,450 --> 00:08:37,330 over. Starting with second -year resident Dr. Melissa King, fresh from 137 00:08:37,530 --> 00:08:38,530 Everyone calls me Mel. 138 00:08:39,150 --> 00:08:40,169 I'm so happy to be here. 139 00:08:41,230 --> 00:08:42,450 Trinity Santos, intern. 140 00:08:43,330 --> 00:08:44,790 Victoria Javadi, MS3. 141 00:08:45,930 --> 00:08:47,350 Dennis Whitaker, MS4. 142 00:08:48,330 --> 00:08:51,570 Welcome to the pit. We got two traumas from the tea. Five minutes out. Okay, 143 00:08:51,590 --> 00:08:52,349 copy that. 144 00:08:52,350 --> 00:08:54,890 Actually, this is the most important person that you're going to meet today. 145 00:08:54,950 --> 00:08:56,490 This is Dana. She's our charge nurse. 146 00:08:56,970 --> 00:08:58,850 She is the ringleader of our circus. 147 00:08:59,450 --> 00:09:01,030 Do what she says when she says it. 148 00:09:01,730 --> 00:09:06,630 As you can see, our house is always packed, and our department is mostly 149 00:09:06,630 --> 00:09:09,310 up with boarders. Those are admitted patients waiting for a room upstairs, 150 00:09:09,410 --> 00:09:10,410 sometimes for days. 151 00:09:11,330 --> 00:09:14,810 Beds are a very precious commodity around here, so please be quick and 152 00:09:14,810 --> 00:09:15,810 with your workups. 153 00:09:15,950 --> 00:09:19,670 What else? We treat the sicker patients back here, but please keep your eye on 154 00:09:19,670 --> 00:09:21,770 that waiting room. Make sure nobody's going to die out there. 155 00:09:23,230 --> 00:09:26,970 Your senior residents are Dr. Collins and Dr. Langdon. 156 00:09:27,250 --> 00:09:28,450 You report to them. 157 00:09:29,040 --> 00:09:30,040 And they report to me. 158 00:09:30,080 --> 00:09:32,900 Okay. Great. Senior residents, you got your sign -offs? 159 00:09:33,160 --> 00:09:34,520 Yep. Yep. Okay. 160 00:09:34,900 --> 00:09:35,900 Let's do this. 161 00:09:38,160 --> 00:09:39,160 Virgil Straker. 162 00:09:39,540 --> 00:09:42,100 Nine millimeter GSW to the left shoulder. 163 00:09:42,840 --> 00:09:46,120 CT angiogram negative. Surgery wants to admit for overnight observation. 164 00:09:46,520 --> 00:09:50,120 Good vitals. Does that repeat a crit? All right. Stable crits every two hours 165 00:09:50,120 --> 00:09:53,340 times three. Discharge it on Sefton. Recheck tomorrow. He'll get way more 166 00:09:53,340 --> 00:09:54,239 at home. 167 00:09:54,240 --> 00:09:55,960 Good morning, Mr. Straker. You want to go home? 168 00:09:56,300 --> 00:09:57,300 Hell yeah. 169 00:09:57,580 --> 00:09:58,580 Okay. 170 00:10:04,479 --> 00:10:08,640 Murphy Rothenstein, 48 -year -old woman with cirrhosis and upper GI, bleed 171 00:10:08,640 --> 00:10:11,000 intubated and stable after one unit. 172 00:10:11,600 --> 00:10:12,640 Awaiting ICU bed. 173 00:10:12,980 --> 00:10:13,980 Hey, Doc. 174 00:10:14,820 --> 00:10:17,260 And we all know Louis Cloverfield. 175 00:10:17,660 --> 00:10:22,560 Blood alcohol of 420 at 11 p .m. I've been cutting back. 176 00:10:22,860 --> 00:10:23,860 How is he still breathing? 177 00:10:23,960 --> 00:10:26,160 That's a lethal dose for you and me. That's happy hour for Louis. 178 00:10:26,360 --> 00:10:28,160 Sobered up, had two rounds of lorazepam. 179 00:10:28,360 --> 00:10:29,460 Hold out your hands for me, Louis. 180 00:10:31,620 --> 00:10:35,220 Nothing to Lirazepam. All right. Any script for Librium? It's good to see 181 00:10:35,240 --> 00:10:36,840 Louie. It's always a pleasure, Doc. 182 00:10:37,500 --> 00:10:40,880 Bar fight with complete evulsion of tooth number eight. 183 00:10:41,940 --> 00:10:42,940 Smile, Charlie. 184 00:10:43,460 --> 00:10:45,240 Oh, where's your tooth, Charlie? 185 00:10:46,240 --> 00:10:47,300 If I could find out. 186 00:10:48,520 --> 00:10:49,520 Cancel the discharge. 187 00:10:49,700 --> 00:10:51,820 Order a chest x -ray. Got to rule out aspiration. 188 00:10:52,440 --> 00:10:53,440 Incoming. 189 00:10:55,100 --> 00:10:59,140 42 -year -old male, Sam Wallace, blunt head with agonal respiration. Dropped 190 00:10:59,140 --> 00:11:01,060 down on the T -tracks. Couldn't tube him, LMA in place. 191 00:11:01,280 --> 00:11:02,340 Suicide attempt. Rescue. 192 00:11:02,640 --> 00:11:06,140 He's a good Samaritan. Took a spill, helping a woman who fell off the tracks. 193 00:11:06,240 --> 00:11:07,199 She's right behind him. 194 00:11:07,200 --> 00:11:08,200 Trauma one, go ahead. 195 00:11:09,300 --> 00:11:14,200 Woman falls from T -platforms. Good vitals, no head injuries. 196 00:11:14,540 --> 00:11:17,580 De -gloving injury, right lower leg with open fracture, dislocation of the 197 00:11:17,580 --> 00:11:18,580 ankle. 198 00:11:20,040 --> 00:11:21,460 Trauma two, trauma two, let's go. 199 00:11:29,070 --> 00:11:30,070 How we doing? Ready? 200 00:11:31,130 --> 00:11:33,490 Here we go. Ready? One, two, three. 201 00:11:35,450 --> 00:11:38,630 Good breath sounds bilaterally, but we need to protect it. Apparently, he 202 00:11:38,630 --> 00:11:41,770 down to save the lady. When he climbed back up, he flipped, fell back, and hit 203 00:11:41,770 --> 00:11:42,269 his head. 204 00:11:42,270 --> 00:11:43,270 That's more of an R2. 205 00:11:43,510 --> 00:11:44,550 Mel, right? 206 00:11:44,790 --> 00:11:45,930 I need you on the eighth bath. 207 00:11:46,630 --> 00:11:49,390 Pupils, four millimeters, and reactive. Okay, that's encouraging. 208 00:11:49,630 --> 00:11:51,990 What do you want for men? 120 ketamine, 80 of rock. 209 00:11:52,190 --> 00:11:53,190 A -tip on a monitor. 210 00:11:53,290 --> 00:11:54,269 Morrison's clear. 211 00:11:54,270 --> 00:11:55,630 That's a lot more blood than expected. 212 00:11:57,020 --> 00:12:01,380 He's probably anticoagulated for a fifth check his medical records TV's on a 213 00:12:01,380 --> 00:12:03,960 dough act stand by before factor PCC There's a brain bleed. 214 00:12:04,240 --> 00:12:10,200 This is a PCC. No Clotting factors two seven nine and ten. Okay, you're back 215 00:12:10,200 --> 00:12:14,660 To the offense didn't touch it. Did she faint or did she trip off the platform? 216 00:12:15,160 --> 00:12:18,100 The other guy jumped down pulled her off the tracks just as the train was 217 00:12:18,100 --> 00:12:21,460 rolling in I slayed the engine to the foot the train ran over her foot got 218 00:12:21,460 --> 00:12:23,080 caught between the platform and the incoming train 219 00:12:27,000 --> 00:12:28,560 Do you speak any English? 220 00:12:29,760 --> 00:12:31,440 Airway and breathing are perfect. 221 00:12:31,700 --> 00:12:32,700 As is circulation. 222 00:12:32,900 --> 00:12:34,940 BP 140 over 85. 223 00:12:35,600 --> 00:12:36,600 Student. 224 00:12:36,740 --> 00:12:38,420 What might have made her faint on the platform? 225 00:12:38,720 --> 00:12:39,960 TIA, CBA. 226 00:12:40,280 --> 00:12:41,280 Close she needs. 227 00:12:41,640 --> 00:12:43,340 EKG and a troponin. Okay, good. 228 00:12:44,400 --> 00:12:47,860 Subway trained to glove your foot with an open fracture dislocation. Ooh, and I 229 00:12:47,860 --> 00:12:49,920 thought my heels were painful. You're dynamically stable. 230 00:12:50,200 --> 00:12:53,800 Ma 'am, I'm Dr. Yolanda Garcia. Any pain in your chest or belly? 231 00:12:56,520 --> 00:13:00,700 Can we please push the morphine? No. It could cloud her mental status. I can't 232 00:13:00,700 --> 00:13:02,420 do an exam like this. Push the damn morphine. 233 00:13:03,160 --> 00:13:04,560 We're doing a popliteal block. 234 00:13:04,800 --> 00:13:08,420 Numbs to lower leg. No side effects. Wonderful. Where's the other guy? Next 235 00:13:08,420 --> 00:13:09,419 door. He's a bit worse. 236 00:13:09,420 --> 00:13:11,300 Pan scanner, let me know when she stops screaming. 237 00:13:15,640 --> 00:13:17,040 The cords are very interior. 238 00:13:17,460 --> 00:13:20,540 Yeah, that's because we can't flex the neck. Keep the hockey stick straight up. 239 00:13:22,560 --> 00:13:23,339 I'm in. 240 00:13:23,340 --> 00:13:25,000 Good. Well done. Bring me up to speed. 241 00:13:25,440 --> 00:13:30,300 Intubated for agnal respirations, GCS5, probably anticoagulated. With what? 242 00:13:30,960 --> 00:13:32,880 First time here. There's no medical records. 243 00:13:33,380 --> 00:13:36,020 Call for FFP? No, we got four -factor PCC. 244 00:13:36,380 --> 00:13:39,060 80 of mannitol to reduce brain swelling, then right up to CT. 245 00:13:41,120 --> 00:13:43,320 Do me a favor. Swap it with Jesse for me, would you? Of course. 246 00:13:43,940 --> 00:13:47,340 Dr. Rabinovich, can you have a moment? I'm just a little busy right now, 247 00:13:48,000 --> 00:13:49,000 One sec. 248 00:13:51,080 --> 00:13:52,080 Nerve block complete. 249 00:13:52,220 --> 00:13:53,500 Seems like it's starting to work. 250 00:13:53,800 --> 00:13:54,800 Swapping out, Jessie. 251 00:13:54,940 --> 00:13:58,060 Takes ten minutes for the full effect, and the marquee lasts a good four hours. 252 00:13:58,620 --> 00:13:59,620 She's next for CT. 253 00:13:59,920 --> 00:14:01,400 You have any idea what language that is? 254 00:14:01,680 --> 00:14:04,040 Oh, definitely not Tagalog. Maybe Hindi or Urdu? 255 00:14:04,700 --> 00:14:07,360 Yeah, I'm gonna go get language services. Don't you speak, like, five 256 00:14:07,760 --> 00:14:09,800 Six, but that's not one of them. Six? 257 00:14:10,040 --> 00:14:11,240 And I thought Collins was smart. 258 00:14:11,440 --> 00:14:14,160 Oh, way too early for you to start being an ass, London. 259 00:14:14,400 --> 00:14:17,280 Open a facility in front of a patient? She doesn't speak English. 260 00:14:18,000 --> 00:14:19,180 Judgmental and dismissive. 261 00:14:19,560 --> 00:14:20,560 How we doing? 262 00:14:20,780 --> 00:14:21,599 Vital stable. 263 00:14:21,600 --> 00:14:22,600 Unlike these two. 264 00:14:22,980 --> 00:14:24,940 Ooh, good for you. Princess made a joke. 265 00:14:25,580 --> 00:14:28,620 And I thank you for that beautiful blessing. Namaste. 266 00:14:29,060 --> 00:14:32,760 Okay, do we have a phone or anything with the relative's name on it? Uh, EMT 267 00:14:32,760 --> 00:14:35,000 said the purse got obliterated when the subway ran over it. 268 00:14:36,760 --> 00:14:39,680 Anyway, I can speak with her? Highly doubt it. We don't know what language 269 00:14:39,680 --> 00:14:43,700 speaks. Hey, um... Any chance she jumped? 270 00:14:44,620 --> 00:14:45,840 She may have been pushed. 271 00:14:46,120 --> 00:14:47,120 Yeah. 272 00:14:47,240 --> 00:14:48,820 Could be looking at a possible he -crown. 273 00:14:49,260 --> 00:14:50,360 I take it you're free now? 274 00:14:55,340 --> 00:14:57,020 We need to talk about your numbers. 275 00:14:57,220 --> 00:14:58,420 Uh, people we've saved? 276 00:14:58,840 --> 00:15:01,640 Metrics. Our daughter balloon times beat federal standards. 277 00:15:01,940 --> 00:15:03,560 You're talking about press gaining scores? 278 00:15:04,580 --> 00:15:05,580 Patient satisfaction? 279 00:15:06,040 --> 00:15:08,300 If they're still alive, they should be satisfied. 280 00:15:08,680 --> 00:15:13,720 Our goal is 36 % very satisfied with their care. Your department is at eight. 281 00:15:14,320 --> 00:15:17,460 Do you know how likely patients are to recommend this hospital? This is an 282 00:15:17,460 --> 00:15:19,000 emergency department, not a Taco Bell. 283 00:15:20,360 --> 00:15:23,640 11%. Well, if you want people to be happier, don't make them wait for 12 284 00:15:23,920 --> 00:15:25,920 There's a nursing shortage across the country. 285 00:15:26,140 --> 00:15:29,820 Most of our patients are boarders who are waiting for a bed upstairs. 286 00:15:31,020 --> 00:15:32,480 We don't have the beds. 287 00:15:32,740 --> 00:15:35,300 That's bullshit. The beds are up there. You just don't want to hire the staff 288 00:15:35,300 --> 00:15:36,300 you need to care for. 289 00:15:37,640 --> 00:15:38,639 Oh, Doc. 290 00:15:38,640 --> 00:15:40,060 Doc. It ain't working. 291 00:15:40,260 --> 00:15:41,960 And whatever they're giving me, it's not working. 292 00:15:42,220 --> 00:15:43,720 No response from exit to it. 293 00:15:44,170 --> 00:15:45,210 Should I send in the fleet? 294 00:15:46,310 --> 00:15:47,990 It's okay, sir. We're going to try an enema. 295 00:15:49,150 --> 00:15:52,870 Like I said, there's a nursing shortage. Well, if you paid them a living wage, 296 00:15:52,890 --> 00:15:55,810 they'd be lining up to work here. Our budget can't support that. 297 00:15:56,190 --> 00:15:59,570 Here's a dirty little secret. The hospital saves money keeping patients 298 00:15:59,570 --> 00:16:02,110 here in the pit. It's way cheaper than staffing upstairs. 299 00:16:02,490 --> 00:16:06,730 I have asked you repeatedly to stop referring to the emergency department as 300 00:16:06,730 --> 00:16:11,040 pit. It is derogatory and incompatible to the institution's image. You know 301 00:16:11,040 --> 00:16:14,340 I think about with the institution's image? Me, speaking to the media about 302 00:16:14,340 --> 00:16:17,300 people who code in our waiting rooms and people who get shitty care in our 303 00:16:17,300 --> 00:16:19,120 hallways waiting for an ICU bed for days. 304 00:16:19,360 --> 00:16:22,940 I've heard about doctors who have tried that and find themselves out of work. 305 00:16:23,200 --> 00:16:24,139 Uh -huh. 306 00:16:24,140 --> 00:16:28,100 I know today is difficult for you. Every day is difficult down here. Boarding is 307 00:16:28,100 --> 00:16:29,140 a nationwide problem. 308 00:16:29,420 --> 00:16:33,220 Your predecessor, Adamson, sure as hell knew that. Or wasn't that something he 309 00:16:33,220 --> 00:16:34,220 taught you? Fuck. 310 00:16:34,680 --> 00:16:35,820 Wow. Really? 311 00:16:36,250 --> 00:16:37,250 Yes, really. 312 00:16:37,730 --> 00:16:40,650 Other hospitals are managing this crisis much more effectively. 313 00:16:40,910 --> 00:16:44,050 So you can either step up your game, or you can step aside. 314 00:16:55,370 --> 00:16:58,850 Good Samaritan dude has a small left temporal intraparenchymal bleed. 315 00:16:59,150 --> 00:17:02,430 No epidural, no subdural, no midline shift in the brain. Good news. 316 00:17:02,920 --> 00:17:03,699 You can recover. 317 00:17:03,700 --> 00:17:07,079 D .D. can take her in five. Let's have a look. All right. 318 00:17:07,640 --> 00:17:12,000 If an artery is totally transected, the smooth muscle in the tunica media 319 00:17:12,000 --> 00:17:16,380 contracts with hemostasis. But if it's a partial cut, get out your umbrella. 320 00:17:16,579 --> 00:17:18,760 Grab a culture from the open fibula before you reduce. 321 00:17:19,579 --> 00:17:20,579 You're up. 322 00:17:22,060 --> 00:17:24,280 I'll stabilize the knee for the reduction. Dr. 323 00:17:24,540 --> 00:17:28,860 Langdon will be distracting distally before moving medially to clear the 324 00:17:29,520 --> 00:17:30,520 Good. 325 00:17:31,780 --> 00:17:32,780 Ready? 326 00:17:45,280 --> 00:17:46,280 Med student down. 327 00:17:48,660 --> 00:17:50,120 Good catch on bar fight Billy. 328 00:17:50,580 --> 00:17:53,700 It was an aspirated tooth on chest x -ray. Would have been dead in a week 329 00:17:53,700 --> 00:17:55,200 lung abscess. They could let him be discharged. 330 00:17:55,400 --> 00:17:56,400 We're calling the pulmonary. 331 00:17:56,540 --> 00:17:57,540 Cardiac arrest. 332 00:17:57,620 --> 00:17:59,380 PTA, ten minutes. Where should we put it? 333 00:17:59,880 --> 00:18:01,940 Anywhere. We'll have to put somebody in the hall. 334 00:18:02,680 --> 00:18:03,619 Dr. Ravi? 335 00:18:03,620 --> 00:18:05,220 She, uh, took a fall. 336 00:18:05,640 --> 00:18:07,260 I tripped on the gurney. I'm fine. 337 00:18:10,060 --> 00:18:13,160 Why don't you go get a cool drink in the staff lounge? 338 00:18:14,900 --> 00:18:16,040 I'm fine, really, I swear. 339 00:18:16,420 --> 00:18:19,700 Oh, I know, but it's hospital policy. Anytime someone gets a paper cut around 340 00:18:19,700 --> 00:18:21,260 here, we have to fill out a worker's comp report. 341 00:18:26,960 --> 00:18:27,960 Other way. 342 00:18:31,110 --> 00:18:35,230 I was fine until about two weeks ago after the Rochester Marathon. Okay. Any 343 00:18:35,230 --> 00:18:36,230 falls or injuries? 344 00:18:36,730 --> 00:18:38,350 Just tired, sore muscles. 345 00:18:38,750 --> 00:18:40,550 Yeah, I'd be in bed for a month. 346 00:18:40,830 --> 00:18:42,210 Was this your first triathlon? 347 00:18:42,610 --> 00:18:44,930 God, no. No, I do one every few months. 348 00:18:45,930 --> 00:18:47,250 Have you seen a doctor yet? 349 00:18:47,830 --> 00:18:48,830 No. 350 00:18:49,450 --> 00:18:50,930 I went for a run this morning. 351 00:18:51,350 --> 00:18:52,550 Had to quit after a minute. 352 00:18:52,850 --> 00:18:53,850 Pretty short of breath. 353 00:18:53,970 --> 00:18:54,970 This goes under your tongue. 354 00:18:56,570 --> 00:18:58,170 No current meds, no allergies. 355 00:18:59,000 --> 00:19:01,780 We're going to check a few labs in the EKG. Draw a red and purple top. 356 00:19:02,060 --> 00:19:03,060 Yep. 357 00:19:06,140 --> 00:19:07,760 It's at 98 .2. 358 00:19:08,680 --> 00:19:10,040 Take a deep breath for me, Otis. 359 00:19:11,240 --> 00:19:12,960 A little pimp it now, okay? 360 00:19:17,400 --> 00:19:18,400 Otis? 361 00:19:19,480 --> 00:19:20,480 Otis? 362 00:19:20,900 --> 00:19:22,280 Didn't take him for a lightweight, huh? 363 00:19:25,980 --> 00:19:28,380 Shit. No pulse. Craft card, lane flat. 364 00:19:31,180 --> 00:19:32,180 Let's check a rhythm. 365 00:19:32,340 --> 00:19:33,340 Saline pads. 366 00:19:35,700 --> 00:19:36,700 Quick look paddles. 367 00:19:41,580 --> 00:19:43,040 VTEC. Charging at 200. 368 00:19:44,360 --> 00:19:45,360 Charge. Clear. 369 00:19:47,780 --> 00:19:49,060 All right, he's back to normal sinus. 370 00:19:49,540 --> 00:19:50,700 Need a gurney in here. 371 00:19:53,060 --> 00:19:54,060 So what's the plan? 372 00:19:54,890 --> 00:19:58,370 I see you when you can get a bed and admit for supportive care. 373 00:19:58,790 --> 00:20:01,210 Repeat head CT in three hours. 374 00:20:01,970 --> 00:20:04,010 Or sooner, if he blows a pupil. 375 00:20:04,330 --> 00:20:06,030 Want a Kepler, Lola? Order's already in. 376 00:20:08,230 --> 00:20:09,230 Nice job. 377 00:20:11,390 --> 00:20:12,510 Do you think he'll wake up? 378 00:20:13,470 --> 00:20:14,470 Maybe. 379 00:20:15,550 --> 00:20:16,550 Maybe not. 380 00:20:18,310 --> 00:20:20,090 No good deed goes unpunished. 381 00:20:22,730 --> 00:20:24,910 Oh, has anyone, um, notified the family? 382 00:20:29,530 --> 00:20:30,530 I could try. 383 00:20:31,330 --> 00:20:36,070 Otis Williams, healthy 31 -year -old, VTAC arrest two weeks after triathlon. 384 00:20:36,310 --> 00:20:37,510 And it's all with one shock. 385 00:20:37,970 --> 00:20:39,990 Pulse 98, BP 110 over 60. 386 00:20:40,310 --> 00:20:43,530 He's a little young for the mind, huh? Exactly right with the differential, Dr. 387 00:20:43,650 --> 00:20:46,470 Cullen. Uh, drug overdose, electrolytes on QT. 388 00:20:46,670 --> 00:20:48,830 Oh, forgot a syndrome, WPW. 389 00:20:49,250 --> 00:20:50,250 How you doing there, Otis? 390 00:20:50,350 --> 00:20:51,350 Okay. 391 00:20:51,770 --> 00:20:52,770 What happened? 392 00:20:53,250 --> 00:20:55,190 VTEC again. 200 joules. 393 00:20:56,370 --> 00:20:57,790 Charged and clear. 394 00:20:59,070 --> 00:21:00,070 Back in sinus. 395 00:21:01,090 --> 00:21:02,090 Otis? 396 00:21:04,390 --> 00:21:05,390 Otis? 397 00:21:06,350 --> 00:21:11,590 Oh, groaning's good. Five of nasal, O2, CBC, CMP, proponent, and D -dimer. 398 00:21:12,130 --> 00:21:14,530 What are you doing? One gram calcium glutonate, IV push. 399 00:21:14,850 --> 00:21:18,130 We don't have the last back. Click the monitor. Wine QRS and peak T waves, 400 00:21:18,270 --> 00:21:21,260 hyperkalemia. How'd you get that? I sent him to exercise, caused a muscle 401 00:21:21,260 --> 00:21:23,620 breakdown, rubbed him to my ulcers, knocked out his kidneys. Now he's not 402 00:21:23,620 --> 00:21:24,459 clearing potassium. 403 00:21:24,460 --> 00:21:27,380 I bet it's over 7 .5. Wait two minutes, honey. I don't know. If you risk it, you 404 00:21:27,380 --> 00:21:28,380 only might not get him back. 405 00:21:28,620 --> 00:21:30,920 Calcini, you got to tell him to wait. Oh, my ass. 406 00:21:31,600 --> 00:21:32,600 Not yours. 407 00:21:39,700 --> 00:21:45,820 Pan scan is negative. That means he can admit to orthopedics. 408 00:21:46,300 --> 00:21:48,960 But there may have been a medical etiology if she fainted. 409 00:21:49,290 --> 00:21:51,570 That's not surgical. Get an internal medicine consult. 410 00:21:51,770 --> 00:21:53,530 Or admit to medicine with ortho consulting. 411 00:21:53,830 --> 00:21:54,890 Either way, I'm off the case. 412 00:21:55,330 --> 00:21:56,650 Okay, thanks for nothing. 413 00:21:57,190 --> 00:21:58,089 And substance. 414 00:21:58,090 --> 00:21:59,090 I'll grab the check. 415 00:22:00,310 --> 00:22:02,010 Did we figure out what she's speaking? 416 00:22:02,270 --> 00:22:04,390 Last interpreter thought she might be from Pakistan. 417 00:22:04,790 --> 00:22:06,550 There are 77 languages in Pakistan. 418 00:22:07,610 --> 00:22:11,890 Okay, well, I will buy lunch for whoever figures it out. Good luck. If you need 419 00:22:11,890 --> 00:22:12,910 me, I'll be saving lives. 420 00:22:14,590 --> 00:22:15,590 That was wicked. 421 00:22:17,530 --> 00:22:18,530 That was... 422 00:22:18,570 --> 00:22:21,330 Gross. Yeah, too much for little Miss Crash and Burn. 423 00:22:21,650 --> 00:22:22,650 What'd you do with her? 424 00:22:22,710 --> 00:22:24,170 Nothing. I think she'll be fine. 425 00:22:24,430 --> 00:22:25,430 Are you kidding? 426 00:22:25,470 --> 00:22:27,930 If that took her out, she'll be lucky to make it through this rotation. 427 00:22:28,330 --> 00:22:30,570 I got 50 bucks so she doesn't laugh through this shift. 428 00:22:32,410 --> 00:22:33,410 Come on. 429 00:22:33,530 --> 00:22:36,890 Put your money where your mouth is. No, I didn't say anything, okay? 430 00:22:37,790 --> 00:22:39,630 I sure as hell don't have 50 bucks. 431 00:22:40,290 --> 00:22:43,830 I'll be this lady's age by the time I pay off my student loans. Not that 432 00:22:43,830 --> 00:22:46,150 Hey. 433 00:22:47,690 --> 00:22:48,690 You want to sell a kidney? 434 00:22:49,710 --> 00:22:51,990 I could get you 30K as soon as this weekend. 435 00:22:53,290 --> 00:22:54,650 That's just between you and me. 436 00:22:56,250 --> 00:22:57,250 Think about it. 437 00:23:02,190 --> 00:23:03,190 How you doing? 438 00:23:04,430 --> 00:23:05,430 Yeah. 439 00:23:06,530 --> 00:23:08,870 QRS is narrowed. Much better. 440 00:23:09,090 --> 00:23:12,170 Potassium is 7 .7, creatinine 5 .6. 441 00:23:13,050 --> 00:23:15,050 High potassium and renal failure. 442 00:23:15,660 --> 00:23:16,419 What you thought. 443 00:23:16,420 --> 00:23:17,420 Must be my lucky day. 444 00:23:18,280 --> 00:23:22,320 Ordering 10 units of regular insulin and 25 grams of glucose. 445 00:23:23,480 --> 00:23:24,520 Why insulin and glucose? 446 00:23:25,520 --> 00:23:29,280 Strict potassium intracellularly. Exactly, but the definitive treatment 447 00:23:29,280 --> 00:23:31,920 I'll call renal and get a tech down with the machine. 448 00:23:32,360 --> 00:23:34,660 Have you ever seen a dialysis catheter inserted? 449 00:23:35,460 --> 00:23:38,600 Dr. Collins is going to place ephemeral quentin under ultrasound guidance. It's 450 00:23:38,600 --> 00:23:39,600 an excellent way to learn. 451 00:23:39,980 --> 00:23:41,460 Oh, my chest. 452 00:23:41,860 --> 00:23:44,160 Yeah, we had to shock you. You're going to be sore for a while. 453 00:23:45,070 --> 00:23:46,090 You struck my heart. 454 00:23:46,470 --> 00:23:47,470 Long story. 455 00:23:47,590 --> 00:23:48,890 Dr. Collins will fill you in. 456 00:23:56,970 --> 00:23:57,970 You got a sec? 457 00:24:01,810 --> 00:24:02,810 You okay? 458 00:24:03,390 --> 00:24:04,390 Why wouldn't I be? 459 00:24:04,530 --> 00:24:05,530 Are you okay? 460 00:24:05,850 --> 00:24:06,850 Why wouldn't I be? 461 00:24:08,570 --> 00:24:11,090 You seem annoyed with me already, and I just got here. 462 00:24:13,320 --> 00:24:14,380 Not always about you, Robbie. 463 00:24:17,240 --> 00:24:18,300 Am I going to be okay? 464 00:24:19,280 --> 00:24:22,340 Yeah. You just need to take it easy on yourself. 465 00:24:23,120 --> 00:24:25,640 Muscle breakdown and myoglobin damage your kidneys. 466 00:24:26,600 --> 00:24:27,940 Why'd you shock my heart? 467 00:24:28,560 --> 00:24:32,740 When your kidneys don't work, potassium builds up and messes with the electrical 468 00:24:32,740 --> 00:24:33,860 activity in your heart. 469 00:24:35,440 --> 00:24:36,700 Can it happen again? 470 00:24:37,340 --> 00:24:41,060 We gave you medicine to lower your potassium, and you'll need dialysis to 471 00:24:41,060 --> 00:24:42,060 it all out. 472 00:24:42,250 --> 00:24:43,250 And I'll be okay. 473 00:24:44,030 --> 00:24:45,030 Yeah. 474 00:24:45,270 --> 00:24:48,370 You might need a week or two for your kidneys to recover, but yeah. 475 00:24:49,370 --> 00:24:53,090 You really need to hydrate like crazy before and after a triathlon. 476 00:24:54,730 --> 00:24:55,730 Trust me. 477 00:24:56,290 --> 00:24:57,750 I won't let this happen again. 478 00:24:58,670 --> 00:24:59,670 Good. 479 00:25:00,770 --> 00:25:01,770 Be kind to yourself. 480 00:25:02,210 --> 00:25:03,210 Okay. 481 00:25:14,040 --> 00:25:17,360 Oh, hey, Abbott's told me that he's got a pregnant teen coming back today from 482 00:25:17,360 --> 00:25:19,240 Mifepristone. Let me know when she gets here. Yep. 483 00:25:19,900 --> 00:25:20,759 Bowel obstruction. 484 00:25:20,760 --> 00:25:24,320 Still waiting on a surgery consult. What about Garcia? She was just here for the 485 00:25:24,320 --> 00:25:27,080 traumas. I think she was waiting for her attending to sign off. 486 00:25:29,540 --> 00:25:30,540 Okay. 487 00:25:31,880 --> 00:25:34,100 Oh, one of the med students took a header. 488 00:25:34,560 --> 00:25:37,280 I parked her in the lounge under the guise of a work comp report. 489 00:25:37,500 --> 00:25:39,420 Will you just go in there eyeballing and make sure she's all right? 490 00:25:39,680 --> 00:25:41,840 She's going to miss the morning arrival of the living dead. 491 00:25:42,560 --> 00:25:43,560 How many are we expecting? 492 00:25:43,680 --> 00:25:45,400 We're getting three, but one died en route. 493 00:25:45,700 --> 00:25:48,140 I don't know who's luckier, us or them. What's open? 494 00:25:48,920 --> 00:25:52,700 Fourteen. Eighty -nine -year -old woman from a SNP. History of emphysema, CHF, 495 00:25:52,740 --> 00:25:57,000 MS, B -fib, unresponsive to three shocks, two rounds of epi. What is that? 496 00:25:57,380 --> 00:25:58,840 Lucas chest compression system. 497 00:25:59,140 --> 00:26:00,140 Robotic CPR. 498 00:26:02,900 --> 00:26:03,900 We're going to get a hold. 499 00:26:04,180 --> 00:26:05,400 One, two, three. 500 00:26:10,990 --> 00:26:12,310 Students are dropping like flies. 501 00:26:12,670 --> 00:26:16,830 Take a break, ice the finger. You can count on getting a couple elderly 502 00:26:16,830 --> 00:26:20,970 every day around 7 .30 after the nursing homes and assisted living facilities do 503 00:26:20,970 --> 00:26:23,890 their morning bed checks. You can practically set your watch. 504 00:26:24,110 --> 00:26:25,110 Was there an advance directive? 505 00:26:25,510 --> 00:26:27,230 No. Full coat for the nursing home. 506 00:26:27,470 --> 00:26:28,470 Seriously? 507 00:26:29,610 --> 00:26:30,610 Lucas off. 508 00:26:32,190 --> 00:26:33,190 Still beep him. 509 00:26:33,770 --> 00:26:34,770 Lucas on. 510 00:26:34,930 --> 00:26:38,210 One more round of epi, one more shock, and then we call it. 511 00:26:43,170 --> 00:26:47,690 Joseph Spencer, 79, fever and cough from assisted living. He has a history of 512 00:26:47,690 --> 00:26:48,690 mild Alzheimer's. 513 00:26:49,550 --> 00:26:50,890 One, two, three. 514 00:26:52,170 --> 00:26:56,030 Heart rate 130, BP 90 over 60, gave him 500 cc's and almost daily. 515 00:26:56,530 --> 00:26:57,770 I'm Mr. Spencer. I'm Dr. 516 00:26:58,030 --> 00:26:59,110 King. This is Dr. Collins. 517 00:26:59,510 --> 00:27:00,550 How are you feeling today? 518 00:27:01,250 --> 00:27:04,330 It's dinner time. I'm not really hungry. 519 00:27:04,570 --> 00:27:05,970 Do we have any paperwork from the facility? 520 00:27:06,510 --> 00:27:07,409 He has a pulse. 521 00:27:07,410 --> 00:27:10,830 IV fluids and medications are fine, but no intubation and no chest compression. 522 00:27:11,050 --> 00:27:12,050 That's helpful. 523 00:27:12,430 --> 00:27:13,510 Core trunk right here. 524 00:27:13,930 --> 00:27:15,550 Right middle lobe infiltrate. 525 00:27:16,550 --> 00:27:17,550 Temp 102. 526 00:27:18,370 --> 00:27:22,670 Call a code sepsis. Mm -hmm. Code? To make sure we check all of our boxes. The 527 00:27:22,670 --> 00:27:25,870 federal government audits our sepsis bundle performance and publishes the 528 00:27:25,870 --> 00:27:28,210 online. Today, it better be perfect. 529 00:27:28,650 --> 00:27:33,570 Two sets of blood cultures, lactic acid, 30 cc per kilo NS, the gram of 530 00:27:33,570 --> 00:27:38,570 ceftriaxone, 500 of azithromycin, repeat lactic in three hours. 531 00:27:38,870 --> 00:27:39,870 Nice. 532 00:27:42,830 --> 00:27:45,410 Charging and... Stop. 533 00:27:46,190 --> 00:27:47,190 Call it. 534 00:27:47,370 --> 00:27:49,130 Nurse and I were just back with the DNR. 535 00:27:49,490 --> 00:27:50,770 Are you kidding? 536 00:27:51,130 --> 00:27:54,110 Power out the defibrillator and the lupus. A complete waste of time and 537 00:27:54,190 --> 00:27:57,110 Who the hell worked at that place? A nurse taking care of 60 patients who 538 00:27:57,110 --> 00:28:00,130 couldn't find the form. She called 911 so she could take care of the others. 539 00:28:00,370 --> 00:28:02,690 Okay, let's move her to the viewing room and notify the family. 540 00:28:04,270 --> 00:28:08,550 One of the things we do here is to take a moment of silence when we lose a 541 00:28:08,550 --> 00:28:09,550 patient. 542 00:28:10,090 --> 00:28:14,490 To respect their humanity and also to remember that this was somebody's child 543 00:28:14,490 --> 00:28:17,450 sibling or parent friend 544 00:28:17,450 --> 00:28:28,170 I'm 545 00:28:28,170 --> 00:28:34,870 so sorry, maybe leave it on 546 00:28:34,870 --> 00:28:35,870 vibrate while you're working 547 00:28:39,800 --> 00:28:41,800 Later, Doc. You behave yourself now. 548 00:28:42,100 --> 00:28:43,100 Always. 549 00:28:45,520 --> 00:28:47,260 Your med student's back on her feet. 550 00:28:48,120 --> 00:28:49,120 How old's that kid? 551 00:28:49,320 --> 00:28:50,320 I don't know. I didn't know. 552 00:28:50,480 --> 00:28:52,600 Is she some sort of savant? I don't know. Maybe. 553 00:28:53,180 --> 00:28:56,620 Dr. Rabinovich, I just wanted to apologize for any trouble my clumsiness 554 00:28:56,620 --> 00:28:57,599 have caused. 555 00:28:57,600 --> 00:29:00,600 I feel ridiculous. Oh, I can't tell you how many times I've hit my head on an 556 00:29:00,600 --> 00:29:01,459 overhead lamp. 557 00:29:01,460 --> 00:29:03,040 Twice. I needed to get staples. 558 00:29:03,240 --> 00:29:06,460 Why don't you go work with Dr. McKay and triage? That would help both of us. 559 00:29:07,680 --> 00:29:09,770 Oh, I... I don't need special treatment. 560 00:29:09,970 --> 00:29:11,090 Good, because I don't give it. 561 00:29:14,150 --> 00:29:16,830 Look, I know I might look too young, but I studied my ass off to get here. 562 00:29:17,690 --> 00:29:18,730 Probably harder than the others. 563 00:29:19,870 --> 00:29:20,870 I earned this. 564 00:29:20,990 --> 00:29:25,190 Okay, look, I respect your dedication and your determination, but while you're 565 00:29:25,190 --> 00:29:26,190 here, you're my responsibility. 566 00:29:26,570 --> 00:29:29,390 And when one of my responsibilities takes a header... Wow! 567 00:29:29,910 --> 00:29:32,790 Abbott called for a surgical consult on the SBO three hours ago. You're very 568 00:29:32,790 --> 00:29:34,470 lucky they didn't perf. I'm here to see my daughter. 569 00:29:35,610 --> 00:29:36,630 I'm sorry, is that a patient? 570 00:29:37,120 --> 00:29:38,120 You're talking to her. 571 00:29:41,040 --> 00:29:42,040 Am I interrupting? 572 00:29:42,800 --> 00:29:43,800 No. 573 00:29:44,000 --> 00:29:45,080 No. We're done. 574 00:29:45,340 --> 00:29:46,139 We're good. 575 00:29:46,140 --> 00:29:47,880 Come find me when you're ready to present your next case. 576 00:29:48,140 --> 00:29:49,140 Thank you. 577 00:29:51,180 --> 00:29:52,920 So, how's your birthday going? 578 00:29:53,820 --> 00:29:55,960 Great. Yeah, really great. Hey, Crash. 579 00:29:56,200 --> 00:29:59,320 They're doing a dialysis catheter insertion in North 1 if you want to 580 00:29:59,320 --> 00:30:00,320 out. Mm -hmm. 581 00:30:01,060 --> 00:30:02,140 Did she say Crash? 582 00:30:02,820 --> 00:30:03,820 No. 583 00:30:04,240 --> 00:30:05,560 No, no, it's not crash. 584 00:30:06,080 --> 00:30:07,080 She said crush. 585 00:30:07,420 --> 00:30:08,560 I was crushing it. 586 00:30:10,980 --> 00:30:13,680 Thanks for coming down, Mom, but I've got a patient. 587 00:30:14,400 --> 00:30:15,400 Bye. 588 00:30:19,740 --> 00:30:26,340 What do you want? 589 00:30:26,700 --> 00:30:28,960 I just wanted to make sure you're comfortable. 590 00:30:29,660 --> 00:30:32,480 I am taking a dump in the... 591 00:30:32,970 --> 00:30:33,970 Stop peeing. 592 00:30:34,470 --> 00:30:35,850 So what's that fucking tell you? 593 00:30:37,190 --> 00:30:40,370 I'm clearly in the wrong room. I'm sorry. 594 00:30:46,690 --> 00:30:50,710 So it would have been nice if someone had told me that Eileen Shamsie's 595 00:30:50,710 --> 00:30:52,130 was one of our med students. 596 00:30:52,450 --> 00:30:53,450 We're all at the pride. 597 00:30:54,270 --> 00:30:58,350 Was it as awkward as I had to have been? You have a mean streak in you, you know 598 00:30:58,350 --> 00:30:59,350 that? 599 00:30:59,659 --> 00:31:02,880 What's the deal with the body in 19 let's have its unbeceived that from last 600 00:31:02,880 --> 00:31:04,980 night still waiting on next to Ken's Okay, 601 00:31:05,720 --> 00:31:08,520 can we move him to the viewing room at least nursing home DNR's head and 602 00:31:08,520 --> 00:31:12,140 joining last night's Jane Doe coroner's office is backed up Well, then our 603 00:31:12,140 --> 00:31:18,800 Morton needs to take her then Perla Triathlete Otis 604 00:31:18,800 --> 00:31:24,480 he's stable repeat potassium a 6 .1 renal wrote the dialysis order tech 605 00:31:24,480 --> 00:31:26,540 be down 15 minutes. Thank you 606 00:31:28,679 --> 00:31:29,820 Language mystery solved yet? 607 00:31:30,060 --> 00:31:33,800 No. Hey, what's your take on dogs? 608 00:31:34,940 --> 00:31:36,240 In what context? 609 00:31:36,540 --> 00:31:37,540 For kids. 610 00:31:38,040 --> 00:31:40,420 Kids and puppies go together like fish and chips. 611 00:31:40,780 --> 00:31:42,060 Man's best friend, you know. 612 00:31:42,260 --> 00:31:43,260 Well, you don't have a dog. 613 00:31:43,360 --> 00:31:44,400 I don't have a best friend. 614 00:31:44,680 --> 00:31:45,680 What am I? 615 00:31:45,800 --> 00:31:47,280 You're my best resident. Big difference. 616 00:31:47,620 --> 00:31:49,040 Yeah, but we're still friends. 617 00:31:49,780 --> 00:31:51,620 Not if this conversation goes on much longer. 618 00:31:52,440 --> 00:31:54,240 I have a lethargic four -year -old. 619 00:31:54,640 --> 00:31:56,840 No PMH, no innocent illness. 620 00:31:57,660 --> 00:31:58,660 No fever, vomiting. 621 00:31:58,720 --> 00:32:00,480 Parents just couldn't wake him up this morning. What room? 622 00:32:01,020 --> 00:32:02,020 Oh, cell 15. 623 00:32:02,880 --> 00:32:08,800 There's no nuchal rigidity, no skin lesions, no focal neuro. 624 00:32:09,840 --> 00:32:12,160 He looks well fed and cared for. 625 00:32:12,900 --> 00:32:14,580 DKA from new onset diabetes? 626 00:32:14,920 --> 00:32:15,920 No, BG85. 627 00:32:28,680 --> 00:32:29,920 Can you wake up for me, Tyler? 628 00:32:31,760 --> 00:32:35,320 He's not usually this sleepy? No, and he barely flinched for the blood test. 629 00:32:35,640 --> 00:32:38,680 He wakes up at 90 miles an hour and doesn't stop until he passes out at 630 00:32:38,880 --> 00:32:39,819 He passes out? 631 00:32:39,820 --> 00:32:41,920 No, he just means he goes all day. 632 00:32:42,200 --> 00:32:43,920 Any chance he could have ingested something? 633 00:32:44,180 --> 00:32:48,640 Any pills, vitamins, any prescriptions that may have been left around? 634 00:32:48,860 --> 00:32:52,440 No, that's all kept locked in the medicine cabinet. The whole house is 635 00:32:52,440 --> 00:32:57,320 childproof. What about alcohol? Anything left out? No. What about pets? 636 00:32:59,090 --> 00:33:02,070 No. He's usually quite active. Very. 637 00:33:02,490 --> 00:33:04,370 Any injuries lately? 638 00:33:04,710 --> 00:33:05,689 No. 639 00:33:05,690 --> 00:33:06,730 Bumped his head recently. 640 00:33:07,210 --> 00:33:10,210 Not that I'm aware of, but he does love rough housing with Drew. 641 00:33:10,430 --> 00:33:11,430 But he never gets hurt. 642 00:33:11,690 --> 00:33:13,010 Oxygen level is normal. 643 00:33:13,530 --> 00:33:15,150 Good pulse and blood pressure. 644 00:33:15,550 --> 00:33:18,890 No signs of infection. We're going to start with blood and urine tests to 645 00:33:18,890 --> 00:33:20,370 for any metabolic abnormalities. 646 00:33:25,430 --> 00:33:26,570 Really throbbing. 647 00:33:26,970 --> 00:33:28,790 Yeah, the blood's under pressure. Gotta drain it. 648 00:33:30,550 --> 00:33:32,590 No anesthesia, or...? No. 649 00:33:32,810 --> 00:33:34,210 Stop before I hit the nail bed. 650 00:33:35,210 --> 00:33:36,210 I hope. 651 00:33:39,590 --> 00:33:40,950 Hey, eyes down here. 652 00:33:41,210 --> 00:33:42,209 Watch and learn. 653 00:33:42,210 --> 00:33:43,670 I'm just looking who to see next. 654 00:33:44,110 --> 00:33:46,190 You're supposed to take them in the order they arrive. 655 00:33:47,030 --> 00:33:50,270 Yeah, I know how it works. Okay, no need to cry about it. 656 00:33:50,530 --> 00:33:52,190 Do you want me to choose for you? No. 657 00:33:55,550 --> 00:33:56,550 Wow. 658 00:33:56,980 --> 00:33:58,000 Pain's gone. Thank you. 659 00:33:58,940 --> 00:34:02,720 All right. How about a 20 -year -old cough in eight? 660 00:34:02,940 --> 00:34:04,580 Should be easy. Probably viral. 661 00:34:04,860 --> 00:34:06,260 I don't need an easy one. 662 00:34:07,280 --> 00:34:08,520 Suit yourself, Huckleberry. 663 00:34:08,780 --> 00:34:10,239 I'm going to take the splitting headache. 664 00:34:10,580 --> 00:34:13,159 Maybe I'll catch a subarachnoid hemorrhage or something cool. 665 00:34:13,360 --> 00:34:14,440 Hey, why do you keep calling me that? 666 00:34:15,199 --> 00:34:16,199 Huckleberry? 667 00:34:16,520 --> 00:34:17,580 Term of endearment. 668 00:34:18,060 --> 00:34:19,900 Sounds like a sarcasm. You think? 669 00:34:20,600 --> 00:34:21,600 Ordering on harassment. 670 00:34:23,179 --> 00:34:24,179 Where are you from? 671 00:34:25,210 --> 00:34:26,210 Broken bone, Nebraska. 672 00:34:26,830 --> 00:34:28,210 Jesus, where the hell is that? 673 00:34:28,730 --> 00:34:30,989 About three and a half hours west of Omaha. 674 00:34:31,310 --> 00:34:33,070 Oh, yeah, just a little south of nowhere. 675 00:34:33,489 --> 00:34:34,710 What the hell do you do there? 676 00:34:34,969 --> 00:34:38,590 My parents have a farm, so... You're a farm boy? 677 00:34:40,070 --> 00:34:41,090 Yeah, I guess. 678 00:34:41,830 --> 00:34:43,330 I rest my case, Huckleberry. 679 00:34:47,409 --> 00:34:53,469 I'm so sorry, ma 'am. We don't understand you. 680 00:35:02,160 --> 00:35:03,160 Me? I'm Dr. 681 00:35:03,380 --> 00:35:04,380 Heather Collins. 682 00:35:05,120 --> 00:35:06,840 I'm from here. 683 00:35:07,620 --> 00:35:08,620 Portland, Oregon. 684 00:35:09,520 --> 00:35:10,520 You. 685 00:35:11,020 --> 00:35:12,240 Where are you from? 686 00:35:13,780 --> 00:35:14,780 Uh -huh. 687 00:35:16,860 --> 00:35:17,860 Uh, Chana? 688 00:35:18,620 --> 00:35:20,860 India? I can't tell where you're pointing to. You can stand. 689 00:35:26,000 --> 00:35:27,300 Nepal. You're from Nepal. 690 00:35:27,840 --> 00:35:28,840 Nepali. 691 00:35:34,100 --> 00:35:36,580 Mom's got a bad burn. Needs room checks and hand therapy. 692 00:35:36,960 --> 00:35:39,720 And I got a suspicion she may be unhoused. 693 00:35:40,320 --> 00:35:44,060 I'll talk to her. We can offer them help. Thank you. I appreciate it. Oh, 694 00:35:44,060 --> 00:35:45,060 back. 695 00:35:45,360 --> 00:35:47,460 Dr. Robbie suggested I might be of assistance. 696 00:35:47,700 --> 00:35:49,100 Yeah, I could use the company. 697 00:35:49,400 --> 00:35:51,580 Victoria Javadi, Chiara Alfaro. 698 00:35:52,020 --> 00:35:55,060 She's a department social worker, which pretty much makes her an angel. 699 00:35:55,680 --> 00:35:57,520 Welcome. Thanks. Thank you. 700 00:35:58,120 --> 00:35:59,840 So what rotation is this for you? 701 00:36:00,100 --> 00:36:03,500 Third. I've done OBGYN and PEDS. Are you on your favorites? 702 00:36:04,260 --> 00:36:05,198 Not really. 703 00:36:05,200 --> 00:36:06,620 Well, what are you leaning towards? 704 00:36:07,320 --> 00:36:08,520 I'm not really sure yet. 705 00:36:09,160 --> 00:36:10,620 Okay, well, you have time. 706 00:36:11,240 --> 00:36:13,980 Can I actually ask you a personal question? 707 00:36:14,819 --> 00:36:17,020 I'm 20, and I've earned the right to be here. 708 00:36:18,400 --> 00:36:23,720 Oh. Yeah, I don't doubt that for a minute. I was actually wondering if Dr. 709 00:36:23,880 --> 00:36:27,000 Eileen Shamsi from surgery is a friend or relative of yours. 710 00:36:27,480 --> 00:36:29,960 I saw you talking to her in the hall. Yeah, she's my mother. 711 00:36:32,560 --> 00:36:33,560 Oh. 712 00:36:33,760 --> 00:36:34,760 Oh, wow. 713 00:36:35,540 --> 00:36:36,540 Oh, that's cool. 714 00:36:38,060 --> 00:36:39,060 You're really only 20? 715 00:36:39,840 --> 00:36:44,160 Yeah. And for the record, my father also works here. He's an endocrinologist. 716 00:36:44,570 --> 00:36:45,830 I always think it's like a family business. 717 00:36:48,410 --> 00:36:51,190 I'm sorry, that was a joke. That was a joke. And I'm sure that comes with a lot 718 00:36:51,190 --> 00:36:51,988 of pressure. 719 00:36:51,990 --> 00:36:56,130 And as for the age thing, I'm a 42 -year -old R2, so I have my own haters, trust 720 00:36:56,130 --> 00:36:57,130 me. 721 00:36:58,670 --> 00:36:59,670 Okay. 722 00:37:00,150 --> 00:37:02,770 Sometimes when it gets busy, we'll help the nurses bring back patients. 723 00:37:03,050 --> 00:37:04,050 Okay. 724 00:37:04,410 --> 00:37:07,650 Okay, next to come back is Fred Saida, knee pain after a fall. 725 00:37:07,910 --> 00:37:11,980 Great. Doug, hey, Doug. Hi, Doug Driscoll. Any chance someone could see 726 00:37:12,100 --> 00:37:14,620 I've been here for like two hours. Unfortunately, Mr. Driscoll, there's a 727 00:37:14,620 --> 00:37:17,480 patients still ahead of you. Some of whom are severely ill. Yeah, and I got 728 00:37:17,480 --> 00:37:19,060 chest pains that woke me up in the middle of the night. 729 00:37:19,260 --> 00:37:20,280 Chest pain? Yeah. 730 00:37:20,580 --> 00:37:23,460 No, it's not plural. It's just chest pain, not chest pain. 731 00:37:24,400 --> 00:37:26,600 Yeah, and if I have more than one, it's chest pains. 732 00:37:27,020 --> 00:37:28,880 Are you even a real doctor? She's a student doctor. 733 00:37:29,120 --> 00:37:30,600 Yeah, well, keep her the hell away from me. 734 00:37:30,800 --> 00:37:32,820 I just need to see someone, okay? Not her. 735 00:37:33,320 --> 00:37:37,220 Isn't chest pain an emergency? I don't... It looks here like you get an 736 00:37:37,220 --> 00:37:39,100 minutes after arrival, so it's not a heart attack. 737 00:37:39,300 --> 00:37:41,660 Yeah, but I'm supposed to get a chest X -ray and blood test. 738 00:37:42,400 --> 00:37:46,220 Ah, and you are next in line for lab tech. Okay, so listen for your name. 739 00:37:46,220 --> 00:37:47,460 me. Fred. 740 00:37:49,020 --> 00:37:50,840 Can you get me a wheelchair, please? 741 00:37:52,200 --> 00:37:54,580 Hi, I'm Dr. McKay. What's going on? 742 00:37:55,440 --> 00:37:58,620 I found her on the floor in the bathroom. She can't stop puking. What's 743 00:37:58,620 --> 00:38:00,780 name? Teresa. She's my mom. 744 00:38:01,550 --> 00:38:03,850 Teresa? Teresa, are you taking any medication? 745 00:38:04,190 --> 00:38:06,610 No. Any previous stomach problems? No. 746 00:38:07,290 --> 00:38:08,690 When does the vomiting begin? 747 00:38:09,150 --> 00:38:10,149 Last night. 748 00:38:10,150 --> 00:38:11,150 Last night. 749 00:38:11,590 --> 00:38:14,270 Do you have any dizziness or fatigue? 750 00:38:15,050 --> 00:38:16,090 Mystery solved. 751 00:38:16,670 --> 00:38:19,470 Our lady with the degloved foot is Natali. 752 00:38:19,730 --> 00:38:20,730 Oh, hey. 753 00:38:20,830 --> 00:38:21,830 Congratulations. 754 00:38:22,350 --> 00:38:25,530 Otis' BP is crashing. 70 over 50. Still waiting for dialysis. 755 00:38:29,090 --> 00:38:30,530 How you doing there, Otis? 756 00:38:31,379 --> 00:38:33,740 Okay, that's okay. 15 liters, non -rebreather, please. 757 00:38:39,840 --> 00:38:40,840 Oh, crap. 758 00:38:41,400 --> 00:38:44,580 Diastolic collapse of the right atrium and right ventricle. Tamponade from your 759 00:38:44,580 --> 00:38:47,600 remake of fusion. That's why his BP is low? Yep. Too much fluid and pressure 760 00:38:47,600 --> 00:38:48,980 around the heart. Chambers can't fill. 761 00:38:49,420 --> 00:38:51,940 Otis, you've got some fluid around your heart. We need to get it off. 762 00:38:52,860 --> 00:38:57,600 25 in propofol. 10 cc's of lidocaine with epi, pericardia, and synthesis 763 00:38:57,600 --> 00:38:59,440 have to get the... No, no, just open a central light kit. 764 00:38:59,950 --> 00:39:02,790 Dr. Santos, take the head of the bed and bag him if he stops breathing. 765 00:39:02,970 --> 00:39:04,130 Compressions if we lose the carotid. 766 00:39:04,690 --> 00:39:07,370 Prep and drip the subzyphoid. Please send CCTs at 1 % weight. 767 00:39:07,830 --> 00:39:08,669 Chlorhexidine here. 768 00:39:08,670 --> 00:39:10,470 25 for 20. Long 25. Long 25. 769 00:39:11,010 --> 00:39:12,010 Thank you. 770 00:39:14,490 --> 00:39:15,490 Injecting lidocaine. 771 00:39:16,990 --> 00:39:18,450 Pressure down 60 over 40. 772 00:39:19,470 --> 00:39:20,470 Right. 773 00:39:22,650 --> 00:39:25,690 Wait, you can't ultrasound on place. I know, that's why I'm taking the pro. 774 00:39:26,160 --> 00:39:32,520 18 gauge thin wall 60cc syringe please dr collins let's go you're going in 775 00:39:32,520 --> 00:39:38,440 over the center of my probe advancing very slowly looking for the hyper echo 776 00:39:38,440 --> 00:39:44,100 very very slowly do not hit that hard dr santos you see that see a black and 777 00:39:44,100 --> 00:39:49,080 that's the effusion we're looking for a little white dot there it is got it 778 00:39:49,080 --> 00:39:52,840 aspirating three cc should be enough 779 00:39:57,070 --> 00:39:59,750 Good. Next, we'll place the guide wire and then the triple lumen catheter. 780 00:40:01,030 --> 00:40:02,050 Pulse oxygen 99. 781 00:40:02,310 --> 00:40:04,050 Pressure's up. 124 over 78. 782 00:40:05,370 --> 00:40:06,670 Looks like things are back to normal. 783 00:40:08,830 --> 00:40:09,830 That was cool. 784 00:40:10,650 --> 00:40:11,930 Four of his old friends on board. 785 00:40:12,430 --> 00:40:14,150 That should stop the nausea. 786 00:40:15,310 --> 00:40:17,030 David, have you had any vomiting? 787 00:40:17,450 --> 00:40:19,750 No. Anyone else sick at home? 788 00:40:21,810 --> 00:40:22,810 It's just us. 789 00:40:23,370 --> 00:40:26,670 My husband passed away a few years ago from COVID. 790 00:40:29,470 --> 00:40:30,950 Sorry. Tethium 3 .1. 791 00:40:33,070 --> 00:40:34,070 Isn't that bad? 792 00:40:34,550 --> 00:40:36,910 It can cause heart problems, but we're going to correct it. 793 00:40:37,390 --> 00:40:38,810 Ten in the bag, 20 PO. 794 00:40:40,290 --> 00:40:41,290 Roddy, any questions? 795 00:40:43,150 --> 00:40:47,330 Um... David, have you two traveled out of the country recently? 796 00:40:47,830 --> 00:40:48,870 No, I never go anywhere. 797 00:40:50,190 --> 00:40:51,390 Is she going to have to stay here? 798 00:40:54,400 --> 00:40:57,880 If the rest of the tests are good and she responds to treatment, she can go 799 00:40:57,880 --> 00:40:58,880 home. 800 00:41:06,160 --> 00:41:08,620 Mr. Milton, my name is Dennis Whitaker. 801 00:41:08,920 --> 00:41:11,620 I'm one of the student doctors here. I'll be seeing you first. 802 00:41:12,080 --> 00:41:14,600 Nice to meet you. BP is 150 over 90. 803 00:41:15,320 --> 00:41:16,800 Just a touch high. 804 00:41:17,420 --> 00:41:19,580 I forgot to take my damn enalapril this morning. 805 00:41:19,780 --> 00:41:20,780 We'll get that for you. 806 00:41:20,900 --> 00:41:22,120 Tell me about this belly pain. 807 00:41:23,980 --> 00:41:25,420 Started about here. 808 00:41:27,280 --> 00:41:29,020 Woke me up at like 2 a .m. 809 00:41:29,880 --> 00:41:30,880 Pretty intense. 810 00:41:31,760 --> 00:41:32,980 Lasted about an hour. 811 00:41:33,720 --> 00:41:34,720 Now it's gone. 812 00:41:35,020 --> 00:41:36,280 Any fever, vomiting? 813 00:41:36,680 --> 00:41:38,680 Nah, I never get sick. 814 00:41:39,020 --> 00:41:41,680 Okay. What did you eat last night? 815 00:41:42,300 --> 00:41:43,440 Oh, it was my wife's birthday. 816 00:41:43,780 --> 00:41:45,460 Took her out to Sullivan's birthday. 817 00:41:45,800 --> 00:41:46,800 Well, 818 00:41:47,380 --> 00:41:50,340 the exam is pretty benign. I'm going to touch the gallstone. 819 00:41:50,680 --> 00:41:52,680 If there is a stone... 820 00:41:53,250 --> 00:41:55,050 And you eat fatty food. 821 00:41:55,970 --> 00:41:58,490 There can be pain when the gallbladder contracts. 822 00:41:59,850 --> 00:42:01,750 Oh, bingo. 823 00:42:02,590 --> 00:42:03,810 One stone, there it is. 824 00:42:05,510 --> 00:42:06,510 Do I need surgery? 825 00:42:07,790 --> 00:42:11,710 You should be able to manage with a low -fat diet, but we'll send off labs for 826 00:42:11,710 --> 00:42:15,110 liver and pancreas. Just let us know if you have any more pain. 827 00:42:16,170 --> 00:42:17,170 Okay. 828 00:42:17,670 --> 00:42:18,670 Thanks. 829 00:42:19,430 --> 00:42:20,430 Yeah, you bet. 830 00:42:21,690 --> 00:42:22,690 Great. 831 00:42:23,759 --> 00:42:24,820 You want any Gigi? 832 00:42:25,700 --> 00:42:26,700 For? 833 00:42:27,240 --> 00:42:29,380 Heart attacks can present as upper abdominal pain. 834 00:42:30,140 --> 00:42:31,560 Um, yeah. 835 00:42:31,980 --> 00:42:33,780 No, yeah, that's a great idea. Thank you. 836 00:42:47,260 --> 00:42:49,860 I'm going as fast as I can. 837 00:42:50,100 --> 00:42:51,860 I'm picking up two more patients. I didn't say anything. 838 00:42:55,180 --> 00:42:57,020 I need a fresh set of eyes. On what? 839 00:42:57,320 --> 00:43:01,060 A 54 -year -old woman brought in with intractable vomiting by her 18 -year 840 00:43:01,060 --> 00:43:04,120 son. I'm getting a weird vibe. 841 00:43:06,000 --> 00:43:07,000 How so? 842 00:43:07,620 --> 00:43:09,460 I don't know. Maybe she was given something. 843 00:43:09,800 --> 00:43:11,080 Some sort of elder abuse. 844 00:43:12,340 --> 00:43:15,360 This is a strange dynamic I can't quite figure out. You're really good at 845 00:43:15,360 --> 00:43:16,480 something like that sort of thing. 846 00:43:17,620 --> 00:43:18,760 I don't know about that. 847 00:43:21,900 --> 00:43:23,280 Excuse me, Dr. Langdon? 848 00:43:24,970 --> 00:43:27,390 Almost all of our labs are back on sleeping boy Tyler. 849 00:43:27,690 --> 00:43:29,430 All 100 % normal. 850 00:43:30,430 --> 00:43:31,430 What are we missing? 851 00:43:35,590 --> 00:43:38,890 Is he waking up? No, he's still fast asleep. 852 00:43:39,470 --> 00:43:43,650 Most of the lab results are in and they look great. No abnormal blood count, no 853 00:43:43,650 --> 00:43:48,630 electrolyte abnormalities, no diabetes, no kidney disease. 854 00:43:49,710 --> 00:43:53,770 Good, so what's wrong with him? We're still trying to figure that out. 855 00:43:54,640 --> 00:43:57,000 Did he have a play date yesterday by chance? 856 00:43:57,220 --> 00:44:01,020 No, he had preschool, but he was fine when I picked him up. Any kids in his 857 00:44:01,020 --> 00:44:02,020 class still? 858 00:44:02,140 --> 00:44:04,600 No, my phone tree would have lit up if someone else was sick. 859 00:44:05,040 --> 00:44:06,560 He eat anything this morning? 860 00:44:06,940 --> 00:44:07,940 No. 861 00:44:08,500 --> 00:44:09,500 Why? 862 00:44:10,180 --> 00:44:12,200 It looks like some sort of gelatin. 863 00:44:13,240 --> 00:44:17,040 Any chance he could have gotten into some bath beets or laundry pods? 864 00:44:17,360 --> 00:44:19,220 No, and there's no such thing in our house. 865 00:44:19,500 --> 00:44:20,500 What about gummies? 866 00:44:20,620 --> 00:44:22,460 No, we're very strict about candy. 867 00:44:22,980 --> 00:44:23,980 Right? 868 00:44:30,000 --> 00:44:31,780 Danny. What about Danny? 869 00:44:32,280 --> 00:44:37,340 Your brother, he... He gave me some gummies he got in Cleveland. They were 870 00:44:37,340 --> 00:44:38,340 coat pocket. 871 00:44:39,300 --> 00:44:40,340 Are you fucking serious? 872 00:44:41,200 --> 00:44:42,200 Pot gummies? 873 00:44:42,660 --> 00:44:44,580 Yes. I'm so sorry. 874 00:44:45,020 --> 00:44:48,340 Let me call the lab. Maybe the tox screen is back. Hey, this is Dr. Langdon 875 00:44:48,340 --> 00:44:49,058 the ED. 876 00:44:49,060 --> 00:44:52,860 Can I fast -track a lab on a little boy, last name Jones, first name Tyler, tox 877 00:44:52,860 --> 00:44:56,500 screen? Fuck out! I mean it. Why don't we step outside and maybe you can help 878 00:44:56,500 --> 00:44:57,780 figure out how much he may have taken. 879 00:44:59,750 --> 00:45:01,550 Thanks. I appreciate that quick turnaround. 880 00:45:04,430 --> 00:45:07,110 Labs confirm it. Your son tested positive for cannabis. 881 00:45:07,910 --> 00:45:08,990 It's a fucking nightmare. 882 00:45:13,930 --> 00:45:14,930 Teresa. 883 00:45:15,870 --> 00:45:17,270 David, this is my attendee, Dr. 884 00:45:17,530 --> 00:45:18,970 Rabinovich. Hi, Dr. Robbie. 885 00:45:19,450 --> 00:45:20,850 We need to do a pelvic exam. 886 00:45:21,710 --> 00:45:23,610 David, I don't think you want to be in here for that. 887 00:45:24,410 --> 00:45:25,410 Definitely not. 888 00:45:25,430 --> 00:45:27,330 Can you have Nurse Perla come join me, please? 889 00:45:28,810 --> 00:45:31,290 You want a coffee or a soda or something? 890 00:45:31,990 --> 00:45:33,550 Why do I need a pelvic exam? 891 00:45:33,790 --> 00:45:35,170 Uh, you don't. 892 00:45:36,110 --> 00:45:39,310 Your son seems like a nice kid. He's clearly worried about you. 893 00:45:40,350 --> 00:45:44,410 But your exam and your labs are not matching any of the usual diagnoses, so 894 00:45:44,410 --> 00:45:45,410 not really sure what's going on. 895 00:45:47,330 --> 00:45:48,510 I'm not here for me. 896 00:45:49,270 --> 00:45:50,310 I'm here for David. 897 00:45:50,730 --> 00:45:54,210 I don't understand. He said that you've had persistent vomiting, some... I made 898 00:45:54,210 --> 00:45:56,850 myself sick with Ipecac. 899 00:45:57,740 --> 00:45:59,460 To induce vomiting? Why would you do that? 900 00:45:59,820 --> 00:46:01,920 So David would bring me here. 901 00:46:02,680 --> 00:46:06,740 My son has some problems. He needs professional help. 902 00:46:07,200 --> 00:46:08,380 Okay, what kind of problems? 903 00:46:08,740 --> 00:46:09,740 Drugs? Alcohol? 904 00:46:11,500 --> 00:46:13,300 I found some of his writing. 905 00:46:15,160 --> 00:46:18,120 I thought it was schoolwork, but it wasn't. 906 00:46:20,300 --> 00:46:23,140 It was a list of girls he wanted to hurt. 907 00:46:37,200 --> 00:46:38,200 Heard them out. 908 00:46:38,440 --> 00:46:41,700 He said they should all be eliminated. 909 00:46:44,520 --> 00:46:45,820 Has David seen a therapist? 910 00:46:46,460 --> 00:46:47,460 No. 911 00:46:48,980 --> 00:46:53,620 He's not a bad kid, but I'm afraid he's troubled, and I didn't want to call the 912 00:46:53,620 --> 00:46:56,820 police because I was afraid they'd overreact. He's just a kid. How old is 913 00:46:57,780 --> 00:46:59,640 He just turned 18 last month. 914 00:47:01,240 --> 00:47:04,400 Then he's considered an adult, and he would have to consent to treatment. 915 00:47:06,760 --> 00:47:08,620 Do you have any guns in the house? No. 916 00:47:09,540 --> 00:47:13,100 My husband did, but I got rid of all of them after he passed. 917 00:47:13,780 --> 00:47:14,780 He's a good soul. 918 00:47:15,640 --> 00:47:18,020 I just don't want to see him hurt anyone or himself. 919 00:47:21,320 --> 00:47:22,340 How you feeling, Crash? 920 00:47:23,560 --> 00:47:26,240 I'd really appreciate it if you didn't call me that. Why not? 921 00:47:26,720 --> 00:47:29,340 It's a cool nickname. You earned it. You should own it. 922 00:47:30,980 --> 00:47:31,980 I don't like it. 923 00:47:33,760 --> 00:47:35,340 Whatever. It's just a joke. 924 00:47:39,310 --> 00:47:44,930 You know, if it makes you feel any better, I sharted the first time I saw 925 00:47:44,930 --> 00:47:45,930 emergency C -section. 926 00:47:48,030 --> 00:47:49,030 Really? 927 00:47:49,910 --> 00:47:51,370 Of course not. 928 00:48:01,650 --> 00:48:06,190 I got a situation. 929 00:48:07,000 --> 00:48:10,900 18 -year -old kid brings in his dehydrated mom. Dad died during the 930 00:48:11,220 --> 00:48:14,640 Mom's vomiting is self -induced for the sole purpose of getting him here after 931 00:48:14,640 --> 00:48:16,340 she finds his death list for classmates. 932 00:48:17,560 --> 00:48:19,580 I... Okay. 933 00:48:20,680 --> 00:48:22,060 What does she want us to do? 934 00:48:22,500 --> 00:48:25,200 Help him, protect him, save him. Where is he now? 935 00:48:25,500 --> 00:48:26,500 Talking to McKay. 936 00:48:27,700 --> 00:48:28,900 How are you doing? 937 00:48:29,420 --> 00:48:33,800 Me? I'm good. I'm always good. You know that. Do I? Does anybody? 938 00:48:34,240 --> 00:48:35,240 I'm an open book. 939 00:48:35,640 --> 00:48:36,640 Not even close. 940 00:48:37,100 --> 00:48:39,160 You do know you can always come talk to me, right? 941 00:48:43,140 --> 00:48:44,140 How's it going over here? 942 00:48:44,700 --> 00:48:45,700 Good, good. 943 00:48:45,720 --> 00:48:49,620 We're just going over aftercare instructions, prescription medications, 944 00:48:49,620 --> 00:48:50,900 diet for the next few days. 945 00:48:51,180 --> 00:48:53,160 Dr. McKay, can you check with aesthetics on mom? 946 00:48:53,380 --> 00:48:53,859 I can. 947 00:48:53,860 --> 00:48:57,280 David, I wanted you to meet Kiara. She's a social worker here who helps in 948 00:48:57,280 --> 00:48:58,320 situations like this. 949 00:48:59,140 --> 00:49:00,640 We heard about your father's passing. 950 00:49:01,460 --> 00:49:02,460 We're really sorry. 951 00:49:03,250 --> 00:49:07,050 And we know they can put a lot of pressure on somebody your age which 952 00:49:07,050 --> 00:49:09,830 with school And now having to take care of your mom. 953 00:49:10,330 --> 00:49:15,030 That's a lot fine We just want to make sure that when your mom goes home you 954 00:49:15,030 --> 00:49:18,590 handle it You want to make sure you have someone you can talk to if you need to 955 00:49:18,590 --> 00:49:19,590 I'm okay. 956 00:49:19,990 --> 00:49:25,950 I don't need to talk to anybody After a parent dies the sadness can last a long 957 00:49:25,950 --> 00:49:28,210 time. How's that going for you? 958 00:49:29,130 --> 00:49:33,050 What about school What about it? 959 00:49:33,770 --> 00:49:35,090 Anything you enjoy there? 960 00:49:36,330 --> 00:49:37,330 Not really. 961 00:49:39,290 --> 00:49:42,290 A lot of people have thoughts that can disturb them. 962 00:49:42,870 --> 00:49:46,010 If you've had any, it's okay to talk about it. Does that have to do with my 963 00:49:47,410 --> 00:49:48,410 Is she gonna be okay? 964 00:49:48,710 --> 00:49:51,910 Yeah, she's gonna be fine. She's probably got a stomach virus, maybe food 965 00:49:51,910 --> 00:49:54,190 poisoning. I think she's more worried about you. 966 00:49:55,370 --> 00:49:56,690 She always worries about me. 967 00:49:56,990 --> 00:49:58,250 Does she have a reason to? 968 00:49:58,750 --> 00:49:59,750 No. 969 00:50:00,150 --> 00:50:01,490 I almost ate. I gotta go. 970 00:50:04,010 --> 00:50:05,590 You sure you wouldn't prefer to wait with your mom? 971 00:50:05,990 --> 00:50:08,150 I'm late for school. She'll just call me when she's ready. 972 00:50:10,150 --> 00:50:12,370 It would actually be kind of helpful to talk to you some more. 973 00:50:12,790 --> 00:50:13,790 Hey, David? 974 00:50:15,410 --> 00:50:16,410 David? 975 00:50:17,150 --> 00:50:19,070 Hey, just give me five minutes. Leave me alone. 976 00:50:24,830 --> 00:50:28,930 Hey, David! 977 00:50:38,860 --> 00:50:39,799 Got a college kid. 978 00:50:39,800 --> 00:50:40,800 Respiratory rest. Coming in hot. 979 00:51:13,390 --> 00:51:14,390 to be here. 980 00:51:15,590 --> 00:51:17,850 Dr. Adamson just went down with a full size of 65. 981 00:52:13,360 --> 00:52:15,380 You're not so tough. 982 00:52:15,680 --> 00:52:17,920 You need to be loved. 983 00:52:18,480 --> 00:52:20,740 You're lost in the dead. 984 00:52:21,180 --> 00:52:23,560 You're caught up there. 985 00:52:23,760 --> 00:52:26,360 No matter where you come from. 986 00:52:26,720 --> 00:52:31,020 You're a monster back to all the mirrors. 987 00:52:31,860 --> 00:52:33,600 You're not 988 00:52:33,600 --> 00:52:39,340 so tough.