All language subtitles for The.Pitt.S01E01.540p.x265.AAC.[9jaRocks.Com].eng-

Is it true?

Simi told Hector
that Dr. Deranjian said

the hospital was up for sale.

They might turn it into
an ortho center with no ER.

Oh, they're always
threatening to shut us down,

but they never do.

Do you believe him?

I never trust the doctors.

Gloria is looking for you.

No guts, no Gloria.

Must be time
for my weekly spanking.

Try to be nice,
for all our sakes.

You sure you're cool
being here today?

Yeah. Why wouldn't I be?

Well, if you need to talk...

Yeah, I won't, but thanks.

Where's Abbot?

Getting some air.

Hey.

You OK in there?

Uh, awesome.

I'd like to say it goes away,
but I had morning sickness

for six months
with my second daughter.

Hell, who am I kidding?

That one still worries me sick.

- Thanks.
- But it's worth it.

You tell anybody yet?

Oh, no.

Not until I pass 12 weeks.
Not this time.

Nothing but good vibes.

But just so you know,
Robby's working today.

Today's the day
Doc Adamson died.

He hasn't worked it
in four years.

So why is he here?

All I know is,
he still blames himself

for Adamson's death, so if
he's a little prickly today,

give him a pass, OK?

- Right.
- Thank you.

Hang in there, kid.

Good morning, Jack.

What are you doing here?

I'm working.

And you?

Oh, I don't know.

Had a guy come in.

Hit by a drunk driver
in a crosswalk.

39-year-old vet.

Survived three tours
without a scratch.

I spent the last two hours
coding him.

That's always a rough way
to end the night.

I must have had a reason

at one time
to keep coming back,

but I can't think of it
right now.

Because this is the job
that keeps on giving.

Nightmares.

Ulcers.

Suicidal tendencies.

Besides, if you jump
on my shift,

that's just rude, man.

I hope I'm never
one of your patients.

That makes two of us,
my friend.

I got a pregnant teen coming
back today for mifepristone

and a small bowel obstruction
waiting on surgery

for the last three hours.

Oh, and unfortunately,

the Kraken is still boarding
in BH.

Still?

Guy's been here for a week
waiting on a psych bed.

Yep.
He's only getting worse.

He's catching some Zyprexa Z's
at the moment.

But when he wakes up,
God help you all.

I wrote a note
for the family of my dead vet,

if anyone shows.

Oh, and you got
the med students

and new interns starting today,
so good luck with that.

Lucky, lucky me.

- Sir, come back here!
- No more needles!

- Oh!
- Sir!

- No more needles!
- Stop!

Sure you want
to work today, huh?

Help me!
They're gonna hurt me!

Sir, I promise
nobody is going to hurt you.

Sir!

Who left this mess?

They had a rough night.

Good morning, sunshine.

You obviously haven't seen
this board.

Oh, we've seen worse.

Nothing like a little challenge
every now and then

to keep everybody
on their toes.

- Dr. Robinavitch?
- Yep.

Melissa King.
I will be joining you today.

I just came from two months
at the VA.

Hey, welcome to the Pitt.

This is Dr. Jack Abbot.

Nice to meet you.

I can't tell you how excited
I am to be here today, so...

Talk to me
at the end of the day.

Ignore him.
He had a rough night

and is having
an ongoing existential crisis.

Don't worry,
you'll get there soon enough.

I married my second husband,
Everett, in 1964.

He unfortunately passed in 1976
from a heart attack

while we were vacationing
in Kissimmee, Florida.

- It was awful.
- Good morning.

We're gonna round, Dr. Mohan.

Excuse me, Estelle.
I'll be right back.

So you know we track
every resident's

patients seen per hour.

I was just taking
her history.

It's a brief backstory
about what brought them in,

- not an autobiography.
- I was almost done.

You hadn't even made it
to this century.

Patients, they check in
for registration here.

A nurse eyeballs them,
makes sure they're not dying.

If not, they're moved to one
of two triage rooms for vitals

and a quick chair exam
where you can order

your labs and your X-rays.

And then they come back to...

Waiting room,
until a bed opens up.

For how long?

Eight hours,
if they're lucky.

A lot of times, 12.

Uh, is it always this busy?

Uh, no.

It gets a lot busier.

Take this.

Hey, Mateo.

Good morning, Cass.

This is Sherry.

Hi.

Sherry, I'm Dr. McKay.

I have some student doctors
with me today.

Do you mind if they observe?

- Sure.
- OK.

What's going on, Sherry?

I--

I burned my hand on a Sterno.

What were you doing
with a Sterno?

Uh, cooking.

You were cooking
with a Sterno?

Yeah, we were making s'mores.

That's sweet.

My son loves s'mores.

Uh, we've--
we've been here for hours,

and I have to get them
to school.

Do you know how much longer
this will take?

Uh, yeah, let's see.

- You take anything for the pain?
- Uh, not yet.

1,000 of Tylenol,

400 ibuprofen,
and saline dressing?

Yes, please.

McKay, we're gonna round.

And the fun begins.

All right, Sherry,
we're gonna patch you up

and get you out of here
as soon as possible, OK?

- I'll be back.
- OK.

As you can see, we have some
new faces with us this morning.

Good morning, good morning.
Come on over.

Starting with second-year
resident Dr. Melissa King,

fresh from the VA.

Everyone calls me Mel.

I'm so happy to be here.

Trinity Santos, intern.

Victoria Javadi, MS3.

Uh, Dennis Whitaker, MS4.

Welcome to the Pitt.
I'm--

We've got two traumas
from the T.

- Five minutes out.
- OK, copy that.

Actually, this is
the most important person

that you're gonna meet today.
This is Dana.

She's our charge nurse.

She is the ringleader
of our circus.

Do what she says
when she says it.

As you can see,
our house is always packed,

and our department is mostly
clogged up with boarders.

Those are admitted patients
waiting for a room upstairs,

sometimes for days.

Beds are a very precious
commodity around here,

so please be quick
and efficient

with your workups.

What else?

We treat the sicker patients
back here,

but please keep your eye
on that waiting room.

Make sure nobody's
gonna die out there.

Your senior residents
are Dr. Collins

and Dr. Langdon.

You report to them,
and they report to me.

OK? Great.

Senior residents,
you got your sign-outs?

- Yep.
- Yep.

OK. Let's do this.

Virgil Straker.

9mm GSW to the left shoulder.

CT angiogram negative,
surgery wants to admit

for overnight observation.

Good vitals.
They repeat a crit?

Stable crits
every two hours times three.

Discharge on Ceftin,
recheck tomorrow.

He'll get way more rest
at home.

Good morning, Mr. Straker.
You want to go home?

- Hell yeah.
- OK.

Hey. Hey, Ro.

Hey, Ro, I'm finally
getting out of here!

All right,
Murphy Rottenstein.

48-year-old woman
with cirrhosis

and upper GI bleed.

Intubated and stable
after one unit.

Awaiting ICU bed.

Hey, Doc.

And we all know
Louie Cloverfield.

Blood alcohol of .420
at 11:00 PM.

- I've been cutting back.
- How is he still breathing?

That's a lethal dose
for you and me.

That's happy hour for Louie.

Sobered up.
Had two rounds of lorazepam.

Hold out your hands
for me, Louie.

- Another two of lorazepam.
- On it.

And a script for Librium.

It's good to see you, Louie.

It's always a pleasure, Doc.

Bar fight
with complete avulsion

of tooth number eight.

Smile, Charlie.

Oh!
Where's your tooth, Charlie?

Fuck if I know.

Cancel the discharge.
Order a chest X-ray.

Got to rule out aspiration.

Incoming!

42-year-old male,
Sam Wallace.

Blunt head
with agonal respirations.

Dropped down on the T tracks.
Couldn't tube him.

- LMA in place.
- Suicide attempt?

Rescue.
He's a good Samaritan.

Took a spill helping a woman
who fell off the track.

- She's right behind us.
- OK. Trauma one. Go ahead.

Copy.

Come on.

Woman fell from T platform.

Good vitals
and no head injuries.

Degloving injury,
right lower leg

with open fracture dislocation
to the ankle.

Whoa.
OK.

Trauma two.
Trauma two. Let's go!

How are we doing?
We ready?

OK, here we go.
Ready?

One, two, three.

Good breath sounds
bilaterally,

but we need to protect...

Apparently he jumped down
to save the lady.

When he climbed back up,
he slipped,

- fell back, and hit his head.
- OK, thanks.

Uh, Mel, right?

I need you on the E-FAST.

Pupils 4 millimeters
and reactive.

OK, that's encouraging.

- What do you want for meds?
- 120 ketamine, 80 of rock.

- A-fib on a monitor.
- Courses clear.

That's a lot more blood
than expected.

Um, he's probably
anticoagulated for A-fib.

Check his medical records,
see if he's on a DOAC.

Stand by with four-factor PCC
if there's a brain bleed.

What's in the PCC, Mel?

Uh, clotting factors
two, seven, nine, and ten.

OK. Be right back.

50 of fent didn't touch her.

Did she faint or did she trip
off the platform?

Nobody knows.

The other guy jumped down,
pulled her off the tracks

just as the train
was rolling in.

Isolated injury to the foot.

The train ran over her foot?

Got caught
between the platform

and the incoming train.

Ma'am?
Ma'am, what's your name?

All right,
type 3 open fracture.

Two grams Cefazolin,
400 of gent.

Do you speak any English?

Airway and breathing
are perfect.

As is circulation.

BP 140 over 85.

Students, what might have
made her faint on the platform?

- Uh, TIA, CVA.
- Could be an arrhythmia,

- cardiac event.
- So she needs...

- Hed CT.
- EKG and troponin.

- OK, good.
- What do we got, party people?

Subway train
degloved her foot

with an open fracture
dislocation.

Ooh, and I thought
my heels were painful.

- Hemodynamically stable.
- E-FAST negative.

Ma'am,
I'm Dr. Yolanda Garcia.

Any pain in your chest
or belly?

Can we please push
the morphine?

No, it could cloud
her mental status.

I can't do an exam like this.
Push the damn morphine.

We're doing
a popliteal block.

Numbs the lower leg,
no side effects.

Wonderful.
Where's the other guy?

Next door.
He's a bit worse.

Pan scan her.

Let me know
when she stops screaming.

The cords are very anterior.

Yeah, that's because
we can't flex the neck.

Keep the hockey stick
straight up.

- I'm in.
- Good. Well done.

Bring me up to speed.

Intubated
for agonal respirations.

GCS 5.
Probably anticoagulated.

With what?

First time here.

There's no medical records.

- Call for FFP?
- No, we got four-factor PCC.

80 of mannitol
to reduce brain swelling,

then right up to CT.

Do me a favor.

Swap out with Jesse for me,
would you?

Of course.

Dr. Robinavitch,
do you have a moment?

I'm just a little busy
right now, Gloria.

One sec.

Nerve block complete.

Seems like
it's starting to work.

Swapping out, Jesse.

Takes ten minutes
for the full effect,

and the Marcaine lasts
a good four hours.

She's next for CT.

You have any idea
what language that is?

Definitely not Tagalog.

Maybe Hindi or Urdu.

I'm gonna go get
language services.

Don't you speak,
like, five languages?

Six,
but that's not one of them.

Six?

And I thought
Collins was smart.

Oh, it's way too early

for you to start being an ass,
Langdon.

Open hostility
in front of the patient?

She doesn't speak English.

Judgmental and dismissive.

How are we doing?

- Vitals stable.
- Unlike these two.

Ooh, good for you.
Princess made a joke.

Why are you always an asshole?

And I thank you
for that beautiful blessing.

- Namaste.
- OK, do we have a phone

or anything
with a relative's name on it?

EMT said
the purse got obliterated

when the subway ran over it.

- Any way I can speak with her?
- Highly doubt it.

We don't know
what language she speaks.

Hey, um, any chance she jumped?

She may have been pushed.

- Jesus.
- Yeah.

Could be looking
at a possible hate crime.

I take it you're free now?

We need to talk
about your numbers.

- Of people we've saved?
- Metrics.

Our door-to-balloon times
beat federal standards.

I'm talking about
Press Ganey scores.

Patient satisfaction.

If they're still alive,
they should be satisfied.

Our goal is 36%
very satisfied with their care.

Your department is at 8.

Do you know how likely patients
are to recommend this hospital?

This is
an emergency department,

not a Taco Bell.

11%.

Well, if you want people
to be happier,

don't make 'em wait
for 12 hours.

There's a nursing shortage
across the country.

Most of our patients
are boarders

who are waiting for a bed
upstairs.

We don't have the beds.

That's bullshit.
The beds are up there.

You just don't want to hire
the staff you need

to care for them.

Oh, Doc.
Doc, it ain't working.

Man, whatever they're
giving me, it's not working.

No response to mag citrate.

Should I send in the Fleet?

OK, sir,
we're gonna try an enema.

Like I said,
there's a nursing shortage.

Well, if you paid them
a living wage,

they'd be lining up
to work here.

Our budget can't
support that.

Here's a dirty little secret.

The hospital saves money

keeping patients down here
in the Pitt.

It's way cheaper
than staffing upstairs.

I have asked you repeatedly

to stop referring
to the emergency department

as the Pitt--it is derogatory

and incompatible
to the institution's image.

You know what's incompatible
with the institution's image?

Me speaking to the media

about people who code
in our waiting rooms

and people who get
shitty care in our hallways

waiting for an ICU bed
for days.

I've heard about doctors
who have tried that

and find themselves
out of work.

Uh-huh.

I know today is
difficult for you.

Every day is difficult
down here.

Boarding is
a nationwide problem.

Your predecessor, Adamson,
sure as hell knew that.

Or wasn't that
something he taught you?

Fuck.
Wow. Really?

Yes, really.

Other hospitals are
managing this crisis

much more effectively.

So you can either
step up your game,

or you can step aside.

Good Samaritan dude has
a small left temporal

intraparenchymal bleed.

No epidural, no subdural,
no midline shift in the brain.

Oh, that's good news.
He could recover.

CT can take her in five.

Let's have a look.
Bandage scissors?

All right.

If an artery is
totally transected,

the smooth muscle
and the tunica media

contracts with hemostasis.

But if it's a partial cut,
get out your umbrella.

Grab a culture from the open
fibula before you reduce.

You're up.

I'll stabilize the knee
for the reduction.

Dr. Langdon will be
distracting distally

before moving medially
to clear the tibia.

Good.

Ready?

Med student down.

Good catch
on Bar Fight Billy.

There was an aspirated tooth
on chest X-ray.

Would have been dead in a week
from a lung abscess

had you let him be discharged.

Good call on the pulmonary.

Cardiac arrest,
ETA 10 minutes.

- Where should we put it?
- Anywhere.

We might have to put
somebody in the hall.

Dr. Robby?
She, uh, took a fall.

No, I--
I tripped on the gurney.

I'm fine.

Why don't you go get
a cold drink

in the staff lounge?

I'm fine, really.
I swear.

Oh, I know,
but it's hospital policy.

Anytime someone gets
a paper cut around here,

we have to fill out
a workers' comp report.

Other way.

I was fine
until about two weeks ago,

after the Rochester Marathon.

OK.
Any falls or injuries?

Just tired.
Sore muscles.

Yeah, I'd be in bed
for a month.

Was this your first triathlon?

God no.

No, I do one every few months.

Have you seen a doctor yet?

Uh, no.

I went for a run this morning.

Had to quit after a minute.

Pretty short of breath.

This goes under your tongue.

- No current meds, no allergies?
- Mm-mm.

We're gonna check a few labs
and an EKG.

- Draw a red and purple top.
- Yep.

Temp 98.2.

Take a deep breath
for me, Otis.

Little pinprick now, OK?

Otis?

Otis.

I didn't take him
for a lightweight, huh?

Oh, shit.
No pulse.

Crash cart!
Lay him flat!

- Let's check a rhythm.
- Saline pads.

Quick look paddles.

V-tach.

Charging at 200.

Charged.

Clear!

All right,
he's back to normal sinus.

Need a gurney in here!

So what's the plan?

ICU when we can get a bed
and admit for supportive care.

Repeat head CT in three hours.

Or sooner, if he blows a pupil.

- Want a Keppra load?
- Order's already in.

Nice job.

Do you think he'll wake up?

Maybe.

Maybe not.

No good deed goes unpunished.

Oh, has anyone,
um, notified the family?

I could try.

Otis Williams.
Healthy 31-year-old.

V-tach arrest
two weeks after triathlon.

NSR with one shock.

Pulse 98, BP 110 over 60.

He's a little young
for an MI.

Exactly right,

What's in the differential,
Dr. Collins?

Drug overdose,
electrolytes, long QT--

ooh, Brugada syndrome, WPW...

How you doing there, Otis?

OK.
What ha--

V-tach again.

200 joules.

Charged, and clear!

Back in sinus.

Otis?

Otis?

Oh, groaning's good.
5 of nasal O2, CBC,

CMP, troponin, and D-dimer.

What are you doing?

One gram calcium gluconate,
IV push.

- We don't have the labs back.
- Look at the monitor.

Widened QRS and PT waves.

- Hyperkalemia.
- How'd he get that?

Intense exercise
caused muscle breakdown.

Rhabdomyolysis knocked out
his kidneys.

Now he's not
clearing potassium.

I bet it's over 7.5.

Wait two minutes
for the i-STAT.

If he arrests again,
we might not get him back.

If it's hypercalcemia,
you could kill him.

- Wait.
- Oh, it's my ass, not yours.

Pan scan is negative.

That means you can admit
to orthopedics.

But there may have been
a medical etiology

- if she fainted.
- That's not surgical.

Get an internal
medicine consult,

or admit to medicine
with ortho consulting.

Either way, I'm off the case.

OK.
Thanks for nothing.

Ancef's in.
I'll grab the gent.

Did we figure out
what she's speaking?

Last interpreter thought
she might be from Pakistan.

There are 77 languages
in Pakistan.

OK, well, I will buy lunch
for whoever figures it out.

Good luck.

If you need me,
I'll be saving lives.

That was wicked.

- That was gross.
- Yeah.

Too much for Little Miss
Crash and Burn.

- What'd you do with her?
- Nothing.

- I think she'll be fine.
- Are you kidding?

If that took her out,
she'll be lucky to make it

through this rotation.

I got 50 bucks says she doesn't
last through this shift.

Come on.

Put your money
where your mouth is.

Uh, no.
I didn't say anything, OK?

And I sure as hell
don't have 50 bucks.

I'll be this lady's age
by the time

I pay off my student loans.

Not that you're--

Hey.

You want to sell a kidney?

I could get you 30K
as soon as this weekend.

That's just between you and me.

Think about it.

How you doing?

Yeah.

QRS has narrowed.

Much better.

Potassium is 7.7.

Creatinine, 5.6.

High potassium
and renal failure.

Just what you thought.

It must be my lucky day.

Ordering 10 units
of regular insulin

and 25 grams of glucose.

Why insulin and glucose?

Shift the potassium
intracellularly.

Exactly, but the definitive
treatment is...

Hemodialysis.
I'll call renal

and get a tech down
with the machine.

Have you ever seen
a dialysis catheter inserted?

Dr. Collins is gonna place
a femoral Quinton

under ultrasound guidance.

It's an excellent way to learn.

Oh, my chest.

Yeah, we had to shock you.

You're gonna be sore
for a while.

You shocked my heart?

Long story.
Dr. Collins will fill you in.

You got a sec?

You OK?

Why wouldn't I be?
Are you OK?

Why wouldn't I be?

You seem annoyed with me
already,

and I just got here.

It's not always
about you, Robby.

Am I gonna be OK?

Yeah.

You just need to take it easy
on yourself.

Muscle breakdown and myoglobin
damaged your kidneys.

Why'd you shock my heart?

When your kidneys don't work,
potassium builds up

and messes with the electrical
activity in your heart.

Can it happen again?

We gave you medicine
to lower your potassium,

and you'll need dialysis
to clear it all out.

Then I'll be OK?

Yeah.

You might need a week or two

for your kidneys to recover,
but yeah.

You really need
to hydrate like crazy

before and after a triathlon.

Trust me,
I won't let this happen again.

Good.

Be kind to yourself, OK?

Oh, hey.

Abbot's told me that he's got
a pregnant teen

coming back today
for mifepristone.

- Let me know when she gets here.
- Yep.

Bowel obstruction,
still waiting

on a surgery consult.
What about Garcia?

She was just here
for the traumas.

I think she was waiting
for her attending to sign off.

OK.

Oh, one of the med students
took a header.

I parked her in the lounge
under the guise

of a work comp report.

Will you just go in there,
eyeball her,

and make sure she's all right?

She's gonna miss
the morning arrival

of the living dead.

How many are we expecting?

We were getting three,
but one died en route.

Don't know who's luckier,
us or them.

- What's open?
- 14.

89-year-old woman from a SNF.

History of emphysema, CHF, MS.

V-fib, unresponsive
to three shocks.

- Two rounds of epi.
- What is that?

LUCAS
chest compression system.

Robotic CPR.

Everybody get a hold.
One, two, three.

Students are dropping
like flies.

Take a break.
Ice the finger.

You can count on getting
a couple elderly patients

every day around 7:30,
after the nursing homes

and assisted living facilities
do their morning bed checks.

You can practically
set your watch.

Was there
an advanced directive?

No, full code,
per the nursing home.

Seriously?

LUCAS off.

Still V-fib.

LUCAS on.

One more round of epi,
one more shock,

and then we call it?

Joseph Spencer, 79.

Fever and cough.
From assisted living.

He has a history
of mild Alzheimer's.

One, two, three.

Heart rate 130.
BP 90 over 60.

Gave him 500 cc's
normal saline.

Hi, Mr. Spencer.
I'm Dr. King.

This is Dr. Collins.

How are you feeling today?

Is it dinnertime?
I--I'm not really hungry.

Do we have any paperwork
from the facility?

He has a POLST.

IV fluids
and medications are fine,

but no intubation
and no chest compressions.

That's helpful.

Coarse rhonchi here.

Right middle lobe infiltrate.

Temp 102.
Call a code sepsis.

- Mm-hmm.
- Code?

To make sure
we check all of our boxes.

The federal government audits
our sepsis bundle performance

and publishes the data online.

Today, it better be perfect.

Two sets of blood cultures,
lactic acid,

30 cc's per kilo NS,
a gram of ceftriaxone,

500 of azithromycin,
repeat lactic in three hours.

Nice.

Charging, and...

Stop.

Call it.

Nursing home just faxed us
a DNR.

Are you kidding me?

Power off the defibrillator
and the LUCAS.

Complete waste
of time and money.

Who the hell works
at that place?

A nurse taking care
of 60 patients

who couldn't find the form.

She called 911 so she could
take care of the others.

OK, let's move her
to the viewing room

- and notify the family.
- Yep.

One of the things we do here
is to take a moment of silence

when we lose a patient,
to respect their humanity

and also to remember
that this was somebody's child

or sibling or parent, friend.

Oh. Ow, ow!

I am so sorry.

Maybe leave it on vibrate
while you're working.

- Later, Doc.
- You behave yourself now.

Always.

Your med student's
back on her feet.

- How old's that kid?
- I don't know. I didn't ask.

What is she,
some sort of savant?

I don't know. Maybe.

Dr. Robinavitch.

I just wanted to apologize
for any trouble

my clumsiness
might have caused.

I feel ridiculous.

Oh, I can't tell
how many times

I've hit my head
on an overhead lamp.

Twice I needed to get staples.

Why don't you go work
with Dr. McKay in triage?

That would help both of us.

Oh, I--I don't need
special treatment.

Good,
because I don't give it.

Look, I know
I might look too young,

but I studied
my ass off to get here.

Probably harder
than the others.

I earned this.

OK, look, I respect
your dedication

and your determination,
but while you're here,

you're my responsibility.

And when one
of my responsibilities

takes a header--wow!

Abbot called
for a surgical consult

on the SBO three hours ago.

You're very lucky
they didn't perf.

I'm here to see my daughter.

I'm sorry, is that a patient?

You're talking to her.

Am I interrupting?

No.

No, we're done.
We're good.

Come find me when you're ready
to present your next case.

Thank you.

So how's your
first day going?

- It's great.
- Yeah?

Yeah, really great.

Hey, Crash,
they're doing a dialysis

catheter insertion in North One
if you want to check it out.

Mm-hmm.

- That thing--
- Did she say Crash?

No.

No, no, it's not crash.

Um, she said crush,
'cause I'm always crushing it.

Um, thanks for coming down,
Mom, but I've--

I've got a patient.

Bye.

What do you want?

Um, I--I just wanted to make
sure you're comfortable.

I am taking a dump
in a dustpan,

so what's that
fucking tell you?

Um, I'm--

I'm clearly--
I'm clearly in the wrong room.

- Yeah.
- I'm sorry.

Mm-hmm.

So it would have been nice
if someone had told me

that Eileen Shamsi's daughter
was one of our med students.

What, and ruin the surprise?

Was it as awkward
as I hoped it would be?

You--you have a mean streak
in you, you know that?

What's the deal
with the body in 19?

That's Abbot's MVC vet
from last night.

Still waiting on next of kin.

- Supposedly on their way.
- OK.

Can we move him
to the viewing room, at least?

Nursing home DNR
is heading there,

joining last night's Jane Doe.

Coroner's office is backed up.

Well, then our morgue
needs to take her, then.

Perlah.

Triathlete, Otis?

Oh, he's stable.

Repeat potassium is 6.1.

Renal wrote the dialysis order.

Tech should be down
in 15 minutes.

Good. Thank you.

Language mystery solved yet?

No.

Hey, what's your take on dogs?

In what context?

For kids.

Kids and puppies go together
like fish and chips.

Man's best friend, you know?

Well, you don't have a dog.

I don't have a best friend.

- What am I?
- You're my best resident.

Big difference.

Yeah,
but we're still friends.

Not if this conversation
goes on much longer.

I have a lethargic
four-year-old,

no PMH, no antecedent illness,
no fever or vomiting.

Parents just couldn't
wake him up this morning.

- What room?
- Oh, South 15.

There's no nuchal rigidity,

no skin lesions,
no focal neuro.

He looks well fed
and cared for.

DKA from new-onset diabetes?

No, BG 85.

CBC, BMP, UA, and UDS ordered.

Can you wake up
for me, Tyler?

He's not usually this sleepy?

No, and he barely flinched
for the blood test.

He wakes up
at 90 miles an hour

and doesn't stop
till he passes out at night.

He passes out?

No, he just means
he goes all day.

Any chance he could have
ingested something?

Any pills, vitamins,

any prescriptions
that may have been left around?

No, that's all kept locked
in the medicine cabinet.

The whole house is childproof.

Uh, what about alcohol?
Anything left out?

- No.
- What about pets?

No.

So he's usually,
like, quite active?

- Very.
- Um, any injuries lately?

No.

Hasn't bumped
his head recently?

Not that I'm aware of,
but he does love

roughhousing with Drew.

But he never gets hurt.

Oxygen level is normal.

Good pulse and blood pressure.
No signs of infection.

We're gonna start
with blood and urine tests,

check for any
metabolic abnormalities.

It's really throbbing.

Yeah, the blood's
under pressure.

Gotta drain it.

No anesthesia, or--

I'll stop
before I hit the nail bed.

I hope.

Hey, eyes down here.

Watch and learn.

I'm just looking
who to see next.

You're supposed to take them
in the order they arrive.

Yeah, I know how it works.

OK.
No need to cry about it.

Do you want me
to choose for you?

No.

Wow, pain's gone.

- Thank you.
- Yeah.

All right.

How about a 20-year-old cough
in eight?

Should be easy.
Probably viral.

I don't need an easy one.

Suit yourself, Huckleberry.

I'm gonna take
the splitting headache.

Maybe I'll catch a subarachnoid
hemorrhage or something cool.

Hey, why do you
keep calling me that?

Huckleberry?

It's a term of endearment.

It sounds like sarcasm.

You think?

Bordering on harassment.

Where are you from?

Broken Bow, Nebraska.

Jesus,
where the hell is that?

It's about three and a half
hours west of Omaha.

Oh, yeah, just a little
south of nowhere.

What the hell do you do there?

My parents have a farm, so...

You're a farm boy?

Yeah, I guess.

I rest my case, Huckleberry.

I'm so sorry, ma'am.

We don't understand you.

Oh.

Me, I'm Dr. Heather Collins.

I'm from here.

Portland, Oregon.

You.

Where are you from?

Uh-huh.

Uh, China?
India?

I can't tell
where you're pointing.

Tajikistan?

Nepal.

Mm.

- You're from Nepal.
- Nepali.

Mom's got a bad burn.

Needs wound checks
and hand therapy.

And I got a sneaking suspicion
she may be unhoused.

I'll talk to her.
We can offer some help.

Thank you, I appreciate it.
Ah, you're back.

Dr. Robby suggested
I might be of assistance.

Yeah, I could use
the company.

Victoria Javadi,
this is Kiara Alfaro.

She's the department
social worker,

which pretty much makes her
an angel.

- Welcome.
- Thanks.

Thank you.

So what rotation
is this for you?

Um, third.

I've done OB-GYN and pedes.

You have any favorites?

Not really.

Well, what are you
leaning towards?

I'm not really sure yet.

OK, well, you have time.

Uh, can I actually ask you
a personal question?

I'm 20, and I've earned
the right to be here.

Oh.

Yeah, I don't--I don't
doubt that for a minute.

I--I was actually wondering if
Dr. Eileen Shamsi from surgery

is a friend
or relative of yours.

I saw you talking to her
in the hall and I thought--

Yeah, she's my mother.

Oh.

Oh, wow.

Oh, that's cool.

- You're really only 20?
- Yeah.

And for the record, my--
my father also works here.

He's an endocrinologist.

Oh, so it's like
a family business.

I'm sorry. That was a joke.
That was a joke.

And I'm sure that comes
with a lot of pressure.

And as for the age thing,
I'm a 42-year-old R2,

so I have my own haters,
trust me.

OK.

Um, sometimes
when it gets busy,

we'll help the nurses
bring back patients.

- OK.
- Um, OK.

Next to come back
is Fred Saeta.

- Knee pain after a fall.
- Great.

- Fred Sa--
- Doc. Hey, Doc. Hi.

Hi. Doug Driscoll.

Any chance
someone could see me now?

I've been here
for, like, two hours.

Unfortunately, Mr. Driscoll,
there's a lot of patients

still ahead of you,
some of whom are severely ill.

Yeah, and I got chest pains
that woke me up

- in the middle of the night.
- Chest pain.

- Yeah.
- No, it's not plural.

It's just chest pain,
not chest pains.

Yeah, and if I have more
than one, it's chest pains.

- Are you even a real doctor?
- She's a student doctor.

Yeah, well, keep her
the hell away from me.

I just need to see someone, OK?
Not her.

Isn't chest pain an emergency?
I don't--

It looks here
like you got an EKG

five minutes after arrival,
so it's not a heart attack.

Yeah, but I'm supposed to get
a chest X-ray and blood tests.

Ah, and you are next in line
for lab tech, OK?

So listen for your name.
Excuse me.

Fred--

Actually, can you get me
a wheelchair, please?

Uh, hi.
I'm--I'm Dr. McKay.

What's going on?

I, uh, found her
on the floor in the bathroom.

- She can't stop puking.
- What's her name?

Theresa.
She's my mom.

Theresa?

Theresa, are you taking
any medication?

No.

Any previous
stomach problems?

No.

When did the vomiting begin?

Um, last night.

- Last night.
- Oh, come on!

Do you have
any dizziness or fatigue?

Mystery solved.

Our lady with the degloved foot
is Nepali.

Oh, hey, congratulations.

Otis's BP is crashing.
70 over 50.

Still waiting for dialysis.

How you doing there, Otis?

- Not so good.
- 50 liters.

Non-rebreather, please.

Oh, crap.

Diastolic collapse of the right
atrium and right ventricle.

Tamponade
from uremic effusion.

- That's why his BP is low?
- Yep.

Too much fluid and pressure

around the heart,
chambers can't fill.

Otis, you've got
some fluid around your heart.

We need to get it off.

What's happening?

25 of Propofol,
10 cc's of lidocaine with epi,

pericardiocentesis tray.

I have to get that
from central.

No, no.
Just open a central line kit.

Dr. Santos,
take the head of the bed

and bag him
if he stops breathing,

compressions
if we lose the carotid.

Prep and drape
the subxiphoid, please.

- 10 cc's of 1% with.
- Chlorhexidine here.

- 25 or 27-gauge?
- Long 25, 25.

Thank you.

Injecting lidocaine.

Pressure down.
60 over 40.

Right.

Wait, you can't ultrasound
and place.

I know, that's why
I'm taking the probe.

18-gauge thin wall

on a 60 cc syringe,
please, Dr. Collins.

Let's go.

You're going in right over
the center of my probe,

advancing very slowly.

We're looking
for the hyperechoic tip.

Very, very slowly.
Do not hit that heart.

Dr. Santos, do you see
that sea of black?

That's the effusion.

We're looking
for a little white dot.

There it is.

Got it.

Aspirating.

3 cc's should be enough.

Good.

Next, we'll place
the guide wire,

and then
the triple lumen catheter.

Pulse ox is 99.

Pressure is up. 124 over 78.

Looks like things
are back to normal.

That was cool.

Four Zofrans on board.

That should stop the nausea.

David, have you had
any vomiting?

- No.
- Anyone else sick at home?

No, it's just us.

My husband passed away
a few years ago, from COVID.

Oh, I'm so sorry.

Potassium, 3.1.

Is that bad?

It can cause heart problems.

But we're gonna correct it, OK?

10 in the bag, 20 PO.

Javadi, any questions?

Um...

uh, David,
have you two traveled

out of the country recently?

We never go anywhere.

Is she gonna have to stay here?

If the rest
of the tests are good,

and she responds to treatment,
she can go home.

Mr. Milton,
my name is Dennis Whitaker.

I'm one
of the student doctors here.

I'll be seeing you first.

Nice to meet you.

BP's 150 over 90.

That's just a touch high.

I forgot to take my damn
enalapril this morning.

Oh, we'll get that for you.

Tell me about
this belly pain.

Uh, it started about here.

Um, woke me up
at, like, 2:00 AM.

Pretty intense.

Lasted about an hour.

Now it's gone.

Any fever or vomiting?

Nah, I never get sick.

OK.

Uh, what did you eat
last night?

Oh, it was
my wife's birthday.

I took her out to Sullivan's
for a steak.

Oh.

Well, the exam
is pretty benign.

I'm gonna test for gallstones.

If there is a stone
and you eat fatty food,

there can be pain
when the gallbladder contracts.

Oh.

Uh, bingo.

One stone.
There it is.

Do I need surgery?

Uh, you should be able
to manage with a low-fat diet.

But we'll send off labs
for liver and pancreas.

Just let us know
if you have any more pain.

OK.

Thanks.

Yeah, you bet.

Great.

You want an EKG?

For?

Heart attacks can present
as upper abdominal pain.

Um, yeah.

No, yeah, that's a great idea.

Thank you.

I'm going as fast as I can.

I'm picking up
two more patients.

I didn't say anything.

I, uh--I need
a fresh set of eyes.

On what?

54-year-old woman brought in
with intractable vomiting

by her 18-year-old son.

I'm, um--
I'm getting a weird vibe.

How so?

Like, I don't know,
maybe she was given something.

Some sort of elder abuse.

There's just a strange dynamic
I can't quite figure out.

You're really good at
sussing out that sort of thing.

I don't know about that.

Uh, excuse me, Dr. Langdon.

Almost all of our labs are back
on sleeping boy Tyler.

All 100% normal.

What are we missing?

Is he waking up?

No, he's--
he's still fast asleep.

Most of the lab results
are in, and they look great.

No abnormal blood count,
no, uh,

electrolyte abnormalities,
no diabetes,

no, um, kidney disease, so...

Good.
So--so what's wrong with him?

We're still trying
to figure that out.

Did he, uh, have a playdate
yesterday, by chance?

No, he had preschool,

but he was fine
when I picked him up.

Any kids in his class ill?

No, my phone tree
would have lit up

if someone else was sick.

He eat anything this morning?

No.

Why?

It looks like
some sort of gelatin.

Any chance he could have gotten

into some bath beads
or laundry pods?

No, there's no such thing
in our house.

What about gummies?

No, we're very strict
about candy.

Right?

Oh, shit.

Danny.

What about Danny?

Your brother, he--

he gave me some gummies
he got in Cleveland.

They were in my coat pocket.

Are you fucking serious?

Pot gummies?

Yes. I'm so sorry.

Let me call the lab.
Maybe the tox screen is back.

Hey, this is Dr. Langdon
from the ED.

Can I fast-track a lab
on a little boy,

last name Jones,
first name Tyler, tox screen?

Get the fuck out!
I mean it.

Why don't we step outside,
and maybe you can help me

figure out
how much he may have taken.

Thanks.

I appreciate
that quick turnaround.

The labs confirm it.

Your son tested positive
for cannabis.

This is a fucking nightmare.

Theresa, David, this is
my attending, Dr. Robinavitch.

Hi, I'm Dr. Robby.

We need to do a pelvic exam.

And David, I don't think you
want to be in here for that.

Definitely not.

Can you have Nurse Perlah
come join me, please?

Do you want a coffee
or a soda or something?

Why do I need a pelvic exam?

Uh, you don't.

Your son seems like a nice kid.

He's clearly worried about you.

But your exam and your labs
are not matching

any of the usual diagnoses,

so I'm not really sure
what's going on.

I'm not here for me.

- I'm here for David.
- I don't understand.

He said that you've had
persistent vomiting,

some--some dehydration.

I made myself sick
with ipecac.

To induce vomiting?
Why would you do that?

So David would bring me here.

My son has some problems.

He needs professional help.

OK.
What kind of problems?

Drugs, alcohol?

I found some of his writing.

I thought it was schoolwork,
but it wasn't.

It was lists of girls
he wanted to hurt.

Hurt them how?

He said, "They should all
be eliminated."

Has David seen a therapist?

No.

He's not a bad kid,
but I'm afraid he's troubled,

and I didn't want
to call the police

because I was afraid
they'd overreact.

- He's just a kid.
- How old is David?

He just turned 18 last month.

Then he's considered an adult

and he would have to consent
to treatment.

Do you have any guns
in the house?

No.

My husband did,

but I got rid of all of them
after he passed.

He's a good soul.

I just don't want to see him
hurt anyone or himself.

How are you feeling, Crash?

I'd really appreciate
if you didn't call me that.

Why not?
It's a cool nickname.

You earned it.
You should own it.

I don't like it.

All right.
It's just a joke.

You know, if it makes you
feel any better,

I sharted the first time
I saw an emergency C-section.

Really?

Of course not.

Excuse me.
I'll be right back.

I got a situation.

18-year-old kid brings in
his dehydrated mom.

Dad died during the pandemic.

Mom's vomiting is self-induced
for the sole purpose

of getting him here
after she finds

his death list for classmates.

I--OK.

What does she want us to do?

Help him, protect him,
save him.

- Where is he now?
- Talking to McKay.

How are you doing?

Me? I'm good.

I'm always good.
You know that.

Do I?
Does anybody?

- I'm an open book.
- Not even close.

You do know you can always
come talk to me, right?

Yep.

- How's it going over here?
- Good, good.

We're just going over
aftercare instructions,

prescription medications,
special diet

for the next few days.

Dr. McKay, can you check
orthostatics on Mom?

I can.

David, I wanted you
to meet Kiara.

She's a social worker here
who helps

in situations like this.

We heard about
your father's passing.

We're really sorry.

And we know that it can put
a lot of pressure

on somebody your age,
which, combined with school

and now having to take care
of your mom, that's a lot.

It's fine.

We just want to make sure
that when your mom goes home,

you can handle it.

We want to make sure
you have someone

you can talk to if you need to.

I'm OK.

I don't need
to talk to anybody.

After a parent dies,

the sadness can last
a long time.

How's that going for you?

It's not a problem.

What about school?

What about it?

Anything you enjoy there?

Not really.

A lot of people have thoughts
that can disturb them.

If you've had any,
it's OK to talk about it.

What's that have to do
with my mom?

- Is she gonna be OK?
- Yeah, she's gonna be fine.

She's probably got
a stomach virus,

maybe food poisoning.

I think she's more worried
about you.

She always worries about me.

- Does she have a reason to?
- No.

It's almost 8:00.
I gotta go.

Are you sure you wouldn't
prefer to wait with your mom?

I'm late for school.

She can just call me
when she's ready.

It would actually be
kind of helpful

to talk to you some more.

Hey, David.

David.

Just give me five minutes.

Leave me alone!

Hey, David!

Shit.

Robby!

Robby.

Got a college kid,
respiratory arrest,

coming in hot.

Robby,
we need to intubate here.

Dr. Adamson just went down
with a pulse ox of 65.

Robby!