1
00:00:23,540 --> 00:00:25,460
Robby.

2
00:00:28,790 --> 00:00:30,300
Robby.

3
00:00:30,300 --> 00:00:31,920
College kid in
respiratory distress is here.

4
00:00:31,920 --> 00:00:33,340
- All right.
- You OK?

5
00:00:33,340 --> 00:00:35,090
Yep.

6
00:00:35,090 --> 00:00:37,140
I wanted to talk to the patient
in Central 12's son,

7
00:00:37,140 --> 00:00:38,340
but he took off.

8
00:00:38,350 --> 00:00:39,430
Is there a problem?

9
00:00:39,430 --> 00:00:40,760
Uh, according to Mom,

10
00:00:40,770 --> 00:00:41,850
she found a list
of high school girls

11
00:00:41,850 --> 00:00:44,890
that he'd like to eliminate.

12
00:00:44,890 --> 00:00:47,020
What's wrong
with kids these days?

13
00:00:47,020 --> 00:00:48,940
Uh, you mean
besides social media

14
00:00:48,940 --> 00:00:51,690
and the worldwide pandemic
and the environmental crisis?

15
00:00:51,690 --> 00:00:53,490
- Yeah, yeah, yeah.
- And gun violence?

16
00:00:53,490 --> 00:00:55,200
You're a fucking fountain
of hope today, aren't you?

17
00:00:55,200 --> 00:00:57,950
Nick Bradley, 19,
found unresponsive by parents.

18
00:00:57,950 --> 00:00:59,370
No meds, no allergies.

19
00:00:59,370 --> 00:01:00,950
On arrival,
he was barely breathing

20
00:01:00,950 --> 00:01:03,290
with pinpoint pupils,
bradycardic at 38.

21
00:01:03,290 --> 00:01:05,000
Pupils responded to Narcan,

22
00:01:05,000 --> 00:01:07,580
but we tubed him when his
respirations didn't pick up.

23
00:01:07,580 --> 00:01:09,580
Any drugs or alcohol
on the scene?

24
00:01:09,590 --> 00:01:11,130
- No.
- Signs of trauma?

25
00:01:11,130 --> 00:01:12,380
Nothing.

26
00:01:12,380 --> 00:01:14,050
OK.
Open your eyes, Nick.

27
00:01:14,050 --> 00:01:16,510
On three.
One, two, three.

28
00:01:18,430 --> 00:01:21,680
- Where was he found?
- In bed by his mom.

29
00:01:21,680 --> 00:01:26,180
Pupils are 6 millimeters,
non-reactive.

30
00:01:26,190 --> 00:01:28,690
Heart rate's 64.
BP is cycling.

31
00:01:28,690 --> 00:01:31,480
No response to pain.
GCS 3.

32
00:01:31,480 --> 00:01:34,030
- Does that fit any toxidrome?
- No.

33
00:01:34,030 --> 00:01:36,490
If it was just opiates
with Narcan,

34
00:01:36,490 --> 00:01:38,820
he'd be breathing on his own.

35
00:01:38,820 --> 00:01:41,030
Uh, beta blockers
shouldn't get pinpoint pupils.

36
00:01:41,030 --> 00:01:42,530
Maybe parents had some

37
00:01:42,540 --> 00:01:43,620
prescription meds
in their bathroom.

38
00:01:43,620 --> 00:01:45,290
They're on their way.

39
00:01:45,290 --> 00:01:47,410
<i>Code trauma, tier 1,
ETA five minutes.</i>

40
00:01:47,420 --> 00:01:49,750
That's a stand-up scooter
rider versus car door.

41
00:01:49,750 --> 00:01:52,000
- No helmet.
- No blood in the belly.

42
00:01:52,000 --> 00:01:57,130
No pericardial effusion,
and lungs are up.

43
00:01:57,130 --> 00:01:59,010
Hemocue's good, 15.

44
00:01:59,010 --> 00:02:01,850
- BP 84 over 58.
- OK.

45
00:02:01,850 --> 00:02:03,810
What's your plan, Dr. Collins?

46
00:02:03,810 --> 00:02:07,770
Um, push dose epi,
0.1 milligram.

47
00:02:07,770 --> 00:02:10,190
Foley for urine,
stabilize for CT,

48
00:02:10,190 --> 00:02:13,440
and throw a wide net.

49
00:02:17,570 --> 00:02:18,860
Where--
where are we going now?

50
00:02:18,860 --> 00:02:20,700
We need the room
for someone else,

51
00:02:20,700 --> 00:02:23,700
but you can rest in the hall
till we get your labs back.

52
00:02:25,370 --> 00:02:27,870
Your parents must be proud.

53
00:02:27,870 --> 00:02:30,080
Having a son for a doctor.

54
00:02:30,080 --> 00:02:32,750
Yeah, I guess.

55
00:02:32,750 --> 00:02:34,460
Um, you know,

56
00:02:34,460 --> 00:02:38,550
I was the first one
in my family to go to college.

57
00:02:38,550 --> 00:02:42,390
You know, they sacrificed a lot
to get me here.

58
00:02:42,390 --> 00:02:43,970
How's your pain, Mr. Milton?

59
00:02:43,970 --> 00:02:45,430
Uh, I'm fine.

60
00:02:45,430 --> 00:02:47,020
Could use a latte, though.

61
00:02:47,020 --> 00:02:49,270
That could bring back
the gallstone pain.

62
00:02:49,270 --> 00:02:50,770
How about a bourbon?

63
00:02:50,770 --> 00:02:52,480
It's barely 8:00.

64
00:02:52,480 --> 00:02:54,810
Uh, how about some ice chips?

65
00:02:54,820 --> 00:02:56,820
No, thanks.

66
00:02:56,820 --> 00:02:58,610
I prefer my whiskey neat.

67
00:02:58,610 --> 00:03:00,030
Yeah, that's not happening.

68
00:03:04,780 --> 00:03:07,490
Systolic back down to 90.

69
00:03:07,500 --> 00:03:09,500
Another 0.1 of epi.

70
00:03:09,500 --> 00:03:13,250
Flaccid paralysis
of all four extremities.

71
00:03:13,250 --> 00:03:16,130
No eye movement with ice water.

72
00:03:16,130 --> 00:03:17,710
So no brainstem function.

73
00:03:17,710 --> 00:03:19,090
Due to?

74
00:03:19,090 --> 00:03:21,550
Hypoxic injury,
massive hemorrhage.

75
00:03:21,550 --> 00:03:23,760
Samira, escort him to CT.

76
00:03:23,760 --> 00:03:25,800
Take the drug box with you.

77
00:03:25,810 --> 00:03:27,350
Call me if you need me.

78
00:03:27,350 --> 00:03:29,890
Hey, are you OK?

79
00:03:29,890 --> 00:03:31,640
- Yep.
- Are you sure?

80
00:03:31,640 --> 00:03:33,940
Have you ever had
to worry about me?

81
00:03:33,940 --> 00:03:36,270
No, but it never hurts
to check in.

82
00:03:36,270 --> 00:03:38,110
It's part of my job.

83
00:03:38,110 --> 00:03:40,440
Consider yourself checked in.

84
00:03:40,440 --> 00:03:41,950
OK.

85
00:03:42,990 --> 00:03:45,320
Ah, ah, ah, ah, ah.

86
00:03:45,320 --> 00:03:46,620
Got something?

87
00:03:46,620 --> 00:03:48,240
Oh, I had a case
for Dr. Collins.

88
00:03:48,240 --> 00:03:50,620
- May I see?
- Yeah.

89
00:03:50,620 --> 00:03:53,920
A 68-year-old male,
history of hypertension,

90
00:03:53,920 --> 00:03:55,630
one hour of right
upper quadrant pain

91
00:03:55,630 --> 00:03:57,880
after eating a fatty meal,
now resolved.

92
00:03:57,880 --> 00:03:59,300
Afebrile, non-tender.

93
00:03:59,300 --> 00:04:01,210
There was a gallstone present
on POCUS.

94
00:04:01,220 --> 00:04:03,720
EKG shows no acute
ischemic changes,

95
00:04:03,720 --> 00:04:06,010
but I'm still waiting
on LFTs and lipase.

96
00:04:06,010 --> 00:04:08,510
Why did you order the EKG?

97
00:04:08,510 --> 00:04:11,770
The nurse suggested it
to rule out any cardiac issues.

98
00:04:11,770 --> 00:04:14,310
Well, good call
on both your parts.

99
00:04:14,310 --> 00:04:15,650
Nurses know what they're doing.

100
00:04:15,650 --> 00:04:17,110
Never hesitate
to listen to them.

101
00:04:17,110 --> 00:04:18,690
Come find me when
those labs are back.

102
00:04:18,690 --> 00:04:20,150
- Hey, how's that finger?
- Oh, it's nothing.

103
00:04:20,150 --> 00:04:21,610
- Dr. Robby?
- Yep?

104
00:04:21,610 --> 00:04:23,030
The son and daughter
of Mr. Spencer

105
00:04:23,030 --> 00:04:24,610
from assisted living,
they're here.

106
00:04:24,610 --> 00:04:26,870
OK. I'll be right there.

107
00:04:33,750 --> 00:04:36,880
Your father has pneumonia
and a condition called sepsis.

108
00:04:36,880 --> 00:04:38,790
What is--
what is that exactly?

109
00:04:38,790 --> 00:04:41,130
It means that the bacteria
has spread from his lung

110
00:04:41,130 --> 00:04:42,710
to his bloodstream.

111
00:04:42,720 --> 00:04:45,260
So far, he's been
responding well to treatment.

112
00:04:45,260 --> 00:04:47,680
Hey, Pop.

113
00:04:47,680 --> 00:04:49,970
It's Helen and Jereme.

114
00:04:51,850 --> 00:04:54,180
Jereme...

115
00:04:54,190 --> 00:04:56,020
Hillary...

116
00:04:56,020 --> 00:04:57,230
Boob...

117
00:04:57,230 --> 00:04:58,940
Fud.

118
00:05:00,940 --> 00:05:03,820
It's the "Nowhere Man"
from "Yellow Submarine."

119
00:05:03,820 --> 00:05:06,150
It's what he used to call me
when I didn't do my homework.

120
00:05:06,160 --> 00:05:07,950
Is this his baseline?

121
00:05:07,950 --> 00:05:10,160
He has good days
and bad days.

122
00:05:11,700 --> 00:05:13,870
Why don't we step out
for one more second?

123
00:05:18,500 --> 00:05:20,670
So your father came in
with low blood pressure,

124
00:05:20,670 --> 00:05:22,000
which is improving.

125
00:05:22,000 --> 00:05:23,630
Can he go back
to assisted living?

126
00:05:23,630 --> 00:05:25,470
Eventually, we hope so.

127
00:05:25,470 --> 00:05:27,260
Your dad has
an advanced directive

128
00:05:27,260 --> 00:05:28,970
expressing his wishes,
which says that

129
00:05:28,970 --> 00:05:31,300
IV fluids and medications
are OK,

130
00:05:31,310 --> 00:05:33,770
but no artificial life support,
no CPR.

131
00:05:33,770 --> 00:05:36,560
He doesn't want a bunch
of machines keeping him alive.

132
00:05:36,560 --> 00:05:38,230
OK.

133
00:05:38,230 --> 00:05:40,020
Then we will continue
with oxygen

134
00:05:40,020 --> 00:05:42,520
and IV fluids and antibiotics,

135
00:05:42,530 --> 00:05:44,190
but if his lungs stop working,

136
00:05:44,190 --> 00:05:45,650
we're not going
to place a tube in his windpipe

137
00:05:45,650 --> 00:05:46,780
for a breathing machine.

138
00:05:46,780 --> 00:05:49,240
But pneumonia is treatable?

139
00:05:49,240 --> 00:05:51,990
Most of the time, it is.

140
00:05:51,990 --> 00:05:53,030
But if he can get better
in a week,

141
00:05:53,040 --> 00:05:54,290
then put him on a machine.

142
00:05:54,290 --> 00:05:56,120
That's not what <i>he</i> wanted.

143
00:05:56,120 --> 00:05:58,120
Do either of you have
durable power of attorney

144
00:05:58,120 --> 00:05:59,710
for health care?

145
00:05:59,710 --> 00:06:00,960
- Yes.
- We both do.

146
00:06:00,960 --> 00:06:02,130
OK.

147
00:06:02,130 --> 00:06:03,630
Well, this is a decision

148
00:06:03,630 --> 00:06:05,000
that does not need
to be made right now.

149
00:06:05,010 --> 00:06:06,550
Why don't you think about it?

150
00:06:06,550 --> 00:06:08,090
Talk about it.

151
00:06:08,090 --> 00:06:11,970
If things get worse,
sometimes allowing

152
00:06:11,970 --> 00:06:15,020
for a comfortable natural death
can be the most humane path.

153
00:06:18,440 --> 00:06:21,270
No routine cases until
we assess the tier 1.

154
00:06:21,270 --> 00:06:22,270
Thanks.

155
00:06:22,270 --> 00:06:24,860
Dr. Langdon?

156
00:06:24,860 --> 00:06:27,990
So, uh, how was the VA?

157
00:06:27,990 --> 00:06:30,740
Yeah, it was, uh good,
uh, you know, challenging.

158
00:06:30,740 --> 00:06:33,370
I learned a ton.
I just think it--

159
00:06:33,370 --> 00:06:34,700
maybe it should be mandatory

160
00:06:34,700 --> 00:06:35,740
that all doctors
spend time there,

161
00:06:35,750 --> 00:06:37,250
like, on a regular basis

162
00:06:37,250 --> 00:06:39,250
because of all
they've sacrificed for us.

163
00:06:39,250 --> 00:06:42,000
That's a nice thought.
Why'd you choose the Pitt?

164
00:06:42,000 --> 00:06:43,460
Oh, I have a sister
with special needs

165
00:06:43,460 --> 00:06:45,090
and she got into
this really great facility

166
00:06:45,090 --> 00:06:46,460
here in Pittsburgh.

167
00:06:46,460 --> 00:06:48,170
And PTMC has such
a great reputation,

168
00:06:48,170 --> 00:06:50,010
I thought, you know,
it'd be a good fit.

169
00:06:50,010 --> 00:06:51,090
Can I present my headache
to you?

170
00:06:51,090 --> 00:06:52,640
Uh, yeah, what do you got?

171
00:06:52,640 --> 00:06:54,510
A 36-year-old woman
with severe headache

172
00:06:54,510 --> 00:06:56,350
due to paracervical
trigger point.

173
00:06:56,350 --> 00:06:59,060
Her pain went from 11 to zero
after 2 ccs of IM Marcaine

174
00:06:59,060 --> 00:07:00,350
- to the--
- Wait, wait, wait.

175
00:07:00,350 --> 00:07:01,850
You did
a trigger point injection

176
00:07:01,850 --> 00:07:03,560
- before presenting the case?
- Yeah. I--

177
00:07:03,560 --> 00:07:05,820
Interns always present first.

178
00:07:05,820 --> 00:07:07,110
I spent a month at
the pain clinic at Hopkins.

179
00:07:07,110 --> 00:07:08,860
- No, it's not OK.
- Incoming!

180
00:07:08,860 --> 00:07:10,820
- I'm very comfortable with--
- It's definitely not OK.

181
00:07:10,820 --> 00:07:12,610
23-year-old Ben Kemper,
no helmet,

182
00:07:12,620 --> 00:07:14,450
got doored riding an e-scooter.

183
00:07:14,450 --> 00:07:16,450
Neck versus handlebar then
face-planted to the pavement.

184
00:07:16,450 --> 00:07:18,040
Obvious facial fractures,

185
00:07:18,040 --> 00:07:20,000
but alert and oriented
with good vitals.

186
00:07:22,380 --> 00:07:23,710
Here we go.

187
00:07:25,340 --> 00:07:27,550
One, two, three.

188
00:07:29,970 --> 00:07:31,260
How are we doing, Ben?

189
00:07:31,260 --> 00:07:33,640
Blood, back in my throat.

190
00:07:33,640 --> 00:07:35,430
That's probably
from the nosebleed.

191
00:07:35,430 --> 00:07:37,310
Short Rapid Rhino, please.

192
00:07:37,310 --> 00:07:40,520
Tachy at 120,
pulse ox borderline at 90.

193
00:07:40,520 --> 00:07:41,890
Blow by at 15 liters for now.

194
00:07:41,890 --> 00:07:43,480
- Neck contusion.
- BP 138 over 84.

195
00:07:43,480 --> 00:07:45,150
Larynx shifted to the right,
no crepitance.

196
00:07:45,150 --> 00:07:47,150
4 of morphine.

197
00:07:47,150 --> 00:07:51,650
I'm going to stick something in
your nose to stop the bleeding.

198
00:07:51,650 --> 00:07:53,360
No hemotympanum.

199
00:07:53,360 --> 00:07:56,240
Inflate the balloon.

200
00:07:56,240 --> 00:07:58,700
How about now, Ben?

201
00:07:58,700 --> 00:08:01,200
- Better.
- What's up?

202
00:08:01,210 --> 00:08:04,420
Good vitals,
A and O, let's have a look.

203
00:08:08,300 --> 00:08:09,630
Ouch.

204
00:08:09,630 --> 00:08:12,340
- Floating face.
- Le Fort III fracture.

205
00:08:12,340 --> 00:08:14,760
You don't see that every day.
OK, let's prep for airway.

206
00:08:14,760 --> 00:08:17,050
Double setup just in case.

207
00:08:30,900 --> 00:08:34,110
- Nice work.
- Thanks.

208
00:08:34,110 --> 00:08:36,200
All right, Mr. Tagari,
you are good to go.

209
00:08:36,200 --> 00:08:37,870
Oh, thank you.

210
00:08:37,870 --> 00:08:42,200
Remember, 10% off
for doctors and nurses.

211
00:08:42,200 --> 00:08:43,620
I'm a student doctor.

212
00:08:43,620 --> 00:08:45,670
Oh, right. Sorry.

213
00:08:45,670 --> 00:08:48,040
- I hit my head, remember?
- Well, my son loves pizza,

214
00:08:48,040 --> 00:08:49,630
so I will take you up on it
for sure, OK?

215
00:08:49,630 --> 00:08:50,880
- Thank you. Thank you.
- Thank you.

216
00:08:50,880 --> 00:08:52,630
- Wait for a nurse.
- OK, thanks.

217
00:08:52,630 --> 00:08:54,590
Hi.

218
00:08:54,590 --> 00:08:57,180
I just realized it sounds like
I always feed my kid junk food.

219
00:08:57,180 --> 00:08:58,390
- Oh.
- You know?

220
00:08:58,390 --> 00:08:59,930
Pizza, s'mores.

221
00:08:59,930 --> 00:09:02,810
No, no, please.
I--I like pizza and s'mores.

222
00:09:02,810 --> 00:09:05,640
- Who doesn't?
- Mm.

223
00:09:05,640 --> 00:09:09,190
- How many kids do you have?
- Just one, Harrison.

224
00:09:09,190 --> 00:09:11,610
He's 11 now.

225
00:09:11,610 --> 00:09:12,980
What does your husband do?

226
00:09:12,990 --> 00:09:14,940
No husband,
just me and my son.

227
00:09:14,950 --> 00:09:16,400
I take it you don't have kids?

228
00:09:16,410 --> 00:09:18,780
I--I don't mean on account
of your age.

229
00:09:18,780 --> 00:09:20,410
Or maybe I do.

230
00:09:20,410 --> 00:09:22,370
I mean, most medical students
don't have kids.

231
00:09:22,370 --> 00:09:25,960
Oh, yeah, no, no.
Um, no kids.

232
00:09:25,960 --> 00:09:29,250
Just not even a boyfriend.
Uh, it's just school for now.

233
00:09:29,250 --> 00:09:31,250
Yeah.
That'll keep you pretty busy.

234
00:09:31,250 --> 00:09:33,590
I do not miss it.

235
00:09:33,590 --> 00:09:35,880
Must have been difficult
as a young mother.

236
00:09:35,880 --> 00:09:37,380
It had its moments,

237
00:09:37,390 --> 00:09:39,090
but my life has been
full of challenges,

238
00:09:39,100 --> 00:09:42,390
and med school was not one
of the hardest, by far.

239
00:09:42,390 --> 00:09:44,720
It was one of the most
rewarding, though.

240
00:09:44,730 --> 00:09:48,480
- Other than having my son.
- Hey.

241
00:09:48,480 --> 00:09:50,940
Facial lash with possible
foreign object in the eye,

242
00:09:50,940 --> 00:09:54,360
which is always a solid 7
on the WMMV Scale.

243
00:09:54,360 --> 00:09:56,070
What Makes Mateo Vomit.

244
00:09:59,320 --> 00:10:01,990
- You OK?
- Yeah.

245
00:10:01,990 --> 00:10:05,580
Yeah.
Um, he's funny, the...

246
00:10:05,580 --> 00:10:07,000
- the nurse.
- Oh, Mateo.

247
00:10:07,000 --> 00:10:08,710
You can say his name.

248
00:10:10,000 --> 00:10:12,340
Um, yeah, uh...

249
00:10:12,340 --> 00:10:15,510
a foreign object in the eye
could be really serious.

250
00:10:22,350 --> 00:10:25,470
Hey, Fruitcake.

251
00:10:25,470 --> 00:10:26,890
Hey, I'm talking to you,
Fruitcake.

252
00:10:26,890 --> 00:10:28,640
Myrna, I told you
a hundred times

253
00:10:28,640 --> 00:10:31,060
my name is Dr. Robby.

254
00:10:31,060 --> 00:10:33,190
You want to see my vagina?

255
00:10:33,190 --> 00:10:35,280
I have already seen it.

256
00:10:35,280 --> 00:10:38,150
And once was enough,
thank you.

257
00:10:38,150 --> 00:10:40,200
Robby,
parents of Nick Bradley,

258
00:10:40,200 --> 00:10:42,990
- the OD teen, are here.
- OK, park them in Trauma 1.

259
00:10:42,990 --> 00:10:44,780
He's not back from CT yet.

260
00:10:44,790 --> 00:10:46,040
I'll be right there
in a minute.

261
00:10:46,040 --> 00:10:47,370
Got it.
Behaving yourself, Myrna?

262
00:10:47,370 --> 00:10:49,290
Oh, yes, ma'am.

263
00:10:53,000 --> 00:10:54,000
How we doing?

264
00:10:54,000 --> 00:10:55,090
Ketamine and sux on board.

265
00:10:55,090 --> 00:10:56,800
Pulse ox holding at 94.

266
00:10:56,800 --> 00:10:58,170
Prepping the neck
just in case.

267
00:10:58,170 --> 00:10:59,220
Let's have a look.

268
00:11:01,510 --> 00:11:03,470
A little deeper.

269
00:11:03,470 --> 00:11:05,060
Lots of swelling.
I can't see the cords.

270
00:11:05,060 --> 00:11:07,600
To the right.
The left.

271
00:11:07,600 --> 00:11:09,140
Yeah, it really distorted
from the trauma,

272
00:11:09,140 --> 00:11:10,310
and the edema's
only going to get worse.

273
00:11:10,310 --> 00:11:11,730
Which is why we should crike.

274
00:11:11,730 --> 00:11:13,520
You don't crike
a laryngeal fracture.

275
00:11:13,520 --> 00:11:14,770
Don't listen to
Edwina Scissorhands here.

276
00:11:14,770 --> 00:11:16,190
If they can't cut it,

277
00:11:16,190 --> 00:11:17,820
surgery doesn't know
how to fix it.

278
00:11:17,820 --> 00:11:19,490
The contusion is high
at the thyroid cartilage,

279
00:11:19,490 --> 00:11:21,110
so you just stand there
looking pretty, ER Ken,

280
00:11:21,110 --> 00:11:23,570
and let me fix this.

281
00:11:23,570 --> 00:11:24,990
- We're down to 85.
- All right, pull out.

282
00:11:24,990 --> 00:11:27,240
- I-gel, bag and crike.
- I-gel, please.

283
00:11:27,240 --> 00:11:28,540
Turn off the alarm.

284
00:11:28,540 --> 00:11:29,620
I've never done
a crike before.

285
00:11:29,620 --> 00:11:31,000
No. Mel will do the crike.

286
00:11:31,000 --> 00:11:32,120
You've already had
a busy morning.

287
00:11:32,120 --> 00:11:33,500
Glove up, Mel.

288
00:11:33,500 --> 00:11:35,000
No, I'm doing the crike, doctor.

289
00:11:35,000 --> 00:11:36,000
You would be doing it,
<i>doctor,</i>

290
00:11:36,000 --> 00:11:37,460
if it wasn't an odd day.

291
00:11:37,460 --> 00:11:38,710
Surgery gets even days,
ED gets odd days.

292
00:11:38,710 --> 00:11:40,420
You know this.
For crikes' sake.

293
00:11:40,420 --> 00:11:42,090
That's because you're
all fucking odd down here.

294
00:11:42,090 --> 00:11:43,890
OK, team work, please.
Let's focus on the patient.

295
00:11:43,890 --> 00:11:45,890
I so appreciate
your gracious understanding.

296
00:11:45,890 --> 00:11:47,600
I'll assist in case
she screws up.

297
00:11:47,600 --> 00:11:49,680
Yolanda, play nice.

298
00:11:49,680 --> 00:11:51,230
Sats are up with the I-gel.

299
00:11:51,230 --> 00:11:53,650
You ready?
Hello?

300
00:11:53,650 --> 00:11:55,440
Oh, uh, hello.

301
00:11:55,440 --> 00:11:56,940
You've done this?

302
00:11:56,940 --> 00:12:00,490
Yes, in the cadaver lab.

303
00:12:00,490 --> 00:12:03,530
Let's hope that's not where
this poor soul ends up.

304
00:12:03,530 --> 00:12:05,410
We'll do an open technique
since we have a minute.

305
00:12:05,410 --> 00:12:07,580
OK.

306
00:12:07,580 --> 00:12:09,620
OK, you're going to be
making a vertical incision

307
00:12:09,620 --> 00:12:12,210
to avoid the jugulars
in the carotids.

308
00:12:13,710 --> 00:12:15,420
Mm-hmm, good.

309
00:12:15,420 --> 00:12:17,090
If this was a crike that needed
to happen in seconds,

310
00:12:17,090 --> 00:12:20,090
you could use a 10 blade,
your finger, and a bougie.

311
00:12:23,510 --> 00:12:25,010
This is called a Weitlaner.

312
00:12:25,010 --> 00:12:27,470
And this is your trake hook.

313
00:12:27,470 --> 00:12:31,350
C-spine, head CT, OMF.
Start a propofol drip.

314
00:12:31,350 --> 00:12:33,060
OK, now we're going to make
a horizontal incision

315
00:12:33,060 --> 00:12:35,150
across
the cricothyroid membrane.

316
00:12:37,570 --> 00:12:39,690
Yeah.

317
00:12:39,690 --> 00:12:41,690
4.0 Shiley next.

318
00:12:41,690 --> 00:12:42,950
Get ready to bag the crike.

319
00:12:44,780 --> 00:12:46,870
Yeah, yeah, yeah, good.

320
00:12:54,170 --> 00:12:55,080
Oh, excuse me.

321
00:12:55,080 --> 00:12:57,250
No worries.

322
00:12:57,250 --> 00:12:58,540
End tidal CO2 is yellow.

323
00:12:58,540 --> 00:13:00,130
Yellow is yes.
Nicely done.

324
00:13:00,130 --> 00:13:03,170
Sew it in.
OK, I will be next-door.

325
00:13:04,930 --> 00:13:06,180
Does your resident
know how to suture,

326
00:13:06,180 --> 00:13:07,590
or do I need to teach?

327
00:13:07,600 --> 00:13:10,640
- You're all class, Yoyo.
- I know, thanks.

328
00:13:10,640 --> 00:13:13,100
That means a lot of nothing
coming from you.

329
00:13:13,100 --> 00:13:15,600
- Mel, you OK?
- If you're done fighting.

330
00:13:15,600 --> 00:13:17,100
We're not fighting.
This is playing.

331
00:13:17,100 --> 00:13:18,900
Langdon's too soft to fight.

332
00:13:18,900 --> 00:13:20,900
Oh, yeah, I have nothing
but respect for Dr. Garcia.

333
00:13:20,900 --> 00:13:22,360
In fact, I think she would

334
00:13:22,360 --> 00:13:24,240
make a wonderful hostess
at Applebee's.

335
00:13:24,240 --> 00:13:25,740
Later, Odds.

336
00:13:28,070 --> 00:13:29,870
Let's go.

337
00:13:29,870 --> 00:13:31,530
OK, thanks.

338
00:13:31,540 --> 00:13:34,000
Just received word
your son's head CT is normal,

339
00:13:34,000 --> 00:13:35,830
and he's maintaining
a good heart rate.

340
00:13:35,830 --> 00:13:38,040
- You got him back.
- Thank you. Thank God.

341
00:13:38,040 --> 00:13:39,500
Right now, he's unconscious

342
00:13:39,500 --> 00:13:42,750
with a tube in his throat
for oxygen.

343
00:13:42,760 --> 00:13:44,260
Why don't we step out
for a minute while they

344
00:13:44,260 --> 00:13:45,840
get him settled,
and then you can come back?

345
00:13:45,840 --> 00:13:48,300
You can sit with him
as long as you want.

346
00:13:48,300 --> 00:13:50,760
Nicky, it's Mama.
I'm here, baby.

347
00:13:50,760 --> 00:13:53,220
You're doing great, son.

348
00:13:53,220 --> 00:13:56,100
Blown.

349
00:13:56,100 --> 00:13:59,520
- OK, let's step outside.
- OK.

350
00:14:05,700 --> 00:14:07,570
So we don't know

351
00:14:07,570 --> 00:14:09,610
how long he was at home
without breathing.

352
00:14:09,620 --> 00:14:12,830
- He's breathing now.
- Not on his own.

353
00:14:12,830 --> 00:14:14,120
But he's going to wake up.

354
00:14:14,120 --> 00:14:15,870
We certainly hope so.

355
00:14:15,870 --> 00:14:17,160
We're going
to know better after

356
00:14:17,160 --> 00:14:18,620
we get some more
test results back.

357
00:14:18,620 --> 00:14:21,380
Are you sure that
he didn't take anything

358
00:14:21,380 --> 00:14:22,460
that could have caused this?

359
00:14:22,460 --> 00:14:24,210
No, no, he's a good kid.

360
00:14:24,210 --> 00:14:26,460
He's in college,
he has a part-time job.

361
00:14:26,470 --> 00:14:29,760
He even chose to live at home
so he could focus on school.

362
00:14:29,760 --> 00:14:31,640
Dr. Robby.
From the urine.

363
00:14:31,640 --> 00:14:34,140
What's that?

364
00:14:34,140 --> 00:14:35,470
It's a drug test.

365
00:14:35,470 --> 00:14:38,100
And it is positive
for fentanyl.

366
00:14:38,100 --> 00:14:40,850
No, that is impossible.
Nick doesn't do drugs.

367
00:14:40,860 --> 00:14:43,190
There are a lot of pills
that are sold illegally

368
00:14:43,190 --> 00:14:45,400
that have fentanyl,
not just painkillers.

369
00:14:45,400 --> 00:14:47,110
Xanax, Ativan.

370
00:14:47,110 --> 00:14:49,610
- No, not our son.
- Uh--

371
00:14:49,610 --> 00:14:51,240
Well, maybe he didn't know
that he took something

372
00:14:51,240 --> 00:14:52,780
with fentanyl, I don't know.

373
00:14:52,780 --> 00:14:55,040
The hows and the whys
don't really matter.

374
00:14:55,040 --> 00:14:57,000
What matters is
spending time with Nick.

375
00:14:57,000 --> 00:14:58,370
We've got some
more tests to run.

376
00:14:58,370 --> 00:14:59,460
We'll know our options
after that,

377
00:14:59,460 --> 00:15:00,830
but in the meantime,

378
00:15:00,830 --> 00:15:02,750
why don't you take a seat
and talk to him?

379
00:15:05,300 --> 00:15:06,550
Can he hear us?

380
00:15:06,550 --> 00:15:07,880
You know,
we're never really sure,

381
00:15:07,880 --> 00:15:09,840
so we should assume
that he can.

382
00:15:09,840 --> 00:15:12,220
And we'll come find you
as soon as we know more, OK?

383
00:15:12,220 --> 00:15:13,220
OK.

384
00:15:19,810 --> 00:15:21,940
Can we move Nick Bradley
to a private room?

385
00:15:21,940 --> 00:15:23,480
The kid going to make it?

386
00:15:24,980 --> 00:15:26,780
Didn't he respond to Narcan?

387
00:15:26,780 --> 00:15:28,820
I think his pinpoint pupils
just grew into blown pupils

388
00:15:28,820 --> 00:15:29,940
from brainstem death.

389
00:15:29,950 --> 00:15:33,280
- Shit.
- Yeah.

390
00:15:33,280 --> 00:15:35,830
Not much older than Jake.

391
00:15:35,830 --> 00:15:37,160
Don't go there.

392
00:15:38,660 --> 00:15:41,250
Hard not to sometimes.

393
00:15:41,250 --> 00:15:43,420
Mr. Spencer's room.

394
00:15:43,420 --> 00:15:45,210
Hey, Robby,

395
00:15:45,210 --> 00:15:47,420
Theresa, the mother of the
young man David who bolted,

396
00:15:47,420 --> 00:15:48,760
she's asking for her son.

397
00:15:48,760 --> 00:15:50,260
OK.
I'll be there in a minute.

398
00:15:50,260 --> 00:15:51,720
What is happening?

399
00:15:51,720 --> 00:15:54,550
Uh, his oxygen levels
are dropping.

400
00:15:54,550 --> 00:15:56,850
Mr. Spencer,
how are you feeling?

401
00:15:56,850 --> 00:15:59,390
I don't remember
where I parked.

402
00:15:59,390 --> 00:16:01,350
Mr. Spencer,
do you know where you are?

403
00:16:01,350 --> 00:16:03,770
It's so loud in here.

404
00:16:03,770 --> 00:16:06,270
Dad?
Do you know where you are?

405
00:16:06,270 --> 00:16:08,690
Dad, look at me.
What's my name?

406
00:16:08,690 --> 00:16:12,820
I don't know where my car is.

407
00:16:12,820 --> 00:16:14,530
BiPAP, 15 over 5.

408
00:16:14,530 --> 00:16:15,870
Let's step out.

409
00:16:20,200 --> 00:16:22,000
What's a BiPAP?

410
00:16:22,000 --> 00:16:25,330
It is a pressurized air mask
that can improve his oxygen.

411
00:16:25,330 --> 00:16:26,790
Either his pneumonia
is getting worse

412
00:16:26,790 --> 00:16:28,800
or his heart couldn't
handle the fluids

413
00:16:28,800 --> 00:16:30,590
that we gave him
to treat the sepsis.

414
00:16:30,590 --> 00:16:32,090
His lungs are filling up
with fluid.

415
00:16:32,090 --> 00:16:33,550
Can't you take
the fluid away?

416
00:16:33,550 --> 00:16:35,390
Not without his
blood pressure crashing

417
00:16:35,390 --> 00:16:36,680
with very bad consequences,

418
00:16:36,680 --> 00:16:38,810
so let's just hope
the BiPAP works.

419
00:16:38,810 --> 00:16:40,810
And if it doesn't?

420
00:16:40,810 --> 00:16:43,230
Then I would need
to know your decision

421
00:16:43,230 --> 00:16:44,640
about using
a breathing machine.

422
00:16:44,650 --> 00:16:46,650
We're still talking about it.

423
00:16:46,650 --> 00:16:48,940
Well, we know
he expressed <i>his</i> wishes.

424
00:16:48,940 --> 00:16:51,030
In writing.
"Do not intubate."

425
00:16:51,030 --> 00:16:54,110
We're thinking
try it for a week.

426
00:16:54,110 --> 00:16:57,410
That would be
a very painful week.

427
00:16:57,410 --> 00:17:00,160
He wouldn't get a lot of rest
with all the monitors

428
00:17:00,160 --> 00:17:02,370
and all the blood tests.
He might need to be sedated.

429
00:17:02,370 --> 00:17:03,870
He might need to be restrained

430
00:17:03,870 --> 00:17:05,960
because he'd be
in an unfamiliar place

431
00:17:05,960 --> 00:17:08,590
with a very uncomfortable tube
down his throat.

432
00:17:08,590 --> 00:17:10,920
And he wouldn't really know
what was happening.

433
00:17:10,920 --> 00:17:14,420
Elderly patients
can often develop psychosis.

434
00:17:14,430 --> 00:17:17,720
- But he might get better.
- Or he might get worse.

435
00:17:17,720 --> 00:17:19,970
What would you do?

436
00:17:19,970 --> 00:17:21,720
I really
can't answer that for you.

437
00:17:21,720 --> 00:17:23,270
This is your father.
It's your decision to make.

438
00:17:23,270 --> 00:17:24,930
I can guarantee you

439
00:17:24,940 --> 00:17:26,770
that we will keep him
as comfortable as possible

440
00:17:26,770 --> 00:17:28,610
if a natural death
is what you choose.

441
00:17:28,610 --> 00:17:30,360
But he's not your father.

442
00:17:30,360 --> 00:17:32,110
And he can recover from this.

443
00:17:32,110 --> 00:17:33,820
What my sister means

444
00:17:33,820 --> 00:17:35,860
is that we're still deciding
the best thing to do.

445
00:17:38,910 --> 00:17:40,990
Well, the sooner you decide,
the better.

446
00:17:40,990 --> 00:17:42,370
I'm really sorry.

447
00:17:42,370 --> 00:17:44,330
I wish there was more
that I could do.

448
00:17:44,330 --> 00:17:46,710
I'm not sure that
he has that much time left.

449
00:17:53,090 --> 00:17:55,260
Dr. Robby.

450
00:18:01,640 --> 00:18:03,220
You were right.

451
00:18:03,220 --> 00:18:04,850
She can't say whether
she was bumped by accident

452
00:18:04,850 --> 00:18:06,690
- or shoved on purpose.
- No other witnesses?

453
00:18:06,690 --> 00:18:09,270
No, not really.

454
00:18:09,270 --> 00:18:11,230
We pulled security footage.
Maybe we'll find something.

455
00:18:11,230 --> 00:18:13,480
Hopefully she tripped.

456
00:18:13,480 --> 00:18:14,940
I don't mean
I hope she tripped.

457
00:18:14,940 --> 00:18:17,450
I mean I hope she wasn't
pushed on purpose.

458
00:18:17,450 --> 00:18:19,360
That would this a hate crime.

459
00:18:19,370 --> 00:18:21,910
Yes, ma'am.

460
00:18:21,910 --> 00:18:24,080
- Ma'am?
- Doctor.

461
00:18:24,080 --> 00:18:26,250
Sorry.
I'm--I'm sorry.

462
00:18:27,420 --> 00:18:28,500
No harm, no foul.

463
00:18:28,500 --> 00:18:32,880
Will you let me know
if she says anything else?

464
00:18:34,300 --> 00:18:35,920
Will do.

465
00:18:38,590 --> 00:18:39,880
At the risk of seeming--

466
00:18:39,890 --> 00:18:41,090
Then you probably shouldn't.

467
00:18:41,100 --> 00:18:43,430
- I just--
- No, trust me.

468
00:18:43,430 --> 00:18:45,180
- How do you know--
- I just know.

469
00:18:45,180 --> 00:18:48,140
- I just wanted--
- I know.

470
00:18:48,140 --> 00:18:51,060
Look, I'll let you know
if she says anything else

471
00:18:51,060 --> 00:18:53,820
that could be important
to your investigation.

472
00:18:57,450 --> 00:18:59,320
Thank you.

473
00:18:59,320 --> 00:19:02,280
- You know, for the record--
- Nope.

474
00:19:12,330 --> 00:19:15,250
Any luck getting our
psych boarders upstairs?

475
00:19:15,250 --> 00:19:18,590
Yeah, right, at least
the Kraken's still sleeping.

476
00:19:20,090 --> 00:19:21,220
Is it me or was
that officer--

477
00:19:21,220 --> 00:19:23,260
- No.
- What?

478
00:19:23,260 --> 00:19:26,560
- You don't even know what I--
- What you were going to say?

479
00:19:26,560 --> 00:19:29,600
Maybe you do.

480
00:19:29,600 --> 00:19:31,560
- He seemed nice.
- Absolutely not.

481
00:19:31,560 --> 00:19:33,440
Mm-mm.

482
00:19:33,440 --> 00:19:34,980
There is no possible scenario

483
00:19:34,980 --> 00:19:37,400
in which you and I
have this conversation.

484
00:19:37,400 --> 00:19:39,280
You of all people
should know better.

485
00:19:39,280 --> 00:19:42,030
- I was--
- No.

486
00:19:42,030 --> 00:19:43,660
Just walk away.

487
00:19:43,660 --> 00:19:46,830
Best possible scenario.
Just keep on walking.

488
00:19:46,830 --> 00:19:48,660
Mm-hmm.

489
00:19:48,660 --> 00:19:51,580
You got to lay off mixing
Adderall and energy drinks.

490
00:19:51,580 --> 00:19:52,920
Trust me, I will.

491
00:19:52,920 --> 00:19:55,040
All right. Thanks.

492
00:19:56,380 --> 00:19:57,800
That's the thing about
emergency medicine.

493
00:19:57,800 --> 00:19:59,300
You never know what
you're going to get.

494
00:19:59,300 --> 00:20:01,220
And we get everything.

495
00:20:01,220 --> 00:20:02,470
Is that why you chose it?

496
00:20:02,470 --> 00:20:04,180
Maybe a little.

497
00:20:04,180 --> 00:20:05,680
I also get to pick my shifts,

498
00:20:05,680 --> 00:20:08,350
which, for a single mother,
is amazing.

499
00:20:08,350 --> 00:20:11,060
But mostly, I just like
the people, you know?

500
00:20:11,060 --> 00:20:12,730
They're always there
when you need them.

501
00:20:12,730 --> 00:20:14,360
Who wouldn't want to
be a part of that, you know?

502
00:20:17,110 --> 00:20:18,980
Fuck off.

503
00:20:25,280 --> 00:20:27,120
<i>This is the
monitoring center.</i>

504
00:20:27,120 --> 00:20:29,040
<i>We see that you are not
in your inclusion zone.</i>

505
00:20:29,040 --> 00:20:31,080
<i>Do you have permission
to be outside this area?</i>

506
00:20:31,080 --> 00:20:33,620
Yes, I am at work.

507
00:20:33,620 --> 00:20:37,460
Just like last time
and the time before that.

508
00:20:39,050 --> 00:20:40,170
I'll be right back.

509
00:20:42,300 --> 00:20:44,680
What is the point
of this fucking thing

510
00:20:44,680 --> 00:20:46,300
if it doesn't even work?

511
00:20:54,060 --> 00:20:55,440
Sorry.

512
00:20:55,440 --> 00:20:57,440
You're doing great.
Take your time.

513
00:20:57,440 --> 00:20:58,480
You OK?

514
00:20:58,480 --> 00:20:59,980
I am--yeah.

515
00:20:59,980 --> 00:21:01,400
I get frustrated
when I can't do things,

516
00:21:01,400 --> 00:21:02,900
or at least it looks like it.

517
00:21:02,900 --> 00:21:05,110
Yeah, you and me both.

518
00:21:05,110 --> 00:21:08,450
Thanks, but my frustration
manifests itself emotionally,

519
00:21:08,450 --> 00:21:10,330
and then, uh, I get upset,

520
00:21:10,330 --> 00:21:12,160
and then it looks like
I can't handle things,

521
00:21:12,160 --> 00:21:14,330
and, you know, then I can't cry
in front of the patient

522
00:21:14,330 --> 00:21:15,540
because no one wants
to see their doctor cry.

523
00:21:15,540 --> 00:21:17,290
That's just a big red flag.

524
00:21:17,290 --> 00:21:20,550
You just did a perfect crike.
You're doing great.

525
00:21:23,720 --> 00:21:25,680
Hey, you!
Pasty white!

526
00:21:25,680 --> 00:21:27,140
How about a sandwich?

527
00:21:27,140 --> 00:21:30,430
Uh, what brings you
here today, sir?

528
00:21:30,430 --> 00:21:33,310
I'm here
for a fucking sandwich.

529
00:21:33,310 --> 00:21:35,060
OK.

530
00:21:35,060 --> 00:21:37,980
OK, uh, excuse me...

531
00:21:37,980 --> 00:21:39,400
- Perlah.
- Perlah.

532
00:21:39,400 --> 00:21:41,270
Can this patient
get a sandwich?

533
00:21:41,280 --> 00:21:42,730
I already gave you
a sandwich, Earl.

534
00:21:42,740 --> 00:21:45,650
I ain't ate this whole week.

535
00:21:45,650 --> 00:21:47,320
Sure.

536
00:21:47,320 --> 00:21:49,160
Give him another sandwich.
They're on the food cart.

537
00:21:49,160 --> 00:21:50,370
Just make sure
it's not egg salad,

538
00:21:50,370 --> 00:21:51,910
or he'll throw it on the floor.

539
00:21:51,910 --> 00:21:53,790
OK. Good to know.
Thanks.

540
00:22:08,340 --> 00:22:09,970
Any quick ones up here?

541
00:22:09,970 --> 00:22:11,760
It's only 8:30,
and Robby's already on my case

542
00:22:11,760 --> 00:22:13,720
for being too slow.

543
00:22:13,720 --> 00:22:14,850
I can usually at least
make it to lunch

544
00:22:14,850 --> 00:22:16,480
before he starts hounding me.

545
00:22:16,480 --> 00:22:18,350
Cut him a little slack
today, OK?

546
00:22:18,350 --> 00:22:20,940
It's the anniversary
of Dr. Adamson's death.

547
00:22:20,940 --> 00:22:23,570
That's sad.

548
00:22:23,570 --> 00:22:26,240
But it's still no reason
to take it out on me.

549
00:22:26,240 --> 00:22:27,950
I'm just saying.

550
00:22:27,950 --> 00:22:30,490
- Dr. Mohan?
- Samira, please.

551
00:22:30,490 --> 00:22:32,490
I just wanted to apologize.

552
00:22:32,490 --> 00:22:35,540
When my phone went off earlier,
that was really unprofessional.

553
00:22:35,540 --> 00:22:36,910
Don't sweat it.
Trust me.

554
00:22:36,910 --> 00:22:38,290
We need to laugh.

555
00:22:38,290 --> 00:22:39,830
Otherwise,
we'd never stop crying.

556
00:22:39,830 --> 00:22:41,170
Thank you.

557
00:22:41,170 --> 00:22:42,590
Besides,
with all the craziness

558
00:22:42,590 --> 00:22:43,920
that comes through here
every hour,

559
00:22:43,920 --> 00:22:45,710
nobody cares or notices.

560
00:22:45,720 --> 00:22:48,090
Got an unresponsive
unhoused man coming in.

561
00:22:48,090 --> 00:22:52,180
Might be a good teaching case,
Funky Music.

562
00:22:54,310 --> 00:22:55,640
Let's go.

563
00:22:55,640 --> 00:22:57,020
Caucasian male,

564
00:22:57,020 --> 00:22:58,640
approximately
60 to 70 years old,

565
00:22:58,640 --> 00:23:01,980
found unresponsive.
No signs of trauma, no ID.

566
00:23:03,440 --> 00:23:05,110
On three.

567
00:23:05,110 --> 00:23:07,400
One, two, three.

568
00:23:09,700 --> 00:23:12,120
Oof.
Did you take anything?

569
00:23:12,120 --> 00:23:13,620
I smell the alcohol
from here.

570
00:23:13,620 --> 00:23:14,830
This guy's wearing
the spring, summer,

571
00:23:14,830 --> 00:23:16,000
and fall collection.

572
00:23:17,200 --> 00:23:18,370
Oh! Whoa!

573
00:23:18,370 --> 00:23:20,120
- Jesus, uh--
- Oh, oh, oh!

574
00:23:20,120 --> 00:23:21,210
What the--

575
00:23:21,210 --> 00:23:22,540
Oh!

576
00:23:22,540 --> 00:23:25,210
Uh, what's wrong?
What's going on?

577
00:23:25,210 --> 00:23:28,170
Patient tested positive
for rats.

578
00:23:28,170 --> 00:23:29,590
No.

579
00:23:29,590 --> 00:23:33,140
If it matters,
I only counted three.

580
00:23:33,140 --> 00:23:34,640
Oh, there goes one.

581
00:23:39,190 --> 00:23:41,270
Because your son
tested positive for THC,

582
00:23:41,270 --> 00:23:43,440
the psychoactive ingredient
in cannabis,

583
00:23:43,440 --> 00:23:45,110
we're going to have to
admit him for overnight

584
00:23:45,110 --> 00:23:47,110
observation and monitoring.

585
00:23:47,110 --> 00:23:49,190
And what about his brain?

586
00:23:49,200 --> 00:23:51,610
Is there a chance that much pot
is going to do some damage?

587
00:23:51,610 --> 00:23:53,030
He's only four.

588
00:23:53,030 --> 00:23:54,700
The honest answer
is we don't know.

589
00:23:54,700 --> 00:23:56,280
There haven't been
any long-term studies,

590
00:23:56,290 --> 00:23:58,040
but the fact that this is
a one-time occurrence

591
00:23:58,040 --> 00:24:00,250
suggests that there should be
no long-term effects.

592
00:24:00,250 --> 00:24:01,960
But you don't know.

593
00:24:01,960 --> 00:24:04,130
So my son could end up
with learning disabilities,

594
00:24:04,130 --> 00:24:06,630
psychiatric problems,
or even autism because of this.

595
00:24:06,630 --> 00:24:08,420
There's no evidence
to suggest any of that.

596
00:24:08,420 --> 00:24:11,170
Hello.
I'm Kiara Alfaro.

597
00:24:11,180 --> 00:24:13,090
I'm the department
social worker.

598
00:24:13,090 --> 00:24:16,010
Kiara will help you
navigate the next steps.

599
00:24:16,010 --> 00:24:17,310
What steps?

600
00:24:17,310 --> 00:24:18,850
Well, a case like this

601
00:24:18,850 --> 00:24:21,890
requires mandatory reporting
to child services

602
00:24:21,890 --> 00:24:23,980
- and sometimes law enforcement.
- No.

603
00:24:23,980 --> 00:24:25,150
Why--why do you have
to involve the police?

604
00:24:25,150 --> 00:24:26,480
It's a controlled substance.

605
00:24:26,480 --> 00:24:28,150
They're not taking
my kid away.

606
00:24:28,150 --> 00:24:30,030
- They were pot gummies.
- No one's suggesting that.

607
00:24:30,030 --> 00:24:32,150
Well, fuck your suggestions!
No one is touching my child!

608
00:24:32,150 --> 00:24:33,660
In fact, we're leaving.

609
00:24:33,660 --> 00:24:35,160
Well you--
no, you can't take your son.

610
00:24:35,160 --> 00:24:36,740
He could stop breathing.
He could have a seizure.

611
00:24:36,740 --> 00:24:38,330
- I will observe him at home.
- Amanda, please.

612
00:24:38,330 --> 00:24:39,990
- Fuck off, Drew.
- Get security.

613
00:24:40,000 --> 00:24:41,370
If you can't cooperate,

614
00:24:41,370 --> 00:24:42,790
I'm going to have to ask you
to leave.

615
00:24:42,790 --> 00:24:44,250
Amanda, please.
He needs to stay here.

616
00:24:44,250 --> 00:24:46,000
And you need
to get a fucking hotel.

617
00:24:46,000 --> 00:24:47,290
Your son can't leave
the hospital,

618
00:24:47,290 --> 00:24:48,630
but I can have you removed.

619
00:24:48,630 --> 00:24:49,960
Don't you dare touch me.

620
00:24:49,960 --> 00:24:51,590
Get out! All of you!

621
00:24:51,590 --> 00:24:53,760
Mrs. Jones, I know this
is scary and stressful.

622
00:24:53,760 --> 00:24:55,930
Oh, fuck you! Fuck you!
This is my son.

623
00:24:55,930 --> 00:24:57,260
My son!
And nobody is touching him!

624
00:24:57,260 --> 00:24:58,930
Whoa, whoa, whoa.
What's going on?

625
00:24:58,930 --> 00:25:00,350
- How can I help you?
- By backing the fuck off!

626
00:25:00,350 --> 00:25:01,930
Mom's worried about
a CYF investigation.

627
00:25:01,930 --> 00:25:03,940
- Amanda, just calm down!
- OK, OK, OK, enough!

628
00:25:03,940 --> 00:25:05,350
This is a hospital.

629
00:25:05,350 --> 00:25:06,980
This isn't
"The Jerry Springer Show."

630
00:25:06,980 --> 00:25:09,440
Ma'am, nobody's trying
to take your child,

631
00:25:09,440 --> 00:25:11,150
so why don't you
stay here with him

632
00:25:11,150 --> 00:25:12,900
while your husband talks
to our social worker outside

633
00:25:12,900 --> 00:25:14,570
and straightens all this out?

634
00:25:14,570 --> 00:25:16,950
Well, I don't want him
speaking for me and my son.

635
00:25:16,950 --> 00:25:18,910
Well,
it is either you or him.

636
00:25:18,910 --> 00:25:21,910
Your son is not leaving,
but you can be escorted out

637
00:25:21,910 --> 00:25:24,000
and even arrested
if you refuse to cooperate.

638
00:25:24,000 --> 00:25:25,500
Nobody wants that.

639
00:25:25,500 --> 00:25:27,500
So you tell us.
What do you want to do?

640
00:25:30,500 --> 00:25:33,260
- I'm staying with my son.
- OK, great.

641
00:25:33,260 --> 00:25:35,090
You do that.

642
00:25:35,090 --> 00:25:37,470
We all on the same page here?

643
00:25:37,470 --> 00:25:38,890
Thank you, Olsen.

644
00:25:38,890 --> 00:25:39,890
- You know where to find me.
- You OK?

645
00:25:39,890 --> 00:25:41,680
Yeah, we got this.

646
00:25:41,680 --> 00:25:43,480
- All good.
- It's all yours.

647
00:25:43,480 --> 00:25:45,230
Mrs. Jones, we just
have a couple things.

648
00:25:48,610 --> 00:25:49,860
Everything all right
out there?

649
00:25:49,860 --> 00:25:52,190
Yeah, just another day
in paradise.

650
00:25:52,190 --> 00:25:54,110
- How are you feeling?
- Better.

651
00:25:54,110 --> 00:25:56,650
- Where's David?
- He left.

652
00:25:56,660 --> 00:25:59,530
He said he had to
get back to school.

653
00:25:59,530 --> 00:26:01,120
Oh.

654
00:26:01,120 --> 00:26:02,910
Um, maybe you
could try calling him,

655
00:26:02,910 --> 00:26:04,120
get him to come back.

656
00:26:06,870 --> 00:26:09,750
What's going to happen
to him if I do?

657
00:26:09,750 --> 00:26:12,000
Hopefully he'll be willing
to talk to somebody.

658
00:26:12,000 --> 00:26:14,630
- Will you talk to him?
- I can try.

659
00:26:14,630 --> 00:26:17,380
I don't think
he wanted to talk to me.

660
00:26:17,390 --> 00:26:19,720
Have you shared with anyone

661
00:26:19,720 --> 00:26:21,810
about the writings
of his you found?

662
00:26:21,810 --> 00:26:23,600
No.

663
00:26:23,600 --> 00:26:25,310
I didn't know who to tell.

664
00:26:25,310 --> 00:26:27,560
I just don't want
to see him get hurt.

665
00:26:27,560 --> 00:26:29,400
Neither do we.

666
00:26:38,780 --> 00:26:40,120
It's just going straight
to voicemail.

667
00:26:40,120 --> 00:26:42,200
Maybe if you can text him.

668
00:26:54,550 --> 00:26:56,630
He's not texting back.

669
00:26:56,630 --> 00:26:58,220
Oh, I'm sorry about all this.

670
00:26:58,220 --> 00:26:59,760
It's OK, it's OK.

671
00:26:59,760 --> 00:27:02,970
What are you doing for David
is very brave.

672
00:27:02,970 --> 00:27:04,220
I'm his mother.

673
00:27:04,220 --> 00:27:06,350
I'll do anything
to protect him.

674
00:27:08,350 --> 00:27:09,600
Do you think
he would hurt anyone?

675
00:27:09,600 --> 00:27:11,270
No.

676
00:27:12,980 --> 00:27:16,990
But...

677
00:27:16,990 --> 00:27:20,740
I'm sure
a lot of parents felt that way

678
00:27:20,740 --> 00:27:23,700
before their children
did unspeakable things.

679
00:27:26,370 --> 00:27:27,790
Does he have any history
of violence?

680
00:27:27,790 --> 00:27:29,210
Has he ever been
in any trouble?

681
00:27:29,210 --> 00:27:30,670
No, never.

682
00:27:30,670 --> 00:27:33,080
He's very quiet.

683
00:27:33,090 --> 00:27:35,500
And he takes great care of me.

684
00:27:35,500 --> 00:27:41,010
He--he's struggled
with his father's death.

685
00:27:41,010 --> 00:27:42,970
We both have.

686
00:27:42,970 --> 00:27:45,260
Flight is ten minutes out
with an electrocution.

687
00:27:45,260 --> 00:27:48,350
OK, grab Collins.
I'll be right there.

688
00:27:48,350 --> 00:27:49,770
Keep trying to reach him.

689
00:27:49,770 --> 00:27:51,390
If you do,
have someone come find me.

690
00:27:51,400 --> 00:27:53,770
- OK?
- OK.

691
00:27:53,770 --> 00:27:55,900
- Thank you.
- Of course.

692
00:27:55,900 --> 00:27:58,070
- You got some good news for me?
- I sure do.

693
00:27:58,070 --> 00:27:59,690
There are two rooms
in ICU being cleaned.

694
00:27:59,700 --> 00:28:01,450
- They'll be ready by now.
- Great.

695
00:28:01,450 --> 00:28:02,570
And I got bagels
in the lounge.

696
00:28:02,570 --> 00:28:04,120
Nice job.
Thank you.

697
00:28:06,620 --> 00:28:09,080
- Is it true?
- You have to be more specific.

698
00:28:09,080 --> 00:28:10,710
Are there rats in the ED?

699
00:28:10,710 --> 00:28:13,040
Uh, apparently,
if somebody already snitched.

700
00:28:13,040 --> 00:28:15,500
Do you know how bad
this looks?

701
00:28:15,500 --> 00:28:17,500
One more reason
to shutter this place.

702
00:28:17,510 --> 00:28:19,710
Only the emergency department
admits rats.

703
00:28:19,720 --> 00:28:21,300
Emergency department
would never admit rats,

704
00:28:21,300 --> 00:28:22,880
unless they had
the right insurance.

705
00:28:22,890 --> 00:28:24,260
Did you catch any of them?

706
00:28:24,260 --> 00:28:26,050
One, and I charged him
for a full visit.

707
00:28:26,060 --> 00:28:27,600
I'm glad
you think this is funny.

708
00:28:27,600 --> 00:28:28,770
I'm sorry that you don't.

709
00:28:28,770 --> 00:28:30,560
Did you call an exterminator?

710
00:28:30,560 --> 00:28:32,350
He's waiting
on a second opinion.

711
00:28:33,770 --> 00:28:35,560
You're pushing your luck today.

712
00:28:35,560 --> 00:28:36,860
Don't worry.
Last I heard,

713
00:28:36,860 --> 00:28:38,230
they were headed
for the cafeteria,

714
00:28:38,230 --> 00:28:39,400
so they should be dead
within the hour.

715
00:28:39,400 --> 00:28:40,860
OK.

716
00:28:40,860 --> 00:28:43,740
- I'll be here all week.
- Or maybe not.

717
00:28:47,450 --> 00:28:49,620
Drug-seeking woman
kicked off the city bus

718
00:28:49,620 --> 00:28:51,000
for disrupting
and disturbing passengers.

719
00:28:51,000 --> 00:28:52,580
I called 911!

720
00:28:52,580 --> 00:28:54,370
She's been screaming
for narcotics nonstop.

721
00:28:54,380 --> 00:28:55,960
We found an empty Percocet
bottle filled five days ago.

722
00:28:55,960 --> 00:28:57,130
What are you doing?
What are you doing?

723
00:28:57,130 --> 00:28:58,590
She's been uncooperative

724
00:28:58,590 --> 00:28:59,800
and combative
since we picked her up.

725
00:28:59,800 --> 00:29:01,210
Get off her.
Let her go.

726
00:29:01,220 --> 00:29:02,760
Stop fighting.

727
00:29:02,760 --> 00:29:04,590
Calm the fuck down,
or I'm calling the cops.

728
00:29:04,590 --> 00:29:06,300
My meds at home
aren't working!

729
00:29:06,300 --> 00:29:08,510
Please, I have sickle cell!

730
00:29:08,510 --> 00:29:10,310
OK, stop.
Everybody stop.

731
00:29:10,310 --> 00:29:11,980
Stop!

732
00:29:12,690 --> 00:29:14,310
What's your name?

733
00:29:14,310 --> 00:29:16,560
It's Joyce.
It's Joyce St. Claire.

734
00:29:16,560 --> 00:29:18,770
Joyce, is this
your sickle cell pain?

735
00:29:18,770 --> 00:29:21,070
- Yes!
- 10 milligrams of IV morphine.

736
00:29:21,070 --> 00:29:22,400
- You really want 10?
- Yes.

737
00:29:22,400 --> 00:29:23,530
Repeat it in five minutes
if needed.

738
00:29:23,530 --> 00:29:24,900
And she needs a Dilaudid drip.

739
00:29:24,910 --> 00:29:25,990
This is a
vaso-occlusive crisis!

740
00:29:25,990 --> 00:29:27,160
I'm so sorry this happened.

741
00:29:27,160 --> 00:29:28,780
You're going to be OK now.

742
00:29:28,780 --> 00:29:30,080
You're safe here.

743
00:29:30,080 --> 00:29:31,370
Come on.

744
00:29:31,370 --> 00:29:33,040
You're going to be safe here.
I promise.

745
00:29:33,040 --> 00:29:34,870
Just breathe. OK?

746
00:30:00,270 --> 00:30:01,820
Live wire hit
his left forearm,

747
00:30:01,820 --> 00:30:03,530
shocked him once for v-fib.

748
00:30:03,530 --> 00:30:05,570
- Was there a power pole down?
- No, abandoned factory.

749
00:30:05,570 --> 00:30:06,650
We found bolt cutters
at his side.

750
00:30:06,660 --> 00:30:07,910
Got electrocuted.

751
00:30:07,910 --> 00:30:08,950
Was he trying
to steal copper?

752
00:30:08,950 --> 00:30:09,950
Most likely.

753
00:30:09,950 --> 00:30:11,830
Powerline fried his arm,

754
00:30:11,830 --> 00:30:14,700
and the current through his
whole body stopped his heart.

755
00:30:14,710 --> 00:30:17,370
Ready?

756
00:30:17,380 --> 00:30:19,540
Steady, lift.

757
00:30:21,300 --> 00:30:24,090
Add a myoglobin and a CK
to the labs.

758
00:30:24,090 --> 00:30:26,130
Two liters normal saline
wide open.

759
00:30:26,130 --> 00:30:27,880
Dr. Santos,
what are we worried about?

760
00:30:27,890 --> 00:30:30,850
Um, rhabdomyolysis
from tissue damage

761
00:30:30,850 --> 00:30:33,810
can kill the kidneys, ongoing
risk of cardiac irritability.

762
00:30:33,810 --> 00:30:35,390
- Excellent.
- AP pads in place.

763
00:30:35,390 --> 00:30:37,100
Guy fell off
a telephone pole?

764
00:30:37,100 --> 00:30:39,480
- No, he was on a platform.
- Boring.

765
00:30:39,480 --> 00:30:42,020
Cut into a live wire.

766
00:30:42,020 --> 00:30:43,690
Tense ventral compartment.

767
00:30:43,690 --> 00:30:45,110
Set up the STIC
pressure monitor.

768
00:30:45,110 --> 00:30:46,610
V-fib.

769
00:30:46,610 --> 00:30:48,070
- All right, charge to 300.
- Charge to 300.

770
00:30:48,070 --> 00:30:49,280
Am I running this or are you?

771
00:30:49,280 --> 00:30:51,410
- Sorry, reflex response.
- Clear.

772
00:30:52,370 --> 00:30:54,160
Ah, fuck!

773
00:30:54,160 --> 00:30:57,120
Sorry.

774
00:30:57,120 --> 00:30:59,710
So what--what happened?

775
00:30:59,710 --> 00:31:02,250
I bought it
for my girlfriend's dog.

776
00:31:02,250 --> 00:31:06,300
I work nights,
and he yaps all day long.

777
00:31:06,300 --> 00:31:09,010
And when I woke up,
I was wearing it.

778
00:31:09,010 --> 00:31:10,550
Stupid bitch!

779
00:31:12,010 --> 00:31:14,930
Sorry, sorry.

780
00:31:14,930 --> 00:31:17,430
I think she must have
used Krazy Glue.

781
00:31:17,440 --> 00:31:20,770
Yeah, it, um,
it looks that way.

782
00:31:20,770 --> 00:31:22,520
Have you tried
removing the batteries?

783
00:31:22,520 --> 00:31:26,530
Of course.
She glued the case shut.

784
00:31:26,530 --> 00:31:29,400
All right, I think we have
a couple options, Gary.

785
00:31:29,410 --> 00:31:32,450
Um, we can try to find
a solvent that will dissolve

786
00:31:32,450 --> 00:31:34,910
or at least soften the glue
enough for you to peel it off

787
00:31:34,910 --> 00:31:37,000
without taking your skin
with it.

788
00:31:37,000 --> 00:31:39,250
Or, um...

789
00:31:39,250 --> 00:31:41,790
- Dr. Javadi?
- Um...

790
00:31:41,790 --> 00:31:44,880
I--I guess your skin cells
on your neck will naturally

791
00:31:44,880 --> 00:31:48,380
slough off and you should just
be able to remove it in time.

792
00:31:48,380 --> 00:31:51,430
- How much time?
- Um, couple of weeks, maybe.

793
00:31:51,430 --> 00:31:52,760
Couple weeks?

794
00:31:52,760 --> 00:31:54,390
I think this guy's
got scurvy.

795
00:31:54,390 --> 00:31:55,510
What is he, a pirate?

796
00:31:55,510 --> 00:31:57,220
No, he's an unhoused man

797
00:31:57,220 --> 00:31:59,770
who lives almost exclusively
on dollar store ramen.

798
00:31:59,770 --> 00:32:02,350
There's perifollicular
hemorrhage, gingivitis,

799
00:32:02,360 --> 00:32:04,730
bleeding gums, and, um, yeah,

800
00:32:04,730 --> 00:32:06,150
no fruit or vegetables
in his diet.

801
00:32:06,150 --> 00:32:07,440
I suppose that could do it

802
00:32:07,440 --> 00:32:09,280
as long as
you've ruled out piracy.

803
00:32:09,280 --> 00:32:12,410
No parrot, no peg leg,
doesn't reek of sweat and rum?

804
00:32:12,410 --> 00:32:14,320
Well, now that you
mention it, there was a smell.

805
00:32:14,330 --> 00:32:17,330
Probably a pirate.

806
00:32:17,330 --> 00:32:18,750
Tell him to pick up
some vitamin C

807
00:32:18,750 --> 00:32:20,210
next time he docks
at a dollar store.

808
00:32:22,580 --> 00:32:24,250
I can't tell
if you're joking.

809
00:32:24,250 --> 00:32:26,590
No, Captain Scurvy's
got a vitamin C deficiency.

810
00:32:26,590 --> 00:32:29,050
Cheapest way to fix it
is with a daily supplement.

811
00:32:29,050 --> 00:32:30,880
Captain Scurvy
is another joke.

812
00:32:30,880 --> 00:32:32,880
- I'd like to think so.
- It's a good one.

813
00:32:32,890 --> 00:32:34,970
Dr. Langdon, Dr. King,
this is Arthur Carlson

814
00:32:34,970 --> 00:32:36,680
from Children,
Youth, and Families.

815
00:32:36,680 --> 00:32:38,560
He'd like to speak to
the parents of Tyler Jones.

816
00:32:38,560 --> 00:32:40,480
Right, right.

817
00:32:40,480 --> 00:32:42,980
Uh, Mel, would you mind showing
him to Kiara and the family?

818
00:32:42,980 --> 00:32:44,440
Mm. Yeah, right this way.

819
00:32:49,360 --> 00:32:51,110
- Beto?
- Hello, Doctor.

820
00:32:51,110 --> 00:32:54,490
- What are you doing here?
- I'm working day shifts now.

821
00:32:54,490 --> 00:32:56,410
Didn't you retire
a couple of years ago?

822
00:32:56,410 --> 00:32:57,910
No.

823
00:32:57,910 --> 00:33:01,120
- I have to work today.
- Right.

824
00:33:01,120 --> 00:33:02,660
Right.
Just stay right here, OK?

825
00:33:02,670 --> 00:33:04,580
I--I have a lot
of cleaning to do.

826
00:33:04,580 --> 00:33:06,540
Yeah, no,
I'll be just one second.

827
00:33:06,540 --> 00:33:08,880
Hey, Doc, Doc!
How about a sandwich?

828
00:33:08,880 --> 00:33:10,670
Sure, Earl.
Turkey, no egg salad.

829
00:33:10,670 --> 00:33:12,930
I got you.
Just give me one minute.

830
00:33:15,090 --> 00:33:16,850
So Beto said he's working here?

831
00:33:16,850 --> 00:33:18,390
Yeah,
he just started wandering.

832
00:33:18,390 --> 00:33:20,560
Fortunately,
he always winds up back here.

833
00:33:20,560 --> 00:33:22,270
He thinks he still works
in the ED.

834
00:33:22,270 --> 00:33:23,770
I called his family.

835
00:33:23,770 --> 00:33:25,060
They usually pick him up
after a few hours.

836
00:33:25,060 --> 00:33:26,190
Really?

837
00:33:26,190 --> 00:33:27,650
Yeah. It gives them a break.

838
00:33:27,650 --> 00:33:29,110
And look at him.
He's talking to people,

839
00:33:29,110 --> 00:33:31,530
feeling useful,
getting some exercise.

840
00:33:31,530 --> 00:33:33,150
Hell, I wish I was that happy.

841
00:33:33,150 --> 00:33:34,780
You think he's any good
at catching rats?

842
00:33:34,780 --> 00:33:37,450
- Stop.
- Oh, Earl wants a sandwich.

843
00:33:37,450 --> 00:33:39,410
He always wants a sandwich.

844
00:33:39,410 --> 00:33:40,870
Hey, check it out.

845
00:33:40,870 --> 00:33:42,410
I got my kids a puppy.

846
00:33:42,410 --> 00:33:44,580
Cute.
Hope that wasn't your idea.

847
00:33:44,580 --> 00:33:46,370
- Why?
- Seriously?

848
00:33:46,380 --> 00:33:47,710
You really think your wife

849
00:33:47,710 --> 00:33:49,130
needs anything else
to take care of?

850
00:33:49,130 --> 00:33:51,250
- Abby loves dogs.
- I love penguins.

851
00:33:51,260 --> 00:33:52,840
It doesn't mean
I want to take care of one.

852
00:33:52,840 --> 00:33:54,380
I'm pretty sure it's illegal
to own a penguin.

853
00:33:54,380 --> 00:33:55,880
Pretty sure
you're missing the point.

854
00:33:55,890 --> 00:33:57,340
The point is
Tanner promised

855
00:33:57,340 --> 00:33:58,600
he would take care of it.

856
00:33:58,600 --> 00:34:01,680
A four-year-old?
Yeah, OK.

857
00:34:06,940 --> 00:34:08,560
How's she doing?

858
00:34:08,560 --> 00:34:11,610
Still breathing
after 20 of morphine.

859
00:34:13,820 --> 00:34:15,150
How's the pain, Joyce?

860
00:34:16,320 --> 00:34:17,860
A little better.

861
00:34:17,870 --> 00:34:19,910
We've ordered
an exchange transfusion.

862
00:34:19,910 --> 00:34:22,410
Mm.
Figured I needed that.

863
00:34:22,410 --> 00:34:24,950
What's your normal regimen
at home?

864
00:34:24,960 --> 00:34:28,880
90 of extended-release
morphine every 12 hours

865
00:34:28,880 --> 00:34:31,210
and oxycodone
for breakthrough pain,

866
00:34:31,210 --> 00:34:33,710
but it wasn't working.

867
00:34:33,710 --> 00:34:36,840
Starting IV Dilaudid
of four an hour.

868
00:34:36,840 --> 00:34:39,220
You can press this button
if you need a little extra.

869
00:34:39,220 --> 00:34:42,850
That only works once an hour,
though, so don't go crazy.

870
00:34:42,850 --> 00:34:45,770
- Could I confer with you?
- Yeah.

871
00:34:54,530 --> 00:34:57,070
You seem surprised
by the opioid dosage.

872
00:34:57,070 --> 00:34:59,610
- It seemed a little high.
- So was her pain.

873
00:34:59,620 --> 00:35:01,200
How do you know
she's not drug-seeking?

874
00:35:01,200 --> 00:35:03,080
You can't fake
a hemoglobin of 6.

875
00:35:03,080 --> 00:35:05,120
Do you know what sickle cell
crisis does to the body?

876
00:35:05,120 --> 00:35:06,660
Blood cells get caught
and plug up your capillaries

877
00:35:06,660 --> 00:35:08,370
and deprive
all your cells of oxygen.

878
00:35:08,370 --> 00:35:11,210
It's been described
as an electrical stabbing pain

879
00:35:11,210 --> 00:35:12,710
that feels like
it's breaking your bones

880
00:35:12,710 --> 00:35:15,460
and flushing glass
through your body.

881
00:35:15,460 --> 00:35:17,300
I never thought of it
like that.

882
00:35:17,300 --> 00:35:18,680
Little empathy
goes a long way

883
00:35:18,680 --> 00:35:20,430
with those suffering
in real pain.

884
00:35:22,560 --> 00:35:23,970
- Yeah.
- Don't worry.

885
00:35:23,970 --> 00:35:25,470
You'll get good
at spotting the fakers,

886
00:35:25,470 --> 00:35:27,350
and half the time,
all those people need

887
00:35:27,350 --> 00:35:29,940
is someone to really listen
to them and hear their story.

888
00:35:31,480 --> 00:35:33,020
Mm-hmm.

889
00:35:33,020 --> 00:35:36,900
Interior compartment
pressure is 49.

890
00:35:36,900 --> 00:35:38,650
Burn caused massive swelling.

891
00:35:38,650 --> 00:35:40,530
What does he need,
Dr. Santos?

892
00:35:40,530 --> 00:35:43,490
Fasciotomy, but he
still has a radial pulse.

893
00:35:43,490 --> 00:35:45,540
Pressure would have to be
over 100 to lose the pulse,

894
00:35:45,540 --> 00:35:47,200
and at that point,
he'd lose the arm.

895
00:35:47,200 --> 00:35:49,250
49 is enough to destroy
all the nerves and muscles

896
00:35:49,250 --> 00:35:51,120
in a matter of hours.

897
00:35:51,130 --> 00:35:52,830
- Compartment pressure's 49?
- Yeah.

898
00:35:52,840 --> 00:35:54,790
I'm going to make the
initial incision down here.

899
00:35:54,800 --> 00:35:56,500
Ortho can finish it up
in the OR.

900
00:35:56,510 --> 00:35:58,340
Good plan.
I'll let them know.

901
00:35:58,340 --> 00:36:00,090
- Hey, Robby.
- Always good to see you, Fred.

902
00:36:00,090 --> 00:36:01,380
- How do you like my rock star?
- She's pretty good.

903
00:36:01,390 --> 00:36:03,970
She has a great teacher.

904
00:36:03,970 --> 00:36:05,930
Sterile gloves
for Dr. Santos.

905
00:36:05,930 --> 00:36:09,230
Oh, we don't teach forearm
fasciotomies to our residents.

906
00:36:09,230 --> 00:36:11,190
What if she's all alone
somewhere someday

907
00:36:11,190 --> 00:36:13,400
with no backup?

908
00:36:15,480 --> 00:36:18,610
This is the path
to avoid the median nerve

909
00:36:18,610 --> 00:36:20,820
and all major vessels.

910
00:36:20,820 --> 00:36:23,110
Maybe just watch
the first time.

911
00:36:23,120 --> 00:36:25,530
She'll hold the blade,
I'll cut.

912
00:36:25,530 --> 00:36:27,080
10 blade to Dr. Santos.

913
00:36:30,710 --> 00:36:33,080
We'll start proximal.

914
00:36:33,080 --> 00:36:34,540
How much pressure?

915
00:36:34,540 --> 00:36:37,670
Just about this much.

916
00:36:41,930 --> 00:36:43,300
Mm-hmm.

917
00:36:46,010 --> 00:36:48,560
Through the skin and sub-Q.

918
00:36:53,060 --> 00:36:54,440
Good.

919
00:36:58,690 --> 00:37:00,570
How they making out?

920
00:37:00,570 --> 00:37:02,280
They're still talking.

921
00:37:03,780 --> 00:37:05,780
- You OK?
- Yeah, for sure.

922
00:37:05,780 --> 00:37:07,950
I just--I hate seeing families
torn apart.

923
00:37:07,950 --> 00:37:09,540
Oh, they'll be fine.

924
00:37:09,540 --> 00:37:12,000
- How can you be sure?
- They're white.

925
00:37:12,000 --> 00:37:14,290
Probably get off
with a slap on the wrist.

926
00:37:14,290 --> 00:37:16,790
If they weren't,
she'd probably lose her child

927
00:37:16,790 --> 00:37:20,420
and he'd end up going
to jail, but...

928
00:37:20,420 --> 00:37:23,380
Sorry, I did a fellowship
in cynicism.

929
00:37:23,380 --> 00:37:24,880
You sure you're OK?

930
00:37:24,890 --> 00:37:26,970
100%.
I'm just going to get some air.

931
00:37:32,850 --> 00:37:35,690
I am a savage, classy, bougie,

932
00:37:35,690 --> 00:37:38,570
ratchet, sassy, moody, nasty.

933
00:37:38,570 --> 00:37:40,530
I am a savage...

934
00:37:41,490 --> 00:37:42,900
I need help!

935
00:37:42,900 --> 00:37:44,030
I got shot.

936
00:37:44,030 --> 00:37:45,280
Can you guys help?

937
00:37:46,160 --> 00:37:47,490
What's your name?

938
00:37:47,490 --> 00:37:48,660
Alex.

939
00:37:48,660 --> 00:37:50,870
OK, Alex, let me take a look.

940
00:37:50,870 --> 00:37:52,250
It fucking hurts.

941
00:37:52,250 --> 00:37:54,210
Oh, I know.
All right.

942
00:37:54,210 --> 00:37:55,420
We're going to take
good care of you.

943
00:37:55,420 --> 00:37:57,080
- Yeah.
- You guys got it?

944
00:37:57,080 --> 00:37:59,290
Let me get you up here, Alex.

945
00:37:59,300 --> 00:38:01,000
I got you.

946
00:38:01,010 --> 00:38:02,380
I have an abdominal GSW

947
00:38:02,380 --> 00:38:05,180
in the ambulance bay,
code trauma now.

948
00:38:05,180 --> 00:38:07,800
GSW just got dumped
by a homeboy ambulance.

949
00:38:07,800 --> 00:38:10,850
- You got this?
- Yeah, go.

950
00:38:10,850 --> 00:38:14,190
2 grams of Ancef.
Ortho's on their way.

951
00:38:17,980 --> 00:38:20,610
Systolic's only 80.
14 gauge left AC.

952
00:38:20,610 --> 00:38:21,730
We got two units
of whole blood

953
00:38:21,730 --> 00:38:23,070
going on the rapid infuser.

954
00:38:23,070 --> 00:38:24,400
Call the OR.
We'll be right up.

955
00:38:24,400 --> 00:38:25,740
Lungs up.

956
00:38:25,740 --> 00:38:26,950
Do you take medications
every day?

957
00:38:26,950 --> 00:38:28,870
- Any allergies?
- No.

958
00:38:28,870 --> 00:38:30,330
Morrison's is full of blood.
You see that?

959
00:38:30,330 --> 00:38:32,200
- Yeah.
- Tore up his liver.

960
00:38:32,200 --> 00:38:33,620
- What's his name?
- Alex.

961
00:38:33,620 --> 00:38:35,000
Alex, you've lost
a lot of blood.

962
00:38:35,000 --> 00:38:36,330
You need to go to surgery
right away.

963
00:38:36,330 --> 00:38:37,330
Am I going to die?

964
00:38:37,330 --> 00:38:38,830
Not now that I'm here.

965
00:38:38,830 --> 00:38:40,130
Spoken with the humility
of a surgeon.

966
00:38:40,130 --> 00:38:41,460
OR's ready.
How's he doing?

967
00:38:41,460 --> 00:38:43,170
- BP is coming up a bit.
- Let's go.

968
00:38:43,170 --> 00:38:44,960
- Can you call my mom?
- Yep.

969
00:38:44,970 --> 00:38:47,590
- She's the "ICE" on my cell.
- Of course, of course.

970
00:38:47,590 --> 00:38:50,180
So he didn't have
to wait for an OR?

971
00:38:50,180 --> 00:38:52,010
No, we're a trauma center.

972
00:38:52,010 --> 00:38:54,430
We always keep one OR
stocked and ready to go.

973
00:38:54,430 --> 00:38:58,100
Well, that's awesome!

974
00:38:58,100 --> 00:39:01,110
What--what happens if there are
multiple traumas needing OR?

975
00:39:01,110 --> 00:39:02,730
We get a lot busier.

976
00:39:04,650 --> 00:39:06,150
<i>Mr. Milton, I'm sorry.</i>

977
00:39:06,150 --> 00:39:07,860
We had to move you
into the hall.

978
00:39:07,860 --> 00:39:09,820
I know it gets pretty chaotic
and noisy out here.

979
00:39:09,820 --> 00:39:12,330
Mr. Milton?

980
00:39:12,330 --> 00:39:14,790
Hey, hey, Bennet,
wake up for me.

981
00:39:17,210 --> 00:39:20,000
Oh, shit, shit, shit.
Um, I need a little help here!

982
00:39:21,210 --> 00:39:22,460
Help!

983
00:39:22,460 --> 00:39:24,050
When did you
check on him last?

984
00:39:24,050 --> 00:39:25,670
I don't know, around
half an hour ago at most.

985
00:39:25,670 --> 00:39:27,170
- I was waiting on labs.
- What's going on?

986
00:39:27,170 --> 00:39:28,840
It's my gallstone guy.
You saw his EKGs.

987
00:39:28,840 --> 00:39:31,510
Unknown downtime.
He was sleeping in the hall.

988
00:39:31,510 --> 00:39:33,510
Crash cart, let's go!

989
00:39:36,600 --> 00:39:38,440
I got it.

990
00:39:40,980 --> 00:39:42,520
Hold compressions.

991
00:39:44,690 --> 00:39:46,230
Asystole.

992
00:39:46,240 --> 00:39:49,990
Resume compressions,
amp of epi.

993
00:39:49,990 --> 00:39:51,450
Slower, slower tempo,
slower tempo.

994
00:39:51,450 --> 00:39:53,410
- Should I intubate?
- No. Drop an LMA.

995
00:39:53,410 --> 00:39:56,080
We don't want
to hold compressions.

996
00:39:56,080 --> 00:39:58,160
Pupils are fixed and dilated.

997
00:39:58,160 --> 00:39:59,620
He's been down a long time.

998
00:40:11,680 --> 00:40:13,010
How we doing in here?

999
00:40:13,010 --> 00:40:14,550
So much better.

1000
00:40:14,560 --> 00:40:17,140
Dr. Mohan, this is my wife,
Ondine.

1001
00:40:17,140 --> 00:40:19,770
Dr. Samira Mohan.
Nice to meet you, Ondine.

1002
00:40:19,770 --> 00:40:21,940
- Thank you for helping her.
- Of course.

1003
00:40:21,940 --> 00:40:24,730
And, again, I'm so sorry
about how you were treated

1004
00:40:24,730 --> 00:40:26,400
when you first arrived.

1005
00:40:26,400 --> 00:40:27,780
Not everyone who works here

1006
00:40:27,780 --> 00:40:29,690
is accustomed to dealing
with sickle cell.

1007
00:40:29,700 --> 00:40:31,150
We will be doing
everything possible

1008
00:40:31,160 --> 00:40:33,820
from here on in
to manage Joyce's crisis.

1009
00:40:33,820 --> 00:40:35,700
In the meantime,
can I get you anything?

1010
00:40:35,700 --> 00:40:36,740
I'm fine.

1011
00:40:36,740 --> 00:40:38,240
- Ondine?
- No, thank you.

1012
00:40:38,250 --> 00:40:39,660
OK. Well, have the nurses
come find me

1013
00:40:39,660 --> 00:40:40,830
if you need anything.

1014
00:40:43,580 --> 00:40:45,960
Take slow, deep breaths
for me, Ian.

1015
00:40:45,960 --> 00:40:48,960
They ordered a neb,
5 albuterol, 125 solumedrol.

1016
00:40:48,960 --> 00:40:50,590
All right.

1017
00:40:50,590 --> 00:40:52,260
Keep an eye on him
and present to Dr. Langdon.

1018
00:40:52,260 --> 00:40:54,340
- OK.
- OK, great.

1019
00:40:54,350 --> 00:40:56,550
I'll see you back in triage
once he settles down.

1020
00:40:56,560 --> 00:40:58,470
Yeah.

1021
00:40:58,470 --> 00:40:59,600
OK, let's take this off.

1022
00:40:59,600 --> 00:41:01,020
All right, hang in there, Ian.

1023
00:41:01,020 --> 00:41:02,850
This should really help
your asthma.

1024
00:41:12,820 --> 00:41:13,950
How can I help you, hon?

1025
00:41:13,950 --> 00:41:15,320
Um, I'm looking
for Dr. Langdon.

1026
00:41:15,320 --> 00:41:17,160
Yeah, let me see where he is.

1027
00:41:20,710 --> 00:41:22,500
Dr. Langdon,
we have a med student

1028
00:41:22,500 --> 00:41:24,130
at Central looking for you.

1029
00:41:25,710 --> 00:41:27,420
Copy that.
He's headed this way.

1030
00:41:27,420 --> 00:41:28,590
Thanks.

1031
00:41:29,880 --> 00:41:31,130
Hey, Crash.

1032
00:41:31,130 --> 00:41:33,630
You missed
a pretty cool fasciotomy.

1033
00:41:33,630 --> 00:41:34,930
I'm not sure
I'd be describing

1034
00:41:34,930 --> 00:41:36,510
a fasciotomy as cool.

1035
00:41:36,510 --> 00:41:39,220
You would if you were
the one who did it.

1036
00:41:39,220 --> 00:41:42,350
How's it going out
in the arrivals lounge?

1037
00:41:44,350 --> 00:41:47,270
Do you know anything
about Dr. McKay?

1038
00:41:47,270 --> 00:41:49,610
I've been here
for less than two hours.

1039
00:41:49,610 --> 00:41:52,820
I don't know anybody,
including you.

1040
00:41:52,820 --> 00:41:55,700
I thought you were some kind
of kid genius.

1041
00:41:55,700 --> 00:41:58,120
I'm like any other
third-year med student.

1042
00:41:58,120 --> 00:42:01,040
Clearly.

1043
00:42:01,040 --> 00:42:02,500
Hey, I'm just trying
to break the ice.

1044
00:42:02,500 --> 00:42:04,540
I'm not trying to annoy you.

1045
00:42:04,540 --> 00:42:06,460
And yet, you're still
calling me Crash

1046
00:42:06,460 --> 00:42:07,880
when I asked you not to.

1047
00:42:07,880 --> 00:42:09,670
Really?
You're still on that?

1048
00:42:09,670 --> 00:42:11,050
Still on that.

1049
00:42:12,380 --> 00:42:15,260
Yep. OK, sorry.

1050
00:42:15,260 --> 00:42:20,220
I had no idea genius
was so sensitive.

1051
00:42:20,220 --> 00:42:23,310
But I get it.
Big brain, big feelings.

1052
00:42:23,310 --> 00:42:24,770
Makes total sense.

1053
00:42:24,770 --> 00:42:26,690
I'll try to be softer.

1054
00:42:50,670 --> 00:42:51,960
We switch out
every few minutes.

1055
00:42:51,960 --> 00:42:53,630
- You can take a break.
- I'm fine.

1056
00:42:53,630 --> 00:42:54,920
Hold compressions.

1057
00:42:56,930 --> 00:42:58,510
Still in asystole.

1058
00:42:58,510 --> 00:43:01,010
Resume compressions.

1059
00:43:01,010 --> 00:43:02,390
Should we shock him?

1060
00:43:02,390 --> 00:43:03,810
You don't shock asystole.

1061
00:43:03,810 --> 00:43:05,100
It could be fine v-fib.

1062
00:43:05,100 --> 00:43:07,770
- Not a chance.
- OK.

1063
00:43:07,770 --> 00:43:08,980
Uh, when was his last epi?

1064
00:43:08,980 --> 00:43:10,690
- Three minutes ago.
- OK.

1065
00:43:10,690 --> 00:43:12,110
Well, ACLS says every
three to five minute, right?

1066
00:43:12,110 --> 00:43:14,690
- So let's push another round.
- Fine.

1067
00:43:14,690 --> 00:43:17,530
Robby, Mr. Spencer's adult
children are asking for you.

1068
00:43:17,530 --> 00:43:19,450
And the parents
of Nick Bradley,

1069
00:43:19,450 --> 00:43:21,410
the fentanyl overdose,
also want to speak with you.

1070
00:43:21,410 --> 00:43:22,780
OK.

1071
00:43:22,790 --> 00:43:26,000
Three rounds of epi
and then call it.

1072
00:43:26,000 --> 00:43:28,540
Mr. Spencer's maxed out
on BiPAP, 25 on 10.

1073
00:43:28,540 --> 00:43:31,540
- Sats?
- Not great, High 80s.

1074
00:43:34,510 --> 00:43:36,130
Hi. I heard you wanted
to talk to me.

1075
00:43:36,130 --> 00:43:37,970
Yeah.
That alarm kept going off.

1076
00:43:37,970 --> 00:43:40,970
Yeah.
Why don't we step outside?

1077
00:43:41,680 --> 00:43:43,300
The alarm is for low oxygen.

1078
00:43:43,310 --> 00:43:45,600
Does he need more
of that, um, BiPAP?

1079
00:43:45,600 --> 00:43:47,640
I'm afraid
that's as high as we go.

1080
00:43:47,640 --> 00:43:49,440
So the decision
at this point is--

1081
00:43:49,440 --> 00:43:52,400
We want you to put our father
on the breathing machine.

1082
00:43:54,230 --> 00:43:55,900
Even though that goes
against his desires

1083
00:43:55,900 --> 00:43:58,240
to not be intubated?

1084
00:43:58,240 --> 00:44:00,740
We're not ready
to let go yet.

1085
00:44:00,740 --> 00:44:03,830
And if your father is?

1086
00:44:05,370 --> 00:44:06,830
He was a stubborn
son of a bitch

1087
00:44:06,830 --> 00:44:09,370
who would never have given up
on either of us.

1088
00:44:09,370 --> 00:44:12,170
We're not giving up on him.

1089
00:44:12,170 --> 00:44:14,170
You're absolutely certain
you want

1090
00:44:14,170 --> 00:44:16,260
to put your father through this
after everything I've told you?

1091
00:44:20,890 --> 00:44:24,930
I may have to honor
his advanced directive.

1092
00:44:24,930 --> 00:44:29,060
No, you have to honor our
durable power for health care.

1093
00:44:29,060 --> 00:44:32,520
If not, we can talk
to your hospital attorney.

1094
00:44:35,070 --> 00:44:37,320
Jereme,
you're on board with this?

1095
00:44:37,320 --> 00:44:39,530
Yeah, I guess so.

1096
00:44:41,240 --> 00:44:43,910
OK. You can sit with him
until we're ready.

1097
00:44:43,910 --> 00:44:46,080
- And when will that be?
- Momentarily.

1098
00:44:57,710 --> 00:44:59,050
Please don't tell me

1099
00:44:59,050 --> 00:45:00,380
you're going to intubate
that poor man.

1100
00:45:00,380 --> 00:45:02,090
It's what the family wants.

1101
00:45:02,090 --> 00:45:03,840
So what?
They want to torture him?

1102
00:45:03,840 --> 00:45:06,350
I explained all that.

1103
00:45:06,350 --> 00:45:10,310
If I co-sign, you can
override their durable power.

1104
00:45:10,310 --> 00:45:12,140
They're threatening
to go to the hospital attorney.

1105
00:45:12,140 --> 00:45:13,600
Let them.
Call the Ethics Committee.

1106
00:45:13,600 --> 00:45:14,850
They'll agree with us.

1107
00:45:14,860 --> 00:45:16,190
No, no,
you're probably right.

1108
00:45:16,190 --> 00:45:17,690
But we don't have
that kind of time.

1109
00:45:17,690 --> 00:45:19,440
We are stuck.

1110
00:45:19,440 --> 00:45:22,530
- What are you talking about?
- Shit.

1111
00:45:24,780 --> 00:45:26,160
What?

1112
00:45:26,160 --> 00:45:27,580
I got to go
tell those parents

1113
00:45:27,580 --> 00:45:30,080
their 18-year-old son
is brain-dead.

1114
00:45:30,080 --> 00:45:32,710
- Want me to come with you?
- No, It's OK.

1115
00:45:32,710 --> 00:45:34,040
What are you going to say?

1116
00:45:34,040 --> 00:45:35,460
I'm going to say
that it's likely,

1117
00:45:35,460 --> 00:45:37,000
but we still need
to do an apnea test

1118
00:45:37,000 --> 00:45:40,090
and a cerebral perfusion study.

1119
00:45:40,090 --> 00:45:41,800
There's no
cranial nerve activity.

1120
00:45:41,800 --> 00:45:45,640
- Those people need some hope.
- False hope.

1121
00:45:45,640 --> 00:45:47,760
- Hope is hope.
- Is it?

1122
00:45:47,760 --> 00:45:51,350
What, are we praying
for miracles today?

1123
00:45:51,350 --> 00:45:52,890
They need time to process

1124
00:45:52,890 --> 00:45:55,900
before they can accept
what's happening.

1125
00:45:55,900 --> 00:45:59,320
You ever consider
taking that advice?

1126
00:45:59,320 --> 00:46:02,440
Physician, heal thyself.

1127
00:46:02,450 --> 00:46:04,030
Don't you have patients?

1128
00:46:26,640 --> 00:46:29,300
No, no, no, no, no, no.
People wake up from comas.

1129
00:46:29,310 --> 00:46:31,430
You can wake him up.

1130
00:46:31,430 --> 00:46:33,680
You can do that.
You can--you can shock--

1131
00:46:33,680 --> 00:46:36,270
you can--
you can shock him back.

1132
00:46:41,780 --> 00:46:44,700
Nick.

1133
00:46:52,330 --> 00:46:53,830
Hey, hey, hey.

1134
00:46:53,830 --> 00:46:55,580
Hey, hey, hey, hey, hey.

1135
00:46:55,580 --> 00:46:57,580
Nick.

1136
00:46:59,840 --> 00:47:03,550
Please, no!

1137
00:48:09,030 --> 00:48:10,990
No change.

1138
00:48:10,990 --> 00:48:12,490
No pericardial effusion,

1139
00:48:12,490 --> 00:48:16,450
no tension pneumothorax,
no cardiac activity.

1140
00:48:16,450 --> 00:48:18,710
Try calcium.
Could be hyperkalemia.

1141
00:48:18,710 --> 00:48:20,750
No, his potassium was normal.

1142
00:48:20,750 --> 00:48:23,290
- Ready to call this?
- Not yet.

1143
00:48:23,290 --> 00:48:25,300
Dr. Robby said
three rounds of epi.

1144
00:48:25,300 --> 00:48:26,880
It's time.
Let's push another amp.

1145
00:48:26,880 --> 00:48:28,470
This one could do it.

1146
00:48:31,090 --> 00:48:32,220
OK.