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1
00:00:00,172 --> 00:00:02,695
And easy on the CrossFit
for a while, okay?
2
00:00:02,734 --> 00:00:04,295
- Okay.
- Thank you.
3
00:00:04,320 --> 00:00:06,875
Just cleared Treatment 3.
Just got to turn it over.
4
00:00:06,900 --> 00:00:09,592
- Sure.
- Man, we're up again already?
5
00:00:09,617 --> 00:00:11,250
- Looks like it.
- What's going on?
6
00:00:11,275 --> 00:00:13,046
- Who are they?
- Big brother.
7
00:00:13,071 --> 00:00:14,292
- Hey.
- Oh.
8
00:00:14,317 --> 00:00:16,571
- Up.
- JCAHO.
9
00:00:16,596 --> 00:00:19,936
Yeah, they're doing a
surprise site survey.
10
00:00:19,961 --> 00:00:22,211
- Who's JCAHO?
- The Joint Commission.
11
00:00:22,236 --> 00:00:23,519
They rate the performance standards
12
00:00:23,544 --> 00:00:24,994
of hospitals and certify them.
13
00:00:25,019 --> 00:00:27,193
So far, JCAHO's reports
have been positive.
14
00:00:27,218 --> 00:00:28,522
So let's keep it that way.
15
00:00:28,547 --> 00:00:31,526
Stick to protocols and with big smiles.
16
00:00:32,923 --> 00:00:34,122
Dr. Choi, we're gonna need
17
00:00:34,147 --> 00:00:36,713
some of your Navy-inspired
discipline today.
18
00:00:36,738 --> 00:00:38,584
Sorry, I'm with the paramedics today.
19
00:00:38,609 --> 00:00:40,185
- Resident ride along.
- Mm.
20
00:00:40,210 --> 00:00:42,882
And discipline, that a nice
way of saying I'm a tight ass?
21
00:00:42,907 --> 00:00:44,515
Oh, yes. Tight.
22
00:00:44,540 --> 00:00:47,470
I didn't say that.
23
00:00:47,668 --> 00:00:49,973
And, uh, getting those docs in line,
24
00:00:49,998 --> 00:00:52,094
isn't that? the chief
resident's job anyway?
25
00:00:52,119 --> 00:00:54,617
Wonderful, the guy enforcing the rules
26
00:00:54,642 --> 00:00:56,109
is the one who's always breaking them.
27
00:00:56,134 --> 00:00:57,134
Yeah.
28
00:00:57,159 --> 00:00:59,038
Good luck with that.
29
00:00:59,063 --> 00:01:01,125
Code One team to the ED.
30
00:01:01,149 --> 00:01:02,546
- What do we got?
- Nathan Clay.
31
00:01:02,572 --> 00:01:04,739
58-year-old male. "Peeds" versus auto.
32
00:01:04,764 --> 00:01:06,380
GCS 12. Vitals stable.
33
00:01:06,405 --> 00:01:08,072
Gross deformity to the left upper arm.
34
00:01:08,097 --> 00:01:09,203
- Right in here.
- Ow.
35
00:01:09,228 --> 00:01:10,609
He's complaining of
chest and back pains.
36
00:01:10,775 --> 00:01:12,608
Mr. Clay, can you hear me?
37
00:01:12,633 --> 00:01:14,641
Mr. Clay? On my count.
38
00:01:14,666 --> 00:01:16,116
One, two, three.
39
00:01:17,644 --> 00:01:19,446
Central line and a CVC catheter.
40
00:01:19,471 --> 00:01:21,579
- Right away.
- Airway's intact.
41
00:01:21,604 --> 00:01:23,771
- Breath sounds clear bilaterally.
- Ow!
42
00:01:23,796 --> 00:01:25,081
Tenderness in the left chest
43
00:01:25,106 --> 00:01:26,532
and thoracic spine. What happened here?
44
00:01:26,557 --> 00:01:28,473
He's walking with his
wife on Michigan Avenue.
45
00:01:28,498 --> 00:01:30,845
Suddenly flips out,
starts wailing on her.
46
00:01:30,870 --> 00:01:32,621
A couple of Samaritans
jumped in to help out.
47
00:01:32,646 --> 00:01:34,743
He takes off right into traffic.
48
00:01:34,966 --> 00:01:37,300
Score one for, uh, karma.
49
00:01:37,325 --> 00:01:39,421
12-lead EKGs, chest X-rays,
50
00:01:39,446 --> 00:01:41,696
CT of the chest, abdomen, and pelvis,
51
00:01:41,721 --> 00:01:43,582
with recons of the TLS spine.
52
00:01:43,607 --> 00:01:44,703
- On it.
- Leave me... no.
53
00:01:44,728 --> 00:01:45,930
Leave me alone. I'm fine.
54
00:01:45,955 --> 00:01:47,696
Laura Clay. 55-year-old female.
55
00:01:47,720 --> 00:01:48,555
- GCS 15.
- I'm fine.
56
00:01:48,580 --> 00:01:49,438
I need to get to my husband.
57
00:01:49,463 --> 00:01:50,672
Whoa, whoa, whoa. Ma'am, ma'am, ma'am.
58
00:01:50,697 --> 00:01:52,456
- Okay.
- Heart rate's tachycardic.
59
00:01:52,481 --> 00:01:53,846
This is all my fault.
60
00:01:53,870 --> 00:01:57,297
Look, I blocked my fall with
my hand, not my C spine.
61
00:01:57,322 --> 00:01:58,563
I'm neurologically intact.
62
00:01:58,588 --> 00:01:59,787
Technical. Are you a doctor?
63
00:01:59,812 --> 00:02:03,138
- Yes, yes, I am.
- Laura! Please...
64
00:02:03,163 --> 00:02:05,008
- Dr. Rhodes!
- Honey, I'm here.
65
00:02:05,033 --> 00:02:07,171
- Ma'am, stay right there.
- I'm right here.
66
00:02:07,196 --> 00:02:09,057
There are too many of them!
67
00:02:09,082 --> 00:02:10,500
- I'm here, my love!
- Help me!
68
00:02:10,552 --> 00:02:13,376
2... I need restraints. 2
of Versed and 5 of Haldol.
69
00:02:13,401 --> 00:02:14,507
- There are too many of th...
- No, not Haldol!
70
00:02:14,532 --> 00:02:16,614
Quetiapine. He's not abusive.
71
00:02:16,639 --> 00:02:19,020
He has Lewy Body Dementia.
72
00:02:19,045 --> 00:02:22,174
Wait, scratch the
Haldol. 25 of quetiapine.
73
00:02:22,199 --> 00:02:23,359
- Laura!
- It's all right, my love.
74
00:02:23,384 --> 00:02:25,084
What the hell's Lewy Body?
75
00:02:25,109 --> 00:02:27,069
Debilitating form of dementia.
76
00:02:27,094 --> 00:02:30,589
Alzheimer's meets Parkinson's.
77
00:02:33,757 --> 00:02:37,957
- Synced and corrected by martythecrazy -
- www.addic7ed.com -
78
00:02:39,601 --> 00:02:41,402
He took a pretty good whack.
79
00:02:41,427 --> 00:02:43,772
He's got a chest bruise,
left first rib fracture,
80
00:02:43,797 --> 00:02:45,413
proximal humerus fracture.
81
00:02:45,465 --> 00:02:47,582
- How are his labs?
- It's all good.
82
00:02:47,626 --> 00:02:49,474
Calcium was elevated.
83
00:02:49,499 --> 00:02:51,552
I suspect he'll develop a
kidney stone down the road,
84
00:02:51,588 --> 00:02:53,825
but it's likely he's had a few before.
85
00:02:53,850 --> 00:02:55,202
Prior heart surgery?
86
00:02:55,341 --> 00:02:57,475
Says it was a quadruple bypass.
87
00:02:57,510 --> 00:02:59,374
Had it done at Northwestern
five years ago.
88
00:02:59,399 --> 00:03:02,290
- He remembers the details?
- Yeah, he's lucid.
89
00:03:02,315 --> 00:03:05,756
Somewhat. All right, EKG is normal,
90
00:03:05,781 --> 00:03:07,447
but because of the prior heart surgery,
91
00:03:07,468 --> 00:03:09,126
I'm gonna repeat it every few hours.
92
00:03:09,151 --> 00:03:11,201
He's all yours.
93
00:03:13,122 --> 00:03:14,788
Mr. Clay?
94
00:03:14,813 --> 00:03:17,484
Mr. Clay, I'm Dr. Charles.
How are you feeling?
95
00:03:17,509 --> 00:03:19,643
My wife, Laura, where is she?
96
00:03:19,730 --> 00:03:23,139
She's being treated right
now, but will be in shortly.
97
00:03:23,164 --> 00:03:27,208
I hurt her again, didn't I?
98
00:03:27,705 --> 00:03:32,561
This isn't the life she deserves.
99
00:03:34,297 --> 00:03:36,130
Mr. Clay?
100
00:03:36,155 --> 00:03:38,990
Mr. Clay?
101
00:03:44,165 --> 00:03:47,299
Damn, you got the
online thing down, huh?
102
00:03:47,335 --> 00:03:49,426
- There was a time.
- Yeah, what's her name?
103
00:03:49,451 --> 00:03:50,950
Easy. She's taken.
104
00:03:50,975 --> 00:03:52,925
Vicki. Doctor at the VA.
105
00:03:52,950 --> 00:03:54,171
Oh, man.
106
00:03:54,196 --> 00:03:55,612
There are so many female paramedics
107
00:03:55,637 --> 00:03:57,720
who are gonna be sorry to
hear you're off the market.
108
00:03:57,745 --> 00:03:59,124
Couple guys, too.
109
00:03:59,149 --> 00:04:00,216
Well, you let 'em down easy for me.
110
00:04:00,241 --> 00:04:01,290
All right.
111
00:04:01,315 --> 00:04:02,565
You sure you gonna be okay back here?
112
00:04:02,590 --> 00:04:04,083
'Cause we can just throw
Desmond in the back.
113
00:04:04,108 --> 00:04:05,409
Eh, I'm fine.
114
00:04:05,434 --> 00:04:07,343
Ambo's like the Humvee.
You sit where there's room.
115
00:04:07,368 --> 00:04:09,703
- Comfort's not a factor.
- Well, good.
116
00:04:09,728 --> 00:04:10,974
This day's gonna go by quick then.
117
00:04:10,999 --> 00:04:14,041
Ambo 61, 40-year-old
male down in his home.
118
00:04:14,066 --> 00:04:15,755
222 Bromley Avenue.
119
00:04:15,780 --> 00:04:17,531
Some kind of lower extremity insult.
120
00:04:17,556 --> 00:04:19,305
He's in severe pain, possibly trapped.
121
00:04:19,330 --> 00:04:21,197
Copy Main. Ambo 61 responding.
122
00:04:21,222 --> 00:04:23,436
All right, we're on!
123
00:04:29,670 --> 00:04:30,886
It doesn't make any sense.
124
00:04:30,911 --> 00:04:32,558
I've had Boomer since he was a puppy.
125
00:04:32,583 --> 00:04:34,466
He's super loyal. I leave
the room for a second,
126
00:04:34,491 --> 00:04:35,749
he's looking for me.
127
00:04:35,774 --> 00:04:37,003
I had a dog like that.
128
00:04:37,028 --> 00:04:39,543
He might nip a little, but
this was a full-on attack.
129
00:04:39,568 --> 00:04:42,027
In my experience, dogs
can be unpredictable.
130
00:04:42,052 --> 00:04:44,091
Even really friendly ones.
131
00:04:44,116 --> 00:04:45,953
Sometimes if a dog's
in pain, though, he...
132
00:04:45,978 --> 00:04:46,968
He wasn't.
133
00:04:47,025 --> 00:04:50,059
We were playing tug of
war, like we always do.
134
00:04:50,197 --> 00:04:52,134
Dog bites shouldn't be stitched.
135
00:04:52,159 --> 00:04:53,725
They need to stay open
136
00:04:53,750 --> 00:04:55,827
so the wound doesn't become infected.
137
00:04:55,852 --> 00:04:57,870
Also, I'm gonna give you a tetanus shot
138
00:04:57,895 --> 00:04:59,035
and an antibiotic.
139
00:04:59,060 --> 00:05:00,676
Boomer's healthy. He's
had all his shots.
140
00:05:00,701 --> 00:05:02,701
It's just a precaution.
141
00:05:16,992 --> 00:05:18,647
Paul's in trouble down there.
142
00:05:18,672 --> 00:05:21,373
- Did you call 911?
- Yes, I'm his neighbor.
143
00:05:22,735 --> 00:05:24,735
Paul?
144
00:05:24,900 --> 00:05:26,700
It's the paramedics.
145
00:05:29,848 --> 00:05:32,516
- Ooh.
- Ooh, that's ripe.
146
00:05:33,095 --> 00:05:35,890
Man, look at this. He's a hoarder.
147
00:05:43,460 --> 00:05:44,959
What do you think?
148
00:05:45,213 --> 00:05:46,644
You good going in there?
149
00:05:46,669 --> 00:05:48,460
- I'm good.
- Okay.
150
00:05:48,485 --> 00:05:50,196
Uh, get the truck company here.
151
00:05:50,221 --> 00:05:51,484
Tell 'em they're gonna
have to help dig us out,
152
00:05:51,509 --> 00:05:52,575
and grab me a second radio.
153
00:05:52,600 --> 00:05:54,027
And, uh, I'm gonna try and
go in through the back door.
154
00:05:54,052 --> 00:05:55,802
You got it.
155
00:06:01,945 --> 00:06:03,702
Paul!
156
00:06:03,727 --> 00:06:06,233
Everything okay?
157
00:06:07,438 --> 00:06:09,537
Okay.
158
00:06:15,908 --> 00:06:17,897
Third squad caught a high-rise fire.
159
00:06:17,922 --> 00:06:20,256
Dispatch is pulling a truck
from up north to help us out.
160
00:06:20,281 --> 00:06:22,696
It'll be a while before they get here.
161
00:06:25,126 --> 00:06:28,682
In the beginning, I wanted
to think it would pass.
162
00:06:28,707 --> 00:06:31,658
Any wife would, but
I'm also a neurologist,
163
00:06:31,683 --> 00:06:34,851
and I couldn't ignore his symptoms.
164
00:06:34,876 --> 00:06:37,471
Oh, so you diagnosed
the Lewy Body Dementia?
165
00:06:37,496 --> 00:06:40,149
Yes, but I got second
and third opinions,
166
00:06:40,174 --> 00:06:42,285
and they both agreed it was LBD,
167
00:06:42,310 --> 00:06:44,059
and that was about four years ago.
168
00:06:44,102 --> 00:06:46,753
Four years, really?
169
00:06:46,777 --> 00:06:49,421
You know, Nathan expressed
deep regret to me
170
00:06:49,446 --> 00:06:50,945
about the pain that he's caused you.
171
00:06:50,970 --> 00:06:52,411
That kind of insight is rare
172
00:06:52,436 --> 00:06:54,768
for somebody who's been
battling LBD for that long.
173
00:06:55,123 --> 00:06:58,338
Well, my husband was an engineer,
174
00:06:58,363 --> 00:07:00,947
and his brain is wired
to solve problems.
175
00:07:00,972 --> 00:07:02,768
Last year, I retired early.
176
00:07:02,793 --> 00:07:05,698
I wanted to devote more time
to his cognitive therapy.
177
00:07:05,777 --> 00:07:07,498
Hmm, well, it's been working.
178
00:07:07,522 --> 00:07:09,011
There's moments when he's lucid.
179
00:07:09,036 --> 00:07:12,433
But more and more, it's this.
180
00:07:12,458 --> 00:07:13,973
Mrs. Clay,
181
00:07:14,156 --> 00:07:17,516
Nathan's latest EKG is still normal.
182
00:07:17,541 --> 00:07:19,772
I want to do another one in a few hours,
183
00:07:19,797 --> 00:07:22,548
but if it is good too,
I'll discharge him.
184
00:07:22,573 --> 00:07:25,138
- Thank you, doctor.
- Mm-hmm.
185
00:07:28,126 --> 00:07:32,251
I know that it would be better
and safer for the both of us
186
00:07:32,276 --> 00:07:35,381
if Nathan went to a care facility,
187
00:07:35,406 --> 00:07:38,587
but if I do that, then it's over.
188
00:07:39,637 --> 00:07:41,911
And I'm not ready to give up our Sundays
189
00:07:41,936 --> 00:07:43,846
listening to opera.
190
00:07:43,913 --> 00:07:47,832
I know it's hard to imagine,
but my Nathan is still in there.
191
00:07:48,038 --> 00:07:52,196
Last week he made me
dinner, Florentine lasagna.
192
00:07:52,298 --> 00:07:53,993
He can still cook?
193
00:07:54,018 --> 00:07:57,330
Well, meals take longer to
prepare than they used to,
194
00:07:57,731 --> 00:07:59,765
but...
195
00:08:00,282 --> 00:08:02,282
he does it for me.
196
00:08:04,880 --> 00:08:07,598
He's fighting just as hard as I am.
197
00:08:12,326 --> 00:08:14,543
Hi, honey.
198
00:08:16,631 --> 00:08:18,998
Everything's gonna be okay.
199
00:08:19,023 --> 00:08:21,273
Everything's okay.
200
00:08:23,501 --> 00:08:25,027
How you doing, Ethan?
201
00:08:25,211 --> 00:08:28,212
Fine, as long as I
breathe through my mouth.
202
00:08:28,237 --> 00:08:29,934
Is it as tight in
there as I think it is?
203
00:08:29,959 --> 00:08:31,644
It's worse.
204
00:08:31,669 --> 00:08:33,330
Are you claustrophobic?
205
00:08:33,362 --> 00:08:35,757
Didn't used to be.
206
00:08:41,102 --> 00:08:43,293
I mean, and Tate totally snores,
207
00:08:43,318 --> 00:08:45,151
but I don't mind.
208
00:08:45,177 --> 00:08:48,668
Oh, he does this thing where
he shoots his dirty boxers
209
00:08:48,693 --> 00:08:51,767
into the hamper like a buzzer beater.
210
00:08:52,514 --> 00:08:54,093
Anyway, it's cute.
211
00:08:54,118 --> 00:08:56,193
Oh, my God.
212
00:08:56,294 --> 00:08:58,061
You're in love.
213
00:08:58,700 --> 00:09:01,618
Whoa, whoa, whoa, whoa. What's that?
214
00:09:01,643 --> 00:09:03,294
What's what?
215
00:09:03,799 --> 00:09:07,110
Used gloves go in the
bio bin, not the trash.
216
00:09:07,135 --> 00:09:08,434
Okay, those were actually clean though.
217
00:09:08,509 --> 00:09:10,142
- They were on the floor.
- Probably just got stuck
218
00:09:10,167 --> 00:09:11,591
to the pair that came out before them.
219
00:09:11,616 --> 00:09:14,150
Unless you're certain, it's bio.
220
00:09:14,175 --> 00:09:15,895
Come on, Maggie. You know the protocol.
221
00:09:15,920 --> 00:09:17,054
I do.
222
00:09:17,080 --> 00:09:18,592
I've also been through this circus
223
00:09:18,617 --> 00:09:19,650
about a dozen times.
224
00:09:19,675 --> 00:09:21,958
JCAHO days are about patient care,
225
00:09:21,983 --> 00:09:24,077
not about a pair of latex gloves.
226
00:09:24,375 --> 00:09:27,770
Look, I'm already in the
doghouse with Goodwin.
227
00:09:27,795 --> 00:09:30,241
If there's any chance of
getting out, I want it.
228
00:09:30,266 --> 00:09:34,586
So by the book... by the book.
229
00:09:34,610 --> 00:09:36,250
By the book.
230
00:09:40,487 --> 00:09:43,021
Okay honey, eight across.
231
00:09:43,214 --> 00:09:44,604
It's five letters
232
00:09:44,629 --> 00:09:47,678
and the clue is rental agreement,
233
00:09:47,703 --> 00:09:50,337
and the first letter is L.
234
00:09:55,022 --> 00:09:57,904
I'm thinking the second is E.
235
00:09:58,258 --> 00:10:02,315
L-E...
236
00:10:02,998 --> 00:10:04,581
Lease.
237
00:10:04,641 --> 00:10:07,509
Good. Good, honey.
238
00:10:07,534 --> 00:10:08,944
All right, next one.
239
00:10:08,969 --> 00:10:11,459
We're gonna do 23 down.
240
00:10:11,484 --> 00:10:12,933
Six letters.
241
00:10:13,047 --> 00:10:14,547
The clue is collects...
242
00:10:14,572 --> 00:10:15,521
With an S.
243
00:10:18,257 --> 00:10:19,670
- What happened?
- I don't know.
244
00:10:19,695 --> 00:10:22,059
His blood pressure tanked.
245
00:10:22,211 --> 00:10:24,084
All right, bag and hang a liter bolus.
246
00:10:24,109 --> 00:10:25,392
- Yes, doctor.
- SATS are dropping.
247
00:10:25,417 --> 00:10:27,840
- Intubate?
- Yep.
248
00:10:28,407 --> 00:10:32,515
Grab the bag and hook it up to the O2.
249
00:10:32,849 --> 00:10:35,003
All right, 20 of etomidate. 100 of sux.
250
00:10:35,028 --> 00:10:36,053
Let's bring in the FAST scan.
251
00:10:36,078 --> 00:10:38,968
- April, give me some pressure.
- Here, doctor.
252
00:10:42,445 --> 00:10:45,069
And I'm in.
253
00:10:45,330 --> 00:10:46,996
- Got it.
- Okay.
254
00:10:47,021 --> 00:10:49,679
- Scan.
- Here you go.
255
00:10:52,489 --> 00:10:54,962
Heart rate 110.
256
00:10:57,686 --> 00:11:00,576
All right, belly's clean.
257
00:11:00,810 --> 00:11:03,800
Poor wall motion of the
LV and a small effusion.
258
00:11:03,825 --> 00:11:05,681
He's bleeding internally?
259
00:11:05,706 --> 00:11:07,656
Dr. Charles.
260
00:11:08,175 --> 00:11:09,377
Mrs. Clay, please, right over here.
261
00:11:09,402 --> 00:11:10,485
SATS are back up.
262
00:11:10,647 --> 00:11:12,025
Oxygenation improving.
263
00:11:12,050 --> 00:11:13,989
It's not gonna matter if he
goes into cardiac arrest.
264
00:11:14,014 --> 00:11:15,754
CT of the heart and great vessels.
265
00:11:15,779 --> 00:11:17,612
Let's get him ready to go.
266
00:11:21,194 --> 00:11:22,912
Laura?
267
00:11:22,947 --> 00:11:24,780
If we may?
268
00:11:28,136 --> 00:11:29,802
The blunt trauma from the car accident
269
00:11:29,827 --> 00:11:32,578
displaced one of Nathan's bypass grafts.
270
00:11:32,607 --> 00:11:34,941
His aorta is leaking blood.
271
00:11:34,976 --> 00:11:37,021
- A pseudo-aneurysm.
- Mm-hmm.
272
00:11:37,046 --> 00:11:38,629
How bad?
273
00:11:38,874 --> 00:11:41,124
Right now it's just a slow drip.
274
00:11:41,149 --> 00:11:42,532
It hasn't ruptured yet.
275
00:11:42,557 --> 00:11:44,716
So there's still an opportunity
276
00:11:44,741 --> 00:11:46,241
to operate, repair the suture line,
277
00:11:46,266 --> 00:11:47,382
and plug the hole?
278
00:11:47,407 --> 00:11:48,809
Normally, yes.
279
00:11:48,834 --> 00:11:51,435
Your husband's prior
heart bypass surgery
280
00:11:51,582 --> 00:11:55,146
significantly increases the
difficulty of the operation.
281
00:11:55,264 --> 00:11:58,486
His odds of surviving
the procedure plummet.
282
00:11:58,511 --> 00:12:01,896
So if surgery isn't a
viable option, what is?
283
00:12:06,211 --> 00:12:08,261
Given the circumstances,
284
00:12:08,444 --> 00:12:10,861
we feel the safest choice
285
00:12:10,934 --> 00:12:13,602
is to make Nathan comfortable.
286
00:12:17,519 --> 00:12:19,102
How long?
287
00:12:19,146 --> 00:12:21,089
We can't be certain.
288
00:12:21,234 --> 00:12:23,651
A day, a week,
289
00:12:23,734 --> 00:12:25,484
maybe a few months
290
00:12:25,581 --> 00:12:27,664
until the aneurysm ruptures.
291
00:12:27,800 --> 00:12:29,800
We're very sorry.
292
00:12:33,631 --> 00:12:35,968
Help. I can't move.
293
00:12:35,993 --> 00:12:38,460
I'm coming, Paul.
294
00:12:43,980 --> 00:12:46,390
Don't touch that!
295
00:12:46,415 --> 00:12:48,330
What was that?
296
00:12:57,512 --> 00:12:59,285
Ah!
297
00:13:01,913 --> 00:13:04,065
Ethan, what happened?
298
00:13:04,090 --> 00:13:07,056
Got bit by the lid of a tin can.
299
00:13:09,785 --> 00:13:11,489
Truck company is almost here.
300
00:13:11,514 --> 00:13:14,065
They're going to clear a path
to get the stretcher through.
301
00:13:16,898 --> 00:13:18,531
Please, hurry!
302
00:13:18,556 --> 00:13:20,784
Hold on, Paul!
303
00:13:20,809 --> 00:13:22,608
Oh, thank God.
304
00:13:23,194 --> 00:13:25,828
I haven't been able to
pee in over 16 hours.
305
00:13:25,853 --> 00:13:27,519
I thought I was gonna explode.
306
00:13:27,629 --> 00:13:29,495
Brachytherapy for prostate cancer?
307
00:13:29,520 --> 00:13:30,736
Two days ago.
308
00:13:30,761 --> 00:13:32,740
My urologist said it was the way to go.
309
00:13:32,765 --> 00:13:33,970
Who's your urologist?
310
00:13:33,995 --> 00:13:35,878
I'll call and tell them
you've experienced a blockage.
311
00:13:35,903 --> 00:13:37,903
Dr. Mason, over at Advocate South.
312
00:13:37,928 --> 00:13:39,741
Uh, contact info's, uh, in my phone
313
00:13:39,766 --> 00:13:41,933
in my pants pocket.
314
00:13:43,676 --> 00:13:45,280
Oh, sorry.
315
00:13:45,305 --> 00:13:48,822
Oh, whoa, whoa, whoa, whoa, whoa, whoa.
316
00:13:48,848 --> 00:13:50,440
Everything okay?
317
00:13:50,464 --> 00:13:52,748
Just a little spill. I got it.
318
00:13:52,773 --> 00:13:53,999
Okay, hold on.
319
00:13:54,024 --> 00:13:56,522
I'll call environmental services
and have them send a janitor.
320
00:13:56,547 --> 00:13:57,366
It's just pee.
321
00:13:57,391 --> 00:13:58,673
I've cleaned it a thousand times.
322
00:13:58,698 --> 00:14:00,663
Yeah, but not with JCAHO
and Robocop Halstead
323
00:14:00,688 --> 00:14:01,803
on the prowl.
324
00:14:01,828 --> 00:14:04,029
By the book, remember?
325
00:14:04,054 --> 00:14:05,362
Oh, man.
326
00:14:05,387 --> 00:14:08,390
I think the seed came out.
It's radioactive, right?
327
00:14:08,415 --> 00:14:10,838
Oh, it did.
328
00:14:10,902 --> 00:14:13,263
Okay, I'll call Urology instead.
329
00:14:19,353 --> 00:14:21,673
Cath lab for a cardio angiogram?
330
00:14:21,698 --> 00:14:24,696
Should give a better view
of Nathan's pseudo-aneurysm
331
00:14:24,721 --> 00:14:27,389
and hopefully help me estimate
a timeline for his wife.
332
00:14:27,414 --> 00:14:29,581
You mind grabbing me an MRI of his head
333
00:14:29,606 --> 00:14:30,822
while you're up there?
334
00:14:30,847 --> 00:14:31,976
Brain scan?
335
00:14:32,106 --> 00:14:33,536
His injuries don't necessitate it.
336
00:14:33,561 --> 00:14:35,301
It's not for him. It's for me.
337
00:14:35,326 --> 00:14:37,278
Uh, Dr. Charles.
338
00:14:37,303 --> 00:14:40,938
Dr. Rhodes, his awareness
and gross motor skills
339
00:14:41,111 --> 00:14:42,744
are just too strong
340
00:14:42,780 --> 00:14:45,981
for somebody who's been
battling LBD as long as he has.
341
00:14:46,006 --> 00:14:49,565
No amount of cognitive therapy
in the world is gonna outthink
342
00:14:49,590 --> 00:14:51,928
this disease to the degree
that he appears to be.
343
00:14:51,953 --> 00:14:55,071
Laura and two other neurologists
344
00:14:55,096 --> 00:14:57,303
have all agreed on the
Lewy Body diagnosis.
345
00:14:57,328 --> 00:14:59,245
- You think they're wrong?
- I don't know what to think.
346
00:14:59,270 --> 00:15:01,044
That's why I need the scan.
347
00:15:01,130 --> 00:15:03,060
I need the wife's consent.
348
00:15:03,085 --> 00:15:04,916
Hasn't she been through enough?
349
00:15:04,941 --> 00:15:07,670
I'm just trying to spare
her some false hope here.
350
00:15:07,694 --> 00:15:08,940
- Um.
- Hello.
351
00:15:08,966 --> 00:15:10,799
- Gentlemen.
- Doctors.
352
00:15:10,824 --> 00:15:12,194
JCAHO day isn't exactly the time
353
00:15:12,219 --> 00:15:15,220
to be sneaking in unauthorized tests.
354
00:15:15,302 --> 00:15:16,919
I don't know what to tell you.
355
00:15:17,038 --> 00:15:19,132
- Okay.
- Thanks, pal.
356
00:15:19,157 --> 00:15:20,323
Mm.
357
00:15:28,930 --> 00:15:30,980
What've we got?
358
00:15:31,014 --> 00:15:33,282
Hey, guys, start clearing out!
359
00:15:35,555 --> 00:15:37,102
Don't touch that.
360
00:15:37,174 --> 00:15:38,414
Get away.
361
00:15:38,439 --> 00:15:40,055
- Get away.
- There's a second person.
362
00:15:40,080 --> 00:15:41,870
I'm hearing another victim.
363
00:15:42,414 --> 00:15:45,077
Ethan, the neighbors seem
sure it's only Paul in there.
364
00:15:45,102 --> 00:15:47,245
Don't touch that!
365
00:15:47,270 --> 00:15:50,157
There's someone else here.
366
00:15:50,345 --> 00:15:52,574
Dr. Perrington,
367
00:15:54,758 --> 00:15:57,422
got a hemoptysis patient.
368
00:15:57,447 --> 00:16:00,921
Chest X-ray says it's a COPD,
but I think he needs a bronch.
369
00:16:00,946 --> 00:16:02,766
You want to take a quick look?
370
00:16:02,992 --> 00:16:03,985
Really?
371
00:16:04,010 --> 00:16:07,109
The esteemed Dr. Halstead
needs my help with a patient.
372
00:16:07,134 --> 00:16:08,748
I'm honored.
373
00:16:09,700 --> 00:16:12,797
Look, I, uh... I'm sorry about
what happened the other day.
374
00:16:12,822 --> 00:16:16,492
You want a consult, page my resident.
375
00:16:22,188 --> 00:16:24,717
Okay, no redness, no inflammation.
376
00:16:24,742 --> 00:16:25,825
Looks good.
377
00:16:25,850 --> 00:16:27,266
So I can go?
378
00:16:27,291 --> 00:16:29,775
The nurses are working on your
discharge paperwork right now.
379
00:16:29,800 --> 00:16:32,330
Your wound should heal in
about seven days or so.
380
00:16:32,355 --> 00:16:35,773
Until then, irrigate them
and keep them covered.
381
00:16:37,022 --> 00:16:39,627
You all right? Oh, just itchy
382
00:16:39,652 --> 00:16:41,347
and a little sweaty.
383
00:16:41,372 --> 00:16:43,234
Mind if I take a look?
384
00:16:44,589 --> 00:16:46,131
No rash.
385
00:16:46,156 --> 00:16:48,891
Could be an allergic
reaction to the antibiotics.
386
00:16:49,266 --> 00:16:52,188
- You do feel warm though.
- I'll get a temp.
387
00:16:53,639 --> 00:16:56,157
Oh, my sister checking in.
388
00:16:56,182 --> 00:16:57,768
I left Boomer with her.
389
00:16:57,792 --> 00:17:00,075
She's not a dog person either.
390
00:17:00,100 --> 00:17:02,102
I get the impression
they're not for you.
391
00:17:02,127 --> 00:17:03,227
I've treated a lot of dog wounds,
392
00:17:03,252 --> 00:17:05,135
especially on kids.
393
00:17:05,379 --> 00:17:08,380
It's 99.4. Was normal at intake.
394
00:17:09,161 --> 00:17:11,258
- CBC and CMP?
- Yeah.
395
00:17:11,283 --> 00:17:14,094
- I'm not out of here, am I?
- Sorry.
396
00:17:14,119 --> 00:17:16,202
Itching and fever, even a low one,
397
00:17:16,227 --> 00:17:18,403
could be more than an allergic reaction.
398
00:17:18,539 --> 00:17:20,642
Someone will be with you shortly.
399
00:17:23,756 --> 00:17:26,611
Paul, is there anyone else in the house?
400
00:17:26,636 --> 00:17:28,404
No, no, it's just me.
401
00:17:28,429 --> 00:17:29,834
You've got to hurry!
402
00:17:29,859 --> 00:17:32,450
Ah! Ah!
403
00:17:32,864 --> 00:17:35,448
Ethan, what happened?
404
00:17:35,473 --> 00:17:36,938
Are you okay?
405
00:17:47,506 --> 00:17:48,989
Ahh!
406
00:17:58,985 --> 00:18:01,236
- What's all this?
- Well, it's pretty clear
407
00:18:01,261 --> 00:18:02,968
an attending job at
Med isn't gonna happen.
408
00:18:02,993 --> 00:18:04,276
You don't know that.
409
00:18:04,301 --> 00:18:05,793
Just being realistic.
410
00:18:05,942 --> 00:18:07,408
Perrington's on the hiring committee.
411
00:18:07,433 --> 00:18:08,649
She hates me.
412
00:18:08,758 --> 00:18:10,424
Not to mention Goodwin.
413
00:18:10,449 --> 00:18:12,466
But really, Miami, Will?
414
00:18:12,620 --> 00:18:15,977
I've seen you sunburn walking
from the ED to your car.
415
00:18:16,375 --> 00:18:18,955
Hey, got to go where the jobs are.
416
00:18:21,907 --> 00:18:24,059
No coffee. JCAHO day.
417
00:18:24,303 --> 00:18:26,289
Right.
418
00:18:35,367 --> 00:18:36,616
I don't understand.
419
00:18:36,641 --> 00:18:39,086
There should be atrophy,
heavy degeneration,
420
00:18:39,112 --> 00:18:40,821
tangled cells in the white matter.
421
00:18:40,846 --> 00:18:41,928
When was this taken?
422
00:18:41,980 --> 00:18:43,239
About an hour ago.
423
00:18:43,327 --> 00:18:44,559
I'm sorry. I had a hunch.
424
00:18:44,584 --> 00:18:45,833
I rushed it. I really should have...
425
00:18:45,858 --> 00:18:47,494
That is a healthy brain.
426
00:18:47,519 --> 00:18:50,603
There's no disease. This means that...
427
00:18:50,628 --> 00:18:52,662
Nathan doesn't have Lewy Body Dementia.
428
00:18:52,687 --> 00:18:54,359
He has the symptoms.
429
00:18:54,384 --> 00:18:57,121
Keeps getting worse.
Practically a textbook case.
430
00:18:57,146 --> 00:18:58,443
How?
431
00:18:58,468 --> 00:19:01,633
Take a look at this cross
section we took during the MRI.
432
00:19:01,658 --> 00:19:03,830
Notice the adenoma,
433
00:19:03,905 --> 00:19:06,922
benign tumor, in the parathyroid gland.
434
00:19:06,955 --> 00:19:09,852
So you think this is all
hormonal irregularity?
435
00:19:09,877 --> 00:19:11,601
Elevated parathyroid hormone
436
00:19:11,626 --> 00:19:13,461
is consistent with increased calcium
437
00:19:13,486 --> 00:19:15,605
and cognitive impairment.
Nathan has both.
438
00:19:15,630 --> 00:19:17,491
Yes, but he also has hallucinations,
439
00:19:17,516 --> 00:19:19,466
physical aggression. You don't see that
440
00:19:19,491 --> 00:19:21,691
in patients with hyperparathyroidism.
441
00:19:21,747 --> 00:19:24,705
That's where his recent bypass
surgery makes him unique, okay?
442
00:19:24,730 --> 00:19:27,352
The beta blocker he's
been taking ever since
443
00:19:27,392 --> 00:19:30,516
causes increased levels
of violent behavior
444
00:19:30,541 --> 00:19:32,322
in a select amount of patients.
445
00:19:32,501 --> 00:19:35,616
Oh, my God.
446
00:19:37,567 --> 00:19:40,420
A hormonal imbalance
447
00:19:40,843 --> 00:19:43,313
with a medication side effect.
448
00:19:45,606 --> 00:19:47,876
Why didn't I see that?
449
00:19:47,901 --> 00:19:50,118
The clues were right in front of me.
450
00:19:50,350 --> 00:19:53,533
Because they mimic the symptoms
451
00:19:53,558 --> 00:19:56,203
of Lewy Body Dementia to a T,
452
00:19:56,374 --> 00:19:59,032
and four years ago that adenoma
would have been so small
453
00:19:59,057 --> 00:20:00,588
no scan could have caught it.
454
00:20:00,613 --> 00:20:01,998
Look, I'm just telling you
455
00:20:02,023 --> 00:20:04,381
that presented with the same evidence,
456
00:20:04,411 --> 00:20:06,628
I would have done
exactly the same thing,
457
00:20:06,653 --> 00:20:09,604
reached exactly the same diagnosis.
458
00:20:09,635 --> 00:20:10,767
Anybody would have.
459
00:20:10,792 --> 00:20:12,124
You didn't.
460
00:20:12,260 --> 00:20:14,246
I did.
461
00:20:14,922 --> 00:20:18,783
And if I had caught
the PTH four years ago,
462
00:20:18,808 --> 00:20:20,622
Nathan doesn't run into traffic,
463
00:20:20,647 --> 00:20:22,648
doesn't get hit by a car.
464
00:20:22,827 --> 00:20:25,313
Today never happens.
465
00:20:26,352 --> 00:20:27,932
He's dying
466
00:20:27,957 --> 00:20:30,913
and it's entirely my fault.
467
00:20:33,009 --> 00:20:35,357
Don't touch that!
468
00:20:35,382 --> 00:20:36,962
Help. Please, please anybody!
469
00:20:38,681 --> 00:20:40,055
I need help!
470
00:20:42,639 --> 00:20:44,167
Ethan.
471
00:20:44,192 --> 00:20:46,783
Ethan, talk to me.
472
00:20:50,312 --> 00:20:52,116
Ethan, do you copy?
473
00:20:52,141 --> 00:20:53,140
Let's go.
474
00:20:53,165 --> 00:20:54,771
Living room's clear.
475
00:21:09,921 --> 00:21:12,222
- Thank God.
- Paul?
476
00:21:12,247 --> 00:21:16,047
- Help me, please.
- Paul, I'm Dr. Choi.
477
00:21:18,107 --> 00:21:19,874
Okay, your heart's racing.
When's the last time
478
00:21:19,899 --> 00:21:23,385
you had any fluids?
479
00:21:23,743 --> 00:21:27,451
My leg, burned it. Yeah.
480
00:21:27,476 --> 00:21:30,016
- I see that.
- Don't touch that.
481
00:21:41,027 --> 00:21:43,277
- How did this happen?
- I was cooking.
482
00:21:43,302 --> 00:21:47,087
I tripped and spilled
a frying pan, grease.
483
00:21:47,112 --> 00:21:49,284
This didn't just happen.
484
00:21:49,309 --> 00:21:51,501
This burn is thick, leathery.
485
00:21:51,526 --> 00:21:53,538
- 24 hours old?
- I guess.
486
00:21:53,563 --> 00:21:55,543
Why didn't you seek help sooner?
487
00:21:55,617 --> 00:21:59,815
I didn't want anybody to see how I live.
488
00:22:00,417 --> 00:22:03,451
Okay, I'm here now.
489
00:22:03,476 --> 00:22:05,810
Gonna take care of you.
490
00:22:07,795 --> 00:22:10,296
Brachytherapy seed.
491
00:22:10,478 --> 00:22:12,611
Yep, doesn't happen often,
492
00:22:12,636 --> 00:22:14,488
but it can get expelled in the urine.
493
00:22:14,513 --> 00:22:16,930
So, um, how radioactive is it?
494
00:22:16,955 --> 00:22:18,204
To us, harmless.
495
00:22:18,229 --> 00:22:20,480
Still, don't touch it
with your bare hands.
496
00:22:20,505 --> 00:22:21,671
Whoa.
497
00:22:21,696 --> 00:22:23,195
So you're not gonna dispose of it?
498
00:22:23,220 --> 00:22:24,656
Not on JCAHO day.
499
00:22:24,681 --> 00:22:26,039
Sorry.
500
00:22:26,064 --> 00:22:28,499
Call the radiation safety officer.
501
00:22:28,524 --> 00:22:30,374
Oh, man.
502
00:22:30,399 --> 00:22:31,765
Here we go.
503
00:22:31,979 --> 00:22:33,395
I get it.
504
00:22:33,420 --> 00:22:35,345
You didn't do Nathan's bypass surgery.
505
00:22:35,370 --> 00:22:37,222
You don't know what you're walking into.
506
00:22:37,247 --> 00:22:41,007
I can get you every angio he had.
507
00:22:41,032 --> 00:22:44,911
You will know exactly where the
surgeon placed every suture.
508
00:22:44,936 --> 00:22:46,379
The bigger issues are the adhesions
509
00:22:46,404 --> 00:22:49,280
and scar tissue that have
formed over the last five years.
510
00:22:49,305 --> 00:22:51,907
We can expose a healthy
heart in 10 or 15 minutes.
511
00:22:51,932 --> 00:22:54,376
After a quadruple bypass surgery,
512
00:22:54,869 --> 00:22:56,582
it could take hours.
513
00:22:56,607 --> 00:22:59,039
An infinite number of
complications can arise.
514
00:22:59,065 --> 00:23:02,254
When I decided to make
Nathan comfortable,
515
00:23:02,533 --> 00:23:05,855
I believed he had a
neurological death sentence.
516
00:23:06,206 --> 00:23:08,289
Now it's a whole new world.
517
00:23:08,549 --> 00:23:10,680
The dementia can be reversed.
518
00:23:10,706 --> 00:23:13,372
I understand, but the fact
that he doesn't have LBD
519
00:23:13,397 --> 00:23:15,571
doesn't make the surgery any easier.
520
00:23:15,596 --> 00:23:17,933
Nathan's odds of dying
in that operating room
521
00:23:17,958 --> 00:23:19,684
are just as high as they ever were.
522
00:23:19,865 --> 00:23:22,844
It's still my recommendation
to not operate.
523
00:23:23,293 --> 00:23:25,293
I'm sorry.
524
00:23:28,090 --> 00:23:30,090
I'll do the surgery.
525
00:23:32,851 --> 00:23:35,017
Thank you.
526
00:23:36,088 --> 00:23:39,422
Thank you for giving us a second chance.
527
00:23:44,080 --> 00:23:47,221
Difficult is not impossible.
528
00:23:49,240 --> 00:23:51,439
Hmm.
529
00:23:56,638 --> 00:23:59,742
- Brett, how close are you?
- Ugh, Ethan, finally.
530
00:23:59,767 --> 00:24:02,029
- You okay?
- I'm fine, but Paul's got
531
00:24:02,054 --> 00:24:04,040
a serious third degree burn
that needs to be released
532
00:24:04,065 --> 00:24:05,333
in the ED. ETA?
533
00:24:05,358 --> 00:24:06,808
I think we're almost to the kitchen.
534
00:24:06,833 --> 00:24:08,166
We need more room for the gear.
535
00:24:08,191 --> 00:24:10,561
Don't touch that! Get away, get away.
536
00:24:10,586 --> 00:24:12,081
Who was that?
537
00:24:12,106 --> 00:24:15,162
The other person I heard, a parrot.
538
00:24:15,186 --> 00:24:17,208
Look, you still have
the hallway to deal with
539
00:24:17,233 --> 00:24:18,599
and Paul's foot's still swelling.
540
00:24:18,624 --> 00:24:19,961
No pulse in the instep or ankle.
541
00:24:19,986 --> 00:24:22,486
All right, uh, we're
coming as fast as we can.
542
00:24:22,511 --> 00:24:25,898
But not fast enough?
543
00:24:26,035 --> 00:24:29,264
Okay, Paul, here's the deal.
544
00:24:29,289 --> 00:24:31,122
Your skin's so burned,
blood can't get in
545
00:24:31,147 --> 00:24:33,548
or out of your foot. I'm
gonna cut into your leg
546
00:24:33,573 --> 00:24:35,451
on both sides of the burn
to release the pressure.
547
00:24:35,476 --> 00:24:36,364
Here?
548
00:24:36,389 --> 00:24:38,475
I wait any longer, you're
gonna lose your foot.
549
00:24:38,500 --> 00:24:40,820
But... is it gonna hurt?
550
00:24:40,845 --> 00:24:42,501
Already pushed morphine in your IV.
551
00:24:42,525 --> 00:24:43,675
That'll help.
552
00:24:43,700 --> 00:24:45,250
But I'll feel it?
553
00:24:45,372 --> 00:24:47,996
Focus on me, not my hands.
554
00:24:48,021 --> 00:24:50,021
It'll be over before you know it.
555
00:24:50,046 --> 00:24:51,387
Okay?
556
00:24:51,412 --> 00:24:53,980
Deep breath.
557
00:24:54,005 --> 00:24:55,428
Then exhale.
558
00:24:57,361 --> 00:24:58,944
Keep breathing, Paul. Keep breathing.
559
00:24:58,969 --> 00:25:00,971
Big breath.
560
00:25:00,996 --> 00:25:04,505
Bigger exhale.
561
00:25:04,530 --> 00:25:06,561
Done.
562
00:25:06,642 --> 00:25:08,342
Good job, Paul.
563
00:25:11,654 --> 00:25:13,875
Good job.
564
00:25:16,133 --> 00:25:18,524
A high white cell count,
what does that mean?
565
00:25:18,549 --> 00:25:20,563
You probably have an infection.
566
00:25:20,833 --> 00:25:22,749
- From Boomer?
- It's possible.
567
00:25:22,774 --> 00:25:24,314
Have you felt sick recently?
568
00:25:24,368 --> 00:25:26,219
No, not really.
569
00:25:26,244 --> 00:25:29,111
I mean, every now and then
my throat aches a little.
570
00:25:29,163 --> 00:25:30,319
It doesn't really bother me though.
571
00:25:30,344 --> 00:25:31,677
Hmm.
572
00:25:32,906 --> 00:25:36,168
Hmm, the lymph nodes are swollen,
573
00:25:36,204 --> 00:25:38,421
consistent with an upper
respiratory infection.
574
00:25:38,456 --> 00:25:40,911
Let's get a rapid strep test.
575
00:25:42,672 --> 00:25:44,524
What kind of dog is Boomer?
576
00:25:44,549 --> 00:25:46,536
Boxer bulldog mix.
577
00:25:46,561 --> 00:25:47,977
A rescue.
578
00:25:48,049 --> 00:25:50,716
When I went to the shelter,
all the dogs swarmed me,
579
00:25:50,741 --> 00:25:52,402
but Boomer hung back.
580
00:25:52,427 --> 00:25:53,913
Not because he was shy.
581
00:25:53,938 --> 00:25:55,500
It was a move so he'd stand out.
582
00:25:55,525 --> 00:25:57,149
He was playing me.
583
00:25:57,281 --> 00:25:59,447
Smart dog.
584
00:25:59,472 --> 00:26:02,139
I'm gonna swab the back of your throat.
585
00:26:03,687 --> 00:26:06,343
I'll get this to the lab.
586
00:26:20,365 --> 00:26:23,611
I'm doing what I think is right.
587
00:26:24,122 --> 00:26:27,375
Nathan's mental impairment
is due to a pea-sized tumor
588
00:26:27,400 --> 00:26:28,633
that is easily removable.
589
00:26:28,658 --> 00:26:30,872
A 45-minute operation will cure him.
590
00:26:31,207 --> 00:26:34,439
But first, he has to survive
591
00:26:34,464 --> 00:26:37,798
this monumentally difficult surgery.
592
00:26:45,718 --> 00:26:48,164
I'm sorry, you can't bring
your dog into the hospital.
593
00:26:48,192 --> 00:26:49,406
It's my sister's dog.
594
00:26:49,431 --> 00:26:51,014
She's somewhere in the back
not answering her texts.
595
00:26:51,039 --> 00:26:52,588
Only service dogs in the ED.
596
00:26:52,613 --> 00:26:54,227
I'm sorry.
597
00:26:54,688 --> 00:26:57,003
- Oh, is this Boomer?
- How'd you know?
598
00:26:57,028 --> 00:26:58,266
I've been taking care of Tara.
599
00:26:58,291 --> 00:26:59,727
She said he was a boxer bulldog mix.
600
00:26:59,752 --> 00:27:01,887
I thought it was only
gonna be one or two hours.
601
00:27:01,912 --> 00:27:03,579
It's been five. Is she okay?
602
00:27:03,604 --> 00:27:05,096
She spiked a low fever.
603
00:27:05,121 --> 00:27:06,727
- We're testing for strep.
- Strep?
604
00:27:06,752 --> 00:27:07,904
That's nothing. Okay, good.
605
00:27:07,929 --> 00:27:09,438
Look, I have to go to work.
606
00:27:09,463 --> 00:27:11,024
There's no pets allowed in my building.
607
00:27:11,049 --> 00:27:13,324
He barks one time and I can get evicted.
608
00:27:13,349 --> 00:27:14,837
I'm sorry, there's
nowhere else to take him.
609
00:27:14,862 --> 00:27:16,695
Um, no, no, no. I can't take this...
610
00:27:23,997 --> 00:27:25,496
I know.
611
00:27:25,521 --> 00:27:27,902
It all happened really fast.
612
00:27:28,838 --> 00:27:31,343
What do I do?
613
00:27:31,753 --> 00:27:33,521
Get him out of here. Now.
614
00:27:33,546 --> 00:27:35,469
- But where do I take...
- Reese, I don't care where.
615
00:27:35,494 --> 00:27:37,328
Just out.
616
00:27:39,126 --> 00:27:42,190
Hey, look at this guy.
617
00:27:42,215 --> 00:27:44,349
Yeah, Earl, this is Boomer.
618
00:27:44,374 --> 00:27:45,868
Could you watch him for a minute?
619
00:27:45,892 --> 00:27:47,175
But don't get too close because...
620
00:27:47,200 --> 00:27:48,533
Oh, come on, fella.
621
00:27:48,558 --> 00:27:51,275
Come on, guy. Let's go.
622
00:27:51,300 --> 00:27:53,108
Come on, big boy.
623
00:27:53,134 --> 00:27:55,084
Hey. Okay.
624
00:27:55,218 --> 00:27:57,018
Okay.
625
00:27:59,438 --> 00:28:01,271
When I'm out,
626
00:28:01,393 --> 00:28:04,116
the city will condemn my home,
627
00:28:04,271 --> 00:28:05,771
won't they?
628
00:28:05,838 --> 00:28:08,204
Fresh start, I guess.
629
00:28:12,592 --> 00:28:14,385
Get away. Don't touch that.
630
00:28:14,409 --> 00:28:15,751
Don't touch that.
631
00:28:15,776 --> 00:28:17,891
There they are. Ethan.
632
00:28:17,916 --> 00:28:19,607
Hey, guys.
633
00:28:21,378 --> 00:28:23,183
Hey, you okay?
634
00:28:23,248 --> 00:28:24,580
For a second there, it sounded like...
635
00:28:24,605 --> 00:28:27,079
Little hairy for a while, that's all.
636
00:28:27,104 --> 00:28:29,321
Escharotomy in the field.
637
00:28:29,346 --> 00:28:31,679
Damn, nice job.
638
00:29:01,790 --> 00:29:05,224
One across. Six letters.
639
00:29:05,249 --> 00:29:08,417
Bread, milk, eggs.
640
00:29:10,444 --> 00:29:12,882
Thoughts?
641
00:29:13,995 --> 00:29:16,246
Staple.
642
00:29:16,461 --> 00:29:18,127
Nice.
643
00:29:22,850 --> 00:29:25,100
Thank you.
644
00:29:25,308 --> 00:29:27,141
Sure.
645
00:29:30,813 --> 00:29:32,763
All right, guys.
646
00:29:36,162 --> 00:29:40,383
- Got it, clear.
- Lift him up.
647
00:29:48,709 --> 00:29:51,062
Don't touch that.
648
00:30:26,004 --> 00:30:27,420
Dr. Manning,
649
00:30:27,445 --> 00:30:30,874
uh, Tara's rapid strep
came back negative.
650
00:30:31,520 --> 00:30:33,985
Okay, so we're back at square one.
651
00:30:34,010 --> 00:30:35,158
You know what, let's run a, uh...
652
00:30:36,747 --> 00:30:38,882
Easy! Easy.
653
00:30:40,107 --> 00:30:42,607
I'm sorry. I am so sorry.
654
00:30:42,632 --> 00:30:45,451
- Hey, Earl, what's going on?
- I don't know what happened.
655
00:30:45,476 --> 00:30:46,938
Twenty people petted this dog,
656
00:30:46,963 --> 00:30:49,442
and this patient is the
only one he barked at.
657
00:30:49,467 --> 00:30:50,954
Come on, boy. Come on.
658
00:30:50,979 --> 00:30:53,426
Come on, Boomer. Come
on, come on, Boomer.
659
00:30:54,592 --> 00:30:59,172
Let's run an infused CT
chest and abdomen on Tara.
660
00:30:59,712 --> 00:31:02,012
Oh, I've heard stories.
661
00:31:02,037 --> 00:31:04,501
- Mm-hmm.
- Yeah.
662
00:31:11,633 --> 00:31:13,466
Easy.
663
00:31:13,681 --> 00:31:16,481
Snakes in the grass.
664
00:31:16,506 --> 00:31:21,259
Bypass grafts are buried
in the scar tissue,
665
00:31:21,284 --> 00:31:23,033
tough to see.
666
00:31:23,058 --> 00:31:25,652
Soften your grip...
667
00:31:25,678 --> 00:31:28,012
an... and go slow.
668
00:31:32,969 --> 00:31:35,839
- I see it.
- Mm-hmm.
669
00:31:35,904 --> 00:31:39,295
Proximal pseudo-aneurysm
of the LAD bypass graft.
670
00:31:39,324 --> 00:31:40,879
Let's cannulate and get him on the pump
671
00:31:40,904 --> 00:31:41,887
so we can do the repair.
672
00:31:41,912 --> 00:31:44,176
No, I don't need the pump.
673
00:31:44,201 --> 00:31:46,063
It just needs a single repair stitch.
674
00:31:46,088 --> 00:31:47,977
I can do it on the beating heart.
675
00:31:48,401 --> 00:31:50,969
- 8-0 suture.
- Suture.
676
00:31:52,546 --> 00:31:54,554
EKG's ischemic. STs elevation.
677
00:31:54,579 --> 00:31:56,344
Pseudo-aneurysm's ruptured.
678
00:31:56,370 --> 00:31:58,321
He's bleeding. 8-0 suture to me.
679
00:31:58,346 --> 00:32:00,463
- I've got the better angle.
- Dr. Rhodes.
680
00:32:00,488 --> 00:32:04,767
I pushed for the surgery.
I can't lose him.
681
00:32:09,609 --> 00:32:11,911
I'll get you better exposure.
682
00:32:11,936 --> 00:32:14,512
There.
683
00:32:20,181 --> 00:32:22,317
Going to put a second stitch in now.
684
00:32:22,342 --> 00:32:25,027
Don't back-wall the graft.
685
00:32:27,227 --> 00:32:30,796
Bleeding has stopped
and EKG's improving.
686
00:32:30,821 --> 00:32:32,103
Pressure's good.
687
00:32:32,128 --> 00:32:33,316
We're out of the woods.
688
00:32:33,341 --> 00:32:34,840
Not yet.
689
00:32:34,865 --> 00:32:37,252
I want to check his other bypass grafts.
690
00:32:37,489 --> 00:32:39,638
Something goes wrong in the future,
691
00:32:39,663 --> 00:32:44,455
no surgeon's gonna open
his chest a third time.
692
00:32:48,190 --> 00:32:50,830
Lymphoma.
693
00:32:52,063 --> 00:32:54,438
I have cancer?
694
00:32:55,166 --> 00:32:59,238
The next step is a biopsy to
determine exactly which kind.
695
00:32:59,263 --> 00:33:01,123
But I'm only 26.
696
00:33:01,148 --> 00:33:02,615
I go to the gym every day.
697
00:33:02,640 --> 00:33:03,803
I don't smoke.
698
00:33:03,828 --> 00:33:04,861
I know.
699
00:33:04,886 --> 00:33:06,031
It's not fair.
700
00:33:06,056 --> 00:33:07,415
But I don't feel sick.
701
00:33:07,440 --> 00:33:09,773
Well, that's because
it was caught early.
702
00:33:09,829 --> 00:33:12,124
You have time to get way ahead of this.
703
00:33:12,149 --> 00:33:13,453
Mm-hmm.
704
00:33:13,478 --> 00:33:16,794
The lymph nodes are
around here, aren't they?
705
00:33:17,404 --> 00:33:19,928
Boomer's been nipping at me for a month.
706
00:33:19,953 --> 00:33:22,002
Always right there.
707
00:33:22,820 --> 00:33:24,834
Do you think he knew?
708
00:33:25,120 --> 00:33:26,962
Maybe.
709
00:33:27,005 --> 00:33:31,426
It seems some dogs can smell cancers,
710
00:33:31,451 --> 00:33:33,501
even in the very early stages.
711
00:33:33,526 --> 00:33:36,266
Yeah, he wasn't attacking you.
712
00:33:36,336 --> 00:33:39,581
He was trying to protect you.
713
00:33:49,368 --> 00:33:51,191
Maggie, what's going
on with Treatment 4?
714
00:33:51,216 --> 00:33:54,204
- We don't have the space for this...
- I know, I know. It's been all day.
715
00:33:54,229 --> 00:33:56,999
Dr. Halstead, environmental
services hasn't shown up yet.
716
00:33:57,024 --> 00:33:59,071
I can't even get an estimate
as to when they will.
717
00:33:59,954 --> 00:34:01,976
I'll go see them in person.
718
00:34:02,001 --> 00:34:03,834
I'll drag someone down
here if I have to.
719
00:34:03,859 --> 00:34:04,975
Knock some heads.
720
00:34:05,000 --> 00:34:07,333
I need that room back.
721
00:34:17,237 --> 00:34:19,429
How's he doing?
722
00:34:20,161 --> 00:34:21,710
Well.
723
00:34:21,735 --> 00:34:23,885
Good.
724
00:34:24,685 --> 00:34:27,103
How are you doing?
725
00:34:27,222 --> 00:34:29,555
As a neurologist,
726
00:34:29,760 --> 00:34:32,821
Lewy Body Dementia was
my worst nightmare.
727
00:34:32,853 --> 00:34:35,619
I'd seen so many cases,
728
00:34:35,762 --> 00:34:37,770
and I'm wondering
729
00:34:38,045 --> 00:34:40,383
if it influenced my diagnosis.
730
00:34:40,408 --> 00:34:41,719
Hmm.
731
00:34:42,656 --> 00:34:47,019
Medicine, you know.
732
00:34:47,281 --> 00:34:49,571
Imperfect science.
733
00:34:49,596 --> 00:34:51,513
Practiced by human beings, no less.
734
00:34:54,151 --> 00:34:57,919
Four years we could have been doing CTs,
735
00:34:58,329 --> 00:35:01,452
but I had an answer,
so there was no reason
736
00:35:01,477 --> 00:35:04,968
to continue radiating his brain.
737
00:35:04,993 --> 00:35:07,352
I robbed Nathan
738
00:35:07,377 --> 00:35:09,288
of his mind.
739
00:35:10,135 --> 00:35:12,636
I imprisoned him.
740
00:35:14,860 --> 00:35:16,901
I drained our savings.
741
00:35:16,926 --> 00:35:18,586
Squandered our time together,
742
00:35:18,611 --> 00:35:21,701
time that we can never get back.
743
00:35:23,580 --> 00:35:26,290
How am I gonna tell him what I've done?
744
00:35:26,933 --> 00:35:29,016
He's never gonna forgive me.
745
00:35:35,097 --> 00:35:38,348
Your husband's gonna forgive you, Laura.
746
00:35:38,451 --> 00:35:41,061
I want you to trust me on that.
747
00:35:41,726 --> 00:35:43,726
Your struggle,
748
00:35:43,751 --> 00:35:45,634
if I may,
749
00:35:45,858 --> 00:35:48,477
is figuring out
750
00:35:48,502 --> 00:35:51,503
how you're gonna forgive yourself.
751
00:35:58,876 --> 00:36:00,534
Vitals are stable.
752
00:36:00,559 --> 00:36:02,750
EKG looks good.
753
00:36:07,663 --> 00:36:10,030
Cleveland Clinic has an axiom.
754
00:36:10,200 --> 00:36:12,636
Emergency surgery on a healthy heart?
755
00:36:12,661 --> 00:36:14,336
Yes.
756
00:36:14,361 --> 00:36:16,654
Redo surgery for a repaired heart?
757
00:36:16,915 --> 00:36:18,498
Yes.
758
00:36:18,745 --> 00:36:22,477
Emergency surgery for a repaired heart?
759
00:36:22,502 --> 00:36:24,199
No,
760
00:36:24,740 --> 00:36:27,707
because overwhelmingly,
761
00:36:27,830 --> 00:36:30,883
those patients die on the table.
762
00:36:31,583 --> 00:36:34,035
I couldn't do nothing.
763
00:36:34,841 --> 00:36:38,297
I suspect it was ego more than altruism.
764
00:36:39,601 --> 00:36:41,935
Great surgeons
765
00:36:42,148 --> 00:36:44,194
know the balance.
766
00:36:44,919 --> 00:36:46,919
You're confident,
767
00:36:46,944 --> 00:36:49,516
not arrogant.
768
00:36:49,820 --> 00:36:52,635
I like that, Dr. Rhodes.
769
00:36:53,126 --> 00:36:56,259
Nice job today.
770
00:37:05,279 --> 00:37:08,413
You're good. You're good.
771
00:37:08,667 --> 00:37:10,313
Good boy.
772
00:37:10,338 --> 00:37:12,552
Good boy.
773
00:37:17,035 --> 00:37:19,376
Don't come from above.
774
00:37:19,400 --> 00:37:21,316
Come from the front so he can see you,
775
00:37:21,341 --> 00:37:23,310
and hold out the back
of your hand first.
776
00:37:23,335 --> 00:37:25,092
- Okay.
- Come on, buddy.
777
00:37:25,117 --> 00:37:27,475
- Yeah?
- Yeah.
778
00:37:27,500 --> 00:37:30,890
Hey, there.
779
00:37:31,334 --> 00:37:34,789
Did you ever hear that
origin story about dogs?
780
00:37:35,105 --> 00:37:37,993
In Eden, humans and animals got along,
781
00:37:38,018 --> 00:37:39,596
even spoke the same language,
782
00:37:39,621 --> 00:37:43,109
but when Adam and Eve sinned
and God drove them out,
783
00:37:43,134 --> 00:37:46,430
a great chasm opened up
between people and animals.
784
00:37:46,611 --> 00:37:50,062
And as the chasm grew wider,
at the very last moment,
785
00:37:50,087 --> 00:37:53,734
a dog leaped across it to be with us.
786
00:37:55,829 --> 00:37:57,990
That's a great story.
787
00:37:59,220 --> 00:38:01,220
Yeah.
788
00:38:05,738 --> 00:38:08,439
Come in.
789
00:38:08,667 --> 00:38:10,521
Ms. Goodwin, can I talk
to you for a moment?
790
00:38:10,546 --> 00:38:12,746
Quickly, I'm on the
homestretch with JCAHO,
791
00:38:12,771 --> 00:38:14,673
and I don't want to let up now.
792
00:38:14,699 --> 00:38:16,507
I know my voice isn't official,
793
00:38:16,532 --> 00:38:17,731
but I'd like to put in a good word
794
00:38:17,756 --> 00:38:20,540
for Will regarding the
open ED attending position.
795
00:38:20,565 --> 00:38:21,514
Really?
796
00:38:21,539 --> 00:38:23,037
It'd be a shame to lose him.
797
00:38:23,062 --> 00:38:24,099
He's a great doctor.
798
00:38:24,124 --> 00:38:25,653
He cares about this hospital.
799
00:38:25,678 --> 00:38:28,836
Just a few weeks ago you asked
to be taken off his shifts.
800
00:38:28,861 --> 00:38:30,611
We don't always see eye to eye,
801
00:38:30,636 --> 00:38:33,940
but his heart is in the right place.
802
00:38:33,965 --> 00:38:35,431
Well, Dr. Manning,
803
00:38:35,456 --> 00:38:40,215
I'm glad your opinion of
Dr. Halstead has changed.
804
00:38:41,453 --> 00:38:43,453
Okay.
805
00:38:49,550 --> 00:38:51,967
Dr. Halstead, environmental services
806
00:38:51,992 --> 00:38:53,316
are on their way?
807
00:38:53,341 --> 00:38:54,807
Nope.
808
00:38:54,890 --> 00:38:57,665
Turns out, every department
in the hospital's calling ES
809
00:38:57,690 --> 00:39:00,267
to handle things they normally
take care of themselves.
810
00:39:00,292 --> 00:39:02,636
Be tomorrow before a janitor shows up.
811
00:39:02,661 --> 00:39:05,275
Ah, bureaucracy.
812
00:39:07,609 --> 00:39:09,642
Whew.
813
00:39:09,667 --> 00:39:11,267
Mm.
814
00:39:19,016 --> 00:39:20,883
There. The room is yours again.
815
00:39:20,908 --> 00:39:22,614
Against protocol?
816
00:39:23,364 --> 00:39:24,982
I won't tell if you won't.
817
00:39:25,007 --> 00:39:27,909
Huh, guess that means I
get to clean this up now
818
00:39:27,934 --> 00:39:30,721
the way I wanted to eight hours ago.
819
00:39:32,071 --> 00:39:34,071
- You know, toss me a pair.
- Oh?
820
00:39:34,096 --> 00:39:35,796
You know, the kind
that, uh, stick to yours
821
00:39:35,821 --> 00:39:38,104
when you pull 'em out.
822
00:39:39,049 --> 00:39:41,321
- You want in?
- Heck yeah.
823
00:39:41,346 --> 00:39:43,379
We've come this far.
824
00:39:43,404 --> 00:39:45,744
And they call you Robocop.
825
00:39:45,769 --> 00:39:48,603
Robocop?
826
00:39:57,476 --> 00:39:59,201
Katrina.
827
00:39:59,226 --> 00:40:01,554
Reese, come with me.
828
00:40:01,579 --> 00:40:03,154
Uh-oh.
829
00:40:03,179 --> 00:40:05,729
Yeah, I've seen that look.
830
00:40:05,754 --> 00:40:07,825
Dr. Rhodes.
831
00:40:08,018 --> 00:40:10,058
Everyone.
832
00:40:10,914 --> 00:40:14,970
Look, we all know how important
JCAHO site visits are.
833
00:40:14,995 --> 00:40:18,538
Yet, despite what I
said about the rules,
834
00:40:18,562 --> 00:40:21,897
my team ordered tests on the sly,
835
00:40:21,922 --> 00:40:24,255
brought a dog into the ED,
836
00:40:24,280 --> 00:40:27,683
and handled radioactive material.
837
00:40:30,465 --> 00:40:34,078
Sharon, you have every
right to be upset.
838
00:40:34,103 --> 00:40:36,364
Really. But we can't really be ignoring
839
00:40:36,389 --> 00:40:38,851
the, uh, the second law
of thermodynamics here.
840
00:40:38,876 --> 00:40:40,159
Now, can we?
841
00:40:40,184 --> 00:40:41,507
How's that?
842
00:40:41,531 --> 00:40:44,673
Well, systems do tend to degenerate
843
00:40:44,698 --> 00:40:48,563
into ever more disordered
versions of themselves, right?
844
00:40:48,644 --> 00:40:50,483
I mean, look around you.
845
00:40:50,508 --> 00:40:51,820
All we're doing here, all day long,
846
00:40:51,845 --> 00:40:54,995
is battle the universe's
desire to fall apart.
847
00:40:55,020 --> 00:40:59,098
Yeah, should've seen the
house I was in today.
848
00:40:59,123 --> 00:41:00,506
I'm just saying, I love rules.
849
00:41:00,531 --> 00:41:03,211
We all do, but in bringing
order to disorder,
850
00:41:03,236 --> 00:41:06,379
every now and then a
couple gonna get bent.
851
00:41:06,737 --> 00:41:09,608
Nice try, Daniel.
852
00:41:10,459 --> 00:41:13,474
But the good news is JCAHO
853
00:41:13,499 --> 00:41:15,499
didn't catch any of you,
854
00:41:15,523 --> 00:41:18,448
so we keep our top rating.
855
00:41:21,213 --> 00:41:23,914
I'll see you all tomorrow.
856
00:41:23,939 --> 00:41:26,602
Second law of thermodynamics.
857
00:41:26,627 --> 00:41:28,593
Please.
858
00:41:29,515 --> 00:41:33,741
- Synced and corrected by martythecrazy -
- www.addic7ed.com -
9999
00:00:0,500 --> 00:00:2,00
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