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