All language subtitles for The.Pitt.S01E01.7.00.A.M.720p.AMZN.WEB-DL.DDP5.1.H.264-FLUX.Hi

[Robert Bradley's Blackwater
Surprise's "Baby"]

♪ ♪

♪ Baby ♪

♪ It's all right ♪

♪ Maybe ♪

♪ You'll stay here tonight ♪

♪ Baby ♪
[siren wailing]

♪ It's all right ♪

♪ Maybe ♪

♪ You can stay here tonight ♪

♪ ♪

♪ Out on the street ♪

♪ Love, music, and my guitar ♪

♪ Drove up a woman ♪

♪ In one of those
old fancy cars ♪

♪ She said, hey, boy ♪

♪ Why don't you get on in? ♪

♪ For tonight ♪

♪ I'll be your lover
and your friend ♪

[indistinct chatter] [music
continues in earbuds]

[door beeps]

Is it true?

Simi told Hector that
Dr. Deranjian said

the hospital was up for sale.

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

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

but they never do.

[both speaking Tagalog]

Gloria is looking for you.

No guts, no Gloria.

Must be time for
my weekly spanking.

Try to be nice,
for all our sakes.

You sure you're cool
being here today?

Yeah. Why wouldn't I be?

Well, if you need to talk...

Yeah, I won't, but thanks.

Where's Abbot?

Getting some air.

Really?

[retching]

[coughs] [door creaks]

Hey.

You OK in there?

Uh, awesome.

[both laugh]

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

for six months with
my second daughter.

[toilet flushes] Hell,
who am I kidding?

That one still worries me sick.

[sighs]

- Thanks.
- But it's worth it.

You tell anybody yet?

Oh, no.

Not until I pass 12
weeks. Not this time.

Nothing but good vibes.

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

Today's the day
Doc Adamson died.

He hasn't worked
it in four years.

So why is he here?

All I know is, he
still blames himself

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

give him a pass, OK?

- Right.
- Thank you.

Hang in there, kid.

[groans]

[sighs]

[distant siren wailing]

Good morning, Jack.

- [sighs]
- What are you doing here?

I'm working.

And you?

Oh, I don't know.

Had a guy come in.

Hit by a drunk driver
in a crosswalk.

39-year-old vet.

Survived three tours
without a scratch.

[sighs]

I spent the last two
hours coding him.

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

I must have had a reason

at one time to keep coming back,

but I can't think
of it right now.

Because this is the job
that keeps on giving.

Nightmares.

Ulcers.

Suicidal tendencies.

Besides, if you
jump on my shift,

that's just rude, man.

[breathes deeply]

I hope I'm never one
of your patients.

That makes two of us, my friend.

I got a pregnant teen coming
back today for mifepristone

and a small bowel obstruction
waiting on surgery

for the last three hours.

Oh, and unfortunately,

the Kraken is still
boarding in BH.

- Still?
- [elevator dings]

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

- Yep.
- He's only getting worse.

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

But when he wakes
up, God help you all.

[sighs]

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

if anyone shows.

Oh, and you got the med students

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

Lucky, lucky me.

- Sir, get back here!
- No needles! No needles!

- Oh!
- Sir! Stop!

- Somebody help me!
- They're gonna hurt me!

Sure you want to
work today, huh?

Sir, I promise nobody
is going to hurt you.

Sir!

[scoffs] Who left this mess?

It was a tough night.

Good morning, sunshine.

You obviously haven't
seen this board.

Oh, we've seen worse.

Nothing like a little
challenge every now and then

to keep everybody on their toes.

- Dr. Robinavitch?
- Yep.

- Melissa King.
- I will be joining you today.

I just came from two
months at the VA.

Hey, welcome to the Pitt.

This is Dr. Jack Abbot.

Nice to meet you.

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

Talk to me at the
end of the day.

- Ignore him.
- He had a rough night

and is having an ongoing
existential crisis.

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

I married my second
husband, Everett, in 1964.

He unfortunately passed in
1976 from a heart attack

while we were vacationing
in Kissimmee, Florida.

- It was awful.
- Good morning.

We're gonna round, Dr. Mohan.

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

So you know we track
every resident's

patients seen per hour.

I was just taking her history.

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

- not an autobiography.
- I was almost done.

You hadn't even made
it to this century.

Patients, they check in
for registration here.

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

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

and a quick chair exam
where you can order

your labs and your X-rays.

And then they come back to...

Waiting room, until
a bed opens up.

For how long?

Eight hours, if they're lucky.

A lot of times, 12.

Uh, is it always this busy?

Uh, no.

It gets a lot busier.

[door beeps, buzzes]

Take this.

Hey, Mateo.

Good morning, Cass.

This is Sherry.

Hi.

Sherry, I'm Dr. McKay.

I have some student
doctors with me today.

Do you mind if they observe?

Sure.

What's going on, Sherry?

- I...
- [groans]

I burned my hand on a Sterno.

What were you doing
with a Sterno?

Uh, cooking.

You were cooking with a Sterno?

Yeah, we were making s'mores.

That's sweet.

My son loves s'mores.

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

and I have to get
them to school.

Do you know how much
longer this will take?

Uh, yeah, let's see.

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

1,000 Tylenol, 400 ibuprofen,
and saline dressing?

- Yes, please.
- [knock at door]

McKay, we're going to round.

And the fun begins.

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

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

I'll be back.

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

Good morning, good
morning. Come on over.

Starting with second-year
resident Dr. Melissa King,

fresh from the VA.

Everyone calls me Mel.

I'm so happy to be here.

Trinity Santos, intern.

Victoria Javadi, MS3.

Uh, Dennis Whitaker, MS4.

- Welcome to the Pitt.
- I'm...

We've got two
traumas from the T.

- Five minutes out.
- OK, copy that.

Actually, this is the
most important person

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

She's our charge nurse.

She is the ringleader
of our circus.

Do what she says
when she says it.

As you can see, our
house is always packed,

and our department is mostly
clogged up with boarders.

Those are admitted patients
waiting for a room upstairs,

sometimes for days.

Beds are a very precious
commodity around here,

so please be quick and efficient

with your workups.

What else?

We treat the sicker
patients back here,

but please keep your eye
on that waiting room.

Make sure nobody's
gonna die out there.

Your senior residents
are Dr. Collins

and Dr. Langdon.

You report to them,
and they report to me.

Senior residents, you
got your sign-outs?

- Yep.
- OK. Let's do this.

- Virgil Straker.
- [indistinct chatter]

9mm GSW to the left shoulder.

CT angiogram negative,
surgery wants to admit

for overnight observation.

- Good vitals.
- They repeat a crit?

Stable crits every
two hours times three.

Discharge on Ceftin,
recheck tomorrow.

He'll get way more rest at home.

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

- Hell yeah.
- OK.

Hey. Hey, Ro.

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

All right, Murphy Rottenstein.

48-year-old woman with cirrhosis

and upper GI bleed.

Intubated and stable
after one unit.

Awaiting ICU bed.

Hey, Doc.

And we all know
Louie Cloverfield.

Blood alcohol of
.420 at 11:00 PM.

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

That's a lethal
dose for you and me.

That's happy hour for Louie.

- Sobered up.
- Had two rounds of lorazepam.

Hold out your hands
for me, Louie.

- Another two of lorazepam.
- On it.

And a script for Librium.

It's good to see you, Louie.

It's always a pleasure, Doc.

Bar fight with complete avulsion

of tooth number eight.

Smile, Charlie.

- Oh!
- Where's your tooth, Charlie?

Fuck if I know.

- Cancel the discharge.
- Order a chest X-ray.

Got to rule out aspiration.

Incoming!

42-year-old male, Sam Wallace.

Blunt head with
agonal respirations.

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

- LMA in place.
- Suicide attempt?

- Rescue.
- He's a good Samaritan.

Took a spill helping an elderly
woman who fell off the tracks.

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

- Copy.
- [screaming]

Come on.

Elderly woman, fell
from T platform.

Good vitals and
no head injuries.

Degloving injury,
right lower leg

with open fracture
dislocation to the ankle.

- Whoa.
- OK.

Trauma two. Trauma
two. Let's go!

[crying indistinctly]

- How are we doing?
- We ready?

OK, here we go. Ready?

One, two, three.

Good breath sounds bilaterally,

but we need to protect...

Apparently he jumped
down to save the lady.

When he climbed
back up, he slipped,

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

Uh, Mel, right?

I need you on the E-FAST.

Pupils four millimeters
and reactive.

OK, that's encouraging.

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

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

That's a lot more
blood than expected.

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

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

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

What's in the PCC, Mel?

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

OK. Be right back.

50 of fent didn't touch her.

Did she faint or did she
trip off the platform?

Nobody knows.

The other guy jumped down,
pulled her off the tracks

just as the train
was rolling in.

Isolated injury to the foot.

The train ran over her foot?

Got caught between the platform

and the incoming train.

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

All right, type 3 open fracture.

Two grams Cefazolin,
400 of gent.

- Do you speak any English?
- [screams]

Airway and breathing
are perfect.

As is circulation.

BP 140 over 85.

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

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

- cardiac event.
- So she needs...

- Hed CT.
- EKG and troponin.

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

Subway train degloved her foot

with an open
fracture dislocation.

Ooh, and I thought my
heels were painful.

- Hemodynamically stable.
- E-FAST negative.

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

Any pain in your chest or belly?

[sobbing]

Can we please push the morphine?

No, it could cloud
her mental status.

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

We're doing a popliteal block.

Numbs the lower leg,
no side effects.

- Wonderful.
- Where's the other guy?

- Next door.
- He's a bit worse.

Pan scan her.

Let me know when
she stops screaming.

[machine beeping]

The cords are very anterior.

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

Keep the hockey
stick straight up.

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

Bring me up to speed.

Intubated for
agonal respirations.

GCS 5. Probably
anticoagulated.

With what?

First time here.

There's no medical records.

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

80 of mannitol to
reduce brain swelling,

then right up to CT.

[phone ringing]

Do me a favor.

Swap out with Jesse
for me, would you?

- Of course.
- My attending.

Dr. Robinavitch, do
you have a moment?

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

One sec.

- [moaning]
- Nerve block complete.

Seems like it's
starting to work.

Swapping out, Jesse.

Takes ten minutes
for the full effect,

and the Marcaine lasts
a good four hours.

She's next for CT.

You have any idea
what language that is?

Definitely not Tagalog.

Maybe Hindi or Urdu.

I'm gonna go get
language services.

Don't you speak,
like, five languages?

Six, but that's not one of them.

Six?

And I thought Collins was smart.

Oh, it's way too early

for you to start
being an ass, Langdon.

Open hostility in
front of the patient?

She doesn't speak English.

Judgmental and dismissive.

How are we doing?

- Vitals stable.
- Unlike these two.

- Ooh, good for you.
- Princess made a joke.

And I thank you for
that beautiful blessing.

- Namaste.
- OK, do we have a phone

or anything with a
relative's name on it?

EMT said the purse
got obliterated

when the subway ran over it.

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

We don't know what
language she speaks.

Hey, um, any chance she jumped?

She may have been pushed.

- Jesus.
- Yeah.

Could be looking at a
possible hate crime.

I take it you're free now?

We need to talk
about your numbers.

- Of people we've saved?
- Metrics.

Our door-to-balloon times
beat federal standards.

I'm talking about
Press Ganey scores.

Patient satisfaction.

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

Our goal is 36% very
satisfied with their care.

Your department is at 8%.

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

This is an emergency department,

not a Taco Bell.

11%.

Well, if you want
people to be happier,

don't make 'em
wait for 12 hours.

There's a nursing shortage
across the country.

Most of our patients
are boarders

who are waiting
for a bed upstairs.

We don't have the beds.

- That's bullshit.
- The beds are up there.

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

to care for them.

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

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

No response to mag citrate.

Should I send in
the Fleet? [sighs]

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

Like I said, there's
a nursing shortage.

Well, if you paid
them a living wage,

they'd be lining
up to work here.

Our budget can't support that.

- [laughs]
- Here's a dirty little secret.

The hospital saves money

keeping patients down
here in the Pitt.

It's way cheaper than
staffing upstairs.

I have asked you repeatedly

to stop referring to
the emergency department

as the Pitt... it is derogatory

and incompatible to the
institution's image.

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

Me speaking to the media

about people who code
in our waiting rooms

and people who get shitty
care in our hallways

waiting for an ICU bed for days.

I've heard about doctors
who have tried that

and find themselves out of work.

Uh-huh.

I know today is
difficult for you.

Every day is
difficult down here.

Boarding is a
nationwide problem.

Your predecessor, Adamson,
sure as hell knew that.

Or wasn't that
something he taught you?

- Fuck.
- Wow. Really?

Yes, really.

Other hospitals are
managing this crisis

much more effectively.

So you can either
step up your game,

or you can step aside.

[sighs]

Good Samaritan dude has
a small left temporal

intraparenchymal bleed.

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

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

CT can take her in five.

Let's have a look.
Bandage scissors?

All right.

If an artery is
totally transected,

the smooth muscle
and the tunica media

contracts with hemostasis.

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

Grab a culture from the open
fibula before you reduce.

You're up.

I'll stabilize the
knee for the reduction.

Dr. Langdon will be
distracting distally

before moving medially
to clear the tibia.

Good.

Ready?

- [cracking]
- [groaning softly]

[thuds]

Med student down.

Good catch on Bar Fight Billy.

There was an aspirated
tooth on chest X-ray.

Would have been dead in a
week from a lung abscess

had you let him be discharged.

Good call on the pulmonary.

Cardiac arrest, ETA 10 minutes.

- Where should we put it?
- Anywhere.

We might have to put
somebody in the hall.

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

- No, I...
- I tripped on the gurney.

I'm fine.

Why don't you go
get a cold drink

in the staff lounge?

- I'm fine, really.
- I swear.

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

Anytime someone gets a
paper cut around here,

we have to fill out a
workers' comp report.

Other way.

I was fine until
about two weeks ago,

after the Rochester Marathon.

- OK.
- Any falls or injuries?

- Just tired.
- Sore muscles.

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

Was this your first triathlon?

God no.

No, I do one every few months.

Have you seen a doctor yet?

Uh, no.

I went for a run this morning.

Had to quit after a minute.

Pretty short of breath.

This goes under your tongue.

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

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

- Draw a red and purple top.
- Yep.

[beeps] Temp 98.2.

Take a deep breath for me, Otis.

[breathes deeply]

Little pinprick now, OK?

Otis?

Otis.

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

Oh, shit. No pulse.

Crash cart! Lay him flat!

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

Quick look paddles.

- [sustained beeping]
- V-tach.

Charging at 200.

[whirring] Charged.

Clear!

[steady beeping]

All right, he's back
to normal sinus.

Need a gurney in here!

So what's the plan?

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

Repeat head CT in three hours.

Or sooner, if he blows a pupil.

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

Nice job.

Do you think he'll wake up?

Maybe.

Maybe not.

No good deed goes unpunished.

Oh, has anyone, um,
notified the family?

I could try.

- Otis Williams.
- Healthy 31-year-old.

V-tach arrest two
weeks after triathlon.

NSR with one shock.

Pulse 98, BP 110 over 60.

He's a little young for an MI.

Exactly right,

What's in the
differential, Dr. Collins?

Drug overdose,
electrolytes, long QT...

ooh, Brugada syndrome, WPW...

How you doing there, Otis?

- OK.
- What ha...

- [machine flatlines]
- V-tach again.

200 joules.

- [whirring]
- Charged, and clear!

- Back in sinus.
- [steady beeping]

Otis?

[groaning]

Otis?

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

CMP, troponin, and D-dimer.

What are you doing?

One gram calcium
gluconate, IV push.

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

Widened QRS and PT waves.

- Hyperkalemia.
- How'd he get that?

Intense exercise caused
muscle breakdown.

Rhabdomyolysis knocked
out his kidneys.

Now he's not clearing potassium.

I bet it's over 7.5.

Wait two minutes for the i-STAT.

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

If it's hypercalcemia,
you could kill him.

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

[groaning]

Pan scan is negative.

That means you can
admit to orthopedics.

But there may have
been a medical etiology

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

Get an internal
medicine consult,

or admit to medicine
with ortho consulting.

Either way, I'm off the case.

- OK.
- Thanks for nothing.

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

Did we figure out
what she's speaking?

Last interpreter thought
she might be from Pakistan.

There are 77
languages in Pakistan.

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

Good luck.

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

That was wicked.

- [scoffs] That was gross.
- Yeah.

Too much for Little
Miss Crash and Burn.

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

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

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

through this rotation.

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

[scoffs]

Come on.

Put your money
where your mouth is.

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

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

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

I pay off my student loans.

Not that you're...

Hey, you want to sell a kidney?

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

That's just between you and me.

Think about it.

How you doing?

Yeah.

QRS has narrowed.

Much better.

Potassium is 7.7.

Creatinine, 5.6.

High potassium
and renal failure.

Just what you thought.

It must be my lucky day.

Ordering 10 units
of regular insulin

and 25 grams of glucose.

Why insulin and glucose?

Shift the potassium
intracellularly.

Exactly, but the
definitive treatment is...

- Hemodialysis.
- I'll call renal

and get a tech down
with the machine.

Have you ever seen a
dialysis catheter inserted?

Dr. Collins is gonna
place a femoral Quinton

under ultrasound guidance.

It's an excellent way to learn.

[groans] Oh, my chest.

Yeah, we had to shock you.

You're gonna be
sore for a while.

You shocked my heart?

- Long story.
- Dr. Collins will fill you in.

You got a sec?

You OK?

- Why wouldn't I be?
- Are you OK?

Why wouldn't I be?

You seem annoyed
with me already,

and I just got here.

It's not always
about you, Robby.

Am I gonna be OK?

Yeah.

You just need to take
it easy on yourself.

Muscle breakdown and myoglobin
damaged your kidneys.

Why'd you shock my heart?

When your kidneys don't
work, potassium builds up

and messes with the electrical
activity in your heart.

Can it happen again?

We gave you medicine to
lower your potassium,

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

Then I'll be OK?

Yeah.

You might need a week or two

for your kidneys to
recover, but yeah.

You really need to
hydrate like crazy

before and after a triathlon.

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

Good.

Be kind to yourself.

[sighs] Oh, hey.

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

coming back today
for mifepristone.

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

Bowel obstruction, still waiting

on a surgery consult.
What about Garcia?

She was just here
for the traumas.

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

OK.

Oh, one of the med
students took a header.

I parked her in the
lounge under the guise

of a work comp report.

Will you just go in
there, eyeball her,

and make sure she's all right?

She's gonna miss
the morning arrival

of the living dead.

How many are we expecting?

We were getting three,
but one died en route.

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

- What's open?
- 14.

89-year-old woman from a SNF.

History of emphysema, CHF, MS.

V-fib, unresponsive
to three shocks.

- Two rounds of epi.
- What is that?

LUCAS chest compression system.

Robotic CPR.

[machine thumping]

- Everybody get a hold.
- One, two, three.

[yells]

Students are
dropping like flies.

- Take a break.
- Ice the finger.

You can count on getting
a couple elderly patients

every day around 7:30,
after the nursing homes

and assisted living facilities
do their morning bed checks.

You can practically
set your watch.

Was there an advanced directive?

No, full code, per
the nursing home.

Seriously?

LUCAS off.

Still V-fib.

LUCAS on.

One more round of
epi, one more shock,

and then we call it?

[machine beeping]

Joseph Spencer, 79.

Fever and cough.
From assisted living.

He has a history of
mild Alzheimer's.

One, two, three.

- Pulse 130.
- BP 90 over 60.

Gave him 500 cc's normal saline.

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

This is Dr. Collins.

How are you feeling today?

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

Do we have any paperwork
from the facility?

He has a POLST.

IV fluids and
medications are fine,

but no intubation and
no chest compressions.

That's helpful.

Coarse rhonchi here.

Right middle lobe infiltrate.

- Temp 102.
- Call a code sepsis.

- Mm-hmm.
- Code?

To make sure we check
all of our boxes.

The federal government audits
our sepsis bundle performance

and publishes the data online.

Today, it better be perfect.

Two sets of blood
cultures, lactic acid,

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

500 of azithromycin, repeat
lactic in three hours.

Nice.

Charging, and...

Stop.

Call it.

Nursing home just
faxed us a DNR.

[scoffs] Are you kidding me?

Power off the defibrillator
and the LUCAS.

Complete waste of
time and money.

Who the hell works
at that place?

A nurse taking
care of 60 patients

who couldn't find the form.

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

OK, let's move her
to the viewing room

- and notify the family.
- Yep.

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

when we lose a patient,
to respect their humanity

And also to remember that
this was somebody's child

or sibling or parent, friend.

♪ I like the sound
of funky music ♪

Oh. Ow, ow!

[music stops]

I am so sorry.

Maybe leave it on vibrate
while you're working.

- Later, Doc.
- You behave yourself now.

Always.

Your med student's
back on her feet.

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

What is she, some
sort of savant?

I don't know. Maybe.

Dr. Robinavitch, hi.

I just wanted to
apologize for any trouble

my clumsiness might have caused.

I feel ridiculous.

Oh, I can't tell how many times

I've hit my head on
an overhead lamp.

Twice I needed to get staples.

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

That would help both of us.

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

Good, because I don't give it.

[exhales]

Look, I know I might
look too young,

but I studied my
ass off to get here.

Probably harder than the others.

I earned this.

OK, look, I respect
your dedication

and your determination,
but while you're here,

you're my responsibility.

And when one of my
responsibilities

takes a header... wow!

Abbot called for
a surgical consult

on the SBO three hours ago.

You're very lucky
they didn't perf.

I'm here to see my daughter.

I'm sorry, is that a patient?

You're talking to her.

Am I interrupting?

No.

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

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

Thank you.

So how's your first day going?

- It's great.
- Yeah?

Yeah, really great.

Hey, Crash, they're
doing a dialysis

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

Mm-hmm.

- The thing...
- Did she say Crash?

No.

No, no, it's not crash.

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

[chuckles]

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

I've got a patient.

Bye.

What do you want?

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

I am taking a dump in a dustpan,

so what's that fucking tell you?

Um, I'm...

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

- Yeah.
- I'm sorry.

Mm-hmm.

[grunts, splatters]

So it would have been nice
if someone had told me

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

What, and ruin the surprise?

Was it as awkward as
I hoped it would be?

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

And what's the deal
with the body in 19?

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

Still waiting on next of kin.

- Supposedly on their way.
- OK.

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

Nursing home DNR
is heading there,

joining last night's Jane Doe.

Coroner's office is backed up.

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

Perlah.

Triathlete, Otis?

Oh, he's stable.

Repeat potassium is 6.1.

Renal wrote the dialysis order.

Tech should be
down in 15 minutes.

Good. Thank you.

Language mystery solved yet?

No.

Hey, what's your take on dogs?

In what context?

For kids.

Kids and puppies go together
like fish and chips.

Man's best friend, you know?

Well, you don't have a dog.

I don't have a best friend.

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

Big difference.

Yeah, but we're still friends.

Not if this conversation
goes on much longer.

I have a lethargic
four-year-old,

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

Parents just couldn't
wake him up this morning.

- What room?
- Oh, south 15.

There's no nuchal rigidity,

no skin lesions, no focal neuro.

He looks well fed and cared for.

DKA from new-onset diabetes?

No, BG 85.

CBC, BMP, UA, and UDS ordered.

[exhales]

Can you wake up for me, Tyler?

He's not usually this sleepy?

No, and he barely flinched
for the blood test.

He wakes up at 90 miles an hour

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

He passes out?

No, he just means
he goes all day.

Any chance he could
have ingested something?

Any pills, vitamins,

any prescriptions that
may have been left around?

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

The whole house is childproof.

- Uh, what about alcohol?
- Anything left out?

- No.
- What about pets?

No.

So he's usually,
like, quite active?

- Very.
- Um, any injuries lately?

No.

Hasn't bumped his head recently?

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

roughhousing with Drew.

But he never gets hurt.

Oxygen level is normal.

Good pulse and blood pressure.
No signs of infection.

We're gonna start with
blood and urine tests,

check for any metabolic
abnormalities.

- [groans]
- It's really throbbing.

Yeah, the blood's
under pressure.

Gotta drain it.

No anesthesia, or...

I'll stop before I
hit the nail bed.

I hope.

Hey, eyes down here.

Watch and learn.

I'm just looking
who to see next.

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

Yeah, I know how it works.

- OK.
- No need to cry about it.

Do you want me to
choose for you?

No.

Wow, pain's gone.

Thank you.

All right.

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

Should be easy.
Probably viral.

I don't need an easy one.

Suit yourself, Huckleberry.

I'm gonna take the
splitting headache.

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

Hey, why do you keep
calling me that?

Huckleberry?

It's a term of endearment.

It sounds like sarcasm.

You think?

Bordering on harassment.

Where are you from?

Broken Bow, Nebraska.

Jesus, where the hell is that?

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

Oh, yeah, just a little
south of nowhere.

What the hell do you do there?

My parents have a farm, so...

You're a farm boy?

Yeah, I guess.

I rest my case, Huckleberry.

[speaking native language]

I'm so sorry, ma'am.

We don't understand you.

[speaking native language]

Oh.

Me, I'm Dr. Heather Collins.

I'm from here.

Portland, Oregon.

You.

Where are you from?

Uh-huh.

Uh, China? India?

I can't tell where
you're pointing.

Tajikistan?

Nepal.

Mm.

- You're from Nepal.
- Nepali.

[laughs]

Mom's got a bad burn.

Needs wound checks
and hand therapy.

And I got a sneaking
suspicion she may be unhoused.

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

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

Dr. Robby suggested I
might be of assistance.

Yeah, I could use the company.

Victoria Javadi,
this is Kiara Alfaro.

She's the department
social worker,

which pretty much
makes her an angel.

- Welcome.
- Thanks.

Thank you.

So what rotation
is this for you?

Um, third.

I've done OB-GYN and pedes.

You have any favorites?

Not really.

Well, what are you
leaning towards?

I'm not really sure yet.

OK, well, you have time.

Uh, can I actually ask
you a personal question?

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

Oh.

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

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

is a friend or
relative of yours.

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

Yeah, she's my mother.

Oh.

Oh, wow.

Oh, that's cool.

- You're really only 20?
- Yeah.

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

He's an endocrinologist.

Oh, so it's like
a family business.

[laughs]

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

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

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

so I have my own
haters, trust me.

[door beeps] OK.

Um, sometimes when it gets busy,

we'll help the nurses
bring back patients.

- OK.
- Um, OK.

Next to come back is Fred Saeta.

Knee pain after a fall.

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

Hi. Doug Driscoll.

Any chance someone
could see me now?

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

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

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

Yeah, and I got chest
pains that woke me up

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

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

It's just chest pain,
not chest pains.

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

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

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

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

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

It looks here like
you got an EKG

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

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

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

So listen for your
name. Excuse me.

- Fred...
- [retching]

Actually, can you get
me a wheelchair, please?

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

What's going on?

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

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

- Theresa.
- She's my mom.

Theresa?

Theresa, are you
taking any medication?

No.

Any previous stomach problems?

Oh, no.

When did the vomiting begin?

Um, last night.

Last night.

Do you have any
dizziness or fatigue?

Mystery solved.

Our lady with the
degloved foot is Nepali.

Oh, hey, congratulations.

- Otis's BP is crashing.
- 70 over 50.

Still waiting for dialysis.

[machine beeping rapidly]

How you doing there, Otis?

- Not so good.
- 50 liters.

Non-rebreather, please.

Oh, crap.

Diastolic collapse of the right
atrium and right ventricle.

Tamponade from uremic effusion.

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

Too much fluid and pressure

around the heart,
chambers can't fill.

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

We need to get it off.

What's happening?

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

pericardiocentesis tray.

I have to get that from central.

- No, no.
- Just open a central line kit.

Dr. Santos, take
the head of the bed

and bag him if he
stops breathing,

compressions if we
lose the carotid.

Prep and drape the
subxiphoid, please.

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

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

Thank you.

Injecting lidocaine.

- Pressure down.
- 60 over 40.

Right.

Wait, you can't
ultrasound and place.

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

18-gauge thin wall

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

Let's go.

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

advancing very slowly.

We're looking for
the hyperechoic tip.

Very, very slowly. Do
not hit that heart.

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

That's the effusion.

We're looking for
a little white dot.

There it is.

Got it.

Aspirating.

3 cc's should be enough.

[steady beeping]

Good.

Next, we'll place
the guide wire,

and then the triple
lumen catheter.

Pulse ox is 99.

Pressure is up. 124 over 78.

Looks like things
are back to normal.

That was cool.

Four Zofrans on board.

That should stop the nausea.

David, have you
had any vomiting?

- No.
- Anyone else sick at home?

No, it's just us.

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

Oh, I'm so sorry.

Potassium, 3.1.

Is that bad?

It can cause heart problems.

But we're gonna correct it, OK?

10 in the bag, 20 PO.

Javadi, any questions?

Um...

uh, David, have you two traveled

out of the country recently?

We never go anywhere.

Is she gonna have to stay here?

If the rest of the
tests are good,

and she responds to
treatment, she can go home.

Mr. Milton, my name
is Dennis Whitaker.

I'm one of the
student doctors here.

I'll be seeing you first.

Nice to meet you.

BP's 150 over 90.

OK, that's just a touch high.

I forgot to take my damn
enalapril this morning.

Oh, we'll get that for you.

Tell me about this belly pain.

Uh, it started about here.

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

Pretty intense.

- Lasted about an hour.
- Mm-hmm.

Now it's gone.

Any fever or vomiting?

Nah, I never get sick.

OK.

Uh, what did you eat last night?

Oh, it was my wife's birthday.

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

OK.

Well, the exam is pretty benign.

I'm gonna test for gallstones.

If there is a stone
and you eat fatty food,

there can be pain when
the gallbladder contracts.

Oh. [chuckles]

Uh, bingo.

One stone. There it is.

Do I need surgery?

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

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

Just let us know if
you have any more pain.

OK.

Thanks.

Yeah, you bet.

Great.

You want an EKG?

For?

Heart attacks can present
as upper abdominal pain.

Um, yeah.

No, yeah, that's a great idea.

Thank you.

I'm going as fast as I can.

I'm picking up
two more patients.

I didn't say anything.

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

On what?

54-year-old woman brought
in with intractable vomiting

by her 18-year-old son.

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

How so?

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

Some sort of elder abuse.

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

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

- [laughs]
- I don't know about that.

Uh, excuse me, Dr. Langdon.

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

All 100% normal.

What are we missing?

Is he waking up?

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

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

No abnormal blood count, no, uh,

electrolyte abnormalities,
no diabetes,

no, um, kidney disease, so...

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

We're still trying
to figure that out.

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

No, he had preschool,

but he was fine when
I picked him up.

Any kids in his class ill?

No, my phone tree
would have lit up

if someone else was sick.

He eat anything this morning?

No.

Why?

It looks like some
sort of gelatin.

Any chance he could have gotten

into some bath beads
or laundry pods?

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

What about gummies?

No, we're very
strict about candy.

Right?

Oh, shit.

Danny.

What about Danny?

Your brother, he...

he gave me some gummies
he got in Cleveland.

They were in my coat pocket.

Are you fucking serious?

Pot gummies?

Yes. I'm so sorry.

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

Hey, this is
Dr. Langdon from the ED.

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

last name Jones, first
name Tyler, tox screen?

- Get the fuck out!
- I mean it.

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

figure out how much
he may have taken.

Thanks.

I appreciate that
quick turnaround.

The labs confirm it.

Your son tested
positive for cannabis.

This is a fucking nightmare.

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

Hi, I'm Dr. Robby.

We need to do a pelvic exam.

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

Definitely not.

Can you have Nurse Perlah
come join me, please?

Do you want a coffee
or a soda or something?

Why do I need a pelvic exam?

Uh, you don't.

Your son seems like a nice kid.

He's clearly worried about you.

But your exam and your
labs are not matching

any of the usual diagnoses,

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

I'm not here for me.

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

He said that you've had
persistent vomiting,

some... some dehydration.

I made myself sick with ipecac.

- To induce vomiting?
- Why would you do that?

So David would bring me here.

My son has some problems.

He needs professional help.

- OK.
- What kind of problems?

Drugs, alcohol?

I found some of his writing.

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

It was lists of girls
he wanted to hurt.

Hurt them how?

He said, "They should
all be eliminated."

Has David seen a therapist?

No.

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

and I didn't want
to call the police

because I was afraid
they'd overreact.

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

He just turned 18 last month.

Then he's considered an adult

and he would have to
consent to treatment.

Do you have any
guns in the house?

No.

My husband did,

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

He's a good soul.

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

How are you feeling, Crash?

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

- Why not?
- It's a cool nickname.

You earned it.
You should own it.

I don't like it.

- All right.
- It's just a joke.

You know, if it makes
you feel any better,

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

Really?

Of course not.

- Excuse me.
- I'll be right back.

I got a situation.

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

Dad died during the pandemic.

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

of getting him here
after she finds

his death list for classmates.

I... OK.

What does she want us to do?

Help him, protect him, save him.

- Where is he now?
- Talking to McKay.

How are you doing?

Me? I'm good.

I'm always good.
You know that.

- Do I?
- Does anybody?

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

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

Yep.

Zofran. It's what...

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

We're just going over
aftercare instructions,

prescription
medications, special diet

for the next few days.

Dr. McKay, can you check
orthostatics on Mom?

I can.

David, I wanted
you to meet Kiara.

She's a social
worker here who helps

in situations like this.

We heard about your
father's passing.

We're really sorry.

And we know that it can
put a lot of pressure

on somebody your age,
which combined with school

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

It's fine.

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

you can handle it.

We want to make sure
you have someone

you can talk to if you need to.

I'm OK.

I don't need to talk to anybody.

After a parent dies,

the sadness can
last a long time.

How's that going for you?

It's not a problem.

What about school?

What about it?

Anything you enjoy there?

Not really.

A lot of people have thoughts
that can disturb them.

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

What's that have
to do with my mom?

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

She's probably got
a stomach virus,

maybe food poisoning.

I think she's more
worried about you.

She always worries about me.

- Does she have a reason to?
- No.

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

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

I'm late for school.

She can just call
me when she's ready.

It would actually
be kind of helpful

to talk to you some more.

Hey, David.

David.

Just give me five minutes.

Leave me alone!

[people gasping]

Hey, David!

Shit.

Robby!

Robby.

Got a college kid,
respiratory arrest,

coming in hot.

[indistinct chatter]

[tense music]

♪ ♪

[baby crying]

[high-pitched ringing]

♪ ♪

[machine beeping rapidly]

Robby, we need to intubate here.

Dr. Adamson just went down

with a pulse ox of 65.

[breathing heavily]

[ringing intensifies]

Robby!

[The Smile's "No Words"]

♪ ♪

♪ You're not so tough ♪

♪ Your need to be loved ♪

♪ You roast in the desert ♪

♪ A scorched earth ♪

♪ Your mind come loose ♪

♪ The monster's back ♪

♪ Toward a mirage ♪

♪ No words ♪

♪ ♪

♪ You're not so tough ♪

♪ A whip, no crack ♪

♪ A sudden switch ♪

♪ A constant threat that ♪

♪ You'll torch the place ♪

♪ That plants are ♪

♪ Snakes ♪