1 00:00:23,561 --> 00:00:25,479 Robby. 2 00:00:28,816 --> 00:00:30,317 Robby. 3 00:00:30,401 --> 00:00:31,944 College kid in respiratory distress is here. 4 00:00:32,028 --> 00:00:33,362 - All right. - You OK? 5 00:00:33,446 --> 00:00:35,114 Yep. 6 00:00:35,197 --> 00:00:37,158 I wanted to talk to the patient in Central 12's son, 7 00:00:37,241 --> 00:00:38,367 but he took off. 8 00:00:38,451 --> 00:00:39,452 Is there a problem? 9 00:00:39,535 --> 00:00:40,786 Uh, according to Mom, 10 00:00:40,870 --> 00:00:41,871 she found a list of high school girls 11 00:00:41,954 --> 00:00:44,915 that he'd like to eliminate. 12 00:00:44,999 --> 00:00:47,043 What's wrong with kids these days? 13 00:00:47,126 --> 00:00:48,961 Uh, you mean besides social media 14 00:00:49,045 --> 00:00:51,714 and the worldwide pandemic and the environmental crisis? 15 00:00:51,797 --> 00:00:53,507 - Yeah, yeah, yeah. - And gun violence? 16 00:00:53,591 --> 00:00:55,217 You're a fucking fountain of hope today, aren't you? 17 00:00:55,301 --> 00:00:57,970 Nick Bradley, 19, found unresponsive by parents. 18 00:00:58,054 --> 00:00:59,388 No meds, no allergies. 19 00:00:59,472 --> 00:01:00,973 On arrival, he was barely breathing 20 00:01:01,057 --> 00:01:03,309 with pinpoint pupils, bradycardic at 38. 21 00:01:03,392 --> 00:01:05,019 Pupils responded to Narcan, 22 00:01:05,102 --> 00:01:07,605 but we tubed him when his respirations didn't pick up. 23 00:01:07,688 --> 00:01:09,607 Any drugs or alcohol on the scene? 24 00:01:09,690 --> 00:01:11,150 - No. - Signs of trauma? 25 00:01:11,233 --> 00:01:12,401 Nothing. 26 00:01:12,485 --> 00:01:14,070 OK. Open your eyes, Nick. 27 00:01:14,153 --> 00:01:16,530 On three. One, two, three. 28 00:01:18,449 --> 00:01:21,702 - Where was he found? - In bed by his mom. 29 00:01:21,786 --> 00:01:26,207 Pupils are 6 millimeters, non-reactive. 30 00:01:26,290 --> 00:01:28,709 Heart rate's 64. BP is cycling. 31 00:01:28,793 --> 00:01:31,504 No response to pain. GCS 3. 32 00:01:31,587 --> 00:01:34,048 - Does that fit any toxidrome? - No. 33 00:01:34,131 --> 00:01:36,509 If it was just opiates with Narcan, 34 00:01:36,592 --> 00:01:38,844 he'd be breathing on his own. 35 00:01:38,928 --> 00:01:41,055 Uh, beta blockers shouldn't get pinpoint pupils. 36 00:01:41,138 --> 00:01:42,556 Maybe parents had some 37 00:01:42,640 --> 00:01:43,641 prescription meds in their bathroom. 38 00:01:43,724 --> 00:01:45,309 They're on their way. 39 00:01:45,392 --> 00:01:47,436 Code trauma, tier 1, ETA five minutes. 40 00:01:47,520 --> 00:01:49,772 That's a stand-up scooter rider versus car door. 41 00:01:49,855 --> 00:01:52,024 - No helmet. - No blood in the belly. 42 00:01:52,108 --> 00:01:57,154 No pericardial effusion, and lungs are up. 43 00:01:57,238 --> 00:01:59,031 Hemocue's good, 15. 44 00:01:59,115 --> 00:02:01,867 - BP 84 over 58. - OK. 45 00:02:01,951 --> 00:02:03,828 What's your plan, Dr. Collins? 46 00:02:03,911 --> 00:02:07,790 Um, push dose epi, 0.1 milligram. 47 00:02:07,873 --> 00:02:10,209 Foley for urine, stabilize for CT, 48 00:02:10,292 --> 00:02:13,462 and throw a wide net. 49 00:02:17,591 --> 00:02:18,884 Where… where are we going now? 50 00:02:18,968 --> 00:02:20,719 We need the room for someone else, 51 00:02:20,803 --> 00:02:23,722 but you can rest in the hall till we get your labs back. 52 00:02:25,391 --> 00:02:27,893 Your parents must be proud. 53 00:02:27,977 --> 00:02:30,104 Having a son for a doctor. 54 00:02:30,187 --> 00:02:32,773 Yeah, I guess. 55 00:02:32,857 --> 00:02:34,483 Um, you know, 56 00:02:34,567 --> 00:02:38,571 I was the first one in my family to go to college. 57 00:02:38,654 --> 00:02:42,408 You know, they sacrificed a lot to get me here. 58 00:02:42,491 --> 00:02:43,993 How's your pain, Mr. Milton? 59 00:02:44,076 --> 00:02:45,452 Uh, I'm fine. 60 00:02:45,536 --> 00:02:47,037 Could use a latte, though. 61 00:02:47,121 --> 00:02:49,290 That could bring back the gallstone pain. 62 00:02:49,373 --> 00:02:50,791 How about a bourbon? 63 00:02:50,875 --> 00:02:52,501 It's barely 8:00. 64 00:02:52,585 --> 00:02:54,837 Uh, how about some ice chips? 65 00:02:54,920 --> 00:02:56,839 No, thanks. 66 00:02:56,922 --> 00:02:58,632 I prefer my whiskey neat. 67 00:02:58,716 --> 00:03:00,050 Yeah, that's not happening. 68 00:03:04,805 --> 00:03:07,516 Systolic back down to 90. 69 00:03:07,600 --> 00:03:09,518 Another 0.1 of epi. 70 00:03:09,602 --> 00:03:13,272 Flaccid paralysis of all four extremities. 71 00:03:13,355 --> 00:03:16,150 No eye movement with ice water. 72 00:03:16,233 --> 00:03:17,735 So no brainstem function. 73 00:03:17,818 --> 00:03:19,111 Due to? 74 00:03:19,195 --> 00:03:21,572 Hypoxic injury, massive hemorrhage. 75 00:03:21,655 --> 00:03:23,782 Samira, escort him to CT. 76 00:03:23,866 --> 00:03:25,826 Take the drug box with you. 77 00:03:25,910 --> 00:03:27,369 Call me if you need me. 78 00:03:27,453 --> 00:03:29,914 Hey, are you OK? 79 00:03:29,997 --> 00:03:31,665 - Yep. - Are you sure? 80 00:03:31,749 --> 00:03:33,959 Have you ever had to worry about me? 81 00:03:34,043 --> 00:03:36,295 No, but it never hurts to check in. 82 00:03:36,378 --> 00:03:38,130 It's part of my job. 83 00:03:38,214 --> 00:03:40,466 Consider yourself checked in. 84 00:03:40,549 --> 00:03:41,967 OK. 85 00:03:43,010 --> 00:03:45,346 Ah, ah, ah, ah, ah. 86 00:03:45,429 --> 00:03:46,639 Got something? 87 00:03:46,722 --> 00:03:48,265 Oh, I had a case for Dr. Collins. 88 00:03:48,349 --> 00:03:50,643 - May I see? - Yeah. 89 00:03:50,726 --> 00:03:53,938 A 68-year-old male, history of hypertension, 90 00:03:54,021 --> 00:03:55,648 one hour of right upper quadrant pain 91 00:03:55,731 --> 00:03:57,900 after eating a fatty meal, now resolved. 92 00:03:57,983 --> 00:03:59,318 Afebrile, non-tender. 93 00:03:59,401 --> 00:04:01,237 There was a gallstone present on POCUS. 94 00:04:01,320 --> 00:04:03,739 EKG shows no acute ischemic changes, 95 00:04:03,822 --> 00:04:06,033 but I'm still waiting on LFTs and lipase. 96 00:04:06,116 --> 00:04:08,535 Why did you order the EKG? 97 00:04:08,619 --> 00:04:11,789 The nurse suggested it to rule out any cardiac issues. 98 00:04:11,872 --> 00:04:14,333 Well, good call on both your parts. 99 00:04:14,416 --> 00:04:15,668 Nurses know what they're doing. 100 00:04:15,751 --> 00:04:17,127 Never hesitate to listen to them. 101 00:04:17,211 --> 00:04:18,712 Come find me when those labs are back. 102 00:04:18,796 --> 00:04:20,172 - Hey, how's that finger? - Oh, it's nothing. 103 00:04:20,256 --> 00:04:21,632 - Dr. Robby? - Yep? 104 00:04:21,715 --> 00:04:23,050 The son and daughter of Mr. Spencer 105 00:04:23,133 --> 00:04:24,635 from assisted living, they're here. 106 00:04:24,718 --> 00:04:26,887 OK. I'll be right there. 107 00:04:33,769 --> 00:04:36,897 Your father has pneumonia and a condition called sepsis. 108 00:04:36,981 --> 00:04:38,816 What is… what is that exactly? 109 00:04:38,899 --> 00:04:41,151 It means that the bacteria has spread from his lung 110 00:04:41,235 --> 00:04:42,736 to his bloodstream. 111 00:04:42,820 --> 00:04:45,281 So far, he's been responding well to treatment. 112 00:04:45,364 --> 00:04:47,700 Hey, Pop. 113 00:04:47,783 --> 00:04:49,994 It's Helen and Jereme. 114 00:04:51,870 --> 00:04:54,206 Jereme… 115 00:04:54,290 --> 00:04:56,041 Hillary… 116 00:04:56,125 --> 00:04:57,251 Boob… 117 00:04:57,334 --> 00:04:58,961 Fud. 118 00:05:00,963 --> 00:05:03,841 It's the "Nowhere Man" from "Yellow Submarine." 119 00:05:03,924 --> 00:05:06,176 It's what he used to call me when I didn't do my homework. 120 00:05:06,260 --> 00:05:07,970 Is this his baseline? 121 00:05:08,053 --> 00:05:10,180 He has good days and bad days. 122 00:05:11,724 --> 00:05:13,892 Why don't we step out for one more second? 123 00:05:18,522 --> 00:05:20,691 So your father came in with low blood pressure, 124 00:05:20,774 --> 00:05:22,026 which is improving. 125 00:05:22,109 --> 00:05:23,652 Can he go back to assisted living? 126 00:05:23,736 --> 00:05:25,487 Eventually, we hope so. 127 00:05:25,571 --> 00:05:27,281 Your dad has an advanced directive 128 00:05:27,364 --> 00:05:28,991 expressing his wishes, which says that 129 00:05:29,074 --> 00:05:31,327 IV fluids and medications are OK, 130 00:05:31,410 --> 00:05:33,787 but no artificial life support, no CPR. 131 00:05:33,871 --> 00:05:36,582 He doesn't want a bunch of machines keeping him alive. 132 00:05:36,665 --> 00:05:38,250 OK. 133 00:05:38,334 --> 00:05:40,044 Then we will continue with oxygen 134 00:05:40,127 --> 00:05:42,546 and IV fluids and antibiotics, 135 00:05:42,629 --> 00:05:44,214 but if his lungs stop working, 136 00:05:44,298 --> 00:05:45,674 we're not going to place a tube in his windpipe 137 00:05:45,758 --> 00:05:46,800 for a breathing machine. 138 00:05:46,884 --> 00:05:49,261 But pneumonia is treatable? 139 00:05:49,345 --> 00:05:52,014 Most of the time, it is. 140 00:05:52,097 --> 00:05:53,097 But if he can get better in a week, 141 00:05:53,140 --> 00:05:54,308 then put him on a machine. 142 00:05:54,391 --> 00:05:56,143 That's not what he wanted. 143 00:05:56,226 --> 00:05:58,145 Do either of you have durable power of attorney 144 00:05:58,228 --> 00:05:59,730 for health care? 145 00:05:59,813 --> 00:06:00,981 - Yes. - We both do. 146 00:06:01,065 --> 00:06:02,149 OK. 147 00:06:02,232 --> 00:06:03,650 Well, this is a decision 148 00:06:03,734 --> 00:06:05,027 that does not need to be made right now. 149 00:06:05,110 --> 00:06:06,570 Why don't you think about it? 150 00:06:06,653 --> 00:06:08,113 Talk about it. 151 00:06:08,197 --> 00:06:11,992 If things get worse, sometimes allowing 152 00:06:12,076 --> 00:06:15,037 for a comfortable natural death can be the most humane path. 153 00:06:18,457 --> 00:06:21,293 No routine cases until we assess the tier 1. 154 00:06:21,377 --> 00:06:22,363 Thanks. 155 00:06:22,378 --> 00:06:24,880 Dr. Langdon? 156 00:06:24,963 --> 00:06:28,008 So, uh, how was the VA? 157 00:06:28,092 --> 00:06:30,761 Yeah, it was, uh good, uh, you know, challenging. 158 00:06:30,844 --> 00:06:33,389 I learned a ton. I just think it… 159 00:06:33,472 --> 00:06:34,723 maybe it should be mandatory 160 00:06:34,807 --> 00:06:35,807 that all doctors spend time there, 161 00:06:35,849 --> 00:06:37,267 like, on a regular basis 162 00:06:37,351 --> 00:06:39,269 because of all they've sacrificed for us. 163 00:06:39,353 --> 00:06:42,022 That's a nice thought. Why'd you choose the Pitt? 164 00:06:42,106 --> 00:06:43,482 Oh, I have a sister with special needs 165 00:06:43,565 --> 00:06:45,109 and she got into this really great facility 166 00:06:45,192 --> 00:06:46,485 here in Pittsburgh. 167 00:06:46,568 --> 00:06:48,195 And PTMC has such a great reputation, 168 00:06:48,278 --> 00:06:50,030 I thought, you know, it'd be a good fit. 169 00:06:50,114 --> 00:06:51,115 Can I present my headache to you? 170 00:06:51,198 --> 00:06:52,658 Uh, yeah, what do you got? 171 00:06:52,741 --> 00:06:54,535 A 36-year-old woman with severe headache 172 00:06:54,618 --> 00:06:56,370 due to paracervical trigger point. 173 00:06:56,453 --> 00:06:59,081 Her pain went from 11 to zero after 2 ccs of IM Marcaine 174 00:06:59,164 --> 00:07:00,374 - to the… - Wait, wait, wait. 175 00:07:00,457 --> 00:07:01,875 You did a trigger point injection 176 00:07:01,959 --> 00:07:03,585 - before presenting the case? - Yeah. I… 177 00:07:03,669 --> 00:07:05,838 Interns always present first. 178 00:07:05,921 --> 00:07:07,131 I spent a month at the pain clinic at Hopkins. 179 00:07:07,214 --> 00:07:08,882 - No, it's not OK. - Incoming! 180 00:07:08,966 --> 00:07:10,843 - I'm very comfortable with… - It's definitely not OK. 181 00:07:10,926 --> 00:07:12,636 23-year-old Ben Kemper, no helmet, 182 00:07:12,719 --> 00:07:14,471 got doored riding an e-scooter. 183 00:07:14,555 --> 00:07:16,473 Neck versus handlebar then face-planted to the pavement. 184 00:07:16,557 --> 00:07:18,058 Obvious facial fractures, 185 00:07:18,142 --> 00:07:20,018 but alert and oriented with good vitals. 186 00:07:22,396 --> 00:07:23,730 Here we go. 187 00:07:25,357 --> 00:07:27,568 One, two, three. 188 00:07:29,987 --> 00:07:31,280 How are we doing, Ben? 189 00:07:31,363 --> 00:07:33,657 Blood, back in my throat. 190 00:07:33,740 --> 00:07:35,451 That's probably from the nosebleed. 191 00:07:35,534 --> 00:07:37,327 Short Rapid Rhino, please. 192 00:07:37,411 --> 00:07:40,539 Tachy at 120, pulse ox borderline at 90. 193 00:07:40,622 --> 00:07:41,915 Blow by at 15 liters for now. 194 00:07:41,999 --> 00:07:43,500 - Neck contusion. - BP 138 over 84. 195 00:07:43,584 --> 00:07:45,169 Larynx shifted to the right, no crepitance. 196 00:07:45,252 --> 00:07:47,171 4 of morphine. 197 00:07:47,254 --> 00:07:51,675 I'm going to stick something in your nose to stop the bleeding. 198 00:07:51,758 --> 00:07:53,385 No hemotympanum. 199 00:07:53,469 --> 00:07:56,263 Inflate the balloon. 200 00:07:56,346 --> 00:07:58,724 How about now, Ben? 201 00:07:58,807 --> 00:08:01,226 - Better. - What's up? 202 00:08:01,310 --> 00:08:04,438 Good vitals, A and O, let's have a look. 203 00:08:08,317 --> 00:08:09,651 Ouch. 204 00:08:09,735 --> 00:08:12,362 - Floating face. - Le Fort III fracture. 205 00:08:12,446 --> 00:08:14,781 You don't see that every day. OK, let's prep for airway. 206 00:08:14,865 --> 00:08:17,075 Double setup just in case. 207 00:08:30,923 --> 00:08:34,134 - Nice work. - Thanks. 208 00:08:34,218 --> 00:08:36,220 All right, Mr. Tagari, you are good to go. 209 00:08:36,303 --> 00:08:37,888 Oh, thank you. 210 00:08:37,971 --> 00:08:42,226 Remember, 10% off for doctors and nurses. 211 00:08:42,309 --> 00:08:43,644 I'm a student doctor. 212 00:08:43,727 --> 00:08:45,687 Oh, right. Sorry. 213 00:08:45,771 --> 00:08:48,065 - I hit my head, remember? - Well, my son loves pizza, 214 00:08:48,148 --> 00:08:49,650 so I will take you up on it for sure, OK? 215 00:08:49,733 --> 00:08:50,901 - Thank you. Thank you. - Thank you. 216 00:08:50,984 --> 00:08:52,653 - Wait for a nurse. - OK, thanks. 217 00:08:52,736 --> 00:08:54,613 Hi. 218 00:08:54,696 --> 00:08:57,199 I just realized it sounds like I always feed my kid junk food. 219 00:08:57,282 --> 00:08:58,408 - Oh. - You know? 220 00:08:58,492 --> 00:08:59,952 Pizza, s'mores. 221 00:09:00,035 --> 00:09:02,829 No, no, please. I…I like pizza and s'mores. 222 00:09:02,913 --> 00:09:05,666 - Who doesn't? - Mm. 223 00:09:05,749 --> 00:09:09,211 - How many kids do you have? - Just one, Harrison. 224 00:09:09,294 --> 00:09:11,630 He's 11 now. 225 00:09:11,713 --> 00:09:13,006 What does your husband do? 226 00:09:13,090 --> 00:09:14,967 No husband, just me and my son. 227 00:09:15,050 --> 00:09:16,426 I take it you don't have kids? 228 00:09:16,510 --> 00:09:18,804 I…I don't mean on account of your age. 229 00:09:18,887 --> 00:09:20,430 Or maybe I do. 230 00:09:20,514 --> 00:09:22,391 I mean, most medical students don't have kids. 231 00:09:22,474 --> 00:09:25,978 Oh, yeah, no, no. Um, no kids. 232 00:09:26,061 --> 00:09:29,273 Just not even a boyfriend. Uh, it's just school for now. 233 00:09:29,356 --> 00:09:31,275 Yeah. That'll keep you pretty busy. 234 00:09:31,358 --> 00:09:33,610 I do not miss it. 235 00:09:33,694 --> 00:09:35,904 Must have been difficult as a young mother. 236 00:09:35,988 --> 00:09:37,406 It had its moments, 237 00:09:37,489 --> 00:09:39,116 but my life has been full of challenges, 238 00:09:39,199 --> 00:09:42,411 and med school was not one of the hardest, by far. 239 00:09:42,494 --> 00:09:44,746 It was one of the most rewarding, though. 240 00:09:44,830 --> 00:09:48,500 - Other than having my son. - Hey. 241 00:09:48,584 --> 00:09:50,961 Facial lash with possible foreign object in the eye, 242 00:09:51,044 --> 00:09:54,381 which is always a solid 7 on the WMMV Scale. 243 00:09:54,464 --> 00:09:56,091 What Makes Mateo Vomit. 244 00:09:59,344 --> 00:10:02,014 - You OK? - Yeah. 245 00:10:02,097 --> 00:10:05,601 Yeah. Um, he's funny, the… 246 00:10:05,684 --> 00:10:07,019 - the nurse. - Oh, Mateo. 247 00:10:07,102 --> 00:10:08,729 You can say his name. 248 00:10:10,022 --> 00:10:12,357 Um, yeah, uh… 249 00:10:12,441 --> 00:10:15,527 a foreign object in the eye could be really serious. 250 00:10:22,367 --> 00:10:25,495 Hey, Fruitcake. 251 00:10:25,579 --> 00:10:26,913 Hey, I'm talking to you, Fruitcake. 252 00:10:26,997 --> 00:10:28,665 Myrna, I told you a hundred times 253 00:10:28,749 --> 00:10:31,084 my name is Dr. Robby. 254 00:10:31,168 --> 00:10:33,211 You want to see my vagina? 255 00:10:33,295 --> 00:10:35,297 I have already seen it. 256 00:10:35,380 --> 00:10:38,175 And once was enough, thank you. 257 00:10:38,258 --> 00:10:40,218 Robby, parents of Nick Bradley, 258 00:10:40,302 --> 00:10:43,013 - the OD teen, are here. - OK, park them in Trauma 1. 259 00:10:43,096 --> 00:10:44,806 He's not back from CT yet. 260 00:10:44,890 --> 00:10:46,058 I'll be right there in a minute. 261 00:10:46,141 --> 00:10:47,392 Got it. Behaving yourself, Myrna? 262 00:10:47,476 --> 00:10:49,311 Oh, yes, ma'am. 263 00:10:53,023 --> 00:10:54,024 How we doing? 264 00:10:54,107 --> 00:10:55,108 Ketamine and sux on board. 265 00:10:55,192 --> 00:10:56,818 Pulse ox holding at 94. 266 00:10:56,902 --> 00:10:58,195 Prepping the neck just in case. 267 00:10:58,278 --> 00:10:59,278 Let's have a look. 268 00:11:01,531 --> 00:11:03,492 A little deeper. 269 00:11:03,575 --> 00:11:05,077 Lots of swelling. I can't see the cords. 270 00:11:05,160 --> 00:11:07,621 To the right. The left. 271 00:11:07,704 --> 00:11:09,164 Yeah, it really distorted from the trauma, 272 00:11:09,247 --> 00:11:10,332 and the edema's only going to get worse. 273 00:11:10,415 --> 00:11:11,750 Which is why we should crike. 274 00:11:11,833 --> 00:11:13,543 You don't crike a laryngeal fracture. 275 00:11:13,627 --> 00:11:14,795 Don't listen to Edwina Scissorhands here. 276 00:11:14,878 --> 00:11:16,213 If they can't cut it, 277 00:11:16,296 --> 00:11:17,839 surgery doesn't know how to fix it. 278 00:11:17,923 --> 00:11:19,508 The contusion is high at the thyroid cartilage, 279 00:11:19,591 --> 00:11:21,134 so you just stand there looking pretty, ER Ken, 280 00:11:21,218 --> 00:11:23,595 and let me fix this. 281 00:11:23,679 --> 00:11:25,013 - We're down to 85. - All right, pull out. 282 00:11:25,097 --> 00:11:27,265 - I-gel, bag and crike. - I-gel, please. 283 00:11:27,349 --> 00:11:28,558 Turn off the alarm. 284 00:11:28,642 --> 00:11:29,643 I've never done a crike before. 285 00:11:29,726 --> 00:11:31,019 No. Mel will do the crike. 286 00:11:31,103 --> 00:11:32,145 You've already had a busy morning. 287 00:11:32,229 --> 00:11:33,522 Glove up, Mel. 288 00:11:33,605 --> 00:11:35,023 No, I'm doing the crike, doctor. 289 00:11:35,107 --> 00:11:36,093 You would be doing it, doctor, 290 00:11:36,108 --> 00:11:37,484 if it wasn't an odd day. 291 00:11:37,567 --> 00:11:38,735 Surgery gets even days, ED gets odd days. 292 00:11:38,819 --> 00:11:40,445 You know this. For crikes' sake. 293 00:11:40,529 --> 00:11:42,114 That's because you're all fucking odd down here. 294 00:11:42,197 --> 00:11:43,907 OK, team work, please. Let's focus on the patient. 295 00:11:43,990 --> 00:11:45,909 I so appreciate your gracious understanding. 296 00:11:45,992 --> 00:11:47,619 I'll assist in case she screws up. 297 00:11:47,703 --> 00:11:49,705 Yolanda, play nice. 298 00:11:49,788 --> 00:11:51,248 Sats are up with the I-gel. 299 00:11:51,331 --> 00:11:53,667 You ready? Hello? 300 00:11:53,750 --> 00:11:55,460 Oh, uh, hello. 301 00:11:55,544 --> 00:11:56,962 You've done this? 302 00:11:57,045 --> 00:12:00,507 Yes, in the cadaver lab. 303 00:12:00,590 --> 00:12:03,552 Let's hope that's not where this poor soul ends up. 304 00:12:03,635 --> 00:12:05,429 We'll do an open technique since we have a minute. 305 00:12:05,512 --> 00:12:07,597 OK. 306 00:12:07,681 --> 00:12:09,641 OK, you're going to be making a vertical incision 307 00:12:09,725 --> 00:12:12,227 to avoid the jugulars in the carotids. 308 00:12:13,729 --> 00:12:15,439 Mm-hmm, good. 309 00:12:15,522 --> 00:12:17,107 If this was a crike that needed to happen in seconds, 310 00:12:17,190 --> 00:12:20,110 you could use a 10 blade, your finger, and a bougie. 311 00:12:23,530 --> 00:12:25,031 This is called a Weitlaner. 312 00:12:25,115 --> 00:12:27,492 And this is your trake hook. 313 00:12:27,576 --> 00:12:31,371 C-spine, head CT, OMF. Start a propofol drip. 314 00:12:31,455 --> 00:12:33,081 OK, now we're going to make a horizontal incision 315 00:12:33,165 --> 00:12:35,167 across the cricothyroid membrane. 316 00:12:37,586 --> 00:12:39,713 Yeah. 317 00:12:39,796 --> 00:12:41,715 4.0 Shiley next. 318 00:12:41,798 --> 00:12:42,966 Get ready to bag the crike. 319 00:12:44,801 --> 00:12:46,887 Yeah, yeah, yeah, good. 320 00:12:54,186 --> 00:12:55,172 Oh, excuse me. 321 00:12:55,187 --> 00:12:57,272 No worries. 322 00:12:57,355 --> 00:12:58,565 End tidal CO2 is yellow. 323 00:12:58,648 --> 00:13:00,150 Yellow is yes. Nicely done. 324 00:13:00,233 --> 00:13:03,195 Sew it in. OK, I will be next-door. 325 00:13:04,946 --> 00:13:06,198 Does your resident know how to suture, 326 00:13:06,281 --> 00:13:07,616 or do I need to teach? 327 00:13:07,699 --> 00:13:10,660 - You're all class, Yoyo. - I know, thanks. 328 00:13:10,744 --> 00:13:13,121 That means a lot of nothing coming from you. 329 00:13:13,205 --> 00:13:15,624 - Mel, you OK? - If you're done fighting. 330 00:13:15,707 --> 00:13:17,125 We're not fighting. This is playing. 331 00:13:17,209 --> 00:13:18,919 Langdon's too soft to fight. 332 00:13:19,002 --> 00:13:20,921 Oh, yeah, I have nothing but respect for Dr. Garcia. 333 00:13:21,004 --> 00:13:22,380 In fact, I think she would 334 00:13:22,464 --> 00:13:24,257 make a wonderful hostess at Applebee's. 335 00:13:24,341 --> 00:13:25,759 Later, Odds. 336 00:13:28,094 --> 00:13:29,888 Let's go. 337 00:13:29,971 --> 00:13:31,556 OK, thanks. 338 00:13:31,640 --> 00:13:34,017 Just received word your son's head CT is normal, 339 00:13:34,100 --> 00:13:35,852 and he's maintaining a good heart rate. 340 00:13:35,936 --> 00:13:38,063 - You got him back. - Thank you. Thank God. 341 00:13:38,146 --> 00:13:39,523 Right now, he's unconscious 342 00:13:39,606 --> 00:13:42,776 with a tube in his throat for oxygen. 343 00:13:42,859 --> 00:13:44,277 Why don't we step out for a minute while they 344 00:13:44,361 --> 00:13:45,862 get him settled, and then you can come back? 345 00:13:45,946 --> 00:13:48,323 You can sit with him as long as you want. 346 00:13:48,406 --> 00:13:50,784 Nicky, it's Mama. I'm here, baby. 347 00:13:50,867 --> 00:13:53,245 You're doing great, son. 348 00:13:53,328 --> 00:13:56,122 Blown. 349 00:13:56,206 --> 00:13:59,543 - OK, let's step outside. - OK. 350 00:14:05,715 --> 00:14:07,592 So we don't know 351 00:14:07,676 --> 00:14:09,636 how long he was at home without breathing. 352 00:14:09,719 --> 00:14:12,848 - He's breathing now. - Not on his own. 353 00:14:12,931 --> 00:14:14,140 But he's going to wake up. 354 00:14:14,224 --> 00:14:15,892 We certainly hope so. 355 00:14:15,976 --> 00:14:17,185 We're going to know better after 356 00:14:17,269 --> 00:14:18,645 we get some more test results back. 357 00:14:18,728 --> 00:14:21,398 Are you sure that he didn't take anything 358 00:14:21,481 --> 00:14:22,482 that could have caused this? 359 00:14:22,566 --> 00:14:24,234 No, no, he's a good kid. 360 00:14:24,317 --> 00:14:26,486 He's in college, he has a part-time job. 361 00:14:26,570 --> 00:14:29,781 He even chose to live at home so he could focus on school. 362 00:14:29,865 --> 00:14:31,658 Dr. Robby. From the urine. 363 00:14:31,741 --> 00:14:34,160 What's that? 364 00:14:34,244 --> 00:14:35,495 It's a drug test. 365 00:14:35,579 --> 00:14:38,123 And it is positive for fentanyl. 366 00:14:38,206 --> 00:14:40,876 No, that is impossible. Nick doesn't do drugs. 367 00:14:40,959 --> 00:14:43,211 There are a lot of pills that are sold illegally 368 00:14:43,295 --> 00:14:45,422 that have fentanyl, not just painkillers. 369 00:14:45,505 --> 00:14:47,132 Xanax, Ativan. 370 00:14:47,215 --> 00:14:49,634 - No, not our son. - Uh… 371 00:14:49,718 --> 00:14:51,261 Well, maybe he didn't know that he took something 372 00:14:51,344 --> 00:14:52,804 with fentanyl, I don't know. 373 00:14:52,888 --> 00:14:55,056 The hows and the whys don't really matter. 374 00:14:55,140 --> 00:14:57,017 What matters is spending time with Nick. 375 00:14:57,100 --> 00:14:58,393 We've got some more tests to run. 376 00:14:58,476 --> 00:14:59,477 We'll know our options after that, 377 00:14:59,561 --> 00:15:00,854 but in the meantime, 378 00:15:00,937 --> 00:15:02,772 why don't you take a seat and talk to him? 379 00:15:05,317 --> 00:15:06,568 Can he hear us? 380 00:15:06,651 --> 00:15:07,903 You know, we're never really sure, 381 00:15:07,986 --> 00:15:09,863 so we should assume that he can. 382 00:15:09,946 --> 00:15:12,240 And we'll come find you as soon as we know more, OK? 383 00:15:12,324 --> 00:15:13,324 OK. 384 00:15:19,831 --> 00:15:21,958 Can we move Nick Bradley to a private room? 385 00:15:22,042 --> 00:15:23,501 The kid going to make it? 386 00:15:25,003 --> 00:15:26,796 Didn't he respond to Narcan? 387 00:15:26,880 --> 00:15:28,840 I think his pinpoint pupils just grew into blown pupils 388 00:15:28,924 --> 00:15:29,966 from brainstem death. 389 00:15:30,050 --> 00:15:33,303 - Shit. - Yeah. 390 00:15:33,386 --> 00:15:35,847 Not much older than Jake. 391 00:15:35,931 --> 00:15:37,182 Don't go there. 392 00:15:38,683 --> 00:15:41,269 Hard not to sometimes. 393 00:15:41,353 --> 00:15:43,438 Mr. Spencer's room. 394 00:15:43,521 --> 00:15:45,231 Hey, Robby, 395 00:15:45,315 --> 00:15:47,442 Theresa, the mother of the young man David who bolted, 396 00:15:47,525 --> 00:15:48,777 she's asking for her son. 397 00:15:48,860 --> 00:15:50,278 OK. I'll be there in a minute. 398 00:15:50,362 --> 00:15:51,738 What is happening? 399 00:15:51,821 --> 00:15:54,574 Uh, his oxygen levels are dropping. 400 00:15:54,658 --> 00:15:56,868 Mr. Spencer, how are you feeling? 401 00:15:56,952 --> 00:15:59,412 I don't remember where I parked. 402 00:15:59,496 --> 00:16:01,373 Mr. Spencer, do you know where you are? 403 00:16:01,456 --> 00:16:03,792 It's so loud in here. 404 00:16:03,875 --> 00:16:06,294 Dad? Do you know where you are? 405 00:16:06,378 --> 00:16:08,713 Dad, look at me. What's my name? 406 00:16:08,797 --> 00:16:12,842 I don't know where my car is. 407 00:16:12,926 --> 00:16:14,552 BiPAP, 15 over 5. 408 00:16:14,636 --> 00:16:15,887 Let's step out. 409 00:16:20,225 --> 00:16:22,018 What's a BiPAP? 410 00:16:22,102 --> 00:16:25,355 It is a pressurized air mask that can improve his oxygen. 411 00:16:25,438 --> 00:16:26,815 Either his pneumonia is getting worse 412 00:16:26,898 --> 00:16:28,817 or his heart couldn't handle the fluids 413 00:16:28,900 --> 00:16:30,610 that we gave him to treat the sepsis. 414 00:16:30,694 --> 00:16:32,112 His lungs are filling up with fluid. 415 00:16:32,195 --> 00:16:33,571 Can't you take the fluid away? 416 00:16:33,655 --> 00:16:35,407 Not without his blood pressure crashing 417 00:16:35,490 --> 00:16:36,700 with very bad consequences, 418 00:16:36,783 --> 00:16:38,827 so let's just hope the BiPAP works. 419 00:16:38,910 --> 00:16:40,829 And if it doesn't? 420 00:16:40,912 --> 00:16:43,248 Then I would need to know your decision 421 00:16:43,331 --> 00:16:44,666 about using a breathing machine. 422 00:16:44,749 --> 00:16:46,668 We're still talking about it. 423 00:16:46,751 --> 00:16:48,962 Well, we know he expressed his wishes. 424 00:16:49,045 --> 00:16:51,047 In writing. "Do not intubate." 425 00:16:51,131 --> 00:16:54,134 We're thinking try it for a week. 426 00:16:54,217 --> 00:16:57,429 That would be a very painful week. 427 00:16:57,512 --> 00:17:00,181 He wouldn't get a lot of rest with all the monitors 428 00:17:00,265 --> 00:17:02,392 and all the blood tests. He might need to be sedated. 429 00:17:02,475 --> 00:17:03,893 He might need to be restrained 430 00:17:03,977 --> 00:17:05,979 because he'd be in an unfamiliar place 431 00:17:06,062 --> 00:17:08,606 with a very uncomfortable tube down his throat. 432 00:17:08,690 --> 00:17:10,942 And he wouldn't really know what was happening. 433 00:17:11,026 --> 00:17:14,446 Elderly patients can often develop psychosis. 434 00:17:14,529 --> 00:17:17,741 - But he might get better. - Or he might get worse. 435 00:17:17,824 --> 00:17:19,993 What would you do? 436 00:17:20,076 --> 00:17:21,745 I really can't answer that for you. 437 00:17:21,828 --> 00:17:23,288 This is your father. It's your decision to make. 438 00:17:23,371 --> 00:17:24,956 I can guarantee you 439 00:17:25,040 --> 00:17:26,791 that we will keep him as comfortable as possible 440 00:17:26,875 --> 00:17:28,626 if a natural death is what you choose. 441 00:17:28,710 --> 00:17:30,378 But he's not your father. 442 00:17:30,462 --> 00:17:32,130 And he can recover from this. 443 00:17:32,213 --> 00:17:33,840 What my sister means 444 00:17:33,923 --> 00:17:35,884 is that we're still deciding the best thing to do. 445 00:17:38,928 --> 00:17:41,014 Well, the sooner you decide, the better. 446 00:17:41,097 --> 00:17:42,390 I'm really sorry. 447 00:17:42,474 --> 00:17:44,350 I wish there was more that I could do. 448 00:17:44,434 --> 00:17:46,728 I'm not sure that he has that much time left. 449 00:17:53,109 --> 00:17:55,278 Dr. Robby. 450 00:18:01,659 --> 00:18:03,244 You were right. 451 00:18:03,328 --> 00:18:04,871 She can't say whether she was bumped by accident 452 00:18:04,954 --> 00:18:06,706 - or shoved on purpose. - No other witnesses? 453 00:18:06,790 --> 00:18:09,292 No, not really. 454 00:18:09,375 --> 00:18:11,252 We pulled security footage. Maybe we'll find something. 455 00:18:11,336 --> 00:18:13,505 Hopefully she tripped. 456 00:18:13,588 --> 00:18:14,964 I don't mean I hope she tripped. 457 00:18:15,048 --> 00:18:17,467 I mean I hope she wasn't pushed on purpose. 458 00:18:17,550 --> 00:18:19,385 That would this a hate crime. 459 00:18:19,469 --> 00:18:21,930 Yes, ma'am. 460 00:18:22,013 --> 00:18:24,099 - Ma'am? - Doctor. 461 00:18:24,182 --> 00:18:26,267 Sorry. I'm…I'm sorry. 462 00:18:27,435 --> 00:18:28,520 No harm, no foul. 463 00:18:28,603 --> 00:18:32,899 Will you let me know if she says anything else? 464 00:18:34,317 --> 00:18:35,944 Will do. 465 00:18:38,613 --> 00:18:39,906 At the risk of seeming… 466 00:18:39,989 --> 00:18:41,116 Then you probably shouldn't. 467 00:18:41,199 --> 00:18:43,451 - I just… - No, trust me. 468 00:18:43,535 --> 00:18:45,203 - How do you know… - I just know. 469 00:18:45,286 --> 00:18:48,164 - I just wanted… - I know. 470 00:18:48,248 --> 00:18:51,084 Look, I'll let you know if she says anything else 471 00:18:51,167 --> 00:18:53,837 that could be important to your investigation. 472 00:18:57,465 --> 00:18:59,342 Thank you. 473 00:18:59,425 --> 00:19:02,303 - You know, for the record… - Nope. 474 00:19:12,355 --> 00:19:15,275 Any luck getting our psych boarders upstairs? 475 00:19:15,358 --> 00:19:18,611 Yeah, right, at least the Kraken's still sleeping. 476 00:19:20,113 --> 00:19:21,239 Is it me or was that officer… 477 00:19:21,322 --> 00:19:23,283 - No. - What? 478 00:19:23,366 --> 00:19:26,578 - You don't even know what I… - What you were going to say? 479 00:19:26,661 --> 00:19:29,622 Maybe you do. 480 00:19:29,706 --> 00:19:31,583 - He seemed nice. - Absolutely not. 481 00:19:31,666 --> 00:19:33,459 Mm-mm. 482 00:19:33,543 --> 00:19:35,003 There is no possible scenario 483 00:19:35,086 --> 00:19:37,422 in which you and I have this conversation. 484 00:19:37,505 --> 00:19:39,299 You of all people should know better. 485 00:19:39,382 --> 00:19:42,051 - I was… - No. 486 00:19:42,135 --> 00:19:43,678 Just walk away. 487 00:19:43,761 --> 00:19:46,848 Best possible scenario. Just keep on walking. 488 00:19:46,931 --> 00:19:48,683 Mm-hmm. 489 00:19:48,766 --> 00:19:51,603 You got to lay off mixing Adderall and energy drinks. 490 00:19:51,686 --> 00:19:52,937 Trust me, I will. 491 00:19:53,021 --> 00:19:55,064 All right. Thanks. 492 00:19:56,399 --> 00:19:57,817 That's the thing about emergency medicine. 493 00:19:57,901 --> 00:19:59,319 You never know what you're going to get. 494 00:19:59,402 --> 00:20:01,237 And we get everything. 495 00:20:01,321 --> 00:20:02,488 Is that why you chose it? 496 00:20:02,572 --> 00:20:04,199 Maybe a little. 497 00:20:04,282 --> 00:20:05,700 I also get to pick my shifts, 498 00:20:05,783 --> 00:20:08,369 which, for a single mother, is amazing. 499 00:20:08,453 --> 00:20:11,080 But mostly, I just like the people, you know? 500 00:20:11,164 --> 00:20:12,749 They're always there when you need them. 501 00:20:12,832 --> 00:20:14,375 Who wouldn't want to be a part of that, you know? 502 00:20:17,128 --> 00:20:19,005 Fuck off. 503 00:20:25,303 --> 00:20:27,138 This is the monitoring center. 504 00:20:27,222 --> 00:20:29,057 We see that you are not in your inclusion zone. 505 00:20:29,140 --> 00:20:31,100 Do you have permission to be outside this area? 506 00:20:31,184 --> 00:20:33,645 Yes, I am at work. 507 00:20:33,728 --> 00:20:37,482 Just like last time and the time before that. 508 00:20:39,067 --> 00:20:40,193 I'll be right back. 509 00:20:42,320 --> 00:20:44,697 What is the point of this fucking thing 510 00:20:44,781 --> 00:20:46,324 if it doesn't even work? 511 00:20:54,082 --> 00:20:55,458 Sorry. 512 00:20:55,541 --> 00:20:57,460 You're doing great. Take your time. 513 00:20:57,543 --> 00:20:58,543 You OK? 514 00:20:58,586 --> 00:21:00,004 I am…yeah. 515 00:21:00,088 --> 00:21:01,422 I get frustrated when I can't do things, 516 00:21:01,506 --> 00:21:02,924 or at least it looks like it. 517 00:21:03,007 --> 00:21:05,134 Yeah, you and me both. 518 00:21:05,218 --> 00:21:08,471 Thanks, but my frustration manifests itself emotionally, 519 00:21:08,554 --> 00:21:10,348 and then, uh, I get upset, 520 00:21:10,431 --> 00:21:12,183 and then it looks like I can't handle things, 521 00:21:12,267 --> 00:21:14,352 and, you know, then I can't cry in front of the patient 522 00:21:14,435 --> 00:21:15,561 because no one wants to see their doctor cry. 523 00:21:15,645 --> 00:21:17,313 That's just a big red flag. 524 00:21:17,397 --> 00:21:20,566 You just did a perfect crike. You're doing great. 525 00:21:23,736 --> 00:21:25,697 Hey, you! Pasty white! 526 00:21:25,780 --> 00:21:27,156 How about a sandwich? 527 00:21:27,240 --> 00:21:30,451 Uh, what brings you here today, sir? 528 00:21:30,535 --> 00:21:33,329 I'm here for a fucking sandwich. 529 00:21:33,413 --> 00:21:35,081 OK. 530 00:21:35,164 --> 00:21:38,001 OK, uh, excuse me… 531 00:21:38,084 --> 00:21:39,419 - Perlah. - Perlah. 532 00:21:39,502 --> 00:21:41,296 Can this patient get a sandwich? 533 00:21:41,379 --> 00:21:42,755 I already gave you a sandwich, Earl. 534 00:21:42,839 --> 00:21:45,675 I ain't ate this whole week. 535 00:21:45,758 --> 00:21:47,343 Sure. 536 00:21:47,427 --> 00:21:49,178 Give him another sandwich. They're on the food cart. 537 00:21:49,262 --> 00:21:50,388 Just make sure it's not egg salad, 538 00:21:50,471 --> 00:21:51,931 or he'll throw it on the floor. 539 00:21:52,015 --> 00:21:53,808 OK. Good to know. Thanks. 540 00:22:08,364 --> 00:22:09,991 Any quick ones up here? 541 00:22:10,074 --> 00:22:11,784 It's only 8:30, and Robby's already on my case 542 00:22:11,868 --> 00:22:13,745 for being too slow. 543 00:22:13,828 --> 00:22:14,871 I can usually at least make it to lunch 544 00:22:14,954 --> 00:22:16,497 before he starts hounding me. 545 00:22:16,581 --> 00:22:18,374 Cut him a little slack today, OK? 546 00:22:18,458 --> 00:22:20,960 It's the anniversary of Dr. Adamson's death. 547 00:22:21,044 --> 00:22:23,588 That's sad. 548 00:22:23,671 --> 00:22:26,257 But it's still no reason to take it out on me. 549 00:22:26,341 --> 00:22:27,967 I'm just saying. 550 00:22:28,051 --> 00:22:30,511 - Dr. Mohan? - Samira, please. 551 00:22:30,595 --> 00:22:32,513 I just wanted to apologize. 552 00:22:32,597 --> 00:22:35,558 When my phone went off earlier, that was really unprofessional. 553 00:22:35,641 --> 00:22:36,934 Don't sweat it. Trust me. 554 00:22:37,018 --> 00:22:38,311 We need to laugh. 555 00:22:38,394 --> 00:22:39,854 Otherwise, we'd never stop crying. 556 00:22:39,937 --> 00:22:41,189 Thank you. 557 00:22:41,272 --> 00:22:42,607 Besides, with all the craziness 558 00:22:42,690 --> 00:22:43,941 that comes through here every hour, 559 00:22:44,025 --> 00:22:45,735 nobody cares or notices. 560 00:22:45,818 --> 00:22:48,112 Got an unresponsive unhoused man coming in. 561 00:22:48,196 --> 00:22:52,200 Might be a good teaching case, Funky Music. 562 00:22:54,327 --> 00:22:55,661 Let's go. 563 00:22:55,745 --> 00:22:57,038 Caucasian male, 564 00:22:57,121 --> 00:22:58,664 approximately 60 to 70 years old, 565 00:22:58,748 --> 00:23:02,001 found unresponsive. No signs of trauma, no ID. 566 00:23:03,461 --> 00:23:05,129 On three. 567 00:23:05,213 --> 00:23:07,423 One, two, three. 568 00:23:09,717 --> 00:23:12,136 Oof. Did you take anything? 569 00:23:12,220 --> 00:23:13,638 I smell the alcohol from here. 570 00:23:13,721 --> 00:23:14,847 This guy's wearing the spring, summer, 571 00:23:14,931 --> 00:23:16,015 and fall collection. 572 00:23:17,225 --> 00:23:18,393 Oh! Whoa! 573 00:23:18,476 --> 00:23:20,144 - Jesus, uh… - Oh, oh, oh! 574 00:23:20,228 --> 00:23:21,229 What the… 575 00:23:22,647 --> 00:23:25,233 Uh, what's wrong? What's going on? 576 00:23:25,316 --> 00:23:28,194 Patient tested positive for rats. 577 00:23:28,277 --> 00:23:29,612 No. 578 00:23:29,695 --> 00:23:33,157 If it matters, I only counted three. 579 00:23:33,241 --> 00:23:34,659 Oh, there goes one. 580 00:23:39,205 --> 00:23:41,290 Because your son tested positive for THC, 581 00:23:41,374 --> 00:23:43,459 the psychoactive ingredient in cannabis, 582 00:23:43,543 --> 00:23:45,128 we're going to have to admit him for overnight 583 00:23:45,211 --> 00:23:47,130 observation and monitoring. 584 00:23:47,213 --> 00:23:49,215 And what about his brain? 585 00:23:49,298 --> 00:23:51,634 Is there a chance that much pot is going to do some damage? 586 00:23:51,717 --> 00:23:53,052 He's only four. 587 00:23:53,136 --> 00:23:54,720 The honest answer is we don't know. 588 00:23:54,804 --> 00:23:56,305 There haven't been any long-term studies, 589 00:23:56,389 --> 00:23:58,057 but the fact that this is a one-time occurrence 590 00:23:58,141 --> 00:24:00,268 suggests that there should be no long-term effects. 591 00:24:00,351 --> 00:24:01,978 But you don't know. 592 00:24:02,061 --> 00:24:04,147 So my son could end up with learning disabilities, 593 00:24:04,230 --> 00:24:06,649 psychiatric problems, or even autism because of this. 594 00:24:06,732 --> 00:24:08,443 There's no evidence to suggest any of that. 595 00:24:08,526 --> 00:24:11,195 Hello. I'm Kiara Alfaro. 596 00:24:11,279 --> 00:24:13,114 I'm the department social worker. 597 00:24:13,197 --> 00:24:16,033 Kiara will help you navigate the next steps. 598 00:24:16,117 --> 00:24:17,326 What steps? 599 00:24:17,410 --> 00:24:18,870 Well, a case like this 600 00:24:18,953 --> 00:24:21,914 requires mandatory reporting to child services 601 00:24:21,998 --> 00:24:24,000 - and sometimes law enforcement. - No. 602 00:24:24,083 --> 00:24:25,168 Why…why do you have to involve the police? 603 00:24:25,251 --> 00:24:26,502 It's a controlled substance. 604 00:24:26,586 --> 00:24:28,171 They're not taking my kid away. 605 00:24:28,254 --> 00:24:30,047 - They were pot gummies. - No one's suggesting that. 606 00:24:30,131 --> 00:24:32,175 Well, fuck your suggestions! No one is touching my child! 607 00:24:32,258 --> 00:24:33,676 In fact, we're leaving. 608 00:24:33,759 --> 00:24:35,178 Well you… no, you can't take your son. 609 00:24:35,261 --> 00:24:36,762 He could stop breathing. He could have a seizure. 610 00:24:36,846 --> 00:24:38,347 - I will observe him at home. - Amanda, please. 611 00:24:38,431 --> 00:24:40,016 - Fuck off, Drew. - Get security. 612 00:24:40,099 --> 00:24:41,392 If you can't cooperate, 613 00:24:41,476 --> 00:24:42,810 I'm going to have to ask you to leave. 614 00:24:42,894 --> 00:24:44,270 Amanda, please. He needs to stay here. 615 00:24:44,353 --> 00:24:46,022 And you need to get a fucking hotel. 616 00:24:46,105 --> 00:24:47,315 Your son can't leave the hospital, 617 00:24:47,398 --> 00:24:48,649 but I can have you removed. 618 00:24:48,733 --> 00:24:49,984 Don't you dare touch me. 619 00:24:50,067 --> 00:24:51,611 Get out! All of you! 620 00:24:51,694 --> 00:24:53,779 Mrs. Jones, I know this is scary and stressful. 621 00:24:53,863 --> 00:24:55,948 Oh, fuck you! Fuck you! This is my son. 622 00:24:56,032 --> 00:24:57,283 My son! And nobody is touching him! 623 00:24:57,366 --> 00:24:58,951 Whoa, whoa, whoa. What's going on? 624 00:24:59,035 --> 00:25:00,369 - How can I help you? - By backing the fuck off! 625 00:25:00,453 --> 00:25:01,954 Mom's worried about a CYF investigation. 626 00:25:02,038 --> 00:25:03,956 - Amanda, just calm down! - OK, OK, OK, enough! 627 00:25:04,040 --> 00:25:05,374 This is a hospital. 628 00:25:05,458 --> 00:25:07,001 This isn't "The Jerry Springer Show." 629 00:25:07,084 --> 00:25:09,462 Ma'am, nobody's trying to take your child, 630 00:25:09,545 --> 00:25:11,172 so why don't you stay here with him 631 00:25:11,255 --> 00:25:12,924 while your husband talks to our social worker outside 632 00:25:13,007 --> 00:25:14,592 and straightens all this out? 633 00:25:14,675 --> 00:25:16,969 Well, I don't want him speaking for me and my son. 634 00:25:17,053 --> 00:25:18,930 Well, it is either you or him. 635 00:25:19,013 --> 00:25:21,933 Your son is not leaving, but you can be escorted out 636 00:25:22,016 --> 00:25:24,018 and even arrested if you refuse to cooperate. 637 00:25:24,101 --> 00:25:25,520 Nobody wants that. 638 00:25:25,603 --> 00:25:27,522 So you tell us. What do you want to do? 639 00:25:30,525 --> 00:25:33,277 - I'm staying with my son. - OK, great. 640 00:25:33,361 --> 00:25:35,112 You do that. 641 00:25:35,196 --> 00:25:37,490 We all on the same page here? 642 00:25:37,573 --> 00:25:38,908 Thank you, Olsen. 643 00:25:38,991 --> 00:25:39,977 - You know where to find me. - You OK? 644 00:25:39,992 --> 00:25:41,702 Yeah, we got this. 645 00:25:41,786 --> 00:25:43,496 - All good. - It's all yours. 646 00:25:43,579 --> 00:25:45,248 Mrs. Jones, we just have a couple things. 647 00:25:48,626 --> 00:25:49,877 Everything all right out there? 648 00:25:49,961 --> 00:25:52,213 Yeah, just another day in paradise. 649 00:25:52,296 --> 00:25:54,131 - How are you feeling? - Better. 650 00:25:54,215 --> 00:25:56,676 - Where's David? - He left. 651 00:25:56,759 --> 00:25:59,554 He said he had to get back to school. 652 00:25:59,637 --> 00:26:01,138 Oh. 653 00:26:01,222 --> 00:26:02,932 Um, maybe you could try calling him, 654 00:26:03,015 --> 00:26:04,141 get him to come back. 655 00:26:06,894 --> 00:26:09,772 What's going to happen to him if I do? 656 00:26:09,855 --> 00:26:12,024 Hopefully he'll be willing to talk to somebody. 657 00:26:12,108 --> 00:26:14,652 - Will you talk to him? - I can try. 658 00:26:14,735 --> 00:26:17,405 I don't think he wanted to talk to me. 659 00:26:17,488 --> 00:26:19,740 Have you shared with anyone 660 00:26:19,824 --> 00:26:21,826 about the writings of his you found? 661 00:26:21,909 --> 00:26:23,619 No. 662 00:26:23,703 --> 00:26:25,329 I didn't know who to tell. 663 00:26:25,413 --> 00:26:27,582 I just don't want to see him get hurt. 664 00:26:27,665 --> 00:26:29,417 Neither do we. 665 00:26:38,801 --> 00:26:40,136 It's just going straight to voicemail. 666 00:26:40,219 --> 00:26:42,221 Maybe if you can text him. 667 00:26:54,567 --> 00:26:56,652 He's not texting back. 668 00:26:56,736 --> 00:26:58,237 Oh, I'm sorry about all this. 669 00:26:58,321 --> 00:26:59,780 It's OK, it's OK. 670 00:26:59,864 --> 00:27:02,992 What are you doing for David is very brave. 671 00:27:03,075 --> 00:27:04,243 I'm his mother. 672 00:27:04,327 --> 00:27:06,370 I'll do anything to protect him. 673 00:27:08,372 --> 00:27:09,624 Do you think he would hurt anyone? 674 00:27:09,707 --> 00:27:11,292 No. 675 00:27:13,002 --> 00:27:17,006 But… 676 00:27:17,089 --> 00:27:20,760 I'm sure a lot of parents felt that way 677 00:27:20,843 --> 00:27:23,721 before their children did unspeakable things. 678 00:27:26,390 --> 00:27:27,808 Does he have any history of violence? 679 00:27:27,892 --> 00:27:29,226 Has he ever been in any trouble? 680 00:27:29,310 --> 00:27:30,686 No, never. 681 00:27:30,770 --> 00:27:33,105 He's very quiet. 682 00:27:33,189 --> 00:27:35,524 And he takes great care of me. 683 00:27:35,608 --> 00:27:41,030 He…he's struggled with his father's death. 684 00:27:41,113 --> 00:27:42,990 We both have. 685 00:27:43,074 --> 00:27:45,284 Flight is ten minutes out with an electrocution. 686 00:27:45,368 --> 00:27:48,371 OK, grab Collins. I'll be right there. 687 00:27:48,454 --> 00:27:49,789 Keep trying to reach him. 688 00:27:49,872 --> 00:27:51,415 If you do, have someone come find me. 689 00:27:51,499 --> 00:27:53,793 - OK? - OK. 690 00:27:53,876 --> 00:27:55,920 - Thank you. - Of course. 691 00:27:56,003 --> 00:27:58,089 - You got some good news for me? - I sure do. 692 00:27:58,172 --> 00:27:59,715 There are two rooms in ICU being cleaned. 693 00:27:59,799 --> 00:28:01,467 - They'll be ready by now. - Great. 694 00:28:01,550 --> 00:28:02,593 And I got bagels in the lounge. 695 00:28:02,677 --> 00:28:04,136 Nice job. Thank you. 696 00:28:06,639 --> 00:28:09,100 - Is it true? - You have to be more specific. 697 00:28:09,183 --> 00:28:10,726 Are there rats in the ED? 698 00:28:10,810 --> 00:28:13,062 Uh, apparently, if somebody already snitched. 699 00:28:13,145 --> 00:28:15,523 Do you know how bad this looks? 700 00:28:15,606 --> 00:28:17,525 One more reason to shutter this place. 701 00:28:17,608 --> 00:28:19,735 Only the emergency department admits rats. 702 00:28:19,819 --> 00:28:21,320 Emergency department would never admit rats, 703 00:28:21,404 --> 00:28:22,905 unless they had the right insurance. 704 00:28:22,988 --> 00:28:24,281 Did you catch any of them? 705 00:28:24,365 --> 00:28:26,075 One, and I charged him for a full visit. 706 00:28:26,158 --> 00:28:27,618 I'm glad you think this is funny. 707 00:28:27,702 --> 00:28:28,786 I'm sorry that you don't. 708 00:28:28,869 --> 00:28:30,579 Did you call an exterminator? 709 00:28:30,663 --> 00:28:32,373 He's waiting on a second opinion. 710 00:28:33,791 --> 00:28:35,584 You're pushing your luck today. 711 00:28:35,668 --> 00:28:36,877 Don't worry. Last I heard, 712 00:28:36,961 --> 00:28:38,254 they were headed for the cafeteria, 713 00:28:38,337 --> 00:28:39,422 so they should be dead within the hour. 714 00:28:39,505 --> 00:28:40,881 OK. 715 00:28:40,965 --> 00:28:43,759 - I'll be here all week. - Or maybe not. 716 00:28:47,471 --> 00:28:49,640 Drug-seeking woman kicked off the city bus 717 00:28:49,724 --> 00:28:51,016 for disrupting and disturbing passengers. 718 00:28:51,100 --> 00:28:52,601 I called 911! 719 00:28:52,685 --> 00:28:54,395 She's been screaming for narcotics nonstop. 720 00:28:54,478 --> 00:28:55,980 We found an empty Percocet bottle filled five days ago. 721 00:28:56,063 --> 00:28:57,148 What are you doing? What are you doing? 722 00:28:57,231 --> 00:28:58,607 She's been uncooperative 723 00:28:58,691 --> 00:28:59,817 and combative since we picked her up. 724 00:28:59,900 --> 00:29:01,235 Get off her. Let her go. 725 00:29:01,318 --> 00:29:02,778 Stop fighting. 726 00:29:02,862 --> 00:29:04,613 Calm the fuck down, or I'm calling the cops. 727 00:29:04,697 --> 00:29:06,323 My meds at home aren't working! 728 00:29:06,407 --> 00:29:08,534 Please, I have sickle cell! 729 00:29:08,617 --> 00:29:10,327 OK, stop. Everybody stop. 730 00:29:10,411 --> 00:29:11,996 Stop! 731 00:29:12,705 --> 00:29:14,331 What's your name? 732 00:29:14,415 --> 00:29:16,584 It's Joyce. It's Joyce St. Claire. 733 00:29:16,667 --> 00:29:18,794 Joyce, is this your sickle cell pain? 734 00:29:18,878 --> 00:29:21,088 - Yes! - 10 milligrams of IV morphine. 735 00:29:21,172 --> 00:29:22,423 - You really want 10? - Yes. 736 00:29:22,506 --> 00:29:23,549 Repeat it in five minutes if needed. 737 00:29:23,632 --> 00:29:24,925 And she needs a Dilaudid drip. 738 00:29:25,009 --> 00:29:26,010 This is a vaso-occlusive crisis! 739 00:29:26,093 --> 00:29:27,178 I'm so sorry this happened. 740 00:29:27,261 --> 00:29:28,804 You're going to be OK now. 741 00:29:28,888 --> 00:29:30,097 You're safe here. 742 00:29:30,181 --> 00:29:31,390 Come on. 743 00:29:31,474 --> 00:29:33,058 You're going to be safe here. I promise. 744 00:29:33,142 --> 00:29:34,894 Just breathe. OK? 745 00:30:00,294 --> 00:30:01,837 Live wire hit his left forearm, 746 00:30:01,921 --> 00:30:03,547 shocked him once for v-fib. 747 00:30:03,631 --> 00:30:05,591 - Was there a power pole down? - No, abandoned factory. 748 00:30:05,674 --> 00:30:06,675 We found bolt cutters at his side. 749 00:30:06,759 --> 00:30:07,927 Got electrocuted. 750 00:30:08,010 --> 00:30:09,010 Was he trying to steal copper? 751 00:30:09,053 --> 00:30:10,039 Most likely. 752 00:30:10,054 --> 00:30:11,847 Powerline fried his arm, 753 00:30:11,931 --> 00:30:14,725 and the current through his whole body stopped his heart. 754 00:30:14,809 --> 00:30:17,394 Ready? 755 00:30:17,478 --> 00:30:19,563 Steady, lift. 756 00:30:21,315 --> 00:30:24,109 Add a myoglobin and a CK to the labs. 757 00:30:24,193 --> 00:30:26,153 Two liters normal saline wide open. 758 00:30:26,237 --> 00:30:27,905 Dr. Santos, what are we worried about? 759 00:30:27,988 --> 00:30:30,866 Um, rhabdomyolysis from tissue damage 760 00:30:30,950 --> 00:30:33,828 can kill the kidneys, ongoing risk of cardiac irritability. 761 00:30:33,911 --> 00:30:35,412 - Excellent. - AP pads in place. 762 00:30:35,496 --> 00:30:37,122 Guy fell off a telephone pole? 763 00:30:37,206 --> 00:30:39,500 - No, he was on a platform. - Boring. 764 00:30:39,583 --> 00:30:42,044 Cut into a live wire. 765 00:30:42,127 --> 00:30:43,712 Tense ventral compartment. 766 00:30:43,796 --> 00:30:45,130 Set up the STIC pressure monitor. 767 00:30:45,214 --> 00:30:46,632 V-fib. 768 00:30:46,715 --> 00:30:48,092 - All right, charge to 300. - Charge to 300. 769 00:30:48,175 --> 00:30:49,301 Am I running this or are you? 770 00:30:49,385 --> 00:30:51,428 - Sorry, reflex response. - Clear. 771 00:30:52,388 --> 00:30:54,181 Ah, fuck! 772 00:30:54,265 --> 00:30:55,641 Sorry. 773 00:30:55,724 --> 00:30:57,142 Sorry. 774 00:30:57,226 --> 00:30:59,728 So what…what happened? 775 00:30:59,812 --> 00:31:02,273 I bought it for my girlfriend's dog. 776 00:31:02,356 --> 00:31:06,318 I work nights, and he yaps all day long. 777 00:31:06,402 --> 00:31:09,029 And when I woke up, I was wearing it. 778 00:31:09,113 --> 00:31:10,573 Stupid bitch! 779 00:31:12,032 --> 00:31:14,952 Sorry, sorry. 780 00:31:15,035 --> 00:31:17,454 I think she must have used Krazy Glue. 781 00:31:17,538 --> 00:31:20,791 Yeah, it, um, it looks that way. 782 00:31:20,875 --> 00:31:22,543 Have you tried removing the batteries? 783 00:31:22,626 --> 00:31:26,547 Of course. She glued the case shut. 784 00:31:26,630 --> 00:31:29,425 All right, I think we have a couple options, Gary. 785 00:31:29,508 --> 00:31:32,469 Um, we can try to find a solvent that will dissolve 786 00:31:32,553 --> 00:31:34,930 or at least soften the glue enough for you to peel it off 787 00:31:35,014 --> 00:31:37,016 without taking your skin with it. 788 00:31:37,099 --> 00:31:39,268 Or, um… 789 00:31:39,351 --> 00:31:41,812 - Dr. Javadi? - Um… 790 00:31:41,896 --> 00:31:44,899 I…I guess your skin cells on your neck will naturally 791 00:31:44,982 --> 00:31:48,402 slough off and you should just be able to remove it in time. 792 00:31:48,485 --> 00:31:51,447 - How much time? - Um, couple of weeks, maybe. 793 00:31:51,530 --> 00:31:52,781 Couple weeks? 794 00:31:52,865 --> 00:31:54,408 I think this guy's got scurvy. 795 00:31:54,491 --> 00:31:55,534 What is he, a pirate? 796 00:31:55,618 --> 00:31:57,244 No, he's an unhoused man 797 00:31:57,328 --> 00:31:59,788 who lives almost exclusively on dollar store ramen. 798 00:31:59,872 --> 00:32:02,374 There's perifollicular hemorrhage, gingivitis, 799 00:32:02,458 --> 00:32:04,752 bleeding gums, and, um, yeah, 800 00:32:04,835 --> 00:32:06,170 no fruit or vegetables in his diet. 801 00:32:06,253 --> 00:32:07,463 I suppose that could do it 802 00:32:07,546 --> 00:32:09,298 as long as you've ruled out piracy. 803 00:32:09,381 --> 00:32:12,426 No parrot, no peg leg, doesn't reek of sweat and rum? 804 00:32:12,509 --> 00:32:14,345 Well, now that you mention it, there was a smell. 805 00:32:14,428 --> 00:32:17,348 Probably a pirate. 806 00:32:17,431 --> 00:32:18,766 Tell him to pick up some vitamin C 807 00:32:18,849 --> 00:32:20,225 next time he docks at a dollar store. 808 00:32:22,603 --> 00:32:24,271 I can't tell if you're joking. 809 00:32:24,355 --> 00:32:26,607 No, Captain Scurvy's got a vitamin C deficiency. 810 00:32:26,690 --> 00:32:29,068 Cheapest way to fix it is with a daily supplement. 811 00:32:29,151 --> 00:32:30,903 Captain Scurvy is another joke. 812 00:32:30,986 --> 00:32:32,905 - I'd like to think so. - It's a good one. 813 00:32:32,988 --> 00:32:34,990 Dr. Langdon, Dr. King, this is Arthur Carlson 814 00:32:35,074 --> 00:32:36,700 from Children, Youth, and Families. 815 00:32:36,784 --> 00:32:38,577 He'd like to speak to the parents of Tyler Jones. 816 00:32:38,661 --> 00:32:40,496 Right, right. 817 00:32:40,579 --> 00:32:42,998 Uh, Mel, would you mind showing him to Kiara and the family? 818 00:32:43,082 --> 00:32:44,458 Mm. Yeah, right this way. 819 00:32:49,380 --> 00:32:51,131 - Beto? - Hello, Doctor. 820 00:32:51,215 --> 00:32:54,510 - What are you doing here? - I'm working day shifts now. 821 00:32:54,593 --> 00:32:56,428 Didn't you retire a couple of years ago? 822 00:32:56,512 --> 00:32:57,930 No. 823 00:32:58,013 --> 00:33:01,141 - I have to work today. - Right. 824 00:33:01,225 --> 00:33:02,685 Right. Just stay right here, OK? 825 00:33:02,768 --> 00:33:04,603 I…I have a lot of cleaning to do. 826 00:33:04,687 --> 00:33:06,563 Yeah, no, I'll be just one second. 827 00:33:06,647 --> 00:33:08,899 Hey, Doc, Doc! How about a sandwich? 828 00:33:08,983 --> 00:33:10,693 Sure, Earl. Turkey, no egg salad. 829 00:33:10,776 --> 00:33:12,945 I got you. Just give me one minute. 830 00:33:15,114 --> 00:33:16,865 So Beto said he's working here? 831 00:33:16,949 --> 00:33:18,409 Yeah, he just started wandering. 832 00:33:18,492 --> 00:33:20,577 Fortunately, he always winds up back here. 833 00:33:20,661 --> 00:33:22,287 He thinks he still works in the ED. 834 00:33:22,371 --> 00:33:23,789 I called his family. 835 00:33:23,872 --> 00:33:25,082 They usually pick him up after a few hours. 836 00:33:25,165 --> 00:33:26,208 Really? 837 00:33:26,291 --> 00:33:27,668 Yeah. It gives them a break. 838 00:33:27,751 --> 00:33:29,128 And look at him. He's talking to people, 839 00:33:29,211 --> 00:33:31,547 feeling useful, getting some exercise. 840 00:33:31,630 --> 00:33:33,173 Hell, I wish I was that happy. 841 00:33:33,257 --> 00:33:34,800 You think he's any good at catching rats? 842 00:33:34,883 --> 00:33:37,469 - Stop. - Oh, Earl wants a sandwich. 843 00:33:37,553 --> 00:33:39,430 He always wants a sandwich. 844 00:33:39,513 --> 00:33:40,889 Hey, check it out. 845 00:33:40,973 --> 00:33:42,433 I got my kids a puppy. 846 00:33:42,516 --> 00:33:44,601 Cute. Hope that wasn't your idea. 847 00:33:44,685 --> 00:33:46,395 - Why? - Seriously? 848 00:33:46,478 --> 00:33:47,730 You really think your wife 849 00:33:47,813 --> 00:33:49,148 needs anything else to take care of? 850 00:33:49,231 --> 00:33:51,275 - Abby loves dogs. - I love penguins. 851 00:33:51,358 --> 00:33:52,860 It doesn't mean I want to take care of one. 852 00:33:52,943 --> 00:33:54,403 I'm pretty sure it's illegal to own a penguin. 853 00:33:54,486 --> 00:33:55,904 Pretty sure you're missing the point. 854 00:33:55,988 --> 00:33:57,364 The point is Tanner promised 855 00:33:57,448 --> 00:33:58,615 he would take care of it. 856 00:33:58,699 --> 00:34:01,702 A four-year-old? Yeah, OK. 857 00:34:06,957 --> 00:34:08,584 How's she doing? 858 00:34:08,667 --> 00:34:11,628 Still breathing after 20 of morphine. 859 00:34:13,839 --> 00:34:15,174 How's the pain, Joyce? 860 00:34:16,341 --> 00:34:17,885 A little better. 861 00:34:17,968 --> 00:34:19,928 We've ordered an exchange transfusion. 862 00:34:20,012 --> 00:34:22,431 Mm. Figured I needed that. 863 00:34:22,514 --> 00:34:24,975 What's your normal regimen at home? 864 00:34:25,059 --> 00:34:28,896 90 of extended-release morphine every 12 hours 865 00:34:28,979 --> 00:34:31,231 and oxycodone for breakthrough pain, 866 00:34:31,315 --> 00:34:33,734 but it wasn't working. 867 00:34:33,817 --> 00:34:36,862 Starting IV Dilaudid of four an hour. 868 00:34:36,945 --> 00:34:39,239 You can press this button if you need a little extra. 869 00:34:39,323 --> 00:34:42,868 That only works once an hour, though, so don't go crazy. 870 00:34:42,951 --> 00:34:45,788 - Could I confer with you? - Yeah. 871 00:34:54,546 --> 00:34:57,091 You seem surprised by the opioid dosage. 872 00:34:57,174 --> 00:34:59,635 - It seemed a little high. - So was her pain. 873 00:34:59,718 --> 00:35:01,220 How do you know she's not drug-seeking? 874 00:35:01,303 --> 00:35:03,097 You can't fake a hemoglobin of 6. 875 00:35:03,180 --> 00:35:05,140 Do you know what sickle cell crisis does to the body? 876 00:35:05,224 --> 00:35:06,683 Blood cells get caught and plug up your capillaries 877 00:35:06,767 --> 00:35:08,393 and deprive all your cells of oxygen. 878 00:35:08,477 --> 00:35:11,230 It's been described as an electrical stabbing pain 879 00:35:11,313 --> 00:35:12,731 that feels like it's breaking your bones 880 00:35:12,815 --> 00:35:15,484 and flushing glass through your body. 881 00:35:15,567 --> 00:35:17,319 I never thought of it like that. 882 00:35:17,402 --> 00:35:18,695 Little empathy goes a long way 883 00:35:18,779 --> 00:35:20,447 with those suffering in real pain. 884 00:35:22,574 --> 00:35:23,992 - Yeah. - Don't worry. 885 00:35:24,076 --> 00:35:25,494 You'll get good at spotting the fakers, 886 00:35:25,577 --> 00:35:27,371 and half the time, all those people need 887 00:35:27,454 --> 00:35:29,957 is someone to really listen to them and hear their story. 888 00:35:31,500 --> 00:35:33,043 Mm-hmm. 889 00:35:33,127 --> 00:35:36,922 Interior compartment pressure is 49. 890 00:35:37,005 --> 00:35:38,674 Burn caused massive swelling. 891 00:35:38,757 --> 00:35:40,551 What does he need, Dr. Santos? 892 00:35:40,634 --> 00:35:43,512 Fasciotomy, but he still has a radial pulse. 893 00:35:43,595 --> 00:35:45,556 Pressure would have to be over 100 to lose the pulse, 894 00:35:45,639 --> 00:35:47,224 and at that point, he'd lose the arm. 895 00:35:47,307 --> 00:35:49,268 49 is enough to destroy all the nerves and muscles 896 00:35:49,351 --> 00:35:51,145 in a matter of hours. 897 00:35:51,228 --> 00:35:52,855 - Compartment pressure's 49? - Yeah. 898 00:35:52,938 --> 00:35:54,815 I'm going to make the initial incision down here. 899 00:35:54,898 --> 00:35:56,525 Ortho can finish it up in the OR. 900 00:35:56,608 --> 00:35:58,360 Good plan. I'll let them know. 901 00:35:58,443 --> 00:36:00,112 - Hey, Robby. - Always good to see you, Fred. 902 00:36:00,195 --> 00:36:01,405 - How do you like my rock star? - She's pretty good. 903 00:36:01,488 --> 00:36:03,991 She has a great teacher. 904 00:36:04,074 --> 00:36:05,951 Sterile gloves for Dr. Santos. 905 00:36:06,034 --> 00:36:09,246 Oh, we don't teach forearm fasciotomies to our residents. 906 00:36:09,329 --> 00:36:11,206 What if she's all alone somewhere someday 907 00:36:11,290 --> 00:36:13,417 with no backup? 908 00:36:15,502 --> 00:36:18,630 This is the path to avoid the median nerve 909 00:36:18,714 --> 00:36:20,841 and all major vessels. 910 00:36:20,924 --> 00:36:23,135 Maybe just watch the first time. 911 00:36:23,218 --> 00:36:25,554 She'll hold the blade, I'll cut. 912 00:36:25,637 --> 00:36:27,097 10 blade to Dr. Santos. 913 00:36:30,726 --> 00:36:33,103 We'll start proximal. 914 00:36:33,187 --> 00:36:34,563 How much pressure? 915 00:36:34,646 --> 00:36:37,691 Just about this much. 916 00:36:41,945 --> 00:36:43,322 Mm-hmm. 917 00:36:46,033 --> 00:36:48,577 Through the skin and sub-Q. 918 00:36:53,081 --> 00:36:54,458 Good. 919 00:36:58,712 --> 00:37:00,589 How they making out? 920 00:37:00,672 --> 00:37:02,299 They're still talking. 921 00:37:03,800 --> 00:37:05,802 - You OK? - Yeah, for sure. 922 00:37:05,886 --> 00:37:07,971 I just…I hate seeing families torn apart. 923 00:37:08,055 --> 00:37:09,556 Oh, they'll be fine. 924 00:37:09,640 --> 00:37:12,017 - How can you be sure? - They're white. 925 00:37:12,100 --> 00:37:14,311 Probably get off with a slap on the wrist. 926 00:37:14,394 --> 00:37:16,813 If they weren't, she'd probably lose her child 927 00:37:16,897 --> 00:37:20,442 and he'd end up going to jail, but… 928 00:37:20,525 --> 00:37:23,403 Sorry, I did a fellowship in cynicism. 929 00:37:23,487 --> 00:37:24,905 You sure you're OK? 930 00:37:24,988 --> 00:37:26,990 100%. I'm just going to get some air. 931 00:37:32,871 --> 00:37:35,707 I am a savage, classy, bougie, 932 00:37:35,791 --> 00:37:38,585 ratchet, sassy, moody, nasty. 933 00:37:38,669 --> 00:37:40,545 I am a savage… 934 00:37:41,505 --> 00:37:42,923 I need help! 935 00:37:43,006 --> 00:37:44,049 I got shot. 936 00:37:44,132 --> 00:37:45,300 Can you guys help? 937 00:37:46,176 --> 00:37:47,511 What's your name? 938 00:37:47,594 --> 00:37:48,679 Alex. 939 00:37:48,762 --> 00:37:50,889 OK, Alex, let me take a look. 940 00:37:50,973 --> 00:37:52,266 It fucking hurts. 941 00:37:52,349 --> 00:37:54,226 Oh, I know. All right. 942 00:37:54,309 --> 00:37:55,435 We're going to take good care of you. 943 00:37:55,519 --> 00:37:57,104 - Yeah. - You guys got it? 944 00:37:57,187 --> 00:37:59,314 Let me get you up here, Alex. 945 00:37:59,398 --> 00:38:01,024 I got you. 946 00:38:01,108 --> 00:38:02,401 I have an abdominal GSW 947 00:38:02,484 --> 00:38:05,195 in the ambulance bay, code trauma now. 948 00:38:05,279 --> 00:38:07,823 GSW just got dumped by a homeboy ambulance. 949 00:38:07,906 --> 00:38:10,867 - You got this? - Yeah, go. 950 00:38:10,951 --> 00:38:14,204 2 grams of Ancef. Ortho's on their way. 951 00:38:18,000 --> 00:38:20,627 Systolic's only 80. 14 gauge left AC. 952 00:38:20,711 --> 00:38:21,753 We got two units of whole blood 953 00:38:21,837 --> 00:38:23,088 going on the rapid infuser. 954 00:38:23,171 --> 00:38:24,423 Call the OR. We'll be right up. 955 00:38:24,506 --> 00:38:25,757 Lungs up. 956 00:38:25,841 --> 00:38:26,967 Do you take medications every day? 957 00:38:27,050 --> 00:38:28,885 - Any allergies? - No. 958 00:38:28,969 --> 00:38:30,345 Morrison's is full of blood. You see that? 959 00:38:30,429 --> 00:38:32,222 - Yeah. - Tore up his liver. 960 00:38:32,306 --> 00:38:33,640 - What's his name? - Alex. 961 00:38:33,724 --> 00:38:35,017 Alex, you've lost a lot of blood. 962 00:38:35,100 --> 00:38:36,351 You need to go to surgery right away. 963 00:38:36,435 --> 00:38:37,421 Am I going to die? 964 00:38:37,436 --> 00:38:38,854 Not now that I'm here. 965 00:38:38,937 --> 00:38:40,147 Spoken with the humility of a surgeon. 966 00:38:40,230 --> 00:38:41,481 OR's ready. How's he doing? 967 00:38:41,565 --> 00:38:43,191 - BP is coming up a bit. - Let's go. 968 00:38:43,275 --> 00:38:44,985 - Can you call my mom? - Yep. 969 00:38:45,068 --> 00:38:47,612 - She's the "ICE" on my cell. - Of course, of course. 970 00:38:47,696 --> 00:38:50,198 So he didn't have to wait for an OR? 971 00:38:50,282 --> 00:38:52,034 No, we're a trauma center. 972 00:38:52,117 --> 00:38:54,453 We always keep one OR stocked and ready to go. 973 00:38:54,536 --> 00:38:58,123 Well, that's awesome! 974 00:38:58,206 --> 00:39:01,126 What…what happens if there are multiple traumas needing OR? 975 00:39:01,209 --> 00:39:02,753 We get a lot busier. 976 00:39:04,671 --> 00:39:06,173 Mr. Milton, I'm sorry. 977 00:39:06,256 --> 00:39:07,883 We had to move you into the hall. 978 00:39:07,966 --> 00:39:09,843 I know it gets pretty chaotic and noisy out here. 979 00:39:09,926 --> 00:39:12,346 Mr. Milton? 980 00:39:12,429 --> 00:39:14,806 Hey, hey, Bennet, wake up for me. 981 00:39:17,225 --> 00:39:20,020 Oh, shit, shit, shit. Um, I need a little help here! 982 00:39:21,229 --> 00:39:22,481 Help! 983 00:39:22,564 --> 00:39:24,066 When did you check on him last? 984 00:39:24,149 --> 00:39:25,692 I don't know, around half an hour ago at most. 985 00:39:25,776 --> 00:39:27,194 - I was waiting on labs. - What's going on? 986 00:39:27,277 --> 00:39:28,862 It's my gallstone guy. You saw his EKGs. 987 00:39:28,945 --> 00:39:31,531 Unknown downtime. He was sleeping in the hall. 988 00:39:31,615 --> 00:39:33,533 Crash cart, let's go! 989 00:39:36,620 --> 00:39:38,455 I got it. 990 00:39:40,999 --> 00:39:42,542 Hold compressions. 991 00:39:44,711 --> 00:39:46,254 Asystole. 992 00:39:46,338 --> 00:39:50,008 Resume compressions, amp of epi. 993 00:39:50,092 --> 00:39:51,468 Slower, slower tempo, slower tempo. 994 00:39:51,551 --> 00:39:53,428 - Should I intubate? - No. Drop an LMA. 995 00:39:53,512 --> 00:39:56,098 We don't want to hold compressions. 996 00:39:56,181 --> 00:39:58,183 Pupils are fixed and dilated. 997 00:39:58,266 --> 00:39:59,643 He's been down a long time. 998 00:40:11,696 --> 00:40:13,031 How we doing in here? 999 00:40:13,115 --> 00:40:14,574 So much better. 1000 00:40:14,658 --> 00:40:17,160 Dr. Mohan, this is my wife, Ondine. 1001 00:40:17,244 --> 00:40:19,788 Dr. Samira Mohan. Nice to meet you, Ondine. 1002 00:40:19,871 --> 00:40:21,957 - Thank you for helping her. - Of course. 1003 00:40:22,040 --> 00:40:24,751 And, again, I'm so sorry about how you were treated 1004 00:40:24,835 --> 00:40:26,420 when you first arrived. 1005 00:40:26,503 --> 00:40:27,796 Not everyone who works here 1006 00:40:27,879 --> 00:40:29,714 is accustomed to dealing with sickle cell. 1007 00:40:29,798 --> 00:40:31,174 We will be doing everything possible 1008 00:40:31,258 --> 00:40:33,844 from here on in to manage Joyce's crisis. 1009 00:40:33,927 --> 00:40:35,720 In the meantime, can I get you anything? 1010 00:40:35,804 --> 00:40:36,804 I'm fine. 1011 00:40:36,847 --> 00:40:38,265 - Ondine? - No, thank you. 1012 00:40:38,348 --> 00:40:39,683 OK. Well, have the nurses come find me 1013 00:40:39,766 --> 00:40:40,851 if you need anything. 1014 00:40:43,603 --> 00:40:45,981 Take slow, deep breaths for me, Ian. 1015 00:40:46,064 --> 00:40:48,984 They ordered a neb, 5 albuterol, 125 solumedrol. 1016 00:40:49,067 --> 00:40:50,610 All right. 1017 00:40:50,694 --> 00:40:52,279 Keep an eye on him and present to Dr. Langdon. 1018 00:40:52,362 --> 00:40:54,364 - OK. - OK, great. 1019 00:40:54,448 --> 00:40:56,575 I'll see you back in triage once he settles down. 1020 00:40:56,658 --> 00:40:58,493 Yeah. 1021 00:40:58,577 --> 00:40:59,619 OK, let's take this off. 1022 00:40:59,703 --> 00:41:01,037 All right, hang in there, Ian. 1023 00:41:01,121 --> 00:41:02,873 This should really help your asthma. 1024 00:41:12,841 --> 00:41:13,967 How can I help you, hon? 1025 00:41:14,050 --> 00:41:15,343 Um, I'm looking for Dr. Langdon. 1026 00:41:15,427 --> 00:41:17,179 Yeah, let me see where he is. 1027 00:41:20,724 --> 00:41:22,517 Dr. Langdon, we have a med student 1028 00:41:22,601 --> 00:41:24,144 at Central looking for you. 1029 00:41:25,729 --> 00:41:27,439 Copy that. He's headed this way. 1030 00:41:27,522 --> 00:41:28,607 Thanks. 1031 00:41:29,900 --> 00:41:31,151 Hey, Crash. 1032 00:41:31,234 --> 00:41:33,653 You missed a pretty cool fasciotomy. 1033 00:41:33,737 --> 00:41:34,946 I'm not sure I'd be describing 1034 00:41:35,030 --> 00:41:36,531 a fasciotomy as cool. 1035 00:41:36,615 --> 00:41:39,242 You would if you were the one who did it. 1036 00:41:39,326 --> 00:41:42,370 How's it going out in the arrivals lounge? 1037 00:41:44,372 --> 00:41:47,292 Do you know anything about Dr. McKay? 1038 00:41:47,375 --> 00:41:49,628 I've been here for less than two hours. 1039 00:41:49,711 --> 00:41:52,839 I don't know anybody, including you. 1040 00:41:52,923 --> 00:41:55,717 I thought you were some kind of kid genius. 1041 00:41:55,800 --> 00:41:58,136 I'm like any other third-year med student. 1042 00:41:58,220 --> 00:42:01,056 Clearly. 1043 00:42:01,139 --> 00:42:02,516 Hey, I'm just trying to break the ice. 1044 00:42:02,599 --> 00:42:04,559 I'm not trying to annoy you. 1045 00:42:04,643 --> 00:42:06,478 And yet, you're still calling me Crash 1046 00:42:06,561 --> 00:42:07,896 when I asked you not to. 1047 00:42:07,979 --> 00:42:09,689 Really? You're still on that? 1048 00:42:09,773 --> 00:42:11,066 Still on that. 1049 00:42:12,400 --> 00:42:15,278 Yep. OK, sorry. 1050 00:42:15,362 --> 00:42:20,242 I had no idea genius was so sensitive. 1051 00:42:20,325 --> 00:42:23,328 But I get it. Big brain, big feelings. 1052 00:42:23,411 --> 00:42:24,788 Makes total sense. 1053 00:42:24,871 --> 00:42:26,706 I'll try to be softer. 1054 00:42:50,689 --> 00:42:51,982 We switch out every few minutes. 1055 00:42:52,065 --> 00:42:53,650 - You can take a break. - I'm fine. 1056 00:42:53,733 --> 00:42:54,943 Hold compressions. 1057 00:42:56,945 --> 00:42:58,530 Still in asystole. 1058 00:42:58,613 --> 00:43:01,032 Resume compressions. 1059 00:43:01,116 --> 00:43:02,409 Should we shock him? 1060 00:43:02,492 --> 00:43:03,827 You don't shock asystole. 1061 00:43:03,910 --> 00:43:05,120 It could be fine v-fib. 1062 00:43:05,203 --> 00:43:07,789 - Not a chance. - OK. 1063 00:43:07,872 --> 00:43:08,999 Uh, when was his last epi? 1064 00:43:09,082 --> 00:43:10,709 - Three minutes ago. - OK. 1065 00:43:10,792 --> 00:43:12,127 Well, ACLS says every three to five minute, right? 1066 00:43:12,210 --> 00:43:14,713 - So let's push another round. - Fine. 1067 00:43:14,796 --> 00:43:17,549 Robby, Mr. Spencer's adult children are asking for you. 1068 00:43:17,632 --> 00:43:19,467 And the parents of Nick Bradley, 1069 00:43:19,551 --> 00:43:21,428 the fentanyl overdose, also want to speak with you. 1070 00:43:21,511 --> 00:43:22,804 OK. 1071 00:43:22,887 --> 00:43:26,016 Three rounds of epi and then call it. 1072 00:43:26,099 --> 00:43:28,560 Mr. Spencer's maxed out on BiPAP, 25 on 10. 1073 00:43:28,643 --> 00:43:31,563 - Sats? - Not great, High 80s. 1074 00:43:34,524 --> 00:43:36,151 Hi. I heard you wanted to talk to me. 1075 00:43:36,234 --> 00:43:37,986 Yeah. That alarm kept going off. 1076 00:43:38,069 --> 00:43:40,989 Yeah. Why don't we step outside? 1077 00:43:41,698 --> 00:43:43,325 The alarm is for low oxygen. 1078 00:43:43,408 --> 00:43:45,619 Does he need more of that, um, BiPAP? 1079 00:43:45,702 --> 00:43:47,662 I'm afraid that's as high as we go. 1080 00:43:47,746 --> 00:43:49,456 So the decision at this point is… 1081 00:43:49,539 --> 00:43:52,417 We want you to put our father on the breathing machine. 1082 00:43:54,252 --> 00:43:55,920 Even though that goes against his desires 1083 00:43:56,004 --> 00:43:58,256 to not be intubated? 1084 00:43:58,340 --> 00:44:00,759 We're not ready to let go yet. 1085 00:44:00,842 --> 00:44:03,845 And if your father is? 1086 00:44:05,388 --> 00:44:06,848 He was a stubborn son of a bitch 1087 00:44:06,931 --> 00:44:09,392 who would never have given up on either of us. 1088 00:44:09,476 --> 00:44:12,187 We're not giving up on him. 1089 00:44:12,270 --> 00:44:14,189 You're absolutely certain you want 1090 00:44:14,272 --> 00:44:16,274 to put your father through this after everything I've told you? 1091 00:44:20,904 --> 00:44:24,949 I may have to honor his advanced directive. 1092 00:44:25,033 --> 00:44:29,079 No, you have to honor our durable power for health care. 1093 00:44:29,162 --> 00:44:32,540 If not, we can talk to your hospital attorney. 1094 00:44:35,085 --> 00:44:37,337 Jereme, you're on board with this? 1095 00:44:37,420 --> 00:44:39,547 Yeah, I guess so. 1096 00:44:41,257 --> 00:44:43,927 OK. You can sit with him until we're ready. 1097 00:44:44,010 --> 00:44:46,096 - And when will that be? - Momentarily. 1098 00:44:57,732 --> 00:44:59,067 Please don't tell me 1099 00:44:59,150 --> 00:45:00,402 you're going to intubate that poor man. 1100 00:45:00,485 --> 00:45:02,112 It's what the family wants. 1101 00:45:02,195 --> 00:45:03,863 So what? They want to torture him? 1102 00:45:03,947 --> 00:45:06,366 I explained all that. 1103 00:45:06,449 --> 00:45:10,328 If I co-sign, you can override their durable power. 1104 00:45:10,412 --> 00:45:12,163 They're threatening to go to the hospital attorney. 1105 00:45:12,247 --> 00:45:13,623 Let them. Call the Ethics Committee. 1106 00:45:13,707 --> 00:45:14,874 They'll agree with us. 1107 00:45:14,958 --> 00:45:16,209 No, no, you're probably right. 1108 00:45:16,292 --> 00:45:17,711 But we don't have that kind of time. 1109 00:45:17,794 --> 00:45:19,462 We are stuck. 1110 00:45:19,546 --> 00:45:22,549 - What are you talking about? - Shit. 1111 00:45:24,801 --> 00:45:26,177 What? 1112 00:45:26,261 --> 00:45:27,595 I got to go tell those parents 1113 00:45:27,679 --> 00:45:30,098 their 18-year-old son is brain-dead. 1114 00:45:30,181 --> 00:45:32,726 - Want me to come with you? - No, It's OK. 1115 00:45:32,809 --> 00:45:34,060 What are you going to say? 1116 00:45:34,144 --> 00:45:35,478 I'm going to say that it's likely, 1117 00:45:35,562 --> 00:45:37,021 but we still need to do an apnea test 1118 00:45:37,105 --> 00:45:40,108 and a cerebral perfusion study. 1119 00:45:40,191 --> 00:45:41,818 There's no cranial nerve activity. 1120 00:45:41,901 --> 00:45:45,655 - Those people need some hope. - False hope. 1121 00:45:45,739 --> 00:45:47,782 - Hope is hope. - Is it? 1122 00:45:47,866 --> 00:45:51,369 What, are we praying for miracles today? 1123 00:45:51,453 --> 00:45:52,912 They need time to process 1124 00:45:52,996 --> 00:45:55,915 before they can accept what's happening. 1125 00:45:55,999 --> 00:45:59,335 You ever consider taking that advice? 1126 00:45:59,419 --> 00:46:02,464 Physician, heal thyself. 1127 00:46:02,547 --> 00:46:04,048 Don't you have patients? 1128 00:46:26,654 --> 00:46:29,324 No, no, no, no, no, no. People wake up from comas. 1129 00:46:29,407 --> 00:46:31,451 You can wake him up. 1130 00:46:31,534 --> 00:46:33,703 You can do that. You can…you can shock… 1131 00:46:33,787 --> 00:46:36,289 you can… you can shock him back. 1132 00:46:41,795 --> 00:46:44,714 Nick. 1133 00:46:52,347 --> 00:46:53,848 Hey, hey, hey. 1134 00:46:53,932 --> 00:46:55,600 Hey, hey, hey, hey, hey. 1135 00:46:55,683 --> 00:46:57,602 Nick. 1136 00:46:59,854 --> 00:47:03,566 Please, no! 1137 00:48:09,048 --> 00:48:11,009 No change. 1138 00:48:11,092 --> 00:48:12,510 No pericardial effusion, 1139 00:48:12,594 --> 00:48:16,472 no tension pneumothorax, no cardiac activity. 1140 00:48:16,556 --> 00:48:18,725 Try calcium. Could be hyperkalemia. 1141 00:48:18,808 --> 00:48:20,768 No, his potassium was normal. 1142 00:48:20,852 --> 00:48:23,313 - Ready to call this? - Not yet. 1143 00:48:23,396 --> 00:48:25,315 Dr. Robby said three rounds of epi. 1144 00:48:25,398 --> 00:48:26,900 It's time. Let's push another amp. 1145 00:48:26,983 --> 00:48:28,484 This one could do it. 1146 00:48:31,112 --> 00:48:32,238 OK.