1 00:00:13,383 --> 00:00:16,422 Sync and corrections by btsix www.addic7ed.com 2 00:01:14,610 --> 00:01:16,611 Hey, I need my cast off. 3 00:01:16,612 --> 00:01:17,904 As soon as you park that outside. 4 00:01:17,905 --> 00:01:19,614 - Morning, Doc. - Olsen. 5 00:01:19,615 --> 00:01:21,032 Happy Fourth. 6 00:01:21,033 --> 00:01:22,700 Excuse me, guys. 7 00:01:22,701 --> 00:01:25,703 Sorry. 8 00:01:50,271 --> 00:01:51,688 Hey, how's it going, Dad? 9 00:01:51,689 --> 00:01:53,523 I'm so sleep-deprived. 10 00:01:53,524 --> 00:01:55,567 My house is starting to feel like a CIA black site. 11 00:01:55,568 --> 00:01:57,527 Have you considered hiring a night nurse? 12 00:01:57,528 --> 00:01:59,279 - You're looking at him. - You got a ripe one coming in 13 00:01:59,280 --> 00:02:00,947 you're gonna have to deal with before everybody out there 14 00:02:00,948 --> 00:02:02,365 - starts puking. - Lovely. 15 00:02:02,366 --> 00:02:03,950 Your replacement came in early. 16 00:02:03,951 --> 00:02:05,743 She brought in a full bagel spread. 17 00:02:05,744 --> 00:02:07,537 - I'm just saying. - She's not my replacement. 18 00:02:07,538 --> 00:02:09,080 She's just covering as chief while I go 19 00:02:09,081 --> 00:02:10,456 - on my little sabbatical. - Three months? 20 00:02:10,457 --> 00:02:12,041 I'll be back before your daughter 21 00:02:12,042 --> 00:02:13,877 - sleeps through the night. - Hey, dude, that's cold. 22 00:02:13,878 --> 00:02:15,546 - Morning. - Good morning. 23 00:02:30,144 --> 00:02:31,769 Good morning, John. 24 00:02:31,770 --> 00:02:33,771 I could have sworn it was still around 4:00 a.m... 25 00:02:33,772 --> 00:02:35,565 Did you guys have an easy night last night? 26 00:02:35,566 --> 00:02:37,233 The waiting room actually looks manageable. 27 00:02:37,234 --> 00:02:39,152 I wouldn't call it easy, but not too bad. 28 00:02:39,153 --> 00:02:41,321 I figured we'd have hands and burns down here a bunch, 29 00:02:41,322 --> 00:02:43,406 but so far nobody's blown off any fingers. 30 00:02:43,407 --> 00:02:45,283 Oh, you know you just jinxed it. 31 00:02:45,284 --> 00:02:46,659 You guys and your jinxes. 32 00:02:46,660 --> 00:02:49,370 - Please, Jesus, please. - Hail Mary again. 33 00:02:49,371 --> 00:02:51,372 - In the sanctified flesh. - Don't let me die alone. 34 00:02:51,373 --> 00:02:54,626 - Just try to relax, Margaret. - I need a priest. 35 00:02:54,627 --> 00:02:57,295 - Hey, hey, Dr. Robby. - What's the good word, Perlah? 36 00:02:57,296 --> 00:02:59,214 All your results came back normal, Mrs. Walker. 37 00:02:59,215 --> 00:03:00,215 I'm dying. 38 00:03:00,216 --> 00:03:01,633 You're not dying, Mrs. Walker, I promise. 39 00:03:01,634 --> 00:03:03,051 Jesus is coming for me. 40 00:03:03,052 --> 00:03:05,345 If He is, He hasn't checked in at registration yet. 41 00:03:05,346 --> 00:03:06,679 Please don't let me die a sinner. 42 00:03:06,680 --> 00:03:08,264 Don't worry, Margaret... we're going to have 43 00:03:08,265 --> 00:03:10,266 the hospital chaplain come and see you in a moment. 44 00:03:10,267 --> 00:03:11,768 I'm not going to last that long. 45 00:03:11,769 --> 00:03:13,603 Yes, you will, because we're going to give you a shot 46 00:03:13,604 --> 00:03:15,021 to keep you alive until they get here. 47 00:03:15,022 --> 00:03:16,648 What are you thinking, Dr. Robinavitch? 48 00:03:16,649 --> 00:03:18,524 500 mikes of cyanocobalamin? 49 00:03:18,525 --> 00:03:20,693 In her condition, I'd push a full 1,000. 50 00:03:20,694 --> 00:03:23,738 Whoo. You heard the man, Perlah. 51 00:03:23,739 --> 00:03:26,032 God bless you. God bless all of you. 52 00:03:26,033 --> 00:03:27,617 Amen to that. 53 00:03:27,618 --> 00:03:29,619 Hail Mary, full of grace, the Lord is with thee... 54 00:03:29,620 --> 00:03:31,454 Ooh, nothing like the miracle healing powers 55 00:03:31,455 --> 00:03:32,956 of a good old B12 shot. 56 00:03:32,957 --> 00:03:36,125 - How does she hold down a job? - She doesn't. 57 00:03:36,126 --> 00:03:37,794 She's wearing a waitress uniform. 58 00:03:37,795 --> 00:03:39,337 Yeah, from a diner that closed 20 years ago. 59 00:03:39,338 --> 00:03:41,631 Tier One Trauma, ETA six minutes. 60 00:03:41,632 --> 00:03:43,466 And so it begins. 61 00:03:43,467 --> 00:03:45,969 My husband is still waiting to see a doctor. 62 00:03:45,970 --> 00:03:47,220 I apologize for the wait, 63 00:03:47,221 --> 00:03:49,013 but here are two doctors just for you. 64 00:03:49,014 --> 00:03:51,182 Mr. Burgess has been complaining 65 00:03:51,183 --> 00:03:52,684 of leg cramps for a day. 66 00:03:52,685 --> 00:03:56,271 Slightly tachy at 110, BP 128 over 75. 67 00:03:56,272 --> 00:03:58,231 Afebrile, good sats. 68 00:03:58,232 --> 00:04:00,191 I'm Dr. Shen, but I'm going off shift. 69 00:04:00,192 --> 00:04:02,443 Dr. Robinavitch will be one of the doctors looking after you. 70 00:04:02,444 --> 00:04:03,736 What other medications 71 00:04:03,737 --> 00:04:05,697 are you currently taking, Mr. Burgess? 72 00:04:05,698 --> 00:04:07,824 I brought his meds. 73 00:04:07,825 --> 00:04:09,826 Thank you. 74 00:04:09,827 --> 00:04:11,369 These are his supplements, 75 00:04:11,370 --> 00:04:13,538 mostly all-natural and organic where possible. 76 00:04:13,539 --> 00:04:16,332 And these are his homeopathic prescriptions. 77 00:04:16,333 --> 00:04:20,378 I also have a list of his refrigerated probiotics. 78 00:04:23,090 --> 00:04:25,049 Where the hell is everybody? 79 00:04:25,050 --> 00:04:27,302 Our new attending is torturing 80 00:04:27,303 --> 00:04:29,554 our intern and med students in Trauma One. 81 00:04:29,555 --> 00:04:31,848 She came in early to meet the night shift 82 00:04:31,849 --> 00:04:33,433 and took things over. 83 00:04:33,434 --> 00:04:36,352 Okay, that takes giant balls of disrespect. 84 00:04:36,353 --> 00:04:37,729 Giant Balls of Disrespect 85 00:04:37,730 --> 00:04:39,522 was the name of my band in high school. 86 00:04:39,523 --> 00:04:41,733 And my nickname for my ex-husband. 87 00:04:41,734 --> 00:04:43,901 Hey, uh, is this your last shift? 88 00:04:43,902 --> 00:04:47,864 - For a while, yeah. - Oh, I am so jealous. 89 00:04:47,865 --> 00:04:50,533 Hey, I'll pay you a grand if you take my second husband. 90 00:04:50,534 --> 00:04:51,784 Tempting. 91 00:04:51,785 --> 00:04:53,745 So tell me about this new attending. 92 00:04:53,746 --> 00:04:56,873 Uh, she's pretty, divorced, one kid. 93 00:04:56,874 --> 00:04:59,417 Can already tell she is a strict rule follower. 94 00:04:59,418 --> 00:05:01,336 I'm probably going to grow to hate her. 95 00:05:01,337 --> 00:05:05,089 - What's her name, again? - Dr. Baran Al-Hashimi. 96 00:05:05,090 --> 00:05:07,759 Al-Hashimi? What is that? 97 00:05:07,760 --> 00:05:10,136 Irish? 98 00:05:10,137 --> 00:05:13,097 She's some sort of clinical informatics expert. 99 00:05:13,098 --> 00:05:14,974 Once she started talking about AI, 100 00:05:14,975 --> 00:05:18,394 I started thinking about robots and kind of stopped listening. 101 00:05:18,395 --> 00:05:20,897 Clear. Off the chest, Ogilvie. 102 00:05:20,898 --> 00:05:22,440 Get ready to step up here, Joy. 103 00:05:22,441 --> 00:05:24,692 Ogilvie, off the chest! 104 00:05:24,693 --> 00:05:26,152 Clear! 105 00:05:26,153 --> 00:05:27,987 Still V-tach, but it looks weird. 106 00:05:27,988 --> 00:05:29,739 - Agreed. - No pulse. 107 00:05:29,740 --> 00:05:31,866 No effusion, good lung sliding. 108 00:05:31,867 --> 00:05:32,909 Start compressions, Joy. 109 00:05:32,910 --> 00:05:34,035 We haven't considered all the Ts. 110 00:05:34,036 --> 00:05:36,037 I checked for tamponade and tension pneumo. 111 00:05:36,038 --> 00:05:37,246 What if it's thrombosis? 112 00:05:37,247 --> 00:05:39,457 If it's a pulmonary or cardiac clot, TNK could save him. 113 00:05:39,458 --> 00:05:41,584 We are sticking with the algorithm for now. 114 00:05:41,585 --> 00:05:43,586 - Algorithm's not working. - Faster and deeper, please. 115 00:05:43,587 --> 00:05:46,464 - Uh, you need a break, Joy? - No, I need an attending. 116 00:05:46,465 --> 00:05:48,841 I'm right here. 117 00:05:48,842 --> 00:05:50,760 Stop compressions. We're calling it. 118 00:05:52,262 --> 00:05:54,097 Sorry, the patient's dead. 119 00:05:56,892 --> 00:05:59,435 All right. Who can tell me what went well? 120 00:05:59,436 --> 00:06:01,145 We followed the V-tach algorithm. 121 00:06:01,146 --> 00:06:02,897 We checked for reversible causes. 122 00:06:02,898 --> 00:06:04,649 We limited our rhythm and pulse checks to 10 seconds. 123 00:06:04,650 --> 00:06:06,025 Excellent. 124 00:06:06,026 --> 00:06:07,318 Should we have given thrombolytics? 125 00:06:07,319 --> 00:06:08,694 No, you should have recognized 126 00:06:08,695 --> 00:06:10,822 that the cardiac rhythm on the monitor was polymorphic, 127 00:06:10,823 --> 00:06:12,657 not just V-tach. 128 00:06:12,658 --> 00:06:14,617 It was torsades de pointes. 129 00:06:14,618 --> 00:06:16,828 That's French... "twisting of the points." 130 00:06:16,829 --> 00:06:18,704 From prolonged QT, antiarrhythmics, 131 00:06:18,705 --> 00:06:20,039 electrolyte disorders. 132 00:06:20,040 --> 00:06:21,290 Your patient would have lived 133 00:06:21,291 --> 00:06:23,000 if you had pushed magnesium sulfate. 134 00:06:23,001 --> 00:06:24,877 Good news is he's an organ donor. 135 00:06:24,878 --> 00:06:26,629 Parts of him are going to get used to make Frisbees 136 00:06:26,630 --> 00:06:28,840 and water bottles and end up as microplastics 137 00:06:28,841 --> 00:06:30,550 in our brains and reproductive organs. 138 00:06:30,551 --> 00:06:32,218 Thank you for the words of encouragement, boss. 139 00:06:32,219 --> 00:06:33,845 Dr. Al-Hashimi, Dr. Michael Robinavitch. 140 00:06:33,846 --> 00:06:35,805 - Everybody calls me Robby. - Baran, please. 141 00:06:35,806 --> 00:06:37,432 - Welcome to the Pitt. - Yeah, about that... 142 00:06:37,433 --> 00:06:38,808 Trauma's a minute out. 143 00:06:38,809 --> 00:06:40,768 Ooh, who wants to treat a real patient? 144 00:06:40,769 --> 00:06:42,186 Yes, please. 145 00:06:42,187 --> 00:06:44,064 This thing's going to give me nightmares. 146 00:06:45,816 --> 00:06:47,817 I hope you don't mind me jumping right into things. 147 00:06:47,818 --> 00:06:49,569 I find that a mock code is a great way 148 00:06:49,570 --> 00:06:51,320 to assess the students' capabilities. 149 00:06:51,321 --> 00:06:53,906 Well, it might have been nice if we'd had a little time 150 00:06:53,907 --> 00:06:55,658 to go over how we do things. 151 00:06:55,659 --> 00:06:58,661 Did you not get a packet from Dr. Underwood? Gloria? 152 00:06:58,662 --> 00:07:00,746 It outlined the quality-improvement changes 153 00:07:00,747 --> 00:07:02,582 I instituted at the VA. 154 00:07:02,583 --> 00:07:03,875 We're adopting the program 155 00:07:03,876 --> 00:07:05,668 at all of the university hospitals. 156 00:07:05,669 --> 00:07:08,045 - You didn't read it? - No, I did. I mean, I will. 157 00:07:08,046 --> 00:07:09,589 I'm going to. I want to. 158 00:07:09,590 --> 00:07:11,257 I thought I had a little bit more time 159 00:07:11,258 --> 00:07:13,217 - before you came in today. - We've already distributed 160 00:07:13,218 --> 00:07:15,720 patient passports to everyone at registration. 161 00:07:15,721 --> 00:07:18,264 What is a patient passport? 162 00:07:18,265 --> 00:07:20,850 So glad you asked. 163 00:07:20,851 --> 00:07:22,685 - Samira? - Dr. Al. 164 00:07:22,686 --> 00:07:25,354 We worked together at the VA a few years ago. 165 00:07:25,355 --> 00:07:27,273 - And now you're an R4. - Yes. 166 00:07:27,274 --> 00:07:29,358 And I'm so excited you're joining us. 167 00:07:29,359 --> 00:07:30,818 Dr. Mel King is here, too. 168 00:07:30,819 --> 00:07:32,236 I think you worked with her as well. 169 00:07:32,237 --> 00:07:33,946 - Incoming! - I did indeed. 170 00:07:33,947 --> 00:07:35,907 John Doe... dishwasher, penetrating trauma 171 00:07:35,908 --> 00:07:37,909 from a kitchen knife to the right chest. 172 00:07:37,910 --> 00:07:39,368 - Assault or accident? - Unclear. 173 00:07:39,369 --> 00:07:42,079 Initially had a pulse, lost it two blocks away. 174 00:07:44,458 --> 00:07:46,542 What do we got, party people? 175 00:07:46,543 --> 00:07:49,712 Dr. Yolanda Garcia, trauma surgery fellow, 176 00:07:49,713 --> 00:07:52,590 meet Dr. Baran Al-Hashimi, new E.D. attending. 177 00:07:52,591 --> 00:07:54,467 She's gonna be covering for me while I'm gone. 178 00:07:54,468 --> 00:07:56,052 So nice to meet you. 179 00:07:56,053 --> 00:07:57,553 About time they replaced you, Rabbit-bitch. 180 00:07:57,554 --> 00:07:59,305 I'm gonna miss you, too, Yolo. 181 00:07:59,306 --> 00:08:01,641 Dr. Garcia has a hard time expressing her feelings. 182 00:08:01,642 --> 00:08:02,683 Not all of them. 183 00:08:02,684 --> 00:08:06,187 One, two, three. 184 00:08:06,188 --> 00:08:09,524 - Prep for a left thoracotomy. - I'm on it. 185 00:08:09,525 --> 00:08:11,734 What's up, White Chocolate? 186 00:08:11,735 --> 00:08:15,571 Did you know our farm boy here is a vintage-funk freak? 187 00:08:15,572 --> 00:08:17,949 Unfortunately, he also likes to use 188 00:08:17,950 --> 00:08:20,493 - other people's toothbrushes. - It was one time. 189 00:08:20,494 --> 00:08:22,119 They were the same color. 190 00:08:22,120 --> 00:08:24,121 - What's your plan, Samira? - Dr. Mohan, next steps? 191 00:08:24,122 --> 00:08:25,456 Chest tube to the right. 192 00:08:25,457 --> 00:08:27,250 Stand by with massive transfusion protocol. 193 00:08:27,251 --> 00:08:28,501 I put two units on the infuser. 194 00:08:28,502 --> 00:08:29,835 Sterile gloves, 61/2. 195 00:08:29,836 --> 00:08:30,920 Here, we let the fellows 196 00:08:30,921 --> 00:08:32,338 and the residents kind of take charge. 197 00:08:32,339 --> 00:08:34,507 I'll hold on to them just in case. 198 00:08:34,508 --> 00:08:37,510 Is the VA even a trauma center? 199 00:08:37,511 --> 00:08:41,097 Not for medic runs, but they walk in... 200 00:08:41,098 --> 00:08:45,142 falls, major MVCs, GSWs. 201 00:08:45,143 --> 00:08:46,644 Stab wound's on the right. 202 00:08:46,645 --> 00:08:48,229 Why are we opening the left chest? 203 00:08:48,230 --> 00:08:50,147 Better access if it's tamponade, 204 00:08:50,148 --> 00:08:52,066 and you can cross-clamp the aorta. 205 00:08:52,067 --> 00:08:53,693 Javadi, Whitaker, sterile gloves. 206 00:08:53,694 --> 00:08:54,777 Can I glove up? 207 00:08:54,778 --> 00:08:57,363 It's best if you watch the first one. 208 00:08:57,364 --> 00:08:59,074 This guy's dead anyway. 209 00:09:01,034 --> 00:09:04,121 - 10 blade. - 28 French on a long Kelly. 210 00:09:05,289 --> 00:09:06,831 Javadi, you're on suction, 211 00:09:06,832 --> 00:09:09,792 Whitaker, get ready for internal compressions. 212 00:09:11,545 --> 00:09:13,463 Sorry, that's my phone. 213 00:09:15,048 --> 00:09:16,632 Finochietto retractor. 214 00:09:16,633 --> 00:09:17,967 Whitaker, give me a little room. 215 00:09:17,968 --> 00:09:19,176 I need to get to his heart. 216 00:09:19,177 --> 00:09:20,803 I'm in. Hook up the Thora-Seal. 217 00:09:22,222 --> 00:09:23,514 You want me to get that for you? 218 00:09:23,515 --> 00:09:25,683 Not right now. 219 00:09:33,984 --> 00:09:36,069 No tamponade, pretty dry in here. 220 00:09:37,654 --> 00:09:39,238 Heart's empty. 221 00:09:39,239 --> 00:09:40,865 Somebody start cardiac massage, I'll cross-clamp. 222 00:09:40,866 --> 00:09:42,033 Yeah, I got it. 223 00:09:42,034 --> 00:09:43,451 You do these one-handed, 224 00:09:43,452 --> 00:09:45,494 pushing up against the breastbone with four fingers. 225 00:09:45,495 --> 00:09:47,455 - Very good. - Not much blood to suction. 226 00:09:47,456 --> 00:09:50,041 - Okay, team, I think we need... - Samira, next steps? 227 00:09:50,042 --> 00:09:51,125 Keep transfusing. 228 00:09:51,126 --> 00:09:52,627 - Open the right chest. - That is correct. 229 00:09:52,628 --> 00:09:54,420 Booties on, kids. There will be blood. 230 00:09:56,798 --> 00:09:58,675 Frank? 231 00:10:00,177 --> 00:10:03,304 Langdon. 232 00:10:03,305 --> 00:10:05,514 Frank? 233 00:10:12,522 --> 00:10:14,690 You should be good to go now, hon. 234 00:10:14,691 --> 00:10:16,776 - Thanks, Lupe. - Of course. 235 00:10:16,777 --> 00:10:18,654 Hey, go get 'em. 236 00:10:21,615 --> 00:10:24,033 Hey, Doc. 237 00:10:24,034 --> 00:10:27,036 It's been a while. 238 00:10:27,037 --> 00:10:30,706 I got a-a bad toothache today. 239 00:10:30,707 --> 00:10:33,376 We'll take care of that, Louie. 240 00:10:33,377 --> 00:10:34,711 All right. 241 00:11:08,078 --> 00:11:10,287 There's too much blood to suction. 242 00:11:10,288 --> 00:11:12,289 Uh, retracting the lung. 243 00:11:12,290 --> 00:11:14,667 - Try to identify the source. - Could be the right ventricle. 244 00:11:14,668 --> 00:11:16,627 Or more likely, the hilum. 245 00:11:16,628 --> 00:11:18,421 Fresh lap pads. 246 00:11:19,673 --> 00:11:23,009 Siri, turn on silent mode! 247 00:12:13,560 --> 00:12:15,144 Good morning. 248 00:12:15,145 --> 00:12:16,896 If it was a good morning, I'd still be in bed. 249 00:12:16,897 --> 00:12:18,564 So what are you doing here? 250 00:12:18,565 --> 00:12:20,566 Benji's mom is visiting for the holiday. 251 00:12:20,567 --> 00:12:22,568 - She's still alive? - That woman's too mean to die. 252 00:12:22,569 --> 00:12:24,195 Plus, who else is going to get this place 253 00:12:24,196 --> 00:12:25,988 through the Fourth of July weekend? 254 00:12:25,989 --> 00:12:27,823 Sure as hell ain't going to be me. 255 00:12:27,824 --> 00:12:30,159 I rest my case. What am I walking into? 256 00:12:30,160 --> 00:12:31,702 Nothing too bad, yet. 257 00:12:31,703 --> 00:12:34,705 Uh, these are the ones I'd keep an eye on. 258 00:12:34,706 --> 00:12:38,709 The prodigal son returns. 259 00:12:38,710 --> 00:12:39,877 Too soon? 260 00:12:39,878 --> 00:12:42,338 No, I guess not. 261 00:12:42,339 --> 00:12:45,007 - You're back. - I took some time. 262 00:12:45,008 --> 00:12:48,219 I'm like an old trail horse... I always find my way back home. 263 00:12:48,220 --> 00:12:49,970 You look good, kid. How you feeling? 264 00:12:49,971 --> 00:12:51,931 Uh, yeah, great. 265 00:12:51,932 --> 00:12:54,517 You know, it's been a... 266 00:12:54,518 --> 00:12:57,019 - it's been a journey. - I bet. 267 00:12:57,020 --> 00:12:58,687 Thanks. Robby around? 268 00:12:58,688 --> 00:13:00,606 Uh, he's in with a trauma. 269 00:13:00,607 --> 00:13:03,025 But if you hurry back, you can catch some of the pass-ons. 270 00:13:03,026 --> 00:13:05,278 - They're in North. - Uh, thanks. 271 00:13:07,030 --> 00:13:09,074 I'll keep an eye on him. 272 00:13:11,201 --> 00:13:13,452 I think we have a lost little lamb. 273 00:13:13,453 --> 00:13:16,080 Uh, excuse me, hon. Can we help you? 274 00:13:16,081 --> 00:13:18,040 I'm looking for the charge nurse. 275 00:13:18,041 --> 00:13:20,125 Oh, well, you found two of 'em. 276 00:13:20,126 --> 00:13:21,544 I'm Lena. This is Dana. 277 00:13:21,545 --> 00:13:22,878 I'm night shift, going home, 278 00:13:22,879 --> 00:13:25,214 but Dana is queen of the day shift. 279 00:13:25,215 --> 00:13:27,258 Emma Nolan. Nice to meet you both. 280 00:13:27,259 --> 00:13:29,718 Uh, I'm a new grad RN here to shadow. 281 00:13:29,719 --> 00:13:31,262 Welcome to the Pitt, Emma Nolan. 282 00:13:31,263 --> 00:13:32,972 Here, let me put some of your stuff behind the desk, 283 00:13:32,973 --> 00:13:35,766 - and I'll give you a quick tour. - Okay. 284 00:13:35,767 --> 00:13:38,269 - Where you from, sweetheart? - Sault Ste. Marie. 285 00:13:38,270 --> 00:13:39,728 Oh. 286 00:13:39,729 --> 00:13:42,273 It's in Upper Michigan, practically Canada. 287 00:13:42,274 --> 00:13:45,109 My great-grandmother was from up that way... 288 00:13:45,110 --> 00:13:48,279 nice area, a lot of bugs. 289 00:13:48,280 --> 00:13:50,114 How about a cup of coffee? 290 00:13:51,491 --> 00:13:53,075 Can't locate the source. 291 00:13:53,076 --> 00:13:54,869 Proximal hilum is under the sternum. 292 00:13:54,870 --> 00:13:56,871 Along with most of the right ventricle. 293 00:13:56,872 --> 00:13:59,665 - You need better exposure. - Convert to a clamshell. 294 00:13:59,666 --> 00:14:02,084 - Exactly. - Trauma shears. 295 00:14:02,085 --> 00:14:04,712 Would've been nice to let them come up with that plan. 296 00:14:04,713 --> 00:14:06,953 Heart's going to need double compressions just like this. 297 00:14:08,174 --> 00:14:10,634 Squeeze from the apex to the aorta. 298 00:14:12,178 --> 00:14:13,804 Right ventricle looks good. 299 00:14:13,805 --> 00:14:15,264 Massive hemorrhage from the hilum. 300 00:14:15,265 --> 00:14:18,767 Second MTP pack is going, additional four units. 301 00:14:18,768 --> 00:14:21,186 Hilar injury looks very proximal... 302 00:14:21,187 --> 00:14:23,439 may be pulmonary artery and vein. 303 00:14:23,440 --> 00:14:26,108 Clamp's on. Nope, no good. 304 00:14:26,109 --> 00:14:27,610 Still bleeding like a stuck pig. 305 00:14:27,611 --> 00:14:28,611 I can give it a try. 306 00:14:28,612 --> 00:14:29,987 Dr. Garcia is a very skilled surgeon. 307 00:14:29,988 --> 00:14:31,655 If she can't get it, we need to think of something else. 308 00:14:31,656 --> 00:14:32,866 Like what? 309 00:14:36,328 --> 00:14:37,828 Hilar flip. 310 00:14:37,829 --> 00:14:39,496 We're going to rotate the lung 180 degrees, 311 00:14:39,497 --> 00:14:41,123 like putting a kink in the garden hose. 312 00:14:41,124 --> 00:14:43,876 - It'll stop the bleeding. - That could possibly work. 313 00:14:43,877 --> 00:14:47,630 Or he'll die when you rip the entire lung off the hilum. 314 00:14:47,631 --> 00:14:50,466 Gently, very, very gently, very, very slowly. 315 00:15:06,107 --> 00:15:07,942 - Blood loss is slowing down. - That's a good sign. 316 00:15:07,943 --> 00:15:09,234 Hilum looks dry. 317 00:15:09,235 --> 00:15:11,070 Yeah, but the heart feels empty. 318 00:15:11,071 --> 00:15:13,614 Okay, we fixed the leak. Now let's fill the tank. 319 00:15:15,784 --> 00:15:17,868 You are very popular today. 320 00:15:17,869 --> 00:15:20,664 Sorry, I'll turn it off when I can. 321 00:15:24,834 --> 00:15:26,543 Nine-year-old Kylie Connors... 322 00:15:26,544 --> 00:15:28,754 brought in by her dad's girlfriend, Gina. 323 00:15:28,755 --> 00:15:31,173 Kylie took a tumble on the stairs this morning. 324 00:15:31,174 --> 00:15:34,176 3-centimeter chin lac and a chipped front incisor. 325 00:15:34,177 --> 00:15:36,095 She's got LET on a pressure dressing. 326 00:15:36,096 --> 00:15:37,930 Bleeding pretty good on arrival. 327 00:15:37,931 --> 00:15:40,099 Dermabond should do the trick. 328 00:15:40,100 --> 00:15:42,184 Any questions? 329 00:15:42,185 --> 00:15:44,561 Dr. King? 330 00:15:44,562 --> 00:15:46,021 Mel? 331 00:15:46,022 --> 00:15:48,608 Oh, um, I didn't say anything. 332 00:15:51,403 --> 00:15:54,196 - Uh, how you feeling, Kylie? - Tired. 333 00:15:54,197 --> 00:15:56,991 - We've been here since 5:30. - Oh, that makes two of us. 334 00:15:56,992 --> 00:15:59,368 But don't worry. We'll patch you up good as new. 335 00:15:59,369 --> 00:16:01,996 And we will get you out of here as soon as we can. 336 00:16:01,997 --> 00:16:03,414 - Any questions? - Can you raise your chin? 337 00:16:03,415 --> 00:16:05,290 No, I'm just her dad's girlfriend, 338 00:16:05,291 --> 00:16:07,334 - so I'm new to all this. - No worries. We got you. 339 00:16:07,335 --> 00:16:08,628 Next. 340 00:16:10,213 --> 00:16:14,091 26-year-old Liam Sanders... took a fall from his bicycle. 341 00:16:14,092 --> 00:16:16,218 No LOC, nonfocal neuro, 342 00:16:16,219 --> 00:16:18,554 lower-leg lac with no bony tenderness. 343 00:16:18,555 --> 00:16:20,389 Were you wearing a helmet, Liam? 344 00:16:20,390 --> 00:16:22,266 No, I was just riding in my neighborhood. 345 00:16:22,267 --> 00:16:24,059 You should always wear a helmet. 346 00:16:24,060 --> 00:16:25,561 Hey, nice of you to join us. 347 00:16:25,562 --> 00:16:27,647 - Hey. - Dr. Langdon! 348 00:16:30,066 --> 00:16:32,901 Sold to Dr. Langdon. 349 00:16:32,902 --> 00:16:35,237 Candace O'Grady, 82... 350 00:16:35,238 --> 00:16:39,409 Brought in by her son Richard for intractable vomiting. 351 00:16:41,244 --> 00:16:43,078 Hardly any hemorrhage on the right. 352 00:16:43,079 --> 00:16:44,496 - Looks like the flip worked. - How's the heart, Whitaker? 353 00:16:44,497 --> 00:16:46,457 Feels full of blood. First time since we started. 354 00:16:46,458 --> 00:16:50,377 Hold compressions. 355 00:16:50,378 --> 00:16:53,047 - Quivering bag of worms. - Resume compressions. 356 00:16:53,048 --> 00:16:55,549 When the heart quivers like that, it's obvious V-fib. 357 00:16:55,550 --> 00:16:58,844 - Okay, internal paddles ready. - Mm-hmm. Charge to...? 358 00:16:58,845 --> 00:17:00,637 - 25 joules. - 50 joules. 359 00:17:00,638 --> 00:17:02,556 50 gets it right the first time. 360 00:17:02,557 --> 00:17:04,725 Charged. 361 00:17:04,726 --> 00:17:06,018 Okay, Whitaker, when you're ready. 362 00:17:06,019 --> 00:17:08,063 Clear. 363 00:17:10,648 --> 00:17:12,776 That's what normal sinus looks like. 364 00:17:14,569 --> 00:17:15,652 Strong carotid. 365 00:17:15,653 --> 00:17:18,781 Saline lap pads and up to the OR. 366 00:17:18,782 --> 00:17:21,116 That's a hell of a way to start the day. 367 00:17:21,117 --> 00:17:24,953 Unconventional, but a decent outcome. 368 00:17:24,954 --> 00:17:27,289 Why don't we split up for efficiency? 369 00:17:27,290 --> 00:17:29,626 Residents present to either one of us but not both. 370 00:17:31,127 --> 00:17:33,088 We can certainly discuss that. 371 00:17:37,550 --> 00:17:39,510 Were you feeling weak or dizzy? 372 00:17:39,511 --> 00:17:40,886 No. 373 00:17:40,887 --> 00:17:42,638 I-I got up to pee, and I tripped over 374 00:17:42,639 --> 00:17:44,640 a laundry basket that I couldn't see in the dark. 375 00:17:44,641 --> 00:17:46,183 Did you hit your head? 376 00:17:46,184 --> 00:17:48,143 Does my chart say that I hit my head? 377 00:17:48,144 --> 00:17:50,312 No, we just want to be thorough 378 00:17:50,313 --> 00:17:52,564 to make sure you don't miss anything. 379 00:17:52,565 --> 00:17:54,900 How about we focus on patching me up? 380 00:17:54,901 --> 00:17:56,527 Ah! 381 00:17:56,528 --> 00:17:58,529 All right, Mr. Williams, 382 00:17:58,530 --> 00:18:00,322 we're going to check an X-ray of your wrist 383 00:18:00,323 --> 00:18:02,533 and try to get you out of here as quickly as possible. 384 00:18:02,534 --> 00:18:05,035 Great. And let's keep the bullshit extra charges 385 00:18:05,036 --> 00:18:06,537 to a minimum, huh? 386 00:18:06,538 --> 00:18:08,831 My deductible is already a bitch. 387 00:18:11,334 --> 00:18:13,169 Sure. 388 00:18:34,858 --> 00:18:36,275 Bye. 389 00:18:36,276 --> 00:18:38,735 My mother is trying to destroy my life. 390 00:18:38,736 --> 00:18:40,904 Yeah, they seem to take pleasure in that. 391 00:18:40,905 --> 00:18:42,739 I committed to a partnership-track position 392 00:18:42,740 --> 00:18:44,575 next year at a hospital back in Jersey 393 00:18:44,576 --> 00:18:46,577 so I could be close and support her. 394 00:18:46,578 --> 00:18:49,580 But now she's getting married and selling our house 395 00:18:49,581 --> 00:18:52,124 to go on a year-long cruise around the world. 396 00:18:52,125 --> 00:18:54,710 Wow. I mean, that's a... 397 00:18:54,711 --> 00:18:56,670 Pretty fucking stupid idea, if you ask me. 398 00:18:56,671 --> 00:18:58,755 She's known this guy less than a year. 399 00:18:58,756 --> 00:19:02,134 What if he's a player? What if she disappears at sea? 400 00:19:02,135 --> 00:19:03,886 I mean, what if they're in love? 401 00:19:03,887 --> 00:19:05,554 Lust is more like it. 402 00:19:05,555 --> 00:19:08,682 That is even better. 403 00:19:08,683 --> 00:19:11,977 Man, it has been a while, 404 00:19:11,978 --> 00:19:15,397 and I'm solo this weekend. 405 00:19:15,398 --> 00:19:17,650 I need to get laid. 406 00:19:21,529 --> 00:19:23,655 It's a little much before 8:00 a.m., right? 407 00:19:23,656 --> 00:19:25,491 Yeah. 408 00:19:26,993 --> 00:19:28,786 Or ever. 409 00:19:34,250 --> 00:19:35,792 How's it going, Esme? 410 00:19:35,793 --> 00:19:38,046 Oh, just another day in paradise. 411 00:19:55,271 --> 00:19:57,981 Heard you're going on a trip. 412 00:19:57,982 --> 00:20:00,234 Taking a sabbatical. Leave tonight. 413 00:20:00,235 --> 00:20:02,069 Where you going? 414 00:20:02,070 --> 00:20:05,906 Um, Head-Smashed-In Buffalo Jump. 415 00:20:05,907 --> 00:20:08,700 Captain Crunch flying squirrel socks. 416 00:20:08,701 --> 00:20:11,995 What, are we talking in code, or are you having a stroke? 417 00:20:11,996 --> 00:20:15,457 It's an Aboriginal UNESCO Heritage Site in Alberta. 418 00:20:15,458 --> 00:20:17,459 I've never seen the Badlands. 419 00:20:17,460 --> 00:20:20,671 What is this, like, uh, some sort of spirit quest? 420 00:20:20,672 --> 00:20:23,966 Uh, yeah, something like that. 421 00:20:23,967 --> 00:20:26,593 Look, I, uh... I guess we should talk. 422 00:20:26,594 --> 00:20:28,971 - Got a lot of things I need to... - At some point, not right now. 423 00:20:28,972 --> 00:20:30,639 Right now I got to hit the head, 424 00:20:30,640 --> 00:20:32,641 and I would like you to go help Donnie out in Triage. 425 00:20:32,642 --> 00:20:33,976 Triage? 426 00:20:33,977 --> 00:20:35,519 N-no. 427 00:20:35,520 --> 00:20:37,229 No, I already picked up a patient in North 2, 428 00:20:37,230 --> 00:20:38,647 a bicycle fall leg lac, so maybe... 429 00:20:38,648 --> 00:20:39,815 Pretty sure we can cover for you. 430 00:20:39,816 --> 00:20:43,068 We've been doing it for months. 431 00:20:43,069 --> 00:20:44,653 Right. 432 00:20:44,654 --> 00:20:47,239 No, and I... and I am... I am very, uh... 433 00:20:47,240 --> 00:20:48,991 both very sorry and appreciative of that. 434 00:20:48,992 --> 00:20:50,492 I just would hate to think 435 00:20:50,493 --> 00:20:53,161 that this is some kind of a punishment for... 436 00:20:53,162 --> 00:20:55,080 but, uh, yeah. Yeah. No, for sure. 437 00:20:55,081 --> 00:20:58,709 We'll... we'll talk later, before you go. 438 00:20:58,710 --> 00:21:01,169 Like I said, not right now. 439 00:21:01,170 --> 00:21:03,547 Donnie just passed his NP certification. 440 00:21:03,548 --> 00:21:05,466 He can help if you get in over your head. 441 00:21:08,928 --> 00:21:10,887 Hey, Mel... 442 00:21:10,888 --> 00:21:13,765 can you take over a bike fall leg lac in North 2 443 00:21:13,766 --> 00:21:15,642 for Langdon while he's out in Triage? 444 00:21:15,643 --> 00:21:17,436 Um, you know, I-I can work in Triage if you want... 445 00:21:17,437 --> 00:21:19,313 No, I want to keep Langdon out in Triage, 446 00:21:19,314 --> 00:21:21,023 and I want to keep you back here. 447 00:21:21,024 --> 00:21:23,525 - You okay with that? - Sure. 448 00:21:23,526 --> 00:21:25,528 - Great. - Absolutely. 449 00:21:31,534 --> 00:21:33,243 So... 450 00:21:33,244 --> 00:21:35,537 who should I pick up? 451 00:21:35,538 --> 00:21:37,539 We're about to get the morning rush. 452 00:21:37,540 --> 00:21:38,749 What do you mean? 453 00:21:38,750 --> 00:21:40,250 Every morning around this time, 454 00:21:40,251 --> 00:21:42,711 the nursing homes and assisted-living facilities 455 00:21:42,712 --> 00:21:45,381 - do their morning bed checks. - Uh-huh. 456 00:21:48,134 --> 00:21:50,678 It looks pretty quiet to me. 457 00:21:53,931 --> 00:21:56,141 Huh. 458 00:21:56,142 --> 00:21:57,893 Incoming. 459 00:21:57,894 --> 00:21:59,561 Oh, like I said. 460 00:21:59,562 --> 00:22:01,104 Come on. 461 00:22:01,105 --> 00:22:02,647 Ethan Bostick, 79... 462 00:22:02,648 --> 00:22:04,733 found altered this morning at assisted living. 463 00:22:04,734 --> 00:22:06,068 No history of dementia. 464 00:22:06,069 --> 00:22:07,944 - Has a POLST. - What's a POLST? 465 00:22:07,945 --> 00:22:10,572 Physician Orders for Life-Sustaining Treatment... 466 00:22:10,573 --> 00:22:13,033 no CPR, no intubation. 467 00:22:13,034 --> 00:22:15,118 Then there's... there's nothing for us to do. 468 00:22:15,119 --> 00:22:16,953 South 15 is open. 469 00:22:16,954 --> 00:22:19,956 Uh, well, "do not resuscitate" does not mean "do not treat." 470 00:22:19,957 --> 00:22:23,794 He may perk up with fluids, IV antibiotics. 471 00:22:28,591 --> 00:22:29,883 What's the good word, Crash? 472 00:22:29,884 --> 00:22:32,260 You save that ventriloquist dummy? 473 00:22:32,261 --> 00:22:33,970 - Yeah. - Really? 474 00:22:33,971 --> 00:22:36,431 No. 475 00:22:36,432 --> 00:22:38,433 Wait, tell me you're not actually charting 476 00:22:38,434 --> 00:22:40,602 - about losing a mannequin. - It's part of the exercise. 477 00:22:40,603 --> 00:22:42,437 Dr. Al-Hashimi asked us to do it. 478 00:22:42,438 --> 00:22:44,439 Who's his next of kin... Barbie? 479 00:22:45,983 --> 00:22:49,986 What's your, uh, take on the new attending? 480 00:22:49,987 --> 00:22:51,656 Too soon to tell. 481 00:22:53,616 --> 00:22:54,950 You? 482 00:22:54,951 --> 00:22:56,201 She's already bugging me 483 00:22:56,202 --> 00:22:57,828 about being behind on my charting. 484 00:22:57,829 --> 00:22:59,496 Now I know why everyone says 485 00:22:59,497 --> 00:23:01,790 being a second-year resident sucks... because it does. 486 00:23:01,791 --> 00:23:03,583 I must've slept through the part of med school 487 00:23:03,584 --> 00:23:06,420 where they tell you 90% of your time will be spent typing. 488 00:23:06,421 --> 00:23:08,004 Which is just one more reason 489 00:23:08,005 --> 00:23:10,215 surgery is a better lifestyle choice. 490 00:23:10,216 --> 00:23:13,218 Hey, Dr. Shamsi. Dr. Trinity Santos. 491 00:23:13,219 --> 00:23:15,429 Ah, yes, the ER intern who's interested 492 00:23:15,430 --> 00:23:17,431 - in my surgery program. - That's me. 493 00:23:17,432 --> 00:23:20,016 But I'm an R2 now and thinking of double boarding 494 00:23:20,017 --> 00:23:21,852 in surgery and emergency medicine, 495 00:23:21,853 --> 00:23:24,354 which I know would sound ridiculously ambitious 496 00:23:24,355 --> 00:23:26,690 if I didn't have the talent to back it up. 497 00:23:26,691 --> 00:23:28,276 And the required attitude. 498 00:23:29,902 --> 00:23:31,653 Are you here to see a patient? 499 00:23:31,654 --> 00:23:33,447 I was. I did. 500 00:23:33,448 --> 00:23:34,823 And now I'm here to learn 501 00:23:34,824 --> 00:23:37,492 why you aren't returning my calls or texts. 502 00:23:37,493 --> 00:23:39,035 Okay, I'm out. 503 00:23:39,036 --> 00:23:41,163 Nice seeing you again, Dr. Shamsi. 504 00:23:41,164 --> 00:23:42,706 As soon as I get a little free time, 505 00:23:42,707 --> 00:23:44,833 I will make plans for all of us to do something together. 506 00:23:44,834 --> 00:23:46,668 - What about Tuesday? - I'm working. 507 00:23:46,669 --> 00:23:48,545 On your birthday? 508 00:23:48,546 --> 00:23:50,338 I will call you and Dad tomorrow, 509 00:23:50,339 --> 00:23:52,048 and we'll come up with something to do together, I promise. 510 00:23:52,049 --> 00:23:54,050 But right now I actually have 511 00:23:54,051 --> 00:23:56,304 a bunch of night-shift hand-offs. 512 00:24:03,394 --> 00:24:07,147 We have schedules. You have chaos. 513 00:24:07,148 --> 00:24:09,274 You know she's wasting her talents down here. 514 00:24:09,275 --> 00:24:12,277 Victoria is a big girl. She can make her own decisions. 515 00:24:12,278 --> 00:24:15,864 She's also a young girl who's still very impressionable. 516 00:24:15,865 --> 00:24:18,909 - And you can be very... - "Pressionable"? 517 00:24:21,496 --> 00:24:22,871 Yes? 518 00:24:22,872 --> 00:24:25,707 Who? 519 00:24:25,708 --> 00:24:28,502 Oh, for God's sake. I'll be right there. 520 00:24:28,503 --> 00:24:31,004 We need to talk. 521 00:24:31,005 --> 00:24:33,341 How about same time tomorrow? 522 00:24:35,927 --> 00:24:37,761 Next Tuesday's your birthday? 523 00:24:37,762 --> 00:24:40,055 No. 524 00:24:40,056 --> 00:24:42,307 - Yes. - Your 21st birthday? 525 00:24:42,308 --> 00:24:43,725 Please don't say anything, okay? 526 00:24:43,726 --> 00:24:45,101 I-I get a little anxious about... 527 00:24:45,102 --> 00:24:46,603 Dr. Santos, little girl with the chin lac 528 00:24:46,604 --> 00:24:48,104 is getting into a gown. 529 00:24:48,105 --> 00:24:50,732 Don't want anyone to know what? 530 00:24:50,733 --> 00:24:53,068 Nothing. 531 00:24:53,069 --> 00:24:54,986 - Have a good day. - You too. 532 00:24:56,656 --> 00:24:57,990 Oh. 533 00:24:59,408 --> 00:25:02,118 Hey, Duke, I'm just calling to remind you 534 00:25:02,119 --> 00:25:05,121 that this is my last shift for a while. 535 00:25:05,122 --> 00:25:07,666 So I need you to come in before 3:00 536 00:25:07,667 --> 00:25:11,127 in case we need to run some tests. 537 00:25:11,128 --> 00:25:13,798 Okay? We had a deal, brother. 538 00:25:15,841 --> 00:25:17,968 - Oh. Hello. - Hi. 539 00:25:17,969 --> 00:25:20,136 - I know you're crazy busy. - Always. 540 00:25:20,137 --> 00:25:22,222 But I figured we should really go over a few things 541 00:25:22,223 --> 00:25:23,765 - before you're gone. - Sure. 542 00:25:23,766 --> 00:25:25,850 Where would you like to start? 543 00:25:25,851 --> 00:25:27,561 Well, one little thing that I think 544 00:25:27,562 --> 00:25:30,146 would have a big impact with staff and patients alike 545 00:25:30,147 --> 00:25:31,982 is if we launched a campaign 546 00:25:31,983 --> 00:25:35,151 to eradicate referring to this wonderful department 547 00:25:35,152 --> 00:25:37,779 - as the Pitt. - Really? 548 00:25:37,780 --> 00:25:39,781 I know you think it's silly and petty. 549 00:25:39,782 --> 00:25:41,783 No, I think it's just kind of endearing, 550 00:25:41,784 --> 00:25:45,662 - pretty damn accurate. - I would argue the opposite. 551 00:25:45,663 --> 00:25:48,164 I think subconsciously it affects those who work here. 552 00:25:48,165 --> 00:25:49,791 It also lowers expectations, 553 00:25:49,792 --> 00:25:52,168 which in turn lowers patient-satisfaction scores. 554 00:25:52,169 --> 00:25:54,004 You have been talking to Gloria. 555 00:25:54,005 --> 00:25:57,465 - Yes, and she agrees with me. - Don't doubt that for a moment. 556 00:25:57,466 --> 00:25:59,301 You have to see the man over there right now! 557 00:25:59,302 --> 00:26:01,886 We see people in order of severity, ma'am. 558 00:26:05,308 --> 00:26:06,808 I don't know what you're saying. 559 00:26:06,809 --> 00:26:09,144 I can taste the shit in the back of my throat. 560 00:26:09,145 --> 00:26:10,395 Actually, the lady's right. 561 00:26:10,396 --> 00:26:12,022 He's going to make all of us sick. 562 00:26:12,023 --> 00:26:13,106 Yes, please. 563 00:26:19,905 --> 00:26:21,489 All right. 564 00:26:21,490 --> 00:26:23,033 We'll get him back. 565 00:26:23,034 --> 00:26:25,452 Tell Dana we're bringing the funk. 566 00:26:25,453 --> 00:26:27,496 - Oh, my God. - Whew! 567 00:26:28,331 --> 00:26:30,832 So when did your eye start bothering you, Ms. Mathews? 568 00:26:30,833 --> 00:26:32,876 Sister Grace, please. 569 00:26:32,877 --> 00:26:34,919 I'm only married to God. 570 00:26:34,920 --> 00:26:36,630 Of course, I'm sorry. 571 00:26:36,631 --> 00:26:40,216 A few days ago. I thought it was pink eye 572 00:26:40,217 --> 00:26:42,427 or maybe I scratched it while gardening. 573 00:26:42,428 --> 00:26:44,679 It's a very bad case of conjunctivitis. 574 00:26:44,680 --> 00:26:46,431 We should send a sample to the lab 575 00:26:46,432 --> 00:26:47,891 to direct our treatment. 576 00:26:47,892 --> 00:26:49,769 Look up for me. Thank you. 577 00:26:53,022 --> 00:26:55,857 Okay, I'll put a numbing drop in your eye 578 00:26:55,858 --> 00:26:58,903 and check for a scratch with a special lamp. 579 00:27:01,864 --> 00:27:03,865 And I'll get you to look up for me again. 580 00:27:03,866 --> 00:27:05,700 Thank you. 581 00:27:05,701 --> 00:27:08,203 Have you ever considered serving God? 582 00:27:08,204 --> 00:27:09,371 Which one? 583 00:27:09,372 --> 00:27:11,706 Excuse me? 584 00:27:11,707 --> 00:27:13,458 My family is Hindu, 585 00:27:13,459 --> 00:27:16,252 so we have, like, 33 different kinds of deities. 586 00:27:16,253 --> 00:27:18,505 Oh, we have the one. 587 00:27:18,506 --> 00:27:21,549 Some people only need one, right? 588 00:27:21,550 --> 00:27:23,051 Okay. 589 00:27:25,179 --> 00:27:28,056 Most important rule around here... be smart, be safe. 590 00:27:28,057 --> 00:27:30,100 I can't warn you enough about protecting yourself 591 00:27:30,101 --> 00:27:31,518 and your fellow nurses. 592 00:27:31,519 --> 00:27:33,978 We use the STAMP acronym to assess patients. 593 00:27:33,979 --> 00:27:35,397 You know it? 594 00:27:35,398 --> 00:27:37,941 Uh, S is for staring or refusal to make eye contact. 595 00:27:37,942 --> 00:27:39,609 If they're staring, they're scaring. 596 00:27:39,610 --> 00:27:41,152 - T? - Tone of voice. 597 00:27:41,153 --> 00:27:43,530 Often the threat level rises with their voice. 598 00:27:43,531 --> 00:27:44,989 A is for anxiety. 599 00:27:44,990 --> 00:27:46,658 You can also think "aggression." 600 00:27:46,659 --> 00:27:48,076 M is mumbling. 601 00:27:48,077 --> 00:27:49,285 Which, if you listen closely enough, 602 00:27:49,286 --> 00:27:50,954 is often them saying what they're thinking of doing 603 00:27:50,955 --> 00:27:52,622 as they talk themselves up to it. 604 00:27:52,623 --> 00:27:54,165 - And P? - Pacing. 605 00:27:54,166 --> 00:27:55,583 Good. 606 00:27:55,584 --> 00:27:57,502 We also have a safe word... "hula hoop." 607 00:27:57,503 --> 00:27:59,295 I guess technically it's two words, but whatever. 608 00:27:59,296 --> 00:28:01,297 If there's a threat, say "hula hoop," 609 00:28:01,298 --> 00:28:04,759 and we'll all respond. 610 00:28:04,760 --> 00:28:06,302 Yeah? 611 00:28:06,303 --> 00:28:07,762 Lovely. 612 00:28:07,763 --> 00:28:11,933 Okay, I'll be right there with reinforcements. 613 00:28:11,934 --> 00:28:14,770 Duty calls. We're headed for Triage. 614 00:28:20,526 --> 00:28:22,485 We're going to get your cast off... 615 00:28:41,547 --> 00:28:44,257 The antibiotics should clear everything up, 616 00:28:44,258 --> 00:28:47,177 but you should try to stay off it for a few days. 617 00:28:47,178 --> 00:28:50,555 Uh, I have to work. I'm late as it is. 618 00:28:50,556 --> 00:28:54,559 Well, um, take breaks and elevate when you can. 619 00:28:54,560 --> 00:28:56,394 Tylenol and Advil for the pain. 620 00:28:56,395 --> 00:28:59,147 If the pain persists or feel like it's getting worse, 621 00:28:59,148 --> 00:29:00,356 come on back. 622 00:29:00,357 --> 00:29:02,692 - We'll get you fixed up. - Thanks. 623 00:29:02,693 --> 00:29:05,737 They said give this to the doctor. 624 00:29:05,738 --> 00:29:08,823 - What the hell is it? - Patient passport. 625 00:29:08,824 --> 00:29:10,825 Lets patients know what they're waiting for 626 00:29:10,826 --> 00:29:12,327 and how long it'll take. 627 00:29:12,328 --> 00:29:14,579 You check off if he needs labs, X-rays, CT. 628 00:29:14,580 --> 00:29:16,539 None of the above. When did we start this? 629 00:29:16,540 --> 00:29:18,583 Today, the new attending. 630 00:29:20,336 --> 00:29:22,670 What's up with your tooth, Louie? 631 00:29:22,671 --> 00:29:25,381 It's been going on for a while, 632 00:29:25,382 --> 00:29:27,383 but it got bad last night. 633 00:29:27,384 --> 00:29:30,011 Lower-left side. 634 00:29:30,012 --> 00:29:32,180 Okay. 635 00:29:32,181 --> 00:29:35,642 Oh, yeah. 636 00:29:35,643 --> 00:29:37,519 It could be an infection at the root. 637 00:29:37,520 --> 00:29:40,688 We can drain it, but then... 638 00:29:40,689 --> 00:29:42,857 you're, uh... you're breathing kind of fast. 639 00:29:42,858 --> 00:29:44,776 Yeah, I've been... 640 00:29:44,777 --> 00:29:48,238 well, I've been, uh, walking more, 641 00:29:48,239 --> 00:29:49,906 trying to get in shape. 642 00:29:49,907 --> 00:29:52,742 But sometimes I get a little short of breath. 643 00:29:52,743 --> 00:29:55,787 Yeah, you need to walk past the liquor store, not into it. 644 00:29:55,788 --> 00:29:58,414 Only shape you're getting in is for a liver transplant. 645 00:29:58,415 --> 00:30:01,417 I don't need a new liver. Just get rid of this toothache. 646 00:30:01,418 --> 00:30:02,877 Deep breath. 647 00:30:06,632 --> 00:30:08,258 One more. 648 00:30:08,259 --> 00:30:10,885 - Is my heart still ticking? - Like a jackrabbit. 649 00:30:10,886 --> 00:30:14,097 - How long you been sitting down? - Oh, just for a few minutes. 650 00:30:14,098 --> 00:30:15,640 Not that long. 651 00:30:15,641 --> 00:30:17,476 Um, Louie... 652 00:30:19,270 --> 00:30:21,480 There's something I need to tell you. 653 00:30:23,816 --> 00:30:27,068 Last time I saw you, about ten months ago, 654 00:30:27,069 --> 00:30:31,865 I treated you, and I took some of your medicine. 655 00:30:31,866 --> 00:30:34,951 I'm not sure I follow. 656 00:30:34,952 --> 00:30:37,620 I have an addiction to benzos, 657 00:30:37,621 --> 00:30:41,291 and I helped myself to some of the Librium I prescribed you 658 00:30:41,292 --> 00:30:42,917 for your withdrawal. 659 00:30:42,918 --> 00:30:44,837 You stole my pills? 660 00:30:46,547 --> 00:30:48,047 Yeah. 661 00:30:48,048 --> 00:30:50,550 Yes, um... 662 00:30:50,551 --> 00:30:53,177 I'm sorry. It was, uh... 663 00:30:53,178 --> 00:30:56,097 it was not only wrong and utterly unprofessional, 664 00:30:56,098 --> 00:30:58,850 but it was a betrayal of my Hippocratic Oath, 665 00:30:58,851 --> 00:31:02,103 and it was a fucking crime. 666 00:31:02,104 --> 00:31:06,525 That's where I've been... rehab and counseling. 667 00:31:08,319 --> 00:31:10,945 - Huh. - I'm sorry. 668 00:31:10,946 --> 00:31:13,823 I-I understand if you'd prefer a different doctor. 669 00:31:13,824 --> 00:31:17,285 Hey, Doc, we have a situation. 670 00:31:17,286 --> 00:31:19,704 Excuse me. 671 00:31:19,705 --> 00:31:21,122 What kind of situation? 672 00:31:21,123 --> 00:31:23,708 Someone left a little baby in the restroom. 673 00:31:31,884 --> 00:31:33,801 Okay, let's think 674 00:31:33,802 --> 00:31:36,721 about reversible causes of confusion in the elderly. 675 00:31:36,722 --> 00:31:40,350 Uh, hypo or hypernatremia, infection, but he's afebrile, 676 00:31:40,351 --> 00:31:42,268 good O2 sats, and urine dip is negative. 677 00:31:42,269 --> 00:31:46,356 Yeah, great. Joy, anything to add? 678 00:31:46,357 --> 00:31:48,942 Nah. 679 00:31:48,943 --> 00:31:51,403 - V-tach. Can I... - Yeah. 680 00:31:53,155 --> 00:31:55,073 No pulse. Should we call for a code blue? 681 00:31:55,074 --> 00:31:59,077 No CPR, no shock, we honor his POLST and his wishes. 682 00:31:59,078 --> 00:32:02,664 So what does that leave us? 683 00:32:02,665 --> 00:32:05,333 Making sure he's comfortable. 684 00:32:05,334 --> 00:32:06,834 I'll suction. 685 00:32:06,835 --> 00:32:09,045 Altered mental in the elderly can also be 686 00:32:09,046 --> 00:32:13,467 toxicity from anticholinergics, sedative-hypnotics, opioids. 687 00:32:14,927 --> 00:32:17,178 A-am I missing something? 688 00:32:17,179 --> 00:32:19,263 Social skills? 689 00:32:19,264 --> 00:32:21,557 What? 690 00:32:24,103 --> 00:32:25,436 He looks so peaceful. 691 00:32:25,437 --> 00:32:26,646 Shouldn't we go find a new patient? 692 00:32:26,647 --> 00:32:29,273 No, stay here. 693 00:32:31,068 --> 00:32:33,112 Asystole. 694 00:32:42,037 --> 00:32:44,330 Quick and painless. 695 00:32:44,331 --> 00:32:46,124 We should all be so lucky. 696 00:32:46,125 --> 00:32:48,209 I'll try to contact some family. 697 00:32:49,795 --> 00:32:53,257 Yeah, one of the things we like to do here... 698 00:32:56,135 --> 00:32:58,219 When we have the time... 699 00:32:58,220 --> 00:33:01,055 is to take a moment of silence when we lose a patient 700 00:33:01,056 --> 00:33:03,433 to respect their humanity. 701 00:33:03,434 --> 00:33:07,562 He was someone's son, perhaps a father himself, 702 00:33:07,563 --> 00:33:10,065 a brother or a friend. 703 00:33:12,818 --> 00:33:16,238 Oh, uh, make sure your phones are on silent. 704 00:33:20,409 --> 00:33:23,077 Great, great, great. Okay. Uh... 705 00:33:23,078 --> 00:33:26,456 Is anyone missing a baby? 706 00:33:26,457 --> 00:33:30,793 Did anyone leave their child in the restroom? 707 00:33:30,794 --> 00:33:34,297 Do you, uh, remember seeing a woman enter with a baby 708 00:33:34,298 --> 00:33:36,174 but leave without one? 709 00:33:36,175 --> 00:33:38,468 No, sorry. 710 00:33:38,469 --> 00:33:40,470 Might be on the security tapes. 711 00:33:40,471 --> 00:33:42,722 - I'll have Ahmad check it out. - Please. 712 00:33:42,723 --> 00:33:43,890 Yeah. 713 00:33:43,891 --> 00:33:46,225 Harlow Graham to window one. 714 00:33:46,226 --> 00:33:49,562 Harlow Graham to window one. 715 00:33:49,563 --> 00:33:53,525 Harlow Graham to window one, please. 716 00:33:58,322 --> 00:34:00,114 Donnie Donahue, nurse practitioner. 717 00:34:00,115 --> 00:34:01,491 This is Emma, new grad nurse. 718 00:34:01,492 --> 00:34:03,034 - Hey. - Nice to meet you. 719 00:34:03,035 --> 00:34:04,869 - What's going on? - Somebody dumped their kid. 720 00:34:04,870 --> 00:34:07,497 Maybe Mom just stepped out for a smoke or something. 721 00:34:07,498 --> 00:34:09,290 What? I'm being helpful. 722 00:34:09,291 --> 00:34:10,833 Sometimes they just need a little break, 723 00:34:10,834 --> 00:34:13,294 and then they come back. 724 00:34:13,295 --> 00:34:14,962 At least they didn't leave her in a suitcase 725 00:34:14,963 --> 00:34:17,298 - at the bus station. - Does that happen? 726 00:34:17,299 --> 00:34:19,175 If that's a true story, I don't want to know about it. 727 00:34:19,176 --> 00:34:21,302 - It ain't the worst I've seen. - Please, don't tell me. 728 00:34:21,303 --> 00:34:23,722 - I'm a new dad, remember? - Okay. 729 00:34:30,687 --> 00:34:32,688 There you go. I'll get Robby. 730 00:34:32,689 --> 00:34:34,398 - Should I come with? - No, stay here. 731 00:34:34,399 --> 00:34:36,693 Donnie, Jesse, teach her something. 732 00:34:39,404 --> 00:34:43,157 You know how to check a rectal temp on an infant? 733 00:34:43,158 --> 00:34:44,784 Uh... 734 00:34:44,785 --> 00:34:46,703 theoretically. 735 00:34:52,209 --> 00:34:55,086 Mr. Williams, how's the pain? 736 00:34:55,087 --> 00:34:56,712 Nothing I can't manage 737 00:34:56,713 --> 00:34:58,714 with some Vicodin and a little scotch. 738 00:34:58,715 --> 00:35:01,342 Well, it's best not to mix the two. 739 00:35:01,343 --> 00:35:03,678 James here is going to take you to get an X-ray of your wrist. 740 00:35:03,679 --> 00:35:05,555 I'm going to be fine. 741 00:35:05,556 --> 00:35:08,015 Well, it'll tell us if you need a cast. 742 00:35:08,016 --> 00:35:09,684 Oh, I doubt it. 743 00:35:09,685 --> 00:35:11,936 I should probably go home, keep some ice on it. 744 00:35:11,937 --> 00:35:14,730 I know you guys always need the beds. 745 00:35:14,731 --> 00:35:17,108 Well, uh, it'll only take a minute, 746 00:35:17,109 --> 00:35:18,860 and then we'll know for sure. 747 00:35:18,861 --> 00:35:20,945 Yeah, I-I really don't think it's necessary. 748 00:35:20,946 --> 00:35:23,490 And I have a busy day, but I appreciate your concern. 749 00:35:26,743 --> 00:35:29,287 I'd really like to observe you for a little bit, 750 00:35:29,288 --> 00:35:31,873 in case you did hit your head. 751 00:35:31,874 --> 00:35:33,457 My head? 752 00:35:33,458 --> 00:35:35,918 I hit my schnoz on my arm, I think, nothing more. 753 00:35:35,919 --> 00:35:38,212 You think? You don't remember? 754 00:35:38,213 --> 00:35:39,672 No. 755 00:35:39,673 --> 00:35:41,507 Or, yes. 756 00:35:41,508 --> 00:35:44,552 I'm going to be fine, really. 757 00:35:44,553 --> 00:35:46,805 But thank you for your concern. 758 00:35:50,517 --> 00:35:52,310 Okay. 759 00:35:54,605 --> 00:35:58,274 How about we take that X-ray just to be safe? 760 00:35:58,275 --> 00:36:00,776 - Yeah. Yeah, okay. - Yeah? 761 00:36:00,777 --> 00:36:02,987 - Okay. - Okay, good idea. 762 00:36:04,907 --> 00:36:06,991 - Somebody found a baby? - Yeah. 763 00:36:06,992 --> 00:36:09,410 Not the first time it's happened. 764 00:36:09,411 --> 00:36:11,245 So, about those pills I took... 765 00:36:11,246 --> 00:36:14,290 Oh, don't worry about it, Doc. 766 00:36:14,291 --> 00:36:17,668 If the pills helped you, great. 767 00:36:17,669 --> 00:36:19,921 I never really liked taking 'em. 768 00:36:21,840 --> 00:36:23,424 I appreciate that, Louie. 769 00:36:23,425 --> 00:36:25,426 That's not really the point, but... 770 00:36:25,427 --> 00:36:27,845 I need to lift up your shirt for a second. 771 00:36:33,810 --> 00:36:36,187 How long has your belly been hard like that? 772 00:36:36,188 --> 00:36:37,647 I don't know. 773 00:36:37,648 --> 00:36:39,774 I figured I could wait another week. 774 00:36:39,775 --> 00:36:41,817 You need, uh, some lab tests 775 00:36:41,818 --> 00:36:44,654 and a procedure to drain off some of this fluid. 776 00:36:44,655 --> 00:36:46,656 Yeah, I know the drill. 777 00:36:46,657 --> 00:36:49,033 I've been tapped a few times before. 778 00:36:49,034 --> 00:36:52,245 Three times in the last six months. 779 00:36:52,246 --> 00:36:55,039 You need to give your liver a break, Louie. 780 00:36:55,040 --> 00:36:56,458 Yeah, I know. 781 00:37:01,046 --> 00:37:03,047 I just heard somebody dumped a baby 782 00:37:03,048 --> 00:37:04,465 in the waiting-room bathroom. 783 00:37:04,466 --> 00:37:07,677 - How sad is that? - Huh? 784 00:37:07,678 --> 00:37:10,805 What's up with you today, Mel... ancholia? 785 00:37:10,806 --> 00:37:13,224 What makes you think there's something up with me? 786 00:37:13,225 --> 00:37:15,017 You're moping around here all day 787 00:37:15,018 --> 00:37:17,478 like somebody gunned down your favorite K-Pop band. 788 00:37:17,479 --> 00:37:19,480 I don't really have a favorite K-Pop band. 789 00:37:19,481 --> 00:37:21,315 It's not that I don't like the genre. 790 00:37:21,316 --> 00:37:23,067 - It's just kinda... - Okay, forget K-Pop. 791 00:37:23,068 --> 00:37:24,694 What's going on with you? 792 00:37:24,695 --> 00:37:26,070 You usually ride in here 793 00:37:26,071 --> 00:37:27,863 on your unicorn tossing wildflowers. 794 00:37:27,864 --> 00:37:30,574 - "Unicorn"? - Never mind. 795 00:37:30,575 --> 00:37:33,077 Is everything okay with your sister? 796 00:37:33,078 --> 00:37:34,829 Oh, yeah, she's great. 797 00:37:34,830 --> 00:37:36,872 It's just this... 798 00:37:38,542 --> 00:37:40,710 Spill, girl. 799 00:37:40,711 --> 00:37:42,336 Um... 800 00:37:42,337 --> 00:37:45,715 well, a-a couple months ago, I got named in a... 801 00:37:45,716 --> 00:37:47,883 Malpractice lawsuit. 802 00:37:47,884 --> 00:37:51,762 And so, um, today is the... the deposition. 803 00:37:51,763 --> 00:37:53,472 That's it? 804 00:37:53,473 --> 00:37:56,642 Every emergency-medicine doc gets sued sooner or later. 805 00:37:56,643 --> 00:37:59,061 Seriously, don't sweat it. You're still a resident. 806 00:37:59,062 --> 00:38:00,730 We're protected by the hospital. 807 00:38:00,731 --> 00:38:04,567 You could cut somebody's head off and get away with it. 808 00:38:04,568 --> 00:38:06,986 But, you know, like, don't. 809 00:38:06,987 --> 00:38:09,447 You don't want to become known as the one 810 00:38:09,448 --> 00:38:12,033 who put Mel in mel-practice. 811 00:38:12,034 --> 00:38:14,869 Hey, Santos, our little girl, Kylie, has been 812 00:38:14,870 --> 00:38:18,122 in the West Penn Emergency Department a couple times. 813 00:38:18,123 --> 00:38:20,750 I'm not saying this is necessarily the case here, 814 00:38:20,751 --> 00:38:23,544 but recent studies have linked bullying behavior 815 00:38:23,545 --> 00:38:26,464 to different personality disorders. 816 00:38:26,465 --> 00:38:29,133 On the other hand, though, I-I am known to be a bit 817 00:38:29,134 --> 00:38:30,593 overly sensitive sometimes... 818 00:38:30,594 --> 00:38:31,802 - Mel. - Yes? 819 00:38:31,803 --> 00:38:33,137 You're talking to yourself again. 820 00:38:33,138 --> 00:38:34,972 - You need something? - Uh, yeah, a good lawyer. 821 00:38:34,973 --> 00:38:36,766 I don't know. I'm kidding. 822 00:38:36,767 --> 00:38:38,060 I'm... 823 00:38:39,978 --> 00:38:42,188 Yo, Robinavitch, somebody ditched a bundle of joy 824 00:38:42,189 --> 00:38:43,481 in chairs. 825 00:38:43,482 --> 00:38:44,940 - How old? - Couple months maybe. 826 00:38:44,941 --> 00:38:46,359 Donahue's got her in Pedes. 827 00:38:46,360 --> 00:38:48,819 - No one saw who left her? - Apparently not. 828 00:38:48,820 --> 00:38:50,571 - That's so sad. - Tell me about it. 829 00:38:50,572 --> 00:38:52,114 Who throws away a perfectly good baby? 830 00:38:53,283 --> 00:38:54,658 Make a lane! 831 00:38:54,659 --> 00:38:57,161 Ah, sweet baby Jesus, Antoine! 832 00:38:57,162 --> 00:38:59,288 - Right to the outdoor shower! - I just drive 'em. 833 00:38:59,289 --> 00:39:00,748 I'm not a wash and detail service. 834 00:39:00,749 --> 00:39:03,125 Yeah, yeah, God forbid you prove useful. 835 00:39:03,126 --> 00:39:04,710 Ah, good timing, Ms. Emma. 836 00:39:04,711 --> 00:39:07,421 Time for you and me to do the Lord's work. This way. 837 00:39:07,422 --> 00:39:09,340 Ooh, God, what is that? 838 00:39:09,341 --> 00:39:13,094 Okay, big breath. 839 00:39:13,095 --> 00:39:17,057 All right, lungs sound great. Can you lean forward for me? 840 00:39:22,604 --> 00:39:26,357 Uh, did you hit your back when you fell down the stairs? 841 00:39:26,358 --> 00:39:27,483 No. 842 00:39:27,484 --> 00:39:29,360 Okay, there's a pretty good bruise here. 843 00:39:29,361 --> 00:39:31,238 I got knocked down in soccer. 844 00:39:33,281 --> 00:39:36,117 Oh, no, you broke your wrist last year, too, huh? 845 00:39:36,118 --> 00:39:38,953 Fell off my skateboard. Got a purple cast. 846 00:39:38,954 --> 00:39:40,538 Cool color. 847 00:39:40,539 --> 00:39:42,498 And you were treated at West Penn? 848 00:39:42,499 --> 00:39:44,959 Is that your closest hospital? 849 00:39:44,960 --> 00:39:46,710 Uh, I guess that would make sense. 850 00:39:46,711 --> 00:39:48,712 I've only been dating her dad a few months. 851 00:39:48,713 --> 00:39:51,465 Uh, he lived in Garfield before the divorce. 852 00:39:51,466 --> 00:39:53,968 - And, uh, what about these? - Soccer. 853 00:39:53,969 --> 00:39:55,678 Do you wear shin guards? 854 00:39:55,679 --> 00:39:57,346 My dad ordered them. 855 00:39:57,347 --> 00:40:00,724 Okay. What does your dad do for work? 856 00:40:00,725 --> 00:40:03,602 He draws buildings, but he's not an architect. 857 00:40:03,603 --> 00:40:06,021 He's a draftsman for a firm in Newcastle. 858 00:40:06,022 --> 00:40:10,443 Okay. Um, Kylie, any chance you can pee? 859 00:40:10,444 --> 00:40:12,862 - Mm, maybe. - Okay. 860 00:40:12,863 --> 00:40:14,905 Well, with the bruise on your back, 861 00:40:14,906 --> 00:40:16,490 we need to check your urine. 862 00:40:16,491 --> 00:40:18,076 - Okay. - Okay. 863 00:40:20,996 --> 00:40:23,372 Did you eat anything out of the ordinary recently? 864 00:40:23,373 --> 00:40:24,832 No. 865 00:40:24,833 --> 00:40:27,251 Sorry, but we went through this a bunch. 866 00:40:27,252 --> 00:40:28,919 Don't you people communicate? 867 00:40:28,920 --> 00:40:30,838 You're the third nurse we've told her story to. 868 00:40:30,839 --> 00:40:32,173 I'm a doctor. 869 00:40:32,174 --> 00:40:35,176 Richard, would you go to the cafeteria 870 00:40:35,177 --> 00:40:37,595 and get me a large chamomile tea? 871 00:40:37,596 --> 00:40:39,763 What can we get you, my dear? 872 00:40:39,764 --> 00:40:42,100 I'm fine, thank you. 873 00:40:44,060 --> 00:40:45,896 Yeah, I'll be right back. 874 00:40:49,733 --> 00:40:52,151 Please excuse my son. 875 00:40:52,152 --> 00:40:54,069 Ever since my husband died, 876 00:40:54,070 --> 00:40:56,489 he's been a little overprotective. 877 00:40:56,490 --> 00:40:58,532 I think it's sweet. 878 00:40:58,533 --> 00:41:01,411 - You're very lucky to have him. - I am. 879 00:41:02,996 --> 00:41:06,916 Are you still taking your loperamide and cholestyramine? 880 00:41:06,917 --> 00:41:09,710 Um, mm, not so much. 881 00:41:09,711 --> 00:41:11,420 No? 882 00:41:11,421 --> 00:41:13,839 That may be why you're experiencing the abdominal pain 883 00:41:13,840 --> 00:41:15,466 and vomiting. 884 00:41:15,467 --> 00:41:17,718 When did you stop taking your meds? 885 00:41:17,719 --> 00:41:19,888 Last winter or so. 886 00:41:21,890 --> 00:41:25,559 My neighbor Helen and I bingo in Wintersville. 887 00:41:25,560 --> 00:41:28,229 There's a dispensary next door. 888 00:41:28,230 --> 00:41:30,272 And we got some marijuana. 889 00:41:30,273 --> 00:41:34,568 And I swear it cleared everything up. 890 00:41:34,569 --> 00:41:38,113 A few cookies every few hours... 891 00:41:38,114 --> 00:41:40,783 and no more pain. 892 00:41:40,784 --> 00:41:43,327 "A few cookies"? 893 00:41:43,328 --> 00:41:45,454 How many are you eating in a day? 894 00:41:45,455 --> 00:41:47,540 Oh, uh... 895 00:41:47,541 --> 00:41:50,209 I don't know. 896 00:41:50,210 --> 00:41:55,130 Probably a dozen or so, but they're not very big. 897 00:41:55,131 --> 00:41:57,132 There have been some studies 898 00:41:57,133 --> 00:41:59,343 that show an added dementia risk 899 00:41:59,344 --> 00:42:02,347 with marijuana use in older adults. 900 00:42:03,723 --> 00:42:06,433 Well, that sucks for old people. 901 00:42:07,769 --> 00:42:09,728 Kylie, there are some questions 902 00:42:09,729 --> 00:42:13,774 that we ask every kid who comes in with an injury. 903 00:42:13,775 --> 00:42:15,317 Like what? 904 00:42:15,318 --> 00:42:18,779 Like, sometimes the people that you live with 905 00:42:18,780 --> 00:42:23,784 can get so mad that they hit you or hurt you, 906 00:42:23,785 --> 00:42:25,995 maybe without even meaning to. 907 00:42:25,996 --> 00:42:27,454 Does that ever happen? 908 00:42:27,455 --> 00:42:29,957 No, not to me. 909 00:42:29,958 --> 00:42:32,167 Or sometimes kids can get punished 910 00:42:32,168 --> 00:42:33,794 for doing something wrong 911 00:42:33,795 --> 00:42:37,339 with maybe a spanking or a belt. 912 00:42:37,340 --> 00:42:40,009 I get time-outs. 913 00:42:40,010 --> 00:42:42,136 How about at school, Kylie? 914 00:42:42,137 --> 00:42:45,639 You know, is anybody being, you know, mean or bullying you? 915 00:42:45,640 --> 00:42:48,226 No, I have lots of friends. 916 00:43:09,039 --> 00:43:11,206 Yo, Whitaker. 917 00:43:11,207 --> 00:43:14,043 Dr. Langdon. 918 00:43:14,044 --> 00:43:17,838 - You, uh, meet Louie here? - Uh, yeah, yeah, many times. 919 00:43:17,839 --> 00:43:20,215 - Good morning, Mr. Cloverfield. - What's up, Doc? 920 00:43:20,216 --> 00:43:22,426 Where's your new resident badge buddy, buddy? 921 00:43:22,427 --> 00:43:26,764 Oh, uh, yeah, they... they didn't give me a new one yet. 922 00:43:26,765 --> 00:43:28,098 Bummer. 923 00:43:28,099 --> 00:43:29,683 You and, uh, your ducklings got time 924 00:43:29,684 --> 00:43:31,352 to tap a six-pack off our friend here? 925 00:43:31,353 --> 00:43:33,896 - Louie needs a paracentesis. - Yeah, sure. 926 00:43:33,897 --> 00:43:35,856 It's good to see you again, Louie... 927 00:43:35,857 --> 00:43:37,608 not in this condition, of course. 928 00:43:37,609 --> 00:43:38,692 How you feeling? 929 00:43:38,693 --> 00:43:42,029 Feeling like I need a drink pretty soon. 930 00:43:42,030 --> 00:43:43,864 Okay, well, first things first... 931 00:43:43,865 --> 00:43:46,116 we are going to make you more comfortable 932 00:43:46,117 --> 00:43:47,743 by draining some fluid. 933 00:43:47,744 --> 00:43:49,453 You're gonna take off a big volume, 934 00:43:49,454 --> 00:43:52,581 so start with 60 grams of 25% albumin IV. 935 00:43:52,582 --> 00:43:55,167 - You tapped him before? - No. 936 00:43:55,168 --> 00:43:57,670 That's okay, Doc. I'll talk him through it. 937 00:43:57,671 --> 00:43:59,422 Okay. 938 00:44:01,049 --> 00:44:04,469 Sats 99 on room air, normal BP, normal pulse. 939 00:44:07,263 --> 00:44:08,931 Oh, well hydrated. 940 00:44:08,932 --> 00:44:10,683 No obvious source of infection. 941 00:44:10,684 --> 00:44:13,686 Could be a benign virus, but can't assume that. 942 00:44:13,687 --> 00:44:16,313 - Is this the abandoned baby? - Mm-hmm. 943 00:44:16,314 --> 00:44:18,691 - How old? - How old do you think she is? 944 00:44:18,692 --> 00:44:22,111 - Month, month and a half? - It's tricky. 945 00:44:22,112 --> 00:44:25,489 Under 28 days is a Safe Haven drop-off, no questions asked. 946 00:44:25,490 --> 00:44:28,951 But over 28 days is a crime, child abandonment. 947 00:44:28,952 --> 00:44:31,120 How should we assess? 948 00:44:31,121 --> 00:44:34,248 Under 28 days gets everything, including an LP. 949 00:44:34,249 --> 00:44:36,583 But over 28 days, 950 00:44:36,584 --> 00:44:38,752 you can follow PECARN or Step-by-step 951 00:44:38,753 --> 00:44:41,463 to determine risk of invasive bacterial infection. 952 00:44:41,464 --> 00:44:42,965 This baby looks great. 953 00:44:42,966 --> 00:44:44,925 But we know nothing about the birth history. 954 00:44:44,926 --> 00:44:48,762 Did Mom have group B strep, active HSV lesions? 955 00:44:48,763 --> 00:44:52,808 We should assume the worst. Put in your orders, Dr. Mohan. 956 00:44:52,809 --> 00:44:54,852 CBC... 957 00:44:54,853 --> 00:44:57,354 Blood culture, chem panel, 958 00:44:57,355 --> 00:45:00,232 chest X-ray, UA and culture, 959 00:45:00,233 --> 00:45:02,443 respiratory virus panel. 960 00:45:02,444 --> 00:45:06,739 Check inflammatory markers... procalcitonin and CRP... 961 00:45:06,740 --> 00:45:08,824 then take it from there. 962 00:45:08,825 --> 00:45:11,034 That sounds like a plan. 963 00:45:11,035 --> 00:45:13,203 Dr. Robby, Santos needs you in North 1. 964 00:45:13,204 --> 00:45:14,747 Okay, I'll be right there. 965 00:45:14,748 --> 00:45:17,208 If you'll excuse me, if you'll excuse me. 966 00:45:19,544 --> 00:45:23,797 - Mind if I join with? - Uh, no, I got this. 967 00:45:23,798 --> 00:45:25,549 It will help me get a better sense 968 00:45:25,550 --> 00:45:27,801 of how you like to do things by seeing you in action 969 00:45:27,802 --> 00:45:29,303 with the residents. 970 00:45:29,304 --> 00:45:31,014 Be my guest. 971 00:45:33,725 --> 00:45:35,935 I will be right back. 972 00:45:41,024 --> 00:45:43,817 Um, nine-year-old Kylie Connors... 973 00:45:43,818 --> 00:45:45,861 took a tumble running up the stairs this morning. 974 00:45:45,862 --> 00:45:47,654 Chin lac and fractured tooth. 975 00:45:47,655 --> 00:45:49,865 Brought in by her dad's girlfriend, Gina. 976 00:45:49,866 --> 00:45:52,993 Supposedly, the dad had to leave early for work. 977 00:45:52,994 --> 00:45:55,788 Kylie has a lot of bruising on her body... 978 00:45:55,789 --> 00:45:57,372 some old, some new. 979 00:45:57,373 --> 00:46:00,959 Are you concerned about non-accidental trauma? 980 00:46:00,960 --> 00:46:02,586 Or worse. 981 00:46:02,587 --> 00:46:05,047 Her urine sample shows gross hematuria, 982 00:46:05,048 --> 00:46:08,258 which could be renal injury, or vaginal bleeding from trauma 983 00:46:08,259 --> 00:46:10,511 could have contaminated the specimen. 984 00:46:10,512 --> 00:46:13,430 Lots to consider. What's your plan? 985 00:46:13,431 --> 00:46:16,099 Labs, ultrasound, social-work consult, 986 00:46:16,100 --> 00:46:18,143 then decide if this is reportable. 987 00:46:18,144 --> 00:46:19,562 Mm-hmm. 988 00:46:22,774 --> 00:46:24,608 Let me know if you can feel this. 989 00:46:24,609 --> 00:46:26,443 No. Am I supposed to? 990 00:46:26,444 --> 00:46:27,654 No. 991 00:46:31,866 --> 00:46:34,034 Your hair's such a pretty color. 992 00:46:34,035 --> 00:46:35,244 Thank you. 993 00:46:35,245 --> 00:46:37,746 Reminds me of my mom. 994 00:46:37,747 --> 00:46:41,041 - She died when I was nine. - Oh, I'm sorry about that. 995 00:46:41,042 --> 00:46:43,627 She wore glasses like you, too. 996 00:46:43,628 --> 00:46:45,629 Weird. 997 00:46:45,630 --> 00:46:49,049 What do you like to do when you're not working? 998 00:46:49,050 --> 00:46:51,468 Um, spend some time with my sister, 999 00:46:51,469 --> 00:46:53,262 read. 1000 00:46:53,263 --> 00:46:54,888 Do you drink coffee? 1001 00:46:54,889 --> 00:46:58,517 Uh, no, I avoid caffeine. 1002 00:46:58,518 --> 00:46:59,643 Me too. 1003 00:46:59,644 --> 00:47:01,311 Um... 1004 00:47:01,312 --> 00:47:03,314 what about boba? 1005 00:47:04,858 --> 00:47:08,361 I love boba. 1006 00:47:10,989 --> 00:47:12,990 I'd offer you some gum, but it's laced with nicotine. 1007 00:47:12,991 --> 00:47:14,867 Trying to quit smoking. 1008 00:47:14,868 --> 00:47:17,452 That's good. 1009 00:47:17,453 --> 00:47:19,204 Verdict's still out. 1010 00:47:19,205 --> 00:47:21,582 Get in all those nooks and crannies, Mr. Digby. 1011 00:47:21,583 --> 00:47:23,458 Your skin will thank you. 1012 00:47:23,459 --> 00:47:25,377 We all will. 1013 00:47:25,378 --> 00:47:29,423 Oh, I could stay in here all day. 1014 00:47:29,424 --> 00:47:31,675 It's a miracle what little soap, water, and human decency 1015 00:47:31,676 --> 00:47:33,677 can do sometimes. 1016 00:47:33,678 --> 00:47:35,095 Don't forget the ears, pal. 1017 00:47:35,096 --> 00:47:37,097 Don't want anything growing in there either. 1018 00:47:37,098 --> 00:47:38,682 Okay. Okay. 1019 00:47:38,683 --> 00:47:40,601 What's your story, Emma? 1020 00:47:40,602 --> 00:47:43,478 What'd your parents do? Got siblings? Boyfriend? 1021 00:47:43,479 --> 00:47:46,440 Ever kill a man in a bar fight? 1022 00:47:46,441 --> 00:47:47,734 Uh... 1023 00:47:57,160 --> 00:47:59,494 So, Mr. Williams, 1024 00:47:59,495 --> 00:48:01,914 sometimes a fracture of the scaphoid bone 1025 00:48:01,915 --> 00:48:03,790 doesn't show up on day one. 1026 00:48:03,791 --> 00:48:07,502 So my advice to be safe is wear a splint for two weeks 1027 00:48:07,503 --> 00:48:09,713 and then come back for a repeat X-ray, 1028 00:48:09,714 --> 00:48:11,506 and we'll see if it's really there. 1029 00:48:13,801 --> 00:48:16,428 My knee hurts. 1030 00:48:16,429 --> 00:48:19,765 Oh, did you hurt your knee? 1031 00:48:19,766 --> 00:48:21,517 I must have. 1032 00:48:28,066 --> 00:48:30,150 What is this? 1033 00:48:30,151 --> 00:48:33,070 That's, um, for your wrist. 1034 00:48:33,071 --> 00:48:35,989 And I need this? 1035 00:48:35,990 --> 00:48:38,742 Well, um, if it's a, uh... 1036 00:48:38,743 --> 00:48:40,827 John, can you? 1037 00:48:40,828 --> 00:48:43,372 If it's a fracture and we don't immobilize, 1038 00:48:43,373 --> 00:48:45,583 the bone might not heal properly. 1039 00:48:47,543 --> 00:48:51,380 How long is this gonna take? 1040 00:48:51,381 --> 00:48:53,800 Just a few minutes to fit you. 1041 00:48:56,678 --> 00:48:59,180 Is this place new? 1042 00:49:01,891 --> 00:49:05,895 Mr. Williams, do you know what day it is? 1043 00:49:09,440 --> 00:49:11,984 It's Taco Tuesday. 1044 00:49:11,985 --> 00:49:14,237 Do you know where you are? 1045 00:49:15,738 --> 00:49:18,991 Yeah, I'm in the slowest medical clinic in the West. 1046 00:49:18,992 --> 00:49:21,451 Do you know what year it is? 1047 00:49:21,452 --> 00:49:23,578 How about you just fix my wrist 1048 00:49:23,579 --> 00:49:27,791 and you stop with all the questions? 1049 00:49:27,792 --> 00:49:30,878 I am not here to be profiled. 1050 00:49:35,049 --> 00:49:37,968 Yeah, of course. 1051 00:49:37,969 --> 00:49:40,096 I'll be back, okay? 1052 00:49:50,815 --> 00:49:53,567 All right, Mr. Digby, looking better already. 1053 00:49:53,568 --> 00:49:55,485 Certainly smell a little better. 1054 00:49:55,486 --> 00:49:56,987 Do you have any conditioner? 1055 00:49:56,988 --> 00:49:59,114 Let's get you dried off and back inside. 1056 00:49:59,115 --> 00:50:00,782 Get him gowned up and put him in South 21, 1057 00:50:00,783 --> 00:50:01,950 across from the old nun. 1058 00:50:01,951 --> 00:50:05,245 Maybe some of her divine grace will wear off on him. 1059 00:50:05,246 --> 00:50:06,580 Who do we have here? 1060 00:50:06,581 --> 00:50:09,499 Evelyn Bostick, 81, with Alzheimer's. 1061 00:50:09,500 --> 00:50:11,752 We brought her husband in about 30 minutes ago. 1062 00:50:11,753 --> 00:50:13,378 She was supposed to get a ride in, 1063 00:50:13,379 --> 00:50:15,047 but they found her wandering in traffic. 1064 00:50:15,048 --> 00:50:17,090 - Where are we? - You're at the hospital, dear. 1065 00:50:17,091 --> 00:50:18,467 I'm not sick. 1066 00:50:18,468 --> 00:50:20,469 We brought you to see your husband. 1067 00:50:20,470 --> 00:50:22,471 Oh, no. Is Ethan okay? 1068 00:50:22,472 --> 00:50:25,057 I'll be in to chat with you, Mrs. Bostick. 1069 00:50:25,058 --> 00:50:27,601 He died. 1070 00:50:27,602 --> 00:50:29,478 What you got, Amboy? 1071 00:50:29,479 --> 00:50:32,689 Allen Billings... had a pallet fall onto his outstretched arm. 1072 00:50:32,690 --> 00:50:35,108 - Looks like an open dislocation. - Yeah, that's got to hurt. 1073 00:50:35,109 --> 00:50:36,818 Don't worry, sir. We got you. 1074 00:50:42,867 --> 00:50:46,119 - How's she doing? - Seems happy enough. 1075 00:50:46,120 --> 00:50:48,121 - Yeah. Hi. - Hi. 1076 00:50:48,122 --> 00:50:50,874 Just got a quick point-of-care CBC. 1077 00:50:57,298 --> 00:50:59,300 Is there a problem? 1078 00:51:02,804 --> 00:51:04,638 Did I miss something? 1079 00:51:04,639 --> 00:51:07,642 Dr. Al? Dr. Al? 1080 00:51:07,692 --> 00:51:11,602 Sync and corrections by btsix www.addic7ed.com