Sync and corrections by btsix www.addic7ed.com
Oh, okay.
Where are we now?
Got the VRI for our deaf patient in Central 12.
Still waiting on Pedes for Baby Jane Doe.
Central 6 is sitting pretty with his insulin drip.
And the Westbridge diversions are
kindly waiting their turn to sit
for hours in our lovely halls.
You are some kind of savant.
Worthy of a raise?
Just more of my love.
I got enough of that.
I have a sexual assault victim in triage.
I called PAAR, so an advocate is on the way.
Okay. We'll take care of it.
Uh, Dr. McKay, what's going on with your patient in Central 9?
Isn't she good to go?
Oh, she was, but she decided
she wanted to stay in the hospital now
because she's in too much pain.
In our loud and overcrowded ED
with more Westbridge cases arriving every moment?
She would be more comfortable at home.
The debrief was lovely.
Thank you.
Would you mind helping Dana with a sexual assault victim
- who just came in? - Of course. Sure.
Why don't you and I go see if we can't convince
- your patient to leave? - All right.
I need to take care of a sexual assault victim in triage.
One of you needs to hold down the fort.
- We can call for a SANE. - On a holiday? Could be hours.
We're not gonna make this patient wait.
And since I'm the only SANE on staff...
Princess will cover.
Hey! Hey!
You two better not be teaching her any bad habits.
- Come on. You ready, Doc? - Sure.
A SANE is a Sexual Assault Nurse Examiner.
We do forensic exams, collect evidence,
and hand it over to the police if a report is made.
We also provide resources, support,
- sometimes even testimony. - You go to court?
SANEs are very valuable in a hospital, especially an ED.
More nurses should train for it.
That's a not so subtle hint.
Looks like this is the new hot spot, huh?
And only getting hotter.
Any word on what's going on with Westbridge?
I got 20 on lantern flies.
Nope, nothing.
These patient passports have an interesting alternative use.
Where's the sexual assault victim?
She's in Triage, Chair 2.
Thanks, Lupe.
Here's her intake.
Got it.
Hi, Ms. Miller.
I'm Dana.
How are you doing?
- I've been better. - Yeah.
You're in a safe place now.
I'm the charge nurse in the ED
and a sexual assault nurse examiner.
This is Emma, who will be assisting.
And I'm Dr. Al-Hashimi.
I'll be checking you for any injuries
that need immediate attention.
You can just call me Ilana.
I don't have any injuries.
Okay, that's good.
We're gonna get a room ready for you.
Meanwhile, Dr. Al-Hashimi is gonna ask you a few questions.
How long is this gonna take?
I can't promise an exact time,
but we'll try to be as fast as you need.
- Thank you. - Yeah.
Okay, Ilana, do you take any prescription medications?
Just Synthroid, one tab a day.
Okay, and any allergies to medications?
- No. No. - Okay.
Dana will come get you when the room is ready,
and I'll be back to finish your exam.
Come find me when she's in a gown.
Will do.
We're gonna use Triage Exam Rooms 1 and 2 for this.
It's the most private space we have away from the ED.
All right, this can be a lot.
You up for it?
Yeah.
Yes. I'm good.
Let me know if you need to step out.
Yes.
Dr. Ellis.
- Oh, no. - Oh, yes.
Need the room.
Find another place to lay your head.
Not even a 20-minute power nap?
You know, my double is at 1:30. I'm...
Nope, we're getting Westbridge diversions.
And chairs is insane.
- Did you see out there? - No.
I do not come in through that mess.
Okay.
Yeah.
People sleep in here?
Yeah, the night shift docs just need rest,
especially if they have to come in during the day.
But today, we can't waste the space.
I need you to get me a stool on wheels and Esme for a turnover.
So you're having a headache and abdominal pain?
Yeah, that's right.
Okay, and which would you say is worse?
My headache was terrible last week...
But now...
Hey, you're... you're breaking up.
Can you run that back again?
Sure.
My headache was terrible last week...
But now my abdominal pain...
Oh, my God.
Come on, you piece of...
fuck.
Um...
I'll... I'll be right back.
Sorry.
Um, Dr. Al-Hashimi?
Jackson's parents are here.
Okay. I'll take that.
Um, Mr. and Mrs. Davis, this is one of my attendings,
- Dr. Al-Hashimi. - Hi. Nice to meet you.
- Demi. - Charles.
What the hell's going on?
He's barely conscious.
Jackson's just a little tired due to the sedative
- he was given. - You sedated him?
Oh, your son was brought in extremely agitated.
You'd be, too, if you were tased.
And why the fuck did they do that?
This is bullshit. We're taking him home.
Why don't we step out for a second?
Right now, Jackson is on an involuntary psych hold.
What? That's not necessary.
He just needs some rest.
He's been studying for the bar exam.
We can watch him at home.
So far, all of his tests look good,
but Jackson has reported hearing voices.
This could be serious.
Dr. Jefferson will come back and speak with you.
He can explain more of what may be going on with Jackson.
And who is Dr. Jefferson?
He's from Psychiatry, and he's excellent.
He can explain next steps and answer all of your questions.
Javadi, why don't you take the Davises to the family room?
- Sure. - Excuse me.
It's just this way.
You have reached the Pittsburgh Neuroscience Group.
If this is a medical emergency,
please hang up and dial 911.
For our address and office hours, press 1.
To refill a prescription, press 2.
To leave a message for the doctor on call...
Hi, this is Dr. Baran al-Hashimi.
I'm a patient of Dr. Fairgraves.
I need to speak to him if he's on call.
If he's not, I'll take his next available appointment.
And please call me if he has a cancellation.
Thank you.
Like I said, you're more than welcome to stay down here
until an inpatient bed opens up upstairs.
But that can take a while, sometimes days,
even longer.
It's gonna be really noisy here,
and you won't get any rest.
At home, you'll be surrounded by your family
and be more comfortable.
It's your choice, Roxie.
It's not that I don't wanna go home, but...
- Hi, Mom. - Mom.
Lena texted me to come back. I figured I'd bring the boys.
What's going on? Is everything okay?
Robby, police officer, incoming trauma.
Coming.
I'll be right back.
We'll give you a chance to talk.
Okay, why don't you have a seat?
Do you need anything before we begin?
You're in control now, Ilana.
We're here to help and support you.
Once I open this kit, I cannot leave the room.
But if you need a break or some air, just let us know.
Okay? Emma can go with you if you like.
An advocate from Pittsburgh Action Against Rape
has been called, and they should arrive soon.
- Can we start? - Sure.
I'm gonna put my face shield on
so I don't contaminate anything.
Emma has already done the same.
Now, in order for the doctor to do her exam,
I need you in a gown,
but I need to collect your clothing first.
Is that okay?
I'm gonna need you to undress on top of these pads.
Put each item of clothing on the pads, okay?
Then we'll package each piece in a separate bag.
We'll get you new clothes.
- Don't worry. - All right.
Emma's gonna be behind this curtain,
and I'll be in here with you.
And take off your shoes first.
When you're done, I want you to put on your gown
open in the back.
What if the mom doesn't wanna leave?
Well, then she's gonna have to put up with us.
I can't imagine... her boys.
Oh, don't go there.
I'm gonna see if I can grease the wheels,
get her a room upstairs soon.
Good luck. What was that?
Battle plan for our hall space.
It's filling up fast.
Police officer should be here any minute.
Yeah, well, as soon as you can, please,
I need you to fix the VRI.
All right. Thanks.
Santos, I need you to pick up some more
- of these Westbridge diversions. - Sure.
You want my firstborn too?
Maybe. Will they know how to suture?
Intubated neck wound, sats not great.
We were diverted here. Is there a trauma room open?
- Trauma 1! - What's the story?
My buddy, Officer Hiro, high-velocity GSW.
He's getting harder to bag.
Warehouse robbery gone sideways.
One, two, three.
You guys wait here.
We'll take care of him, I promise.
I thought you left us already for the open road?
And miss seeing you in uniform?
You should see me as a flight attendant.
- Did you do this intubation? - Under active fire, yeah.
Are you serious?
I go in with the team in case there's an injury.
That's badass.
Dr. Santos, let's make sure these lungs are up.
- Could you see the cords? - Yeah, there was a great view,
but it was hard to pass after I cleared them.
Yeah, sats down to 85.
Dr. Santos, what could cause respiratory failure
in an intubated patient?
There are a lot of possibilities.
Think DOPE.
Displacement, Obstruction, Pneumothorax,
Equipment failure.
Good lung sliding, no pneumo.
It is displacement.
Okay, that is a transected trachea.
Pulling out.
Bag.
But if you intubate again, won't it just come straight
- out the wound? - Yep, exactly.
So we're gonna need another plan.
Okay. Sats down to 83.
Yeah, he's not moving any air.
Okay, I need a neonatal mask.
- Neonatal? - Yep.
I'm just going to finish my initial exam.
Let me know if you feel any pain, okay?
My legs are fine.
All looks good.
No need for X-rays or advanced imaging.
Got it.
- Two areas of ecchymosis... - That means bruising.
Over the shoulders bilaterally.
- I'll document with photos. - Okay.
Dana will finish up her work, and I will be in the ER
if you have any questions.
You're in great hands.
Thank you.
All right, Ilana.
I read your intake.
Why don't you give me your description
of exactly what happened?
I was at a 4th of July barbecue
with a bunch of friends.
I helped set up.
Where does it hurt?
Like here, under my belly button.
Okay, do you have any fever, vomiting, diarrhea?
Oh, no. It's... it's just a stomachache.
Okay, well, still, go see the nurse and have her call me.
Okay.
But I'm still having ice cream tonight.
Why don't you see how you feel later?
It... it's not bad. You don't have to get so sad.
I'm not sad. I'm... I'm good.
Your face doesn't look good.
Oh.
Well, you still wanna watch the fireworks tonight?
I have our headphones...
- I'm not being rude. - Sorry, Becca. I gotta go.
Elliot Green, 17, syncopal episode at football practice.
Look, I just got dizzy, okay?
It's hell week. I need to get back.
Yeah, okay, tough guy.
A and O, systolic of 95, tachy at 122, no meds, no allergies.
How long were you at practice?
I started at 9:00, so, like, four hours.
Four hours in this heat with all that gear?
No pain, no game.
God, I'm hungry.
- Hey. When's our break? - There's no breaks down here.
Always make sure you pack a protein bar, something quick.
Ogilvie, Joy, jump in on this.
Syncope at football practice.
No, I just... I just needed to hydrate.
Possible heatstroke?
Well, with heatstroke, you would have
an altered mental status.
And they're usually dry, not sweaty.
Mortality is 50%, especially in the elderly.
In extreme heat like this...
Langdon, can you cover this?
- No problem. - Mr. Diaz. Orlando.
Orlando, where are you going?
- Home. Can you take these out? - Uh, no.
It takes 48 hours for you to get out of DKA.
Your blood is still full of acid.
Look, I can't add thousands of dollars
to the 100 grand I already owe.
I'm... I'm sorry. 100 grand?
In medical debt. My wife doesn't even know.
I'll never be able to pay it off as it is.
Where are your wife and daughter?
Maybe we can all talk.
I told them to go back to work a couple hours ago.
But the hospital is giving you a big discount.
And, Mr. Diaz, I know it's not ideal,
but can you stay for at least 12 hours?
It would get you out of the danger zone.
No. I really can't.
Every minute I stay is a meal, shoes, school supplies.
Plus, I have a second job I have to get to by 4:00.
- You need fluids! - I drink plenty of water.
And potassium and insulin. Okay, how about this?
You stay and I'll get together everything you'll need at home.
Also, a referral to Northside Christian Health Center.
Come on. You don't work until 4:00.
It'll keep you from passing out on the job again...
or worse.
Okay, I guess.
Great.
Thank you. Please.
Sats up to 98.
- Neonatal mask is working. - Santos, finish the FAST.
What... what are you injecting?
Lido with epi.
It'll clamp off any little bleeders.
We need some skin hooks. 4 Shiley?
Mm, I don't like the curve of a Shiley.
I didn't know you were so picky.
Santos, take a break.
Help me cut down a 6-0 ET tube.
What is going on here?
You have a field medic assisting you?
Dr. Abbot is an attending,
and he's also a SWAT physician.
My buddy Hiro here is in bad need of an airway.
- Cut it right here. - We can do this.
No, no, I got it.
You must be Gloria's new hire.
Yes. Dr. Al-Hashimi.
Well, I'd shake your hand, but my tube is ready.
And if I could find and secure the distal trachea,
we have a shot at this.
Okay, keeping an eye on the sats.
Slow is smooth. Smooth is fast.
You know, you can call me just to say hi sometimes.
What's up now?
GSW with tracheal transection.
Very retracted, but I think I can get it.
Both lungs are up?
- Sats down to 91. - Scanning the belly now.
Okay.
I got it. I got it.
Gently, gently, or we're gonna lose it.
Down to 89.
Oh, no.
I'm in. Balloon up.
End tidal, excellent wave form.
Good breath sounds.
I'll sew the tracheal to the skin, 2-0 silk.
- Sats are coming up. - Whoo.
Not bad, Abbot.
Mm, while you were playing with that airway,
you missed a big bruise in the left upper quadrant.
He was wearing body armor.
High-velocity projectile doesn't have
to penetrate to damage.
There's no fluid in the suprasplenic space.
Let me look.
Okay, right there.
Looks like a subcapsular hematoma of his spleen.
Must have been a big impact.
AR-15 muzzle velocity is 3,000 feet per second.
CT angio of the neck ASAP,
along with CT chest, abdomen, pelvis.
Yep, just as soon as we secure this tube.
- First liter's in. - Mucous membranes dry.
Pupils 4 millimeters reactive.
Did you get tackled today?
No, just running drills.
Any chest pain? Palpitations?
No.
Hands off, please, running the 12 lead.
How are we looking?
Good. Healthy kid.
No history, no trauma.
Differential for syncope in an adolescent?
Cardiac arrhythmia from drugs...
- Hypovolemia, seizure... - Long QT, WPW...
- Sepsis. - Or Brugada.
Uh, Brugada is more common in Asian males.
But still should be considered.
Long odds, though.
Brugada prevalence is 1 in 20,000 in North America,
as high as 1 in 300 in Asia and the Middle East.
And?
First described in 1992, has a high incidence
of sudden death among young patients with otherwise
- structurally normal hearts... - Oof, oof, wait.
Did you just say "sudden death"?
Temp is 102.5.
Sorry, our student doctors are discussing
a rare condition you don't have.
I... I just didn't drink enough water.
I overheated.
Not my type, bud.
Other than standard labs, what else to order?
CK to rule out rhabdo.
To make sure you don't have
any muscle breakdown from the heat.
Let's set up a cooling room for Elliot here
and the other heat exhaustions we'll inevitably get today.
Last photo.
Okay.
We'll take the SD card and seal it
in an evidence envelope with everything else.
Okay.
Next, Emma's gonna turn off the light,
and I'll run a blue light over your skin.
Anything glows, I'll swab it with a wet, then dry Q-tip.
Is that okay?
Yeah, sure.
All right.
Take off your gown on the left side
and turn a little bit towards me, just to the left.
There.
Something on the left wrist.
Swab.
Sorry.
Don't be.
- It's just cold. - Yeah.
Almost done.
- Thanks, Antoine. - No problem.
Keep your head down out there.
What's the story?
Neck angio is negative, missed the carotids.
- He's lucky. - What about the belly?
Small splenic injury, no free fluid in the abdomen.
- That should heal on its own. - What's the plan?
Head and Neck will have an OR ready
with thoracic standing by.
How soon can they take him?
We're a little backed up with Westbridge patients,
but let's bring him up.
I'll get him taken care of for you.
Hey.
You're gonna be okay, Hiro. We're getting you to surgery.
I'll write the procedure note.
Thank you.
SWAT? Really?
I suck at golf.
You spend time in the Middle East?
More than I would have liked.
I worked in Kabul with Médecins Sans Frontières
and in 2020, at the maternity hospital.
I met the most incredible, bravest doctors there.
Dasht-e-Barchi.
Tragedy.
We should grab a beer sometime, share war stories.
I'd like that.
She seems cool.
Yep, maybe.
I'm not gonna be around long enough to find out.
Oh, there she is! Vic!
Dad!
Victoria, this is Dr. Amy Joon.
Dr. Joon is the smartest person I know.
Don't tell your mother. Just kidding.
But seriously, don't.
- Hi. - Hello.
Are... are you here to see a patient?
No. We're here to see you.
Dr. Joon is Chief of Dermatology.
And Victoria's first shift in the ER
was on the day of the PittFest shooting.
I heard all the incredible stories,
including your own acts of med student prowess.
Wow, med student prowess.
That's... I'm... I'm pretty sure
I was just trying to stay out of the way.
Ah, she's modest, like her dad.
And her mother?
Oh. Sorry.
Dr. Joon.
Yep, coming.
I'm doing a favor for someone at the mayor's office
who needs Mohs surgery on a basal cell carcinoma.
And then I am grilling for 30.
- Oh, wow. - Happy 4th, all.
- Happy 4th. - Yeah.
- Thanks for coming down. - My pleasure.
- Let's grab a coffee sometime. - Absolutely. Yes.
Thank you.
You know Mom really wants me to go into surgery.
Ah, your mom wants me to stop drinking
- and join a pickleball league. - Oh, that's the same.
- Yeah, well... - Exact same.
I will risk an Achilles tear before I give up scotch.
Hey, I hope I didn't embarrass you coming down here.
No.
I'm just trying to present you with some options
for your residency.
I... I really appreciate it, Dad.
I do. I just...
I'm still not sure.
Well, either way, you'll do what's right.
You always do.
- Proud of ya. - Okay.
Dr. Javadi, you are a man of many talents.
You don't know the half of it.
Your daughter has some
high standards to live up to.
Oh, you don't know the half of it.
Mr. and Mrs. Davis, this is Dr. Jefferson from Psychiatry.
Please call me Caleb.
Can you tell us what's going on with our son?
All of his labs and X-rays came back normal.
Given his age and his hearing voices,
do either of you have a family history of mental illness?
Not mine.
My brother took his own life.
Wait, what?
Uncle Ken?
You said he drank himself to death.
- Ma. - He did that too.
Was he ever formally diagnosed
with a mental health issue?
No.
He was depressed, had mood swings.
- But he didn't wanna see anyone. - Oh, my God.
Okay, why am I just now hearing about this?
- Jada, please. - Please what, Mom?
Why would you not tell Jackson or me?
I can't believe this.
- Jada. - Excuse me.
Jada.
What happens next?
We keep your son here for the next three days
for observation and therapy.
And that will help us to understand what is going on.
Jada should really hear this.
Let me see if I can find her, bring her back.
Okay. I'm gonna swab your mouth now.
My mouth?
Two dry swabs along the inside of your cheek
and then along the gum line.
How you feeling?
I wish this day never happened.
Would you like some medicine to help you relax?
You've experienced a horrific trauma.
You've been doing this a while?
Let's just say Florence Nightingale
and I were roommates.
Who?
I rest my case.
She was the founder of modern nursing.
Okay, you can have something to eat or drink now.
- I'm fine. - Are you sure?
I'll just keep going.
Okay.
We now have a heat exhaustion treatment area in North 5.
Evaporated cooling. Great plan.
Yeah, it was Dr. Langdon's idea.
He figured we'd be seeing a lot more patients in this heat.
He's right.
How are you feeling?
That's a loaded question.
It wasn't meant to be.
You have a deposition in a couple of hours?
- Yes. - How are you feeling about it?
Um, trying to think positively
but feeling, um, less so.
This job's really important to me and my sister.
You know, I support both of us.
It's gonna go great.
Just tell them what happened.
You're not at fault. Your job's not in jeopardy.
I mean, the lawyers said that I could...
The lawyers' job is to try and shake your confidence.
So don't let them. You're a very good doctor.
I have been training residents for years.
You are one of the very best.
I am?
No, we need to stick to the plan.
- I promise. - Look.
Thanks.
She's not thinking clearly, okay?
It's gonna be great.
This is not what she wants.
Then I'm taking her home. That's it.
We have to honor your wife's wishes.
Even if she's loaded up on morphine
- and can't think straight? - Especially then.
Hello.
Paul Hamler, this is my attending, Dr. Robinavitch.
- Hi. - Hi.
Uh, my wife is not thinking clearly.
What is it that she's asking for?
Said she wants to stay here.
Why don't we all go in and talk?
Brian Jenkins is allowed to hunt with a.22
on his grandpa's farm.
Sounds like an accident just waiting to happen.
Mm-hmm. And you're not Brian Jenkins.
How are we doing in here, Roxie?
Been better.
Rumor has it you're still interested
in booking a room with us?
I don't wanna go back home yet.
It's all set up, Rox.
You're gonna be more comfortable at home.
Paul, I changed my mind.
It is our home.
I don't...
I don't want you living with my ghost.
I will happily live with your ghost.
Can we just all stop talking about ghosts, please?
Yes. I'm sorry.
I'm sorry, sweetie. You're right.
Got trauma flying in. ETA, five minutes.
Okay. Um, I'm very sorry.
I will be right back.
Excuse me.
It's a boating accident, swimmer versus propeller.
Ouch.
- What body parts involved? - They didn't say.
- How old? - Nope.
Anything?
All I got was boating accident,
- swimmer versus propeller. - Propeller. Got it.
Picked a hell of a day to come back, huh?
How's Jake?
He's good.
He's better. He's coping.
He's gonna be a senior this fall.
That's great.
That was a lot for him to go through.
A lot for all of us to go through.
Yeah.
Okay, I'm just gonna say it!
I'm sorry.
I betrayed your trust.
I betrayed our patients' trust.
And I'm really fucking sorry.
It'll never happen again, I swear.
I'm really glad that you got the help that you need.
But I don't know if I want you working in my ER.
Why'd you intubate him?
He was splinting from the pain,
barely moving air with sats in the 80s.
How'd he get sliced up in the propeller?
He was in the Allegheny
trying to untangle a water ski tow line
when his buddy started the engine.
Drunk buddy, I assume?
Well, it's 4th of July. You tell me.
Focus on the patient, please.
Sofie, take over bagging.
Okay. One, two, three.
Watch that buckle.
- Do you need me in here? - Nope.
We have a senior resident and an attending.
Mel, can we start with a...
- An EFAST? Sure. - Yes, please.
Why?
To check and make sure there's no pneumothorax.
Otherwise, it could become a tension.
Exactly. Oh, wow.
- You want O-neg? - Not without a BP first.
108/64, pulse is 102.
- Sats are good. - Okay, let's have O-neg ready,
- but don't give it just yet. - Anything else?
How about a hemocue?
Uh, yeah. Yeah, yeah, of course.
Next step is fingernails.
We'll go under each nail,
first with the wet swab and then with the dry one.
Do you wanna take a break, hon?
No.
How much longer?
After these, we'll get to external...
And internal vaginal collection.
It's the advocate from PAAR.
They've been doing this longer than I have.
They provide resources, assistance, and support
for sexual assault survivors.
Hey.
This will not define you, okay?
You don't have to talk to them, but I recommend you do.
They're available 24/7.
- Okay. - Okay.
Hi.
I'm Paulette Sanderson from Pittsburgh Action Against Rape.
Hi, Paulette. I'm the SANE, Dana.
- And this is Ilana. - Hello.
I'm sorry to meet you under these circumstances,
but I and my organization are here to help you navigate
everything that comes next.
I brought you some clothes and basic necessities.
I can even stay with you through the rest
of your examination if you'd like.
I don't think that's necessary.
- Okay. - That's fine.
Would it be okay if I asked you a few questions?
Sure.
Mm, our VRI isn't working.
Video Relay Interpreter?
Yeah, of course I rebooted it.
Wait, how are you gonna fix it if you don't know
what the hell it is?
Yeah, okay. Whatever.
I wanna do a head and belly scan on Harlow.
Can you try telling her why?
What about the VRI?
It's DOA.
I'm charting every free minute I get.
I wasn't coming over for that.
Good job in the Trauma earlier.
What's this?
Daniel Scott, 32,
weak and dizzy while washing his car.
Tachy at 106, BP 90/60.
Temp's too high to register.
We have a cooling room set up in North 5.
Okay, how are you feeling, Mr. Scott?
Thirsty.
Let's see if we can't fix that.
He's gonna need a core temp, a CMP... whoa.
Oh, hey, we need a trauma room.
- What's open? - 2.
I'll grab the Ativan.
- Any past medical history? - No.
Wife says he's healthy. No meds, no allergies.
He needs a core temp.
Ready to transfer.
Let's give 2 of Ativan.
Don't want him seizing again.
I gotta get back to my patients.
Okay.
One, two, three.
Orders?
Second IV with saline open.
Sepsis panel, UA, urine drug screen, EKG, and CK.
I don't see any apparent trauma.
- Pupils reactive. - Mr. Scott? Daniel?
Can you talk to me?
Post-ictal, but moving all extremities.
Pulse 137, BP 88/60.
What are you thinking, Dr. Santos?
Uh, heat stroke, but consider sepsis or drugs.
Rectal temp is 104.6.
All right, let's start with four ice packs
on the groin and axilla.
Should we do a full body ice bath?
That'll take too long. Do you have an Arctic Sun?
Yeah, we do.
Get pads on the chest, abdomen, and both legs.
I'll check back in.
Ceftazidime is up, and first hemoglobin, 8.2.
8 is pretty low. He must have bled down from 14.
Anything you wanna do about that?
Um, young, healthy guy. We transfuse at 7.
Do we?
We'd be in real trouble if he equilibrates
- from acute blood loss. - Am I interrupting something?
- Multiple deep lacerations... - Motorboat versus...
Jesus.
This looks like some "Jurassic Park" shit.
Is that your official surgical diagnosis?
He is hemodynamically stable.
What else do we know?
Uh, intubated in the field due to poor tidal volume.
EFAST was negative for pneumothorax,
so no need to do a chest tube.
And no free fluid in the abdomen,
good hemostasis inside the wounds.
Nothing arterial.
At first, he had a hemoglobin of 8.2.
We'll follow that closely.
With no active bleeding, I wouldn't transfuse just yet.
Dr. Langdon agrees with you.
Let's get him to CT.
Jason Stills, 62, was gathering the makings
of a salad when he started feeling dizzy and nauseated.
Vomited once.
How are you feeling, Mr. Stills?
Like I'm gonna die.
Well, you came to the right place to prevent that.
Do you mind if I touch your abdomen?
- Yeah, sure. - Okay.
- Does this hurt at all? - No.
He's tachycardic at 124 with a temp of 102.4.
Hey, Joy, what's your suggestion?
Keep hydrating, check electrolytes,
and move him to the cooling room.
Precisely.
Good luck finding a parking spot.
- North 5. - What? No valet?
Jada. Hey.
I... I've been looking all over for you.
I just went for a walk.
I wanted to talk to you, if that's okay.
So does Dr. Jefferson.
It's important that you get to hear what he has to say.
Why?
He doesn't want me to go crazy like my brother?
Or kill myself like my uncle?
Of course not.
We... we still have no idea what caused Jackson's episode.
Episode.
Right.
Look, I... I know this must be so scary for you.
And you probably feel betrayed by your parents.
But they had no way of knowing about Jackson.
You know, and some families just have a difficult time
talking about mental health.
Now you can help us take the first steps
to finding out what we can do to help your brother.
Mr. Diaz, I have a surprise for you.
Oh.
Sorry.
It's okay.
Have you... have you seen my patient?
Orlando? Mr. Diaz?
Room was empty.
- Seriously? - Yeah.
What happened to you?
Oh.
Bullet grazed my vest.
You were shot?
Shot at.
Geniuses thought today was the day to rob a goods warehouse.
Didn't think about how long it would take
to load the appliances.
They panicked.
All hell broke loose.
Jesus.
Why do you do this?
My therapist said I needed a hobby.
Funny.
Shit.
This... this sucks.
- Oh, it's nothing. - No.
No, don't worry about me. I'm fine. Seriously.
No, my patient.
He didn't have any insurance,
and he was already in a mountain of medical debt.
He couldn't afford any of his meds.
Hmm.
What's in the bag?
Insulin, test strips, electrolyte powder.
I... I got him everything he needed for home care.
So Uber it to his house.
Is the hospital gonna pay for that?
I'll pay for it.
What are you doing?
What you clearly can't.
Did you make a chart?
No.
This can stay off the books.
Don't need the paperwork from the hospital
or the police department.
Okay.
Our little secret.
How's he doing? Any more seizures?
Nope.
Temp 102.9.
Labs back?
Mostly signs of dehydration.
A tad hypernatremic, mild BUN and creatinine bump.
CK 400 something... nothing worrisome yet.
Okay, good. Keep cooling.
- I'll monitor him. - Great.
That'll give Dr. Santos a chance to get caught up.
Your R2 year can be challenging.
You just have to keep grinding.
What's your dispo plan for Mr. Scott?
Uh, ICU admission.
You should call Neurology to consult.
Yeah, done.
Since it was exertional heat illness in a young person,
the mortality is low.
But non-exertional heatstroke in an elderly person,
- you need to worry. - Okay.
I'll put in orders for repeat labs.
Good work in there.
This 49-year-old woman presents to the emergency department...
Uh, with the chief complaint of right ear pain.
Hey, Donnie, can you do something about that?
What?
Seriously?
That... that's not driving you nuts?
The baby, it won't stop crying.
Oh, that? It's music to my ears now.
I think Jesse's the nurse.
Well, can't you... ugh.
Fuck.
What the hell is going on?
With what?
With her. Can't you make her stop crying?
She's been fed and changed. She's cranky from rhinovirus.
Isn't there something that you can do?
She's due for her next Tylenol.
Give me a minute. I'll be right back.
Wait, no, no, no, I'm not gonna stay here.
What is your problem?
This is precisely why I didn't go into Pedes.
Okay.
Hey, hey.
Hey, little Miss Sunshine.
Is it time for you to take a little nap?
That would be so fucking nice.
Yes, it would.
I'm starting to understand why you got left here.
Hey, shh.
What's the word from CT?
Nothing intrathoracic, nothing intra-abdominal.
Propeller just missed gutting him.
- Very fortunate. - Okay.
Repeat hemoglobin is 8.
We're holding off on transfusing.
Plan?
I'll have Mel and Langdon suture up the lacerations.
Wait, what? That could take days.
I... I can't...
Calm down, Sadness. I'm kidding.
This is one for my skilled surgical residents upstairs,
not you Boy Scout butchers.
Boy, I missed you, Yoyo.
Mm. Can't say the same.
Okay, let's take up this art project.
So about before...
Back to it.
Good talk.
How we doing, Princess?
All right. A little bloated.
I had one too many hot dogs from the truck.
You meant the board, huh?
Gus, our incarcerated patient, got a spot upstairs.
Looking for our unhoused patient, Digby, and, of course,
we have Whitaker, Donahue, and the med students
on these diversion intakes, but they just keep coming.
Yeah, we may need to start just sending people up
and ask for forgiveness instead of permission.
Hello?
Oh, okay.
Yes, I will be right there.
C-suite wants to see me upstairs.
Ooh, called to the principal's office
on your first day... not a good sign.
- I think I'm a baby whisperer. - Hey, great.
We'll add Baby Jane Doe to your patient load.
Forget I said anything.
Where are we with your deaf patient, Harlow?
Uh, the VRI was a bust, but the interpreter's on the way.
Figured I'd just give her a head and belly scan
- and go from there. - No, wait for the interpreter.
No need to give the patient unnecessary radiation.
And your charting?
Catching up and checking it twice.
Good.
Hey, have you had a chance to speak to Langdon today?
Uh, no.
Why? Did he say something?
No, just curious.
How is everything at home with you and Whitaker?
He's weirder than you'd expect.
- Hmm. - Yeah.
But I don't see him all that much.
He spends a lot of time at Amy's.
He has a girlfriend?
I don't know what to call it.
The... the farmer who got burned last year
the day of the mass cas, his widow, Amy.
Oh, he died?
Yeah, he had burns on 90% of his body.
His chance of survival was very slim.
Okay, so I'm an optimist.
The sun doesn't always come out tomorrow, Annie.
Wait, wasn't she pregnant?
No, she was a young orphan.
No, not Annie. Amy.
Yes. Yes, very pregnant and young.
Whitaker is now seeing this Amy?
And her baby.
He got really close to the family
when the husband was dying.
He really believed that the guy would pull through.
He helped her through the loss of her husband,
and then again when she had the kid,
and now he spends almost every weekend at the farm.
Huh.
Plus, he's on the street team,
and he just wants to help everybody.
And I just don't wanna see him taken advantage of, you know?
He's just a fucking Huckleberry.
Yeah, but he's our fucking Huckleberry.
I'll talk to him.
Hey, your call.
Strong deflection. Well played.
You're the boss.
Or you are until end of shift today.
Still the boss.
When you see me in here, still the boss.
Copy that, Boss.
Dr. Robby, can... can I grab you for a second?
Yeah. Sure. What's up?
Um, can't you order my wife to go home?
I'm sorry.
My wife's dying,
and you're telling me there's nothing I can do?
Mr. Hamler, that's not...
No, no.
There's gotta be something.
Please.
It may not seem like much, but right now,
you being here for her and respecting her wishes
is the best thing that you can do for her.
Supporting her and her choices is the most remarkable gift
that you can give her at this time.
And the meds we have her on will help her pain.
And she may get to a point where
she feels well enough to go home.
Give me one second.
Okay, I'm gonna let you guys get acquainted.
I will be right back.
Oh, oh, oh, excuse me!
I... I'm waiting for Dr. Mohan. Is she available?
I will try and find her for you, sir.
Whether you choose to report or not, we're here for you.
Call me any time.
It could be a month or a year from now.
I'll follow up with you too.
Thank you.
Thanks.
You've had a pap smear before?
Yeah, every few years.
Good.
Same position, but I'll start with swabs
on the outside, external genitalia.
Then I'll use a speculum to get internal swabs.
You ready? Okay.
I'll help you get your feet in the stirrups.
Good.
Okay. All right.
Now, slide your bottom down.
Oh. Yeah, a little bit more.
A little more.
- Sorry. I... I can't. - Okay. It's okay.
We can take a break. No problem.
I don't want a break. I wanna stop.
Okay. Is this about reporting?
Because you can do this collection
without a police report for now.
And none of it goes in your permanent medical record.
I don't wanna do this anymore.
Tell me why you wanna stop.
He's my friend.
He knows all my friends.
It was just a dumb...
he was drunk, he didn't mean it.
- It didn't mean anything. - Okay.
Okay.
It's okay. I understand.
I do.
Ilana, this is a difficult process, to say the least.
Why don't you take a breather and come back?
And whatever you wanna do, we'll do.
Let's go find the good snacks.
Jesus Christ.
Sorry.
Giving new meaning to the nickname Crash, huh?
I've been trying to get to the bathroom
for over an hour now.
Yeah, you and me both, sister.
Uh-oh, this can't be good.
Who's this?
That is hospital CEO Trent Norris.
He's the big boss.
Hmm. Nice outfit.
Hey, Rockstar. Gather your staff, please.
Sure, anything you wanna tell me first?
- No. - Okay.
Hey, everybody, can you, uh, gather 'round
and listen up for a moment, please?
Can I have your attention, everyone?
Internal disaster at Westbridge
has been identified as a cyberattack.
And now Good Dominion Hospital has been hit as well.
Their ambulances are being diverted over to St. Mary's,
but we can expect more walk-ins and Westbridge diversions.
Uh, for how long?
We don't know how long. If the ransom is paid...
Ransom?
Are we next?
Our IT protection system has blocked thousands
of intrusion attempts in the hours
since Westbridge was hit this morning.
But IT believes we're still vulnerable.
So we're gonna preemptively shut down
all the computer systems.
- Oh, my God. - Jesus.
Patient registration, electronic health records,
lab and radiology interfaces, email, internet.
You didn't wanna talk to me first?
You didn't wanna consult my department?
I consulted your fellow attending.
When are we going down?
Soon. Very soon.
Okay, hey, somebody get a picture of the board.
Quickly, quickly! We're about to go analog.
- No! - Oh, my gosh.
- Phones work? - They don't work.
- Oh, my gosh. - Did you get the photo?
Yeah, yeah, I got it.
This is gonna be fun.
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