1 00:00:09,597 --> 00:00:14,066 Sync and corrections by btsix www.addic7ed.com 2 00:00:15,560 --> 00:00:17,311 Next time, maybe inform the department chair 3 00:00:17,312 --> 00:00:18,312 before the shit hits the fan. 4 00:00:18,313 --> 00:00:19,980 I was on my way to tell you. 5 00:00:19,981 --> 00:00:21,315 Make sure you get everything you need. 6 00:00:21,316 --> 00:00:22,399 OK, let's do this. 7 00:00:22,400 --> 00:00:23,984 IT called me up because 8 00:00:23,985 --> 00:00:26,320 I've trained in cyberattack prevention and response. 9 00:00:26,321 --> 00:00:27,654 Then you can tell everybody what to do. 10 00:00:27,655 --> 00:00:28,763 No, thank you. 11 00:00:28,764 --> 00:00:30,282 Best if it comes from the department chair. 12 00:00:30,283 --> 00:00:31,326 Oh, you think? 13 00:00:33,786 --> 00:00:35,996 All right, everybody, circle up. 14 00:00:35,997 --> 00:00:37,289 What the fuck? 15 00:00:37,290 --> 00:00:39,207 We may have had a cyberattack. 16 00:00:39,208 --> 00:00:41,502 No, we shut down to prevent a cyberattack. 17 00:00:43,212 --> 00:00:45,339 OK, everybody, settle down. Listen up. 18 00:00:45,340 --> 00:00:46,673 As you can see, we're doing a little 19 00:00:46,674 --> 00:00:49,176 redecorating in the central work area. 20 00:00:49,177 --> 00:00:52,054 Our hospital computers are at risk for a cyberattack, 21 00:00:52,055 --> 00:00:54,056 so we are going old school, analog. 22 00:00:54,057 --> 00:00:55,515 - For how long? - Great question. 23 00:00:55,516 --> 00:00:57,517 Our IT department has shut everything down 24 00:00:57,518 --> 00:00:59,853 to give them time to bolster our cyber defenses. 25 00:00:59,854 --> 00:01:01,813 I believe the question was, for how long? 26 00:01:01,814 --> 00:01:03,065 Uh, hard to say. 27 00:01:03,066 --> 00:01:04,358 Could be up to 24 hours. 28 00:01:04,359 --> 00:01:06,026 Jesus Christ. 29 00:01:06,027 --> 00:01:07,653 So first order of business, 30 00:01:07,654 --> 00:01:09,571 we need to replicate the electronic patient boards 31 00:01:09,572 --> 00:01:10,906 on these dry-erase boards. 32 00:01:10,907 --> 00:01:12,032 So please, somebody tell me 33 00:01:12,033 --> 00:01:13,158 they got a photo of the boards. 34 00:01:13,159 --> 00:01:14,159 Uh, yeah, yeah, yeah. 35 00:01:14,160 --> 00:01:15,619 Right here. OK. 36 00:01:15,620 --> 00:01:16,704 Oh, uh... 37 00:01:18,873 --> 00:01:21,041 It's a little blurry. 38 00:01:21,042 --> 00:01:23,710 No, more than a little blurry. 39 00:01:23,711 --> 00:01:26,463 - Sorry. - Oh, my God. 40 00:01:26,464 --> 00:01:28,215 - I remember. - Great. 41 00:01:28,216 --> 00:01:30,217 If everybody else can remember their patient names 42 00:01:30,218 --> 00:01:31,551 and their room numbers, that would be awesome. 43 00:01:31,552 --> 00:01:33,553 No, I mean I can remember all of it. 44 00:01:33,554 --> 00:01:34,721 All of what? 45 00:01:34,722 --> 00:01:36,890 Names, doctors, room numbers. 46 00:01:36,891 --> 00:01:39,351 I kind of have a photographic memory. 47 00:01:39,352 --> 00:01:41,436 Seriously? The whole board? 48 00:01:41,437 --> 00:01:43,855 Central 12, Harlow Graham, headache, 49 00:01:43,856 --> 00:01:46,566 - abdominal pain, ASL only. - Oh, shit. 50 00:01:46,567 --> 00:01:48,485 I have an interpreter waiting for me. 51 00:01:48,486 --> 00:01:50,612 - Go. - OK, for patient privacy, 52 00:01:50,613 --> 00:01:52,322 all chief complaints will be abbreviated. 53 00:01:52,323 --> 00:01:53,657 So HA for headache, 54 00:01:53,658 --> 00:01:55,617 AP for abdominal pain, and so forth. 55 00:01:55,618 --> 00:01:58,912 Central 10, Jackson Davis, new-onset psychosis. 56 00:01:58,913 --> 00:02:00,330 Javadi, psych admission. 57 00:02:00,331 --> 00:02:02,374 Greek letter psi for psych. 58 00:02:02,375 --> 00:02:04,584 Pedes is Baby Jane Doe, fever, Dr. Mohan, 59 00:02:04,585 --> 00:02:06,128 awaiting admission orders. 60 00:02:06,129 --> 00:02:07,879 Nurses need to convert to a zone defense... 61 00:02:07,880 --> 00:02:08,922 north, central, south, trauma. 62 00:02:08,923 --> 00:02:10,090 Where's Dana? 63 00:02:10,091 --> 00:02:11,758 In with a sexual assault case. 64 00:02:11,759 --> 00:02:13,301 She can't leave until the exam is finished. 65 00:02:13,302 --> 00:02:14,594 Yeah, it could be a while. 66 00:02:14,595 --> 00:02:16,054 Princess has charge nurse experience. 67 00:02:16,055 --> 00:02:17,472 - Not really. - That's a great idea. 68 00:02:17,473 --> 00:02:18,765 Princess it is. 69 00:02:18,766 --> 00:02:19,766 You can make the nursing assignments. 70 00:02:19,767 --> 00:02:21,101 - Next. - Central 9, 71 00:02:21,102 --> 00:02:23,019 Roxie Hamler, end-stage lung cancer. 72 00:02:23,020 --> 00:02:24,438 Sorry, do we have to stand here while 73 00:02:24,439 --> 00:02:25,605 - she recites the whole board? - No. 74 00:02:25,606 --> 00:02:26,857 In fact, go check on your patients 75 00:02:26,858 --> 00:02:28,358 and then please come back here. 76 00:02:28,359 --> 00:02:29,901 Thank you. 77 00:02:29,902 --> 00:02:31,702 How many hours a day are you on your laptop? 78 00:02:34,741 --> 00:02:36,074 At least eight hours. 79 00:02:36,075 --> 00:02:37,451 I work from home. 80 00:02:37,452 --> 00:02:39,370 And are you at a desk all day? 81 00:02:41,247 --> 00:02:42,581 No, no. 82 00:02:42,582 --> 00:02:43,999 I will either sit on the sofa, 83 00:02:44,000 --> 00:02:46,293 or sometimes I'll be in bed, 84 00:02:46,294 --> 00:02:48,462 kind of sitting up with the computer on my lap, 85 00:02:48,463 --> 00:02:49,963 that kind of thing. 86 00:02:49,964 --> 00:02:52,591 So you're always looking down at the screen? 87 00:02:52,592 --> 00:02:54,217 - Yeah. - OK. 88 00:02:54,218 --> 00:02:56,679 I'm going to check the muscles in your neck. 89 00:03:03,352 --> 00:03:04,478 - Ooh! - Ooh! 90 00:03:04,479 --> 00:03:06,646 Ow, that hurts. 91 00:03:06,647 --> 00:03:09,357 All right. Well, I think we can help. 92 00:03:09,358 --> 00:03:11,526 Come on over. 93 00:03:11,527 --> 00:03:13,111 OK, gather up. 94 00:03:13,112 --> 00:03:15,280 Listen up, everybody. This is our chart rack. 95 00:03:15,281 --> 00:03:17,282 So as you can see, each slot and clipboard 96 00:03:17,283 --> 00:03:18,366 has a room number on it. 97 00:03:18,367 --> 00:03:19,826 When you pick up a new patient, 98 00:03:19,827 --> 00:03:22,162 you grab a fresh chart from the T-system. 99 00:03:22,163 --> 00:03:25,165 Pick your chart by chief complaint. 100 00:03:25,166 --> 00:03:27,375 Use the cartoon to find it. 101 00:03:27,376 --> 00:03:29,127 Why are there two bodies? 102 00:03:29,128 --> 00:03:31,171 Trauma on the left, medical on the right. 103 00:03:31,172 --> 00:03:32,506 So head injury, you go left. 104 00:03:32,507 --> 00:03:34,049 Headache, go right. 105 00:03:34,050 --> 00:03:35,634 Are those fish swimming in seaweed? 106 00:03:35,635 --> 00:03:36,676 No. 107 00:03:36,677 --> 00:03:38,011 That is bees and grass. 108 00:03:38,012 --> 00:03:39,304 That's the section for insect bites, 109 00:03:39,305 --> 00:03:40,847 skin rash, allergies. 110 00:03:40,848 --> 00:03:42,390 OK, let's say, for example, 111 00:03:42,391 --> 00:03:44,518 Dr. Al-Hashimi has a new patient with belly pain. 112 00:03:44,519 --> 00:03:47,187 For the history, circle the positives, 113 00:03:47,188 --> 00:03:49,147 like vomiting and diarrhea. 114 00:03:49,148 --> 00:03:51,733 Backslash the negative, such as recent travel, 115 00:03:51,734 --> 00:03:53,318 sick contacts, fever. 116 00:03:53,319 --> 00:03:57,239 For physical exam, checkmark normals on the left, 117 00:03:57,240 --> 00:03:59,533 and circle any abnormal findings on the right. 118 00:03:59,534 --> 00:04:00,575 Questions? 119 00:04:00,576 --> 00:04:01,785 Is your generative AI program 120 00:04:01,786 --> 00:04:02,786 still gonna be working? 121 00:04:04,205 --> 00:04:05,455 Not for a while. 122 00:04:05,456 --> 00:04:07,207 And ditch your SpectraLink phones. 123 00:04:07,208 --> 00:04:08,834 Those are voice over internet. 124 00:04:11,838 --> 00:04:13,046 Emergency. 125 00:04:13,047 --> 00:04:14,548 Go ahead, Medic Command. 126 00:04:14,549 --> 00:04:15,715 That is how we will hear about incoming runs. 127 00:04:15,716 --> 00:04:17,175 Thanks. 128 00:04:17,176 --> 00:04:18,885 Two minutes out with abdominal pain and fever. 129 00:04:18,886 --> 00:04:20,387 OK, has everybody got that so far? 130 00:04:20,388 --> 00:04:21,930 How do we write orders? 131 00:04:21,931 --> 00:04:23,557 Physician order form in triplicate. 132 00:04:23,558 --> 00:04:26,393 Labs, X-rays, IV fluid, medication. 133 00:04:26,394 --> 00:04:27,769 Will the labs still be able to run blood tests? 134 00:04:27,770 --> 00:04:29,145 Yes. 135 00:04:29,146 --> 00:04:30,564 Are the CT scanners still working? 136 00:04:30,565 --> 00:04:31,898 Yes, but the results will come back 137 00:04:31,899 --> 00:04:34,234 on paper from the radiologist. 138 00:04:34,235 --> 00:04:35,694 This is the dark ages. 139 00:04:35,695 --> 00:04:37,904 So if you have orders with labs or X-rays, 140 00:04:37,905 --> 00:04:39,447 they go into the clerk file here. 141 00:04:39,448 --> 00:04:40,740 They will sign them off. 142 00:04:40,741 --> 00:04:42,242 They will add a downtime slip on them, 143 00:04:42,243 --> 00:04:43,535 make sure they go to the correct department. 144 00:04:43,536 --> 00:04:45,078 I'm sorry, who are the clerks? 145 00:04:45,079 --> 00:04:46,371 - You're looking at them. - At your service. 146 00:04:46,372 --> 00:04:47,622 Larry and Antoine are filling in 147 00:04:47,623 --> 00:04:49,207 - until more help arrives. - We got this. 148 00:04:49,208 --> 00:04:51,251 After the clerk orders, chart gets moved 149 00:04:51,252 --> 00:04:53,003 to the nursing order rack here for IVs, 150 00:04:53,004 --> 00:04:54,754 medications, procedures. 151 00:04:54,755 --> 00:04:56,965 Medications are locked up in the PDS. 152 00:04:56,966 --> 00:04:59,759 The PDS is getting unlocked by a clinical pharmacist, 153 00:04:59,760 --> 00:05:01,344 - Dr. Megan Nordt. - We've got your back. 154 00:05:01,345 --> 00:05:02,345 This is a lot. 155 00:05:02,346 --> 00:05:04,306 Any questions? Yes. 156 00:05:04,307 --> 00:05:05,599 Uh, no. 157 00:05:05,600 --> 00:05:07,142 What's up with the third rack? 158 00:05:07,143 --> 00:05:08,727 When your patient is ready to be discharged, 159 00:05:08,728 --> 00:05:09,936 chart goes here. 160 00:05:09,937 --> 00:05:11,229 This lets everybody know 161 00:05:11,230 --> 00:05:12,439 we're about to have an open bed. 162 00:05:12,440 --> 00:05:14,274 Or that your tuna melt is up. 163 00:05:14,275 --> 00:05:15,526 Jesse? 164 00:05:16,777 --> 00:05:18,820 - What is that? - What is that? 165 00:05:18,821 --> 00:05:20,614 That is a fax machine. 166 00:05:20,615 --> 00:05:22,115 They still make those? 167 00:05:22,116 --> 00:05:23,909 This is our lifeline to labs and X-rays. 168 00:05:23,910 --> 00:05:25,785 When the results come back, they will fax to us, 169 00:05:25,786 --> 00:05:27,495 and the clerks will put them on the charts. 170 00:05:27,496 --> 00:05:28,830 - Yes? - If you say so. 171 00:05:28,831 --> 00:05:30,582 Incoming. 172 00:05:30,583 --> 00:05:33,835 OK, Dr. McKay, Dr. Whitaker, Ogilvie, you're with me. 173 00:05:33,836 --> 00:05:36,671 The rest of you, build your clipboards. 174 00:05:38,966 --> 00:05:41,676 Howard Knox, 52, abdominal pain and fever. 175 00:05:41,677 --> 00:05:44,346 152 over 90, tachy at 120. 176 00:05:44,347 --> 00:05:46,139 - Couldn't get an IV. - I wonder why. 177 00:05:46,140 --> 00:05:47,682 Hello, sir. My name is Dr. Robby. 178 00:05:47,683 --> 00:05:50,143 - Howard. - This is a teaching hospital. 179 00:05:50,144 --> 00:05:52,270 I'll be supervising Doctors McKay and Dr. Whitaker 180 00:05:52,271 --> 00:05:53,480 - and student Dr. Ogilvie. - Hey. 181 00:05:53,481 --> 00:05:54,648 - Hello. - How are you feeling? 182 00:05:54,649 --> 00:05:56,066 - Not so great. - OK. 183 00:05:56,067 --> 00:05:57,567 - Princess, what's free? - Trauma 1. 184 00:05:57,568 --> 00:05:58,945 Perlah? 185 00:06:01,364 --> 00:06:04,991 All right, orders for Mylanta and bupivacaine, Central 12. 186 00:06:04,992 --> 00:06:06,368 Wrong spot, Dr. Santos. 187 00:06:06,369 --> 00:06:08,329 And you need a sticker. 188 00:06:10,039 --> 00:06:11,373 Put it in the nursing orders rack. 189 00:06:11,374 --> 00:06:12,874 And meet me over at PDS. 190 00:06:12,875 --> 00:06:14,501 How much does this suck? 191 00:06:14,502 --> 00:06:16,169 I didn't think today could get any worse. 192 00:06:16,170 --> 00:06:18,338 This is how we rolled when I was a resident. 193 00:06:18,339 --> 00:06:19,881 Was that in the 1900s? 194 00:06:19,882 --> 00:06:22,175 Yeah, when charts were written by candlelight. 195 00:06:22,176 --> 00:06:24,010 Hey, today will be an adventure. 196 00:06:24,011 --> 00:06:26,263 Think of it like "Back to the Future." 197 00:06:28,849 --> 00:06:30,892 Or possibly "Titanic." 198 00:06:30,893 --> 00:06:32,769 Here is your antacid. 199 00:06:32,770 --> 00:06:34,187 Cheers. 200 00:06:34,188 --> 00:06:35,897 And I marked the trigger point 201 00:06:35,898 --> 00:06:37,440 that is bringing out your headache, 202 00:06:37,441 --> 00:06:39,192 and a shot of local anesthetic in that area 203 00:06:39,193 --> 00:06:41,195 could really help. 204 00:06:42,405 --> 00:06:43,530 Yeah, let's do it. 205 00:06:43,531 --> 00:06:44,740 All right. 206 00:06:45,908 --> 00:06:48,702 You are going to feel a little pinprick 207 00:06:48,703 --> 00:06:50,371 and some burning. 208 00:06:56,002 --> 00:06:57,919 OK. 209 00:06:57,920 --> 00:06:59,921 Oh, ow, ow, that really hurts. 210 00:06:59,922 --> 00:07:04,426 Temp 101.4, tachy at 128, pulse ox 92 on 2 liters. 211 00:07:04,427 --> 00:07:05,802 When did the pain start? 212 00:07:05,803 --> 00:07:07,387 It's been on and off for about a week. 213 00:07:07,388 --> 00:07:09,139 - And where do you feel it? - All over. 214 00:07:09,140 --> 00:07:11,725 It started on the left, and now there's some on the right. 215 00:07:11,726 --> 00:07:12,892 How about that fever? 216 00:07:12,893 --> 00:07:14,227 Since last night. 217 00:07:14,228 --> 00:07:15,603 I was burning up. 218 00:07:15,604 --> 00:07:17,439 Then I had chills pretty bad. 219 00:07:17,440 --> 00:07:18,440 I can't find a vein here. 220 00:07:18,441 --> 00:07:19,524 We'll try for a midline. 221 00:07:19,525 --> 00:07:21,234 Let us know if this hurts. 222 00:07:21,235 --> 00:07:22,610 - Ah, ah. - Sorry. 223 00:07:22,611 --> 00:07:24,529 - And on this side? - Yeah, yeah! 224 00:07:24,530 --> 00:07:25,613 Sorry, sir. 225 00:07:25,614 --> 00:07:26,740 Guarding with no rigidity. 226 00:07:26,741 --> 00:07:28,908 For pain, 100 of fent IM? 227 00:07:28,909 --> 00:07:30,243 Plan, Dr. Whitaker? 228 00:07:30,244 --> 00:07:32,912 Blood cultures, lactate, Zosyn. 229 00:07:32,913 --> 00:07:35,415 We're gonna need a CT to figure out what's going on. 230 00:07:35,416 --> 00:07:36,833 Ah-ah. 231 00:07:36,834 --> 00:07:38,918 - Yeah, it's not gonna work. - Yep. 232 00:07:38,919 --> 00:07:40,253 Write neatly. Penmanship counts. 233 00:07:40,254 --> 00:07:41,588 Howard, for the scan, we're gonna have 234 00:07:41,589 --> 00:07:42,630 to lay you flat on your back. 235 00:07:42,631 --> 00:07:43,923 Can you do that? 236 00:07:43,924 --> 00:07:45,133 I could ten years ago, 237 00:07:45,134 --> 00:07:46,760 but now it's too hard to breathe. 238 00:07:46,761 --> 00:07:48,428 If we can't lay you flat, 239 00:07:48,429 --> 00:07:49,929 then we're gonna have to put a tube in your windpipe 240 00:07:49,930 --> 00:07:51,431 to help you breathe... are you OK with that? 241 00:07:51,432 --> 00:07:52,932 Intubation with rapid sequence induction? 242 00:07:52,933 --> 00:07:54,267 No, we can't lay him down. 243 00:07:54,268 --> 00:07:55,435 The tube will go in your nose 244 00:07:55,436 --> 00:07:56,603 while you're awake, sir. 245 00:07:56,604 --> 00:07:57,604 - Well... - Right. 246 00:07:57,605 --> 00:07:58,938 Does it hurt? 247 00:07:58,939 --> 00:08:00,106 You'll be numbed up completely. 248 00:08:00,107 --> 00:08:01,483 You won't feel any discomfort. 249 00:08:01,484 --> 00:08:04,360 Do you happen to know your weight? 250 00:08:04,361 --> 00:08:06,029 A little over 400. 251 00:08:06,030 --> 00:08:07,363 When was the last time you checked? 252 00:08:07,364 --> 00:08:08,865 It's been a while. 253 00:08:08,866 --> 00:08:11,326 Is it possible that you might be over 450? 254 00:08:11,327 --> 00:08:13,286 Possibly. 255 00:08:13,287 --> 00:08:15,580 Perlah, let's call for the Hoyer. 256 00:08:15,581 --> 00:08:18,625 So we're gonna place the tube and get you ready for the scan. 257 00:08:18,626 --> 00:08:20,293 Is this something serious? 258 00:08:20,294 --> 00:08:22,087 Well, it's hard to tell without a CT. 259 00:08:22,088 --> 00:08:23,797 You could just need antibiotics, 260 00:08:23,798 --> 00:08:25,590 or you could require an operation. 261 00:08:25,591 --> 00:08:26,841 If surgery is necessary, 262 00:08:26,842 --> 00:08:28,176 then your weight could make things 263 00:08:28,177 --> 00:08:29,636 - a little bit more complicated. - I know. 264 00:08:29,637 --> 00:08:31,179 - I'm sorry. - Not to worry. 265 00:08:31,180 --> 00:08:32,639 We're gonna take very good care of you. 266 00:08:32,640 --> 00:08:33,890 Team. 267 00:08:33,891 --> 00:08:35,016 OK. 268 00:08:35,017 --> 00:08:36,518 Pain medication for you, OK? 269 00:08:36,519 --> 00:08:38,394 Let's try for a midline, 270 00:08:38,395 --> 00:08:40,271 basilic vein with ultrasound guidance. 271 00:08:40,272 --> 00:08:41,731 Can ultrasound check for an appy? 272 00:08:41,732 --> 00:08:43,650 He's a little too large for an ultrasound. 273 00:08:43,651 --> 00:08:46,027 Plus, our CT can only handle 450 pounds. 274 00:08:46,028 --> 00:08:48,531 And so if he's over that, we send him to the zoo? 275 00:08:49,532 --> 00:08:50,908 He's right there. 276 00:08:53,202 --> 00:08:56,246 I... I heard that there's a large animal CT at the zoo. 277 00:08:56,247 --> 00:08:58,248 Presby's CT can handle 650. 278 00:08:58,249 --> 00:09:00,500 Yeah, if Presby's still up and running. 279 00:09:00,501 --> 00:09:02,001 Wh... 280 00:09:02,002 --> 00:09:04,003 That... that's not a jinx. It's... 281 00:09:04,004 --> 00:09:06,631 Have any of you ever done an awake naso-tracheal? 282 00:09:06,632 --> 00:09:07,882 OK. 283 00:09:07,883 --> 00:09:09,008 Perlah, can you also ask 284 00:09:09,009 --> 00:09:10,176 Dr. Al-Hashimi to come in? 285 00:09:10,177 --> 00:09:11,219 I'm gonna need an assist. 286 00:09:11,220 --> 00:09:12,637 Yep. You got it. 287 00:09:12,638 --> 00:09:14,598 Ah, sorry. Signed. 288 00:09:15,724 --> 00:09:19,018 Hall bed F, George Francis, shortness of breath, 289 00:09:19,019 --> 00:09:21,479 Dr. Mohan, awaiting D-dimer. 290 00:09:21,480 --> 00:09:23,064 Wow. She's still going? 291 00:09:23,065 --> 00:09:25,191 Yeah. Remarkable, really. 292 00:09:25,192 --> 00:09:26,818 Dr. Al, Robby's asking for you. 293 00:09:26,819 --> 00:09:28,027 Uh, OK. 294 00:09:28,028 --> 00:09:29,737 In Trauma if you need me, Princess. 295 00:09:29,738 --> 00:09:30,989 Got it. 296 00:09:32,533 --> 00:09:34,075 Who's supposed to run the downtime slips 297 00:09:34,076 --> 00:09:35,285 to X-ray and lab? 298 00:09:35,286 --> 00:09:37,787 Uh, the charge nurse? 299 00:09:37,788 --> 00:09:39,581 Don't look at me. 300 00:09:39,582 --> 00:09:41,000 My plate's full! 301 00:09:43,043 --> 00:09:45,712 Uh, parents of Roxie Hamler? 302 00:09:45,713 --> 00:09:46,921 Central 9. 303 00:09:46,922 --> 00:09:48,214 Oh, I got it, Donnie. 304 00:09:48,215 --> 00:09:49,549 Hi, I'm Victoria Javadi, 305 00:09:49,550 --> 00:09:50,967 one of the student doctors here. 306 00:09:50,968 --> 00:09:52,552 I've been assisting with Roxie's care. 307 00:09:52,553 --> 00:09:53,887 Oh, thank you so much. 308 00:09:53,888 --> 00:09:56,097 - I'm Lloyd. - Cora. 309 00:09:56,098 --> 00:09:57,223 It's nice to meet you. 310 00:09:57,224 --> 00:09:58,391 She broke her leg? 311 00:09:58,392 --> 00:09:59,726 Um, yeah. 312 00:09:59,727 --> 00:10:01,477 There's a fracture down by the ankle. 313 00:10:01,478 --> 00:10:04,063 She's in a boot now, so there's not quite so much pain. 314 00:10:04,064 --> 00:10:06,400 But I'll take you. She's just in 9. 315 00:10:11,780 --> 00:10:13,239 The hospital Wi-Fi isn't working. 316 00:10:13,240 --> 00:10:14,574 Oh, it'll be down for a while. 317 00:10:14,575 --> 00:10:16,409 Sorry. 318 00:10:16,410 --> 00:10:18,912 Mom broke her leg, Grandpa. 319 00:10:18,913 --> 00:10:21,080 We heard. 320 00:10:21,081 --> 00:10:22,750 How are you, honey? 321 00:10:24,919 --> 00:10:27,378 You've got this, kiddo. 322 00:10:27,379 --> 00:10:29,631 Yeah. 323 00:10:29,632 --> 00:10:31,758 How long will she stay in the ER? 324 00:10:31,759 --> 00:10:35,345 Oh, until a bed opens up upstairs. 325 00:10:35,346 --> 00:10:36,931 Could be a while. 326 00:10:42,186 --> 00:10:43,937 You know, it's getting pretty crowded in here. 327 00:10:43,938 --> 00:10:45,688 Maybe we should take Tucker and Shane out for ice cream. 328 00:10:45,689 --> 00:10:49,150 - Yes, please. - No, no. I'm OK. 329 00:10:49,151 --> 00:10:52,320 Maybe your mom would like some time to rest. 330 00:10:52,321 --> 00:10:54,490 Yeah. Go. 331 00:10:56,158 --> 00:10:58,618 Can she have ice cream? 332 00:10:58,619 --> 00:11:01,788 She can have anything she wants. 333 00:11:01,789 --> 00:11:04,791 Come on, let's go. 334 00:11:04,792 --> 00:11:06,627 Bye, Mom. 335 00:11:08,295 --> 00:11:10,547 Ice cream, ice cream. 336 00:11:13,801 --> 00:11:15,176 Yep. 337 00:11:15,177 --> 00:11:17,178 Listen up. 338 00:11:17,179 --> 00:11:18,680 This is Oxymetazoline. 339 00:11:18,681 --> 00:11:19,881 This will open up the passage. 340 00:11:20,849 --> 00:11:22,308 What medication do you take? 341 00:11:22,309 --> 00:11:25,103 Uh, Lisinopril and Metformin. 342 00:11:25,104 --> 00:11:27,021 Ozempic? Wegovy? 343 00:11:27,022 --> 00:11:28,940 No. Kind of expensive. 344 00:11:28,941 --> 00:11:30,942 I'm going to squirt some numbing gel in your nose. 345 00:11:30,943 --> 00:11:34,445 If it drips back in your throat, that's OK. 346 00:11:34,446 --> 00:11:36,698 Here, in case you need it. 347 00:11:36,699 --> 00:11:38,533 Do you smoke? 348 00:11:38,534 --> 00:11:39,826 Alcohol? 349 00:11:39,827 --> 00:11:41,911 - Never. - Do you exercise? 350 00:11:41,912 --> 00:11:44,372 Moving from the bedroom to the kitchen. 351 00:11:44,373 --> 00:11:45,873 No, I'd walk more, 352 00:11:45,874 --> 00:11:48,501 but I need a bench to rest on every block. 353 00:11:48,502 --> 00:11:50,003 What about water aerobics? 354 00:11:50,004 --> 00:11:52,338 Let's focus on helping Mr. Knox. 355 00:11:52,339 --> 00:11:53,715 Agreed. 356 00:11:53,716 --> 00:11:55,717 It took me 25 years to get this way. 357 00:11:55,718 --> 00:11:58,344 Car crash, burn unit, 358 00:11:58,345 --> 00:12:01,180 four leg surgeries over ten years. 359 00:12:01,181 --> 00:12:03,349 Laid me up so much, I lost my job. 360 00:12:03,350 --> 00:12:05,018 I need to numb the back of your tongue. 361 00:12:05,019 --> 00:12:06,853 This is gonna taste pretty bad. 362 00:12:06,854 --> 00:12:08,271 Is there anyone you'd like us to call? 363 00:12:08,272 --> 00:12:09,480 No. 364 00:12:09,481 --> 00:12:11,024 Any family? 365 00:12:11,025 --> 00:12:13,568 Mm. My parents passed. 366 00:12:13,569 --> 00:12:14,819 I'm single. 367 00:12:14,820 --> 00:12:15,820 Go figure. 368 00:12:15,821 --> 00:12:17,030 Siblings? 369 00:12:17,031 --> 00:12:19,032 Sister in Arizona. 370 00:12:19,033 --> 00:12:21,409 We don't talk much. 371 00:12:21,410 --> 00:12:23,328 Now that we've numbed up the back of your tongue, 372 00:12:23,329 --> 00:12:26,873 we can anesthetize a bit deeper. 373 00:12:26,874 --> 00:12:27,874 Um, sorry to interrupt. 374 00:12:27,875 --> 00:12:28,875 I have a middle-aged woman 375 00:12:28,876 --> 00:12:30,543 with sudden onset blindness. 376 00:12:30,544 --> 00:12:31,878 - I can go. - OK. 377 00:12:31,879 --> 00:12:33,171 Will you see if Abbot's still around? 378 00:12:33,172 --> 00:12:34,172 - Yeah. - Thank you. 379 00:12:34,173 --> 00:12:35,757 What's your sister's name? 380 00:12:35,758 --> 00:12:37,508 Lauren Milford. 381 00:12:37,509 --> 00:12:39,010 Where in Arizona? 382 00:12:39,011 --> 00:12:40,595 Flagstaff, I think. 383 00:12:40,596 --> 00:12:41,804 Just gonna go over your tongue 384 00:12:41,805 --> 00:12:43,056 and numb your vocal cords. 385 00:12:43,057 --> 00:12:44,057 Ah. 386 00:12:44,058 --> 00:12:46,392 Ah... 387 00:12:46,393 --> 00:12:47,560 How many fingers? 388 00:12:47,561 --> 00:12:49,771 I don't see any fingers. 389 00:12:49,772 --> 00:12:51,731 And now? 390 00:12:51,732 --> 00:12:54,275 I can see a little bit of light. 391 00:12:54,276 --> 00:12:56,069 Um, Brooke, you've met Dr. King. 392 00:12:56,070 --> 00:12:57,570 This is Dr. Al-Hashimi. 393 00:12:57,571 --> 00:12:58,905 - Nice to meet you. - And her wife, Wendy. 394 00:12:58,906 --> 00:13:00,156 - Hello. - Hello. 395 00:13:00,157 --> 00:13:01,908 OK if we discuss your symptoms? 396 00:13:01,909 --> 00:13:04,118 As long as I can correct you if you get anything wrong. 397 00:13:04,119 --> 00:13:05,912 Trust me, she will. 398 00:13:05,913 --> 00:13:08,998 One hour of sudden, painless vision loss in the left eye. 399 00:13:08,999 --> 00:13:10,833 No history of hypercoagulable state 400 00:13:10,834 --> 00:13:12,251 or vascular disease. 401 00:13:12,252 --> 00:13:13,753 Could you look straight ahead, please? 402 00:13:13,754 --> 00:13:16,255 Could be a central retinal artery occlusion. 403 00:13:16,256 --> 00:13:17,715 In English, please? 404 00:13:17,716 --> 00:13:19,884 A little blood clot can block the artery 405 00:13:19,885 --> 00:13:22,428 at the back of the eye and decrease your vision. 406 00:13:22,429 --> 00:13:24,055 Sometimes it's called an eye stroke. 407 00:13:24,056 --> 00:13:25,098 Stroke? 408 00:13:25,099 --> 00:13:26,474 Like she could be paralyzed? 409 00:13:26,475 --> 00:13:28,059 No, this would be limited to the eye. 410 00:13:28,060 --> 00:13:29,435 Is it permanent? 411 00:13:29,436 --> 00:13:31,813 First, we have to make the diagnosis. 412 00:13:31,814 --> 00:13:33,064 Retinal exam? 413 00:13:33,065 --> 00:13:34,107 Hard to get a good look. 414 00:13:34,108 --> 00:13:35,650 We need the FOP. 415 00:13:35,651 --> 00:13:37,443 The what? 416 00:13:39,738 --> 00:13:41,447 Oh, Princess. 417 00:13:41,448 --> 00:13:43,449 We need patient stickers on each of these order sheets, 418 00:13:43,450 --> 00:13:45,535 or the pharmacy won't know who to give meds to. 419 00:13:45,536 --> 00:13:46,953 We're on it. 420 00:13:46,954 --> 00:13:49,122 Princess, smartphone fundoscope? 421 00:13:49,123 --> 00:13:50,498 Equipment corridor, eye cart. 422 00:13:50,499 --> 00:13:53,626 - Thanks. - You seem a little confused. 423 00:13:53,627 --> 00:13:55,461 How do I figure out which new patient to pick up? 424 00:13:55,462 --> 00:13:56,796 Top of the board. 425 00:13:56,797 --> 00:13:57,964 They're listed in the order they arrive. 426 00:13:57,965 --> 00:13:59,215 You erase the first one, then put 427 00:13:59,216 --> 00:14:00,675 your initials in the MD box. 428 00:14:00,676 --> 00:14:02,301 OK. Thanks. 429 00:14:02,302 --> 00:14:03,678 - Caleb. - Michael. 430 00:14:03,679 --> 00:14:05,513 Are you managing this chaos OK? 431 00:14:05,514 --> 00:14:08,141 Well, it's all pretty easy when you're a short-timer. 432 00:14:08,142 --> 00:14:10,727 Any more comatose patients for me to have a chat with? 433 00:14:12,479 --> 00:14:13,813 I'm kidding. 434 00:14:13,814 --> 00:14:15,440 OK. 435 00:14:15,441 --> 00:14:17,108 Victoria, this is Nicole Steadman. 436 00:14:17,109 --> 00:14:18,317 I run the parent support group 437 00:14:18,318 --> 00:14:19,777 for the psychiatric service. 438 00:14:19,778 --> 00:14:21,529 Yeah. Nicole's daughter was diagnosed 439 00:14:21,530 --> 00:14:23,281 sophomore year in college. 440 00:14:23,282 --> 00:14:26,451 You think Jackson's parents might have a chat with her? 441 00:14:26,452 --> 00:14:28,327 We can certainly ask. 442 00:14:28,328 --> 00:14:29,996 Now we can see the whole retina 443 00:14:29,997 --> 00:14:31,497 without dilating the pupil. 444 00:14:32,666 --> 00:14:34,292 You're looking in the wrong eye. 445 00:14:34,293 --> 00:14:36,502 Oh, we start with the good eye for comparison. 446 00:14:36,503 --> 00:14:38,629 Oh. 447 00:14:38,630 --> 00:14:39,672 Retina looks great. 448 00:14:39,673 --> 00:14:40,840 Now for the bad eye? 449 00:14:40,841 --> 00:14:42,176 Eyes wide open. 450 00:14:44,553 --> 00:14:45,928 How's it look? 451 00:14:45,929 --> 00:14:47,513 Extremely pale, no blood flow. 452 00:14:47,514 --> 00:14:49,682 Digital massage, 10 seconds on, 5 seconds off. 453 00:14:49,683 --> 00:14:53,102 Order non-contrast head CT. 454 00:14:54,688 --> 00:14:56,772 Come in. 455 00:14:56,773 --> 00:14:57,940 Hi. 456 00:14:57,941 --> 00:14:59,358 Heard your patient took off. 457 00:14:59,359 --> 00:15:00,902 She's taking a little break. 458 00:15:00,903 --> 00:15:03,279 How long are you gonna wait? 459 00:15:03,280 --> 00:15:05,156 You know about the cyber shutdown thing? 460 00:15:05,157 --> 00:15:06,699 Yeah. 461 00:15:06,700 --> 00:15:08,201 Wish I could help, but I gotta stay here 462 00:15:08,202 --> 00:15:09,577 till all the evidence is collected, so... 463 00:15:09,578 --> 00:15:11,204 It's a hot mess out there. 464 00:15:11,205 --> 00:15:12,580 This whole day is. 465 00:15:13,707 --> 00:15:16,209 Sorry. I was just leaving. 466 00:15:16,210 --> 00:15:18,377 You OK? 467 00:15:18,378 --> 00:15:19,879 I'm good. 468 00:15:19,880 --> 00:15:21,589 I'm glad to hear it. 469 00:15:21,590 --> 00:15:22,673 You get something to eat? 470 00:15:22,674 --> 00:15:25,551 No. 471 00:15:25,552 --> 00:15:27,678 Let's keep going. 472 00:15:27,679 --> 00:15:29,013 OK. 473 00:15:29,014 --> 00:15:30,057 Yeah. 474 00:15:40,526 --> 00:15:43,027 Why don't we keep one in the ER? 475 00:15:43,028 --> 00:15:46,697 Because our intubated patients are usually sedated. 476 00:15:46,698 --> 00:15:48,157 Right. 477 00:15:48,158 --> 00:15:49,784 Maybe you could ease up 478 00:15:49,785 --> 00:15:51,452 with your comments about his weight. 479 00:15:52,829 --> 00:15:54,789 I was just wondering how he got so big 480 00:15:54,790 --> 00:15:56,457 and how we could help. 481 00:15:56,458 --> 00:15:58,167 We can help by finding out what's wrong with him 482 00:15:58,168 --> 00:15:59,252 and treating him with respect. 483 00:15:59,253 --> 00:16:00,253 How's your belly now? 484 00:16:00,254 --> 00:16:01,587 Second pain shot helped. 485 00:16:01,588 --> 00:16:03,422 OK. There's more if you need it. 486 00:16:03,423 --> 00:16:04,674 Diminished bowel sounds. 487 00:16:04,675 --> 00:16:06,008 VidaTalk from the ICU. 488 00:16:06,009 --> 00:16:07,593 Great. 489 00:16:07,594 --> 00:16:08,928 Howard, we need to open up that passageway now 490 00:16:08,929 --> 00:16:10,137 so we can pass the tube. 491 00:16:10,138 --> 00:16:11,764 I'm gonna start with my pinky. 492 00:16:11,765 --> 00:16:13,140 Slowly, over a few minutes, I'm gonna go deeper, 493 00:16:13,141 --> 00:16:14,600 all the way to the back of my knuckle. 494 00:16:14,601 --> 00:16:16,310 Once the tube's through your vocal cords, 495 00:16:16,311 --> 00:16:17,812 you won't be able to talk. 496 00:16:17,813 --> 00:16:19,605 But this is a communication device. 497 00:16:19,606 --> 00:16:22,275 Swipe through the screen for anything you want to say. 498 00:16:22,276 --> 00:16:24,777 Hit the icon, and it talks to us. 499 00:16:24,778 --> 00:16:26,988 I would like some pain medicine. 500 00:16:26,989 --> 00:16:28,823 My pain is a nine. 501 00:16:28,824 --> 00:16:30,491 Can I get it to order a pizza? 502 00:16:32,911 --> 00:16:34,745 There's cell service in the ambulance bay. 503 00:16:34,746 --> 00:16:37,290 I found his sister's new number, left a voicemail. 504 00:16:37,291 --> 00:16:38,499 OK, I'm gonna start. 505 00:16:38,500 --> 00:16:39,750 You ready? 506 00:16:39,751 --> 00:16:41,168 Not really. 507 00:16:41,169 --> 00:16:42,169 Go ahead. 508 00:16:42,170 --> 00:16:43,588 Robby, over here. 509 00:16:43,589 --> 00:16:45,799 Here we go. Head back. 510 00:16:47,259 --> 00:16:48,509 You thinking it's surgical? 511 00:16:48,510 --> 00:16:49,969 I'm hoping for a non-perfed appy. 512 00:16:49,970 --> 00:16:51,554 - Can you do it with a scope? - Possibly, 513 00:16:51,555 --> 00:16:53,222 but he could be treated with antibiotics alone. 514 00:16:53,223 --> 00:16:55,224 And if he needs surgery? 515 00:16:55,225 --> 00:16:58,227 With his size, an emergency open laparotomy, 516 00:16:58,228 --> 00:17:00,354 death rate's close to 50%. 517 00:17:00,355 --> 00:17:01,939 OK, one step at a time. 518 00:17:01,940 --> 00:17:04,525 Let's keep trying his sister every 15 minutes. 519 00:17:04,526 --> 00:17:05,902 She'll get it. 520 00:17:09,781 --> 00:17:12,992 Half the downtime slips are blank. 521 00:17:12,993 --> 00:17:15,036 What are you talking about? 522 00:17:15,037 --> 00:17:17,204 Here and here. 523 00:17:17,205 --> 00:17:19,332 Larry, are you using a felt tip pen? 524 00:17:19,333 --> 00:17:21,626 Maybe. 525 00:17:21,627 --> 00:17:24,879 It's not going through for the copies. 526 00:17:24,880 --> 00:17:26,672 Ballpoint pen only. 527 00:17:26,673 --> 00:17:28,050 OK. 528 00:17:30,469 --> 00:17:31,844 Digby still MIA? 529 00:17:31,845 --> 00:17:33,054 Is that the homeless guy? 530 00:17:33,055 --> 00:17:34,848 We need the bed if he eloped. 531 00:17:36,224 --> 00:17:38,184 - What do you need? - An attending. 532 00:17:38,185 --> 00:17:40,019 - Or a senior resident? - Nope, I'm good. 533 00:17:40,020 --> 00:17:42,188 - Dr. Al-Hashimi, can I present? - Yes. 534 00:17:42,189 --> 00:17:44,815 32-year-old deaf woman with myofascial headache. 535 00:17:44,816 --> 00:17:47,068 Ibuprofen caused gastritis and epigastric pain, 536 00:17:47,069 --> 00:17:49,320 and she vasovagalled, but now pain-free 537 00:17:49,321 --> 00:17:51,364 after Mylanta and a trigger point injection. 538 00:17:51,365 --> 00:17:52,531 Excellent. That can take care of the pain 539 00:17:52,532 --> 00:17:54,200 - for several months. - Yeah. 540 00:17:54,201 --> 00:17:56,535 It shouldn't recur if she keeps her screen at eye level. 541 00:17:56,536 --> 00:17:57,912 There was a delay 542 00:17:57,913 --> 00:17:59,538 in getting an ASL interpreter. 543 00:17:59,539 --> 00:18:01,207 And I almost gave up and ordered 544 00:18:01,208 --> 00:18:03,376 an unnecessary brain and abdominal CT. 545 00:18:03,377 --> 00:18:04,585 Good thing you didn't. 546 00:18:04,586 --> 00:18:07,254 Dr. Al-Hashimi, for you. 547 00:18:07,255 --> 00:18:08,631 Nice job on the trigger point. 548 00:18:08,632 --> 00:18:09,882 Yeah, I know. 549 00:18:09,883 --> 00:18:11,592 How's the T-system going? 550 00:18:11,593 --> 00:18:13,719 - Quick and easy. - Yeah. 551 00:18:13,720 --> 00:18:15,930 On these MDMs, don't just circle your diagnosis. 552 00:18:15,931 --> 00:18:17,723 Also put a backslash through all the ones 553 00:18:17,724 --> 00:18:18,766 that you've ruled out. 554 00:18:18,767 --> 00:18:19,809 No problem. 555 00:18:19,810 --> 00:18:21,477 Thank you very much. 556 00:18:21,478 --> 00:18:23,521 Princess, bump Central 13 to the front of the CT line. 557 00:18:23,522 --> 00:18:24,689 What do you got? 558 00:18:24,690 --> 00:18:26,065 Sudden onset blindness patient 559 00:18:26,066 --> 00:18:27,566 has central retinal artery occlusion. 560 00:18:27,567 --> 00:18:29,235 I just spoke to an ophthalmologist 561 00:18:29,236 --> 00:18:30,861 at the VA, principal investigator 562 00:18:30,862 --> 00:18:32,530 for thrombolytics in cases like this. 563 00:18:32,531 --> 00:18:33,948 Not exactly standard of care. 564 00:18:33,949 --> 00:18:35,032 Kind of risky. 565 00:18:35,033 --> 00:18:36,617 We'll do informed consent. 566 00:18:36,618 --> 00:18:38,516 It's our best shot at saving some of her vision. 567 00:18:38,517 --> 00:18:39,784 Your patient, your call. 568 00:18:39,785 --> 00:18:42,235 I'm not gonna be around long enough for any complications. 569 00:18:44,876 --> 00:18:48,587 I'll be taking two swabs from the vagina, 570 00:18:48,588 --> 00:18:50,590 two swabs from the cervix. 571 00:18:53,927 --> 00:18:56,804 Let me know if you feel any discomfort. 572 00:18:56,805 --> 00:18:58,848 OK. 573 00:18:58,849 --> 00:19:03,018 Each swab gets labeled... first vaginal, second vaginal. 574 00:19:03,019 --> 00:19:05,312 Smear a slide with both, and let it air dry. 575 00:19:05,313 --> 00:19:06,522 Same for the cervix? 576 00:19:06,523 --> 00:19:07,523 Yeah. 577 00:19:07,524 --> 00:19:08,859 No slide needed. 578 00:19:10,485 --> 00:19:12,695 How you doing, Ilana? 579 00:19:12,696 --> 00:19:14,780 Hanging in there. 580 00:19:14,781 --> 00:19:16,282 OK. 581 00:19:16,283 --> 00:19:17,701 Almost done. 582 00:19:20,454 --> 00:19:23,289 All these samples go in the vaginal contact envelope. 583 00:19:23,290 --> 00:19:24,665 - I can help with that. - No. 584 00:19:24,666 --> 00:19:26,417 It's gotta be me. 585 00:19:26,418 --> 00:19:29,795 I'm gonna pull this out. 586 00:19:29,796 --> 00:19:31,589 OK. 587 00:19:31,590 --> 00:19:32,631 All good here. 588 00:19:32,632 --> 00:19:34,050 Legs can come down. 589 00:19:37,846 --> 00:19:39,805 Are we done? 590 00:19:39,806 --> 00:19:41,140 One last thing. 591 00:19:41,141 --> 00:19:43,601 Four more swabs inside your mouth. 592 00:19:43,602 --> 00:19:45,269 Didn't you do that already? 593 00:19:45,270 --> 00:19:48,314 This one's different... inside your cheek for your DNA, 594 00:19:48,315 --> 00:19:49,900 not for his. 595 00:19:52,611 --> 00:19:58,032 So it could be bipolar or schizophrenia? 596 00:19:58,033 --> 00:20:00,326 Those are the two most likely possibilities. 597 00:20:00,327 --> 00:20:01,869 How do they know which it is? 598 00:20:01,870 --> 00:20:04,038 Based on response to medicine, 599 00:20:04,039 --> 00:20:06,665 but also with therapy and observation on the ward. 600 00:20:06,666 --> 00:20:10,085 They'll monitor his mood and interactions with others. 601 00:20:12,005 --> 00:20:14,799 Is there a blood test or a brain scan 602 00:20:14,800 --> 00:20:15,841 that will tell us for sure? 603 00:20:15,842 --> 00:20:17,802 Unfortunately not. 604 00:20:17,803 --> 00:20:20,763 When properly medicated, people with bipolar disorder 605 00:20:20,764 --> 00:20:23,516 can have successful careers. 606 00:20:23,517 --> 00:20:25,392 So we hope for bipolar? 607 00:20:25,393 --> 00:20:27,394 You can hope for your son's happiness. 608 00:20:27,395 --> 00:20:30,022 With early treatment, 20% of people 609 00:20:30,023 --> 00:20:32,817 with schizophrenia have a complete recovery. 610 00:20:32,818 --> 00:20:34,693 So 80% don't? 611 00:20:34,694 --> 00:20:36,947 This is a new version of Jackson. 612 00:20:39,699 --> 00:20:40,866 How old was your daughter? 613 00:20:40,867 --> 00:20:42,827 20. 614 00:20:42,828 --> 00:20:46,205 Studying architecture at Georgetown. 615 00:20:46,206 --> 00:20:47,915 Schizophrenia. 616 00:20:47,916 --> 00:20:50,167 I'm sorry. 617 00:20:50,168 --> 00:20:51,836 Oh, she's good. 618 00:20:51,837 --> 00:20:56,715 Living at home, working as a cashier at Giant Eagle. 619 00:20:56,716 --> 00:20:59,134 Employee of the Month. 620 00:20:59,135 --> 00:21:01,387 We still have struggles, 621 00:21:01,388 --> 00:21:04,349 but there's also laughter and love. 622 00:21:11,565 --> 00:21:13,065 Good to go. 623 00:21:13,066 --> 00:21:14,066 How'd that feel? 624 00:21:14,067 --> 00:21:15,609 Very weird. 625 00:21:15,610 --> 00:21:17,695 There's no pain. Just weird. 626 00:21:17,696 --> 00:21:19,989 OK, the next step is, we're gonna take this tube 627 00:21:19,990 --> 00:21:21,991 and pass it through your nose, 628 00:21:21,992 --> 00:21:24,493 stopping at the back of your tongue. 629 00:21:24,494 --> 00:21:26,370 Best not to talk for that. 630 00:21:26,371 --> 00:21:30,040 Tube's soaking in warm water to make it more flexible. 631 00:21:30,041 --> 00:21:32,751 Do you wanna try it? 632 00:21:32,752 --> 00:21:34,587 What day and time is it? 633 00:21:34,588 --> 00:21:36,964 4th of July, 2:31 p.m. 634 00:21:36,965 --> 00:21:38,924 When is my tube coming out? 635 00:21:38,925 --> 00:21:41,760 We have to put it in first. 636 00:21:41,761 --> 00:21:42,761 I know. 637 00:21:42,762 --> 00:21:44,430 Just practicing. 638 00:21:44,431 --> 00:21:47,766 Sounds like you're an expert already. 639 00:21:47,767 --> 00:21:50,811 Before I can't talk, 640 00:21:50,812 --> 00:21:53,606 I just wanna say 641 00:21:53,607 --> 00:21:57,067 thank you for everything. 642 00:21:57,068 --> 00:21:59,112 You're very welcome. 643 00:22:04,868 --> 00:22:06,286 Here we go. 644 00:22:10,957 --> 00:22:12,374 STI prevention. 645 00:22:12,375 --> 00:22:14,001 One shot treats gonorrhea, 646 00:22:14,002 --> 00:22:16,378 then pills for chlamydia and trichomonas. 647 00:22:16,379 --> 00:22:17,922 Thank you. 648 00:22:17,923 --> 00:22:19,715 We also have morning-after contraception. 649 00:22:19,716 --> 00:22:20,799 She has an IUD. 650 00:22:20,800 --> 00:22:23,344 Over 99% effective, not 100%. 651 00:22:23,345 --> 00:22:24,887 We still offer. 652 00:22:24,888 --> 00:22:26,472 I'll pass. 653 00:22:26,473 --> 00:22:29,975 For HIV, we got PEP, Post-Exposure Prophylaxis. 654 00:22:29,976 --> 00:22:31,435 28 days. 655 00:22:31,436 --> 00:22:34,688 The sooner you start, the more effective. 656 00:22:34,689 --> 00:22:36,482 Emma, I'm pretty sure they could use 657 00:22:36,483 --> 00:22:39,652 an extra set of hands out there. 658 00:22:39,653 --> 00:22:42,112 It's nice to meet you, Ilana. 659 00:22:42,113 --> 00:22:43,489 You're a very brave woman. 660 00:22:43,490 --> 00:22:44,574 Yeah. 661 00:22:51,665 --> 00:22:53,165 She's a good nurse. 662 00:22:53,166 --> 00:22:57,670 She's still learning, but she will be. 663 00:22:57,671 --> 00:22:59,630 After this, we're done? 664 00:22:59,631 --> 00:23:01,340 Yeah. 665 00:23:04,511 --> 00:23:06,721 I'm glad you were here today. 666 00:23:11,184 --> 00:23:13,852 Me too. 667 00:23:13,853 --> 00:23:16,897 We have a decision to make. 668 00:23:16,898 --> 00:23:18,899 Studies have shown that some vision 669 00:23:18,900 --> 00:23:21,694 can be restored with a clot-busting medication. 670 00:23:21,695 --> 00:23:23,112 So give it. 671 00:23:23,113 --> 00:23:25,280 But there are possible risks. 672 00:23:25,281 --> 00:23:29,868 For eye stroke, only 17% get better without any treatment. 673 00:23:29,869 --> 00:23:31,870 - Only 17%? - Yes. 674 00:23:31,871 --> 00:23:36,208 But with the medicine, another 20% can improve. 675 00:23:36,209 --> 00:23:38,711 But there can be complications. 676 00:23:38,712 --> 00:23:42,381 2% of patients who receive the medication get worse, 677 00:23:42,382 --> 00:23:47,220 and 1% have severe disability or death. 678 00:23:52,726 --> 00:23:56,312 Honey, this one has to be your call. 679 00:23:57,564 --> 00:24:00,858 No, it's our call. 680 00:24:00,859 --> 00:24:02,735 What would you do without me? 681 00:24:02,736 --> 00:24:04,904 I'd figure out how to get by. 682 00:24:06,781 --> 00:24:09,783 And I'd probably cry for two years solid. 683 00:24:09,784 --> 00:24:12,245 Two years? That's all? 684 00:24:13,455 --> 00:24:14,913 I want the medication. 685 00:24:14,914 --> 00:24:16,833 OK. 686 00:24:20,336 --> 00:24:22,337 OK, we need your full name to make a chart. 687 00:24:22,338 --> 00:24:24,423 Jackie Liddell. 688 00:24:24,424 --> 00:24:26,091 Jackie Liddell. 689 00:24:26,092 --> 00:24:27,134 And you are? 690 00:24:27,135 --> 00:24:28,594 Her friend Jaquie. 691 00:24:28,595 --> 00:24:30,471 - You have the same name? - No, no. 692 00:24:30,472 --> 00:24:32,681 She's Jackie with a C-K. I'm Jaquie with a Q. 693 00:24:32,682 --> 00:24:34,475 You can call me CK. 694 00:24:34,476 --> 00:24:35,601 Oh. 695 00:24:35,602 --> 00:24:36,935 Best not to talk, CK, OK? 696 00:24:36,936 --> 00:24:38,437 - Just chill. - Chill? 697 00:24:38,438 --> 00:24:41,774 - Q, I bit off half my tongue! - What? 698 00:24:41,775 --> 00:24:43,609 She said, I bit off half my tongue. 699 00:24:43,610 --> 00:24:44,943 You can understand that? 700 00:24:44,944 --> 00:24:46,612 Oh, you should hear her when she's had 701 00:24:46,613 --> 00:24:48,572 two pitchers of margaritas, fucked up and slurring. 702 00:24:48,573 --> 00:24:51,116 Ooh, you are such an idiot! 703 00:24:51,117 --> 00:24:52,743 Princess, what's open? 704 00:24:52,744 --> 00:24:54,453 South 15's clean. 705 00:24:54,454 --> 00:24:55,996 Deep tongue laceration. 706 00:24:55,997 --> 00:24:58,749 I can jump on this. 707 00:24:58,750 --> 00:25:01,668 Robby and Al-Hashimi are both with critical patients. 708 00:25:01,669 --> 00:25:03,003 Hello. 709 00:25:03,004 --> 00:25:04,296 I'm Dr. Langdon. 710 00:25:04,297 --> 00:25:06,049 I'll be supervising your care. 711 00:25:08,051 --> 00:25:10,719 Jesus, CK, your doctor's fucking hot. 712 00:25:13,556 --> 00:25:15,974 Tube's at 14 centimeters, just above the airway. 713 00:25:15,975 --> 00:25:18,352 OK, Howard, I'm going to start. 714 00:25:18,353 --> 00:25:22,523 If you want me to stop, you just put your hand up, OK? 715 00:25:22,524 --> 00:25:25,151 Blue mark tells me I'm in the tube. 716 00:25:28,530 --> 00:25:30,697 Looks like he cleared it. 717 00:25:30,698 --> 00:25:33,325 If he inhales, we should see chords. 718 00:25:33,326 --> 00:25:35,661 OK, deep breath for me, Howard. 719 00:25:38,373 --> 00:25:40,833 - OK. - Beautiful. 720 00:25:40,834 --> 00:25:42,501 Chords are sensitive, so we spray lidocaine 721 00:25:42,502 --> 00:25:44,962 - in the scope. - OK. 722 00:25:44,963 --> 00:25:48,507 1 cc going in now. 723 00:25:48,508 --> 00:25:51,176 And we'll just give that a second to work. 724 00:25:51,177 --> 00:25:52,679 How you doing, Howard? 725 00:25:53,972 --> 00:25:55,848 Once the tube's in, you'll have to breathe 726 00:25:55,849 --> 00:25:57,182 through your nose. 727 00:25:57,183 --> 00:25:58,559 OK, Howard, hold still. 728 00:25:58,560 --> 00:26:02,062 I am now going in past your vocal cords 729 00:26:02,063 --> 00:26:04,607 until we see the carina. 730 00:26:06,192 --> 00:26:07,860 Ogilvie. 731 00:26:07,861 --> 00:26:09,069 Uh, there. 732 00:26:09,070 --> 00:26:10,195 Right and left mainstem. 733 00:26:10,196 --> 00:26:12,991 And the tube slides in. 734 00:26:16,870 --> 00:26:20,123 And then the scope comes out. 735 00:26:21,916 --> 00:26:23,542 Great. 736 00:26:23,543 --> 00:26:24,877 OK, inflate the balloon. 737 00:26:24,878 --> 00:26:26,253 Deep breath through your nose. 738 00:26:26,254 --> 00:26:27,462 Amazing. 739 00:26:27,463 --> 00:26:29,590 You good? 740 00:26:29,591 --> 00:26:31,216 Great end-tidal waveform. 741 00:26:31,217 --> 00:26:32,467 Does he need a vent? 742 00:26:32,468 --> 00:26:33,719 He's breathing on his own, 743 00:26:33,720 --> 00:26:35,095 but a little CPAP wouldn't hurt. 744 00:26:35,096 --> 00:26:37,306 Starting at 5, titrate to 10. 745 00:26:37,307 --> 00:26:39,308 OK, that went really well, Howard. 746 00:26:39,309 --> 00:26:41,060 Now we're going to check your weight. 747 00:26:43,021 --> 00:26:44,605 So the nurse examiner is supposed 748 00:26:44,606 --> 00:26:46,523 to lock up the rape kit in this fridge, 749 00:26:46,524 --> 00:26:49,693 where it stays until it gets turned over to law enforcement. 750 00:26:49,694 --> 00:26:52,404 It's called preserving the chain of evidence. 751 00:26:52,405 --> 00:26:54,698 Are you fucking kidding me? 752 00:26:54,699 --> 00:26:56,575 Is there a problem? 753 00:26:56,576 --> 00:26:58,869 Jesus Christ. 754 00:26:58,870 --> 00:27:01,914 Police are supposed to pick up the rape kits within 72 hours. 755 00:27:01,915 --> 00:27:04,917 This one I did two weeks ago. 756 00:27:04,918 --> 00:27:06,419 God damn it. 757 00:27:08,588 --> 00:27:10,881 So how exactly did this happen? 758 00:27:10,882 --> 00:27:13,759 We were in between pubs taking a selfie. 759 00:27:13,760 --> 00:27:14,801 Very nice. 760 00:27:14,802 --> 00:27:17,262 Until she jerked her head up. 761 00:27:17,263 --> 00:27:18,764 Ooh. 762 00:27:18,765 --> 00:27:20,098 Ouch. 763 00:27:20,099 --> 00:27:21,767 OK, topical epi did the trick. 764 00:27:21,768 --> 00:27:23,143 - No more bleeding. - Sweet. 765 00:27:23,144 --> 00:27:24,519 I can go home now? 766 00:27:24,520 --> 00:27:26,438 I don't think so. 767 00:27:26,439 --> 00:27:27,981 It looks like the Grand Canyon across the back of your tongue. 768 00:27:27,982 --> 00:27:29,983 We need to put in some stitches. 769 00:27:29,984 --> 00:27:30,984 I don't want stitches. 770 00:27:30,985 --> 00:27:33,111 Oh. Listen to the doctor. 771 00:27:33,112 --> 00:27:34,821 Don't tell me what to do. 772 00:27:34,822 --> 00:27:36,323 This is all your fault. 773 00:27:36,324 --> 00:27:38,367 - No, it's not. - Uh, yes, it is. 774 00:27:38,368 --> 00:27:40,035 - Uh, Princess. - No, it's not. 775 00:27:40,036 --> 00:27:41,620 Princess, hey, why don't you show Q 776 00:27:41,621 --> 00:27:43,455 where she can wait while we patch up her friend? 777 00:27:43,456 --> 00:27:44,957 Of course. 778 00:27:44,958 --> 00:27:47,125 OK, this is a numbing shot for the tip. 779 00:27:47,126 --> 00:27:48,126 The tip? 780 00:27:48,127 --> 00:27:50,087 That's not where I bit it. 781 00:27:50,088 --> 00:27:51,506 One step at a time. 782 00:27:58,680 --> 00:28:01,098 That's 20 migs of TNK. 783 00:28:01,099 --> 00:28:04,142 In at 14:39. 784 00:28:04,143 --> 00:28:06,436 Feeling anything? 785 00:28:06,437 --> 00:28:07,521 Not yet. 786 00:28:07,522 --> 00:28:10,440 Could take an hour or two. 787 00:28:10,441 --> 00:28:11,942 We're going to move you to another room 788 00:28:11,943 --> 00:28:13,819 for better monitoring. 789 00:28:13,820 --> 00:28:15,363 Dr. King. 790 00:28:18,157 --> 00:28:21,576 I'd like you to stay with her. 791 00:28:21,577 --> 00:28:22,911 Why? 792 00:28:22,912 --> 00:28:24,538 In case there are complications. 793 00:28:24,539 --> 00:28:26,331 You'll be there to respond quickly 794 00:28:26,332 --> 00:28:29,209 to a blown pupil, a seizure, altered mental status. 795 00:28:29,210 --> 00:28:31,253 Or I could catch up on my charts. 796 00:28:31,254 --> 00:28:33,171 And my deposition's coming up. 797 00:28:33,172 --> 00:28:35,674 Think of this as a great way to steal some quiet time 798 00:28:35,675 --> 00:28:37,009 and get mentally prepared. 799 00:28:37,010 --> 00:28:39,220 Jesse, Mel's with you. 800 00:28:41,014 --> 00:28:43,015 Oh, excuse me, Dr. Mohan. 801 00:28:43,016 --> 00:28:44,099 Excuse me. 802 00:28:44,100 --> 00:28:45,100 Dr. Mohan. 803 00:28:45,101 --> 00:28:46,518 Uh, in a minute, George. 804 00:28:46,519 --> 00:28:47,644 I've got this. 805 00:28:47,645 --> 00:28:48,854 Thank you. 806 00:28:48,855 --> 00:28:51,189 Oh, uh, I, um... 807 00:28:51,190 --> 00:28:53,358 D-dimer is back normal. 808 00:28:53,359 --> 00:28:54,359 Oh. 809 00:28:54,360 --> 00:28:55,694 I'm ready to go. 810 00:28:55,695 --> 00:28:57,529 Are you feeling better? 811 00:28:57,530 --> 00:29:01,242 I... I really wasn't short of breath this time. 812 00:29:02,368 --> 00:29:04,077 Then why'd you come in? 813 00:29:05,580 --> 00:29:07,664 When I found out about the blood clot in my leg, 814 00:29:07,665 --> 00:29:10,542 I just kept thinking it's gonna go to my lung and kill me. 815 00:29:10,543 --> 00:29:13,712 We've talked before about how the Eliquis would prevent that. 816 00:29:13,713 --> 00:29:16,423 I know. 817 00:29:16,424 --> 00:29:18,800 Well, I finally took your advice. 818 00:29:18,801 --> 00:29:21,261 I got out of the house, and I joined 819 00:29:21,262 --> 00:29:23,221 the Frick Park Lawn Bowling Club. 820 00:29:23,222 --> 00:29:24,473 Wonderful. 821 00:29:24,474 --> 00:29:25,599 Yeah. 822 00:29:25,600 --> 00:29:27,434 I mean, you're right, you know? 823 00:29:27,435 --> 00:29:29,437 We all need a community. 824 00:29:33,441 --> 00:29:34,900 You're gonna do what? 825 00:29:34,901 --> 00:29:36,568 In order to fix your tongue, 826 00:29:36,569 --> 00:29:39,112 we need to move it forward to access the laceration. 827 00:29:39,113 --> 00:29:40,739 You're just gonna feel some pulling, OK? 828 00:29:40,740 --> 00:29:44,117 I guess so. 829 00:29:44,118 --> 00:29:46,828 Go for it. 830 00:29:46,829 --> 00:29:48,246 What size suture is that? 831 00:29:48,247 --> 00:29:52,042 O-silk, the biggest one we got. 832 00:29:52,043 --> 00:29:54,921 As soon as I cut the needle, you're on traction, Joy. 833 00:30:03,721 --> 00:30:05,263 Oh. 834 00:30:05,264 --> 00:30:07,432 That is pretty deep. 835 00:30:07,433 --> 00:30:09,059 And now we can numb up the cut. 836 00:30:09,060 --> 00:30:10,394 It's best to start with... 837 00:30:10,395 --> 00:30:11,770 Proximal side first so she doesn't 838 00:30:11,771 --> 00:30:14,981 feel the distal injection. 839 00:30:14,982 --> 00:30:15,982 Give it ten minutes. 840 00:30:15,983 --> 00:30:17,527 I'll be back for the repair. 841 00:30:21,697 --> 00:30:23,615 I got a rape kit sitting here for two weeks 842 00:30:23,616 --> 00:30:26,118 that was supposed to be picked up within 72 hours. 843 00:30:26,119 --> 00:30:27,160 I don't care! 844 00:30:27,161 --> 00:30:29,204 Get someone over here now! No. 845 00:30:29,205 --> 00:30:30,705 You expect us to treat your officers 846 00:30:30,706 --> 00:30:32,332 as soon as they come in, 847 00:30:32,333 --> 00:30:34,167 you get a detective to pick these kits up ASAP. 848 00:30:34,168 --> 00:30:35,168 I gotta go. 849 00:30:35,169 --> 00:30:36,795 - Dana... - Hey, Dana. 850 00:30:36,796 --> 00:30:37,963 South 19 got their head CT before we went down. 851 00:30:37,964 --> 00:30:39,297 No results yet. 852 00:30:39,298 --> 00:30:40,465 All right, I'll send a reminder. 853 00:30:40,466 --> 00:30:41,466 - Hey, Dana. - Dana. 854 00:30:41,467 --> 00:30:42,844 Hang on. 855 00:30:43,845 --> 00:30:45,637 What's up? 856 00:30:45,638 --> 00:30:47,556 We put in an order for more pain meds for Roxie. 857 00:30:47,557 --> 00:30:49,641 All right, so put it in the nursing racks. 858 00:30:49,642 --> 00:30:52,310 Oh, I did, a long time ago. 859 00:30:52,311 --> 00:30:54,146 All right. I'll bump it to the front. 860 00:30:54,147 --> 00:30:55,689 Thank you. 861 00:30:55,690 --> 00:30:57,441 Uh, what's that noise? 862 00:30:57,442 --> 00:30:58,483 UFO landed. 863 00:30:58,484 --> 00:30:59,484 Aliens are invading. 864 00:30:59,485 --> 00:31:00,986 Hey, Dana. 865 00:31:00,987 --> 00:31:02,863 Chem 7's not back on Trauma 2 yet. 866 00:31:02,864 --> 00:31:05,157 Let me see the chart. 867 00:31:05,158 --> 00:31:06,700 Oh, Jesus. 868 00:31:06,701 --> 00:31:08,285 I bet your Chem 7 rec went to Radiology. 869 00:31:08,286 --> 00:31:10,120 Larry, Antoine. 870 00:31:10,121 --> 00:31:12,622 You put labs and chest X-ray on the same downtime form. 871 00:31:12,623 --> 00:31:14,875 You need two slips... one for labs, one for radiology. 872 00:31:14,876 --> 00:31:16,543 - Got it. - Won't happen again. 873 00:31:16,544 --> 00:31:17,669 I'll run it down myself. 874 00:31:17,670 --> 00:31:19,379 Use the iStat at bedside. 875 00:31:19,380 --> 00:31:20,839 They won't take him to CT without a creatinine. 876 00:31:20,840 --> 00:31:22,007 Oh, perfect. 877 00:31:22,008 --> 00:31:23,175 Nice to have you back. 878 00:31:23,176 --> 00:31:24,426 Thrilled to be here. 879 00:31:24,427 --> 00:31:25,552 You trying to text? 880 00:31:25,553 --> 00:31:27,095 I am just composing. 881 00:31:27,096 --> 00:31:28,680 I'm gonna send it from the bay. 882 00:31:28,681 --> 00:31:30,891 My mechanic friend, Duke, never showed up. 883 00:31:30,892 --> 00:31:32,434 I thought he was coming in this morning. 884 00:31:32,435 --> 00:31:33,685 That was the plan. 885 00:31:33,686 --> 00:31:35,937 I guess he got busy. 886 00:31:35,938 --> 00:31:37,189 What if he's a no-show? 887 00:31:37,190 --> 00:31:38,773 Tell me what he needs. 888 00:31:38,774 --> 00:31:39,858 I'll pass it on to the night shift. 889 00:31:39,859 --> 00:31:40,859 That won't be necessary. 890 00:31:43,613 --> 00:31:45,447 Oh, Princess. 891 00:31:45,448 --> 00:31:46,531 Ask and you shall receive. 892 00:31:46,532 --> 00:31:47,699 Normal head CT. 893 00:31:47,700 --> 00:31:50,035 Thanks. I'll get him discharged. 894 00:31:50,036 --> 00:31:51,870 How's your day going? 895 00:31:51,871 --> 00:31:54,372 I think I'm getting writer's cramp. 896 00:31:54,373 --> 00:31:55,707 You with the big guy? 897 00:31:55,708 --> 00:31:58,001 Yeah. It's sad. 898 00:31:58,002 --> 00:32:01,880 Bad car accident, multiple operations, tons of stress. 899 00:32:03,883 --> 00:32:05,759 Lidocaine shot to a sensitive area. 900 00:32:05,760 --> 00:32:07,552 I got a binge-drinking party girl with a tongue lac. 901 00:32:07,553 --> 00:32:08,887 Mm. 902 00:32:08,888 --> 00:32:10,096 Sounds like she needs some help. 903 00:32:10,097 --> 00:32:12,849 In more ways than one. 904 00:32:12,850 --> 00:32:16,561 How's, uh... how's your first shift back going? 905 00:32:16,562 --> 00:32:18,730 One day at a time. 906 00:32:18,731 --> 00:32:20,357 First year sober is the hardest. 907 00:32:20,358 --> 00:32:21,566 That's what they keep telling me. 908 00:32:21,567 --> 00:32:24,237 I'm nine years and counting. 909 00:32:26,614 --> 00:32:28,240 Oh. 910 00:32:28,241 --> 00:32:31,743 Special delivery for my guy. 911 00:32:31,744 --> 00:32:33,745 If you, um... if you need anything, call me. 912 00:32:33,746 --> 00:32:35,331 Thanks. 913 00:32:41,295 --> 00:32:42,921 Where are you going? 914 00:32:42,922 --> 00:32:44,297 Blisters in North 3. 915 00:32:44,298 --> 00:32:45,799 That's where I'm going. 916 00:32:45,800 --> 00:32:47,676 Did you sign up for the patient? 917 00:32:47,677 --> 00:32:49,469 I pulled the chart from the rack. 918 00:32:49,470 --> 00:32:51,221 You're supposed to sign up on the dry-erase board. 919 00:32:51,222 --> 00:32:53,098 You're supposed to have a clipboard for the patient. 920 00:32:53,099 --> 00:32:54,933 I thought the nurses had that. 921 00:32:54,934 --> 00:32:56,560 Whatever. 922 00:32:56,561 --> 00:32:57,644 Hi. 923 00:32:57,645 --> 00:32:59,104 I'm Student Doctor Ogilvie. 924 00:32:59,105 --> 00:33:01,273 And this is... wow. 925 00:33:01,274 --> 00:33:02,732 That is some rash. 926 00:33:02,733 --> 00:33:05,610 - Yeah. Tell me about it. - Student Doctor Javadi. 927 00:33:05,611 --> 00:33:07,821 - When did this start? - Last night. 928 00:33:07,822 --> 00:33:09,406 And have you been on any hikes recently 929 00:33:09,407 --> 00:33:10,490 around poison ivy? 930 00:33:10,491 --> 00:33:12,450 Nope. Haven't left the house. 931 00:33:12,451 --> 00:33:15,453 What about new medications, lotions, soaps, 932 00:33:15,454 --> 00:33:16,454 detergents, even? 933 00:33:16,455 --> 00:33:17,747 I don't take medicine. 934 00:33:17,748 --> 00:33:19,416 Nothing new with all that other stuff. 935 00:33:19,417 --> 00:33:20,458 Uh-huh. And where did this start? 936 00:33:20,459 --> 00:33:21,918 Everywhere, all at once. 937 00:33:21,919 --> 00:33:25,255 Just a lot of pain, really itchy. 938 00:33:25,256 --> 00:33:26,965 What is it? 939 00:33:26,966 --> 00:33:28,466 I'm not sure yet. 940 00:33:28,467 --> 00:33:31,177 Um, be back in a second. 941 00:33:31,178 --> 00:33:32,804 Can't... will you... 942 00:33:36,976 --> 00:33:39,019 What are you thinking? 943 00:33:39,020 --> 00:33:40,145 I have no idea. 944 00:33:40,146 --> 00:33:41,314 Agreed. 945 00:33:43,149 --> 00:33:44,733 Bullous pemphigoid? 946 00:33:44,734 --> 00:33:46,484 Autoimmune severe pruritis? 947 00:33:46,485 --> 00:33:48,069 Yeah, but not as deadly as pemphigus vulgaris. 948 00:33:48,070 --> 00:33:50,071 Untreated, the death rate is over 90%. 949 00:33:50,072 --> 00:33:51,489 We need to check for pustules, 950 00:33:51,490 --> 00:33:52,657 mucous membrane involvement... 951 00:33:52,658 --> 00:33:54,035 And the Nikolsky sign. 952 00:33:56,495 --> 00:33:57,913 Here you go. 953 00:33:59,373 --> 00:34:00,498 What? 954 00:34:00,499 --> 00:34:02,043 For your progress note. 955 00:34:03,377 --> 00:34:06,379 Did I hear we're making progress? 956 00:34:06,380 --> 00:34:08,673 Oh, um, it's just what we call it 957 00:34:08,674 --> 00:34:11,844 when we write down things to describe a clinical course. 958 00:34:13,346 --> 00:34:14,346 Any changes? 959 00:34:15,348 --> 00:34:16,681 Not so far. 960 00:34:16,682 --> 00:34:19,017 It's time for the next neuro check. 961 00:34:19,018 --> 00:34:21,311 Excuse me, Dr. King, do you have a minute? 962 00:34:21,312 --> 00:34:22,896 Um, no. 963 00:34:22,897 --> 00:34:24,689 I'm observing a patient right now. 964 00:34:24,690 --> 00:34:27,068 60 seconds tops. 965 00:34:28,486 --> 00:34:29,861 I'll check pupils. 966 00:34:29,862 --> 00:34:31,405 We're good here. 967 00:34:37,036 --> 00:34:38,953 Hey. 968 00:34:38,954 --> 00:34:41,289 I just finished my deposition. 969 00:34:41,290 --> 00:34:43,750 Oh, should I go up now? 970 00:34:43,751 --> 00:34:45,460 Yeah. Just wait until you get a call. 971 00:34:45,461 --> 00:34:46,878 OK. 972 00:34:46,879 --> 00:34:48,296 Well, I'd ask how it went, 973 00:34:48,297 --> 00:34:50,382 but we're not supposed to discuss the case. 974 00:34:50,383 --> 00:34:51,883 This isn't a discussion. 975 00:34:51,884 --> 00:34:55,095 It's a monologue, so shut up and listen. 976 00:34:55,096 --> 00:34:57,305 The malpractice case is frivolous. 977 00:34:57,306 --> 00:34:58,890 The mother of the measles kid claims 978 00:34:58,891 --> 00:35:00,266 we caused intellectual decline 979 00:35:00,267 --> 00:35:02,352 by performing a spinal tap. 980 00:35:02,353 --> 00:35:05,563 But the tap was perfect with no complications. 981 00:35:05,564 --> 00:35:07,357 Her son presented with altered mental status 982 00:35:07,358 --> 00:35:10,777 due to low oxygen from measles pneumonia. 983 00:35:10,778 --> 00:35:13,238 Any change in intellect was due to hypoxic brain injury. 984 00:35:13,239 --> 00:35:16,908 It had nothing to do with your spinal tap. 985 00:35:16,909 --> 00:35:18,618 End of monologue. 986 00:35:18,619 --> 00:35:21,413 We never discussed the case. 987 00:35:21,414 --> 00:35:23,748 I gotta get some sleep. 988 00:35:23,749 --> 00:35:27,002 Thanks, I guess. 989 00:35:28,629 --> 00:35:30,922 OK, are you ready to lay down? 990 00:35:30,923 --> 00:35:31,923 I got your head. 991 00:35:31,924 --> 00:35:33,133 Nice and slow. 992 00:35:33,134 --> 00:35:35,302 One, two, three. 993 00:35:36,679 --> 00:35:37,679 OK. 994 00:35:37,680 --> 00:35:38,806 How's that feel? 995 00:35:41,684 --> 00:35:42,934 Lifting up now. 996 00:35:52,820 --> 00:35:54,488 Keep going. 997 00:35:57,116 --> 00:36:00,369 And... that ought to do it right about there. 998 00:36:02,121 --> 00:36:03,955 215? 999 00:36:03,956 --> 00:36:05,875 Oh, that's in kilos. 1000 00:36:08,169 --> 00:36:09,795 OK, team. 1001 00:36:15,426 --> 00:36:17,135 It's not that much over 450. 1002 00:36:17,136 --> 00:36:19,971 No, we can't risk breaking our CT on a holiday weekend. 1003 00:36:19,972 --> 00:36:22,098 Would the medics take him while he's intubated? 1004 00:36:22,099 --> 00:36:24,476 If I go along for the ride, I could still get a nap in 1005 00:36:24,477 --> 00:36:26,020 before my night shift. 1006 00:36:29,982 --> 00:36:32,942 474. 1007 00:36:32,943 --> 00:36:34,819 Our CT can't handle your weight, 1008 00:36:34,820 --> 00:36:38,198 but we're gonna take you over to Presbyterian Hospital. 1009 00:36:38,199 --> 00:36:40,158 Road trip. 1010 00:36:40,159 --> 00:36:42,453 I'll keep you company the whole time. 1011 00:36:44,997 --> 00:36:47,040 Sorry for all this trouble. 1012 00:36:47,041 --> 00:36:48,249 It's OK. 1013 00:36:48,250 --> 00:36:49,710 This is what we do. 1014 00:36:55,174 --> 00:36:56,758 So sub Q starts deep. 1015 00:36:56,759 --> 00:36:57,884 You want to bury the knot. 1016 00:36:57,885 --> 00:36:59,427 Yeah, I've done these before. 1017 00:36:59,428 --> 00:37:01,721 Joy, how do we cut the ends? 1018 00:37:01,722 --> 00:37:03,264 Short. Slide to the knot. 1019 00:37:03,265 --> 00:37:04,265 Turn 45 degrees. 1020 00:37:04,266 --> 00:37:06,392 Excellent. 1021 00:37:06,393 --> 00:37:08,228 Um, Dr. Langdon, we have a case. 1022 00:37:08,229 --> 00:37:09,229 It'll have to wait. 1023 00:37:09,230 --> 00:37:10,355 It could be urgent. 1024 00:37:10,356 --> 00:37:14,192 Find Robby or Al-Hashimi. 1025 00:37:14,193 --> 00:37:16,528 This girl is wasted. 1026 00:37:16,529 --> 00:37:18,571 Drunk as a skunk. 1027 00:37:18,572 --> 00:37:20,365 Should we check her blood alcohol level? 1028 00:37:20,366 --> 00:37:21,991 No, it won't change what we do. 1029 00:37:21,992 --> 00:37:23,535 She can go home when she has a steady gait. 1030 00:37:23,536 --> 00:37:25,703 I already sent one off. 1031 00:37:25,704 --> 00:37:28,373 Joy, do you want to guess her blood alcohol? 1032 00:37:28,374 --> 00:37:29,874 Why would I want to do that? 1033 00:37:29,875 --> 00:37:31,961 I don't know. 'Cause it's fun. 1034 00:37:37,925 --> 00:37:39,592 When will you have a bed? 1035 00:37:39,593 --> 00:37:41,427 I'm not sure she needs a bed. 1036 00:37:41,428 --> 00:37:43,221 She's a febrile infant. 1037 00:37:43,222 --> 00:37:45,223 Who is clearly over a month old and looks amazing. 1038 00:37:45,224 --> 00:37:47,141 Every marker is normal. She has a cold virus. 1039 00:37:47,142 --> 00:37:48,893 Infants with rhinovirus can still have 1040 00:37:48,894 --> 00:37:50,311 a serious bacterial infection. 1041 00:37:50,312 --> 00:37:51,813 Not this one. 1042 00:37:51,814 --> 00:37:53,439 We send kids like this home all the time. 1043 00:37:53,440 --> 00:37:56,443 Except this one doesn't have a home or a parent. 1044 00:37:57,778 --> 00:37:59,320 All right. 1045 00:37:59,321 --> 00:38:01,072 I can't put a kid with a virus in the nursery, 1046 00:38:01,073 --> 00:38:03,324 and I can't waste a private room on a healthy baby. 1047 00:38:03,325 --> 00:38:04,742 Then what do you propose? 1048 00:38:04,743 --> 00:38:06,744 CYF can place her in emergency foster care 1049 00:38:06,745 --> 00:38:08,246 by tomorrow morning. 1050 00:38:08,247 --> 00:38:10,456 You want to leave her down here overnight? 1051 00:38:10,457 --> 00:38:12,876 Seems to be the standard of care these days. 1052 00:38:12,877 --> 00:38:14,210 Have your attending give me a call. 1053 00:38:14,211 --> 00:38:15,253 Will do. 1054 00:38:15,254 --> 00:38:16,588 I can't believe this. 1055 00:38:16,589 --> 00:38:18,381 Let CYF know it's very urgent. 1056 00:38:18,382 --> 00:38:19,883 Got it. 1057 00:38:19,884 --> 00:38:22,427 This is turning into quite the day. 1058 00:38:22,428 --> 00:38:24,304 You know, I've been thinking 1059 00:38:24,305 --> 00:38:25,889 about applying for a fellowship. 1060 00:38:25,890 --> 00:38:27,807 I thought you had a job lined up in New Jersey. 1061 00:38:27,808 --> 00:38:29,934 I did, to be close to my mom. 1062 00:38:29,935 --> 00:38:33,479 But she sold her house to travel the world 1063 00:38:33,480 --> 00:38:35,481 with her new boyfriend. 1064 00:38:35,482 --> 00:38:37,317 So what's the point of New Jersey? 1065 00:38:37,318 --> 00:38:38,776 Yeah, good question. 1066 00:38:38,777 --> 00:38:40,361 Which fellowship? 1067 00:38:40,362 --> 00:38:44,115 I've narrowed it down to ultrasound, toxicology, 1068 00:38:44,116 --> 00:38:47,327 and sports medicine. 1069 00:38:47,328 --> 00:38:48,703 Those are very disparate fields 1070 00:38:48,704 --> 00:38:50,204 leading to very different careers. 1071 00:38:50,205 --> 00:38:51,372 I know. 1072 00:38:51,373 --> 00:38:53,458 I'm a little undecided. 1073 00:38:53,459 --> 00:38:55,084 Do you have research experience? 1074 00:38:55,085 --> 00:38:57,670 I was a part of a study on racial disparities 1075 00:38:57,671 --> 00:38:59,547 in health care until the White House 1076 00:38:59,548 --> 00:39:01,132 cut the funding last year. 1077 00:39:01,133 --> 00:39:03,509 Yeah. You are not alone. 1078 00:39:03,510 --> 00:39:06,471 Have you considered a geriatrics fellowship? 1079 00:39:06,472 --> 00:39:08,348 I have not. 1080 00:39:08,349 --> 00:39:10,475 I've seen your skills with the elderly, 1081 00:39:10,476 --> 00:39:12,644 and there are a lot of openings. 1082 00:39:12,645 --> 00:39:14,479 It might be your best shot. 1083 00:39:14,480 --> 00:39:17,315 Think about it. 1084 00:39:17,316 --> 00:39:18,316 Last stitch. 1085 00:39:18,317 --> 00:39:19,359 You want me to cut? 1086 00:39:19,360 --> 00:39:20,861 I got it. 1087 00:39:22,529 --> 00:39:23,863 It looks good. 1088 00:39:23,864 --> 00:39:25,990 OK. Let's pull the traction suture. 1089 00:39:25,991 --> 00:39:27,368 With pleasure. 1090 00:39:29,328 --> 00:39:31,454 OK, Jackie. 1091 00:39:31,455 --> 00:39:32,830 - Jackie. - Stop it. 1092 00:39:32,831 --> 00:39:33,831 Stop. 1093 00:39:33,832 --> 00:39:35,166 All done. 1094 00:39:35,167 --> 00:39:36,709 All done with what? 1095 00:39:36,710 --> 00:39:38,378 Sewing up your tongue. 1096 00:39:38,379 --> 00:39:40,129 What happened to my tongue? 1097 00:39:40,130 --> 00:39:41,339 You bit it. 1098 00:39:41,340 --> 00:39:42,340 Ha. 1099 00:39:42,341 --> 00:39:43,967 No, I didn't. 1100 00:39:43,968 --> 00:39:45,843 That is called a blackout. 1101 00:39:45,844 --> 00:39:47,679 How much did you drink? 1102 00:39:47,680 --> 00:39:49,889 A couple Bloody Marys. 1103 00:39:49,890 --> 00:39:51,099 Only a couple? 1104 00:39:51,100 --> 00:39:53,267 I don't know. Maybe more. 1105 00:39:53,268 --> 00:39:56,020 It's a holiday, a pub crawl. 1106 00:39:56,021 --> 00:39:58,690 Do you usually have a couple cocktails every day? 1107 00:39:58,691 --> 00:39:59,941 Only on weekends. 1108 00:39:59,942 --> 00:40:01,275 How about during the week? 1109 00:40:01,276 --> 00:40:02,694 Nothing much. 1110 00:40:02,695 --> 00:40:07,699 Just wine with dinner or a few beers. 1111 00:40:07,700 --> 00:40:10,868 Maybe we should recommend rehab? 1112 00:40:10,869 --> 00:40:11,995 Yeah. 1113 00:40:11,996 --> 00:40:13,414 We could try. 1114 00:40:18,002 --> 00:40:20,420 Ready to roll. 1115 00:40:20,421 --> 00:40:22,046 How are you feeling? 1116 00:40:22,047 --> 00:40:23,423 My pain is a two. 1117 00:40:23,424 --> 00:40:25,049 We got meds if you need them. 1118 00:40:25,050 --> 00:40:26,551 Scan will be quicker than the ride to Presby. 1119 00:40:26,552 --> 00:40:27,927 We'll keep trying to reach your sister. 1120 00:40:27,928 --> 00:40:29,554 - You guys are the best. - See you later. 1121 00:40:29,555 --> 00:40:31,389 Can I put a new patient in T1? 1122 00:40:31,390 --> 00:40:33,725 Uh, no, I kind of want to leave one trauma room open. 1123 00:40:33,726 --> 00:40:37,395 Why don't you double up the north if you have to? 1124 00:40:37,396 --> 00:40:40,273 Mr. Digby? 1125 00:40:40,274 --> 00:40:42,191 - It's just Digby. - Right. 1126 00:40:42,192 --> 00:40:44,736 We've been looking all over. Where you been? 1127 00:40:44,737 --> 00:40:46,237 With Louie. 1128 00:40:46,238 --> 00:40:47,739 You've been in there for an hour? 1129 00:40:47,740 --> 00:40:49,782 He was my friend. 1130 00:40:49,783 --> 00:40:51,743 - I had a lot to say. - Hmm. 1131 00:40:51,744 --> 00:40:54,078 Well, let's get you back to your bed. 1132 00:40:56,081 --> 00:40:57,957 Louie got his wings. 1133 00:40:57,958 --> 00:40:59,917 - Dr. Robby. - Dr. Robby. 1134 00:40:59,918 --> 00:41:01,461 We picked up a patient together. 1135 00:41:01,462 --> 00:41:02,920 Teamwork! 1136 00:41:02,921 --> 00:41:04,422 It's a concerning bullous rash. 1137 00:41:04,423 --> 00:41:06,007 We might need a biopsy for pemphigus vulgaris. 1138 00:41:06,008 --> 00:41:07,467 It's phytophotodermatitis. 1139 00:41:07,468 --> 00:41:09,260 - What? - I asked. 1140 00:41:09,261 --> 00:41:11,345 He was making three gallons of margaritas for a party, 1141 00:41:11,346 --> 00:41:13,598 squeezing fresh limes out in the sun. 1142 00:41:13,599 --> 00:41:15,058 Let's go take a peek. 1143 00:41:15,059 --> 00:41:16,935 I don't need to see it again. 1144 00:41:19,438 --> 00:41:20,897 How's it going out there? 1145 00:41:20,898 --> 00:41:22,440 Standing room only. 1146 00:41:22,441 --> 00:41:23,900 If I call the fire department, will they clear 1147 00:41:23,901 --> 00:41:25,151 - that waiting room? - I wish. 1148 00:41:25,152 --> 00:41:26,277 What's up? 1149 00:41:26,278 --> 00:41:28,321 12 patients need med refills. 1150 00:41:28,322 --> 00:41:29,906 Shouldn't they see their doctors? 1151 00:41:29,907 --> 00:41:31,657 With the Medicaid cuts, we are their doctor. 1152 00:41:31,658 --> 00:41:33,409 No, I can't e-prescribe to their pharmacies. 1153 00:41:33,410 --> 00:41:35,119 So get out your pen. Go old school. 1154 00:41:35,120 --> 00:41:37,455 Dana, on what? 1155 00:41:37,456 --> 00:41:39,916 Nordt, you got the security pads? 1156 00:41:39,917 --> 00:41:41,167 Sure do. 1157 00:41:41,168 --> 00:41:42,960 Just need a patient sticker. 1158 00:41:42,961 --> 00:41:45,338 - Any other questions? - Yeah. 1159 00:41:45,339 --> 00:41:47,758 What would have happened if you weren't here today? 1160 00:41:48,926 --> 00:41:50,802 You'd all be curled up in the fetal position, 1161 00:41:50,803 --> 00:41:53,137 crying like babies. 1162 00:41:53,138 --> 00:41:54,722 Were you wearing flip-flops? 1163 00:41:54,723 --> 00:41:56,057 I was. 1164 00:41:56,058 --> 00:41:57,975 - What is it? - Phytophotodermatitis. 1165 00:41:57,976 --> 00:42:00,186 Otherwise known as margarita burn. 1166 00:42:00,187 --> 00:42:01,729 For some people, limes plus sunshine 1167 00:42:01,730 --> 00:42:03,064 can cause a horrible rash. 1168 00:42:03,065 --> 00:42:05,191 This is all because of limes? 1169 00:42:05,192 --> 00:42:08,027 Have you ever squeezed limes outside in the sun before? 1170 00:42:08,028 --> 00:42:09,695 I don't think so. 1171 00:42:09,696 --> 00:42:12,156 You will feel better after a day of steroid pills. 1172 00:42:12,157 --> 00:42:14,075 But once these heal, you gotta wear sunscreen. 1173 00:42:14,076 --> 00:42:16,202 Because these blisters can turn into dark scars 1174 00:42:16,203 --> 00:42:17,495 and stay a while if you don't. 1175 00:42:19,123 --> 00:42:22,458 I'll be right back with your aftercare instructions. 1176 00:42:22,459 --> 00:42:24,377 - Hey, Robby. - Yep. 1177 00:42:24,378 --> 00:42:26,546 My, uh... my hospice patient Roxie 1178 00:42:26,547 --> 00:42:28,506 is still in a ton of pain. 1179 00:42:28,507 --> 00:42:29,799 Where are we with the morphine? 1180 00:42:29,800 --> 00:42:31,717 10 milligrams an hour. 1181 00:42:31,718 --> 00:42:34,303 OK, you can bolus another 2 and go up to 12. 1182 00:42:34,304 --> 00:42:35,680 I will let Princess know. 1183 00:42:35,681 --> 00:42:37,014 12 an hour is a lot. 1184 00:42:37,015 --> 00:42:38,516 Yeah, on top of the MS Contin, 1185 00:42:38,517 --> 00:42:41,477 she could stop breathing. 1186 00:42:41,478 --> 00:42:44,814 Are you familiar with the doctrine of double effect? 1187 00:42:44,815 --> 00:42:46,858 - Not really. - No. 1188 00:42:46,859 --> 00:42:49,360 It is an ethical principle in palliative care. 1189 00:42:49,361 --> 00:42:51,070 We treat pain. 1190 00:42:51,071 --> 00:42:53,030 And if, in doing so, there's a negative side effect, 1191 00:42:53,031 --> 00:42:54,699 we accept it. 1192 00:42:54,700 --> 00:42:57,535 Even if the negative side effect is death? 1193 00:42:57,536 --> 00:43:00,164 In some cases, that could be the best outcome. 1194 00:43:05,961 --> 00:43:07,420 Maybe the nurse has it. 1195 00:43:07,421 --> 00:43:10,131 Emma. Emma, where does... 1196 00:43:10,132 --> 00:43:11,883 Maybe the fax ran out of paper? 1197 00:43:11,884 --> 00:43:14,594 No, there is enough paper. I don't know what's wrong. 1198 00:43:14,595 --> 00:43:16,095 - Could be in another room. - We should call IT. 1199 00:43:16,096 --> 00:43:18,097 You want me to check every room? 1200 00:43:18,098 --> 00:43:19,724 How are we gonna get through this mess? 1201 00:43:19,725 --> 00:43:22,685 I was about to ask you. 1202 00:43:22,686 --> 00:43:24,228 Ask the pharmacist. 1203 00:43:24,229 --> 00:43:25,771 She can't leave the PDS. 1204 00:43:25,772 --> 00:43:27,565 Nothing's getting done here. 1205 00:43:27,566 --> 00:43:32,138 Sync and corrections by btsix www.addic7ed.com