1 00:00:10,225 --> 00:00:13,897 Sync and corrections by btsix www.addic7ed.com 2 00:00:15,633 --> 00:00:17,134 - You know this guy? - Orlando Diaz. 3 00:00:17,135 --> 00:00:18,844 We were treating him for DKA when he eloped. 4 00:00:18,845 --> 00:00:20,470 - How far did he fall? - 20 feet or so. 5 00:00:20,471 --> 00:00:21,989 - Anyone see him pass out? - No. 6 00:00:21,990 --> 00:00:24,033 They went looking for him after he didn't answer his radio. 7 00:00:24,034 --> 00:00:25,642 Pupils equal but sluggish. 8 00:00:25,643 --> 00:00:26,866 He left against medical advice. 9 00:00:26,867 --> 00:00:30,856 On my count, three, two, one. 10 00:00:30,857 --> 00:00:33,150 Dr. Ellis on the case. Day shift, we got this. 11 00:00:33,151 --> 00:00:35,527 - I'm staying. - Continuity of care. 12 00:00:35,528 --> 00:00:36,945 Dr. Al-Hashimi, why don't you go cover 13 00:00:36,946 --> 00:00:38,196 sign-out rounds with Dr. Abbot? 14 00:00:38,197 --> 00:00:39,531 - Shen, you too. - Got it. 15 00:00:39,532 --> 00:00:41,617 OK, let me know if you need anything. 16 00:00:41,618 --> 00:00:44,202 - Lungs are up bilaterally. - Pelvis is stable. 17 00:00:44,203 --> 00:00:48,081 Right tib-fib hematoma, deformed right forearm. 18 00:00:48,082 --> 00:00:50,083 Ruptured TM on the left with sero-sanguinous fluid. 19 00:00:50,084 --> 00:00:51,877 That means basilar skull fracture. 20 00:00:51,878 --> 00:00:53,670 We've got a diabetic patient, 20-foot fall. 21 00:00:53,671 --> 00:00:56,006 BP 204 over 98, pulse 56. 22 00:00:56,007 --> 00:00:57,674 Dr. Mohan, what do those numbers indicate? 23 00:00:57,675 --> 00:00:59,509 I'm trying to treat the patient. 24 00:00:59,510 --> 00:01:00,802 It's the Cushing's reflex. 25 00:01:00,803 --> 00:01:02,888 From increased intracranial pressure. 26 00:01:02,889 --> 00:01:05,223 Yeah, we need to get him to CT right away. 27 00:01:05,224 --> 00:01:06,892 No free fluid in the belly. 28 00:01:06,893 --> 00:01:10,228 - Any family to notify? - Wife and three kids. 29 00:01:10,229 --> 00:01:12,356 Is there a card to sign for Robby? 30 00:01:12,357 --> 00:01:14,358 No, he said no card, no presents. 31 00:01:14,359 --> 00:01:15,776 Oh. Was there a cake? 32 00:01:15,777 --> 00:01:17,361 Oh, he didn't want that either. 33 00:01:17,362 --> 00:01:19,321 That sucks. I need some cake. 34 00:01:19,322 --> 00:01:21,531 Patient was injured when they raided a restaurant. 35 00:01:21,532 --> 00:01:23,325 And they actually arrested the nurse? 36 00:01:23,326 --> 00:01:25,869 - With a takedown and zip ties. - Damn. 37 00:01:25,870 --> 00:01:28,258 Crus, you, uh, know the computer downtime drill? 38 00:01:28,259 --> 00:01:29,456 Yeah, no biggie. 39 00:01:29,457 --> 00:01:31,280 I prefer to treat 'em without labs and X-rays. 40 00:01:31,281 --> 00:01:32,354 Welcome back. 41 00:01:32,355 --> 00:01:34,544 If you do have orders for labs and X-rays, 42 00:01:34,545 --> 00:01:36,588 clipboards go here. 43 00:01:36,589 --> 00:01:39,383 If it's just nursing orders, here. 44 00:01:39,384 --> 00:01:41,176 Please write neatly, for God's sake. 45 00:01:41,177 --> 00:01:43,720 Oh, Monica, this is Nazely, new intern. 46 00:01:43,721 --> 00:01:46,557 - I don't need to know that. - So nice to meet you. 47 00:01:47,642 --> 00:01:49,393 Looks like you and me, Jack. 48 00:01:49,394 --> 00:01:50,811 Yeah, who's our senior? 49 00:01:50,812 --> 00:01:53,939 - Dr. Henderson. - Excellent. 50 00:01:53,940 --> 00:01:55,816 Night shift's on Crus control. 51 00:01:55,817 --> 00:01:57,943 You hear ICE brought us a patient? 52 00:01:57,944 --> 00:01:59,736 Oh, yeah? How'd that go? 53 00:01:59,737 --> 00:02:00,904 There was some collateral damage. 54 00:02:00,905 --> 00:02:02,406 They arrested Jesse. 55 00:02:02,407 --> 00:02:04,408 - For what? - Assaulting a federal officer. 56 00:02:04,409 --> 00:02:05,909 Are you fucking kidding me? 57 00:02:05,910 --> 00:02:07,285 Oh, Dr. Al-Hashimi, 58 00:02:07,286 --> 00:02:09,579 this is Nazely Toomarian... new intern. 59 00:02:16,295 --> 00:02:18,255 OK, everybody, let's huddle up. 60 00:02:18,256 --> 00:02:19,589 Before we start, 61 00:02:19,590 --> 00:02:21,174 let me address the elephant in the room. 62 00:02:21,175 --> 00:02:22,968 For those of you who don't know, 63 00:02:22,969 --> 00:02:24,428 Jesse tried to intervene 64 00:02:24,429 --> 00:02:26,263 when a federal agent was handling his patient, 65 00:02:26,264 --> 00:02:28,598 and both he and the patient were taken away by ICE. 66 00:02:28,599 --> 00:02:30,267 - Did he punch the guy? - No. 67 00:02:30,268 --> 00:02:32,728 He put out a hand to stop him, made physical contact. 68 00:02:32,729 --> 00:02:34,271 It was a little bit more than that. 69 00:02:34,272 --> 00:02:35,897 The hospital lawyers are on the case, 70 00:02:35,898 --> 00:02:38,233 and we will brief the staff every 12 hours 71 00:02:38,234 --> 00:02:39,943 at sign-out rounds with an official update. 72 00:02:39,944 --> 00:02:42,446 In the meantime, don't feed the rumor mill. 73 00:02:42,447 --> 00:02:44,781 You may have also heard that new grad nurse Emma here 74 00:02:44,782 --> 00:02:47,284 - was assaulted by a patient. - I... I'm fine. 75 00:02:47,285 --> 00:02:48,952 Please don't forget "code hula hoop," 76 00:02:48,953 --> 00:02:50,287 and with risky patients, 77 00:02:50,288 --> 00:02:52,622 always keep a path to the door clear. 78 00:02:52,623 --> 00:02:54,291 Sounds like one hell of a day. 79 00:02:54,292 --> 00:02:56,126 And we're still dealing with downtime, 80 00:02:56,127 --> 00:02:58,295 so day shift should brief night residents 81 00:02:58,296 --> 00:02:59,337 about the protocol... 82 00:02:59,338 --> 00:03:00,547 Hey! 83 00:03:00,548 --> 00:03:01,882 Oh, all right! 84 00:03:01,883 --> 00:03:04,468 Oh, thank God. 85 00:03:04,469 --> 00:03:05,802 Yeah, not so fast. 86 00:03:05,803 --> 00:03:07,679 Every chart from the last five hours 87 00:03:07,680 --> 00:03:10,015 needs to be scanned into the Electronic Health Record 88 00:03:10,016 --> 00:03:12,100 and checked for accuracy... 89 00:03:12,101 --> 00:03:14,269 - Um, whose job is that? - Day shift. 90 00:03:14,270 --> 00:03:16,188 With a completed and signed T-sheet. 91 00:03:16,189 --> 00:03:17,939 - Are you kidding me? - That's gonna take forever. 92 00:03:17,940 --> 00:03:19,649 We will set up stations for scanning. 93 00:03:19,650 --> 00:03:21,485 OK, everybody, let's get moving. 94 00:03:21,486 --> 00:03:23,653 Triage is 20 behind. Gotta help 'em clean up. 95 00:03:23,654 --> 00:03:24,863 I'm skipping rounds. 96 00:03:24,864 --> 00:03:26,698 Consider yourself lucky. 97 00:03:26,699 --> 00:03:29,326 Should we join them? 98 00:03:29,327 --> 00:03:30,994 Might as well witness the magic. 99 00:03:30,995 --> 00:03:33,246 It's like changing of the guard at Buckingham Palace. 100 00:03:33,247 --> 00:03:35,165 Except we're allowed to smile. 101 00:03:35,166 --> 00:03:37,375 "Smile though your heart is aching." 102 00:03:38,503 --> 00:03:39,628 Plain films, right tib-fib 103 00:03:39,629 --> 00:03:41,546 and right forearm after CT. 104 00:03:41,547 --> 00:03:43,548 Got the chem-8. Blood sugar's 284. 105 00:03:43,549 --> 00:03:46,176 That's not too bad. Potassium looks good. 106 00:03:46,177 --> 00:03:48,470 Mm-hmm. Anion gap's up at 14. 107 00:03:48,471 --> 00:03:49,679 It was 24 this morning. 108 00:03:49,680 --> 00:03:51,348 He's definitely improving. 109 00:03:51,349 --> 00:03:52,724 The DKA is resolving. 110 00:03:52,725 --> 00:03:54,351 So what made him pass out? 111 00:03:54,352 --> 00:03:56,186 It's hot as hell out there. 112 00:03:56,187 --> 00:03:58,355 He could have been dehydrated from sweating. 113 00:03:58,356 --> 00:04:01,858 Or he could have had an N-STEMI or a posterior CVA. 114 00:04:01,859 --> 00:04:03,319 Ready to roll. 115 00:04:05,029 --> 00:04:07,739 - I can babysit him at CT. - Thank you. 116 00:04:07,740 --> 00:04:10,034 I'll stay in case he needs the OR. 117 00:04:11,828 --> 00:04:13,745 Hey, we're back up. 118 00:04:13,746 --> 00:04:15,747 It's about time. 119 00:04:15,748 --> 00:04:17,207 - Ooh, Robby. - Yeah. 120 00:04:17,208 --> 00:04:19,417 I got intel on where ICE has taken Jesse. 121 00:04:19,418 --> 00:04:20,710 Intel from who? 122 00:04:20,711 --> 00:04:22,546 Uh, my brother-in-law's a cop. 123 00:04:22,547 --> 00:04:24,881 So he'll be processed at DHS Southside 124 00:04:24,882 --> 00:04:27,384 and then transferred to ICE detention in Clearfield. 125 00:04:27,385 --> 00:04:28,718 Clearfield? That's two hours away. 126 00:04:28,719 --> 00:04:30,220 Mm-hmm. 127 00:04:30,221 --> 00:04:32,305 OK, I'll let the hospital attorneys know. 128 00:04:32,306 --> 00:04:34,224 - How are you doing, Oliver? - Alive and kicking. 129 00:04:34,225 --> 00:04:35,600 Uh, Mr. Haas. 130 00:04:35,601 --> 00:04:37,894 Pulmonary edema after missed dialysis, 131 00:04:37,895 --> 00:04:40,522 now stable with his son Mason at the bedside. 132 00:04:40,523 --> 00:04:42,107 - Hello. - I'm Dr. Shen. 133 00:04:42,108 --> 00:04:43,358 I'll be back. 134 00:04:43,359 --> 00:04:44,401 Dialysis tech says 135 00:04:44,402 --> 00:04:46,194 I'm off the machine at 10:42. 136 00:04:46,195 --> 00:04:48,280 Hit the call light, and I'll come running. 137 00:04:48,281 --> 00:04:50,408 South 21 next... 138 00:04:52,368 --> 00:04:54,160 Mr. Digby. 139 00:04:54,161 --> 00:04:55,745 J-just Digby. 140 00:04:55,746 --> 00:04:57,414 Dr. Mohan's patient. 141 00:04:57,415 --> 00:04:59,624 Forearm cellulitis, admit med-surge. 142 00:04:59,625 --> 00:05:01,251 - Awaiting a bed. - I can take him. 143 00:05:01,252 --> 00:05:03,086 Sold to Dr. Toomarian. 144 00:05:03,087 --> 00:05:05,463 Moving right along. 145 00:05:05,464 --> 00:05:07,257 Get enough to eat? 146 00:05:07,258 --> 00:05:09,593 We'll be back. 147 00:05:09,594 --> 00:05:13,054 Lillian Stegman. Tweaked her knee water-skiing. 148 00:05:13,055 --> 00:05:15,098 Doing a 360 off a 5-foot ramp. 149 00:05:15,099 --> 00:05:16,558 Ooh, respect. 150 00:05:16,559 --> 00:05:17,893 X-rays ordered in triage. 151 00:05:17,894 --> 00:05:19,144 That was hours ago. 152 00:05:19,145 --> 00:05:21,396 Ma'am, I'm Dr. Crus Henderson. 153 00:05:21,397 --> 00:05:23,607 Let's get you home real fast. 154 00:05:23,608 --> 00:05:25,358 - That would be wonderful. - OK, heading to North. 155 00:05:25,359 --> 00:05:27,110 Thank you. 156 00:05:27,111 --> 00:05:29,613 Looks like our first scanning station is almost ready. 157 00:05:29,614 --> 00:05:32,365 Whitaker, Santos, after rounds, this will be your post. 158 00:05:32,366 --> 00:05:35,035 - Seriously? - For... how long? 159 00:05:35,036 --> 00:05:37,162 Till we mop up this mess. 160 00:05:37,163 --> 00:05:38,830 And away we go. 161 00:05:38,831 --> 00:05:40,999 All right, now you know everything 162 00:05:41,000 --> 00:05:42,250 there is to know about rounds. 163 00:05:42,251 --> 00:05:43,418 Fascinating, right? 164 00:05:43,419 --> 00:05:45,587 Uh... yeah. 165 00:05:45,588 --> 00:05:47,798 Here, I got something better for you. 166 00:05:49,592 --> 00:05:52,469 So, Digby, we're gonna find you some new clothes, 167 00:05:52,470 --> 00:05:54,262 but my friend Emma and I wondered if you'd like 168 00:05:54,263 --> 00:05:56,848 to get cleaned up a bit first. 169 00:05:56,849 --> 00:05:58,642 I already had a shower. 170 00:05:58,643 --> 00:06:00,226 I know, and you look good. 171 00:06:00,227 --> 00:06:02,312 But the offer also comes with a shave and a haircut, 172 00:06:02,313 --> 00:06:03,563 if you're interested. 173 00:06:03,564 --> 00:06:04,814 No pressure... like I said, 174 00:06:04,815 --> 00:06:05,983 you already look great. 175 00:06:07,360 --> 00:06:10,362 - Sure, I guess. - Fantastic. 176 00:06:10,363 --> 00:06:12,364 All right, kid, fill that basin with some warm water 177 00:06:12,365 --> 00:06:14,033 and lather him up. 178 00:06:16,953 --> 00:06:19,454 - Hey, stay safe out there. - Back at you in here. 179 00:06:19,455 --> 00:06:21,456 Hey, Cary. 180 00:06:21,457 --> 00:06:23,541 You were on scene with Orlando, right? 181 00:06:23,542 --> 00:06:26,002 Did you notice anything about his fall? 182 00:06:26,003 --> 00:06:27,504 Like what? 183 00:06:27,505 --> 00:06:30,674 Like, um, if there was a break in the railing 184 00:06:30,675 --> 00:06:33,677 or if there were security cameras? 185 00:06:33,678 --> 00:06:35,220 Too busy working on the guy... 186 00:06:35,221 --> 00:06:37,681 IV, intubation, backboard, splint. 187 00:06:37,682 --> 00:06:38,848 Thanks. 188 00:06:38,849 --> 00:06:40,517 Oh, two names is a start. 189 00:06:40,518 --> 00:06:42,227 Pretty soon, we'll retire the clipboards. 190 00:06:42,228 --> 00:06:43,561 Baby Jane Doe in Pedes? 191 00:06:43,562 --> 00:06:45,480 Uh, yeah, abandoned 192 00:06:45,481 --> 00:06:48,191 in the waiting room bathroom at 7:30 a.m. 193 00:06:48,192 --> 00:06:50,694 - Safe haven drop-off? - No, she's too old for that. 194 00:06:50,695 --> 00:06:52,529 - At least two months. - I'll take her. 195 00:06:52,530 --> 00:06:54,698 Awaiting foster placement by CYF. 196 00:06:54,699 --> 00:06:57,033 - What if the mom comes back? - Call the cops. 197 00:06:57,034 --> 00:06:58,451 Day shift, get to work scanning. 198 00:06:58,452 --> 00:07:00,036 Night shift, the room numbers 199 00:07:00,037 --> 00:07:02,205 on top of the dry-erase board need a doctor. 200 00:07:02,206 --> 00:07:05,083 - Who's in BH-1? - Psych hold, danger to self. 201 00:07:05,084 --> 00:07:06,543 What's the story? 202 00:07:06,544 --> 00:07:08,420 Doctors King and Langdon were on the case. 203 00:07:08,421 --> 00:07:10,672 It's a sad story... she says her 5-year-old 204 00:07:10,673 --> 00:07:12,549 snuck into the back seat of the car to take a nap. 205 00:07:12,550 --> 00:07:14,217 Heat stroke. 206 00:07:14,218 --> 00:07:16,594 Mom was extremely distraught. Walked out into traffic. 207 00:07:16,595 --> 00:07:18,179 Grady Barnhill, wheezing 208 00:07:18,180 --> 00:07:19,764 and not responding to albuterol. 209 00:07:19,765 --> 00:07:21,683 Pulse ox 87. His mother, Naomi. 210 00:07:21,684 --> 00:07:23,852 - OK, Trauma Two's open. - On our way. 211 00:07:23,853 --> 00:07:26,396 - Uh, Mom, history of asthma? - His whole life. 212 00:07:26,397 --> 00:07:28,481 - Never this bad. - Barely moving air. 213 00:07:28,482 --> 00:07:31,109 Using all his accessory muscles. 214 00:07:31,110 --> 00:07:32,569 Call RT! 215 00:07:32,570 --> 00:07:35,321 Uh, continuous nebs, 20 milligrams an hour. 216 00:07:35,322 --> 00:07:36,823 We have a home nebulizer. 217 00:07:36,824 --> 00:07:39,743 I've been giving him albuterol every hour. 218 00:07:39,744 --> 00:07:40,827 Ready? 219 00:07:40,828 --> 00:07:43,747 On my count, one, two, three. 220 00:07:43,748 --> 00:07:45,248 Does he take any other medications? 221 00:07:45,249 --> 00:07:46,750 Just the albuterol. 222 00:07:46,751 --> 00:07:48,251 He used to be on montelukast and Symbicort. 223 00:07:48,252 --> 00:07:49,878 Why did you stop that? 224 00:07:49,879 --> 00:07:51,921 Because he lost his Medicaid two months ago. 225 00:07:51,922 --> 00:07:53,757 He's so tight, nothing's getting through. 226 00:07:53,758 --> 00:07:55,300 - Mel, EpiPen. - On it. 227 00:07:55,301 --> 00:07:56,801 0.3 milligrams. 228 00:07:56,802 --> 00:07:59,929 That may open his lungs so the nebs can work. 229 00:07:59,930 --> 00:08:01,973 All right, Grady, shot in the thigh. 230 00:08:06,979 --> 00:08:08,813 Hey. 231 00:08:08,814 --> 00:08:10,273 Something to scan? 232 00:08:10,274 --> 00:08:11,816 Critical labs on North Three. 233 00:08:11,817 --> 00:08:13,443 Oh, it's, uh... it's not my patient. 234 00:08:13,444 --> 00:08:14,779 She's about to be. 235 00:08:16,614 --> 00:08:18,948 I'm, uh... I'm off the clock, so... 236 00:08:18,949 --> 00:08:21,576 These were ordered three hours ago from triage, 237 00:08:21,577 --> 00:08:24,079 so, technically, she is a day-shift patient. 238 00:08:24,080 --> 00:08:25,330 Just get the intern started. 239 00:08:25,331 --> 00:08:26,915 I got a meeting upstairs with admin 240 00:08:26,916 --> 00:08:28,917 to get things back on track. 241 00:08:28,918 --> 00:08:30,627 Sorry. Everyone else is tied up. 242 00:08:30,628 --> 00:08:32,003 That's OK. 243 00:08:32,004 --> 00:08:33,213 How'd you get stuck on night shift 244 00:08:33,214 --> 00:08:34,380 for your first rotation? 245 00:08:34,381 --> 00:08:35,840 Just lucky, I guess. 246 00:08:35,841 --> 00:08:37,383 Yeah, if you like a good horror movie. 247 00:08:38,719 --> 00:08:40,678 - Where was med school? - Uh, UC Irvine. 248 00:08:40,679 --> 00:08:42,472 - California, right? - Yep. 249 00:08:42,473 --> 00:08:43,723 Pittsburgh's a little different. 250 00:08:43,724 --> 00:08:44,974 Yeah, a lot more humidity. 251 00:08:44,975 --> 00:08:46,017 Yeah, that'll go away 252 00:08:46,018 --> 00:08:47,977 with your first foot of snow. 253 00:08:47,978 --> 00:08:50,730 Uh, hi, Mrs. Davis. 254 00:08:50,731 --> 00:08:52,816 I am Dr. McKay. This is Doctor... 255 00:08:52,817 --> 00:08:55,026 - Toomarian. - Hello. 256 00:08:55,027 --> 00:08:58,154 Uh, your labs show a lot of inflammation in your liver. 257 00:08:58,155 --> 00:09:01,533 - Is that why I'm so nauseated? - Definitely, yeah. 258 00:09:01,534 --> 00:09:04,661 Have you, um, noticed a change in your skin coloration? 259 00:09:04,662 --> 00:09:06,663 I've been using this bronzing cream 260 00:09:06,664 --> 00:09:09,332 so I don't look like a ghost in my bathing suit. 261 00:09:09,333 --> 00:09:11,334 Do you remember the name of the bronzer? 262 00:09:11,335 --> 00:09:12,836 It could have a chemical that can cause... 263 00:09:12,837 --> 00:09:14,879 Oh, no, no, it's 100% natural. 264 00:09:14,880 --> 00:09:18,174 - It's DHA from sugar beets. - OK. 265 00:09:18,175 --> 00:09:20,343 Why would my liver be inflamed? 266 00:09:20,344 --> 00:09:22,303 Uh, there's a lot of possibilities. 267 00:09:22,304 --> 00:09:24,139 Are you taking any prescription medications? 268 00:09:24,140 --> 00:09:25,140 Not a single one. 269 00:09:25,141 --> 00:09:26,683 - Tylenol? - God, no. 270 00:09:26,684 --> 00:09:28,893 We have to ask everybody about injection drug use. 271 00:09:28,894 --> 00:09:30,019 Never. 272 00:09:30,020 --> 00:09:31,688 Raw clams or oysters? 273 00:09:31,689 --> 00:09:33,523 I'm a vegan. 274 00:09:33,524 --> 00:09:35,733 One step at a time, OK? 275 00:09:35,734 --> 00:09:36,902 We'll be back. 276 00:09:38,237 --> 00:09:40,110 Digby, Haas, now on the big board. 277 00:09:40,111 --> 00:09:41,156 Progress. 278 00:09:41,157 --> 00:09:43,867 So he's just been waiting in the hall the whole time? 279 00:09:43,868 --> 00:09:46,745 OK, well, can you maybe get to him next? 280 00:09:47,997 --> 00:09:50,206 Thank you. 281 00:09:50,207 --> 00:09:51,833 Duke goes to CT, and they bump him. 282 00:09:51,834 --> 00:09:54,335 Yeah, he may end up waiting for hours over there. 283 00:09:54,336 --> 00:09:56,880 Oh, look at that. 7:15 already. 284 00:09:56,881 --> 00:09:58,798 Just a few more loose ends to tie up. 285 00:09:58,799 --> 00:10:02,051 You got more loose ends than a macramé wall hanging. 286 00:10:02,052 --> 00:10:04,345 My mom had one. Took up the whole goddamn wall. 287 00:10:04,346 --> 00:10:06,055 Seriously, you should think about signing out 288 00:10:06,056 --> 00:10:07,849 - and hitting the road. - Yeah, maybe you should too. 289 00:10:07,850 --> 00:10:09,559 Oh, that's right, you sent Lena home. 290 00:10:09,560 --> 00:10:11,436 Are you planning on calling in a replacement, 291 00:10:11,437 --> 00:10:13,229 or are you just gonna work till sunrise? 292 00:10:13,230 --> 00:10:14,689 If I have to. 293 00:10:14,690 --> 00:10:16,733 Oh, so you get to go the extra mile, 294 00:10:16,734 --> 00:10:19,235 and the rest of us just get accused of being martyrs. 295 00:10:19,236 --> 00:10:20,613 - Robby. - Excuse me. 296 00:10:22,573 --> 00:10:24,574 - What's the word? - No subdural, no epidural. 297 00:10:24,575 --> 00:10:26,576 Diffuse brain swelling with effacement 298 00:10:26,577 --> 00:10:28,244 and compression of the ventricles. 299 00:10:28,245 --> 00:10:30,455 C-spine? Chest-abdomen-pelvis? 300 00:10:30,456 --> 00:10:32,749 Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 301 00:10:32,750 --> 00:10:33,917 Which means I'm off the hook. 302 00:10:33,918 --> 00:10:35,418 I'll send Neurosurgery down. 303 00:10:35,419 --> 00:10:37,921 If he doesn't need the OR, why Neurosurgery? 304 00:10:37,922 --> 00:10:39,339 - Wait and see. - Let's get busy. 305 00:10:39,340 --> 00:10:40,590 CVP and an art line. 306 00:10:40,591 --> 00:10:43,760 Orlando. Orlando, squeeze my hand. 307 00:10:43,761 --> 00:10:46,137 Open your eyes. 308 00:10:46,138 --> 00:10:48,681 We already know his GCS is going to be three. 309 00:10:48,682 --> 00:10:50,683 Hey, Javadi, anti-seizure prophylaxis? 310 00:10:50,684 --> 00:10:52,685 - Keppra, 20 migs per kilo. - Mixing it now. 311 00:10:52,686 --> 00:10:54,354 Gotta get this brain swelling down, Samira. 312 00:10:54,355 --> 00:10:55,481 How we gonna do that? 313 00:10:56,774 --> 00:10:58,316 - Samira? - What? 314 00:10:58,317 --> 00:11:01,527 We have to lower the intracranial pressure. 315 00:11:01,528 --> 00:11:03,279 - Mannitol. - Not the best. 316 00:11:03,280 --> 00:11:04,614 Can cause diuresis and hypotension. 317 00:11:04,615 --> 00:11:05,949 Then hypertonic saline. 318 00:11:05,950 --> 00:11:08,451 23%. 50 cc's through a central line. 319 00:11:10,287 --> 00:11:11,913 Still tight as a drum. 320 00:11:11,914 --> 00:11:12,997 Five minutes since the epi. 321 00:11:12,998 --> 00:11:14,415 He can have one more EpiPen. 322 00:11:14,416 --> 00:11:16,125 Sats are borderline, 87. 323 00:11:16,126 --> 00:11:17,585 How about BiPap? 10 over 5. 324 00:11:17,586 --> 00:11:19,754 Yes, with in-line nebs. 325 00:11:19,755 --> 00:11:21,589 All right, Grady, shot number two. 326 00:11:21,590 --> 00:11:23,800 Might as well throw in some magnesium, 50 per kilo. 327 00:11:23,801 --> 00:11:25,134 I'm sorry. He's not ventilating. 328 00:11:25,135 --> 00:11:26,469 We should be ready to intubate. 329 00:11:26,470 --> 00:11:27,845 With an asthma patient? 330 00:11:27,846 --> 00:11:29,764 There's a high risk of cardiac arrest. 331 00:11:29,765 --> 00:11:32,016 Naomi, has he ever been put on a breathing machine before? 332 00:11:32,017 --> 00:11:33,685 - Never. - Hospitalized? 333 00:11:33,686 --> 00:11:35,645 No, we could always break him with the Symbicort. 334 00:11:35,646 --> 00:11:37,105 We're gonna give the current treatment 335 00:11:37,106 --> 00:11:39,148 a few more minutes to help him turn the corner. 336 00:11:42,319 --> 00:11:44,195 I could probably do this myself 337 00:11:44,196 --> 00:11:45,655 now that my cast is off. 338 00:11:45,656 --> 00:11:47,532 Oh, that's OK. 339 00:11:47,533 --> 00:11:49,201 I don't mind. 340 00:11:53,080 --> 00:11:54,999 How long have you been a nurse? 341 00:11:56,375 --> 00:11:58,085 This is my first day. 342 00:12:00,754 --> 00:12:02,798 You're doing really good. 343 00:12:04,717 --> 00:12:06,302 Thank you. 344 00:12:10,306 --> 00:12:12,056 - Oh, shit, you OK? - Yeah. 345 00:12:12,057 --> 00:12:13,558 There's water on the floor. 346 00:12:13,559 --> 00:12:15,059 Sorry! I... I might have spilled. 347 00:12:15,060 --> 00:12:16,519 Yeah, no worries. 348 00:12:16,520 --> 00:12:18,521 We're gonna have to sort these all by patient 349 00:12:18,522 --> 00:12:20,315 before we scan them. 350 00:12:20,316 --> 00:12:23,026 Is, uh, Joy still around? 351 00:12:23,027 --> 00:12:25,695 I heard she left at 6:59. 352 00:12:25,696 --> 00:12:27,697 - Smart girl. - Mm-hmm. 353 00:12:27,698 --> 00:12:29,866 You know what? Find Ogilvie. He's such an ass-kisser. 354 00:12:29,867 --> 00:12:31,492 He might stay and scan all the charts himself. 355 00:12:31,493 --> 00:12:33,703 Oh, he, uh, scrubbed in in the OR, 356 00:12:33,704 --> 00:12:35,580 scrubbed in on the ruptured triple-A. 357 00:12:35,581 --> 00:12:37,332 Oh, the kidney stone that wasn't. 358 00:12:37,333 --> 00:12:39,126 That'll be four hours at least. 359 00:12:41,045 --> 00:12:44,464 So are you still going to Amy's after work? 360 00:12:44,465 --> 00:12:46,382 Yeah, maybe just for tonight, 361 00:12:46,383 --> 00:12:48,761 after Robby briefs me on all the house stuff. 362 00:12:49,803 --> 00:12:51,304 Sounds fun. 363 00:12:52,639 --> 00:12:54,640 When he asked, it was hard to say no. 364 00:12:54,641 --> 00:12:56,226 Sure. 365 00:12:58,228 --> 00:13:00,480 It's gonna be very weird without him here. 366 00:13:00,481 --> 00:13:01,898 Yeah. 367 00:13:01,899 --> 00:13:04,442 You think Dr. Al-Hashimi can handle it? 368 00:13:04,443 --> 00:13:05,985 In a word, no. 369 00:13:05,986 --> 00:13:07,403 She's smart. 370 00:13:07,404 --> 00:13:08,738 It takes more than that. 371 00:13:08,739 --> 00:13:10,323 Yeah, well, at least 372 00:13:10,324 --> 00:13:11,741 it's only three months. 373 00:13:11,742 --> 00:13:13,868 Yeah, three long months. 374 00:13:13,869 --> 00:13:15,578 Then you need to find a new home. 375 00:13:15,579 --> 00:13:17,872 Not necessarily. 376 00:13:17,873 --> 00:13:19,957 I mean, if I wanted, I could just check on 377 00:13:19,958 --> 00:13:23,086 Robby's house once or twice a day, you know. 378 00:13:23,087 --> 00:13:24,797 Why would you do that? 379 00:13:26,090 --> 00:13:28,299 I don't know. Why not? 380 00:13:31,303 --> 00:13:32,762 Hypertonic's in. 381 00:13:32,763 --> 00:13:34,931 Maintenance LR in the AC. 382 00:13:34,932 --> 00:13:36,724 Looks like a halo sign. 383 00:13:36,725 --> 00:13:39,268 Cerebrospinal fluid from a basilar skull fracture. 384 00:13:39,269 --> 00:13:43,272 The halo sign is neither sensitive nor specific for CSF. 385 00:13:43,273 --> 00:13:45,608 Saline, tap water, and runny noses 386 00:13:45,609 --> 00:13:46,776 all separate from blood. 387 00:13:46,777 --> 00:13:48,277 - Hello, Linda. - Robby. 388 00:13:48,278 --> 00:13:50,780 Division chief working on a holiday weekend. 389 00:13:50,781 --> 00:13:52,865 Well, somebody's got to. 390 00:13:52,866 --> 00:13:55,660 Saw the scans. This guy needs an EVD. 391 00:13:55,661 --> 00:13:57,954 External ventricular drain to take down the pressure. 392 00:13:57,955 --> 00:14:01,207 Because CPP equals "MAP" minus ICP. 393 00:14:01,208 --> 00:14:03,876 Cerebral perfusion pressure in the brain 394 00:14:03,877 --> 00:14:05,795 equals mean arterial blood pressure 395 00:14:05,796 --> 00:14:07,296 minus the pressure in the skull. 396 00:14:07,297 --> 00:14:09,006 ICP less than 22 397 00:14:09,007 --> 00:14:11,551 predicts survival and favorable outcome. 398 00:14:11,552 --> 00:14:15,972 CPP from 60 to 70 reduces morbidity and mortality. 399 00:14:15,973 --> 00:14:17,348 Can somebody assist? 400 00:14:17,349 --> 00:14:18,516 Dr. Mohan? 401 00:14:18,517 --> 00:14:19,685 I'm good. 402 00:14:20,769 --> 00:14:22,311 Samira, you should lend a hand. 403 00:14:22,312 --> 00:14:24,105 I said I'm good. 404 00:14:24,106 --> 00:14:26,983 - Javadi? - I don't think so. 405 00:14:26,984 --> 00:14:28,484 Javadi? 406 00:14:28,485 --> 00:14:31,946 As in, daughter of Raymond and Eileen? 407 00:14:31,947 --> 00:14:33,948 I was at your mother's baby shower. 408 00:14:33,949 --> 00:14:35,324 She was a resident. 409 00:14:35,325 --> 00:14:36,743 You were in utero. 410 00:14:38,203 --> 00:14:39,328 I don't know how she got through 411 00:14:39,329 --> 00:14:41,164 motherhood and training. 412 00:14:41,165 --> 00:14:42,707 Feel free to join me. 413 00:14:42,708 --> 00:14:44,625 Oh, my... my shift was over a while ago. 414 00:14:44,626 --> 00:14:46,043 OK. 415 00:14:46,044 --> 00:14:48,087 Masks all around. Two sterile gowns. 416 00:14:48,088 --> 00:14:50,715 We brought the surgical towels. Just need some Betadine. 417 00:14:50,716 --> 00:14:52,384 This is kind of an amazing opportunity. 418 00:14:53,510 --> 00:14:54,760 I'm exhausted. 419 00:14:54,761 --> 00:14:56,721 The Chief of Neurosurgery is here. 420 00:14:56,722 --> 00:14:58,181 She's kind of a legend. 421 00:14:58,182 --> 00:15:00,224 Maybe one of the night residents can do it. 422 00:15:00,225 --> 00:15:02,518 Is this about the volvulus case from earlier? 423 00:15:02,519 --> 00:15:04,061 'Cause if it is, you made a mistake. 424 00:15:04,062 --> 00:15:06,022 You need to move on. 425 00:15:06,023 --> 00:15:07,690 I do not want to come back here and find that 426 00:15:07,691 --> 00:15:10,860 you've applied for a residency in derm. 427 00:15:10,861 --> 00:15:13,529 Step up to the plate. Do it. 428 00:15:13,530 --> 00:15:14,739 Javadi will assist. 429 00:15:14,740 --> 00:15:16,407 Excellent. 430 00:15:16,408 --> 00:15:18,201 You know, I think Eileen did her first EVD with me 431 00:15:18,202 --> 00:15:20,703 back when I was a brand-new assistant professor. 432 00:15:22,039 --> 00:15:23,540 Time flies. 433 00:15:26,418 --> 00:15:27,543 How you doing, Grady? 434 00:15:27,544 --> 00:15:29,045 Still retracting. 435 00:15:29,046 --> 00:15:30,713 - Any improvement? - Not really. 436 00:15:30,714 --> 00:15:31,882 You feeling tired? 437 00:15:33,675 --> 00:15:36,219 - Do we have Aerogen in the ED? - Just in the unit. 438 00:15:36,220 --> 00:15:37,887 How fast can you get back? 439 00:15:37,888 --> 00:15:39,055 Two minutes if I take the stairs. 440 00:15:39,056 --> 00:15:40,056 Go. 441 00:15:40,057 --> 00:15:41,390 Uh, Aerogen? 442 00:15:41,391 --> 00:15:43,351 It has a 5-millimeter mesh 443 00:15:43,352 --> 00:15:46,605 that vibrates over 120,000 times per second. 444 00:15:51,735 --> 00:15:53,111 Dr. Al-Hashimi? 445 00:15:57,407 --> 00:15:58,825 You OK? 446 00:16:01,245 --> 00:16:03,288 Uh, you were telling us about Aerogen. 447 00:16:04,414 --> 00:16:05,832 Dr. Shen can explain. 448 00:16:07,167 --> 00:16:10,127 It produces droplets in the 2-to 5-micron range 449 00:16:10,128 --> 00:16:12,089 for medication delivery. 450 00:16:19,388 --> 00:16:21,931 - How's it going? - Just about to start. 451 00:16:21,932 --> 00:16:23,099 Securing the art line here. 452 00:16:23,100 --> 00:16:25,393 Measure twice, cut once. 453 00:16:25,394 --> 00:16:29,146 We enter 11 centimeters back from the nasion, 454 00:16:29,147 --> 00:16:30,773 3 centimeters lateral. 455 00:16:30,774 --> 00:16:32,400 Without any direct imaging? 456 00:16:32,401 --> 00:16:35,444 No, straight shot into the lateral ventricle... 457 00:16:35,445 --> 00:16:38,990 tried and true since 1890. 458 00:16:38,991 --> 00:16:41,326 OK, go ahead with the incision. 459 00:16:42,828 --> 00:16:45,079 Hey, you worked with Dr. Al-Hashimi at the VA. 460 00:16:45,080 --> 00:16:46,163 I did. 461 00:16:46,164 --> 00:16:47,665 For how long? 462 00:16:47,666 --> 00:16:49,625 During my R2 rotation 463 00:16:49,626 --> 00:16:51,837 and then one again last year. 464 00:16:55,173 --> 00:16:58,342 OK. Hand drill's all set. 465 00:16:58,343 --> 00:16:59,802 Maybe you should do this part. 466 00:16:59,803 --> 00:17:01,137 No, no, there's a safety stop here. 467 00:17:01,138 --> 00:17:02,638 You can't go too deep. 468 00:17:02,639 --> 00:17:04,683 It's not brain surgery. 469 00:17:06,852 --> 00:17:08,103 OK. 470 00:17:11,315 --> 00:17:13,149 - Stay perpendicular. - OK. 471 00:17:13,150 --> 00:17:15,067 Good. 472 00:17:15,068 --> 00:17:16,819 All right, now, four turns 473 00:17:16,820 --> 00:17:18,029 to get through the outer table... 474 00:17:18,030 --> 00:17:19,322 - Yep. - Then half turns 475 00:17:19,323 --> 00:17:20,991 till you penetrate the skull. 476 00:17:31,793 --> 00:17:35,463 Three, four. 477 00:17:35,464 --> 00:17:36,715 One... 478 00:17:38,675 --> 00:17:40,343 Holy smoke! 479 00:17:40,344 --> 00:17:43,804 I thought it was Tom Cruise for a second over here. 480 00:17:43,805 --> 00:17:46,849 Nice job. How's that feel, Digby? 481 00:17:46,850 --> 00:17:48,392 - Pretty good. - I bet. 482 00:17:48,393 --> 00:17:49,685 What do you say we trim up 483 00:17:49,686 --> 00:17:51,521 those gorgeous locks of yours now? 484 00:17:53,106 --> 00:17:55,149 I don't like having my hair cut. 485 00:17:55,150 --> 00:17:58,527 I get it, Rapunzel, but you need your ears lowered. 486 00:17:58,528 --> 00:18:00,613 You'll feel better with a fresh summer look 487 00:18:00,614 --> 00:18:02,658 that won't go unnoticed by the ladies. 488 00:18:04,534 --> 00:18:06,911 - Maybe just a trim? - Great. 489 00:18:06,912 --> 00:18:09,121 I'm thinking a pixie cut. 490 00:18:09,122 --> 00:18:10,915 - What? - I'm kidding. 491 00:18:10,916 --> 00:18:12,708 I cut my husband Benji's hair all the time. 492 00:18:12,709 --> 00:18:14,210 Trust me, you're gonna look fabulous. 493 00:18:14,211 --> 00:18:15,879 When's the last time you had a haircut? 494 00:18:17,422 --> 00:18:20,716 Maybe my daughter's wedding a few years ago. 495 00:18:20,717 --> 00:18:22,051 Where? 496 00:18:22,052 --> 00:18:23,260 St. Sebastian, 497 00:18:23,261 --> 00:18:25,262 Our Lady of Mount Carmel Parish. 498 00:18:25,263 --> 00:18:27,890 Does your daughter know where you are? 499 00:18:27,891 --> 00:18:31,060 Of course. We all live in Pittsburgh. 500 00:18:31,061 --> 00:18:33,313 In fact, they live in my old house. 501 00:18:35,899 --> 00:18:38,234 Your daughter lives in your house? 502 00:18:38,235 --> 00:18:40,111 Yep. 503 00:18:40,112 --> 00:18:42,697 Where do you live? 504 00:18:42,698 --> 00:18:44,908 Wherever I want. 505 00:18:46,618 --> 00:18:48,744 You're gonna pass it 5 to 6 centimeters 506 00:18:48,745 --> 00:18:51,289 from the inner table of the skull, OK? 507 00:18:53,250 --> 00:18:55,418 Centered... 508 00:18:55,419 --> 00:18:57,253 perpendicular... 509 00:18:57,254 --> 00:18:59,089 aiming for the medial canthus. 510 00:19:00,173 --> 00:19:01,841 All yours. 511 00:19:01,842 --> 00:19:03,175 A-and just keep going? 512 00:19:03,176 --> 00:19:04,635 You'll feel a pop when you pass 513 00:19:04,636 --> 00:19:07,263 the ependymal lining. 514 00:19:07,264 --> 00:19:09,014 Art line is calibrated. Good to go. 515 00:19:09,015 --> 00:19:12,935 Titrate the nicardipine to a MAP of 85, please. 516 00:19:12,936 --> 00:19:14,353 And if we can get the intracranial pressure 517 00:19:14,354 --> 00:19:16,189 down to 20? 518 00:19:17,607 --> 00:19:19,024 Dr. Mohan? 519 00:19:19,025 --> 00:19:20,484 I'm sorry. 520 00:19:20,485 --> 00:19:22,778 MAP of 85, ICP of 20? 521 00:19:22,779 --> 00:19:25,781 Um, cerebral perfusion pressure 65. 522 00:19:25,782 --> 00:19:28,576 Which gives him the best shot at survival. 523 00:19:28,577 --> 00:19:30,077 A third of patients like this die. 524 00:19:30,078 --> 00:19:32,621 Half have long-term disability. 525 00:19:32,622 --> 00:19:34,623 We'll know in two weeks if there's a possibility 526 00:19:34,624 --> 00:19:36,959 for a good prognosis. 527 00:19:36,960 --> 00:19:38,127 Felt a pop. 528 00:19:38,128 --> 00:19:39,796 Remove the stylet. 529 00:19:42,299 --> 00:19:45,051 OK, let it drain a bit. 530 00:19:46,970 --> 00:19:49,222 And now pinch it shut. 531 00:19:50,682 --> 00:19:51,682 Perfect. 532 00:19:51,683 --> 00:19:53,601 BP is down, 190 over 88. 533 00:19:53,602 --> 00:19:54,978 Heart rate's 67. 534 00:19:59,024 --> 00:20:00,983 How are you guys doing? 535 00:20:00,984 --> 00:20:02,902 Yeah, making some progress. 536 00:20:02,903 --> 00:20:04,236 You seen Abbot? 537 00:20:04,237 --> 00:20:06,030 Not since rounds. 538 00:20:06,031 --> 00:20:08,741 He asked me to see a patient with the night intern. 539 00:20:08,742 --> 00:20:10,367 And you said yes? 540 00:20:10,368 --> 00:20:13,245 48-year-old woman, new onset jaundice, 541 00:20:13,246 --> 00:20:16,332 elevated liver enzymes, no history of alcohol use. 542 00:20:16,333 --> 00:20:17,666 Take your pick... 543 00:20:17,667 --> 00:20:20,377 hepatitis A, B, C, D, or E. 544 00:20:20,378 --> 00:20:23,255 - No risk factors, no fever. - Tylenol? 545 00:20:23,256 --> 00:20:25,174 Never, and no prescription meds. 546 00:20:25,175 --> 00:20:27,385 Does she eat polar bear liver? 547 00:20:28,553 --> 00:20:30,847 It can cause vitamin A toxicity. 548 00:20:31,723 --> 00:20:32,807 - No. - Yeah. 549 00:20:32,808 --> 00:20:34,058 She, uh, doesn't eat meat, 550 00:20:34,059 --> 00:20:35,684 kind of a health nut. 551 00:20:35,685 --> 00:20:37,144 Well, maybe she's gulping down 552 00:20:37,145 --> 00:20:38,729 cod liver oil to prevent measles. 553 00:20:38,730 --> 00:20:40,981 No. Vegan, no fish. 554 00:20:40,982 --> 00:20:43,025 Would you, uh, mind laying eyes on her? 555 00:20:43,026 --> 00:20:44,652 Seriously? 556 00:20:44,653 --> 00:20:46,987 You have a way of figuring out the weird stuff. 557 00:20:46,988 --> 00:20:48,532 Take the compliment. 558 00:20:49,866 --> 00:20:51,242 OK, fine. 559 00:20:51,243 --> 00:20:53,536 Five minutes at the bedside... that's it. 560 00:20:53,537 --> 00:20:55,538 I'm already gonna be here for hours as it is. 561 00:20:55,539 --> 00:20:57,748 Thank you. 562 00:20:57,749 --> 00:20:59,334 What am I doing... 563 00:21:02,546 --> 00:21:04,880 - Definitely improving. - Tidal volume's up. 564 00:21:04,881 --> 00:21:07,383 Wheezes now expiratory only. 565 00:21:07,384 --> 00:21:08,968 Oh, making some progress. 566 00:21:08,969 --> 00:21:11,095 You feeling better, baby? 567 00:21:11,096 --> 00:21:14,390 - You scared the shit out of me. - Language! 568 00:21:14,391 --> 00:21:16,725 Does he have a primary-care doctor? 569 00:21:16,726 --> 00:21:18,102 Not anymore. 570 00:21:18,103 --> 00:21:20,729 How do you get his prescriptions renewed? 571 00:21:20,730 --> 00:21:22,898 Neighborhood clinic. We pay cash. 572 00:21:22,899 --> 00:21:24,733 - Albuterol's cheap. - Symbicort? 573 00:21:24,734 --> 00:21:27,653 Without Medicaid, 400 bucks a month. 574 00:21:27,654 --> 00:21:29,155 Just for a little inhaler? 575 00:21:31,241 --> 00:21:33,742 Trocar is on the tube. 576 00:21:33,743 --> 00:21:37,121 I tunnel underneath the scalp about 5 centimeters 577 00:21:37,122 --> 00:21:38,622 and poke through. 578 00:21:38,623 --> 00:21:40,417 - To prevent infection? - Mm-hmm, exactly. 579 00:21:41,877 --> 00:21:44,504 Now you hold the knuckle steady while I pull it through. 580 00:21:47,799 --> 00:21:49,968 And you can staple the wound shut. 581 00:21:51,428 --> 00:21:53,596 That looks like something from Home Depot. 582 00:21:53,597 --> 00:21:55,431 Yeah, big Fourth of July sale. 583 00:21:55,432 --> 00:21:56,765 The brain pressure is measured by 584 00:21:56,766 --> 00:21:58,601 the height of the fluid column. 585 00:21:58,602 --> 00:22:01,145 We need to calibrate it to zero at the level of the tragus. 586 00:22:01,146 --> 00:22:03,188 Stopcock's on, ready to attach. 587 00:22:03,189 --> 00:22:04,607 First troponin's normal, 588 00:22:04,608 --> 00:22:07,026 but you need a second to rule out MI. 589 00:22:07,027 --> 00:22:08,862 Hey, can you step out for a second? 590 00:22:14,993 --> 00:22:16,452 I really did do everything I could 591 00:22:16,453 --> 00:22:18,037 to try to make Orlando stay. 592 00:22:18,038 --> 00:22:19,038 Yeah, I don't doubt it. 593 00:22:19,039 --> 00:22:20,039 I wanted to ask you about 594 00:22:20,040 --> 00:22:22,249 Dr. Al-Hashimi at the VA. 595 00:22:22,250 --> 00:22:24,960 Did you ever notice anything unusual about her behavior? 596 00:22:24,961 --> 00:22:26,962 Um, like what? 597 00:22:26,963 --> 00:22:29,590 Lapses in focus, attention? 598 00:22:29,591 --> 00:22:32,177 No, she was always on top of her game. 599 00:22:35,138 --> 00:22:38,807 But this morning when she was checking labs on Baby Jane Doe, 600 00:22:38,808 --> 00:22:41,186 it was like she zoned out for a few seconds. 601 00:22:42,646 --> 00:22:44,481 Maybe she was just tired. 602 00:22:51,488 --> 00:22:53,822 No congestion, nodules, 603 00:22:53,823 --> 00:22:55,282 or cirrhosis. 604 00:22:55,283 --> 00:22:56,951 Good-looking liver. 605 00:22:56,952 --> 00:22:58,827 I should not be sick. 606 00:22:58,828 --> 00:23:01,455 I work so hard to stay healthy... 607 00:23:01,456 --> 00:23:04,333 diet, exercise, eight hours of sleep. 608 00:23:04,334 --> 00:23:08,170 I can't remember the last time I got eight hours. 609 00:23:08,171 --> 00:23:10,172 Maybe you should try sleepmaxxing. 610 00:23:10,173 --> 00:23:12,091 Oh, you definitely should. 611 00:23:12,092 --> 00:23:15,010 Yeah, cold room, white noise, eye shades. 612 00:23:15,011 --> 00:23:18,847 Kiwis before bedtime, lettuce water, mouth taping. 613 00:23:18,848 --> 00:23:20,516 Who do you follow for health? 614 00:23:20,517 --> 00:23:22,851 A few naturopaths and some functional healers. 615 00:23:22,852 --> 00:23:24,853 Do you... do you buy vitamins from them? 616 00:23:24,854 --> 00:23:26,647 Oh, no, no, I don't take vitamins. 617 00:23:26,648 --> 00:23:29,441 Food is the best medicine... kale, blueberries, 618 00:23:29,442 --> 00:23:32,027 - kidney beans, turmeric. - Turmeric? 619 00:23:32,028 --> 00:23:33,737 Uh, how long have you been taking that? 620 00:23:33,738 --> 00:23:36,323 For a few months. It's an anti-inflammatory. 621 00:23:36,324 --> 00:23:38,867 It detoxes the body, and it can prevent Alzheimer's. 622 00:23:38,868 --> 00:23:40,327 How much do you take? 623 00:23:40,328 --> 00:23:42,329 500 milligram capsules, 624 00:23:42,330 --> 00:23:43,581 but I take five a day. 625 00:23:45,250 --> 00:23:46,875 What? 626 00:23:46,876 --> 00:23:48,711 With doses that large of turmeric, 627 00:23:48,712 --> 00:23:51,338 there have been cases of liver failure. 628 00:23:51,339 --> 00:23:53,048 From eating a spice? 629 00:23:53,049 --> 00:23:55,718 All right, Digby, I think you're good to go. 630 00:23:55,719 --> 00:23:57,804 Mm-hmm. Would you like to see? 631 00:24:10,400 --> 00:24:12,901 I haven't looked like this in a long time. 632 00:24:12,902 --> 00:24:15,321 Your family won't recognize you. 633 00:24:17,240 --> 00:24:19,408 Then how will they find me? 634 00:24:19,409 --> 00:24:21,410 They... they won't know what I look like. 635 00:24:21,411 --> 00:24:22,453 They won't know this is me. 636 00:24:22,454 --> 00:24:23,579 Of course they will. 637 00:24:23,580 --> 00:24:24,830 They know your voice. 638 00:24:24,831 --> 00:24:26,665 They know where you hang out. 639 00:24:26,666 --> 00:24:30,502 They even remember that you used to look like this. 640 00:24:30,503 --> 00:24:32,547 They remember the wedding. 641 00:24:35,467 --> 00:24:37,760 Did you dance with your daughter 642 00:24:37,761 --> 00:24:39,179 at her wedding? 643 00:24:40,597 --> 00:24:42,765 I did. 644 00:24:42,766 --> 00:24:45,852 Then she will always remember you. 645 00:24:48,563 --> 00:24:50,106 - Yeah. - OK. 646 00:24:51,608 --> 00:24:53,233 Hey, I was just looking for you. 647 00:24:53,234 --> 00:24:54,568 - What's up? - You tell me. 648 00:24:54,569 --> 00:24:56,904 - The, uh, asthma patient. - What about him? 649 00:24:56,905 --> 00:24:58,280 Seemed like you were hesitating 650 00:24:58,281 --> 00:24:59,948 talking about using Aerogen. 651 00:24:59,949 --> 00:25:01,617 I was wondering if you were having second thoughts. 652 00:25:01,618 --> 00:25:03,410 No. Just thinking. 653 00:25:03,411 --> 00:25:04,661 About? 654 00:25:04,662 --> 00:25:06,663 The best treatment plan for the patient. 655 00:25:06,664 --> 00:25:08,791 And I think he's on it. 656 00:25:08,792 --> 00:25:10,292 - Anything else? - I don't know. 657 00:25:10,293 --> 00:25:12,836 You tell me. Anything else I need to know? 658 00:25:12,837 --> 00:25:14,172 I don't think so. 659 00:25:15,799 --> 00:25:17,299 This is Dr. Robby in the ED. 660 00:25:17,300 --> 00:25:19,009 I'm checking on a patient, Ekins. 661 00:25:19,010 --> 00:25:21,553 We can take Larson and Stevens off the dry-erase. 662 00:25:21,554 --> 00:25:22,638 Consider it done. 663 00:25:22,639 --> 00:25:23,806 He's in the scanner now? 664 00:25:23,807 --> 00:25:25,265 Oh, great. 665 00:25:25,266 --> 00:25:26,350 No, I was just calling to confirm. 666 00:25:26,351 --> 00:25:27,643 Thank you. 667 00:25:27,644 --> 00:25:29,478 Any new information from upstairs? 668 00:25:29,479 --> 00:25:30,896 Nothing we don't already know. 669 00:25:30,897 --> 00:25:32,564 Same old story, huh? 670 00:25:32,565 --> 00:25:33,982 You think we should take up a collection 671 00:25:33,983 --> 00:25:35,818 for Jesse for... for bail money? 672 00:25:35,819 --> 00:25:37,361 They don't usually set bail 673 00:25:37,362 --> 00:25:39,154 until after you've appeared in front of a judge. 674 00:25:39,155 --> 00:25:41,031 With the holiday, it's not likely to happen till Monday. 675 00:25:41,032 --> 00:25:43,200 So he's gonna be locked up all weekend? 676 00:25:43,201 --> 00:25:44,952 That sucks. 677 00:25:44,953 --> 00:25:46,954 It does suck. 678 00:25:46,955 --> 00:25:49,957 Dr. Langdon, Grady's worse... much worse. 679 00:25:49,958 --> 00:25:52,793 - Need an attending? - Uh, no, we have Shen. 680 00:25:52,794 --> 00:25:54,169 Sat's down to 83. 681 00:25:54,170 --> 00:25:56,296 - What's happening? - Give us a minute. 682 00:25:56,297 --> 00:25:57,798 He's tiring out. 683 00:25:57,799 --> 00:25:59,842 Ketamine and rock. It's time to intubate. 684 00:25:59,843 --> 00:26:01,009 I'll call Volk. 685 00:26:01,010 --> 00:26:02,803 Ma'am, we have to put a tube 686 00:26:02,804 --> 00:26:04,012 down your son's windpipe 687 00:26:04,013 --> 00:26:05,514 so a machine can breathe for him. 688 00:26:05,515 --> 00:26:06,849 Oh, my God. 689 00:26:06,850 --> 00:26:08,350 Hold on, hold on. 690 00:26:08,351 --> 00:26:09,560 No lung sliding on the right. 691 00:26:09,561 --> 00:26:11,061 Pneumothorax. 692 00:26:11,062 --> 00:26:13,105 No need to intubate. 693 00:26:13,106 --> 00:26:14,398 What's going on? 694 00:26:14,399 --> 00:26:16,358 He has a collapsed lung. 695 00:26:16,359 --> 00:26:18,277 There was no history of trauma 696 00:26:18,278 --> 00:26:19,778 that would have caused pneumothorax. 697 00:26:19,779 --> 00:26:21,864 Glove up, Dr. King. 698 00:26:21,865 --> 00:26:24,199 In asthma, you can get "air trapping." 699 00:26:24,200 --> 00:26:25,909 When the lungs can't fully exhale, 700 00:26:25,910 --> 00:26:27,286 eventually they overinflate, 701 00:26:27,287 --> 00:26:29,204 causing some of the tiny air sacs to burst. 702 00:26:29,205 --> 00:26:30,414 How do you fix it? 703 00:26:36,296 --> 00:26:37,338 Like that. 704 00:26:42,927 --> 00:26:45,554 It's a good thing Dr. Conley was here. 705 00:26:45,555 --> 00:26:46,889 - Yeah. - We should probably try 706 00:26:46,890 --> 00:26:48,390 to find him a Neuro-Critical ICU bed. 707 00:26:48,391 --> 00:26:50,017 We don't want to board a patient like this. 708 00:26:50,018 --> 00:26:51,685 - Mm-hmm. - Hey, Robby. 709 00:26:51,686 --> 00:26:54,229 - Hey, how did the scan go? - Fine. 710 00:26:54,230 --> 00:26:55,731 It is probably gonna take a little while 711 00:26:55,732 --> 00:26:57,191 to get the results from the radiologist. 712 00:26:57,192 --> 00:26:58,609 Well, that's not a problem. 713 00:26:58,610 --> 00:27:00,861 Nurse Vivi and I need a little time 714 00:27:00,862 --> 00:27:03,405 to coordinate our schedules over the next few months. 715 00:27:03,406 --> 00:27:04,406 - Really? - Yeah. 716 00:27:04,407 --> 00:27:05,407 I've always wanted to learn 717 00:27:05,408 --> 00:27:06,450 how to ride a motorcycle, 718 00:27:06,451 --> 00:27:07,951 and Duke offered to teach me. 719 00:27:07,952 --> 00:27:10,245 Well, nobody knows motorcycles like Duke. 720 00:27:10,246 --> 00:27:12,706 He's giving me the health care worker discount. 721 00:27:12,707 --> 00:27:13,999 He's quite the gentleman. 722 00:27:14,000 --> 00:27:15,792 Let's get him back to his room. 723 00:27:15,793 --> 00:27:18,587 How would next Saturday be for you, Vivi? 724 00:27:18,588 --> 00:27:21,924 Uh, maybe we could have some dinner after. 725 00:27:21,925 --> 00:27:23,550 Dr. Mohan, Lorrie Diaz is here. 726 00:27:23,551 --> 00:27:25,302 She wants to see her husband. She's heading back. 727 00:27:25,303 --> 00:27:26,846 OK, I'm on my way. 728 00:27:28,973 --> 00:27:30,974 - Mrs. Diaz? - Hi. 729 00:27:30,975 --> 00:27:33,852 Did Orlando go up to his room yet? 730 00:27:33,853 --> 00:27:35,354 No. Um... 731 00:27:35,355 --> 00:27:37,481 I brought him some dinner from Burgatory. 732 00:27:37,482 --> 00:27:38,857 It's a chicken burger... 733 00:27:38,858 --> 00:27:40,484 no bun, just lettuce. 734 00:27:40,485 --> 00:27:43,196 Figured it would be better than hospital food. 735 00:27:46,449 --> 00:27:50,744 He's being treated by our top brain-injury specialists. 736 00:27:50,745 --> 00:27:52,246 Will he wake up? 737 00:27:52,247 --> 00:27:54,122 We won't know for several weeks. 738 00:27:54,123 --> 00:27:56,750 And then he could be back to normal? 739 00:27:56,751 --> 00:27:59,836 Best-case scenario, it would take about a year 740 00:27:59,837 --> 00:28:02,464 before he could be independent at home. 741 00:28:02,465 --> 00:28:04,132 And the worst case? 742 00:28:04,133 --> 00:28:07,637 Round-the-clock nursing care for severe disability. 743 00:28:11,182 --> 00:28:13,433 You let him leave? 744 00:28:13,434 --> 00:28:17,396 He insisted on leaving to work at his second job. 745 00:28:17,397 --> 00:28:19,648 You couldn't make him stay? 746 00:28:19,649 --> 00:28:22,651 He was competent. He knew the risks. 747 00:28:22,652 --> 00:28:24,653 We honored his decision to leave. 748 00:28:24,654 --> 00:28:26,405 Even if it was a stupid one? 749 00:28:26,406 --> 00:28:27,906 I tried to stop him. 750 00:28:27,907 --> 00:28:29,533 Offered to get him all the supplies he'd need 751 00:28:29,534 --> 00:28:31,034 to take care of himself at home. 752 00:28:31,035 --> 00:28:33,578 But he left before I could give them to him. 753 00:28:33,579 --> 00:28:36,040 He said he couldn't afford to lose a paycheck. 754 00:28:43,548 --> 00:28:45,841 Dr. Langdon. 755 00:28:48,011 --> 00:28:49,720 Are you OK? 756 00:28:49,721 --> 00:28:52,848 Yeah. I'm just kind of, uh... 757 00:28:52,849 --> 00:28:55,350 wondering if I'm really ready to be back here. 758 00:28:55,351 --> 00:28:57,644 Well, of course you are. 759 00:28:57,645 --> 00:28:59,730 Ten months is a long time. 760 00:28:59,731 --> 00:29:03,025 I almost killed that kid with an intubation. 761 00:29:03,026 --> 00:29:06,320 Didn't even occur to me to check for pneumothorax. 762 00:29:06,321 --> 00:29:08,030 There wasn't any trauma to indicate... 763 00:29:08,031 --> 00:29:09,271 - I should have caught it. - OK. 764 00:29:15,872 --> 00:29:17,247 You know, I, um... 765 00:29:19,083 --> 00:29:22,002 I had a deposition today, 766 00:29:22,003 --> 00:29:25,464 and all the lawyer's questions made me feel like 767 00:29:25,465 --> 00:29:27,800 I was a really, really bad doctor. 768 00:29:30,136 --> 00:29:33,681 We don't always get everything right the first time. 769 00:29:34,766 --> 00:29:37,309 You would have caught the collapsed lung. 770 00:29:37,310 --> 00:29:40,021 And it may have taken a minute, but you would have saved him. 771 00:29:41,230 --> 00:29:43,607 I'm not sure Robby would agree with you. 772 00:29:43,608 --> 00:29:46,318 He's been riding me all day. 773 00:29:46,319 --> 00:29:48,236 Well, Robby's leaving for three months. 774 00:29:48,237 --> 00:29:51,073 And, you know, with Robby gone... 775 00:29:51,074 --> 00:29:53,076 I really don't want you to leave either. 776 00:29:56,579 --> 00:29:59,247 That which does not kill me makes me stronger. 777 00:29:59,248 --> 00:30:02,542 Wow, Friedrich Nietzsche. 778 00:30:02,543 --> 00:30:05,754 Yeah, Nietzsche, yeah... 779 00:30:05,755 --> 00:30:08,090 not Kelly Clarkson. 780 00:30:10,051 --> 00:30:12,052 Hey, that's a thick one. 781 00:30:12,053 --> 00:30:14,930 Yeah, Austin Green. Ogilvie's triple-A. 782 00:30:17,934 --> 00:30:20,519 Uh, G-R-E-E-N? 783 00:30:20,520 --> 00:30:21,937 Yeah. Why? What are you doing? 784 00:30:21,938 --> 00:30:23,438 Checking to see when we'll get Ogilvie 785 00:30:23,439 --> 00:30:25,315 back from the OR. 786 00:30:25,316 --> 00:30:27,359 - Oh, shit. - What? 787 00:30:27,360 --> 00:30:29,111 The guy didn't make it. 788 00:30:29,112 --> 00:30:31,446 He died on the table about 40 minutes ago. 789 00:30:31,447 --> 00:30:33,615 Then where's Ogilvie? 790 00:30:33,616 --> 00:30:35,534 Oh, man. 791 00:30:35,535 --> 00:30:38,161 His patient had a CT a year and a half ago 792 00:30:38,162 --> 00:30:40,455 that showed a 4-centimeter triple-A. 793 00:30:40,456 --> 00:30:42,124 That's too small for surgery. 794 00:30:42,125 --> 00:30:43,458 He was supposed to come back 795 00:30:43,459 --> 00:30:45,210 every six months for a repeat ultrasound, 796 00:30:45,211 --> 00:30:46,920 but looks like he didn't. 797 00:30:46,921 --> 00:30:49,631 We would've seen that if the computers were working. 798 00:30:49,632 --> 00:30:51,299 Why wouldn't he tell Ogilvie? 799 00:30:51,300 --> 00:30:53,135 I don't know. Maybe he forgot all about it. 800 00:30:53,136 --> 00:30:55,179 Or Ogilvie didn't ask the right questions. 801 00:30:56,264 --> 00:30:58,306 Dennis, hey, got a minute? 802 00:30:58,307 --> 00:31:00,809 Uh, sure. What do you need? 803 00:31:00,810 --> 00:31:02,477 Teenager with jewelry magnets 804 00:31:02,478 --> 00:31:04,479 stuck to both sides of her nasal septum. 805 00:31:04,480 --> 00:31:06,481 I tried to move them with a plastic curette. 806 00:31:06,482 --> 00:31:08,316 Too much pain, and then there was bleeding. 807 00:31:08,317 --> 00:31:10,652 Those need to come off before they cause permanent damage. 808 00:31:10,653 --> 00:31:12,195 Yeah, you think, uh, you could find, like, 809 00:31:12,196 --> 00:31:14,114 a senior or an attending? 810 00:31:14,115 --> 00:31:15,991 We're really trying to get off the clock here. 811 00:31:15,992 --> 00:31:17,160 They're all busy. 812 00:31:19,829 --> 00:31:21,496 I already took one for the team. 813 00:31:21,497 --> 00:31:23,415 Yeah, fine. 814 00:31:23,416 --> 00:31:27,002 Uh, labs on your yellow lady. 815 00:31:27,003 --> 00:31:29,421 INR is elevated, 2.2. 816 00:31:29,422 --> 00:31:31,381 Liver's in trouble but not dead yet. 817 00:31:31,382 --> 00:31:32,966 Tell her to skip the turmeric. 818 00:31:32,967 --> 00:31:35,177 Admit for monitoring, and follow the LFTs. 819 00:31:35,178 --> 00:31:36,344 - Got it. - Mm-hmm. 820 00:31:36,345 --> 00:31:37,805 - Central 10? - Yeah. 821 00:31:42,185 --> 00:31:44,352 "Sleepmaxxing"? Really? 822 00:31:44,353 --> 00:31:45,896 I track the online trends. 823 00:31:45,897 --> 00:31:48,273 Is that your secret for the tough ones? 824 00:31:48,274 --> 00:31:49,983 I just think, 825 00:31:49,984 --> 00:31:52,360 what's the stupidest thing this person could have done? 826 00:31:52,361 --> 00:31:53,613 Then assume they did it. 827 00:31:55,031 --> 00:31:57,199 Well, I mean, she was trying to be healthy. 828 00:31:57,200 --> 00:31:59,534 Yeah, by taking advice from fools. 829 00:31:59,535 --> 00:32:01,745 Turmeric is recommended by a lot of doctors. 830 00:32:01,746 --> 00:32:03,747 Yeah, then ask your doctor for the dose 831 00:32:03,748 --> 00:32:06,374 or check someplace reputable, like the CDC. 832 00:32:06,375 --> 00:32:09,669 Oh, right, I forgot, it's now a medical toxic waste site. 833 00:32:09,670 --> 00:32:12,672 I mean, she's in pretty bad shape. 834 00:32:12,673 --> 00:32:15,008 If things get worse, she could need a liver transplant. 835 00:32:15,009 --> 00:32:17,094 Yeah, 'cause she's a big fucking idiot. 836 00:32:18,596 --> 00:32:20,430 Wow. 837 00:32:20,431 --> 00:32:22,682 No, I actually appreciate her. 838 00:32:22,683 --> 00:32:25,436 Our job security depends on all these big fucking idiots. 839 00:32:27,813 --> 00:32:29,065 OK. 840 00:32:31,400 --> 00:32:34,819 Uh, good night, Perlah, Monica. 841 00:32:34,820 --> 00:32:37,572 - Good night, Dr. Robby. - Good night. 842 00:32:37,573 --> 00:32:39,157 Bye, Emma. 843 00:32:39,158 --> 00:32:40,617 You could stay to pitch in. 844 00:32:40,618 --> 00:32:42,577 Mm, Dana told me to go and get some rest 845 00:32:42,578 --> 00:32:43,995 before tomorrow's shift. 846 00:32:43,996 --> 00:32:45,664 Yeah, you had quite a day. 847 00:32:45,665 --> 00:32:47,041 Wasn't so bad. 848 00:32:49,001 --> 00:32:50,835 Why can't I find Duke's results? 849 00:32:50,836 --> 00:32:53,588 Oh, new patient, no EHR yet. 850 00:32:53,589 --> 00:32:56,424 I can run over to Radiology, get a printout. 851 00:32:56,425 --> 00:32:57,802 Thank you, Monica. 852 00:33:00,304 --> 00:33:02,305 Ready to pick up a few more. 853 00:33:02,306 --> 00:33:03,765 Orlando's all tucked in for now. 854 00:33:03,766 --> 00:33:05,392 - How's he doing? - Numbers are good. 855 00:33:05,393 --> 00:33:07,227 CPP 22. 856 00:33:07,228 --> 00:33:09,813 OK, so he's got a shot at a decent outcome at least. 857 00:33:09,814 --> 00:33:11,439 You think he has a chance? 858 00:33:11,440 --> 00:33:13,650 Oh, I don't know that survival was 859 00:33:13,651 --> 00:33:15,652 the outcome he was hoping for. 860 00:33:15,653 --> 00:33:17,279 What? 861 00:33:17,280 --> 00:33:19,489 He told Samira he's got $100,000 in medical debt, 862 00:33:19,490 --> 00:33:21,951 - that his life is probably... - Mrs. Diaz! 863 00:33:24,287 --> 00:33:26,746 - How can we help you? - The bathroom? 864 00:33:26,747 --> 00:33:29,417 Uh, yeah. Perlah can show you the way. 865 00:33:31,168 --> 00:33:33,628 Not a great idea to have a private conversation 866 00:33:33,629 --> 00:33:34,838 about a patient in a public area. 867 00:33:34,839 --> 00:33:36,840 I know. I know. 868 00:33:36,841 --> 00:33:38,216 You were about to start yapping... 869 00:33:38,217 --> 00:33:39,760 But I didn't! 870 00:33:42,305 --> 00:33:45,223 OK. 871 00:33:45,224 --> 00:33:47,559 And how long have they been in there? 872 00:33:47,560 --> 00:33:49,019 At least two hours. 873 00:33:49,020 --> 00:33:51,479 - How did it happen? - With my earring. 874 00:33:51,480 --> 00:33:54,357 It was supposed to be, uh, red, white, and blue 875 00:33:54,358 --> 00:33:56,151 to look cool at the fireworks. 876 00:33:56,152 --> 00:33:57,861 I told her for the nose, one side only, 877 00:33:57,862 --> 00:33:59,154 but she never listens. 878 00:33:59,155 --> 00:34:00,363 This can be pretty serious. 879 00:34:00,364 --> 00:34:01,656 If we don't get them out quickly, 880 00:34:01,657 --> 00:34:03,116 it can cut off the blood supply 881 00:34:03,117 --> 00:34:04,993 and cause the septum to collapse. 882 00:34:04,994 --> 00:34:08,581 Like, my nose could be deformed? 883 00:34:10,791 --> 00:34:13,376 - Oh, my God, get them off. - Yeah, that's the plan. 884 00:34:13,377 --> 00:34:15,128 Yeah, she tried already. It hurt like crazy. 885 00:34:15,129 --> 00:34:16,296 Because they're stuck together 886 00:34:16,297 --> 00:34:18,381 by a very strong magnetic force. 887 00:34:18,382 --> 00:34:20,342 - Yeah. - No, no, no. 888 00:34:20,343 --> 00:34:22,052 Oh, uh, I'm not gonna use the tips. 889 00:34:22,053 --> 00:34:25,138 I'm gonna flip it around and use the handle. 890 00:34:25,139 --> 00:34:26,723 It's still gonna hurt. 891 00:34:26,724 --> 00:34:27,974 Probably not. 892 00:34:27,975 --> 00:34:29,310 Just, uh, hold still. 893 00:34:31,854 --> 00:34:33,272 OK. 894 00:34:36,525 --> 00:34:38,777 Voilà. 895 00:34:38,778 --> 00:34:41,529 - Really? - That was amazing. 896 00:34:41,530 --> 00:34:43,365 I think another half hour, 897 00:34:43,366 --> 00:34:45,033 we can send this dry-erase board back to storage. 898 00:34:45,034 --> 00:34:46,242 With pleasure. 899 00:34:46,243 --> 00:34:47,619 - Dr. Robinavitch? - Yep. 900 00:34:47,620 --> 00:34:49,080 Results on your friend. 901 00:34:53,709 --> 00:34:55,920 - Fuck. - Duke? 902 00:34:59,882 --> 00:35:01,549 Are you gonna tell him? 903 00:35:01,550 --> 00:35:03,176 I want to talk to a surgeon first. 904 00:35:03,177 --> 00:35:05,220 Uh, Dr. Robby, I have an update on the patient. 905 00:35:05,221 --> 00:35:06,680 Now is not a great time. 906 00:35:06,681 --> 00:35:08,056 Oh, I thought you were going home. 907 00:35:08,057 --> 00:35:09,265 Uh, I was. 908 00:35:09,266 --> 00:35:11,059 Dr. Ogilvie is just sitting 909 00:35:11,060 --> 00:35:12,769 out in the ambulance bay covered in blood. 910 00:35:12,770 --> 00:35:14,396 Sorry, what... what's he doing out there? 911 00:35:14,397 --> 00:35:16,356 Kind of, uh, staring off into space. 912 00:35:16,357 --> 00:35:17,691 I tried to talk to him, but it was like 913 00:35:17,692 --> 00:35:19,109 - he couldn't hear me. - Monica, 914 00:35:19,110 --> 00:35:20,735 can you stat page CardioThoracic? 915 00:35:20,736 --> 00:35:22,905 - I'll go check on Ogilvie. - Please. 916 00:35:25,199 --> 00:35:26,409 Oh. 917 00:35:37,795 --> 00:35:40,005 Hey, Ogilvie. 918 00:35:42,591 --> 00:35:44,592 Ogilvie... 919 00:35:44,593 --> 00:35:46,429 y-you OK, man? 920 00:35:51,475 --> 00:35:53,601 99 on 2 liters. 921 00:35:53,602 --> 00:35:55,937 Scattered end expiratory wheezes. 922 00:35:55,938 --> 00:35:58,148 He is so much better. 923 00:35:58,149 --> 00:36:00,191 The steroids should kick in soon. 924 00:36:00,192 --> 00:36:02,610 So he'll keep improving. 925 00:36:02,611 --> 00:36:04,946 Um, when can I go home? 926 00:36:04,947 --> 00:36:06,614 In a day or two. 927 00:36:06,615 --> 00:36:09,909 And we will, uh, discharge you with a Symbicort inhaler. 928 00:36:09,910 --> 00:36:12,078 That should last about a month. 929 00:36:12,079 --> 00:36:14,622 Hopefully we'll be back on Medicaid by then. 930 00:36:14,623 --> 00:36:16,624 How'd you lose it? 931 00:36:16,625 --> 00:36:20,128 They sent a redetermination letter to our old apartment. 932 00:36:20,129 --> 00:36:22,672 It didn't get forwarded. 933 00:36:22,673 --> 00:36:24,758 When I went to pick up his prescription, 934 00:36:24,759 --> 00:36:28,595 pharmacist told me we were no longer covered. 935 00:36:28,596 --> 00:36:30,805 And you haven't been able to get it back since? 936 00:36:30,806 --> 00:36:33,141 I've been trying for months. 937 00:36:33,142 --> 00:36:35,643 To get re-enrolled, you need tax returns, 938 00:36:35,644 --> 00:36:37,020 pay stubs. 939 00:36:37,021 --> 00:36:39,981 I cut hair. My income fluctuates. 940 00:36:39,982 --> 00:36:42,400 A lot of my regulars are struggling, 941 00:36:42,401 --> 00:36:45,528 so it's been tough. 942 00:36:45,529 --> 00:36:47,489 Well, if you run out of Symbicort 943 00:36:47,490 --> 00:36:49,824 before your Medicaid kicks in, you can come back, 944 00:36:49,825 --> 00:36:52,744 and we'll, uh, set you up with another one. 945 00:36:52,745 --> 00:36:54,746 Oh, is there a patient in here? 946 00:36:54,747 --> 00:36:57,832 'Cause everyone in this room looks extremely healthy to me. 947 00:36:57,833 --> 00:37:00,335 Dr. Shen and I will be with Grady all night long. 948 00:37:00,336 --> 00:37:02,253 Yeah. Day shift, we got this. 949 00:37:02,254 --> 00:37:04,214 We're leaving you in good hands. 950 00:37:04,215 --> 00:37:06,049 Um... 951 00:37:06,050 --> 00:37:08,510 I was really scared. 952 00:37:08,511 --> 00:37:09,678 Thank you. 953 00:37:11,347 --> 00:37:13,349 You're very welcome. 954 00:37:17,228 --> 00:37:19,855 Due to his injury, things have changed. 955 00:37:21,315 --> 00:37:23,566 I was looking for Dr. Abbot. 956 00:37:23,567 --> 00:37:26,402 I haven't seen him for a while. 957 00:37:26,403 --> 00:37:27,696 Excuse me. 958 00:37:30,699 --> 00:37:32,700 So now, with a long-term disability, 959 00:37:32,701 --> 00:37:35,411 things may be easier. 960 00:37:35,412 --> 00:37:36,579 "Easier"? 961 00:37:36,580 --> 00:37:38,081 His condition will qualify him 962 00:37:38,082 --> 00:37:39,582 for Medicare and Medicaid. 963 00:37:39,583 --> 00:37:42,085 So, moving forward, costs should be covered, 964 00:37:42,086 --> 00:37:43,878 including home health care. 965 00:37:43,879 --> 00:37:45,213 OK. 966 00:37:45,214 --> 00:37:46,714 Perhaps this isn't the best time... 967 00:37:46,715 --> 00:37:48,049 I just wanted to reassure you 968 00:37:48,050 --> 00:37:49,927 about future costs. 969 00:37:58,102 --> 00:37:59,519 Robby. 970 00:37:59,520 --> 00:38:01,729 Noelle. 971 00:38:01,730 --> 00:38:03,314 You're still here. 972 00:38:03,315 --> 00:38:05,650 It's not the best day to try to get out on time. 973 00:38:05,651 --> 00:38:07,360 Mm. 974 00:38:07,361 --> 00:38:08,778 So I guess this is it for a while. 975 00:38:08,779 --> 00:38:10,280 Unless you want to come with me. 976 00:38:10,281 --> 00:38:12,699 No, but thank you, 977 00:38:12,700 --> 00:38:14,742 even if it isn't a legitimate offer. 978 00:38:14,743 --> 00:38:16,244 - What do you mean? - Oh, please. 979 00:38:16,245 --> 00:38:18,079 I know well enough not to get in between 980 00:38:18,080 --> 00:38:20,165 a man and his vision quest. 981 00:38:21,584 --> 00:38:22,917 "Vision quest." 982 00:38:22,918 --> 00:38:26,088 That is my nice way of putting it. 983 00:38:27,256 --> 00:38:28,590 I probably don't want to hear 984 00:38:28,591 --> 00:38:30,466 your not-so-nice way of putting it. 985 00:38:30,467 --> 00:38:31,927 No, probably not. 986 00:38:33,596 --> 00:38:37,223 I-I hope that this is not, um... 987 00:38:37,224 --> 00:38:38,600 about you running away from me. 988 00:38:38,601 --> 00:38:39,809 I'm a big girl. 989 00:38:39,810 --> 00:38:41,477 You can tell me just to get lost. 990 00:38:41,478 --> 00:38:43,313 This has nothing to do with you. 991 00:38:43,314 --> 00:38:44,606 Oh, right. 992 00:38:44,607 --> 00:38:47,359 It's the old, uh, "it's not you, it's me"? 993 00:38:48,819 --> 00:38:51,030 In this case, it's actually true. 994 00:38:57,202 --> 00:38:58,871 Excuse me. 995 00:39:04,960 --> 00:39:06,294 I'll see you next week? 996 00:39:06,295 --> 00:39:07,629 It's a three-month sabbatical. 997 00:39:07,630 --> 00:39:09,632 Like I said, I will see you next week. 998 00:39:16,305 --> 00:39:19,599 My first day here as a med student... 999 00:39:19,600 --> 00:39:21,309 there was a patient. 1000 00:39:23,020 --> 00:39:24,812 He was a real nice guy, 1001 00:39:24,813 --> 00:39:27,649 came in with belly pain. 1002 00:39:27,650 --> 00:39:31,277 I saw a gall stone on the ultrasound, 1003 00:39:31,278 --> 00:39:33,446 normal EKG, troponin. 1004 00:39:33,447 --> 00:39:36,824 The pain resolved, and he was in the hall 1005 00:39:36,825 --> 00:39:38,702 when he had a cardiac arrest. 1006 00:39:41,497 --> 00:39:42,873 I couldn't save him. 1007 00:39:44,416 --> 00:39:45,876 People die. 1008 00:39:47,336 --> 00:39:50,838 And we do the best we can... 1009 00:39:50,839 --> 00:39:53,258 but people die. 1010 00:39:54,426 --> 00:39:56,428 You ever get used to it? 1011 00:39:57,930 --> 00:39:59,556 No. 1012 00:40:00,933 --> 00:40:03,768 No, you... 1013 00:40:03,769 --> 00:40:05,688 you try to accept it. 1014 00:40:07,690 --> 00:40:09,441 You try to find balance. 1015 00:40:14,863 --> 00:40:17,783 I don't know if I can take another day like today. 1016 00:40:19,326 --> 00:40:22,704 Primary care specialty sounds way better. 1017 00:40:22,705 --> 00:40:24,497 Pedes, maybe. 1018 00:40:24,498 --> 00:40:26,041 Yeah, maybe. 1019 00:40:27,543 --> 00:40:30,713 I know I'd be bored out of my fucking mind. 1020 00:40:32,006 --> 00:40:36,050 Seriously, I like the challenge of undiagnosed illness, 1021 00:40:36,051 --> 00:40:41,055 of quick decisions, of life-saving procedures. 1022 00:40:41,056 --> 00:40:43,474 And I like being here for people 1023 00:40:43,475 --> 00:40:45,894 on the worst days of their lives. 1024 00:40:54,069 --> 00:40:56,070 You know what I think? 1025 00:40:56,071 --> 00:40:57,780 What? 1026 00:40:57,781 --> 00:41:00,116 I think you should go home. 1027 00:41:00,117 --> 00:41:01,576 I think you should sleep on it. 1028 00:41:01,577 --> 00:41:03,077 And I think you should at least wait 1029 00:41:03,078 --> 00:41:04,287 till the morning to decide 1030 00:41:04,288 --> 00:41:05,748 if you want to come back. 1031 00:41:08,751 --> 00:41:11,085 I don't really want to... 1032 00:41:11,086 --> 00:41:13,713 go back in there and see anybody. 1033 00:41:13,714 --> 00:41:14,923 Yeah. 1034 00:41:16,425 --> 00:41:18,968 OK, pull off your gown. I'll take it in. 1035 00:41:18,969 --> 00:41:21,429 Shift is over. 1036 00:41:21,430 --> 00:41:22,931 Go home. 1037 00:41:35,778 --> 00:41:37,111 - Oh! - Oh, God. 1038 00:41:37,112 --> 00:41:38,154 - No, I'm... I'm... - Sorry. 1039 00:41:38,155 --> 00:41:39,614 I'm good. I'm good. I'm good. 1040 00:41:39,615 --> 00:41:41,282 There's a dummy in a wheelchair. 1041 00:41:41,283 --> 00:41:43,202 Uh, yeah, he moves around. 1042 00:41:46,288 --> 00:41:48,456 I see I've been replaced. 1043 00:41:48,457 --> 00:41:49,999 Oh, did I take your spot? 1044 00:41:50,000 --> 00:41:51,667 - Not really, no. - Are you sure? 1045 00:41:51,668 --> 00:41:53,127 Where the hell have you been? 1046 00:41:53,128 --> 00:41:54,796 I found Ogilvie. 1047 00:41:54,797 --> 00:41:56,047 And? 1048 00:41:56,048 --> 00:41:58,382 And he's going home. 1049 00:41:58,383 --> 00:41:59,634 That's it? 1050 00:41:59,635 --> 00:42:00,968 It's a long story. 1051 00:42:00,969 --> 00:42:02,386 Well, I got nothing but time. 1052 00:42:02,387 --> 00:42:04,555 I need to respect his privacy. 1053 00:42:04,556 --> 00:42:06,140 Where's the fun in that? 1054 00:42:06,141 --> 00:42:08,143 - Beep. Beep, beep. - Sorry. 1055 00:42:16,693 --> 00:42:18,152 Um, the shredder jammed. 1056 00:42:18,153 --> 00:42:21,155 Yeah, uh, try putting it in reverse. 1057 00:42:23,492 --> 00:42:24,700 Perfect. 1058 00:42:24,701 --> 00:42:26,828 Just give it a little love tap. 1059 00:42:26,829 --> 00:42:28,371 - OK. - Kick it. 1060 00:42:29,498 --> 00:42:31,124 Jesus Christ. 1061 00:42:33,001 --> 00:42:35,169 Guess Mr. Digby got a room upstairs. 1062 00:42:35,170 --> 00:42:36,671 In your dreams. 1063 00:42:36,672 --> 00:42:38,673 He's not in South 21. 1064 00:42:38,674 --> 00:42:40,049 Yeah, he is. 1065 00:42:40,050 --> 00:42:42,385 There's a new guy in the bed. 1066 00:42:42,386 --> 00:42:44,387 Short hair, clean-shaved? 1067 00:42:44,388 --> 00:42:46,848 I'll take care of it. 1068 00:42:46,849 --> 00:42:48,516 Scout film showed obvious pathology, 1069 00:42:48,517 --> 00:42:50,059 so we ordered the CT angiogram. 1070 00:42:50,060 --> 00:42:51,727 Textbook ascending aortic aneurysm. 1071 00:42:51,728 --> 00:42:53,563 Eight centimeters. 1072 00:42:53,564 --> 00:42:55,439 50% one-year mortality. 1073 00:42:55,440 --> 00:42:56,732 So he definitely needs surgery. 1074 00:42:56,733 --> 00:42:57,733 If he wants to live. 1075 00:42:57,734 --> 00:42:58,776 OK, well, he's a friend, 1076 00:42:58,777 --> 00:43:00,069 so I will talk to him. 1077 00:43:00,070 --> 00:43:01,237 I'll get him admitted to your service. 1078 00:43:01,238 --> 00:43:03,364 - Not today. - Why not? 1079 00:43:03,365 --> 00:43:05,199 He needs to see Cardiology and Pulmonary first 1080 00:43:05,200 --> 00:43:06,450 to be cleared for the OR. 1081 00:43:06,451 --> 00:43:08,369 They can do a stress echo, PFTs. 1082 00:43:08,370 --> 00:43:10,621 He needs to be admitted and evaluated as an inpatient. 1083 00:43:10,622 --> 00:43:12,290 Nothing ever gets done over a holiday weekend. 1084 00:43:12,291 --> 00:43:13,374 He can take it easy at home. 1085 00:43:13,375 --> 00:43:14,792 He's a ticking time bomb. 1086 00:43:14,793 --> 00:43:16,127 He's probably been that way for years. 1087 00:43:16,128 --> 00:43:17,420 We can get him in early next week 1088 00:43:17,421 --> 00:43:19,046 with a specialist to get his testing done. 1089 00:43:19,047 --> 00:43:21,007 All goes well, he's on the OR schedule in a week. 1090 00:43:21,008 --> 00:43:22,592 What happens if it ruptures before then? 1091 00:43:22,593 --> 00:43:24,427 Call 911. 1092 00:43:24,428 --> 00:43:26,095 Sorry, Robby. Best we can do. 1093 00:43:26,096 --> 00:43:28,096 Text me his number. I'll have my office coordinate. 1094 00:43:30,225 --> 00:43:31,893 - Fuck! - Hey! 1095 00:43:31,894 --> 00:43:33,604 Take a walk. Come on! 1096 00:43:37,065 --> 00:43:38,733 Two for discharge. 1097 00:43:38,734 --> 00:43:40,401 Yeah, please don't ring the bell. 1098 00:43:40,402 --> 00:43:42,028 The computers are back up and running. 1099 00:43:42,029 --> 00:43:43,571 Not for these two. 1100 00:43:43,572 --> 00:43:44,947 They don't have electronic health records yet. 1101 00:43:44,948 --> 00:43:46,365 Wait, hold up. 1102 00:43:46,366 --> 00:43:48,576 This kid had a wrist X-ray ordered. 1103 00:43:48,577 --> 00:43:49,869 Ugh, it never happened. 1104 00:43:49,870 --> 00:43:51,162 And water-skiing lady's 1105 00:43:51,163 --> 00:43:52,496 still waiting on a knee series. 1106 00:43:52,497 --> 00:43:53,748 I canceled the X-rays. 1107 00:43:53,749 --> 00:43:56,083 Diagnosed them both with ultrasound. 1108 00:43:56,084 --> 00:43:57,335 Really? 1109 00:43:57,336 --> 00:43:59,086 Yeah. 1110 00:43:59,087 --> 00:44:01,589 The, uh, little boy had a simple buckle fracture. 1111 00:44:01,590 --> 00:44:04,175 Distal radius. He got a Velcro splint. 1112 00:44:04,176 --> 00:44:06,928 And Mrs. Stegman had a small medial meniscus tear. 1113 00:44:06,929 --> 00:44:09,305 Knee immobilizer, crutches, and a follow up with ortho. 1114 00:44:09,306 --> 00:44:11,641 Could have used you on the day shift today. 1115 00:44:11,642 --> 00:44:14,101 They don't teach us a lot of musculoskeletal ultrasound. 1116 00:44:14,102 --> 00:44:15,603 I know. 1117 00:44:15,604 --> 00:44:18,272 That's why I did electives at Harvard and Highland. 1118 00:44:18,273 --> 00:44:21,108 Are you applying for an ultrasound fellowship here? 1119 00:44:21,109 --> 00:44:23,903 I am, but it is so competitive. 1120 00:44:23,904 --> 00:44:26,113 - That's what I hear. - Kind of a long shot. 1121 00:44:26,114 --> 00:44:27,573 I only have one publication, 1122 00:44:27,574 --> 00:44:29,450 but it's a series of case reports diagnosing 1123 00:44:29,451 --> 00:44:31,994 shoulder dislocations with ultrasound only. 1124 00:44:31,995 --> 00:44:33,996 If you want to learn some MSK, you can tag along. 1125 00:44:33,997 --> 00:44:35,498 I got three more to scan. 1126 00:44:35,499 --> 00:44:37,500 Maybe some other time. 1127 00:44:37,501 --> 00:44:39,961 Cool. 1128 00:44:42,297 --> 00:44:44,298 Hey, don't jam the shredder. 1129 00:44:44,299 --> 00:44:45,800 What is that, two charts? 1130 00:44:45,801 --> 00:44:48,345 No, it's my ultrasound fellowship application. 1131 00:44:50,138 --> 00:44:51,806 Hey. 1132 00:44:51,807 --> 00:44:54,809 Uh, sorry about your patient. 1133 00:44:54,810 --> 00:44:57,812 Yeah, Orlando's in pretty bad shape. 1134 00:44:57,813 --> 00:44:59,689 Oh, no, I... I was talking about 1135 00:44:59,690 --> 00:45:03,359 the triple-A guy you worked on with Ogilvie. 1136 00:45:05,904 --> 00:45:08,531 He didn't make it through surgery. 1137 00:45:08,532 --> 00:45:10,074 I tried to talk to Robby about it, 1138 00:45:10,075 --> 00:45:12,076 but I think he's busy. 1139 00:45:12,077 --> 00:45:13,745 Excuse me. 1140 00:45:16,039 --> 00:45:17,916 Oh, shit. 1141 00:45:22,087 --> 00:45:23,629 You think I'm on edge? 1142 00:45:23,630 --> 00:45:25,381 First you're shaming Samira, then McKay... 1143 00:45:25,382 --> 00:45:26,716 They both needed to be called out 1144 00:45:26,717 --> 00:45:28,050 - for unacceptable behavior. - Yeah? 1145 00:45:28,051 --> 00:45:29,343 Yeah, well, you do that in private. 1146 00:45:29,344 --> 00:45:30,803 Same place you share your thoughts 1147 00:45:30,804 --> 00:45:32,013 about a patient's possible suicide. 1148 00:45:32,014 --> 00:45:33,472 And slamming stuff? Please. 1149 00:45:33,473 --> 00:45:34,682 Sign out all the shit that's bugging you 1150 00:45:34,683 --> 00:45:35,850 and get out of here. 1151 00:45:35,851 --> 00:45:37,643 - I can't. - Yes, you can. 1152 00:45:37,644 --> 00:45:39,020 When either of my kids was acting like this, 1153 00:45:39,021 --> 00:45:40,479 I gave them a time-out in their room. 1154 00:45:40,480 --> 00:45:41,647 Whoa, whoa, whoa, you're not my mother. 1155 00:45:41,648 --> 00:45:42,857 Yeah? Well, too bad. 1156 00:45:42,858 --> 00:45:44,025 - You need one. - No, I had one. 1157 00:45:44,026 --> 00:45:45,735 She left. I don't need another one. 1158 00:45:45,736 --> 00:45:47,069 What I need is someone who can actually run this place 1159 00:45:47,070 --> 00:45:49,030 - while I'm gone. - OK, I'm sorry. 1160 00:45:49,031 --> 00:45:50,364 - I didn't know. - Nobody knows. 1161 00:45:50,365 --> 00:45:52,658 Who needs to know? Who gives a fuck? 1162 00:45:52,659 --> 00:45:53,993 I think you need a break. 1163 00:45:53,994 --> 00:45:55,536 That is what the sabbatical is for. 1164 00:45:55,537 --> 00:45:57,079 Then start it now. Walk away. 1165 00:45:57,080 --> 00:45:58,372 I have too much to do. 1166 00:45:58,373 --> 00:46:00,041 Let someone else talk to Duke. 1167 00:46:00,042 --> 00:46:01,792 No, that needs to come from me. 1168 00:46:01,793 --> 00:46:03,127 Why? 1169 00:46:03,128 --> 00:46:04,712 Because I owe him that. 1170 00:46:04,713 --> 00:46:06,547 It needs to come from a friend, not a stranger, 1171 00:46:06,548 --> 00:46:08,591 otherwise he's gonna bail and drop dead while I'm gone. 1172 00:46:08,592 --> 00:46:11,469 OK, wrap that up and then leave. 1173 00:46:11,470 --> 00:46:13,095 It's not just Duke. 1174 00:46:13,096 --> 00:46:14,847 I'm not sure that Al-Hashimi is fit to run this place. 1175 00:46:14,848 --> 00:46:16,057 - What's that supposed to mean? - I'm not sure. 1176 00:46:16,058 --> 00:46:17,472 I'm trying to figure that out. 1177 00:46:17,473 --> 00:46:18,934 Did you know that she wants to have two attendings 1178 00:46:18,935 --> 00:46:20,323 - on at all times? - No. 1179 00:46:20,324 --> 00:46:22,063 Is that something she's worked out with Gloria? 1180 00:46:22,064 --> 00:46:23,606 - I don't know. - I also don't know 1181 00:46:23,607 --> 00:46:24,940 if Langdon is going to relapse. 1182 00:46:24,941 --> 00:46:27,360 I don't know if Whitaker's gonna be able to take care of my shit. 1183 00:46:27,361 --> 00:46:28,903 I don't know if Javadi's gonna give up on 1184 00:46:28,904 --> 00:46:30,780 what she's good at or if Samira's gonna flame out 1185 00:46:30,781 --> 00:46:32,239 because of some bullshit with her mother. 1186 00:46:32,240 --> 00:46:34,617 - Is there anything else? - Yeah, you. 1187 00:46:34,618 --> 00:46:36,869 I don't know about you running around 1188 00:46:36,870 --> 00:46:38,621 with a full syringe of Versed in your pocket. 1189 00:46:38,622 --> 00:46:41,040 I'm worried about the people that I care about. 1190 00:46:41,041 --> 00:46:43,417 We'll all manage until you come back. 1191 00:46:43,418 --> 00:46:44,585 We always do. 1192 00:46:44,586 --> 00:46:45,943 Yeah? What if I don't come back? 1193 00:46:50,353 --> 00:46:53,860 Sync and corrections by btsix www.addic7ed.com