- 2 days ago
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00:00You are sultry, dirty, soft and hard
00:17You are close to me and you're so far
00:22And I'm thinking of the time we spent together
00:29Now I'm burying this in my backyard
00:33Sometimes I sit and wonder
00:40But I'll never tell your number
00:45Cause I'm having fun
00:48I'm looking out for no more
00:51I'm doing all the things I like to do
00:55I'm having fun
00:59Cause I knew it all along
01:02I'd be better off without you
01:06I'm using my cast off
01:11As soon as you park that outside
01:13Morning Doc
01:13Olsen, happy 4th
01:15Excuse me guys
01:17Sorry
01:18Hey, how's it going dad?
01:46I'm so sleep deprived
01:48My house is starting to feel like a CIA black site
01:50Have you considered hiring a night nurse?
01:52You're looking at him
01:53You got a ripe one coming in
01:54You're going to have to deal with
01:55Before everybody out there starts puking
01:56Lovely
01:57Your replacement came in early
01:59She brought in a full bagel spread
02:00I'm just saying
02:01She's not my replacement
02:02She's just covering his chief
02:03While I go on my little sabbatical
02:04Three months?
02:05I'll be back before your daughter sleeps with the night
02:07Hey dude, that's cold
02:08Morning
02:09Morning
02:09Morning
02:10Morning
02:24Morning John
02:25Could have sworn it was still around 4am
02:28Did you guys have an easy night last night?
02:30The waiting room actually looks manageable
02:31I wouldn't call it easy
02:33But not too bad
02:34I figured we'd have hands in burns down here a bunch
02:36But so far nobody's blown off any fingers
02:38Oh, you know you just jinxed it
02:40You guys and your jinxes
02:41Please, Jesus, please
02:42Hail Mary again
02:44In the sanctified flesh
02:45Don't let me die alone
02:46Just try to relax, Margaret
02:47I need a priest
02:48Hey, hey, Dr. Robbie
02:50What's the good word, Perla?
02:52All your results came back normal, Mrs. Walker
02:54I'm dying
02:55You're not dying, Mrs. Walker, I promise
02:56Jesus is coming for me
02:58If he is, he hasn't checked on that registration yet
03:00Please don't let me die a sinner
03:01Don't worry, Margaret
03:03We're going to have the hospital chaplain
03:04Come and see you in a moment
03:05I'm not going to last that long
03:06Yes, you will
03:07Because we're going to give you a shot
03:08To keep you alive until they get here
03:10What are you thinking, Dr. Abinovich?
03:12500 mics of cyanocobalamin?
03:14In her condition, I'd push a full thousand
03:15Woo!
03:17You heard the man, Perla
03:18God bless you
03:19God bless all of you
03:21Amen to that
03:22Nothing like the miracle healing powers
03:26Of a good old B-12 shot
03:27She hold down a job
03:29She doesn't
03:31She's wearing a waitress uniform
03:32Yeah, from a diner that closed 20 years ago
03:34And so it begins
03:38My husband is still waiting to see a doctor
03:41I apologize for the wait
03:42But here are two doctors just for you
03:44Mr. Burgess has been complaining of leg cramps for a day
03:47Slightly tacky at 110
03:49BP 128 over 75
03:51Afebrile, good sats
03:53I'm Dr. Shen, but I'm going off shift
03:55Dr. Abinovich will be one of the doctors looking after you
03:57What other medications are you currently taking, Mr. Burgess?
04:00I brought his meds
04:01Thank you
04:03These are his supplements
04:06Mostly all natural and organic where possible
04:08And these are his homeopathic prescriptions
04:10I also have a list of his refrigerated probiotics
04:14Thank you
04:15Where the hell is everybody?
04:19Our new attending is torturing our intern and med students in trauma one
04:24She came in early to meet the night shift and took things over
04:28Okay, that takes giant balls of disrespect
04:30Giant balls of disrespect was the name of my band in high school
04:33Oh, and my nickname for my ex-husband
04:36Hey, uh, is this your last shift?
04:39For a while, yeah
04:40Oh, I'm so jealous
04:41Hey, I'll pay you a grand if you take my second husband
04:45Attempting
04:46So, tell me about this new attending
04:48Uh, she's pretty, divorced
04:51One kid can already tell she is a strict rule follower
04:54I'm probably going to grow to hate her
04:56What's her name again?
04:57Uh, Dr. Baran Al-Hashimi
04:59Al-Hashimi?
05:00What is that?
05:02Irish
05:03She's some sort of clinical informatics expert
05:07When she started talking about AI
05:09I started thinking about robots
05:11And kind of stopped listening
05:12Clear
05:13Off the chest, Ogilvy
05:16Get ready to step up here, Joy
05:17Ogilvy, off the chest
05:19Clear
05:20Still V-TAC, but it looks weird
05:23Agreed
05:24No pulse
05:24No effusion
05:25Good lung sliding
05:26Hey, start compressions, Joy
05:28We haven't considered all the T's
05:29I checked for tamponade and tension pneumo
05:31What if it's thrombosis?
05:32If it's a pulmonary or a cardiac clock, TNK could save it
05:34We are sticking with the algorithm for now
05:36Algorithm's not working
05:37Faster and deeper, please
05:38Uh, you need a break, Joy?
05:40No, I need an attending
05:41I'm right here
05:42Stop compressions, we're calling it
05:45Sorry, the patient's dead
05:48All right
05:52Who can tell me what went well?
05:54We followed the V-TAC algorithm
05:56We checked for reversible causes
05:57We limited our rhythm and pulse checks
05:59For ten seconds
06:00Excellent
06:00Should we have given thrombolytics?
06:02No, you should have recognized
06:03That the cardiac rhythm on the monitor
06:04Was polymorphic, not just V-TAC
06:07It was torsade de point
06:09That's French, twisting of the points
06:11From Poulon QT, anti-arrhythmic electrolyte disorders
06:14Your patient would have lived if you pushed magnesium sulfate
06:17Good news is, he's an organ donor
06:19Parts of him are going to get used to make frisbees
06:22Water bottles
06:23End up as microplastics in our brains and reproductive organs
06:25Thank you for the words of encouragement, boss
06:27Dr. Alishimi, Dr. Michael Rabinovich, everybody calls me Robbie
06:29Barron, please
06:30Welcome to the pit
06:31Tom is a minute out
06:33Ooh, who wants to treat a real patient?
06:35Yes, please
06:36Things are going to give me nightmares
06:37I hope you don't mind me jumping right into things
06:42I find that a mock code is a great way to assess the student's capabilities
06:46Well, it might have been nice if we'd had a little time to go over how we do things
06:50Did you not get a packet from Dr. Underwood, Gloria?
06:53It outlined the quality improvement changes I instituted at the VA
06:57We're adopting the program at all of the university hospitals
07:00You didn't read it?
07:01No, I did
07:02I mean, I will
07:03I'm going to, I want to
07:04I thought I had a little bit more time before you came in today
07:07We've already distributed patient passports to everyone at registration
07:10What is a patient passport?
07:13I'm so glad you asked
07:14Samira
07:16Dr. Al
07:17We worked together at the VA a few years ago
07:20And now you're in our form
07:21Yes, and I'm so excited you're joining us
07:24Dr. Mel King is here too
07:25I think you worked with her as well
07:27I did indeed
07:28John Doe
07:29Dishwasher penetrating trauma from a kitchen knife to the right chest
07:32Assault or accident?
07:33Unclear
07:34Initially had a pulse
07:35Lost it two blocks away
07:37What do we got, party people?
07:41Dr. Yolanda Garcia
07:43Trauma surgery fellow
07:44Meet Dr. Baran Alashimi
07:46New ED attending
07:47She's going to be covering for me while I'm gone
07:49So nice to meet you
07:50That time they replaced you, rabbit bitch
07:52I'm going to miss you too, YOLO
07:54Dr. Garcia has a hard time expressing your feelings
07:56Not all of them
07:57One, two, three
08:00Prep for a left-door economy
08:02I'm on it
08:03What's up, White Chocolate?
08:07Did you know our farm boy here is a vintage funk freak?
08:11Unfortunately, he also likes to use other people's toothbrushes
08:13It was one time
08:15They were the same color
08:16What's your plan, Samira?
08:18Chest tube to the right
08:20Standby with master transfusion protocol
08:22I put two units on the infuser
08:23Steroid web six and a half
08:24Here we let the fellows and the residents kind of take charge
08:27I'll hold on to them just in case
08:28Is the VA even a trauma sim?
08:32Not for medic runs, but they walk in
08:35Falls, major MBCs, GSWs
08:39Stab wounds on the right
08:41Why are we opening the left chest?
08:43Better access if it's tamponade
08:45And you can cross-clamp VA or not
08:46Javadi, Whitaker, sterile gloves
08:48Can I glove it?
08:49That's best if you watch the first one
08:51This guy's dead anyway
08:54Tamp blade
08:5628 French on a long kelly
08:58Javadi, you're on section Whitaker
09:01Get ready for internal compressions
09:03Sorry, that's my phone
09:07Finished out of a tractor?
09:10Whitaker, give me a little room
09:12I need to get to his heart
09:13I'm in, hook up the door seal
09:15How many get that for you?
09:17Not right now
09:28No tamponade, pretty dry in here
09:32Heart's empty, somebody start cardiac massage
09:34I'll cross-clamp
09:35Yeah, I got it
09:36You do these one-handed
09:37Pushing up against the breastbone
09:38Four fingers
09:39Very good
09:40Not much blood to suction
09:41Okay team
09:42Samira, next steps
09:43Keep transfusing, open the right chest
09:45That is correct
09:46Booties on kids, there will be blood
09:50Frank?
09:54Landis
09:57Frank?
09:58You should be good to go now, hon
10:08Thanks, Lupe
10:09Of course
10:10Hey, go get him
10:15Hey, da
10:17It's been a while
10:19Wow
10:22I got a bad toothache today
10:25We'll take care of that, Louie
10:27Alright
10:49There's too much blood suction
11:04Uh, we're tracking the lung
11:06Try to identify the source
11:07Could be the right ventricle
11:09Or more likely the hilum
11:10Fresh lap pads
11:14Siri, turn on silent mode
11:16Tent mode
11:46Okay
12:08Good morning
12:09It was a good morning
12:10I'd still be in bed
12:11So what are you doing here?
12:12Ventry's mom is visiting for the holiday
12:14Is she still alive?
12:15It always took me to die
12:17Plus who else is gonna get this place
12:18To the 4th of July weekend?
12:20Sure as hell ain't gonna be me
12:21I rest my case
12:22What am I walking into?
12:24Nothing too bad
12:25Yet
12:26Uh, these are the ones I'd keep an eye on
12:30The prodigal son returns
12:33Too soon?
12:35No, I guess not
12:37You're back
12:38It took some time
12:39Like an old trail horse
12:40Always follow the way back out
12:43You look good, kid, how you feeling?
12:44Uh, yeah
12:45Great
12:46You know, it's been, uh
12:48It's been a journey
12:49I bet
12:51Thanks
12:52Rob, you're on?
12:53Uh, he's in with the trauma
12:54But if you hurry back
12:55You can catch some of the pass-ons there in North
12:57Uh, thanks
13:01I'll keep an eye on him
13:05I think we have a lost little lamb
13:07Uh, excuse me, hon
13:08Can we help you?
13:09Uh, I-I'm looking for the charge nurse
13:12Oh, well, you found two of them
13:14I'm Lena, this is Dana
13:15I'm night shift going home
13:16But Dana is queen of the day shift
13:19Hmm, Emma Nolan
13:20Nice to meet you both
13:21I-I'm a new grad R.N. here to shadow
13:24Welcome to the pit, Emma Nolan
13:25Here, let me put some of your stuff behind the desk
13:27And I'll give you a quick tour
13:28Okay
13:30Where you from, sweetheart?
13:31Sault Ste. Marie is in Upper Michigan
13:34Tactically Canada
13:36My great-grandmother was from up that way
13:39Nice area
13:40A lot of bugs
13:42How about a cup of coffee?
13:45I can't locate the source
13:46Proximal high home is under the sternum
13:48Along with most of the right ventricle
13:50You need better exposure
13:52Convert to a clamshell
13:53Exactly
13:54Trauma shears
13:56That'd be nice to let them come up with that clam
13:58Heart's gonna need double compressions just like this
14:00Squeeze from the apex to the aorta
14:06Right ventricle looks good
14:08Massive hemorrhage from the hylum
14:09Second MTP packs going
14:11Additional four units
14:13High larynge looks very proximal
14:15Maybe pulmonary artery and vein
14:17Clamps on
14:18Nope, no good
14:20Still bleeding like a stuffed pig
14:21I can give it a try
14:22Dr. Garcia is a very skilled surgeon
14:24If she can't get it
14:25We need to think of something else
14:26Like what?
14:30Hilary flip
14:31You're gonna rotate the lung 180 degrees
14:33Like putting a king in the garden hose
14:34It'll stop the bleeding
14:36That could possibly work
14:37Or he'll die when you rip the entire lung off the hilum
14:40Gently
14:42Very, very gently
14:43Very, very slowly
14:44Blood loss is lying down
15:01That's a good sign
15:02Hylum looks dry
15:03Maybe the heart feels empty
15:04Okay, we fixed the leak
15:06Now let's fill the tank
15:10You are very popular today
15:12Sorry, I'll turn it off when I can
15:19Nine-year-old Kylie Connors
15:20Riding by her dad's girlfriend Gina
15:22Kylie took a tumble on the stairs this morning
15:24We submitted a chin lag and a chipped front incisor
15:28Just got lead on a pressure dressing
15:30Bleamed pretty good on a rival
15:31Dermabond should do the trick
15:34Any questions?
15:36Dr. King?
15:39Mel
15:40Oh, um, I didn't say anything
15:46How you feeling Kylie?
15:47Tired
15:48We've been here since 5.30
15:49Oh, that makes two of us
15:51But don't worry
15:52We'll patch you up good as new
15:53And we will get you out of here as soon as we can
15:56Any questions?
15:57No, I'm just her dad's girlfriend
15:59So I'm new to all this
16:00No worries
16:01We got you
16:02Next
16:0426-year-old Liam Sanders
16:06Took a fall from his bicycle
16:08No LOC
16:09Non-focal neural
16:10Lower leg lock
16:11With no bony tightness
16:12Were you wearing a helmet, Liam?
16:14No, I was just writing in my neighborhood
16:16You should always wear a helmet
16:17Hey, nice of you to join us
16:19Hey
16:20Dr. Langdon
16:21Sold to Dr. Langdon
16:24Sold to Dr. Langdon
16:26Candace O'Grady, 82
16:28Brought a virus on Richard for intractable vomiting
16:35Hardly any hemorrhage on the right
16:36Looks like the flip worked
16:37As a heart worker
16:38Feels full of blood
16:39First time since we started
16:40Hold compressions
16:44Quivering bag of worms
16:45Resume compressions
16:46When the heart quivers like that
16:48It's obvious if you fit
16:49Okay, internal paddles ready?
16:51Mm-hmm
16:52Charge 2
16:5325 joules
16:5450 joules
16:5550 gets it right the first time
16:58Charged
16:59Okay, Whitaker, when you're ready
17:00Clear
17:05I think that's what normal sinus looks like
17:08Strong carotid
17:09Saline lap pads and up to the OR
17:11So a hell of a way to start the day?
17:15Unconventional
17:16But a decent outcome
17:19Why don't we split up for efficiency
17:21Residents present to either one of us
17:23But not both?
17:25We can certainly discuss that
17:32Were you feeling weak or dizzy?
17:34No
17:35I got up to pee
17:36And I tripped over a laundry basket
17:37That I couldn't see in the dark
17:39Did you hit your head?
17:40Does my chart say that I hit my head?
17:42No
17:43We just
17:44Want to be thorough
17:45To make sure you don't miss anything
17:47How about we focus on patching me up?
17:49Ah
17:51Alright
17:52Mr. Williams
17:53We're gonna check an x-ray of your wrist
17:54And try to get you out of here
17:55As quickly as possible
17:56Great
17:57And let's keep the bullshit extra charges
17:59To a minimum, huh?
18:00My deductible is already a bitch
18:06Sure
18:10You know
18:11You're not here
18:12But, you're so ugly
18:13You're an idiot
18:14You were trying to run all of us
18:15You have to be taken off with
18:16You're full of organs
18:17You're full of organs
18:18You're full of organs
18:19You're full of organs
18:21But, you're really strong
18:22Here there's a lot
18:23You need to damage
18:25Um, uh, Sadie.
18:30Bye.
18:31My mother is trying to destroy my life.
18:34Well, yeah, they seem to take pleasure in that.
18:36I committed to a partnership track position next year
18:38at a hospital back in Jersey
18:39so I could be close and support her.
18:42But now she's getting married
18:43and selling our house
18:44to go on a year-long cruise around the world.
18:47Wow. I mean, that's, uh...
18:49Pretty fucking stupid idea, if you ask me.
18:52She's known this guy less than a year.
18:54What if he's a player?
18:54What if she disappears at sea?
18:57I mean, what if they're in love?
18:59Lust is more like it.
19:00That is even better.
19:03Man, it has been a while,
19:07and I'm solo this weekend.
19:10I need to get laid.
19:16It's a little much before 8 a.m., right?
19:19Yeah.
19:22Forever.
19:24How's it going, Esby?
19:30Oh, just another day in paradise.
19:32I heard you going on a trip.
19:38Take a sabbatical.
19:54Leave tonight.
19:54Where are you going?
19:57Um, head smashed in buffalo jump.
20:01Captain Crunch flying squirrel socks.
20:03Are we talking in code, or do you have a stroke?
20:07It's an aboriginal UNESCO heritage site in Alberta.
20:10I've never seen the Badlands.
20:12What is this, like, uh, some sort of spirit quest?
20:16Uh, yeah.
20:17Something like that.
20:18Look, I, uh, I guess we should talk.
20:21I've got a lot of things I need to...
20:23At some point, not right now.
20:24Right now, I've got to hit the head,
20:25and I would like you to go help Donnie out in triage.
20:28Triage?
20:29No.
20:30No, I already picked up a patient in North, too,
20:32a bicycle pole left.
20:33Pretty sure we can cover for you.
20:34We've been doing it for months.
20:35Right.
20:39No, and I am very, uh,
20:42both very sorry and appreciative of that.
20:44I just would hate to think
20:45there's some kind of a punishment for...
20:48But, uh, yeah.
20:49Yeah, no, for sure.
20:50We'll talk later.
20:51Before you go.
20:54Like I said, not right now.
20:57Donnie just passed his DMP certification.
20:58He can help you if you get in over your head.
21:04Hey, Mel.
21:04Can you take over a bike-fall leg-lack
21:08in North 2 from Langdon
21:09while he's out in triage?
21:11Um, you know, I can work in triage.
21:12No, I want to keep Langdon out in triage,
21:14and I want to keep you back here.
21:16You okay with that?
21:17Sure.
21:18Great.
21:19Absolutely.
21:27So,
21:27who should I pick up?
21:30We're about to get the morning rush.
21:32What do you mean?
21:33Every morning around this time,
21:34the nursing homes
21:36and assisted living facilities
21:38do their morning bed checks.
21:39Uh-huh.
21:43It looks pretty quiet to me.
21:49Uh-huh.
21:51Incoming!
21:52Oh, like I said,
21:54come on.
21:56Ethan Bostick, 79,
21:57found altered this morning
21:58at assisted living.
22:00No history of dementia.
22:01Has a post.
22:02What's a post?
22:03Position orders for life-sustaining treatment.
22:05No CPR,
22:06no intubation.
22:08Then there's nothing for us to do.
22:10South 15 is open.
22:11Uh, well,
22:12do not resuscitate
22:13does not mean do not treat.
22:15He may perk up with
22:16fluids,
22:17HIV antibiotics.
22:18What's the good word, Crash?
22:25You save that
22:26ventriloquist dummy?
22:27Yeah.
22:28Really?
22:29No.
22:29Mm-hmm.
22:30Wait, tell me you're not
22:32actually charting about
22:33losing a mannequin.
22:34It's part of the exercise.
22:35Dr. Olashimi asked us to do it.
22:37Who's his next of kin?
22:38Barbie?
22:39Okay.
22:39Bye.
22:41What's your, uh,
22:42take on the new attending?
22:45Not too soon to tell.
22:48You?
22:50She's already bugging me
22:51about being behind on my charting.
22:53Now I know why everyone says
22:54being a second-year resident sucks.
22:55Because it does.
22:57I must have sat through
22:57the part of med school
22:58where they tell you
22:5990% of your time
22:59will be spent typing.
23:01Which is just one more reason
23:03surgery is a better
23:04lifestyle choice.
23:05Hey, Dr. Shamsi.
23:06Dr. Trinity Santos.
23:08Oh, yes.
23:09The ER intern who's
23:10interested in my
23:10surgery program.
23:11Well, it's me.
23:12But I'm an R2 now
23:13and thinking of double boarding
23:15in surgery and emergency
23:16medicine.
23:17Which I know would sound
23:18ridiculously ambitious
23:19if I didn't have the talent
23:20to back it up.
23:21And a required attitude.
23:24Are you here to see a patient?
23:26I was.
23:27I did.
23:28And now I'm here to learn
23:29why you aren't returning
23:31my calls or texts.
23:32Okay, I'm out.
23:34Nice seeing you again,
23:35Dr. Shamsi.
23:36As soon as I get
23:37a little free time,
23:37I will make plans for all
23:38of us to do something
23:39together.
23:40What about Tuesday?
23:41I'm working.
23:42On your birthday?
23:44I will call you
23:44and Dad tomorrow
23:45and we will come up
23:46this night to do together.
23:46I promise.
23:47But right now,
23:47I should have a bunch
23:49of night shift handoffs.
23:50We have schedules.
23:59You have chaos.
24:02You know she's wasting
24:03her talents, Doctor.
24:04Victoria is a big girl.
24:06She can make her own decisions.
24:07She's also a young girl
24:09who's still very impressionable.
24:10And you can be very...
24:12Impressionable?
24:13Yes.
24:18Who?
24:19Who?
24:20Oh, for God's sake,
24:22I'll be right there.
24:23We need to talk.
24:26About same time tomorrow.
24:27Next Tuesday is your birthday?
24:33No.
24:35Yes.
24:36Your 21st birthday?
24:37Please don't say anything.
24:38Okay, I get a little anxious
24:40about...
24:40Dr. Santos,
24:40little girl with her chin legs
24:41getting to a gown.
24:43Don't worry.
24:43What do you know what?
24:46Nothing.
24:48Have a good day.
24:49Me too.
24:50Mele gayonka arawan.
24:54Hey, Duke.
24:56I'm just going to remind you
24:57that this is my last shift
24:59for a while,
25:00so I need you to come in
25:01before 3 o'clock
25:02in case we need to run
25:05some tests.
25:06Okay?
25:07We had a deal, brother.
25:11Oh.
25:12Hello.
25:12Hi.
25:13I know you're crazy busy.
25:15Always.
25:15But I figured we should
25:16really go over a few things
25:17before you're gone.
25:18Sure.
25:19Where would you like to start?
25:21Well, one little thing
25:22that I think would have
25:23a big impact
25:23with staff and patients alike
25:25is if we launched a campaign
25:26to eradicate referring
25:28to this wonderful department
25:30as the pit.
25:32Really?
25:33I know you think
25:33it's silly and petty.
25:35No, I think it's just
25:35kind of endearing.
25:36Pretty damn accurate.
25:38I would argue the opposite.
25:41I think subconsciously
25:42it affects those
25:42who work here.
25:43It also lowers expectations,
25:45which in turn
25:45lowers patient satisfaction.
25:47Well, you've been
25:47talking to Gloria.
25:48Yes.
25:49And she agrees with me.
25:50Don't doubt that
25:50for a moment.
25:51You have to see the men
25:53who are there right now.
25:54We see people
25:55in order of severity, ma'am.
25:59I don't know what you're saying.
26:02I can't taste the shit
26:03in the back of my throat.
26:04Actually, the ladies' rights
26:05want to make all of us sick.
26:06Yes, please.
26:07All right.
26:16We'll get them back.
26:18Tell Dana
26:18we're bringing the funk.
26:23So when did your eyes
26:24start bothering you,
26:25Miss Matthews?
26:26My sister Grace, please.
26:28I'm only married to God.
26:30Of course.
26:31I'm sorry.
26:31A few days ago,
26:33I thought it was pink eye.
26:35Or maybe I scratched it
26:36while gardening.
26:37It's a very bad case
26:38of conjunctivitis.
26:40We should send a sample
26:40to the lab
26:41to direct her treatment.
26:43Look up for me.
26:48Great.
26:49I'll put a numbing drop
26:50in your eye
26:51and check for a scratch
26:52with a special lamp.
26:56And I'll get you
26:57to look up for me again.
27:01Have you ever considered
27:02serving God?
27:03Which one?
27:04Excuse me?
27:06My family's Hindu,
27:08so we have like
27:0933 different kinds
27:10of deities.
27:11We have the one.
27:13Some people only need
27:15one, right?
27:16Okay.
27:20Most important rule
27:21around here,
27:21be smart, be safe.
27:23Can't warn you enough
27:24about protecting yourself
27:25and your fellow nurses.
27:27We use the STAMP acronym
27:28to assess patients.
27:29You know it?
27:30Uh, S is for staring
27:31or refusal to make eye contact.
27:33If they're staring,
27:34they're scaring.
27:34T?
27:35Tone of voice.
27:35Often the threat level
27:37rises with their voice.
27:38A is for anxiety.
27:40You can also think aggression.
27:42M is mumbling.
27:43If you listen closely enough,
27:44it's often them saying
27:45what they're thinking of doing
27:46is to talk themselves up to it.
27:47And P?
27:48Pacing.
27:49Good.
27:49We also have a safe word.
27:51Hula hoop.
27:52I guess technically
27:53it's two words,
27:54but whatever.
27:54If there's a threat,
27:55say hula hoop
27:56and we'll all respond.
27:59Yeah?
28:01Lovely.
28:02Okay.
28:03I'll be right there
28:04with reinforcements.
28:07Dirty calls.
28:08We're headed for triage.
28:15I'm gonna get your cash off.
28:17Just need your...
28:17The antibiotics should clear everything up,
28:39but you should try to stay off it for a few days.
28:42I have to work.
28:44I'm late as it is.
28:45Well, um,
28:47take breaks
28:48and elevate when you can.
28:49Tie it on Advil for the pain.
28:51If the pain persists
28:53or feel like it's getting worse,
28:54come on back.
28:54We'll get you fixed up.
28:56Thanks.
28:57Listen,
28:58give this to the doctor.
29:01What the hell is it?
29:02Patient passport.
29:04Let's patients know
29:04what they're waiting for
29:05and how long it'll take.
29:06You check off
29:07if he needs labs,
29:08x-rays,
29:09CT.
29:09None of the above.
29:10When do we start this?
29:11Today.
29:12The new attending.
29:15What's up with your tooth, Louis?
29:17It's been going on for a while.
29:20But it got bad last night.
29:23Lower left side.
29:25Okay.
29:27Ah.
29:28Oh.
29:29Ah.
29:29Ah.
29:30It could be an infection at the root.
29:32Ugh.
29:33We can drain it,
29:33but then...
29:34You're, uh...
29:37You're breathing kind of fast.
29:38Yeah, I've been...
29:39Well,
29:40I've been, uh,
29:42walking more,
29:43trying to get in shape.
29:45But sometimes, like,
29:46I get a little short of breath.
29:47Yeah, you need to walk past
29:49the liquor store,
29:49not into it.
29:50What shape you're getting in
29:52is for a liver transplant.
29:53I don't need a new liver.
29:54Just get rid of this toothache.
29:56Deep breath.
30:01One more.
30:03Is my heart still ticking?
30:04Like a jackrabbit.
30:06How long you been sitting down?
30:07Oh, just for a few minutes.
30:09Not that long.
30:10Um, Louis.
30:14There's something I need to tell you.
30:18Last time I saw you,
30:20about ten months ago,
30:22I treated you,
30:23and I took some of your medicine.
30:27I'm not sure I follow.
30:28I have an addiction to benzos,
30:32and I helped myself
30:34to some of the librium
30:35I prescribed you
30:36for your withdrawal.
30:37You stole my pills?
30:39Yeah.
30:40I'm sorry.
30:41It was not only wrong and utterly unprofessional,
30:51but it was a betrayal of my Hippocratic Oath,
30:54and it was a fucking crime.
30:57That's where I've been.
30:59Rehab and counseling.
31:00Oh, I'm sorry.
31:06I-I understand if you'd prefer a different doctor.
31:08Hey, Doc.
31:10We have a situation.
31:12Excuse me.
31:14What kind of situation?
31:16Someone left the little baby in the restroom.
31:18Okay, let's think about reversible causes
31:30of confusion in the elderly.
31:32Uh, hypo or hypernatremia,
31:34infection, but he's afebrile,
31:35good or two sats,
31:36and urine dip was negative.
31:37Yeah, great.
31:38Joy, anything to add?
31:41Nah.
31:44V-tack, can I?
31:45Yeah.
31:48No pulse.
31:49Should we call for a code blue?
31:50No CPR.
31:51No shock.
31:52We honor his pulse and his wishes.
31:55So, what does that leave us?
31:57Making sure he's comfortable.
32:00I'll suction.
32:02Altered mental in the elderly
32:03can also be toxicity from anticholinergic,
32:05sedative hypnotics, opioids.
32:10Am I missing something?
32:12Social skills?
32:14Yeah.
32:18He looks so peaceful.
32:20Should we maybe go find a new patient?
32:21No, stay here.
32:26Asystole.
32:37Quick and painless.
32:39We should all be so lucky.
32:40I'll try to contact some family.
32:45Yeah, one of the things we like to do here,
32:48when we have the time,
32:53is to take a moment of silence
32:55when we lose a patient,
32:56to respect their humanity.
32:58He was someone's son,
33:00perhaps a father himself,
33:02a brother or friend.
33:04Oh, uh,
33:09just make sure your phones are on silent.
33:15Great, great, great.
33:16Okay.
33:18Is anyone missing a baby?
33:21Did anyone leave their child in the restroom?
33:26You, uh,
33:27remember seeing a woman
33:28enter with a baby
33:29to leave without one?
33:30No, sorry.
33:34Might be on the security tapes?
33:36I'll have a mod check it out.
33:37Please.
33:38Yeah.
33:38Harlow Graham to window one.
33:41Harlow Graham to window one.
33:45Harlow Graham to window one, please.
33:53Donnie Donahue, nurse practitioner,
33:55and this is Emma, new grad nurse.
33:56Hey.
33:57Nice to meet you.
33:57What's going on?
33:58Somebody dumped their kid.
34:00Well, maybe Mom just stepped out
34:01for a smoke or something.
34:03What?
34:03I'm being hopeful.
34:04Sometimes I just need a little break
34:05and then they come back.
34:08At least they didn't leave her
34:09in a suitcase at the bus station.
34:11Does that happen?
34:12If that's a true story,
34:13I don't want to know about it.
34:14Get the worst of seeing.
34:15Please, please, don't tell me.
34:16I'm a new dad.
34:17Remember?
34:17Okay.
34:26I'll get Robbie.
34:27Should I come with?
34:28No, stay here.
34:29Donnie, Jesse, teach her something.
34:34You know how to check a rectal temp on an infant?
34:38Uh, theoretically.
34:40Okay.
34:47Mr. Williams, how's the pain?
34:50Nothing I can't manage with some Vicodin
34:52and a little scotch.
34:54Well, it's best not to mix the two.
34:56James here is going to take you
34:57to get an x-ray at your wrist.
34:59I'm going to be fine.
35:01Well, it'll tell us if you need a cast.
35:03I doubt it.
35:04I should probably go home,
35:05keep some ice on it.
35:07I know you guys always need the beds.
35:10Well, it'll only take a minute
35:12and then we'll know for sure.
35:14Yeah, I really don't think it's necessary
35:15and I have a busy day,
35:16but I appreciate your concern.
35:22I'd really like to observe you
35:23for a little bit
35:24in case you did hit your head.
35:27My head?
35:28I have my schnoz on my arm, I think.
35:30Nothing more.
35:31You think you don't remember?
35:33No.
35:34Yes.
35:35I'm going to be fine, really.
35:39Thank you for your concern.
35:45Okay.
35:47Ha!
35:49How about we take that x-ray
35:51just to be safe?
35:53Yeah.
35:55Yeah, okay.
35:56Okay, good idea.
35:59Somebody found a baby?
36:01Yeah.
36:02Not the first time it's happened.
36:03So, about those pills I took.
36:07Don't worry about it, Doc.
36:09If the pills helped you, great.
36:12I never really liked taking them.
36:16I appreciate that, Louie.
36:18That's not really the point,
36:19but you need to lift up your shirt
36:21for a second.
36:29How long has your belly
36:29been hard like that?
36:31I don't know.
36:32I figured I could wait another week.
36:34You need, uh, some lab tests
36:37and a procedure
36:37to drain off some of this fluid.
36:39Yeah, I know the drill.
36:41I've been tapped a few times before.
36:44Three times in the last six months.
36:47You need to give your liver a break, Louie.
36:50Yeah, I know.
36:50I just heard somebody dumped a baby
36:57in the waiting room bathroom.
36:59How sad is that?
37:00Huh?
37:03What's up with you today, Mel?
37:04Lynn, Kalia?
37:06What makes you think
37:07there's something up with me?
37:08You're moping around here all day
37:09like somebody gunned down
37:10your favorite K-pop band.
37:12I don't really have a favorite K-pop band.
37:15Not that I don't like the genre.
37:16Forget K-pop.
37:18What's going on with you?
37:19You usually ride in here
37:20on your unicorn
37:21tossing wildflowers.
37:23Unicorn?
37:23Never mind.
37:25Is everything okay
37:26with your sister?
37:28Oh, yeah, she's great.
37:30It's just this...
37:31I'll be...
37:32Spill, girl.
37:34Um, well, a couple of months ago
37:39I got named in a malpractice lawsuit.
37:43And so, um, today is the deposition.
37:47That's it?
37:48Every emergency medicine doc
37:50gets sued sooner or later.
37:51Seriously, don't sweat it.
37:53I mean, you're still a resident.
37:54We're protected by the hospital.
37:56You could cut somebody's head off
37:57and get away with it.
37:59You know, like, don't.
38:01You won't want to become known
38:03as the one who put Mel in malpractice.
38:07Hey, Santos.
38:08Our little girl Kylie
38:09has been in the West Penn
38:10emergency department
38:11a couple times.
38:13I'm not saying this is
38:14necessarily the case here,
38:16but recent studies
38:17have linked bullying behavior
38:18to different personality disorders.
38:21On the other hand, though,
38:22I am known to be a bit
38:23overly sensitive sometimes.
38:25Mel!
38:26Yes?
38:27You talked to yourself again.
38:27You need something?
38:29Uh, yeah, a good lawyer.
38:30I don't know.
38:31I'm kidding.
38:32I'm not.
38:35Yo, Rabinovich,
38:36somebody ditched
38:36a bundle of joy in chairs.
38:38How old?
38:39A couple months.
38:39Maybe Donahue's got her in peds.
38:41No one saw who left her?
38:42Apparently not.
38:44It's so sad.
38:45Tell me about it.
38:45Who throws away
38:46a perfectly good baby?
38:48Make a lane.
38:49Ah!
38:50Sweet baby Jesus, Antoine!
38:52Right to the outdoor shower!
38:53I'll just drive him.
38:54I'm not a washing detail service.
38:55Yeah, yeah.
38:56God, Rabinovich,
38:57you prove useful.
38:58Ah, good timing, Ms. Emma.
38:59Time for you and me
39:00to do the Lord's work
39:01this way.
39:02Oh, God.
39:03What is that?
39:04Okay, big breath.
39:08All right.
39:09Lungs sound great.
39:10Can you lean forward for me?
39:17Uh, did you hit your back
39:20when you fell down the stairs?
39:21No.
39:22Okay, there's a pretty good
39:23bruise here.
39:24I got knocked down, soccer.
39:25Oh, no, you broke your wrist
39:29last year, too, huh?
39:31Fell with my skateboard.
39:32Got a purple cast.
39:34Cool color.
39:35And you were treated
39:36at West Penn.
39:37Is that your closest hospital?
39:40Uh, I guess that would make sense.
39:41I've only been dating
39:42your dad a few months.
39:44Uh, he lived in Garfield
39:45before the divorce.
39:46And, uh, what about these?
39:48Soccer.
39:49Do you wear shin guards?
39:51My dad ordered them.
39:53What does your dad do for work?
39:55He draws buildings,
39:57but he's not an architect.
39:59He's a draftsman
39:59for a firm in Newcastle.
40:02Um, Kylie,
40:03any chance you can pee?
40:05Mm, maybe.
40:07Okay.
40:08Well, uh,
40:08with the bruise on your back,
40:10we need to check your urine.
40:11Okay.
40:12Okay.
40:16Did you eat anything
40:17out of the ordinary recently?
40:18No.
40:19Sorry, but
40:20we went through this
40:21a bunch.
40:22Don't you people communicate?
40:24You're the third nurse
40:25we've told her story to.
40:25I'm a doctor.
40:27Richard.
40:28Would you go to the cafeteria
40:30and get me a large chamomile tea?
40:32What can we get you, my dear?
40:35I'm fine.
40:39Yeah, I'll be right back.
40:44Please excuse my son.
40:47Ever since my husband died,
40:49he's been a little overprotective.
40:51I think it's sweet.
40:53You're very lucky to have him.
40:55I am.
40:57Are you still taking
40:59your loperamide and cholestyramine?
41:02Um, not so much.
41:05No?
41:06That may be why
41:07you're experiencing
41:08the abdominal pain and vomiting.
41:10When did you stop
41:11taking your meds?
41:12Last winter or so.
41:16My neighbor Helen and I
41:18bingo in Wintersville.
41:20There's a dispensary next door.
41:23And we got some marijuana.
41:24And I swear,
41:27it cleared everything up.
41:29A few cookies
41:30every few hours.
41:33And no more pain.
41:35A few cookies?
41:38How many are you eating in a day?
41:40Oh, uh...
41:42I don't know.
41:45Probably a dozen or so.
41:47But they're not very big.
41:48There have been some studies
41:52that show an added
41:53dementia risk
41:54with marijuana use
41:55in older adults.
41:58No, that sucks
41:59for old people.
42:02Kylie, there are
42:04some questions
42:04that we ask every kid
42:06who comes in
42:07with an injury.
42:08Like what?
42:10Like,
42:11sometimes the people
42:12that you live with
42:13can get so mad
42:15that they hit you
42:17or hurt you.
42:19Maybe without even meaning to.
42:21Does that ever happen?
42:22No, not to me.
42:25Or sometimes
42:25kids can get punished
42:27for doing something wrong
42:28with maybe a spanking
42:30or a belt.
42:32I get timeouts.
42:35How about at school, Kylie?
42:37You know,
42:37is anybody being, you know,
42:38mean or bullying you?
42:40No, I have lots of friends.
42:47Yo, Whitaker.
43:06Dr. Langdon.
43:09You, uh,
43:10meet Louie here?
43:11Yeah, yeah, many times.
43:13Good morning,
43:13Mr. Cloverfield.
43:14What's up, Doc?
43:15Where's your new
43:15resident badge buddy, buddy?
43:17Oh, uh, yeah,
43:19they didn't give me
43:19a new one yet.
43:21Bummer.
43:22You and, uh,
43:23your ducklings got time
43:24to tap a six-pack
43:25off our friend here?
43:26Louie needs a pair of synthesis.
43:28Yeah, sure.
43:29It's good to see you again, Louie.
43:31Not in this condition,
43:32of course.
43:32How you feeling?
43:33Feeling like I need
43:34a drink pretty soon.
43:37Okay, well,
43:38first things first,
43:39we are gonna make you
43:41more comfortable
43:41by draining some fluid.
43:43You're gonna take off
43:43a big volume,
43:44so start with 60 grams
43:45of 25% albumin IV.
43:47You tapped him before?
43:49No.
43:50That's okay, Doc.
43:51I'll talk him through it.
43:53Okay.
43:56Sats, 99 on room air,
43:57normal BP,
43:58normal pulse.
44:02Oh, well hydrated.
44:04No obvious source
44:04of infection.
44:06Could be a benign virus,
44:07but can't assume that.
44:09Is this the abandoned baby?
44:10Mm-hmm.
44:10How old?
44:12How old do you think she is?
44:14Month?
44:14Month and a half?
44:16It's tricky.
44:17Under 28 days
44:18is a safe haven drop-off,
44:19no questions asked.
44:20But over 28 days
44:21is a crime,
44:22child abandonment.
44:24How should we assess?
44:26Under 28 days
44:27gets everything,
44:28including an LP,
44:29but over 28 days,
44:31you can follow PCARN
44:33or step-by-step
44:34to determine risk
44:34of invasive bacterial infection.
44:36This baby looks great.
44:37We know nothing
44:38about the birth history.
44:40Did mom have
44:40group B strep,
44:41active HSV lesions?
44:43We should assume the worst.
44:45Put in your orders,
44:46Dr. Molyin.
44:48CBC,
44:49blood culture,
44:51chem panel,
44:53chest x-ray,
44:54UAN culture,
44:55respiratory virus panel,
44:57check inflammatory markers,
44:59procalcitonin,
45:00and CRP.
45:01Then,
45:02take it from there.
45:04That sounds like a plan.
45:04Dr. Robby,
45:07Santos needs you,
45:07North One.
45:08Okay,
45:08I'll be right there.
45:10Feel excused?
45:11Feel excused?
45:14Mind if I join with?
45:16Uh, no.
45:17Got this.
45:18It will help me
45:19get a better sense
45:20of how you like
45:21to do things
45:21by seeing you
45:22in action
45:22with the residents.
45:24Be my guest.
45:28I will be right back.
45:30Nine-year-old Kylie Connors
45:38took a tumble
45:39running up the stairs
45:40this morning,
45:41chin-lack
45:41and fractured tooth
45:42brought in
45:43by her dad's girlfriend,
45:44Gina.
45:45Supposedly,
45:45the dad had to leave
45:46early for work.
45:48Kylie has a lot
45:49of bruising
45:50on her body,
45:51some old,
45:51some new.
45:52Are you concerned
45:53about non-accidental trauma
45:55or worse?
45:57Her urine sample
45:58shows gross hematuria,
46:00which could be
46:00renal injury
46:01or vaginal bleeding
46:02from trauma
46:03could have contaminated
46:04the specimen.
46:05Lots to consider.
46:07What's your plan?
46:08Labs,
46:09ultrasound,
46:10social work consult,
46:11then decide
46:12if this is reportable.
46:13Mm-hmm.
46:17Let me know
46:18if you can feel this.
46:19No.
46:20Am I supposed to?
46:21No.
46:26Your hair
46:27is such a pretty color.
46:30Reminds me of my mom.
46:32She died
46:33when I was nine.
46:34Oh, I'm sorry about that.
46:36She wore glasses
46:37like you, too.
46:38Weird.
46:40And what do you like
46:41to do when you're not working?
46:44Um, spend some time
46:45with my sister,
46:46Reed.
46:48Do you drink coffee?
46:50Uh, no.
46:51I avoid caffeine.
46:53Me, too.
46:54What about boba?
46:59I love boba.
47:02Hmm.
47:06I'd offer you some gum,
47:07but it's laced with nicotine,
47:08trying to quit smoking.
47:11That's good.
47:12Yeah.
47:12Birdie's still out.
47:14Getting all those
47:15nooks and crannies,
47:16Mr. Digby.
47:16Your skin will thank you.
47:17Well, we all will.
47:20I could stay in here
47:22all day.
47:24A miracle what a little
47:25soap water
47:26and human decency
47:27can do sometimes.
47:28Don't forget the ears, pal.
47:30Don't want anything
47:30growing in there, either.
47:32Okay.
47:33Okay.
47:34What's your story, Emma?
47:35What do your parents do?
47:36Got siblings?
47:37Boyfriend?
47:38Have a killer man
47:39in a bar fight.
47:41Uh...
47:52So, Mr. Williams,
47:54sometimes a fracture
47:56of the scaphoid bone
47:57doesn't show up on day one.
47:59So my advice to be safe
48:01is we're split for two weeks
48:02and then come back
48:03for a repeat x-ray
48:04and we'll see
48:05if it's really there.
48:05My knee hurts.
48:11Oh, did you hurt your knee?
48:15I must have.
48:23What is this?
48:25That's, um,
48:26for your wrist.
48:28And I need this?
48:31Well, um,
48:32if it's a, uh,
48:34John, can you...
48:35Yeah.
48:35If it's a fracture
48:37and we don't immobilize,
48:38the bone might not heal properly.
48:43How long is this gonna take?
48:46Just a few minutes to fit you.
48:51Is this place new?
48:57Mr. Williams,
48:57do you know what day it is?
49:00It's Taco Tuesday.
49:04Do you know where you are?
49:10Yeah, I'm in the slowest
49:12medical clinic in the West.
49:14Do you know what year it is?
49:16How about you just fix my wrist
49:18and you stop
49:19with all the questions?
49:21I am not here to be profiled.
49:30Yeah, of course.
49:33I'll be back, okay?
49:34All right, Mr. Digby,
49:47looking better already.
49:48Certainly smell a little better.
49:50Do you have any conditioner?
49:52Let's get you dried off
49:52and back inside.
49:54Get him gowned up
49:54and put him in South 21
49:55across from the old nun.
49:57Maybe some of her
49:57had to find Grace
49:58or we're off on him.
50:00Who do we have here?
50:02Evelyn Bostic, 81,
50:03with Alzheimer's.
50:04We brought her husband in
50:05about 30 minutes ago.
50:07She was supposed to get a ride in,
50:08but they found her
50:08wandering in traffic.
50:09Where are we?
50:10You're at the hospital, dear.
50:12I'm not sick.
50:13We brought you
50:14to see your husband.
50:15Oh, no.
50:16Is Ethan okay?
50:17Be in to chat
50:18with you, Mrs. Bostic.
50:20He died.
50:22What you got, Aunt Boy?
50:24Alan Billings
50:25had a palate
50:25fall into his outstress
50:26arm.
50:27Looks like an open
50:28dislocation.
50:29Yeah, that's gotta hurt.
50:30Don't worry, sir.
50:31We got you.
50:38How's she doing?
50:39Seems happy enough.
50:41Yeah.
50:43I just got a quick
50:44point-of-care, CBC.
50:52Is there a problem?
50:56Did I miss something?
50:59Dr. L?
51:00Dr. L?
51:02I'm in hurt,
51:11but I refuse to cry.
51:14I'm in hurt, baby,
51:19but I refuse to cry.
51:24It's so true.
51:26You know, you know, you know,
51:27you know I cannot.
51:30And I said, yeah, yeah, yeah.
51:33Yeah, yeah.
51:35Yeah, yeah, yeah.
51:36Yeah, yeah.
51:37Yeah, yeah, yeah.
51:38Yeah, yeah, yeah, baby.
51:40Yeah, yeah, yeah.
51:41Yeah, yeah, yeah, yeah.
51:44Yeah, yeah, yeah, yeah.
51:45I won't cry.
51:47Oh, you know I won't cry.
51:51I said, I won't cry, baby, baby.
51:55You know I won't cry.
51:58You know, you know I won't cry, baby.
52:01I'm telling you I won't cry
52:04Oh, I don't lie
52:08Oh, but I refuse to cry
52:12And I say sometimes, darling
52:16Your friends, they treat you so cold
52:19But baby, you know they act better
52:22Yeah, yeah, when you have that goal
52:26But I won't lie
52:29Yeah, I know, yeah, I know
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