- 20 hours ago
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00:00Can you, um, can you just put him on the phone for a second?
00:25I just want to hear his voice.
00:28There's my guy.
00:30How you doing, buddy?
00:34I would love to hear your, your song.
00:55You should go home.
00:57Oh, that is the last place I want to be.
01:00You shouldn't, you shouldn't see your OB?
01:02I checked myself.
01:04Um, your dress is empty, barely spotting now.
01:07I'm fine.
01:09Oh, honey, I'm so sorry.
01:12Oh, I shouldn't have bought that fucking stroller.
01:15Oh, fuck that fucking stroller.
01:18Oh, fuck that fucking stroller.
01:25Losing a kid is hard on everybody.
01:28That's as hard as it gets.
01:42We do these debriefs to try to give a sense of, um, closure, meaning to difficult cases so that they won't linger.
01:51But trust me, the kids you'll lose will linger.
01:55So what do you do?
01:57I did my residency at Big Charity in New Orleans.
02:01And day one, I got a kid, five-year-old boy, accidentally shot by his brother, playing with dad's gun, worried he was going to get in trouble, right up until he coded and died.
02:14But then I asked myself, like, what do I do with this kid?
02:24Where do I put this feeling?
02:26And I found myself walking all night.
02:28I was walking and walking and walking.
02:29And I found myself back at the gates of Big Charity Cemetery.
02:31And I'm looking at all those mausoleums and those crypts.
02:34And I'm thinking to myself, OK, well, that's what I need.
02:36I just need a safe place where I can put these feelings.
02:38We got patients throwing punches in chairs.
02:42Uh, OK, everybody, let's get back to it.
02:44Just remember, the employee assistance program is available, as are Kiara and myself, if anybody needs to talk.
02:49Where's McKay?
02:50Central 11 with our UTI accounting assistant while we keep her boss on ISA North 2.
02:55Robbie, critical case flying in, possible MDMA overdose, high temp, on route, put pit fast, five minutes out.
03:01Stay here, set up for that. Ahmad and I got chairs.
03:03Hey, hey, is everything all right with Collins?
03:05Something's bothering her. I asked her about it. She said she didn't want to talk to me about it.
03:08Oh, imagine that. She probably learned it from you.
03:11Seriously?
03:12You just gave a speech titled, How to Literally Bury Your Feelings.
03:15Now, Phil, excuse me. I've got to break up a fight.
03:19Phil, you won't control your wife, man. Shut up, man.
03:22There's a little full of bad people in here.
03:24Hey, hey, Olsen. Olsen, what's the talking long enough? Calm down.
03:28No, don't tell you to calm down. How hard is it to put a mask on your kid?
03:31He has allergies, you fucking Fauci zombies.
03:34Allergies.
03:35Oh, TJ.
03:36Hey, hey, that's enough. Jesus almighty, I don't believe what I'm seeing.
03:42What do you people think you are, huh? This ain't Philly? This is a hospital, for Christ's sakes.
03:48What's the matter with you? You call yourselves adults? Huh? There are children in here.
03:55You should be ashamed of yourselves.
03:58Olsen, catch any shrapnel?
04:01Craziest shit I've seen since I've been here, but I'm good. I'm good, seriously.
04:05Jackals.
04:05Ladies, are we finished with the craziness?
04:09This is fucking ridiculous. All I did was offer to put a mask on her child who's been coughing for over an hour, and now I'm missing out my goddamn...
04:17First of all, masks are bullshit. And Bea, it's an allergy. He's allergic to cat dander like I fucking told you.
04:24Shut up. Shut up. Right now. Please.
04:27And only answer the questions I ask. What happened to the tooth? Did you swallow it?
04:32Uh, I don't think so. I think it's still in my hand.
04:35It sure is. I hope you both have all your shots.
04:38What do you mean, like vaccines?
04:39Jesus, please don't stir this pot. Let's take these ladies back and get them treated. Separately.
04:44Stick with me.
04:45Come on. Ma'am, it's time to go.
04:47I guess that makes us a team.
04:49I guess it does. Uh, ma'am, uh, come with Mateo and I?
04:54Mateo and me? Um, yes, with this both.
04:57Okay, Earl, let's take a look at you.
04:58Whoa, she really tagged you.
05:00Red's got a left hook like Billy Conn.
05:02Well, let's get you cleaned up. Come on, baby.
05:07Excuse me, sir. You're not allowed back there.
05:10Unless what? I start a fight? Become homeless? Apparently that's what it takes.
05:15I understand your frustration. I promise you'll be seen as soon as a provider is available.
05:19But how can they become available if new people keep cutting the fucking line?
05:22There's no line. We see patients by severity of need. As soon as we have your tests and labs, you will be seen.
05:27This place is fucking unbelievable.
05:30Run around after run around.
05:33Hey, what's up, Eric Estrada? Still keeping your eye on me?
05:37Always, my friend.
05:38Always.
05:40Who's Eric Estrada?
05:41Shame on you, chips. Know your television history. And thank you.
05:45Yep.
05:48Crazy people.
05:49If you do get my teeth out, I don't want it. I've just been inside. That woman!
05:53Reattachment wouldn't be possible.
05:55Type 2 fracture into the dentin.
05:57Seal with dental cement. Prescription for pen VK.
06:00Soft diet. Follow up with the dentist in one to three days for a crown.
06:03You handle sphinx while I check on Ali?
06:06You got this?
06:07Tell me, partner.
06:09Yes.
06:11Totally got this.
06:11How we doing in here?
06:17You should write that bitch a script for calcium, because I didn't even hit her that hard.
06:20Too much almond milk in your soy lattes!
06:24That doesn't even make sense!
06:26You know, most commercial almond and soy milks are fortified with calcium, so they end up having a higher percentage of calcium than cow's milk.
06:33Prepped with betadine and drapes.
06:35Very nice.
06:36Let's have a closer look.
06:37Dr. King, can you please grab me a 10cc syringe, a 20-gauge needle, and some sterile saline?
06:43Pluck it out, stitch me up, and send me home.
06:45I've got to get back out there to my kid.
06:47Well...
06:47She's still waiting to be seen, by the way.
06:48I'm afraid it's a little more complicated than that.
06:50You got yourself a fight bite, which means a couple things.
06:53First, we need to determine if the bite extended into the joint space.
06:56If it did, you're going to need IV antibiotics on a trip to the OR to see a hand surgeon.
07:01Pinprick and a little burning.
07:02An operation?
07:03Well, you were just shouting a minute ago about infection.
07:06And with good reason.
07:07While I am sure you are in the clear for rabies and HIV, human mouths are filthy.
07:13Some more than others.
07:14How can you tell if it's bad?
07:16Great question, Dr. King.
07:19I'm sorry?
07:20I am going to inject some sterile saline into your knuckle joint, which you won't feel
07:25because of the anesthetic.
07:26If it comes spraying back out of the bite wound, we'll know.
07:28Ready?
07:29I guess.
07:33There she blows.
07:34Shit.
07:35Are you serious?
07:37You hear that, you fucking bitch?
07:39I've got to have surgery thanks to you.
07:41Good.
07:42You assaulted me.
07:44Damn right.
07:45And I'll bet next time you'll keep your masks and opinions to yourself.
07:49You okay?
07:50Yes.
07:52Three grams unison IV.
07:54Call the OR.
07:55Tell them we have a fight bite that needs to be washed out.
07:57Then go take 20 minutes in the lounge.
07:59I'll come find you if I need you.
08:00Well, I don't need a break.
08:01Yes, you do.
08:01Okay.
08:05Oh, uh, did you want me to tell the surgeons to go no mask for surgery?
08:11What?
08:12Well, those of us who save lives for living believe strongly that masks minimize risk
08:16when it comes to spreading disease and infection.
08:18But I want to respect your beliefs.
08:20So, what do you think?
08:22With or without for surgery?
08:23Without?
08:24Um, I want with.
08:28Good call.
08:28Pillocop, just here at cafeteria setting the ice?
08:33Yeah, everything they got.
08:34Hey, I hear they're going to start you working on the Middle East peace plan.
08:37Not since it's the Dalai Lama or Gandhi.
08:39Baby, fucking ain't right, too.
08:40You should have seen me.
08:41It was inspiring.
08:42Also terrifying, a little bit shamey.
08:44Holy eternity of crowd control.
08:46Hey, can we pick it up in here, please?
08:47Overdose is here.
08:51Pitfest OD.
08:51Keeley Ralston brought to the first aid tent at Pitfest with alternatal status and fever.
08:55Tent too high for a field thermometer.
08:57Intubated en route.
08:58We got to cool this lady down.
09:00Get some ice packs.
09:01Head, neck, groin, scent off a rainbow.
09:02On it.
09:04Heart rate 132.
09:05BP 210 over 120.
09:06Jesus, that's high.
09:07Four of Ativan in the field.
09:09Cubas are dilated.
09:10Definitely MDMA overdose.
09:11Dr. Mohan, how do you want to treat the BP?
09:13Uh, beta blockers?
09:14No, unopposed to alpha could kill her.
09:15Four more of Ativan, please.
09:17Seriously?
09:17She might need another 40.
09:20Hypertension and tachycardia from MDMA.
09:22Essentially mediated.
09:23Ativan is the drug of choice.
09:24Damn.
09:24Core tap 107.3.
09:26Okay.
09:26Can we get another hose in here before she fries her brain, please?
09:29Let's go.
09:29Come on.
09:30I'll be right back.
09:36Hi.
09:37You look lost.
09:38No, it's my assistant who actually seems to have been misplaced.
09:41I mean, how long does a CT take?
09:43Certainly not this long.
09:45You can get pretty backed up.
09:46Can I get you a cup of bag of coffee, dry sandwich?
09:48No, thank you.
09:49How about a cola koi for my secret session lunch?
09:51I'm going for it myself.
09:51I'm freaking addicted.
09:52I'm good on drinks.
09:53Can you take me to radiology?
09:55Right this way.
09:56Right this way.
09:57Piper, while we still have a few minutes, there's some things I want to say.
10:05Yeah, it means protection.
10:07I know.
10:08I'm sorry.
10:09Totally.
10:09It's a mistake.
10:10Totally.
10:12I'm a part of the street team here.
10:14It's a group of doctors and nurses who go out in the community and help people who can't
10:19or won't ask for help.
10:22Addicts, unhoused, runaways.
10:24And I'll be honest with you, Piper, I think you need some help.
10:31What are you talking about?
10:33If you're in trouble, we can help you.
10:35I'm not.
10:36Okay?
10:38And if we're done here, I think I'd like to go.
10:42Will you at least take a look at this?
10:46There's a list of resources on the back.
10:48I don't need that.
10:49I know you don't have a phone, but if you could just take my number, okay?
10:57You never know.
10:59What, Rose, Laura?
11:01How about taking the pen?
11:03If you ever feel unsafe or in danger, call this number.
11:06It's a national hotline.
11:08There's somebody on the other end, 24-7.
11:09And a trained professional who can help with anything.
11:12I have all the help I need.
11:13I want to go.
11:15Now.
11:16Okay, I'm going to count.
11:16One, two, three.
11:18Gentle, gentle, gentle.
11:20You, Sam, we have splashdown.
11:22Good luck.
11:22See you on the next one.
11:23Yep.
11:23Temps down to 107.1.
11:25How long does she need to stay in the ice, Dr. Santos?
11:27Why should she be in the ice?
11:28It's 13 minutes.
11:28Dr. Santos.
11:29Until her temp is normal.
11:31Wrong.
11:31You pull her out at 102.
11:32Otherwise, we could overshoot and cause hypothermia.
11:34Heart rate 120.
11:35Pressure 198 over 116.
11:37More Ativan?
11:37Another four, please.
11:39Why is she on the ice, Dr. Santos?
11:40To bring her temp down.
11:42Wow.
11:42State the obvious, yet still don't answer the question.
11:44The quicker we bring it down, there's less of a chance for permanent damage to the brain
11:47and the rear kidneys.
11:48Exactly.
11:48Was she sweating?
11:49Profusely.
11:50What if she wasn't, Dr. Santos?
11:52What if she was dry as a bone?
11:53Then we'd have to think anticholinergic overdose, not sympathetic.
11:59Very good.
12:05Yeah, three.
12:07Hey.
12:09I found you scrubs that should fit.
12:12Oh.
12:14That's great.
12:15I appreciate that.
12:16But they come with a catch.
12:18Mr. Krakosha's asking to see you.
12:21The guy who peed on me?
12:23Why me?
12:23I didn't ask, but maybe you should wait to put these scrubs on until after you...
12:29That's a good idea.
12:29Oh, God.
12:32Oh, man.
12:34We got a load of the...
12:35Oh, my God.
12:38Yeah, I see you.
12:47There's a number, buddy.
12:48Trauma tier two, ETA now.
12:50That's another for a Vativan.
12:52Rectal temp's down to 105.
12:53Okay, moving in the right direction.
12:54We might get lucky here.
12:56Double trauma at the back door.
12:57Auto versus pedestrian before getting a telephone pole.
12:59You got this?
13:00Yep.
13:00Dr. Robbie, I finished with Dr. Rezecki, the therapist upstairs.
13:05Yes, yes, yes.
13:05How'd that go?
13:06Well.
13:07Excellent.
13:11Have you heard from David?
13:12No.
13:13David's the therapist.
13:21Do you think that he's still going to pick you up today?
13:23I think so.
13:24Okay, well...
13:24Robbie, here they come.
13:26Okay, well, you're medically clear, so why don't you stay here for a little while longer
13:29in the hopes that he does?
13:31I still would like him to talk to somebody.
13:33Perla, this is Teresa.
13:34She's a friend of mine, so I expect concierge service, yes?
13:37VIP treatment.
13:38You're in good hands.
13:39Just let me know if David shows up or if he calls.
13:41Good boy.
13:43Good boy.
13:44Walter Purnell, 52, walking his dog in the crosswalk, got struck by a Chevy Impala at
13:48low velocity.
13:49Ambulatory on scene, no KO, no neck, chest, or belly pain.
13:52Good vitals.
13:53Whoa, major road rash.
13:55Yeah, the car didn't hit me so much as throw me, but I slid for a good 10 feet.
13:59Of course, this is the first day I've worn shorts all left in here.
14:02No deformity at the knee or ankle, distal pulses intact, four of morphine so far.
14:07Yeah, feel free to be more generous.
14:08Don't worry, we will patch you up.
14:10We will get you right.
14:10Who's your friend?
14:11Oh, this is Crosby, who thankfully barked and mourned me so I had half a second to try
14:15and move out of the way.
14:16Crosby, you're a hero.
14:18Donnie, you think you can find a milk bone for our little lifesaver here in the doctor's
14:21lounge?
14:22Absolutely.
14:22I'll take good care of him.
14:23Uh, can he stay with me?
14:24He's a very good boy.
14:25No doubt.
14:25Let's get you settled first.
14:26You're going to South 20.
14:27Is that the driver?
14:2828-year-old lady had her seatbelt on, clipped the guy with the dog and went straight into
14:32a telephone pole.
14:34Bloods from a scalp lack.
14:35Also completed chest pain.
14:36Sleepy but arousable.
14:37What's your name?
14:38Paula.
14:39Heart rate's a bit tacky.
14:40112.
14:41BP's fine.
14:42Paula, you in any pain right now?
14:43Yeah, I don't go hurt.
14:45What does it say?
14:46She was driving erratically before the crash.
14:48No ETOH on her breath.
14:49Maybe drugs?
14:51Core tabs 100, 4.2.
14:52Heart rate 116.
14:53BP 180 over 110.
14:55Better but still too high.
14:57Another four at Adavan.
14:58That'll make 20.
14:59Good counting.
15:00Pedestrian itself, 20 meets a doctor.
15:02You got this?
15:03Yep.
15:03Keep chilling.
15:04All hands on deck.
15:05You ready?
15:05Ready.
15:06Okay, here we go.
15:07One, two, three.
15:08I heard motor vehicle collision with chest pain and altered mental status.
15:16Me, Paula.
15:17Restrained driver versus telephone pole.
15:19Altered before the crash.
15:20Good BP, but tacky.
15:21Second line and run a liter of LR wide open.
15:24Still tacky at 115.
15:25BP's 180 over 72.
15:27Airways patent.
15:28Good breath sounds bilaterally.
15:29Peoples are equal and reactive.
15:31Paula, do you know what today's date is?
15:34Sat's 94%.
15:36How about the city we're in?
15:37Itch burps.
15:38Bruising on the chest.
15:40Possible sternal fracture.
15:42Pericardium's clear.
15:43Good, good.
15:44No mark of tenderness.
15:46Nothing in Morrison's pouch.
15:48She's a little tachypneic.
15:49I don't think she needs intubation.
15:51Might just be concussed.
15:52I'm worried about her crumping in the scanner.
15:53She's protecting her airway.
15:55I see lungs sliding.
15:56No pneumo.
15:57With a head injury?
15:57You guys are supposed to be the airway experts.
15:59Stop fighting.
16:00Make a decision.
16:01Call me when she goes to CT.
16:02Paula, can you raise your right arm for me?
16:05Good sign follows command.
16:07You want to intubate with a GC as of 13?
16:10Okay.
16:10We can hold off and monitor.
16:11What's your plan?
16:12Pan scan, head to pelvis, EKG, troponin, straight cath urine for UA and tox screen.
16:17Agreed.
16:17I'm on it.
16:18Got to bend those knees.
16:21I quit showing off.
16:22Is that what you're doing?
16:23Always.
16:26It's a 10-day course of doxycycline.
16:28One pill twice a day.
16:30I'll make sure she takes it on a full stomach.
16:33I can give you your first dose now, Piper.
16:35If you like.
16:36Get you started.
16:37That'd be great.
16:38Actually, I need Piper to answer that one.
16:40You sure?
16:41That'd be great.
16:43Okay.
16:45Hello, everyone.
16:47Looks like we're finishing up here.
16:49I come bearing gifts.
16:50Everything you always wanted to know about STIs but never wanted to read.
16:53No gross pictures, I promise.
16:55I think we're good.
16:56You sure?
16:57Mm-hmm.
16:58Yeah, I learned my lesson.
17:00It won't happen again.
17:04I guess that's it, then.
17:08Well, if you change your mind, go to the free pen.
17:12Thank you both so much for your help.
17:15Yeah.
17:15Thanks.
17:19Okay.
17:20Good luck to you both.
17:25Fuck.
17:30Fuck.
17:31That sums it up.
17:33She'll be back.
17:34Only she'll have slipped a little further.
17:36Sometimes it takes a few visits.
17:39How can I keep her here?
17:41You got anything?
17:42Maybe Kiara has a social services card to play.
17:45She was by trauma one last I saw her.
17:46Brilliant.
17:47Brilliant.
17:48That's why I'm here.
17:50To be brilliant.
17:52And bring peace.
17:53Heart rate's 84, BP 126 over 78, pulse ox 99 on room air.
17:59Good news, Mr. Purnell.
18:00Your heart, lungs, and belly all look good.
18:03Yeah, just the leg.
18:05Ooh, this might be a road rash record.
18:07We might have to bust out the tape.
18:08I'm getting a little worried about Crosby.
18:10Who's Crosby?
18:11His dog.
18:11My dog.
18:12Where's Crosby?
18:13He's in a break room, I think.
18:16I'm sure he's fine.
18:17We got a lot of dog lovers around here.
18:19I'm the new owner of a nine-week-old golden doodle.
18:21Oh, nice.
18:23Crosby's a terrier.
18:24Oh, great dogs.
18:26Determined, courageous, love to dig.
18:28Who's he named for, Sidney or David?
18:30David.
18:31Still my Sunday morning soundtrack.
18:33Oh, sorry.
18:34Yeah, anyways, great name.
18:36So, the knee looks stable.
18:38There's no laxity to suggest a torn ligament.
18:40I think the pain's probably just from the road rash,
18:43but let's get an x-ray just to be sure.
18:44Some more morphine?
18:45You're a wonderfully human being.
18:46Let's start with lead.
18:47No more than 30 cc's.
18:48We're going to try a topical anesthetic
18:51to numb the raw skin
18:53before we start picking out all the gravel?
18:54Well, my morning horoscope
18:55didn't mention any of this.
18:57Well, hey, look on the bright side.
18:59Now you can tell people that you got hit by a car.
19:01Not a lot of people can live to say that.
19:02Yeah, I hope whoever hit me is rich and well-insured.
19:07Flag on the play.
19:11Positive pregnancy test.
19:13Still want to scan?
19:14Maybe she's bleeding from an ectopic.
19:17No, she delivered a healthy baby here 10 days ago.
19:20Normal vaginal delivery, no complications.
19:23Pregnancy test stayed positive for a few weeks.
19:25So, we good to go?
19:26Good to go.
19:27We'll let the tech know.
19:33Oh, man.
19:35She was seen here this morning by Dr. McKay.
19:37For what?
19:38Urinary tract infection,
19:40discharged with oral antibiotics.
19:43Think it has something to do with the crash?
19:44Yes, no, maybe.
19:46Ask me again after I've had the scans, labs, and tox screen.
19:52Wow.
19:53No.
19:54Okay.
19:54Um, so...
19:56I need to talk to you about something.
19:58About what?
19:59Do me a favor.
20:00Look at me and don't turn around
20:03and just walk straight into...
20:04I told you not to turn around!
20:06I wish there was a way to keep it,
20:12but there just isn't.
20:13Well, then fuck it.
20:14We'll just say that we need another urine sample.
20:16That the lab left the last one out too long
20:18and couldn't culture it.
20:20Okay, then what?
20:21I'll give Piper the sample cup
20:22and send her down the hall to the bathroom.
20:24I'll stay with Laura in the room with some bullshit.
20:26You wait for Piper by the bathroom.
20:28To say what exactly?
20:29I don't know.
20:31It'd just be another voice saying,
20:33I see you're in danger?
20:34There are limits to what we can legally do,
20:37but I can try to talk to her.
20:41Hi, it's Dr. McKay again.
20:43Can I come in?
20:47Sorry.
20:49Yeah.
20:52Well, it was a long shot anyway.
20:55Hi.
20:56I think Piper took a pen.
20:59Yeah.
20:59Temp is 103.2.
21:08Nice, almost there.
21:11Oh my God,
21:11there are literally hundreds of different MDMA pills.
21:15And the milligram dosage ring is all over the place.
21:17These names,
21:18BMW 5,
21:20Jurassic Park,
21:21Red Superman?
21:22Well,
21:23why is she seizing?
21:24A febrile seizure?
21:25No,
21:25her temp is down.
21:26Maybe she needs more Ativan.
21:27No,
21:27she's had 20 already and the vitals are stabilizing.
21:30Another four of Ativan and Piper,
21:31gram of pepper.
21:32I don't think this is a CNS problem.
21:35She needs saline.
21:37We don't have her last act yet.
21:38At festivals,
21:39you dance for hours,
21:40you sweat,
21:41you drink gallons of water,
21:42but nobody thinks to replenish their salts.
21:44It's low sodium,
21:45hypernatremia.
21:46She needs 100 cc's of hot saline.
21:48We don't know her sodium levels.
21:49Drop 100 cc's of 3% and have it ready,
21:52okay?
21:53Do it.
21:54And prep a gram of pepper.
21:55Now.
22:09Start the pepper,
22:10please.
22:10It's not going to help.
22:12Problem one.
22:13What are you doing?
22:15Got it.
22:16Thanks.
22:17It's hypernatremia.
22:18Serum sodium is critical.
22:19Only 112.
22:20Knew it.
22:21Okay,
22:22I'll push the other 50 cc's.
22:24What the hell?
22:25She's seizing.
22:26You think?
22:26How long?
22:27About three minutes.
22:28Why did you not come get me?
22:30Hello?
22:30I was,
22:30I was across the hall.
22:31I was 30 feet away.
22:32What did she have already?
22:35It's hypernatremia.
22:37We pushed 100 cc's of 3% saline.
22:39That did the trick.
22:39Again,
22:40why did you not come get me?
22:42It was my fault.
22:44Yeah,
22:44I want,
22:44I wanted to keep going,
22:46with Ativan and Keppra,
22:47but Dr. Mohan had an excellent idea
22:49to treat for hypernatremia
22:51even before her labs came back.
22:53Time's down to 102.4.
22:56Good call,
22:56Dr. Mohan.
22:57Another minute
22:58and we'll de-ice her.
22:59I am going to take that minute
23:01to try to instill
23:02in Dr. Santos
23:03a very clear understanding
23:05of what her role is here
23:06and how she's expected to function.
23:08Dr. Langdon.
23:09Dr. Santos.
23:11When I say doctor
23:12in such a fashion,
23:13to draw attention
23:14to the ridiculous fact
23:16that you have enjoyed that title
23:17for what,
23:1890 days?
23:19So, yeah,
23:20I'm confused.
23:21Is it,
23:22is it hubris or ignorance
23:24that makes you think
23:24that you know more
23:26than other residents
23:27that have two to three years
23:28more experience
23:29and have helped thousands
23:30more patients
23:31in the emergency department
23:32than you have?
23:33Not to mention
23:33the over 500 hours
23:35of advanced training
23:37with lectures
23:38and simulation labs
23:39with senior faculty instruction.
23:40It doesn't matter.
23:42Stupid or arrogant,
23:43you need to realize
23:44that you are a beginner,
23:45which means your job
23:47is to shut up,
23:48listen, and learn
23:48because so far today
23:49the only thing
23:50you have been successful at
23:51is proving repeatedly
23:52that you know nothing.
23:53Dr. Langdon?
23:56Is the patient stable?
24:00Temps one and two,
24:01just about to take her
24:01out of the ice.
24:02Proceed.
24:02Dr. Langdon,
24:03a word, please.
24:04Please.
24:04Please.
24:04Please.
24:04Please.
24:04Please.
24:04Please.
24:04Please.
24:04Please.
24:05Please.
24:05Please.
24:05Please.
24:06Please.
24:06Please.
24:06Please.
24:07Please.
24:07Please.
24:08Please.
24:08Please.
24:09Please.
24:10Look, I know
24:12that sounded rough,
24:13but you only caught the tail.
24:14I can give you a list
24:15of my...
24:16She was giving unsupervised...
24:17Knock it off!
24:18Shut the fuck up!
24:21Where does it say
24:21that shaming, belittling,
24:23and insulting
24:23are effective teaching tools?
24:25Let me just tell you,
24:26harassment has zero
24:27educational value.
24:28You feeling upset?
24:29She's getting under your skin?
24:30Check yourself.
24:31Take a break.
24:32I've been watching you ride her.
24:33This kind of behavior
24:34will not be tolerated.
24:36I don't want to see it.
24:38I'm sorry.
24:39It won't happen again.
24:40Where's your other one?
24:41Where's Mel?
24:42She's taking a break.
24:43Yeah, well, maybe go find her
24:44and see if you can get her
24:45back in the game.
24:46You are senior leadership here.
24:49Step up and act like it.
25:02Wow, you came prepared.
25:04Uh, better safe than sorry.
25:06Uh, sorry I took off like that.
25:09I have a thing about rats
25:10and cows.
25:11Totally freaked me out.
25:12Really?
25:14Oh, there's plenty of both
25:16where I come from.
25:17They're, um,
25:18you know, pretty harmless.
25:19Let's hope Mr. Kokoja
25:20is now, too.
25:21Yeah, no kidding.
25:23Okay.
25:24Is this the guy?
25:33Yes.
25:35Hey, man.
25:36It's Dennis Whitaker.
25:38I just wanted to say sorry
25:39for earlier.
25:41Heard I got you pretty good.
25:43Yeah.
25:44I kind of go out of my head
25:46when I'm off my meds.
25:47Then I guess I piss on people.
25:51I'm pretty sure the meth
25:52doesn't help.
25:54I'm not using it anymore.
25:56I take NSA psychotics
25:57for the schizophrenia
25:58I got from doing meth,
26:00but I've been clean a year.
26:05Why aren't you taking your meds?
26:06Why don't I take my meds?
26:08Well, Doc, I'm kind of
26:09in between houses right now,
26:11living in an encampment
26:12on Liberty Avenue.
26:14That's cost money.
26:15I don't have insurance.
26:17Should I go on?
26:19No, no, that's fine.
26:21I'm sorry.
26:27Life isn't always easy.
26:32Have you talked
26:33to a social worker yet?
26:34No.
26:35Okay.
26:35Do you think you could go grab
26:37Chiara in here?
26:42I really am sorry.
26:44It's okay.
26:45Honestly, really,
26:46it's okay.
26:48I appreciate the apology.
26:57This must be Crosby.
27:01I've read a lot about you, buddy.
27:03That was my least problematic trainee.
27:06Well, technically,
27:07you're all pretty green,
27:09but you're growing on me.
27:11So,
27:12how are you doing?
27:15Um,
27:16good.
27:17Yeah.
27:17Better.
27:19Yeah?
27:21It's,
27:21I mean,
27:22it's just,
27:23it's the, um,
27:24the little girl
27:25and the sister's just
27:26too close to home.
27:29The things we do
27:30are hard.
27:31Yeah.
27:33You're, uh,
27:34sitting here
27:36feeling like,
27:38like maybe you're not up to it.
27:41Yeah.
27:43Been there.
27:45We all been there.
27:48Mel,
27:49you're a sensitive person.
27:52This,
27:53this is, uh,
27:54a tough place
27:56for sensitive people,
27:57but we need them
27:58badly.
28:00Now,
28:04if you're ready,
28:06I need you.
28:08It's a perfect job.
28:09It's practically
28:10a zen exercise.
28:11I've got
28:12a thousand pieces
28:13of gravel
28:14that need to be plucked
28:15out of a two-foot-long
28:16road rash.
28:18A thousand?
28:19Yeah.
28:20Give or take a hundred.
28:23South 20,
28:24make sure you close
28:25the door behind you.
28:27Don't want Crosby
28:27to get out.
28:28Yeah,
28:29no,
28:29thank you.
28:29No problem.
28:30I'll pop you right there.
28:33That's a lot of gravel.
28:36It looks clean to me.
28:37You feel that, Earl?
28:38Feel what?
28:39That's a no.
28:40All right,
28:40now I just apply
28:41the Dermabond.
28:42Cool.
28:43Um,
28:45can I ask you something?
28:47That's why I'm here.
28:49Um,
28:49yeah,
28:49I was just wondering
28:50what the nurses do
28:51after their shifts.
28:53In terms of what?
28:54Um,
28:55do they ever,
28:55like,
28:55go out together?
28:57Like,
28:58hang out to decompress
28:58after a shift
28:59or anything?
28:59Do you think?
29:01Yes,
29:01sometimes.
29:02I mean,
29:02most of us
29:03are just happy
29:03to get the hell
29:04out of here.
29:05Personally,
29:06I'm all about
29:07a long,
29:08long hot shower,
29:10pumpy sweats,
29:12eating some takeout
29:12in front of the TV,
29:13ideally watching something
29:14that makes me laugh.
29:15yeah,
29:17yeah,
29:17I can see that.
29:19I'm not imagining it
29:20in my mind,
29:20of course,
29:20I just mean that
29:21I can see the appeal.
29:23Um,
29:24I was just asking
29:25because,
29:26you know,
29:26since we worked together,
29:27maybe
29:28we could
29:30grab a coffee together
29:31sometime
29:31and could,
29:32like,
29:33help me
29:33get the lay of the land,
29:34so to speak.
29:36You
29:37asking him out?
29:39No,
29:39what?
29:39No,
29:40no,
29:40it's just that
29:41I'm,
29:41I'm,
29:41I'm new here,
29:42so I just thought,
29:43I don't date people
29:44in the workplace.
29:46It's nothing personal,
29:47just,
29:48it's never a good idea.
29:50No,
29:50no,
29:50of course not,
29:51no,
29:51no,
29:52I just,
29:53no,
29:53it's not a good idea,
29:53no,
29:54of course,
29:54I just thought that
29:55since you,
29:55you know how everything
29:56operates here
29:57and you,
29:57like,
29:57have everything so dialed in
29:58that you would be,
29:59like,
29:59a valuable resource,
30:00but,
30:00um,
30:00no,
30:01no,
30:01it's really just
30:02fair to think
30:03it out on my own.
30:07No shortcuts here.
30:09How they treating you,
30:10Earl?
30:12Huh?
30:13So you're wearing it
30:13just something
30:14on a sandwich?
30:15Feel like I'm
30:15washing around,
30:16come.
30:18Just came by
30:18to see if I could
30:19take Dr. Javadi
30:20on a reconnaissance
30:20through chairs?
30:21Yes.
30:22I mean,
30:23sorry,
30:23if you think that's...
30:24Of course.
30:25Of course,
30:25I can finish up
30:26my man here.
30:27Great.
30:33You okay?
30:37I feel ridiculous.
30:38I've spoken,
30:40like,
30:41two complete sentences
30:43in the last half hour
30:44and both of them
30:44have made me sound
30:45even more imbecilate
30:46than the incomplete ones.
30:48You attribute that, too.
30:51It's like my parents
30:52once took me skiing
30:53for Christmas in Utah
30:54and from the moment
30:55I got off the plane
30:56I just,
30:56I could not
30:56catch my breath.
30:58No matter how hard
30:59I tried to see altitude
31:00it made me feel
31:00just, like,
31:01awkward
31:01and uncoordinated.
31:03I couldn't concentrate,
31:04I couldn't get my bearings.
31:06And I'm a very good skier
31:07but I spent the whole vacation
31:08just, like,
31:08on my butt.
31:10Dizzy
31:10and panting.
31:13Mateo's like
31:13a human Utah.
31:15Ha!
31:17Oh,
31:17I've worked
31:19with a few Utahs.
31:20I wish you
31:21many, many Utahs
31:22in your life.
31:25Jesse,
31:26where are you going?
31:27Trauma 2.
31:27Stop, stop, stop.
31:28Stop.
31:28I'm not back in there.
31:30I'm not even
31:31gonna tell you why.
31:32How's she doing?
31:33Still with some
31:34claretic pain.
31:35Oh, hey, Paula.
31:36I'm Dr. Collins.
31:37Your CT shows
31:38that you have
31:38a broken sternum.
31:39That's your breastbone
31:40right here.
31:41Probably from the
31:42shoulder belt
31:42when you crashed
31:43your car.
31:44Crashed my car?
31:45Mm-hmm.
31:45And hit your head.
31:46With a concussion,
31:47sometimes you don't
31:48remember,
31:49but your head CT
31:50doesn't show
31:50anything serious.
31:52So, I saw
31:53on your chart
31:54you're a new mom.
31:55How's your baby doing?
31:57He's good.
31:58He's with my mom.
31:59Mm-hmm.
32:00Wow.
32:00South 15's open.
32:02Oh, hey, Dr. McKay?
32:03Just get the bed
32:03out of 15.
32:04A patient you saw
32:05this morning
32:05came back as an MVC,
32:07sternal fracture,
32:08slightly concussed.
32:09Oh, no.
32:09Paula, do you remember me?
32:10You look familiar.
32:11I was your doctor
32:12this morning
32:12for your bladder infection.
32:14Oh, yeah.
32:15Sorry.
32:15I'm a little out of it.
32:17Still tachycardic,
32:17115 VPs,
32:19124 over 78.
32:20It's no bleeding
32:21anywhere on the CT.
32:22Chest and abdomen
32:23clear apart
32:24from the sternal fracture.
32:25He'll probably still
32:25tag you from
32:26the fracture pain.
32:27I smell my breath.
32:28Let's try four of morphine.
32:30Paula,
32:31we're going to give you
32:31some pain meds.
32:32Let me know if it helps.
32:33Okay?
32:35Mr. Purnell,
32:36you are in luck.
32:37If I had to have gravel
32:38meticulously picked
32:39out of my leg,
32:40this is the person
32:41I'd call,
32:41Dr. Mel King,
32:43detail specialist.
32:43Hello.
32:44I love your dog.
32:45Crosby?
32:46How is he?
32:47Oh, he's great.
32:47Here, something helps
32:49you up close.
32:49Hey, I don't want
32:51to be one of those people
32:52who say they need
32:52an emotional support animal,
32:54but is it possible
32:55he could be with me?
32:56We could tie his leash
32:57to the bed.
32:58He wouldn't be
32:58in any trouble,
32:59I swear.
33:00What do you think?
33:00I'm happy to go get him.
33:02Any pain here?
33:03No.
33:04Okay.
33:04You go get the dog.
33:06You get to work.
33:07I am going to get
33:07some more gauze
33:08from triage.
33:09And just in case,
33:10if anybody asks,
33:11just say you need him
33:12for anxiety.
33:13Okay.
33:14Thanks.
33:16I know you hear me.
33:18You can pretend you don't,
33:19but I know you do.
33:22This glass might be
33:23bulletproof,
33:24but it ain't soundproof,
33:25huh?
33:26Hello?
33:27Can you hear me now,
33:28huh?
33:29Hello?
33:30Whoa, whoa, whoa.
33:30Sir, sir,
33:31what is the issue?
33:32Oh, same issue.
33:33I've been here all day
33:34and you people
33:35have done nothing
33:36to fucking help me.
33:37We're still waiting
33:37on your second troponin.
33:39We can't clear you medically
33:40until it comes back.
33:41For instance,
33:41if it comes back elevated,
33:42that could indicate
33:43a silent heart attack
33:44and you'd need to be admitted
33:45for monitoring
33:46in a cardiology consult.
33:47That's all I'm asking for.
33:49I'm afraid I've had
33:50a silent heart attack.
33:52I just want someone
33:52who knows something
33:53about hearts
33:54to tell me
33:54what's happening to me.
33:56You know,
33:56unlike most of these losers,
33:57I have insurance,
33:59good insurance,
33:59and I pay my taxes,
34:01which pays for them
34:01to not have any insurance.
34:03Sir, you've got about
34:04five seconds
34:04to change your whole attitude
34:05before security
34:06and the police
34:07get involved.
34:07fuck it.
34:08Fuck it.
34:08I'm leaving.
34:12Hey!
34:13Hey!
34:14You are absolutely free to go,
34:16but if you do,
34:17you will be leaving AMA
34:18against medical advice.
34:20This form states that
34:22I have advised you to stay
34:23and complete your evaluation,
34:24but you are choosing to leave,
34:26understanding and accepting
34:27all risks of heart attack,
34:28stroke, disability,
34:29and death.
34:35Sounds like a CYA form
34:37in case I drop dead
34:37on the curb.
34:38That's exactly what it is.
34:41I just want to be treated fairly.
34:44I assure you,
34:45that is our intention.
34:47We are not back here
34:48playing go fish.
34:49We're doing our best
34:49to help some very sick people.
34:51You will be seen,
34:52okay?
34:59Robbie's going to love
35:00that patient satisfaction score.
35:02Crazy people.
35:08What's going on?
35:09Car crash
35:10between Paula
35:10just went south.
35:11BP's crashing
35:1284 over 62,
35:13much less responsive.
35:14Leader of LR wide open?
35:15Putting her on a 100%
35:16now we're right.
35:17Paula, open your eyes.
35:18Paula.
35:19This is the morphine?
35:20She only got a small dose.
35:22Both socks is down to 89.
35:24Set up for intubation
35:25and McKay,
35:26get Robbie in here.
35:28I'll call ICU
35:29and get her bumped
35:30ahead of Joyce
35:30or Sickler.
35:32She should get the next bed.
35:33Between the hypothermia
35:34and the seizure,
35:35she's going to be
35:35out of it for a while.
35:36A similar thing
35:37happened to a friend of mine.
35:39Is that what made you
35:39think of hyponatremia?
35:41Look, I know you value
35:42evidence-based medicine,
35:43but sometimes experience
35:45counts for something.
35:49May I ask
35:50why you did that?
35:51What?
35:52I took the blame
35:53for a delay in care
35:55which didn't belong to you
35:56and gave me credit
35:58for a save
35:58that did belong to you.
36:00You know,
36:00I've been on
36:01Langdon's shit list all day.
36:03Seemed like he was
36:04going to be more upset
36:04about us not calling him in
36:06than glad that we
36:07stopped the seizure,
36:08so no reason for him
36:10to be pissed
36:10at both of us.
36:11Why have you been
36:12on his shit list?
36:13Well, I think he made it
36:15very clear
36:16that he thinks
36:16I don't have what it takes
36:17to make it here.
36:18Whether you do or do not,
36:20it was completely
36:21inappropriate for him
36:21to speak to you that way.
36:23Meh.
36:24I've heard worse.
36:25Well, for what it's worth,
36:26he's wrong.
36:28You're very good at this.
36:32It's actually worth a lot.
36:37I thought the CTs
36:38were normal.
36:38They were.
36:39Systolic's down to 70,
36:40heart rate's up to 130.
36:41100 of ketamine,
36:42100 of rock.
36:42Does she have delayed bleeding?
36:43It's not the chest.
36:44Pericardium's still clear.
36:45No tamponade,
36:46good EF,
36:47lungs are up.
36:48She feels warm.
36:49Well, check her tent.
36:50Meds are on board.
36:51Belly's clear,
36:52no bleeding here.
36:53She's loose.
36:54Okay, go for it.
36:58I see cords.
37:00Looks good.
37:01I'm in.
37:02Connect the bag.
37:03Nice.
37:05Good breath sounds bilaterally.
37:07Temp is 102.4.
37:08What?
37:08Is this septic shock?
37:09Okay, we need to assume
37:10the worst here.
37:11Code sepsis,
37:12two sets of blood cultures,
37:13lactate,
37:1330 per kilo of LRN4,
37:15antibiotics,
37:16ceftriaxone.
37:17No, no,
37:17she was just in the hospital.
37:18Peptazo and Vaco.
37:19Got it.
37:19If this is sepsis,
37:21where is it coming from?
37:22What's the source?
37:23Regulatory tract infection.
37:24She doesn't have one.
37:24She did when I saw her.
37:25It's not a UTI.
37:26We catheterized a year
37:27and a half an hour ago.
37:28There's no nitrates,
37:28zero WBCs.
37:30Your specimen
37:31could have been contaminated
37:32this morning.
37:32Pneumonia?
37:33Chest CT, negative.
37:35Abdominal CT, negative
37:36for an infectious source.
37:38She was altered meningitis.
37:39She's postpartum.
37:40Ugh, endometritis.
37:43The CT of the uterus
37:44shows a thickened endometrium,
37:46but that's normal postpartum.
37:47No retained POCs.
37:48It still could be the source.
37:49We'll do a pelvic
37:50after she's stable.
37:53Mr. Krakosia,
37:53here's my obvious concern.
37:55I write you a script
37:56for 30 days worth of pills.
38:00Then what?
38:01What do you mean?
38:02I'll take them.
38:03Well, you come back
38:04for 30 more, right?
38:05I mean, that's the question.
38:07Even if I could give you
38:08your dose in a once-a-month shot,
38:10you still have to come back
38:12when the month is over.
38:13What if he didn't have to?
38:15Oh, no, he has to.
38:16If he doesn't, he...
38:17Well, he pees.
38:19We have a street team here.
38:20Mr. Krakosia,
38:21are you pretty much
38:22in one spot these days?
38:24Yeah, well, we're on liberty.
38:25There's a benedum.
38:26The alley?
38:27I know it well.
38:28So we could bring
38:30the meds to him?
38:31Absolutely.
38:32The once-a-month injection
38:33sounds like the easier option.
38:35We could just put you
38:36on our schedule.
38:37Uh, I'd be interested
38:39in joining that.
38:40And maybe I can bring out
38:41the medicine myself.
38:42That'd be amazing.
38:43We could use all the help
38:44we can get.
38:44Thanks, Doc.
38:49Yeah, purulent drainage
38:51from the cervix.
38:53Got the culture?
38:55Looks like we have our sores.
38:57The positive urine this morning
38:59was contaminated.
39:00Maybe.
39:02Definitely.
39:03Not-so-clean-catch specimen.
39:06This infection's been brewing
39:08for a while.
39:09So the car crash
39:09was a coincidence?
39:10Not necessarily.
39:12She was probably already septic
39:13as the disease progressed.
39:14Dropped her BP
39:15and passed out while driving.
39:16She wasn't hypotensive
39:17when she wrecked.
39:18Adrenaline rush
39:18from the car crash
39:19and the sternal fracture
39:20raised her BP
39:20been off for a while.
39:21No.
39:22No history of fever.
39:24Bet she was taking Tylenol
39:25for the pain.
39:26Let's call ICU for an admit.
39:28Also one guy to see her.
39:32I mean, she had mild
39:33lower abdominal pain
39:35and a positive urine dip.
39:37No fever,
39:38no back pain
39:38indicate pylenophritis.
39:40She was alert,
39:42walking, talking.
39:43It just seemed
39:44like a simple UTI.
39:45I saw no reason
39:46to have her wait
39:46eight hours
39:47for her bed
39:47for her pelvic exam.
39:54McKay.
39:59Every postpartum patient
40:00needs a pelvic exam
40:01to rule out endometritis.
40:04Wait,
40:04you're saying that
40:05with 20-20 hindsight.
40:06Did you ask about Tylenol
40:08or ibuprofen use?
40:10Because that could
40:11mask a fever.
40:12There was no fever.
40:13Did you do
40:13a careful abdominal exam?
40:15It was a quick chair exam
40:17and there was only
40:17mild tenderness
40:18over the bladder.
40:19Perhaps
40:20there was something
40:22about the patient
40:22that made you
40:23overlove proper treatment.
40:27Like what?
40:29Other than the obvious
40:30health risk factors.
40:32Her size doesn't
40:33inherently make her
40:34unhealthy.
40:35Are you saying
40:36I was biased
40:37against the patient
40:37because of her weight?
40:38I raise it
40:39as a possibility,
40:40not as an accusation.
40:42Wow.
40:43I mean,
40:44I really don't think
40:45that's the case here,
40:46but I will look out
40:48for it.
40:50Yeah.
40:52You were good with him.
40:54Do you get a lot
40:55of homeless in Pittsburgh?
40:56We call them unhoused.
40:57It's not as bad
40:58as Philly or D.C.,
40:59but it's still pretty bad.
41:00Yeah.
41:01It really is great
41:01that you want to help out.
41:03The street team
41:03get cool jackets.
41:05Yeah?
41:05Come find me in the shift
41:06and I'll give you
41:07more information.
41:08I will do.
41:10You made it out
41:11unscathed this time.
41:12Yeah.
41:13Yeah.
41:13I'm joining the street team.
41:15Even got a jacket.
41:16So...
41:17Oh.
41:20Yeah.
41:21It is cool.
41:22Very cool.
41:23Oh.
41:23What's Boach?
41:2912-20s.
41:30I'm taking him
41:31for a visit.
41:32This is Crosby.
41:33Oh, no.
41:35I'm going for a smoke
41:36if anyone asks.
41:36He's an emotional...
41:37Support animal.
41:38I know.
41:39I got it.
41:42Oh!
41:44Oh!
41:45Crosby!
41:47Crosby!
41:48Oh!
41:48Ow!
41:49Drop it!
41:50Drop it!
41:51I got you.
41:51Oh!
41:52Whoa!
41:53Is somebody...
41:53Keep going.
41:54Yeah, that's right.
41:55Is somebody...
41:56Yeah, that's right.
41:56Yeah, that's right.
42:00Got you.
42:01Come on.
42:03Crosby!
42:04Crosby!
42:04Come here, buddy!
42:05Come here.
42:06There you go.
42:07Yeah.
42:08Oh!
42:11Good job.
42:13Wow.
42:13Good work.
42:14There you go.
42:21You got a rat, didn't you?
42:25Yeah.
42:26He does that.
42:27Yeah.
42:29When did those cops get you?
42:31Uh, I don't know.
42:32Who called him?
42:32I don't know.
42:34Where's Dana?
42:34Again, I don't know.
42:36Anytime.
42:45Hard at work?
42:45I'll take my chances.
42:50Oh, my God.
43:20Oh, my God.
43:50Oh, my God.
44:20Oh, my God.
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