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00:01.
00:15Drug show collapse at the waterpark.
00:17Two victims coming in via helicopter.
00:19ETA, five minutes.
00:20Time to rally the troops.
00:21I'll get environmental to clear and drop the trauma rooms.
00:23I'm gonna restock the crash carts with McKay
00:25to take the latest scripts to the drug cage.
00:27It would be a fun one.
00:28Fun one? What's up?
00:29Slide broke at the waterpark.
00:30Two victims.
00:31Five minutes to touchdown.
00:32No information on extended injuries.
00:33I can jump in with that.
00:34Ogilvy, grab some goggles, gloves, gown,
00:38go up to the roof.
00:38First patient that lands, bring him down.
00:41Hey, we've got two choppers.
00:42Then you wanna grab some bodies and meet me?
00:43What injuries are we expecting?
00:44Structural collapse.
00:45Could be anything.
00:46I can increase the morphine drip to manage the pain,
00:49but that could also slow down your breathing.
00:53You will likely feel very drowsy.
00:55You may lose consciousness,
00:57and it could cause you to stop breathing altogether.
01:10I'll be right back.
01:19Hey, you okay?
01:21Yeah.
01:22Sorry.
01:24Look, it's hard seeing your patients die.
01:27But as professionals, we have to create emotional boundaries for ourselves.
01:31It's not about us.
01:32It's about them.
01:35Yeah, she's so calm.
01:37I just...
01:40She had a long time to prepare for this moment.
01:43What she's doing for her sons.
01:46Managing this with so much grace.
01:49The real gift of love.
01:50I feel like an asshole.
01:53All they want is more time with their mother.
01:55All I want is less time with mine.
01:57Don't feel guilty.
01:59I mean, you can be grateful and gracious from a distance.
02:03Just talk to her.
02:04Tell her what you want.
02:05She'll understand.
02:08I doubt that.
02:11Give her a chance.
02:13You know?
02:14She may surprise you.
02:17Hey.
02:18Two birds headed our way.
02:20Need a hand?
02:20That's the rumor.
02:22Santos.
02:23Trauma incoming.
02:24Grab a gown.
02:25You can assist Dr. Langdon.
02:30Fuck me.
02:31Jesus.
02:32I got blood tubes growing moss over here.
02:34Tick tock, people.
02:36Hey, Olive.
02:37Give me a solid.
02:37Run these to the lab.
02:38No problem.
02:39I got more lab results.
02:41Start putting them on the patient clipboards.
02:43PTMC emergency.
02:45Go ahead, medic man.
02:46Do cyber attacks happen often?
02:47More than you realize.
02:48I blame the riskies.
02:49Dr. Mohan.
02:51It's your mother?
02:52She sounds pretty upset.
02:54She says she really needs to talk to you?
02:57You're shitting me.
02:58Tell her I'm not available.
03:10How's your ship going?
03:12It's been a lot already.
03:15You know, I worked in an ER before up in Vermont.
03:18And we had MBAs and ODs, MIs.
03:21But this place...
03:23This place is relentless.
03:26Holiday weekend.
03:27We're not normally offline.
03:29I think we have a very different idea of normal.
03:33It's not for everyone.
03:34I'm not sure it's healthy for anybody.
03:36Here's your leg.
03:38Jesus.
03:47I need more runners.
03:48Well, you could shut down the gift shop.
03:50They always have a couple of volunteers there.
03:52Everyone says volunteers use walkers.
03:54Beggars can't be choosers.
03:56Go get them.
03:57Okay.
03:57I'm gonna grab a smoke first.
03:59No time.
03:59Nicotine gum.
04:00Take the edge off.
04:01You two.
04:02Head to triage.
04:03Help out the front of the house.
04:04They're running out of space and there's a line out the door.
04:06Okay.
04:07Let's go.
04:07Hang on, Moham.
04:11Sign this.
04:14Nicotine patch, 21 milligrams.
04:16Who's it for?
04:17Monica.
04:18This nicotine gum shit.
04:19She'll never survive the shift that I need her so I don't lose my goddamn mind.
04:25Thanks.
04:26Is Dr. Abbott still around?
04:28He'll wait to get some sleep before his night shift starts in a couple hours.
04:30Shit.
04:31Okay.
04:31I should have planned this better.
04:33I was hoping he'd write me a letter of rec for an elective so I could have a shot at
04:37a fellowship next year.
04:38Which one?
04:41Whichever will take me.
04:42Did the electives fill up a while ago?
04:44Don't remind me.
04:45I'm gonna throw myself at the mercy of the court.
04:47Beg for them to take me anyway.
04:48Just kill me now.
04:50Be less painful.
04:52You know, I can't read this handwriting.
04:54It has...
04:551,000 milligrams of acetaminophen orale,
04:584 milligrams of dengetron under the tongue,
05:00and trial of clear fluids.
05:02Seriously?
05:03It says all that?
05:04It's not in the text with emojis.
05:06You kids can't read for shit.
05:11Rehab?
05:11Fall from 10 feet onto a metal fence.
05:13Right below the knee.
05:15Good vitals.
05:16Oh, it hurts.
05:17Oh, my God.
05:18What's she had so far?
05:1950 of vent.
05:19Repeated 25.
05:20No meds.
05:21No allergies.
05:21Where should I put this?
05:22Just hang onto it for now.
05:24On my count.
05:251, 2, 3.
05:29Hey, Whitaker.
05:30Eat fast.
05:30Donnie, primary survey, please.
05:32Pupils equal and reactive.
05:35What's your name?
05:36My leg hurts really bad.
05:38Did I break it?
05:39Um, I wouldn't say that it's broken exactly.
05:41We're gonna get an x-ray to determine that.
05:43Put that on the gurney.
05:45Line it up for x-ray.
05:45Keep your fucking mouth shut.
05:47Good.
05:47Long sliding right and left.
05:49Airway patent.
05:49Breath sounds bilaterally.
05:51My head hurts.
05:52BP, 100 over 60.
05:54Pulse, 118.
05:55Pulse lock, 98%.
05:56Does your belly hurt?
05:58No, asshole.
05:59It's my leg.
06:01Okay, she's really moving here.
06:02Andriticetamine?
06:03Yeah, we can't evaluate like this.
06:06Hey, Ogilvy.
06:08Deep breaths, yeah?
06:09Yeah, okay.
06:10What a girl, what's next?
06:11Uh, once she's sedated, finish the e-fast.
06:14Playing x-ray, check her back straight to CT.
06:16What if the ketamine wears off?
06:18Right.
06:18Uh, we should do a popliteal nerve block before the CT.
06:22Anesthetize from the knee down.
06:24Two of you.
06:25Tip, pushing ketamine now.
06:26What's the bullet?
06:26Forty-two-year-old male with 20 foot fall.
06:29I want chest trauma with hand injury.
06:31Where's my son?
06:32Where's my son?
06:33Saki to 108, SAS 98 on two liters.
06:36BP, 122 over 84.
06:37Or pan scan due to mechanism, you?
06:39Tim fib amputation.
06:41Hoping ortho can give us a little hope for replantation.
06:43Derek, where are you hurting?
06:44Chest.
06:45In my finger.
06:46Did they find my son?
06:47Did you hit your head?
06:48Don't think so.
06:49I need to find my son!
06:51We'll find him for you, but we need to take care of you first.
06:53Pericardium's clear, no fluid in Morrison's.
06:56Move both arms, wiggle your feet.
06:58Good.
06:59Any pain in your neck?
07:00No.
07:01Spleen looks good.
07:02Start with his chest, that's where he hurts.
07:04No hemotemp in him?
07:05Normal sliding.
07:07Best to start with the side he's complaining about first.
07:10Uh, I don't see much sliding there.
07:12His name is Jack.
07:14He's seven.
07:15Pneumothorax?
07:15Set up for a chest tube.
07:16Not yet.
07:17Uh, let's go posterior lateral, look for fluid first.
07:21Traumatic pneumothorax, we should prep the chest.
07:23Not necessarily, he's hemodynamically stable.
07:26Okay.
07:27Does that look like some fluid there?
07:29Hard to say for sure.
07:31Okay, he's tachycardic pneumothorax, he needs a chest tube.
07:34BP and SATs are fine, we can wait for CT.
07:36If it's small, it'll resolve on its own.
07:37We observe and reimage.
07:38I agree.
07:39He's stable for now, let's wait for the scan, Dr. Santos.
07:41Okay, let's order CT chest, abdomen, pelvis, and x-ray left hand.
07:47Whoa, major degloving.
07:49Focus on the primary.
07:50Dr. Langdon's correct, we need to log roll him.
07:54Okay, how about another four more feet?
07:56Put it in.
07:57Hang in there, Derek, we got you.
08:01Fuck off already.
08:03Boyfriend?
08:04Wish.
08:05My mom.
08:06Every time I get a second of service, another dozen types of men.
08:09Hey!
08:09How much longer do I have to wait?
08:11I've got a broken leg here.
08:12Someone will be with you shortly, sir.
08:14Am I allowed to use the bathroom?
08:16I really have to go.
08:17I don't know, ma'am.
08:18I am not your doctor.
08:19It says right there, doctor.
08:21Yes, but I'm not your doctor, but if you go back to your room, a nurse will come find you.
08:24I wasn't in a room.
08:26I had to be parked in the hall.
08:28Are either of you treating my mother?
08:29Nope!
08:37Take a seat.
08:38It's gonna be a while.
08:43Helen Torres, come on down.
08:48Helen Torres.
08:48Yes, yes.
08:49I'm going to go.
08:53Pass the door to this side.
08:55Oh, thank you.
09:10I'm Dr. Mullen.
09:11This is Dr. Kwan.
09:12Helen.
09:13How long has your leg been swollen, Helen?
09:15It's been getting worse over the past week.
09:19Dr. Mullen, your mom called again.
09:21She said you don't need to go back.
09:22Not now.
09:23With a patient.
09:27Sorry about that.
09:29Did you fall or hit your leg?
09:32No.
09:34Have you ever had a blood clot before?
09:37No.
09:41Are you all right?
09:42Excuse me?
09:43Do you need to sit down?
09:45Oh, no.
09:45I'm fine.
09:47You don't look too good.
09:48What?
09:50No, it's just, um...
09:52It's really hot in here.
09:54And, uh...
09:55And, uh...
09:56You need to sit down.
09:57I'm good.
10:00I just...
10:01I need some hair.
10:02Excuse me a second.
10:04I need some help.
10:29Look out, McWay.
10:32Get in.
10:34No, I'm okay.
10:36I'm okay.
10:37Get in the fucking chair.
10:41Excuse me, man.
10:43Excuse me. Coming through.
10:45Out of my way.
10:47We were going down the water slide,
10:48and the bottom just fell off.
10:50I grabbed Zach's arm, and I tried to hold on to the sides,
10:53but my hand slipped, and my ring got stuck.
10:55My finger was ripping off, and I just...
10:58and I lost him.
11:00We can numb up your finger as soon as we gauge the extent of the injury.
11:03You can cut the damn thing off for all I care.
11:05I just need to find Zach.
11:08Okay, do you feel anything here?
11:09Yeah, sharp.
11:10How about here?
11:11Sharp again.
11:12A little late for the show, Yo-Yo.
11:14I am the show, Dr. Langdon. You're the warm-up act.
11:16Maybe somebody miss me.
11:18Mr. Foster suffered a de-gloving injury of the ring finger.
11:21Stable pneumothorax awaiting imaging.
11:23Hello, sir. I'm Dr. Garcia from the trauma service.
11:26Need the ring cutter.
11:27That's why they pay the surgeons a big bucks.
11:29Possible flexor tendon injury.
11:33Try to bend up your ring finger.
11:38Let's go with the block.
11:40You want to feel a pinprick and some burning?
11:43Which tendon did we test, Dr. Santos?
11:46Seriously? That's a med student question.
11:48We're a teaching hospital.
11:50It's always good to review.
11:53Flexor digitorum superficialis is intact as it inserts on the middle phalanx.
11:58Correct.
11:59Gee, thanks.
12:01No sign of tension.
12:03At least no tension, you know.
12:05Let's wait for the CT. I'll be next door.
12:08Langdon.
12:09Mill's sister's been asking for you. She's getting antsy and we could really use the room.
12:12CT's ready.
12:13Okay, let Becca know I'll be there soon.
12:15And Mr. Foster got separated from his son, Zach, at the water park.
12:19I don't know if we can call for you.
12:21My wife, Angela.
12:22Dr. Santos, will you escort Mr. Foster to CT?
12:30Help! Need a hand here?
12:33What the hell happened?
12:34I think I'm having NMI. My chest is so tight I can barely breathe.
12:38Okay, I've got to get a swab lead. Perla, can I get an assist here?
12:41Yeah, I'm on it.
12:44CT's normal.
12:45Why do we take down the tourniquet, Whitaker?
12:47To give the residual limb blood slope.
12:50Two little pumpers.
12:51A little figure eights.
12:52I'll take care of those.
12:54Park.
12:56Park the shark. Orthopedic surgeon.
12:59Is this a favorable amputation?
13:00Pretty clean cut, then sliced through like a guillotine.
13:03X-ray.
13:06Not too bad.
13:07Mm-hmm.
13:10Just, uh, tying off a couple materials.
13:13I'm not blind.
13:16Where's the amputated leg?
13:17Double bag, none ice.
13:19Sterile saline on the inner bag.
13:21Ice water in the outer bag.
13:23No direct ice on skin contact.
13:25We spent a lot of time...
13:27He still needs to look.
13:33Get Robbie.
13:37...
13:44Antibiotics.
13:45Cefazolin and gent.
13:46We've cleared her chest, abdomen, and pelvis.
13:49Clean wound.
13:50No crush injury.
13:51Rapid transport time.
13:54Replantation is a go.
13:55I'll book an OR.
13:56Irrigate the hell out of this with three liters.
13:58Three liters?
13:59A saline, genius.
14:02Thanks, Shark.
14:07I knew he meant saline.
14:10Dr. Robbie, we need you in central sex.
14:13Dr. Mohan may be having a heart attack.
14:14What?
14:18EKG is normal.
14:19You sure?
14:20Check it out.
14:21You can be here on Second Opinion.
14:22What's going on?
14:23It's okay.
14:23I'm okay.
14:24You don't look okay.
14:26You look like shit.
14:27I feel like shit.
14:28What happened?
14:29I don't know.
14:31I just got really hot, and I started having trouble breathing.
14:35We should send out some labs just to be safe.
14:39Any chance you're pregnant?
14:40Not sure I feel comfortable answering that.
14:44No.
14:45She was tacky, but it's resolved now.
14:47Have you eaten anything?
14:48Yeah.
14:49You staying hydrated?
14:50100%.
14:51I'm doing everything right.
14:53It's everything around me that's all fucked up.
14:55It's just my mom moving and calling me over and over again,
14:58and now me scrambling to find a job next year.
15:00I had it all planned out, and now everything's just out the window.
15:03Wait a minute.
15:03Is this a panic attack because of your mommy issues?
15:06What? No.
15:07Jesus.
15:08Do you need to go home?
15:09You should go home.
15:10No, I'm fine.
15:10I don't need the fucking liability.
15:12Go home.
15:13And the rest of you, the last time I checked, the ED is a shit show,
15:16so let's all get back to work, huh?
15:25Sorry for taking so long, Becca.
15:28Nurse Dana said you'll be back in a few minutes,
15:30but it's definitely been more than a few minutes.
15:32You're right.
15:33My apologies.
15:34I brought some drink options.
15:36Okay.
15:37We've got apple juice, cranberry juice, OJ, and Pittsburgh's Finest.
15:43What's that?
15:45Water.
15:46Oh.
15:46OJ, please.
15:48Okay.
15:50Let's see.
15:54All right.
15:56Now, I am going to give you two pills.
15:59The first is an antibiotic that will get rid of the infection.
16:04The second should take care of the burning.
16:05You want to take both pills for three days and drink lots of water.
16:09I'll write it all down.
16:11I hate pills.
16:13Could you mash those up and put them in the OJ for me?
16:16Coming right up.
16:19Okay.
16:22Mel's going to be super worried when you tell her.
16:25You are going to be just fine.
16:26But, um, as far as telling your sister what's going on with you,
16:30that is your decision, not mine.
16:34So, you're not going to tell Mel?
16:38I can't.
16:39Not unless you, my patient, tell me to.
16:45Do you know when Mel's going to be done with her important meeting?
16:50Hopefully soon.
16:52Dr. Langdon.
16:54They need you by control, too.
16:59Becca, I got to go.
17:00I will be-
17:01Don't say in a few minutes unless you actually mean in a few minutes.
17:05I would never.
17:11And I need you to be kind to each other.
17:14I'm kind. She's just a butthead sometimes.
17:19He's your brother.
17:21And he loves you.
17:25Don't go.
17:27I don't want to go.
17:29But it's-
17:31It's not up to me.
17:34Okay?
17:35We'll always be connected.
17:38No matter what.
17:42Invisible string.
17:47Invisible string.
18:01Hey.
18:04You gonna go in and see your mom?
18:07Cancer sucks.
18:10Yeah.
18:11Yeah.
18:12Yeah, it's us.
18:16It's not fair.
18:18No, it's not.
18:24I don't want to go in there.
18:28Nobody's gonna make you.
18:29No.
18:36She didn't used to look like that.
18:41Yeah, I get that.
18:47But if you don't go in there and say goodbye,
18:50I'm gonna tell your mom you love her.
18:53I think you might wish you had for a very long time.
19:01It's your call.
19:06D5 half normal saline, 28K, run it at 125 an hour.
19:11One of the most common reasons for traumatic replantation failure is infection, so we do what, Whitaker?
19:16Rinse and repeat until surgery calls first.
19:21Is everything okay with Dr. Mohan?
19:23She's fine. Focus.
19:27I don't know.
19:32Kenamine's wearing off.
19:36I can't feel my leg.
19:39I'm Dr. Michael Rabinovich.
19:41You're at a hospital, and we gave you a nerve block so that you can't feel any pain.
19:44Why?
19:45You were on a water slide that collapsed and did serious injury to your leg.
19:50Okay.
19:54Fuck.
19:55Is that my leg?
19:57Did you cut my fucking leg off?
19:58Your leg was cut off in the accident.
20:00Our surgeons are gonna try for replantation.
20:03No.
20:04She needs more catamere.
20:05Just wrap up the leg. Emily, I know that this is really hard.
20:07I need you to focus on me right now.
20:08Because we need to get your consent to proceed with the surgery.
20:11Why?
20:11There are risks with the surgery.
20:13There's anesthesia.
20:14And there's no guarantee.
20:15Emily?
20:17Can you just put it back on?
20:19Can you just put it back on?
20:21Sounds like consent to me.
20:22Now can she have sedation?
20:23Okay.
20:23Load it up.
20:24Ketamine and rock.
20:25It's gonna be okay.
20:25It's gonna be okay.
20:26We're gonna intubate before the OR.
20:28It's gonna be okay.
20:30Finishing second cut.
20:32Success.
20:33Can that be saved?
20:34The finger or the ring?
20:36The wedding ring.
20:37Yes, sir.
20:38A jeweler can weld it back together.
20:40Good as new.
20:41Stop.
20:42Irrigate the ring shavings off first.
20:46What did I miss?
20:47Finishing irrigation.
20:50Doesn't look like you lost any skin.
20:52It's a little dusky.
20:53Might not be viable.
20:55There's intact skin on the dorsum.
20:56More irrigation than tack it down with one suture.
20:59Okay, thanks.
21:00Radiologist reports a 25% in the forex.
21:03Is that bad?
21:04That is a partially collapsed lung that needs treatment.
21:07I can put in a chest tube.
21:08He doesn't need a chest tube.
21:10Okay, what do you want? A pigtail catheter?
21:12I was thinking of Thoravent.
21:14What? Why?
21:15It's not a bad idea.
21:17No need for wall suction.
21:18If Hannah can operate today, he can go home tomorrow with a Thoravent.
21:21You can learn a lot from your senior residents.
21:23I'm happy to teach Dr. Santos.
21:26Thank you, Dr. Langdon.
21:32Janelle, I need you to take the samples to the lab and come back with any results that are ready.
21:37Joffrey, head to CT to see if any new results are printed and bring those back.
21:41Pam, check in with whoever's running the PDS to see if any orders need to go to the pharmacy and
21:46bring back any meds that are ready for pickup.
21:48Rinse and repeat every 15 minutes.
21:50Double tie those shoelaces and hydrate.
21:52It's not a sprint.
21:53It's a marathon.
21:55Fine, my pretties.
21:58Okay.
21:58Any word I'm finding on water slide dad's kid?
22:01Not yet.
22:01Called the wife, went straight to voicemail.
22:04At least dispatch said that there were a couple of fatalities on site when adult one kid.
22:08Sweet Jesus.
22:09Who the fuck did this?
22:11No sign up on orders for labs or x-rays.
22:14And it's in the wrong freaking rack?
22:15You guys trying to kill me and the patient?
22:17Uh, I'll take care of it.
22:19Thanks.
22:19Dana, this gum is absent.
22:21Shit, I know.
22:23Pardon me, she said you needed this right away?
22:25Just in time.
22:25Slap one on and give it an hour to kick in.
22:27You're welcome.
22:29What?
22:31The prescription is for you.
22:32My insurance will cover it.
22:33Hers won't.
22:35Is that insurance fraud?
22:37Tell me in jail.
22:38I could use the vacation.
22:43Mom.
22:49I'm...
22:49I'm really glad to see you, Mom.
22:51I...
22:51Garcia told me about the sigmoid volvulus you missed.
22:54It was an oversight.
22:55That could have killed her.
22:57Without electronic records, it's been kind of a challenge to figure out...
22:59Chaos is the status quo in the ED, even when the computers are working properly.
23:02You have to be hypervigilant and double-check everything.
23:05I can handle it.
23:05Why would you want to?
23:07Down here, you're learning street-level medicine all to see to your pants.
23:11Oh, well, I made a mistake, but the more talented practitioners upstairs will fix it.
23:17You are better than this.
23:21I love you.
23:28Well, that is one way to do a debrief.
23:31You should talk to her.
23:32Which one?
23:33Honestly, both of them.
23:35Can you call in some extra doctors?
23:37Sure.
23:37Everyone's dying to work on the Fourth of July.
23:39Why?
23:40Dr. Mohan went down.
23:41Yeah.
23:42I saw your pep talk.
23:45She's taking a little break until her labs are back.
23:47She's going to be fine, but I'm not sure her head is in the game.
23:51Come on, Cap.
23:53Small stab incision with the 11 blade, mid-clavicular line, second intercostal space.
23:58She's gonna stab me.
23:59It's just a medical term.
24:01Stay superior to the rib.
24:07Is there a problem?
24:09Nope.
24:09Everything's going well.
24:11Place the trocar.
24:13Pull back the, uh, adhesive wings.
24:17And advance until you see the red diaphragm move.
24:20That means you're in the pleural space.
24:23Now, remove the trocar.
24:28Perfect.
24:30Okay.
24:30Now we can either, uh, hook up to wall suction, or we can use this one-way valve to repeatedly
24:36aspirate with a syringe.
24:37And with all your vast experience, Dr. Langdon, you should probably decide.
24:43We can avoid wall suction if I pump manually.
24:46How about it, Doc?
24:47Enough.
24:48Apparently, decency and decorum need to be reintroduced to our R2 curriculum.
24:52Nice work, Dr. Langdon.
24:54We'll go check on an OR for Mr. Foster.
25:02Hey.
25:03I'm gonna need you to pick up her pace.
25:05Hey, get a sec.
25:06Dr. Mullen just almost died on me.
25:08Not even close.
25:09She's tougher than she looks.
25:11Propane Hero and North 4.
25:12Hey, any word from surgery on how our big patient, Howard's perforated diverticulitis is going?
25:17Still in the OR.
25:18What about our drunk firework kid?
25:20Waiting to turn in the surgical conga line.
25:23What about social services?
25:24Have they found a temporary foster home for our baby Jane Doe?
25:28Still working on it.
25:29Kid's gonna be old enough to drive by the time she gets out of here.
25:32You joke.
25:34Oh, for fuck's sake.
25:36Go.
25:37Quickly.
25:37Before I change my mind.
25:39Hey.
25:40Did the county pick up Louie's body yet?
25:42No.
25:42He's still in the viewing room.
25:43Jesus.
25:44He's just laying in there?
25:45Yeah.
25:45Another couple of minutes of him.
25:46I'm wheeling him down to the morgue myself.
25:50What's the bullet?
25:51Eight year old boy.
25:51Part of the water park accident.
25:53Thrown off the water side.
25:54How far did he fall?
25:55Maybe six or seven feet.
25:56Landed in a tree.
25:57Had to wait for a ladder trick to get him down.
25:59Major neck trauma.
26:00Must have taken all the impact there.
26:01Couldn't tube him.
26:02Heard to bag.
26:02Sats in the 80s.
26:03BP 85 over 60.
26:05Pulse 50.
26:08Okay.
26:09One, two, and three.
26:12Possible laryngeal fracture.
26:14Hypoxic bradycardic.
26:15Kid needs an airway before your wrists.
26:17Braselot tape.
26:18Peens cart.
26:18Set up suction.
26:19Oh, my God.
26:20Is that Zack?
26:22Hey.
26:23Hey, kid.
26:23Can you look at me?
26:25No response.
26:26No purposeful movement to pain.
26:29Oh, my God.
26:30Is this your kid?
26:32No.
26:32Sir, go back to your room now.
26:33Braselot says 25 kilograms.
26:35Jessie?
26:35Five and a half ET tube.
26:37Okay.
26:38Uh, a 30 of rock.
26:3950 can be.
26:39You're gonna paralyze?
26:40Yep.
26:41If we can't intubate, we crike?
26:43He's too young for a crike.
26:45Needle crike?
26:45You can't ventilate through that.
26:47Sats down to 78.
26:48Eleven blade Kelly and a Peds Bougie.
26:49One quick look and then we cut.
26:51I can't tell if there's lung sliding.
26:53No movement, no air entry.
26:54Way too edematous.
26:55I can't see the cores.
26:57Better with crike work pressure?
26:59Nothing.
27:00Fuck.
27:00Okay.
27:01Tall world between the shoulder blades.
27:02Heart rate down to 49.
27:03Headed to cardiac arrest.
27:04The trach's gonna take 20 minutes.
27:05This kid's not gonna last 60 seconds.
27:07That's why we're doing a slash trach.
27:08Don't know it.
27:08Me neither.
27:09Boss?
27:10Show me what you got.
27:20Pull up the trachea between your thumb and middle finger.
27:24Vertical incision right over the trachea.
27:28Vertical, not horizontal.
27:29Or you transect the trachea and cut the jugular veins.
27:33That's a lot of blood.
27:35Now it's a tactile procedure.
27:37Two centimeter incision through the tracheal rings.
27:40Finger in the trachea.
27:44Bougie into the airway.
27:47Thoughts on what's next, Dr. Whittaker?
27:49Insert the ET tube into the trachea.
27:52Suction.
27:53Lots of blood in the airway.
28:01Okay, back in.
28:03Check the CO2.
28:06Sats are coming up in the 80s.
28:08Bilateral breath sounds.
28:09And tidal CO2 is 70.
28:11That's crazy high.
28:11It'll come down.
28:13Tie down the tube.
28:13Control all the bleeders.
28:15Spray an amp of epi on a stack of 4x4s.
28:17Okay.
28:18Sats are up to the 90s.
28:20Good.
28:20CO2's in the 50s.
28:22Good heart rate.
28:22You forgot the last step.
28:24Change your underwear.
28:26How many of these have you done?
28:28First one.
28:28Are you serious?
28:29What about you?
28:31None.
28:31I practiced in the sim lab when I was at Stanford.
28:34What'd I miss?
28:35All the fun.
28:35Slash trach.
28:36Seriously?
28:38Fractured larynx.
28:39Couldn't oxygenate.
28:39Couldn't ventilate.
28:41He was a meat cleaver on this kid?
28:42E&T can revise the trach in the OR.
28:45They'll be thrilled to clean up your mess.
28:47Or maybe they'll thank us for not letting him die.
28:55So we're still waiting on your prescription and the pharmacy's a little backed up.
29:00But I'm glad to see you're doing good.
29:02Well.
29:03I'm well.
29:06Glad to see you're well.
29:08Can't you expedite my medication?
29:11Sure.
29:12But it may still be a little while before Dr. Mohan can sign off on the discharge.
29:15So.
29:16Sit tight.
29:19And do what?
29:24You just keep this handy for occasions like this?
29:28Uh, I thought that I might not have that much to do today.
29:31But.
29:33Man, I was wrong.
29:47What brings you in today?
29:49A friend made me come in.
29:51Name's Robbie.
29:52He said I should.
29:52Ah, you're Duke.
29:54Donnie.
29:55Yep.
29:56Robbie's VIP is here.
30:01Okay.
30:02I'm Donnie.
30:03Nurse practitioner.
30:04Robbie's already put in orders for a numbing spray for your nostril.
30:09Nostril?
30:09It's my throat.
30:11It's not my nose.
30:12Okay.
30:12Let's get you, uh, set up in a room.
30:18That was the most unprofessional deposition I've ever witnessed.
30:22They were nowhere near that aggressive with Dr. Ellis.
30:25Oh, okay.
30:29It didn't go as badly as you think.
30:31They suggested I was incompetent.
30:34They're posturing to set the stage for a ridiculous settlement request.
30:38This isn't about those parents or that kid.
30:40It's only about trying to make a lot of money.
30:42Well, I don't have a lot of money.
30:45Not your money, Dr. King.
30:47It's an insurance game.
30:48You're protected by the hospital.
30:49This won't affect your career.
30:57Hey!
30:57How was your deposition?
30:59Uh, have you seen Dr. Langdon?
31:01Uh, no.
31:02Why?
31:04Okay, okay.
31:05How is Becca?
31:06Oh, she's fine.
31:07Yeah?
31:08Okay, I should go see her then.
31:09How was your deposition?
31:10I'm sure I was stressful.
31:14Uh, um...
31:15What's going on with Becca?
31:16What's her diagnosis?
31:17Well, I can't tell you.
31:19Why?
31:20HIPAA.
31:21Seriously?
31:22If you want to know what's going on with Becca, you're going to have to ask yourself.
31:25Okay, you survived your deposition.
31:27Welcome back to the seventh circle of hell.
31:29What, uh, what's this?
31:30You're welcome for covering your patients.
31:32They are yours again.
31:33Might want to check on the pancreatitis in our three first.
31:36Oh, okay.
31:37Langdon.
31:38We got some intel on Louie.
31:40They move him out of the viewing room?
31:41No, but County's promised they're on their way to come get him.
31:44Can I get the county coroner's number?
31:46What for?
31:47I just want to make sure if no family shows up, Louie gets a proper burial.
31:50That's expensive.
31:51You may want to rent it by the missus first.
31:53Uh, maybe I started GoFundMe.
31:56I bet people around here would pitch in.
31:57Hey, kid.
31:58You can't do this for a ran house guy that dies around here.
32:02Better but for the grace of God.
32:03No, the success of your sobriety is a testament to your support system.
32:08Louie didn't have that.
32:10Still, Louie was a good man.
32:11He deserves to be put to rest with dignity.
32:14Okay.
32:15I'll dig it up.
32:19You heard all that?
32:22Robbie, your VIP's here.
32:24Got him in Central 11.
32:26Finally.
32:30About fucking time.
32:31If I knew you were going to make me wear a dress, I wouldn't have come at all.
32:35Dennis Whitaker, meet my buddy Duke.
32:37Nice to meet you.
32:38Any friend of Dr. Robbie's?
32:39Friend of mine?
32:40Friend is a vast overstatement.
32:42He's more just a pain in my ass.
32:44Don't let his surly exterior fool you.
32:46Deep down inside, he's just as grumpy.
32:49How did you two meet?
32:50Tinder.
32:52Duke is a motorcycle engineer.
32:54He should have seen his Bonneville when he first brought it in six months ago.
32:58Someone left it for dead.
33:00He helped me bring it back to life.
33:01Today we're going to return the favor.
33:03Dr. Whitaker is one of our most trusted physicians and today he's going to help me oversee your care.
33:07Uh, what seems to be troubling you?
33:10Ask him.
33:11He's the one who made me come in.
33:12He's had some hoarseness on and off for a couple months.
33:15Okay.
33:15Any history of tobacco or alcohol use?
33:18Two of my oldest and closest friends.
33:20Former two-pack-a-day smoker and lover of the drink.
33:23Okay.
33:24You got any medication?
33:25Uh, blood pressure meds.
33:27Mm-hmm.
33:27Which he forgets to take.
33:29He's all numbed up and ready to go.
33:31Okay.
33:31Thank you, Donnie.
33:33My man.
33:34I'm going to take this scope and I'm going to stick it in your nose and we're going to check
33:39out your upper airway.
33:41Uh, that seems like a lot of fuss for a sore throat.
33:43Dr. Whitaker, you want to explain to Duke why this procedure is absolutely necessary?
33:48The scope is going to give us a better view of your voice box and your vocal cords.
33:53Here we go.
33:54Yeah.
33:59I feel a little pressure between your eyes.
34:01I am sorry about that.
34:03Okay.
34:04Just breathe through your nose.
34:05This is going to help us see if there are any abnormalities like inflammation, tumors, nodules.
34:11That all looks pretty normal.
34:13I don't see too much drainage.
34:14Stick your tongue out for me all the way.
34:16All the way out.
34:17Good.
34:18Now say E.
34:19E.
34:20Good.
34:21Now again say E.
34:22E.
34:23Good.
34:24Removing the scope.
34:26Mm.
34:27Dr. Whitaker, what do you think?
34:29Looks normal.
34:29No abnormalities.
34:30Told you it was nothing.
34:32Yeah, with your history of smoking, I'd like to do a chest x-ray.
34:35If there are growths, they can push against the recurrent laryngeal nerve intermittently.
34:40That can paralyze one of the vocal cords and cause the hoarseness.
34:45That sounds like a lot of bullshit doctors speak to charge me more.
34:49You've got Medicare.
34:50Besides, I finally got you into my ED.
34:52You're going to get the golden workup before I leave town tonight.
34:55Only an idiot would ride all night after working a 12-hour day.
34:59That does sound pretty dangerous.
35:01Stay put or do I have to tie you down?
35:03Fine.
35:04So long as you keep your hands where I can see them.
35:06No promises.
35:06Let me know when his chest x-rays back.
35:09Yeah.
35:13Hey.
35:14Hey.
35:15Are we okay?
35:18Uh, yeah.
35:19Why?
35:21I don't know.
35:22You kind of ripped me a new one in front of Langdon.
35:25Whose side are you on?
35:26This isn't middle school.
35:28Langdon made a mistake and owned up to it.
35:30Let it go.
35:31He should've...
35:34He should've been fired.
35:36But instead he waltzes back in here.
35:39No big deal.
35:40Meanwhile, I've been a goddamn pariah for the last 10 months for doing the right thing.
35:43Or maybe you're a pariah because you don't play well with others.
35:48If you still got beef with Langdon, go tell him.
35:50He's here to stay, so put on your big girl panties and work it out.
35:54No.
35:55If you want to have sex and eat ramen in bed, I'm your girl.
35:59But if you want to talk about this Langdon shit again, call a therapist.
36:13How's it hanging, Dr. J?
36:15Never call me that again.
36:17It was a joke.
36:19Relax.
36:20He's clueless about your TikToks.
36:22But you're not.
36:24Props on the side hustle.
36:26There is no hustle.
36:27There's some stupid videos.
36:28Wait.
36:28Are you an influencer?
36:29No.
36:30Yep.
36:30Oh!
36:32Yo, pre-docs!
36:33It's not happy hour yet.
36:34There's still shit ton of patients to be seen.
36:40Oh, Ben, our slash trade kid from the water park, had some purposeful movement in pre-op.
36:46That's a good sign.
36:47Mm-hmm.
36:47Take the win.
36:51We need to talk.
36:54We are talking.
36:55In private.
37:05What the hell was that with Samara earlier?
37:08That was tough love.
37:10That was tough love.
37:10You are her superior.
37:11She was obviously struggling and your advice was go home.
37:14Essentially, yeah.
37:16This is the ED.
37:17It's not for the faint of heart.
37:18It's not for the unempathetic either.
37:21Samara's not having a panic attack because of her patience.
37:24She's having one because of personal baggage.
37:25What she needs to do is pull her head out of her ass and focus on the work.
37:28What about you?
37:29What do you need to get some basic human empathy back?
37:34I don't know.
37:36Something that gives me a little hope this place won't fall to shit when I'm gone.
37:40Found him!
37:42Found who?
37:43The water slide dad's kid?
37:44How'd you manage that?
37:46I went outside, stalked the dad's IG, found a pic of his son, sent it to Pittsburgh PD.
37:50Now they're on the way over.
37:51Well, maybe Gen Z should be working for the FBI.
37:57Hi, Becca.
37:58Mel!
38:01You doing all right?
38:03I'm a little bored.
38:06Um, how are you feeling?
38:08A lot better.
38:09Dr. Langdon gave me some medicine in OJ.
38:11He's super nice.
38:13I see why you like him.
38:15Did he tell you what the medicine was for?
38:17Yes.
38:18Um, did you tell her?
38:20I did not.
38:22Uh, I explained to Becca that due to doctor-patient confidentiality, everything she told me was private.
38:28And that it was her decision if she wanted to share anything with you or not.
38:34Um, do you want to share?
38:35Yes.
38:48I have a urinary tract infection.
38:52Oh.
38:54Okay.
38:55Yeah, those, um, those can happen if you, you know, hold your pee in for too long or you accidentally
39:01wipe from back to front.
39:01Mel, I know.
39:02I know Mel.
39:03He told me.
39:04Oh, good.
39:06You know, he also told me it can happen from having sex.
39:10Uh, yeah, it can.
39:12Uh, it's not like you're having sex.
39:14Yes, I am.
39:19What?
39:19What?
39:20I'm having sex.
39:24With who?
39:25My boyfriend.
39:27You have a boyfriend?
39:28Yes.
39:29His name is Adam and we're having sex.
39:33Lots of sex.
39:37Okay.
39:40Um, Mel, uh, are you okay?
39:45Mm-hmm.
39:49You got a sec?
39:51Sure.
39:52How you feeling?
39:53I'm fine.
39:55Are you sure?
39:56Yeah.
39:57Troponin, D-dimer, and TSH.
39:58All normal.
40:00Listen, I'm sorry about earlier.
40:01I think I was being...
40:02A dick?
40:04I was gonna say I'm professional, but probably that too.
40:08I'm sorry.
40:10Thanks.
40:12But now I kinda need you to stop feeling sorry for yourself and focus back on your patients.
40:16Think you can do that?
40:18Sure.
40:19Great.
40:23With this extra dose and increased morphine from the pump, your pain should subside.
40:30Your breathing will slow down.
40:32You may get very sleepy.
40:35I'll go be with the boys.
40:40They need you more than I do now.
40:43Later.
40:45Right now I'm exactly where I'm supposed to be.
40:56Yeah.
40:58Okay.
40:59Here we go.
41:07For the people who am well.
41:17Thank you for the songs myself.
41:24To me and I will face, The trail be with you.
41:30Feel the mood of me to miss you.
41:31WOT
41:33Give me
41:53I'll see you next time.
42:33I'll see you next time.
42:34I'll see you next time.
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