- 7 hours ago
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00:18You
00:23Donnie, thank you. I'm sorry. We'll get another nurse to her place Jesse. Do we even know when he's ice
00:28assholes took him?
00:28No, but the hospital journeys are all over it. I know you got your own baby. What's going on? It's
00:34a cold hula hoop central 14
00:43What the hell happened you're right
00:52How do you get bloody nose he said
01:03Where's Ogilvy upstairs they let him scrub in on that kidney stone turn triple-a great on the one day
01:09med students might actually be useful in the ED
01:12Oh a present company excluded you're doing great
01:16Sure, hey, uh, can I get a selfie with you?
01:19What do you mean? Yeah, you're kind of a legend among med students
01:23Really? I call you phantom of the pits on account of you secretly living in the hospital for months
01:29What it wasn't months still waiting on labs x-rays meds?
01:34PTMC go ahead medic command. Where are all the nurses there was a code hula hoop in central 14. Oh,
01:41no
01:41What's that hospital worker assault?
01:44Oh
01:45I have the new nurse Emma. Is she okay?
01:48I don't know. I think so
01:50Smoke them if you got them. This place is going tits up
01:56Okay, are we all good in here? Oh, yeah, boss you got this
02:00You sure you're all right?
02:02Uh, I think so. Good
02:03Come on
02:06So
02:07What exactly happened? He grabbed him. I he threw up against the wall. I ran in and gave him a
02:12shot
02:12Right, and did he slip before or after the shot before?
02:16Yeah, he had me in a headlock. I didn't see what happened. What did you give him?
02:20Four milligrams of verset who wrote the order I had in my pocket was on my way to waste. It
02:24was shit was sideways
02:27What?
02:28Okay, so now he's altered from alcohol verset and head trauma now
02:32He's gonna need a head CT to rule out intracranial bleeding in a fraction. Would you rather be Emma with
02:35a head injury or worse?
02:37Don't worry about it. We got this. No, there's no we here
02:40You need to pass this patient off and report him fine. Emma you're done with this bastard. I'll handle it
02:45now
02:45This is my emergency department, and I'm telling you to pass it off
02:48These are my nurses and I choose what cases they work and if you think for one minute putting anyone
02:52else from my staff at risk with that asshole
02:53You better give your fucking head a shake
02:55Come on
02:58MBA coming in okay, I'll be right there. Thank you
03:05I
03:06Did I kill my son?
03:07No
03:09He's not dead. He's recovering in pediatric ICU
03:14We'll be back to check on you again shortly massage, Amanda
03:22Has her husband arrived yet?
03:24Yeah, but he went straight upstairs. Really?
03:27He may have just wanted to see his child first. Let's not jump to conclusions
03:31Dr. Robbie, can I have a word?
03:34Shoot in private
03:36You're going to start to talk
03:38Thank you
03:47What is this about?
03:51I'm going to recommend this ED have two attendings on shift at all times moving forward
03:56This department is clearly too much for one person to handle
04:00It's not healthy for you or the patients and I'm
04:03Very concerned by what I've witnessed today with some of the staff
04:08What is going on with Langdon and Santos? I saw them having it out like it was fight night
04:11Dr. Langdon hasn't even been here for 10 months and you told me this morning there was nothing to worry
04:16about with Dr. Santos
04:17There isn't Santos and Langdon have beef because she's the one who turned in room for taking meds
04:22I'm sorry, what?
04:24Santos is responsible for revealing Langdon's benzo addiction
04:31Was he stealing drugs from this ED?
04:35This ED is the best of the best and I would put it up against any emergency department in the
04:40country
04:40And it is going to be yours to fuck up so don't fuck it up
04:59You're not supposed to smoke out here really seems to be working for me so far
05:08How old are you kid?
05:11I'm 21
05:13On Tuesday
05:14Jeez it's some kind of idiot savant
05:18We no longer use that term
05:21It's derogatory
05:23You bruise easy millennials
05:25Actually, I'm Gen Z
05:27Even worse
05:29I was stripping a purgatory to put myself through school when I was your age
05:34Snowflake
05:36Hey, Amy
05:37Yeah, I'm getting off later than I thought
05:40Well, um, I'll give you a call when I get a better idea of when
05:44I need help
05:45I gotta go
05:45I can't breathe
05:46I got the air away, you take the pulse
05:49Yeah
05:52Oh my god
05:53Can you try and draw thrust?
05:55Radio's weak and thready
05:56What's his name?
05:56My dad
05:57Uh, Oliver
05:58Hey Oliver, can you open your eyes for me?
06:01Here we go
06:06Okay
06:07Okay
06:07One, two, three
06:10Drive-in with severe respiratory distress
06:12Last-sided dialysis shunt probable renal failure and fluid overload
06:16I have respiratory set of BiPAP
06:18When was his last dialysis?
06:19It was supposed to be yesterday morning
06:20I'm gonna need a nitro drip ASAP
06:23You got this?
06:24Yeah
06:25Is that the guy who attacked Emma?
06:27Is he going to CT?
06:28Yeah, Miss Emma here needs an HMP
06:29Uh, Cassie, can you give Emma here a workup?
06:32Started chart, victim of assault
06:34Really?
06:35I'm fine
06:35He was choking you
06:36He had me by the head most
06:37You're a patient now, full exam in South 18
06:39In case she also needs to make a statement to the police
06:41Is that really necessary?
06:44Yeah
06:44Absolutely
06:45Don't worry, he'll be there with you
06:47Come on, let's get you a spot
06:49Well, your guy just bought my guy for CT
06:51No, he's my guy
06:52You're expecting a new one because he's been sitting here forever
06:53I'm never gonna get out of here
06:54Tell it to someone who cares
06:56You know what, you should care
06:57Because if you gave that guy a serious injury with force inflicted from a sedative
07:01You are not licensed to prescribe
07:02Anyone else uses force to stop an assault?
07:04They're a hero, but a nurse does it and we're punished
07:06You just happen to have a vial of her set in your pocket?
07:09It was extra from the medics, good timing, I guess
07:11When we waste a controlled substance, we need a witness to sign off
07:14I was on my way to when I spotted that asshole attacking our girl
07:17Anything else, Nancy Drew?
07:19Where are you going?
07:20Taking a pee
07:20Do I need your permission to do that too now?
07:31Fuck, fuck, fuck, fuck
07:41Should we intubate?
07:43Uh, best to avoid that if possible
07:44Pressure support and after load reduction buys us time for dialysis
07:48BiPAP starting at 10 over 5
07:49Good hard squeeze, good lung sliding, but there's a ton of B lines
07:52Pulmonary edema
07:53Which is best treated by what, Dr. Giovanni?
07:56Uh, nitrates
07:59Dose?
08:00BiP 198 over 132, pulse 120, pulse talk's only 85
08:05Good BiP, let's start at 400 mics per minute for two to five minutes
08:07I was asking Dr. Giovanni
08:09Don't you know I start low with nitro then titrate up?
08:12In flash pulmonary edema, we do the opposite
08:14What he really needs is dialysis to get the fluid off
08:17What's his dialysis schedule?
08:19Uh, Monday, Wednesday, Friday
08:20He missed yesterday because of a wedding
08:22We tried to go to the center this morning
08:23It's usually open on Saturday, but I think they close for the fourth
08:26Where do you live?
08:26Uh, Brookville
08:27It's like an hour and a half away
08:29Yes, ma'am
08:29I tried Pine Ridge Hospital in Ford City, but I didn't know they shut down
08:32Yeah, they sure did
08:40All right, sister
08:42How can I help uncluster this clusterfuck?
08:46You ready to finish our conversation?
08:48We talked, okay, now I gotta need you
08:50Please
08:56Talk to me
08:57I'm tired of this shit
08:59Okay
08:59It's the second time that everyone was attacked by a patient today
09:02Okay
09:02I used to quit on my nurses and these cyber assholes have turned us back into 1999
09:08Well, I'm worried about you, you are not yourself today
09:11What makes two of us sound?
09:13Do you have something you want to say?
09:16Go ahead, I can take it
09:18All right, Danielle
09:20Sometimes it's like you're just tempted to death because you don't give a shit anymore
09:23So this is about the motorcycle?
09:24It's not just about the motorcycle, it's about the whole damn thing
09:27Robbie, you're actually telling people that you're going to a place called smash my head in
09:31Close, not quite
09:32And it's not the only thing
09:33Robbie, your buddy Duke is insisting on leaving and that MBA is here
09:37Okay, I'll be right there
09:39What's open?
09:40Uh, South 15
09:4078 year old woman, very low speed auto versus pedestrian with ground level fall
09:45Bruising on her left hip, no head trauma
09:47Your husband Eddie came along
09:48Hi, how do you do, sir? I'm Dr. Robbie
09:50Come with us, we're going to get you set up right over here
09:54Sorry, we'll get you something for the pain shortly
09:56Thank you
09:57Do you have any medical problems, Frida?
10:00Uh, high blood pressure, low thyroid, um, AFib
10:04Any chest pain, shortness of breath?
10:06No
10:07Front row seat, sir
10:08So, um, what happened?
10:10Well, she walked into the car
10:14You hit me
10:15No, I didn't hit you, you hit the car
10:18You backed up right into me
10:20I wasn't even moving
10:23Well, you're both in very good hands now
10:25Yes
10:27Before we get you in a gown, we'd like to check your head
10:31Of course
10:34I am sorry, we had a whole bunch of craziness come in and you got bumped down a patient or
10:39two for CT
10:40But take comfort in knowing it was for some pretty nasty stuff
10:43How am I supposed to find comfort in that or anything you've told me since I got here for that
10:48matter?
10:49I don't know, but everything is supposed to come with a lesson, right?
10:52Oh, this is more of your send motorcycle bullshit
10:55Maybe
10:56No, no, the truth is I'm just stalling because it's going to be a while longer
10:58Ah, okay, look, I appreciate the effort, but you guys are obviously jammed up
11:03And I'll just come back when it's not our nation's birthday
11:05You're already here
11:06It's not going to be that much longer, I promise
11:08Just stay and get your CT
11:09I will do it all when you get back and this place is less crazy
11:13This place is always crazy, I don't know when I'm going to get back
11:15Can you just sit the fuck down and wait a little bit longer?
11:17It won't kill you, but leaving might
11:25Okay
11:27No problem
11:29Thank you
11:32That's a nasty bruise
11:34Do you take aspirin or any blood thinners?
11:38Uh, eloquence from my AFib
11:41Any tenderness here?
11:43No, not really
11:45Here?
11:45Oh yeah, that hurts
11:47Four of, uh, morphine and Zofrin
11:50What about up here?
11:51Not really
11:54All right, so let's start with labs in plain film
11:56No, CT abdomen pelvis will get a better view of the hip and check for bleeding
12:01The eloquence is concerning
12:03Uh, you think she broke her hip?
12:05If it's broken, you broke it
12:08Usually for a broken hip, the leg is shortened and rotates out
12:12But we'll just wait for CT results
12:22Mr. Cohen, I know that you were checked on scene
12:26But I was wondering if I could do a quick examination of you
12:29Oh no, I'm fine, I was in the car
12:31Just unofficially
12:33Uh, okay
12:37Deep breath for me
12:41Good, again
12:44Great, thanks Eddie
12:46Next thing, would you mind taking your shoes off?
12:51Uh, what for?
12:52Just being safe
12:57My back's not what it used to be
12:59Let me help you
13:04I, uh, could use a pedicure
13:07You and me both
13:09Dr. King, what do you think about doing a Romberg test?
13:13What is that?
13:15It's a general evaluation of balance
13:17Um, can you stand up, sir?
13:20Yep
13:20Okay
13:22How are you doing, Oliver?
13:24Shats are not coming up
13:25Pressure's holding on 409, Cheryl
13:26Let's up the BiPAP to 20 on 10
13:28We could try phlebotomy, decrease the fluid burden on the lungs
13:31Old school, but right by time
13:33Hemoglobin's only 9.2
13:35He's anemic for renal failure
13:36And he can't afford more blood loss
13:38We need to intubate, we're losing this war
13:40Intubation's not a trivial matter for immunosuppressed patients
13:43So we just drop a bunch of red tops?
13:45No, we do the collection on the floors if he's giving blood
13:47We like medieval bloodletting
13:49Essentially
13:49And that is something you should step out for, Mason
13:52Casey, thank you
13:53Got a good vein for 16
13:54One donor bag, 500 cc's, no more
14:00Okay, let it out
14:03Same again, deep breath in
14:07Great, hold on
14:09How's she doing?
14:10Hull socks 100%, normal exam, no evidence of injury
14:13Great
14:14I got way worse for my older brothers
14:15I bet
14:16All right, I'll go write a picture
14:20How about we call it a day?
14:23My shift isn't over
14:24This was a shift and a half for anyone today, believe me
14:28If it's all right with you, I'd rather stay
14:31I'm not a quitter
14:33Okay, but someone good for you
14:34But stick close to Donnie for the rest of the day, would you?
14:38Sure
14:38And you also need to make a statement to the police
14:42If we don't stand up for ourselves, no one else will
14:44We're here to help, not to be punching bags
14:48Thank you for saving me
14:50Got you, girl
15:00Something's wrong?
15:01That depends
15:02Are you a four-month-old with severe diaper rash?
15:05No, I'm Dorian Cole and I'm pretty sure that I broke my collarbone
15:08Okay, we can help with that, I'll be back
15:10Wait, are you serious?
15:11Can I at least get something for my pain?
15:13Sure, sit tight
15:14This place sucks
15:15Tell me about it, try working here
15:17What, you're really working hard to boost those patient satisfaction scores?
15:21The chart for Central 7 doesn't match the patient that's in there
15:23Just hang in there, we're almost over this
15:25I was over this six hours ago
15:26Sheriff's is looking like Mulaney's on St. Paddy's Day
15:29They're gonna break through the doors like zombies
15:31Incoming
15:31If you don't start moving more than me back there
15:33Dante Casella, 34
15:35Blunt trauma from a fireworks explosion in his storage unit
15:38A&O, good vitals, large scalp laceration and bruising to the chest
15:42No meds or allergies
15:43Partial or flow thickness burns
15:44No burns
15:45The blast launched him into a rolled-down garage door frame
15:48Yeah, am I fucking dying here?
15:49I'm Dr. Robbie, this is Dr. Santos
15:51I can't hear you
15:53Try the other side
15:55I'm Dr. Santos
15:57Can you hear me?
15:58Yeah, yeah
15:58Dante
15:59A lot of ringing
16:01Hey, McKay!
16:02Joy, you're with us
16:06One, two, three
16:10I need like four doctors
16:13Shit, I knew it was bad
16:14This is a teaching hospital
16:16You need all the extra help you need
16:19Airway and breathing intact
16:21Good lung sliding bilaterally
16:24Tender over the sternum
16:26Possible fracture
16:26That's your breastbone
16:28No ectopy on monitor
16:30No pericardial effusion
16:31The heart looks good
16:32130 over 85
16:33Pulse 108
16:34Sat's 98 on two liters
16:36Good enough for 50 a cent
16:38He's stuck through his headdressing
16:39Let's take a peek
16:40Normally we don't deal with scaplax on the primary survey
16:43Only if there's active bleeding
16:44Not with glass injuries
16:46The pressure wave can transmit energy through the body
16:49And cause internal damage
16:50Even without any external visible signs
16:51Especially with organs that are air-filled
16:54How are we looking, Dr. Santos?
16:55PFAS negative
16:56No free fluid in the belly
16:59Fuck me
17:00What is that?
17:02It's a pretty big flap
17:03Checking for bleeding source
17:05Is that through the gale yet?
17:06It is indeed
17:07I'm gonna crack my head open or what?
17:09Don't worry
17:10Your skull is intact
17:11It's just a very deep cut
17:16Okay, we got a couple arterials that need control
17:20Figure of eight sutures
17:21Dr. Santos is for 800
17:22What are rainy clips, Alex?
17:24Quicker than sutures
17:25Ding, ding, ding, ding
17:26Okay, clamp those bleeders
17:27Call for CT
17:28I'll be next door
17:29And Duke's CT line keeps growing
17:35500 cc's out
17:37How you doing, Oliver?
17:38I think it's progress in here
17:40I can't tell if it was the phlebotomy
17:42Or if the nitro finally kicked in
17:43Oh, it could have been both
17:46Potassium's high, 6.5
17:48Be expected with the misdialysis
17:49And the added heat stress
17:50He needs, uh
17:51Dr. Fevody
17:52Uh, he needs insulin and glucose
17:54To shift the potassium intracellular
17:55Exactly
17:56Uh, 10 units, ampethy 50
17:58Start with five milligrams of nebulized albuterol
18:00It'll shift some potassium and help his breathing
18:02He's at risk for arrhythmias
18:05No peach tea waves, no QRS widening
18:08Insulin puts him at risk for hypoglycemia
18:10And you'd tie up nurses with frequent accu-checks
18:12Dr. Oshimi's right
18:14The nebs will hold him over until dialysis gets here
18:15You got this?
18:16Mm-hmm
18:20All good in here?
18:21Yep
18:25Uh, I'm gonna go give this guy's kid an update
18:28He's probably freaking out
18:29Come find me if you need me
18:30Uh, yep
18:34Um, hey
18:36Where'd you learn that shoe trick?
18:38Oh, I did a clerkship at NJMS Senior Care
18:41One of the attendings always said you can learn a lot about your patients just by looking at their feet
18:48Bravo ladies on to the next lucky customers
18:53Oh, probably gonna have to stay late to catch up on all these patients
18:56NJF reinforcements will be here soon
18:58We're supposed to be speeding up in the 11th hour and not slowing down
19:00They don't call it the final sprint for nothing
19:02Chop, chop
19:09Is that the mom of the heat shark?
19:12Yeah
19:12Do you believe it was just an accident?
19:16Does it matter?
19:18As a doctor?
19:19No
19:20As a mom
19:22Sometimes I can't tell if motherhood has made me more understanding or more judgmental
19:31Dana, got a couple of visitors
19:32Uh, my, my brother, there was an explosion
19:34Hi, my mom was in a car accident
19:36Uh, okay, Monica, can you help these fine folks find their loved ones?
19:39No
19:40And princess, what are you still doing here?
19:42Don't you got some crazy luau pig roast barbecue thing to get to?
19:44It's lechon, but yes, I do
19:46I'm gonna sneak out on a few
19:47Oh, yeah, yeah
19:48Go have some fun for both of us, all right?
19:51Don't stay too late
19:51Okay
19:54Hello, Miss Stevens, I'm Dr. McKay, how you feeling?
19:58Stupid
19:59And really, really sore
20:02Yeah, we'll, uh, get you something for your pain, okay?
20:06And your last patient left her blanket
20:10Oh, uh, yeah, I
20:15Yeah, I'll take it
20:16Thanks
20:17It's me
20:19Um, I'll be right back, Kim
20:25Fuck
20:27You good?
20:28Yeah, yeah
20:28I, uh, I'm just, um, I'm looking for something to put this in
20:32I, uh, a patient left it
20:37She died, the, uh, cancer mom with two kids
20:41Sounds like a tough one
20:42Yeah, that one sucked
20:45Seeing those two young boys said goodbye to their mother was brutal
20:50Just makes you want to cry
20:53You should cry, you'll feel better
20:56I wish I could
20:58You know, I don't even remember the last time I cried
21:03I'm not even sure I can anymore
21:04Is that what this place does to you?
21:11I don't know
21:58Your mom is stable
22:00I am not a patient
22:01Both my parents used to be in pretty great shape
22:03But lately it's like they can barely get up the stairs
22:05Half their house is inaccessible to them
22:07Have you looked into assisted living options?
22:09Yes, but they refused to even talk about it with me.
22:13Mr. Cullen, we have a visitor.
22:16Care bear.
22:17Dad, you feeling okay?
22:19No, I'm feeling dumb.
22:22Carrie, this is Dr. King, who will be assisting with your mother's care.
22:26I was just explaining that the treatment depends on the injuries, but there are complicating factors.
22:32We are required to report impairments that might affect driving,
22:36and you will likely have to take another driver's test to keep your license.
22:39What has that got to do with Frida?
22:41Well, if the hip injury is serious and you're also limited,
22:47then it could mean an unsafe-to-return-home recommendation for your wife.
22:51You'd be looking at a temporary move to some form of assisted living and rehabilitation for Frida's care.
22:57How temporary?
22:59Best case, three to six months, but she may never return to the functionality she had prior to the injury
23:05and recovery.
23:06Okay, well, kill me now.
23:08See what I'm dealing with, Dad?
23:10You need to find somewhere to live that is safer and healthier for both of you.
23:14You know, the new communities are not anything like the old scary nursing homes.
23:18They're really nice, and you get your own apartment.
23:21And, you know, my sister actually lives in Munchies.
23:23She loves it.
23:24When the dog dies, we can talk.
23:27What if you fall?
23:28What if you have a heart attack or a stroke and there's no one there to help you?
23:32You worry too much.
23:33How can I not?
23:34Look what happened today.
23:36We're going to leave you two alone.
23:38We'll come back with Mrs. Cohen.
23:45Hey, Robbie.
23:47Our scout victim is back from C2.
23:49They're prepping him now.
23:50Shit.
23:51Uh, okay.
23:52I'm coming.
23:53Um.
23:55Is your friend doing okay?
23:56He's on Munchies, that risk radar.
23:57Oh, and Dano put McKay on the guy who attacked the new nurse.
24:00Is she okay?
24:02Physically, yes.
24:03I heard you had a little chat with Langdon earlier.
24:06Yeah, water under the bridge.
24:08You have to figure out a way of working with him now that he's back.
24:10Or until he relapses.
24:12Becoming a very good doctor.
24:13Don't let old conflicts get in the way.
24:15Speaking of which, I want you and everybody else to see the trauma counselor while I'm gone.
24:19Yes?
24:20Yes.
24:20And I asked Whitaker to house it for me while I'm gone.
24:23I figured that would distract from the whole farmer's widow thing.
24:25Wait, what?
24:25Bring the mail, water the plants.
24:27Cool.
24:28Cool.
24:29Yeah, fine.
24:30That looks good.
24:31You can start the repair after this one.
24:33Feeling any pain, sir?
24:35No pain, just wet.
24:38You already numbed him up?
24:39I did.
24:41One percent with Epi.
24:42CT back it?
24:43No, not yet.
24:44I watched the slices come up.
24:46Isolated sternal fracture.
24:47Everything else looked normal.
24:48Could send him home, but given the mechanism, should probably watch him overnight.
24:52I agree with Dr. Garcia.
24:55I agree with Dr. Garcia, too.
24:58Three-layer closure.
24:59Galia, sub-Q, skin staples.
25:02Enjoy the fireworks.
25:04And hey, if I don't see you before you leave, don't forget to buy me a souvenir, like a custom
25:08alkaline carved hunting blade.
25:09Nothing less from my favorite butcher.
25:11Aw.
25:12You're gonna make a great ex-husband one day, Rubinovich.
25:17The hospital's got his defense attorney looking for Jess.
25:19He probably took him to an ICE detention center, said we shouldn't hold our breath, though.
25:23Whatever happened to we the people, huh?
25:28Anything back on that drunk son of a bitch that attacked Emma?
25:31Not yet.
25:33For Christ's sake.
25:34Making a run now.
25:35I'll ask.
25:36Yeah.
25:36That's the guy who attacked Emma?
25:39Some sense.
25:40How you doing?
25:43Beachy.
25:45Oh, that's me.
25:46Hey, you did what you had to do with that guy.
25:48Everything's gonna be fine.
25:50From your lips.
25:54Box of class B launch tubes to the van.
25:57Next second.
25:58Kaboom!
26:00I get launched 10, 15 feet across the garage, right up into the lift track.
26:06Hit something hard.
26:09I don't really remember the rest.
26:12Oh, just my brother's screaming.
26:14I'm lying there thinking, oh, he must be dying.
26:19I guess it was me who was screaming about, your brother is in the family room.
26:23He's waiting to see you, and he is alive and well.
26:28Oops.
26:29Oops.
26:31What's oops mean?
26:33Hello?
26:34Nothing to worry about.
26:38We never say oops in front of a patient.
26:45All right, try again.
26:47You sure?
26:48Mm-hmm.
26:49Mm.
26:51Better?
26:52Keep going?
26:53You might want to leave the fireworks to the professionals.
26:56We are professionals.
26:57Got our official PDA consumer license a few years back.
27:03Gunpowder's in my blood, man.
27:05Nothing like that.
27:12Ain't no fight in it.
27:14I'm more fatty.
27:16I like my memento mori.
27:19Wait, let's keep it on.
27:21I'm like the only one who didn't study Latin for med school.
27:25Yep.
27:25Yes.
27:27And finished.
27:29Nicely done.
27:31Can I see my brother now?
27:32Yep.
27:33Oh, motherfucker.
27:35Chest pain?
27:36Only when I move.
27:38That would be the fracture in your sternum, which we would give you another four more feet for
27:41that.
27:42And try no laughing or sneezing for the next four weeks.
27:48Mr. Haas, we're going to switch you over to a high-flow nasal oxygen instead of the biped and see
27:52how you do.
27:54This looks promising.
27:55Repeat potassium is at 6.1 with the albuterol.
28:03Oh, I'm feeling a little better.
28:10Don't you ever tell your mother about how fast you drove here.
28:13I thought you were going to die.
28:15Any longer I might have, so good job.
28:20Boy just got his permit last week.
28:23Felt like I was living in one of those Fast and the Furious movies.
28:27I can't believe Pine Ridge closed.
28:30When did that happen?
28:31I read about it a few months ago.
28:34Medicare spend me cuts.
28:35Are there any other emergency rooms in the area?
28:38Nope.
28:39It's going to be a long way to drive for folks out where we live.
28:43Mr. Haas, you'll need to stay here a few hours.
28:44Get you tuned up.
28:46Yeah.
28:47I know the drill.
28:48Yeah.
28:50Hey, you know, Mason, if you're hungry, we've got a pretty good cafeteria.
28:53Don't lie to him.
28:55We have a cafeteria.
28:57I'm just going to stay here with my dad.
28:59Yeah, sure.
29:02Thank you for saving him.
29:10Are you still thinking oral emergency medicine when you're down here?
29:14I'm not thinking doing.
29:17Yeah, I hope there are still some hospitals left for you to work at.
29:19Yeah.
29:23Ah, it's on the March of the Walking Dead night shift again.
29:26First one in, Mattel.
29:27You get a gold star.
29:28What happened in here?
29:29Left you guys at the layup this morning.
29:30Don't ask.
29:32Well, speaking of layups, what up, Dr. J?
29:35Oh, right.
29:36That was some sort of basketball player, wasn't it?
29:39Shame on you.
29:40Only the greatest sixer to ever play the game.
29:43Week one of year four of med school.
29:45You'll be ordering me around before you know it.
29:47You enjoy the dark side when you graduate?
29:49The emergency department?
29:51The night shift, baby.
29:52It's wild.
29:55Um, I haven't even decided what residency I'm applying for yet.
29:58We'll figure it out.
30:00I've got lots of time.
30:01Tell that to my parents.
30:03Dana, results are back in your guy.
30:05Oh, give me this.
30:12I choked her?
30:14No, I would never do something like that.
30:16But you did.
30:20Can you, uh, sorry, can you excuse me for a minute?
30:24Jesus Christ.
30:26Great.
30:29What's he saying, anyway?
30:31He's in a bit of shock.
30:33Claims he doesn't remember anything.
30:36He says he was on the golf course getting boozy, maybe a little too boozy.
30:40Things get hazy.
30:41Next thing you know, he's on the floor and everyone's screaming at him.
30:44How convenient.
30:47Maybe it's better for both of you that he doesn't remember what happened.
30:52Let me know when you're ready to take my statement.
31:01All right, well, the good news is your CT was negative for skull fracture and cranial hemorrhage.
31:07You mean that's good news for you and that blonde nurse lady?
31:11But your lab results were positive for alcohol and cocaine.
31:17Okay, you got me.
31:19I did a couple of birdie bumps on the turn, but we were just having fun on the golf course.
31:23Look, when alcohol is mixed with cocaine, your liver produces a metabolite called cocanethylene.
31:28But what does that have to do with me?
31:30Allegedly doing what you said.
31:33It's a psychoactive molecule, more toxic and potent than cocaine.
31:37And it can lead to confusion, paranoia, aggression, and even psychosis.
31:45What happens now?
31:49We're going to monitor you for a few hours, especially given your likely concussion.
31:53And you'll need to give a statement to the police outside in the meantime.
32:02Were you lucky this was just a pope?
32:04Spared the muscle.
32:05See?
32:06It could have been worse.
32:07No shit, Sherman.
32:09The triangular bayonets they created back then were designed to leave wounds that are nearly impossible to stitch.
32:14Those bayonets have never met me.
32:16Oh, wow.
32:17What?
32:18It's all good.
32:19We got it covered.
32:20No, are you guys from the Fort Pitt Museum?
32:23Yeah, you familiar?
32:24Yeah.
32:25I love you guys.
32:27My mom would take me to the fort every time we'd come down and visit family as a kid.
32:30We've been volunteering there as living historians for over 20 years.
32:33I probably saw you then.
32:34Man, I can't wait to tell my parents about this.
32:37Getting stabbed must have been scary.
32:39Yeah, well, point Dexter here stumbled over his boots and nearly impaled me.
32:42Wouldn't it matter if you weren't out of formation?
32:44Well, you're in good hands.
32:46This guy could have saved a lot of lives with his sutures back in 1776.
32:51I was not at it.
32:52I'm going to go around the front.
32:53I will.
32:54Hi again.
32:55Good news, Mrs. Cohen.
32:57Your imaging results show no hip fracture and no internal bleeding.
33:01But you do have a small hairline fracture of the superior pubic ramus.
33:06Well, that doesn't sound good.
33:08Well, if you're going to have a fracture, it's the best one to have.
33:10Do I need to stay in the hospital?
33:12Not necessarily.
33:14Your recovery should be pretty straightforward if we can control your pain.
33:17But you need to take it easy and stay off your feet for six to eight weeks.
33:22How can she go home if she can't walk?
33:23Oh, she can bear weight and walk with some help.
33:26And we'll get you a walker and schedule physical therapy.
33:30So, so we can go home.
33:32Dad, you can't take care of Momo by yourself?
33:36Oh, we'll manage.
33:37You guys, you need to be realistic.
33:40I don't want strangers hanging around in the house.
33:43It's not strangers, it's helpers.
33:45No, no thanks.
33:47No.
33:47Doctors, please.
33:51I am worried about your ability to get the assistance you need, Mrs. Cullen.
33:55It may be time to think about some of those alternative living options we mentioned.
34:01I can take care of her.
34:03Dad.
34:04Are you going to be able to get her into the bathroom, onto the toilet in the middle of the
34:07night?
34:07Are you going to help her change her clothes in the morning?
34:09We're fine.
34:11Dad, please, just try it.
34:15You don't have to sell the house right away.
34:17Just see if you like it.
34:20You could move in with us.
34:21No, I can't.
34:22I have work.
34:23I have the kids.
34:24No, no, no.
34:26No, okay?
34:27Just no.
34:30Carrie, could I speak with you outside for a minute?
34:34Yeah.
34:41It's like that every time.
34:42It's tough to find the balance between respecting your loved one's needs for agency and doing
34:46what's best for their safety.
34:49I was wondering if you had your parents' medication lists with you or on your phone.
34:55Yeah.
34:56I'd like to take a quick look at it, if that's okay.
34:59Yeah.
35:03Now, man, how you doing?
35:05Like you better roll in a bar cart and a happy hour buffet if I'm going to be stuck in
35:09this
35:09place much longer.
35:10This place is a traffic jam.
35:11We're trying to merge you in, I promise.
35:13That's no traffic jam.
35:14That's a 20-car pileup.
35:16The sooner you get out, the sooner I get out, so you know I'm not bullshitting you.
35:21Why are you jonesing so hard to get out and start your ride shooting?
35:25I've got a schedule.
35:26I've got places to go.
35:28I've got people to see.
35:33I just have to get going.
35:37You're worried if you don't leave tonight, you won't leave at all?
35:42I get it.
35:43I can feel it in the air here.
35:45This place is like quicksand.
35:48Brian.
35:50Dr. Robbie, Dante, the fireworks guy, something's wrong.
35:55Okay, shit.
35:57Do not go anywhere.
35:58You are next up.
35:59I'm going to deliver you myself.
36:00I'm starting to feel like a hostage in this place.
36:02How do you think I feel?
36:24All right.
36:25Blood loss from scalp plaque?
36:26That's highly unlikely.
36:27Dr. Santos?
36:28Good rest sounds, but neck veins are up, protecting the heart now.
36:31Okay.
36:31500 CC bolus, 100% non-rebreather, please.
36:34Okay.
36:34Pericardial effusion, RV collapses, tampa.
36:36Yeah.
36:36Let's prep for pericardiocentesis.
36:38What's going on?
36:39Is he going to be okay?
36:40He said he was fine.
36:41CT scan was normal.
36:42Things change.
36:45Dante, there is a collection of blood around your heart.
36:48We need to drain it.
36:49Oh, fuck.
36:50Okay, 0.5 per kilo of ketamine, please.
36:53Will that drop this pressure even more?
36:54We don't have a choice.
36:55We cannot do this on a moving target.
36:58Dante, Jesus fucking Christ, it's my baby brother.
37:00Hey, Perla?
37:01Sir, I'm so sorry, but you can't be in there right now.
37:03What's wrong with him?
37:04Hey, Dante.
37:05Nothing.
37:06Just hand me in the car.
37:07Okay.
37:08So sorry, you can't be in there right now.
37:10We have to stabilize him.
37:11He said he was fine.
37:11Okay, there's been a complication.
37:13I just needed to take a couple of minutes and try to stay calm.
37:16Please.
37:17Just breathe with me in.
37:18Okay, out.
37:19Look at me.
37:20Breathe in.
37:22Out.
37:23Very good.
37:24In.
37:25Out.
37:26Okay, stay calm, okay?
37:27We got this.
37:31I can't believe you've been there.
37:32I was alone.
37:33He's been out of the shock.
37:34From what?
37:34Uh, I am missing a small tear in the right atrium from a sterile fracture.
37:37If it was ventricular, he would have crashed in the field.
37:40I'll go cardiothoracic, see if they have an OR.
37:41So it's down to 64.
37:43Okay, have you ever done an apical approach?
37:45Nope.
37:46Good time like the present.
37:47Collateral to my probe.
37:49Why not subcostal?
37:50Uh, this is a shorter distance.
37:51There are fewer structures.
37:52If you can see fluid, there's nothing between the probe and the pericardium.
37:56Mm-hmm.
37:56There are the needles in the effusion.
37:58Mm-hmm.
37:58Draw back.
38:00Good blood return.
38:02Okay, sometimes it only takes 20 cc's to let that heart fill again.
38:05Carotid pulse much stronger.
38:06Thanks.
38:07Spare it up.
38:08We'll have our room ready in five.
38:10All right, that is 40 cc's out.
38:12Blood pressure's up.
38:1390 systolic.
38:13Okay, now we're going to place the J-wire, and we're going to leave the catheter and the
38:17three-way stopcock.
38:18Still bleeding from the heart.
38:19He can live with a little blood loss, but not with a pressure bag squeezing his heart so
38:23it can't beat.
38:24Good thing we didn't send him home.
38:25Next day, Robbie.
38:27You too, Trinity.
38:28Is that an actual compliment?
38:29Sometimes you guys get lucky.
38:32Got a couple of bad ones.
38:34How old is he?
38:3584.
38:37Meclizine for vertigo.
38:38Anticholinergic effects can cause drowsiness.
38:40It's PRN, so maybe he doesn't take it all the time.
38:42He's also been prescribed methalcarbamol, another anticholinergic.
38:46Could definitely impair driving.
38:48And metoclopramide for his stomach.
38:50Well, that could cause gait problems.
38:53Exactly.
38:55Dr. Robbie, may we present?
38:57Yeah, what do you got?
38:57Hey, you should probably get started crossing your T's and dotting your I's for night shift
39:01handoff.
39:01Right.
39:01Well, vaya con Dios, or whatever the bikers are saying these days.
39:07Our elderly couple, Frida and Ed, we're anxious about their ability to recover at home
39:11or to remain at home in general.
39:13But a number of Mr. Cohen's medications are on the beers list, and they may be contributing
39:18to his deteriorating health.
39:20Maybe.
39:21We can't be certain, but none of them are critical meds.
39:24We could have him stop them right now, follow up with his PCP, see how he's doing in a
39:29few weeks.
39:29Right by the family, sometimes just affirming a patient's independence, autonomy, can do
39:34a world of good.
39:36Um, hey, Dr. Mohan.
39:39I heard a rumor that you were looking for an elective.
39:41Have you considered geriatrics as much of an art as a science?
39:45There's usually an opening, and you seem to have a predisposition to the pace.
39:57Have you seen Dana?
39:58I think she went out for a smoke, lucky girl.
40:19You ever going to tell me what really happened in there?
40:21Nowhere.
40:25You could lose your nursing license.
40:28Let me guess, that Violet Vercet in your pocket, you drew that up for Doug Driscoll,
40:32in case he ever came back, and now you've just been carrying it around ever since.
40:36I did exactly what I needed to.
40:37Now there's a young nurse who gets to go home in one piece because of me.
40:40McKay can sign the Vercet order for me if you will.
40:42I will sign the order.
40:44I will sign an extra order so you can have one when I'm gone.
40:47That's hardly the point.
40:49It's not exactly like I'm against nurse safety.
40:52I'm trying to advocate for your caution, because you're the person who's supposed to be here
40:56keeping this running while I'm gone, not roaming the halls like a vigilante with a loaded syringe
41:00and a vendetta.
41:01It's always do as I say, not as I do with you, isn't it?
41:03What is wrong with you today?
41:05Samira, Mr. Triple A. Mel and Ellis had deposition McKay Street people in the park.
41:09Fucking Langdon.
41:10At some point, you and Langdon got to work this way.
41:12I don't want him here.
41:13He made a mistake and he paid for it.
41:14Did he?
41:14Did he go to jail?
41:15Because I let him get away with the crime.
41:17So what does that make me?
41:18Human!
41:19Are you angry at him or are you angry at you?
41:21Somebody could have died.
41:23Oh, it's CED.
41:23Somebody's always lying.
41:24Go ahead, make jokes.
41:25Make jokes instead of acknowledging...
41:26He didn't kill anybody.
41:27That we know of.
41:28And he saved a lot of lives that we do know of.
41:31Our kids disappoint us sometimes.
41:33Langdon is not a kid.
41:34No, but he's your guy and you're taking him personally.
41:37Langdon fucked up and you think that makes you look bad, but it's on him.
41:42How am I supposed to leave this place when it's a shit show?
41:45First you can't stay, now you can't go.
41:47What is it, Rabinovich?
41:49No, I'm going.
41:50I just thought I could leave it a little better when I did.
41:53Oh, don't be such a martyr.
41:54This place is always teetering on the brink of disaster.
41:56With or without you.
41:57We do it every night, every day off.
41:59This place is bringing to one person.
42:01It'll survive without Adamson.
42:02It'll survive without me.
42:04And it'll survive without you.
42:11My meds are making me worse?
42:12Not worse, but they may be impacting your balance and mobility.
42:16Why would his doctors prescribe drugs that could harm him?
42:20Oh, it's not any one medication.
42:22It's the combination that could be impairing his daily functioning.
42:25We have a case manager that will put together a robust plan that I think will make everyone happy while
42:31allowing you to stay at home.
42:33There's regular physical therapy, an at-home nurse that visits a few times a week, and even personal shoppers to
42:41help with groceries.
42:42This sounds expensive.
42:45Actually, Medicare covers most of it with some assistance from the Area Agency on Aging.
42:49You know, every old person knows what it is to be young, but no young person can know what it
42:56is to be old.
42:58Thank you for listening.
43:01You guys are still coming with me to visit a few assisted living places, just in case it's ever time.
43:06Well, maybe.
43:23Hey, you, uh, you doing all right?
43:27Never better, thanks. Bye.
43:30Bye.
43:36God, you're really just going to keep standing there, aren't you?
43:38Yeah, what's going on?
43:45It was literally my first day of being a doctor.
43:48And Langdon gaslit me and made me question my skills over and over.
43:53And it's taken me a long time to feel like I belong here.
43:56And now he's back.
43:58And I don't even care that he was an addict.
44:00I care that he was a fucking asshole.
44:01And it's like no one here even remembers any of this.
44:05And everyone here talks about community and family, all while they throw you under the bus.
44:10And I...
44:12Robbie is the only attending who actually sees through the bullshit.
44:15But now he's leaving for some grand ego death spirit quest and robo-doc over there shoots me in the
44:20proverbial dick.
44:23Garcia's here. She likes you, right?
44:25She doesn't like me. She likes getting laid.
44:28And her stress-relief squeeze toy, or was.
44:32You know, she and Langdon would make a great couple.
44:35Yeah, that's dark. I'm sorry.
44:40Yeah, why do you care?
44:43Because we're friends, I thought, I think.
44:45Okay, are we? Because on top of all of that, you're the one who's being super shady about moving out
44:49on me.
44:50Moving out?
44:51Yeah, I heard you were going to go squat at Robbie's sad bachelor bed.
44:54Honestly?
44:55I thought that was your idea, to get me to move out of the apartment.
44:58Oh, no, no. I wanted him to give you some fatherly advice about going all farmers only and not giving
45:03you the keys to his fucking house.
45:07Oh, my God.
45:08No, I know. It was none of my business.
45:10No, it's not that. It's...
45:14You actually like living with me, don't you?
45:19What are you talking about?
45:21You leave your dirty clothes everywhere.
45:23You eat all of my avocados as soon as they ripen.
45:26You keep pausing the TV to ask the dumbest questions.
45:28And, you know, I'm going back to the avocado thing, because I've never seen someone consume so many.
45:32It's disgusting.
45:33Just say it, and I won't move out, okay?
45:35I'm not going to be doing much of Robbie's. I'm going to be taking in his mail and re-watering
45:38his plants.
45:40Say what?
45:45Admit that you like having me as your roommate.
45:49You are such a fuckleberry. Have fun with Robbie's plants.
45:56You have no idea how much joy that just brought me.
46:02Hey.
46:03How much longer until I get these things off and go home?
46:08Oh.
46:10You assaulted a nurse.
46:12Yeah.
46:13You said it was the cocoa-ethylite thing that made me go crazy.
46:17Well, if you're drunk and you kill someone, you still kill someone.
46:21So after we clear you in a few hours, you're going to take a ride with the uniformed officer outside
46:25who's going to take you in for processing.
46:27No. No, no, no. This cannot be happening.
46:29No. Since you golf and can buy cocaine, I assume you can post bail after your arraignment.
46:33You're going to ruin my fucking life!
46:34But it being our nation's big, beautiful birthday, that hearing may take longer than usual.
46:38So I'd cancel any grand plans you have for the fourth.
46:45You know, I...
46:47I can leave you with these.
46:50Rehab?
46:51Fuck off!
46:52I'm suing this whole hospital and you for personal injury.
46:55Well, good luck convincing a jury of that one.
46:58Oh, fuck this whole place!
46:59And fuck all of you!
47:02No, not you, officer.
47:04Fuck!
47:04Make sure discharge charts are bundled and placed in the 2B scan bin with nursing notes, order sheets, lab, and
47:10x-ray results.
47:11Day shift needs completed T-sheets on every patient and to write on the board what tests are pending,
47:16so nothing falls through the cracks while we wait to come back online.
47:21Westbridge and Good Dominion have settled their cyber dispute.
47:25They paid the ransom?
47:26Yeah.
47:27Our IT department is confident in our defenses, so they will be rebooting everything soon.
47:32Slowly but surely.
47:33Okay, so when everything comes back on, all the residents have to do is scan all the completed paper charts
47:38and digitize them into the patient's EHRs before they go.
47:41I'm never getting out of this place.
47:45This means you're clear for takeoff.
47:47Nothing here we can't handle with night shift coming in.
47:50Yeah, right.
47:51I'm free to go.
47:53Uh, hey!
47:54I told you I would get you up there, and I promise I'm not leaving until you're back and sent
47:58packing.
47:59Robbie, buddy, you got me to come in, got me to take my test.
48:03You don't gotta babysit me.
48:04That's why I have a nurse.
48:05What's your name, sweetheart?
48:06Nurse Vivi, sir.
48:07That's why I have the lovely nurse Vivi here.
48:09This will not take very long.
48:11Where have I heard that before?
48:15Hey, so, uh, this is it, huh?
48:18Uh, yeah.
48:20Don't let the place burn down.
48:24You know, in a previous life, I had a lot of friends who liked to see how close the edge
48:30was.
48:31As if it was a challenge they were called to meet.
48:35Trouble is, they all inevitably found it.
48:40Okay.
48:44I'm just picking up on a weird vibe from you today, is all.
48:47Yeah.
48:47Well, it's been a weird day.
48:56Are you leaving?
48:57Uh, yeah.
48:58My shift is over and I ain't getting paid to be here.
49:01Quite literally the opposite, in fact.
49:03Well, I-I don't know if you noticed, but we're sort of, uh, in disaster mode here still.
49:08We put in the extra time if we need it.
49:13You know 62% of VD docs report suffering from burnout?
49:17Painfully wary.
49:19So, maybe all you lunatics need to learn how to set some boundaries, like me.
49:26Well, see you tomorrow, Doc.
49:30Good luck in there.
49:31Sorry about the mess.
49:32Mess?
49:38Yep.
49:40Head trauma.
49:41Unwitness fall from the warehouse catwalk where he works as a security guard.
49:46Oh, my God.
49:48Orlando.
49:49He left five hours ago.
50:20He left five hours ago.
50:21I-I'm not.
50:23They're many.
50:30All right.
50:32I-I'm not.
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