- 9 hours ago
The P.i.t.😠- Season 2 Episode 13 - Eng Sub
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00:14You
00:15Know this guy Orlando Diaz we're treating him for DKA when he looked how far he saw 20 feet or
00:20so
00:20Anyone see him pass out no they went looking for him after he didn't answer his radio people's equal with
00:25fluggish
00:25He left against medical advice on my count three two one
00:31Dr. Ellis on the case patient we got this. I'm saying continuity of care
00:35Dr. Alice shoot me once you go cover Sunday rounds with dr. Abbott Chen you two got it. Okay. Let
00:39me know if you need anything
00:41Lungs are up bilaterally pelvis is stable right to fib hematoma deform right forearm
00:48Rrupt your GM on the left star sanguinous fluid means baseless bowel fracture. We've got a diabetic patient 20 foot
00:53fall
00:53BP 204 over 98 pulse 56 dr. Mohan. What are those numbers indicate? I'm trying to treat the patient
00:59The Cushing's reflex from increase intracranial pressure
01:02Yeah, we need to get him to see T right away
01:04No free fluid in the belly any family to notify wife and three kids
01:10Is there a card to sign for Robbie he said no card no presents was there a cake?
01:15Oh, you didn't want that either
01:17That sucks need some cake patient was injured when they raided a restaurant and they actually arrested a nurse
01:23The take down and zip ties
01:24Hey
01:26Cruz you, uh, know the computer downtime drill?
01:28Yeah, no biggie
01:29I prefer to treat him without labs and x-rays
01:31Welcome back
01:32If you do have orders for labs and x-rays, clipboards, go here
01:36If it's just nursing orders, here
01:39Please write neatly for God's sake
01:41Oh, Monica, this is Nasley, new intern
01:43I don't need to know that
01:44So nice to meet you
01:47Looks like you and me, Jack
01:49Yeah, who's our senior?
01:51Dr. Henderson
01:51Yeah, well, yeah
01:53Excellent
01:53Night shift's on cruise control
01:55You hear ICE brought us a patient?
01:58Oh, yeah? Where'd that go?
02:00There was some collateral damage, they arrested Jesse
02:01For what?
02:03Assaulting federal officer
02:04Are you fucking kidding me?
02:06Dr. Alshimi, this is Nasley Tumerian, new intern
02:16Okay, everybody, let's huddle up
02:18Before we start, let me address the elephant in the room
02:21For those of you who don't know
02:23Jesse tried to intervene when a federal agent was handling this patient
02:26And both he and the patient were taken away by ICE
02:28Did he punch the guy?
02:30No, he put out a hand to stop him, made physical contact
02:32And he was a little bit more than that
02:34The hospital lawyers are on the case
02:36And we will brief the staff every 12 hours at sign-out rounds with an official update
02:40In the meantime, don't feed the rumor mill
02:42You may have also heard that new grad nurse Emma here was assaulted by a patient
02:46I-I'm fine
02:47Please don't forget code hula hoop
02:49And with risky patients, always keep a path to the door clear
02:52Sounds like one hell of a day
02:54And we're still dealing with downtime
02:56So day shift should brief night residents about the protocol
02:59Hey!
03:00All right!
03:02Oh, thank God
03:04Yeah, not so fast
03:05Every chart from the last five hours needs to be scanned into the electronic health record
03:10And checked for accuracy
03:11I mean, whose job is that?
03:13Day shift
03:14With a completed and signed T-sheet
03:16Are you kidding me?
03:17That's gonna take forever
03:18We will set up stations for scanning
03:19Okay, everybody, let's get moving
03:21Triage is 20 behind
03:22I gotta help them clean up
03:23I'm skipping around
03:24Set yourself lucky
03:26Should we join them?
03:29Might as well witness the magic
03:31It's like changing the guard at Buckingham Palace
03:33Except we're allowed to smile
03:34Smile though your heart is aching
03:38Clean films, right tip-fib and right forearm after CT
03:41Got the chem-8?
03:42Blue sugar's 284?
03:43That's not too bad
03:45Potassium looks good
03:46Any end gaps up at 14?
03:48It was 24 this morning, he's definitely improving
03:51The decay is resolving
03:52So what made him pass out?
03:54It's hot as hell out there
03:56He could have been dehydrated from sweating
03:58Or he could have had an NSTEMI or a posterior CVA
04:02Ready to roll?
04:05I could babysit him at CT
04:07Thank you, and I'll stay in case he needs the OR
04:11Hey, we're back up
04:13Out of time
04:16Ooh, Robbie
04:17Yep
04:17I got intel and we're ice taking Jesse
04:19Intel from who?
04:20Uh, my brother-in-law's a cop
04:22So, he'll be processed at DHS Southside
04:25And then transferred to ice detention in Clearfield
04:27Clearfield? That's two hours away
04:28Mm-hmm
04:30Okay, I'll let the hospital attorney know
04:32How are you doing, Oliver?
04:33Alive and kicking
04:34Uh, Mr. Haas, pulmonary edema after misdialysis
04:37Now stable with the sun mason at the bedside
04:40Hello
04:41I'm Dr. Shen, I'll be back
04:43Dialysis tech says I'm off the machine at 1042
04:45Got the call light and I'll come running
04:48South 21 next
04:52Mr. Digby
04:54Just Digby
04:55Dr. Mohan's patient, forearm cellulitis
04:58Admit med-surg awaiting a bed
05:00I can take him
05:01Sold
05:01Dr. Tamarian
05:02Moving right along
05:05Good enough to eat
05:07We'll be back
05:10Lillian Stegman
05:11Tweets your new water skiing
05:12You can go 360 off a five-foot ramp
05:15Oof, respect
05:16X-rays ordered in triage
05:17That was hours ago
05:19Ma'am, I'm Dr. Cruz Henderson
05:21Let's get you home real fast
05:23That would be wonderful
05:24Okay, heading to north
05:25Thank you
05:26Looks like our first scanning station is almost ready
05:29Whitaker Santos
05:30After rounds, this will be your post
05:32Seriously?
05:33For how long?
05:35Till we mop up this mess
05:36And away we go
05:39Alright
05:40Now you know everything there is to know about rounds
05:42Fascinating, right?
05:43Ah
05:45Yeah
05:45Here
05:46About something better for you
05:49So Digby
05:50We're gonna find you some new clothes
05:52But my friend Emma and I
05:53Wondered if you'd like to get cleaned up a bit first
05:56I already had a shower
05:58I know
05:59And you look good
06:00But the offer also comes with the shave and the haircut
06:02If you're interested
06:03No pressure
06:04Like I said
06:04You already look great
06:07Sure
06:08I guess
06:09Fantastic
06:10Alright kid
06:11Fill that basin with some warm water
06:12And lather him up
06:17Hey, stay safe out there
06:18Back at you in here
06:19Hey Carrie
06:21You were on scene with Orlando, right?
06:23Did you notice anything about his fall?
06:26Like what?
06:27Like, um
06:28There was a break in the railing
06:30Or
06:31There were security cameras
06:33Too busy working on the guy
06:35IV, intubation, backboard, splint
06:37Thanks
06:39Oh, two names is a start
06:40Pretty soon we'll retire the clipboards
06:42Baby Jane Doe and Peds?
06:44Uh, yeah
06:44Abandoned in the waiting room bathroom at 7.30 a.m.
06:48Safe haven drop off?
06:49No, she's too old for that
06:50At least two months
06:51I'll take her
06:52Awaiting foster placement by CYF
06:54What if the mom comes back?
06:56Call the cops
06:56Day shift
06:57Get to work scanning
06:58Night shift
06:59The room numbers on top of the dry erase board
07:01Need a doctor
07:02Who's in BH1?
07:03Psych hold
07:04Danger to self
07:05What's the story?
07:06Doctors King and Langdon were on the case
07:08It's a sad story
07:09She says her five year old
07:11Snuck in the backseat of the car to take a nap
07:13Heat stroke
07:14Mom was extremely distraught
07:15Walked out into traffic
07:16Brady Barnhill wheezing and not responding to Albuterol
07:19Full Sox 87 is Mona Naomi
07:21Okay, trauma 2 is open
07:22On our way
07:23Mom, history of asthma?
07:25His whole life
07:26Never this fast
07:27Barely moving air
07:28Using all his accessory muscles
07:31Call our team
07:32Uh, continuous nebs
07:3420 milligrams an hour
07:35Yeah, the whole nephew
07:36I've been giving him Albuterol every hour
07:39Ready?
07:40On my count
07:41One, two, three
07:43Does he take any other medications?
07:45Just the Albuterol
07:46He used to be on Montalukaz
07:47And Simicor
07:48Why did you stop that?
07:50Cause he lost his Medicaid
07:51Two months ago
07:52It's so tight
07:52Nothing's getting through
07:53Mel, EpiPen
07:54On it
07:550.3 milligrams
07:56That may open his lungs
07:57So the nebs can work
08:00All right, Grady
08:00Shot in the thigh
08:07Hi
08:08Something to scan?
08:10Critical labs on North 3
08:11Oh, it's uh
08:12It's not my patients
08:13She's about to be
08:16I'm uh, I'm off the clock
08:18So
08:19These were ordered three hours ago
08:21From triage
08:21So technically she is a day shift patient
08:24Just get the interns started
08:25I got a meeting upstairs with admin
08:27To get things back on track
08:29Sorry, everyone else is tied up
08:30Oh, that's okay
08:32How'd you get stuck on night shifts
08:33For your first rotation?
08:34Just lucky, I guess
08:35Yeah, I feel like a good horror movie
08:38Where was med school?
08:39Uh, UC Irvine
08:40California, right?
08:42Yep, Pittsburgh's a little different
08:43Yeah, a lot more humidity
08:44Yeah, that'll go away
08:45With your first foot of snow
08:48Uh, hi, Mrs. Davis
08:50I am Dr. McKay
08:52This is Dr. Tumerian
08:53Hello
08:55Uh, your labs show a lot of inflammation in your liver
08:57So I am so nauseated
09:00Definitely, yeah
09:01Have you, um, noticed a change in your skin coloration?
09:04I've been using this bronzing cream
09:06So I don't look like a ghost in my bathing suit
09:08Do you remember the name of the bronzer?
09:11It could have a chemical that can cause it
09:13Oh, no, no, it's 100% natural
09:14It's DHA from sugar beets
09:18Why would my liver be inflamed?
09:20Uh, there's a lot of possibilities
09:21Are you taking any prescription medications?
09:24Not a single one
09:25Tylenol?
09:26God, no
09:26We have to ask everybody about injection drug use
09:29Never
09:29Rock clams or oysters?
09:31I'm a vegan
09:33One step at a time
09:35We'll be back
09:38Digby Haas, now on the big board
09:40Progress
09:41So, he's just been waiting in the hall the whole time?
09:43Okay, well, can you maybe get to him next?
09:48Thank you
09:50Dude goes to CT and they bump him
09:51Yeah, he may end up waiting for hours over there
09:54Oh, look at that, 7.15 already
09:57Just a few more loose ends to tie up
09:58We got more loose ends than a macramé wall hanging
10:02My mom had one, took up the whole goddamn wall
10:04Seriously, you should think about signing that and hitting the road
10:06Yeah, maybe you should too
10:07Oh, that's right, you sent Lena home
10:09Are you planning on calling in a replacement or are you just going to work till sunrise?
10:13I have to
10:14Oh, so you get to go the extra mile and the rest of us just get accused of being martyrs
10:19Robbie?
10:20Excuse me
10:22What's the word?
10:23No subdural, no epidural
10:24He's brain swelling with effacement and compression of the ventricles
10:28C-spine, chest, abdomen, pelvis
10:30Left pulmonary contusional intradominal hemorrhage
10:33Which means I'm off the hook, I'll send neurosurgery down
10:35If he doesn't need the OR, why neurosurgery?
10:38Wait and see
10:38Let's get busy, CVPed at Heartline
10:40Orlando
10:42Orlando, squeeze my hand
10:45Open your eyes
10:45We already know his GCS is going to be free
10:48Hey, Javadi, anti-seizure prophylaxis
10:50Cap brush and he makes her kilo
10:51Mixing it now
10:52Better get this brain swelling down, Samira
10:54How are we going to do that?
10:56Samira
10:57What?
10:58Do we have to lower the intracranial pressure?
11:01Manitol
11:02Not the best can cause diuresis and hypotension
11:04And hypertonic saline
11:0623%, 50 cc's through a central line
11:10Tight as a drum
11:11Good five minutes to see Epi
11:12We can have one more EpiPen
11:14That's our borderline, 87
11:16How about BiPap, 10 over five?
11:18Yes, with inline nebs
11:19Alright, Grady, shot number two
11:21Might as well throw him some magnesium, 50 per kilo
11:24I'm sorry, he's not ventilating, we should be ready to insubate
11:26With an asthma patient?
11:27There's a high risk of cardiac arrest
11:30Naomi, has he ever been put on a breathing machine before?
11:32Never
11:33Hospitalized?
11:33No, we could always break him with a simbacort
11:35We're going to give the current treatment a few more minutes to help him turn
11:42I could probably do this myself now that my cast is off
11:45That's okay
11:47I don't mind
11:53How long have you been a nurse?
11:56This is my first day
12:00You're doing really good
12:04Thank you
12:08Shit, you okay?
12:11Yeah, there's water in the floor
12:13Sorry, I might have spilled
12:15Yeah, no worries
12:16We're going to have to sort these all by patient before we scan them
12:20Is Joy still around?
12:23I heard she left at 6.59
12:25Smart girl
12:27You know what, find Ogilvy, he's just an ass kisser
12:30He might stay and stay on out and try some cell phone
12:31He, uh, scrubbed in in the OR
12:33Scrubbed in on the ruptured AAA
12:35Or the kidney stone that wasn't
12:37It'll be four hours at least
12:41So, are you still going to Amy's after work?
12:44Yeah, maybe just for tonight
12:46After Robbie briefs me on all the house stuff
12:49Sounds fun
12:52When he asked, it was hard to say no
12:54Sure
12:58It's going to be very weird without him here
13:00Yeah
13:01You think Dr. Al Hashimi can handle it?
13:04A word, no
13:05She's smart
13:07Yeah, it takes more than that
13:09Well, at least it's only three months
13:11Yeah, three long months
13:13Then you need to find a new home
13:16Not necessarily
13:17I mean, if I wanted, I could just check on Robbie's house once or twice a day
13:21Yeah
13:23Why would you do that?
13:25I don't know
13:26Why not?
13:32Hypertonics in
13:32Maintenance, OR in the AC
13:35It's like a halo sign
13:36Cerebral spinal fluid from a basilar skull fracture
13:39The halo sign is neither sensitive nor specific for CSF
13:43Saline, tap water, and runny noses all separate from blood
13:46Hello, Linda
13:47Robbie
13:48Vision chief working on a holiday weekend
13:50Somebody's got to
13:52Saw the scans, this guy needs an EBD
13:55External ventricular drain to take down the pressure
13:58CPP equals MAP minus ICP
14:01Cerebral perfusion pressure in the brain equals mean arterial blood pressure minus the pressure in the skull
14:07ICP less than 22 predicts survival and favorable outcome
14:11CPP from 60 to 70 reduces morbidity and mortality
14:15Can somebody assist?
14:17Dr. Mohan
14:18I'm good
14:20Mr. Mary should lend a hand
14:22I said I'm good
14:24Javadi
14:24I don't think so
14:27Javadi?
14:28As in daughter of Raymond and Eileen?
14:31I was at your mother's baby shower
14:34She was a resident, you were in utero
14:38And how she got through motherhood and training
14:40Feel free to join me
14:42Oh my shift, my shift was over a while ago
14:45Okay, masks all around, two sterile gowns
14:48We brought the surgical towels, just need some beta dye
14:50This is kind of an amazing opportunity
14:53I'm exhausted
14:54Chief of neurosurgery
14:56The chief of neurosurgery is here
14:56She's kind of a legend
14:58Maybe one of the night residents can do it?
14:59Is this about the Mobulus case from earlier?
15:02Because if it is, you made a mistake, you need to move on
15:05I do not want to come back here and find that you've applied for a residency in Durham
15:11Step up to the plate
15:12Do it
15:13Javadi will assist
15:15Excellent
15:16You know, I think Eileen did her first EVD with me back when I was a brand new assistant professor
15:22Time flies
15:26How you doing, Grady?
15:27Still retracting
15:28Any improvement?
15:30Not really
15:30You feeling tired?
15:33Do we have aerogen in the ED? Just in the unit
15:36How fast can you get back?
15:38Two minutes if I take the stairs
15:39Go
15:40Uh, aerogen?
15:41It has a 5mm mesh that vibrates over 120,000 times per second
15:51Dr. Ahashimi
15:57You okay?
16:01Are you telling us about aerogen?
16:04Dr. Shen can explain
16:07It produces droplets in the 2 to 5 micron range
16:11I'm just getting ready
16:19How's it going?
16:20Just about to start
16:22Secure an art line here
16:23Measure twice
16:23Cut once
16:25We enter 11 centimeters back from the nasion
16:293 centimeters lateral
16:30Without any direct imagery?
16:32No
16:32Straight shot into the lateral ventricle
16:35Tried and true since 1890.
16:39Okay. Go ahead with the incision.
16:42Hey, you worked with Dr. Ellis. You met the VA.
16:45I did.
16:46For how?
16:47During my R2 rotation and then one again last year.
16:55Okay. Handrail's all set.
16:58Maybe you should do this part.
16:59No, no. There's a safety stop here. You can't go too deep.
17:02It's not brain surgery.
17:06Okay.
17:07Okay.
17:11Stay perpendicular.
17:12Okay.
17:13Good.
17:15All right. Now, four turns to get through the outer table.
17:18Yep.
17:18And half turns till you penetrate the skull.
17:31Three.
17:33Three.
17:34Four.
17:35One.
17:37Three.
17:39Three.
17:47Four.
17:53I don't like having my hair cut.
17:55I get it, Rapunzel.
17:56But you need your ears lowered.
17:58You'll feel better with a fresh summer look
18:00that won't go and notice by the ladies.
18:04Maybe just a trim?
18:06Great. I'm thinking of pixie cut.
18:09What?
18:10I'm kidding.
18:11A couple of husband Benji's here all the time.
18:13Trust me, you're gonna look fabulous.
18:14When's the last time you had a haircut?
18:17Maybe my daughter's wedding?
18:19A few years ago?
18:20Where?
18:21Saint Sebastian, My Lady of Mount Carmel Parish.
18:25Does your daughter know where you are?
18:27Of course.
18:28Well, I live in Pittsburgh.
18:31In fact, they live in my old house.
18:35Your daughter lives in your house?
18:38Yep.
18:40Where do you live?
18:42Wherever I want.
18:46You're gonna pass it five to six centimeters
18:48from the inner table of the skull.
18:50Okay.
18:53Centered.
18:55Perpendicular.
18:57Aiming for the medial canthus.
19:00All yours.
19:01And just keep going?
19:03You'll feel a pop when you pass through the appendable lining.
19:07All right.
19:07Line is calibrated.
19:08Good to go?
19:09I'll try the nicardine pain to a map of 85, please.
19:13And if we can get the intracranial pressure down to 20.
19:17Dr. Mohan.
19:19I'm sorry.
19:20Map of 85, ICP of 20.
19:23Um, cerebral perfusion pressure 65.
19:25Which gives him the best shot at survival.
19:28A third of patients like this die half have long-term disability.
19:32We'll know in two weeks if there's a possibility for a good prognosis.
19:37Fell to pop.
19:38Remove this dilette.
19:42Okay.
19:43Let it drain a bit.
19:46And now pinch it shut.
19:50Perfect.
19:51BP is down.
19:52190 over 88.
19:53Heart rate 67.
19:58How are you guys doing?
20:01Yeah.
20:01Making some progress.
20:03You seen Abbott?
20:04Not since rounds.
20:06He asked me to see a patient with the night intern.
20:08You said yeah.
20:1048-year-old woman.
20:12New onset jaundice.
20:13Elevated liver enzymes.
20:14No history of alcohol use.
20:16Take your pick.
20:17Hepatitis A, B, C, D, or E.
20:20No risk factors.
20:21No fever.
20:22Tylenol?
20:23Never.
20:24No prescription meds.
20:25Does she eat polar bear liver?
20:28It can cause vitamin A toxicity.
20:31No.
20:32She, uh, doesn't eat meat.
20:34Kind of a health nut.
20:35Well, maybe she's gulping down cod liver oil to prevent measles.
20:39Vegan, no fish.
20:41Would you, uh, mind laying eyes on her?
20:43Seriously.
20:44You have a way of figuring out the weird stuff.
20:46Take the compliment.
20:49Okay, fine.
20:51Five minutes at the bedside.
20:52That's it.
20:53Already gonna be here for hours as it is.
20:57What am I doing?
21:02Definitely improving.
21:04Title volume's up.
21:05Wheeze is now expiratory only.
21:07Oh, making some progress.
21:09You feeling better, baby?
21:11You scared the shit out of me.
21:12Language.
21:14Does he have a primary care doctor?
21:17Not anymore.
21:18How do you get his prescriptions we need?
21:20Neighborhood clinic.
21:22We pay cash.
21:23Not buterol's cheap.
21:24Simple court.
21:25Without Medicaid.
21:26400 bucks.
21:27A month.
21:27Just for a little inhaler?
21:31Choke ours on the tube.
21:33I tunnel underneath the scalp, about five centimeters, and poke through.
21:38To prevent the infection?
21:39Mm-hmm.
21:40Exactly.
21:42Now you hold the knuckle steady while I pull it through.
21:47And you can staple the wound shut.
21:51That looks like something from Home Depot.
21:53Yeah.
21:54Big Fourth of July sale.
21:55The brain pressure is measured by the height of the flula column.
21:58We need to calibrate it to zero at the level of the tragus.
22:01Stop coxon.
22:02Ready to attach.
22:03First trip on end's normal, but you need a second to rule out, am I?
22:07Hey, could you step out for a sec?
22:15I really did do everything I could to try to make Orlando stay.
22:18Yeah, I don't doubt it.
22:19I wanted to ask you about Dr. Elashimi, the VA.
22:22Did you ever notice anything unusual about her behavior?
22:25Um, like what?
22:27Lapses in focus, tension.
22:29No, she was always on top of her game.
22:35But this morning when she was checking labs on baby Jane Doe, it was like she zoned out for a
22:40few seconds.
22:42Maybe she was just tired.
22:52No congestion, nodules, or cirrhosis.
22:55Good looking liver.
22:56I should not be sick.
22:58I worked so hard to stay healthy.
23:01Diet, exercise, eight hours of sleep.
23:04I can't remember the last time I got eight hours.
23:08Maybe you should try sleep maxing.
23:10Oh, you definitely should.
23:12Yeah, cold room, white noise, eye shades.
23:15Kiwis before bedtime, lettuce, water, mouth taping.
23:18Who do you follow for health?
23:20A few naturopaths and some functional healers.
23:23Do you buy vitamins from them?
23:24Oh no, no.
23:25I don't take vitamins.
23:26Food is the best medicine.
23:28Kale, blueberries, kidney beans, turmeric.
23:31Turmeric?
23:32How long have you been taking that?
23:33For a few months.
23:34It's an anti-inflammatory.
23:36It detoxes the body and it can prevent Alzheimer's.
23:39How much do you take?
23:40500 milligram capsules.
23:42But I take five a day.
23:45What?
23:47With doses that large of turmeric, there have been cases of liver failure.
23:51From eating a spice?
23:53All right, Digby.
23:55Good to go.
23:56Mm-hmm.
23:56Would you like to see?
24:10I haven't looked like this in a long time.
24:12Your family won't recognize you.
24:17How?
24:17How will they find me?
24:19They won't know what I look like.
24:21They won't know this is me.
24:22Of course they will.
24:23They know your voice.
24:24They know where you hang out.
24:26They even remember that you used to look like this.
24:30They remember the wedding.
24:31Jane.
24:35Did you dance with your daughter at her wedding?
24:40I did.
24:42And she will always remember you.
24:51Hey, I was just looking for you.
24:53What's up?
24:54You tell me.
24:54The asthma patient.
24:56What about him?
24:57Seemed like you were hesitating, talking about using aerogen.
24:59I was wondering if you were having second thoughts.
25:01No.
25:02Just thinking.
25:03About?
25:04The best treatment plan for the patient.
25:06And I think he's on it.
25:09Anything else?
25:09I don't know.
25:10You tell me.
25:11Anything else I need to know?
25:13I don't think so.
25:15This is Dr. Robbie in the ED.
25:17I'm checking out of patient Eakins.
25:19We can take Larson and Stevens off the dryer race.
25:21Consider it done.
25:22He's in the scanner now?
25:24Oh.
25:25Great.
25:25No, I was just calling to confirm.
25:27Any new information from upstairs?
25:29Nothing we don't already know.
25:31Same old story, huh?
25:32You think we should take up a collection for Jesse?
25:34For bail money?
25:36They don't usually send bail until after you've appeared in front of a judge.
25:39With the holiday, it's not likely to happen until Monday.
25:41So he's going to be locked up all weekend?
25:43That sucks.
25:44It does suck.
25:47Dr. Langdon?
25:48Grady's worse.
25:49Much worse.
25:50Nina tending?
25:51No, we have Shun.
25:53Shots down 83.
25:54What's happening?
25:54Give us a minute.
25:56He's tiring out.
25:57Ketamine and rock.
25:59It's time to intubate.
26:00A couple.
26:01Ma'am, we have to put a tube down your son's windpipe so a machine can breathe for him.
26:05Oh, my God.
26:06Hold on.
26:07Hold on.
26:08No lungs sliding on the right.
26:10Pneumothorax.
26:11No need to intubate.
26:13What's going on?
26:14He has a collapsed lung.
26:16There was no history of trauma that would have caused the pneumothorax.
26:20What about Dr. King?
26:22In asthma, you can get air trapping.
26:24But when the lungs can't fully exhale, eventually they overinflate, causing some of the tiny air sacs to burst.
26:29How do you fix it?
26:36Like that.
26:43It's a good thing Dr. Connolly was here.
26:45Yeah.
26:46We should probably try to find him in a neurocritical ICU bed.
26:48We don't want to board a patient like this.
26:50Mm-hmm.
26:50Hey, Robbie.
26:51Hey, how did the scan go?
26:53Fine.
26:54It is probably going to take a little while to get the results from the radiologist.
26:57Well, that's not a problem.
26:58Nurse Devi and I need a little time to coordinate our schedules over the next few months.
27:03Really?
27:04Yeah, I've always wanted to learn how to ride a motorcycle and Duke offered to teach me.
27:08Well, nobody knows motorcycles like Duke.
27:10He's given me the healthcare worker discount.
27:12He's quite the gentleman.
27:14Let's get him back to his room.
27:16How would next Saturday be for you, Bibi?
27:18Uh, maybe we could have some dinner after.
27:22Dr. Mohan, Lori Diaz is here. She wants to see her husband.
27:24She's heading back.
27:25Okay, I'm on my way.
27:29Mrs. Diaz?
27:30Hi.
27:31They don't allow him to go up to his room yet?
27:34No.
27:35I brought him some dinner from Burgatory.
27:37It's a chicken burger.
27:39No bun.
27:39Just lettuce.
27:40Figured it would be better than hospital food.
27:46He's being treated by our top brain injury specialist.
27:50Will he wake up?
27:52We won't know for several weeks.
27:54And then he could be back to normal.
27:56Best case scenario, it would take about a year before he could be independent at home.
28:02And the worst case?
28:04Round the clock nursing care for severe disability.
28:07Could you let him leave?
28:13He insisted on leaving to work at his second job.
28:17You didn't make a mistake.
28:19He was competent.
28:20He knew the risks.
28:22We honored his decision to leave.
28:24Even if he was a stupid bun.
28:26I tried to stop him.
28:28Offered to get him all the supplies he'd need to take care of himself at home.
28:31But he left before I could give them to him.
28:33He said he couldn't afford to lose a paycheck.
28:43Dr. Langdon?
28:48Are you okay?
28:49Yeah.
28:50I'm just kind of, uh, wondering if I'm really ready to be back here.
28:55Well, of course you are.
28:57Ten months is a long time.
29:00I almost killed that kid with an intubation.
29:03Didn't even occur to me to check for pneumothorax.
29:06Well, there isn't any trauma to indicate-
29:08I should have caught it.
29:08Okay.
29:15You know, I, um, I had a deposition today.
29:22And all the lawyers' questions made me feel like I was a really, really bad doctor.
29:30We don't always get everything right the first time.
29:34You would have caught the collapsed lung.
29:37And it may have taken a minute, but you would have saved him.
29:41I'm not sure Robbie would agree with you.
29:43He's been rioting me all day.
29:46Well, Robbie's leaving for three months.
29:48And, you know, with Robbie gone, I really don't want you to leave either.
29:56That which does not kill me makes me stronger.
29:59Wow.
30:00Frederick needs you.
30:02Yeah?
30:03Needy, yeah.
30:05Not Kelly Clarkson.
30:10Hey, that's a thick one.
30:12Austin Green, Ogilvy's Triple A.
30:18Uh, G-R-E-E-N?
30:20Yeah? Why? What are you doing?
30:22Checking to see when we'll get Ogilvy back from the OR.
30:25Oh, shit.
30:26What?
30:27The guy didn't make it.
30:29He died on the table about 40 minutes ago.
30:31Then where's Ogilvy?
30:34Oh, man.
30:35His patient had a CT a year and a half ago that showed a four centimeter triple A.
30:40It's too small for surgery.
30:42You were supposed to come back every six months for a repeat ultrasound, but looks like you didn't.
30:47You would have seen that if the computers were working.
30:49Why wouldn't you tell Ogilvy?
30:51Maybe forgot all about it. Or Ogilvy didn't ask the right questions.
30:56Dennis. Hey. Got a minute?
30:58Uh, sure. What do you need?
31:01Teenager with jewelry magnets stuck to both sides of her nasal septum.
31:04I tried to move them with the plastic cure, too much pain, and then there was bleeding.
31:08Those need to come off before they cause permanent damage.
31:10Yeah, you think, uh, you could find, like, a senior or an attending?
31:14We're really trying to get off the clock here.
31:16They're all busy.
31:19I already took one for the team.
31:22Fine.
31:23Yeah, labs on your yellow lady.
31:27INR is elevated 2.2.
31:29Liver's in trouble, but not dead yet.
31:31Tell her to skip the turmeric, admit for monitoring, and follow the LFTs.
31:35Got it.
31:36Central 10?
31:37Yeah.
31:42It's late Maxine, really?
31:44I'm gonna track the online trends.
31:46Is that your secret for the tough ones?
31:49I just think, what's the stupidest thing this person could have done?
31:52I'd assume they did it.
31:55Well, I mean, if she was trying to be healthy.
31:57Yeah, but I'm taking advice from fools.
31:59Tumor is recommended by a lot of doctors.
32:02Yeah, then ask your doctor for the dose.
32:03Or check someplace reputable like the CDC.
32:06Oh, right, I forgot. It's now a medical toxic waste site.
32:09I mean, she's in pretty bad shape.
32:12If things get worse, she could need a liver transplant.
32:15Well, because she's a big fucking idiot.
32:18Wow.
32:20No, I actually appreciate her.
32:23Our job security depends on all these big fucking idiots.
32:27Okay.
32:32Good night, Perla, Monica.
32:35Good night, Dr. Robbie.
32:37Good night.
32:37Bye, Emma.
32:39You can stay to pitch in.
32:41Dana told me to go and get some rest before tomorrow's shift.
32:44Yeah, you had quite a day.
32:45It wasn't so bad.
32:49Why can't I find Duke's results?
32:51Oh, new patient, no EHR yet.
32:53Well, I can run over to radiology, get a printout.
32:56Thank you, Monica.
33:00Ready to pick up a few more.
33:02Lando's all tucked in for now.
33:04How's he doing?
33:04Numbers are good. CPP 22.
33:07Okay, so he's got a shot at a decent outcome at least.
33:10You think he has a chance?
33:11What?
33:12Oh, I don't know that survival was the outcome he was hoping for.
33:15What?
33:17He told Samir he's got $100,000 of medical debt.
33:19That his life is probably...
33:20Mrs. Diaz!
33:24How can we help you?
33:25In the bathroom?
33:27Uh, yeah, Perla can show you the way.
33:31What a great idea to have a private conversation about a patient in a public area.
33:36You were about to start yapping...
33:38But I didn't!
33:44Okay...
33:45How long have they been in there?
33:47At least two hours.
33:49How did it happen?
33:50With my earring.
33:51It was supposed to be, uh, red, white and blue to look cool with the fireworks.
33:56I told her for the nose one side only, but she never listens.
33:59This can be pretty serious.
34:00If we don't get them out quickly, it can cut off the blood supply and cause the septum to collapse.
34:06Like...
34:06My nose could be deformed.
34:10Oh my god.
34:11Get them off.
34:12Yeah, that's the plan.
34:13Yeah, she tried already.
34:14It hurt like crazy.
34:15Because they're stuck together by a very strong magnetic force.
34:18Yeah.
34:19No, no, no.
34:20Oh, uh, I'm not gonna use the tips.
34:22I'm gonna flip it around and use the handle.
34:25It's still gonna hurt.
34:26Probably not.
34:28Just, uh, hold still.
34:32Okay.
34:37Voila.
34:38Really?
34:39That was amazing.
34:40Okay.
34:41I think another half-hour we can send this dry race.
34:44We're back to storage.
34:45With pleasure.
34:46Dr. Rabinovich?
34:47Yep.
34:47Results on your friend.
34:53Fuck.
34:54Duke?
35:00Are you gonna tell him?
35:02I want to talk to a surgeon, please.
35:03Dr. Rabinovich?
35:04I have an update on the patient.
35:05But that was not a great time.
35:06Oh.
35:07I thought you were going home.
35:08Uh, I was.
35:09Dr. Ogilvy is just sitting out in the ambulance bay, covered in blood.
35:13Sorry, what's he doing out there?
35:14Kind of, uh, staring off into space.
35:16I tried to talk to him, but it was like he couldn't hear me.
35:18Monica, can you step page coding with the rest of...
35:20Yeah, I'll go check on Ogilvy.
35:22Please.
35:24Oh.
35:37Hey, Ogilvy.
35:42Ogilvy.
35:44You okay, man?
35:5299 on two liters.
35:53Scattered and expiratory wheezes.
35:56He is so much better.
35:58The steroids should kick in soon.
36:00So he'll keep improving.
36:02Um, when can I go home?
36:05In a day or two.
36:06And we will, uh, discharge you with a Symbicort inhaler.
36:09That should last about a month.
36:12Hopefully, we'll be back on Medicaid by then.
36:14How'd you lose it?
36:16They sent a redetermination letter to our old apartment.
36:20It didn't get forwarded.
36:22When I went to pick up his prescription,
36:24the pharmacist told me we were no longer covered.
36:28And you haven't been able to get it back since?
36:30I've been trying for months.
36:33To get re-enrolled, you need tax returns, pay stubs.
36:37I cut hair.
36:38My income fluctuates.
36:40A lot of my regulars are struggling,
36:42so it's been tough.
36:45Well, if you run out of Symbicort before your Medicaid kicks in,
36:49you can come back and we'll set you up with another one.
36:53Is there a patient in here?
36:54Because everyone in this room looks extremely healthy to me.
36:58Dr. Shin and I will be with Grady all night long.
37:00Day shift. We got this.
37:02We're leaving you in good hands.
37:05Um...
37:05I was really scared.
37:11You're very welcome.
37:17Due to his injury, things have changed.
37:21I was looking for Dr. Abbott.
37:23I haven't seen him for a while.
37:26Excuse me.
37:30So now, with a long-term disability, things may be easier.
37:35Easier.
37:36His condition will qualify him for Medicare and Medicaid,
37:39so moving forward, costs should be covered, including home healthcare.
37:44Okay.
37:45Perhaps this isn't the best time to...
37:46I just wanted to reassure you about future costs.
37:58Robbie?
38:00Noelle?
38:02You're still here.
38:03It's not the best day to try to get out on time.
38:06Hmm.
38:07So I guess this is it for a while.
38:09Unless you want to come with me.
38:10No.
38:11But thank you.
38:12Even if it isn't a legitimate offer.
38:15What do you mean?
38:15Oh, please.
38:16I know well enough not to get in between a man and his wife.
38:19Vision Quest.
38:21Vision Quest.
38:22That is my nice way of putting it.
38:27I probably don't want to hear your not-so-nice way of putting it.
38:30No, probably not.
38:33I-I hope that this is not, um, about you running away from me.
38:39I'm a big girl.
38:39You can tell me just to get lost.
38:41This has nothing to do with you.
38:43Oh, right.
38:44It's the old, uh, it's not you, it's me.
38:48In this case, it's actually true.
38:57Excuse me.
39:05I'll see you next week.
39:06It's a three-month sabbatical.
39:07Like I said, I will see you next week.
39:16My first day here as a med student.
39:19There was a patient.
39:22He was a really nice guy.
39:25Came in with belly pain.
39:27I saw a gallstone on the ultrasound.
39:31Normal EKG, troponin.
39:33The pain resolved.
39:34And he was in the hall when he had a cardiac arrest.
39:41I couldn't save him.
39:44People die.
39:47And we do the best we can.
39:50But people die.
39:54You ever get used to that?
39:58No.
40:00No, you...
40:03You try to accept it.
40:07You try to find balance.
40:14I don't know if I can take another day like today.
40:19Primary care specialty sounds way better.
40:23Peds, maybe.
40:24Yeah, maybe.
40:27I know I'd be bored out of my fucking mind.
40:31Seriously.
40:33I like the challenge of undiagnosed illness.
40:36Of quick decisions.
40:38Of life-saving procedures.
40:40And I like being here for people on the worst days of their lives.
40:45Yes.
40:54You know what I think?
40:56What?
40:57I think you should go home.
41:00I think you should sleep on it.
41:01And I think you should at least wait till the morning to decide if you want to come back.
41:08I don't really want to go back in there and see anybody.
41:13Yeah.
41:16Okay, pull off your gown.
41:17I'll take it in.
41:19Shift is over.
41:21Go home.
41:36Oh, God.
41:37No, I'm...
41:37Sorry.
41:38I'm good, I'm good, I'm good.
41:39There's a tummy in a wheelchair.
41:41Yeah, he moves around.
41:46I see I've been replaced.
41:48Oh, did I take your spot?
41:50Not really, no.
41:51Are you sure?
41:51Where the hell have you been?
41:53I found Ogilvy.
41:54And?
41:56And he's going home.
41:58That's it?
41:59It's a long story.
42:01Well, I got nothing but time.
42:02I need to respect his privacy.
42:04Where's the fun in that?
42:07I'm sorry.
42:16Um, the shredder jam?
42:18Yeah, I'll try putting it in reverse.
42:23Perfect.
42:24Just give it a little love tap.
42:27Kick it.
42:29Jesus Christ.
42:33I guess Mr. Dick B got a room upstairs.
42:35In your dreams.
42:36He's not in South 21.
42:39Yeah, he is.
42:40There's a new guy in the bed.
42:42Short hair, clean shapes.
42:44Take care of him.
42:47Scalpham showed off his pathology,
42:48so we ordered the CT injury.
42:50Textbook is sending out again,
42:51losing eight centimeters.
42:5350% one-year mortality.
42:55So he definitely needs surgery.
42:56If he wants to live.
42:57Okay.
42:58Well, he's a friend, so I will talk to him.
43:00I'll get him admitted to your service.
43:01Not today.
43:02Why not?
43:03He needs to do cardiology and pulmonary first
43:05to be cleared for the OR.
43:06They can do a stress echo, PFGs.
43:08He needs to be admitted and evaluated as an inpatient.
43:10Nothing ever gets done over a holiday weekend.
43:12He can take it easy at home.
43:13He's a ticking time bomb.
43:14He's probably been that way for years.
43:16We can get him in early next week with a specialist,
43:18get his testing done.
43:19All goes well.
43:19He's on the OR schedule in a week.
43:21What happens if it ruptures before then?
43:22Call 911.
43:24Sorry, Robbie.
43:25Best we can do.
43:26Text me his number.
43:26I'll have my office coordinate.
43:30Fuck!
43:31Hey!
43:32Take a walk.
43:32Come on.
43:38Two for discharge.
43:39Yeah, please don't ring the bell.
43:40The computers are back up and running.
43:42Not for these two.
43:43They don't have electronic health records yet.
43:45Wait, hold up.
43:46This kid had a wrist x-ray ordered.
43:48Ugh, it never happened.
43:50And water skiing lady's still waiting on a knee series.
43:52I canceled the x-rays.
43:53Diagnosed them both with ultrasound.
43:56Really?
43:57Yeah.
43:59The little boy had a simple buccal fracture,
44:01distal radius.
44:02He got a Velcro splint.
44:04And Mrs. Stegman had a small medial meniscus tear,
44:07the immobilizer crutches, and a follow-up with ortho.
44:09Could have used you on the day shift today.
44:11They don't teach us a lot of musculoskeletal ultrasound.
44:14I know.
44:15That's why I did electives at Harvard and Highland.
44:18Are you applying for an ultrasound fellowship here?
44:21I am, but it is so competitive.
44:24That's what I hear.
44:25Kind of a long shot.
44:26I only have one publication,
44:27but it's a series of case reports
44:29diagnosing shoulder dislocations with ultrasound only.
44:32If you want to learn some MSK, you can tag along.
44:34I got three more to scan.
44:35Maybe some other time.
44:37Cool.
44:42Hey, don't try him in the shredder.
44:44What is that, two charts?
44:46No, it's my ultrasound fellowship application.
44:50Hey.
44:51Uh, sorry.
44:53Got your patient.
44:55Yeah.
44:55Lando's in pretty bad shape.
44:57Oh, no.
44:58I was talking about the triple-A guy
45:00you worked on with Ogilvy.
45:06He didn't make it through surgery.
45:08I tried to talk to Robbie about it,
45:10but I think he's busy.
45:12Excuse me.
45:16Oh, shit.
45:22You think I'm on edge?
45:23What's your shame on Samira?
45:25Them, okay?
45:25They both need to be called out for an acceptable behavior.
45:28Yeah?
45:28Yeah, well, you do that in private.
45:29Same place.
45:29You share your thoughts about a patient's possible suicide
45:31and slamming stuff.
45:33Please, sign out all this shit that's bugging you
45:35and get out of here.
45:36I can't.
45:37Yes, you can.
45:38When either of my kids was acting like this,
45:39I gave them a time out in their room.
45:40Whoa, whoa, whoa.
45:40You're not my mother.
45:41Yeah?
45:42Well, too bad.
45:43You need back.
45:43No, I had one.
45:44She left.
45:44I don't need another one.
45:45What I need is someone who could actually run this place
45:47while I'm gone.
45:48I'm sorry.
45:49I didn't know.
45:50Nobody knows.
45:50Who needs to know?
45:51Who gives a fuck?
45:52I think you need a break.
45:54That is what the sabbatical is for.
45:55That's starting now.
45:56Walk away.
45:57I have too much to do.
45:58Let someone else talk to Duke.
46:00No, that needs to come from me.
46:02Why?
46:03Because I owe him that.
46:04It needs to come from a friend, not a stranger.
46:06Otherwise, he's going to bail and drop dead while I'm gone.
46:08Okay.
46:09Wrap that up and then leave.
46:12It's not just Duke.
46:13I'm not sure that Alashimi is fit to run this place.
46:15What's that supposed to mean?
46:16I'm not sure.
46:16I'm trying to figure that out.
46:17Did you know that she wants to have two attendings on at all times?
46:20No.
46:20Is that something she's worked at with Gloria?
46:22I don't know.
46:23I also don't know if Lightning is going to relapse.
46:25I don't know if Whitaker is going to be able to take care of my shit.
46:27I don't know if Javadi is going to give up on what she's good at or if Samira is going
46:30to flame out because of some bullshit with her mother.
46:32Is there anything else?
46:33Yeah, you.
46:34I don't know about you running around with full syringe of Versed in your pocket.
46:39I'm worried about the people that I care about.
46:41We'll all manage until you come back.
46:43We always do.
46:44Yeah, what if I don't come back?
46:46I don't know.
46:48I don't know.
46:50I know.
47:06I don't know.
47:15We won't let you go.
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