- 8 minutes ago
The Pitt - Season 2 Episode 13 -
7:00 P.M
7:00 P.M
Category
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FunTranscript
00:11You know this guy?
00:12Orlando Diaz. We were treating him for DKA when he eloped.
00:15How far do you fall?
00:1520 feet or so.
00:16Anyone see him pass out?
00:17No, they went looking for him after he didn't answer his radio.
00:20He was equal with sluggish.
00:21He left against medical advice.
00:22On my count, three, two, one.
00:27Dr. Ellis on the case.
00:28Day shift, we got this.
00:29I'm safe.
00:30Continuity of care.
00:31Dr. Alashimi, why don't you go cover sign-up rounds with Dr. Abbott, Chen, you two?
00:35Got it.
00:35Okay, let me know if you need anything.
00:37Lungs are up bilaterally.
00:39Helves are stable.
00:40Right tip, fib, hematoma.
00:42Deformed right forearm.
00:44Rub through TM1, lift the serosanguinous fluid.
00:46That means baseless skull fracture.
00:47We've got a diabetic patient, 20 foot 4.
00:49BP 204 over 98, pulse 56.
00:52Dr. Mohan, what do those numbers indicate?
00:53I'm trying to treat the patient.
00:55The Cushing's reflex.
00:56From increased intracranial pressure.
00:58Yeah, we need to get him to CT right away.
01:01No free fluid in the belly.
01:02Any family to notify?
01:04Wife and three kids.
01:06Is there a card to sign for Robbie?
01:08He said no card, no presents.
01:10Oh, was there a cake?
01:11Oh, he didn't want that either.
01:13That sucks.
01:14I need some cake.
01:15The patient was injured when they raided a restaurant.
01:17And they actually arrested the nurse.
01:19The takedown and zip ties.
01:20Hey, Cruz.
01:22You, uh, know the computer downtime drill?
01:24Yeah, no biggie.
01:25I prefer to treat him without labs and x-rays.
01:27Welcome back.
01:28If you do have orders for labs and x-rays, clipboards, go here.
01:32If it's just nursing orders, here.
01:35Please write neatly, for God's sake.
01:37Oh, Monica, this is Nasli, new intern.
01:39I don't need to know that.
01:41So nice to meet you.
01:43Looks like you and me, Jack.
01:45Yeah, who's our senior?
01:46Dr. Henderson.
01:49Excellent.
01:50Nightship's on cruise control.
01:51You hear Iced brought us a patient?
01:54Oh, yeah?
01:55Where'd that go?
01:55There was some collateral damage.
01:57They arrested Jesse.
01:58For what?
01:59Assaulting a federal officer.
02:00Are you fucking kidding me?
02:02Dr. Alshimi, this is Nasli Tumerian, new intern.
02:05Shaturach and Tsunat Anadouk.
02:12Okay, everybody, let's huddle up.
02:14Before we start, let me address the elephant in the room.
02:17For those of you who don't know,
02:19Jesse tried to intervene when a federal agent was handling this patient,
02:22and both he and the patient were taken away by ICE.
02:24Did he punch the guy?
02:25No, he put out a hand to stop him, made physical contact.
02:28He was a little bit more than that.
02:30The hospital lawyers are on the case,
02:31and we will brief the staff every 12 hours at sign-out rounds with an official update.
02:35In the meantime, don't feed the rumor mill.
02:38You may have also heard that new grad nurse Emma here was assaulted by a patient.
02:42I'm fine.
02:43Please don't forget, code hula hoop.
02:45And with risky patients, always keep a path to the door clear.
02:48Sounds like one hell of a day, and we're still dealing with downtime.
02:52So day shift should brief night residents about the protocol.
02:55Oh, all right.
02:58Oh, thank God.
03:00Yeah, not so fast.
03:01Every chart from the last five hours needs to be scanned into the electronic health record
03:05and checked for accuracy.
03:08Okay, whose job is that?
03:09Day shift.
03:10With a completed and signed T-sheet.
03:12Are you kidding me?
03:13That's going to take forever.
03:14We will set up stations for scanning.
03:15Okay, everybody, let's get moving.
03:17Triage is 20 behind.
03:18Got to help him clean up.
03:19Skipping rounds.
03:21City's self-lucky.
03:22Should we join them?
03:25Might as well witness some magic.
03:27It's like changing the guard at Buckingham Palace.
03:29Except we're allowed to smile.
03:31Smile though your heart is aching.
03:34Clean films, right tip-fib and right forearm after CT.
03:37Got the chemate?
03:38Blue sugar's 284.
03:39That's not too bad.
03:41Potassium looks good.
03:42And he ain't got stuff at 14.
03:44It was 24 this morning.
03:45He's definitely improving.
03:47The decay is resolving.
03:48So what made him pass out?
03:50It's hot as hell out there.
03:52He could have been dehydrated from sweating, or he could have had an NSTEMI or a posterior CVA.
03:58Ready to roll.
04:00If I could babysit him at CT.
04:03And I'll stay in case he needs the OR.
04:07Hey, we're back up.
04:09I have time.
04:12Ooh, Robbie.
04:13Yep.
04:13I got intel on where ICE has taken Jesse.
04:15Intel from who?
04:16Uh, my brother-in-law's a cop.
04:18So, he'll be processed at DHS Southside and then transferred to ICE detention in Clearfield.
04:23Clearfield?
04:24That's two hours away.
04:24Mm-hmm.
04:26Okay, I'll let the hospital attorney know.
04:28How are you doing, Oliver?
04:29Alive and kicking.
04:30Uh, Mr. Haas.
04:31Pulmonary edema after missed dialysis.
04:34Now stable with a sun mason at the bedside.
04:36Hello.
04:37Uh, I'm Dr. Shen.
04:38I'll be back.
04:39Dialysis tech says I'm off the machine at 1042.
04:42Got the call light and I'll come running.
04:44South 21 next.
04:48Mr. Digby.
04:50Just Digby.
04:52Dr. Mohan's patient, forearm cellulitis, admit med-surg awaiting a bed.
04:56I can take him.
04:57Sold.
04:57Dr. Tamarian.
04:59Moving right along.
05:01Good enough to eat?
05:03We'll be back.
05:05Lillian Stegman, tweet your knee water skiing.
05:09You can go 360 off a five-foot ramp.
05:11Ooh, respect.
05:12X-rays ordered in triage.
05:13That was hours ago.
05:15Ma'am.
05:15I'm Dr. Cruz Henderson.
05:17Let's get you home real fast.
05:19That would be wonderful.
05:20Okay, heading to north.
05:22It's like our first scanning station is almost ready.
05:25Whitaker Santos, after rounds, this will be your post.
05:28Seriously?
05:29For how long?
05:30Till we mop up this mess.
05:33And away we go.
05:34All right.
05:36Now you know everything there is to know about rounds.
05:38Fascinating, right?
05:39Uh, yeah.
05:41Here.
05:42About something better for you.
05:45So, Digby, we're going to find you some new clothes, but my friend Emma and I wondered
05:49if you'd like to get cleaned up a bit first.
05:52I already had a shower.
05:54I know.
05:55And you look good.
05:56But the offer also comes with the shave and the haircut if you're interested.
05:59No pressure.
06:00Like I said, you already look great.
06:03Sure, I guess.
06:05Fantastic.
06:06All right, kid, fill that basin with some warm water and lather him up.
06:12Hey, stay safe out there.
06:14Back at you in here.
06:15Hey, Carrie.
06:17You were on scene with Orlando, right?
06:19Did you notice anything about his fall?
06:22Like what?
06:23Like, um, if there was a break in the railing or if there were security cameras.
06:29Too busy working on the guy.
06:31IV, intubation, backboard, splint.
06:34Thanks.
06:35Oh, two names is a start.
06:36Pretty soon we'll retire the clipboards.
06:38Baby Jane Doe and Peds?
06:40Uh, yeah.
06:41Abandoned in the waiting room bathroom at 7.30 a.m.
06:44Safe haven drop off?
06:45No, she's too old for that.
06:46At least two months.
06:47I'll take her.
06:48Awaiting foster placement by CYF.
06:50What if the mom comes back?
06:51Call the cops?
06:53Day shift, get to work scanning, night shift.
06:55The room numbers on top of the dry erase board need a doctor.
06:58Who's in BH1?
06:59Psych holds danger to self.
07:01What's the story?
07:02Doctors King and Langdon were on the case.
07:04It's a sad story.
07:05She says her five-year-old snuck in the backseat of the car to take a nap.
07:09Heat stroke.
07:10Mom was extremely distraught, walked out into traffic.
07:12Brady Barnhill wheezing and not responding to albuterol.
07:16Whole Sox 87 is Mother Naomi.
07:17Okay, trauma 2's open.
07:19On our way.
07:20Mom, history of asthma?
07:21His whole life.
07:22Never this fast.
07:23Barely moving air.
07:24Using all his accessory muscles.
07:27Call our team.
07:29Continuous nebs, 20 milligrams an hour.
07:31Yeah, I've been giving him albuterol every hour.
07:35Ready?
07:36On my count.
07:37One, two, three.
07:39Does he take any other medications?
07:41Just the albuterol.
07:42He used to be on Montalukaz and Simicor.
07:44Why did you stop that?
07:45Because he lost his medicaid two months ago.
07:48It's so tight, nothing's getting through.
07:49Mel, EpiPen.
07:50On it.
07:5123 milligrams.
07:52That may open his lungs so the nebs can work.
07:55All right, Grady, shot in the thigh.
08:02Hi.
08:04Something to scan?
08:06Critical labs on North 3.
08:07Oh, it's not my patients.
08:09She's about to be.
08:12I'm off the clock.
08:15These were ordered three hours ago from triage,
08:17so technically she is a day shift patient.
08:20Just get the intern started.
08:21I got a meeting upstairs with admin to get things back on track.
08:25Sorry, everyone else is tied up.
08:26That's okay.
08:28How'd you get stuck on night shifts for your first rotation?
08:30Just lucky, I guess.
08:32Yeah, I feel like a good horror movie.
08:34Where was mid-school?
08:35UC Irvine.
08:36California, right?
08:38Yep.
08:38Pittsburgh's a little different.
08:39Yeah, a lot more humidity.
08:41Yeah, that'll go away with your first foot of snow.
08:44Uh, hi, Mrs. Davis.
08:46I am Dr. McKay.
08:48This is Dr. Tumerian.
08:49Hello.
08:50Uh, your labs show a lot of inflammation in your liver.
08:54So I'm so nauseated.
08:56Definitely, yeah.
08:57Have you, um, noticed a change in your skin coloration?
09:00I've been using this bronzing cream,
09:02so I don't look like a ghost in my bathing suit.
09:05Do you remember the name of the bronzer?
09:07It could have a chemical that can cause it.
09:09Uh, no, no.
09:09It's 100% natural.
09:11It's DHA from sugar beets.
09:14Why would my liver be inflamed?
09:16Uh, there's a lot of possibilities.
09:18Are you taking any prescription medications?
09:20Not a single one.
09:21Tylenol?
09:21God, no.
09:22We have to ask everybody about injection drug use.
09:25Never.
09:26Rock clams or oysters?
09:27I'm a vegan.
09:29One step at a time.
09:30Thanks.
09:31We'll be back.
09:34Digby Haas now on the big board.
09:36Progress.
09:36So, he's just been waiting in the hall the whole time?
09:39Okay.
09:40Well, can you maybe get to him next?
09:46Dude goes to CT and they bump him.
09:48Yeah, he may end up waiting for hours over there.
09:50Well, look at that.
09:517.15 already.
09:53Just a few more loose ends to tie up.
09:54We've got more loose ends than a macrame wall hanging.
09:58My mom had one.
09:59Took up the whole goddamn wall.
10:00Seriously, you should think about signing up and hitting the road.
10:02Yeah, maybe you should, too.
10:03Oh, that's right.
10:04You sent Nina home.
10:05Are you planning on calling in a replacement or are you just going to work till sunrise?
10:09I have to.
10:10Oh, so you get to go the extra mile and the rest of us just get accused of being martyrs.
10:15Robbie?
10:15Excuse me.
10:18What's the word?
10:19No subdural, no epidural.
10:20He's brain swelling with effacement and compression of the ventricles.
10:24C-spine, chest, abdomen, pelvis?
10:26Uh, left pulmonary contusion, no intradominal hemorrhage.
10:29Which means I'm off the hook.
10:30I'll send neurosurgery down.
10:31If he doesn't need the OR, why neurosurgery?
10:33Wait and see.
10:34Let's get busy.
10:35CBP'd at Artline.
10:36Orlando.
10:38Orlando, squeeze my hand.
10:40Open your eyes.
10:41We already know his GCS is going to be free.
10:44Hey, Javadi, anti-seizure prophylaxis?
10:46Kepra, Tony makes her kilo.
10:47Mixing it now.
10:48Better get this brain swelling down, Samira.
10:50How are we going to do that?
10:52Samira.
10:53What?
10:54Do we have to lower the intracranial pressure?
10:57Manitol.
10:58Not the best can cause diuresis and hypertension.
11:00And hypertonic saline.
11:0223%, 50 cc's through the central line.
11:06Tight as a drum.
11:07Five minutes, 60 up here.
11:09We can have one more EpiPen.
11:10That's our borderline, 87.
11:12How about BiPAP, 10 over 5?
11:13Yes, with inline nebs.
11:15All right, Grady, shot number two.
11:17Might as well throw him some magnesium, 54 kilo.
11:19I'm sorry, he's not ventilating.
11:21We should be ready to insubate.
11:22With an asthma patient?
11:23There's a high risk of cardiac arrest.
11:26Naomi, has he ever been put on a breathing machine before?
11:28Never.
11:29Hospitalized?
11:29No, we could always break him with a simicort.
11:31We're going to give the current treatment a few more minutes to help him join.
11:38I could probably do this myself now that my cast is off.
11:41That's okay.
11:43I don't mind.
11:48How long have you been a nurse?
11:52This is my first day.
11:56You're doing really good.
12:04Shit, you okay?
12:07Yeah, there's water in the floor.
12:09Sorry, I might have spilled.
12:11Yeah, no worries.
12:12We're going to have to sort these all by patient before we scan them.
12:16Is, uh, Joy still around?
12:19I heard she left at 6.59.
12:22Smart girl.
12:23Mm-hmm.
12:23You know what, find Ogilvy.
12:24He's just an ass kisser.
12:25He might stay in the scandal and try some cell phone.
12:27Oh, he, uh, scrubbed in in the O.R., scrubbed in on the ruptured triple A.
12:31With a kidney stone that wasn't?
12:33It'll be four hours at least.
12:37So, are you still going to Amy's after work?
12:40Yeah, maybe just for tonight, after Robbie briefs me on all the house stuff.
12:45Sounds fun.
12:48When he asked, it was hard to say no.
12:50Sure.
12:54It's going to be very weird without him here.
12:56Yeah.
12:57You think Dr. Al-Hashimi can handle it?
13:00A word.
13:01No.
13:02She's smart.
13:03Yeah, it takes more than that.
13:05Well, at least it's only three months.
13:07Yeah, three long months.
13:09Then you need to find a new home.
13:12Not necessarily.
13:13I mean, if I wanted, I could just check on Robbie's house once or twice a day.
13:17You know?
13:19Why would you do that?
13:21I don't know.
13:23I don't know.
13:23Why not?
13:27Hypertonics in.
13:28Maintenance.
13:29LR in the AC.
13:31It's like a halo sign.
13:32Cerebral spinal fluid from a basal skull fracture.
13:35Well, the halo sign is neither sensitive nor specific for CSF.
13:39Saline, tap water, and runny noses all separate from blood.
13:42Hello, Linda.
13:43Robbie.
13:44Vision chief working on a holiday weekend.
13:46Well, somebody's got to.
13:48Saw the scans.
13:49This guy needs an EBD.
13:51External ventricular drain to take down the pressure.
13:54Because CPP equals MAP minus ICP.
13:57Cerebral perfusion pressure in the brain equals mean arterial blood pressure minus the pressure in the skull.
14:03ICP less than 22 predicts survival and favorable outcome.
14:07CPP from 60 to 70 reduces morbidity and mortality.
14:11Can somebody assist?
14:13Dr. Mohan.
14:14I'm good.
14:16Dr. Mary, you should lend a hand.
14:18I said I'm good.
14:20Chavati?
14:20I don't think so.
14:23Chavati?
14:24As in daughter of Raymond and Eileen?
14:27I was at your mother's baby shower.
14:30She was a resident.
14:31You were in utero.
14:34I don't know how she got through motherhood and training.
14:37Feel free to join me.
14:38Oh, my shift was over a while ago.
14:41Okay.
14:42Masks all around.
14:43Two sterile gowns.
14:43We brought the surgical towels.
14:45Just need some beta dye.
14:46This is kind of an amazing opportunity.
14:49I'm exhausted.
14:50The chief of neurosurgery is here.
14:52She's kind of a legend.
14:54Maybe one of the night residents can do it?
14:56Is this about the vulvulus case from earlier?
14:58Because if it is, you made a mistake.
15:00You need to move on.
15:01I do not want to come back here and find that you've applied for a residency in Durham.
15:06Step up to the plate.
15:08Do it.
15:09Chavati will assist.
15:10Excellent.
15:12You know, I think Eileen did her first DVD with me back when I was a brand new assistant professor.
15:18Time flies.
15:22How you doing, Grady?
15:23Still retracting.
15:25Any improvement?
15:26Not really.
15:27You feeling tired?
15:29Do we have aerogen in the ED?
15:31Just in the unit.
15:32How fast can you get back?
15:33Two minutes if I take the stairs.
15:35Go.
15:36Aerogen?
15:36It has a 5mm mesh that vibrates over 120,000 times per second.
15:47Dr. Ahashimi.
15:53You okay?
15:56Are you telling us about aerogen?
16:00Dr. Shen can explain.
16:03It produces droplets in the 2 to 5 micron range.
16:06I'm just going to breathe.
16:15How's it going?
16:16Just about to start.
16:17Secure an art line here.
16:19Measure twice.
16:20Cut once.
16:21We enter 11 centimeters back from the nasion.
16:253 centimeters lateral.
16:26Without any direct imaging?
16:28Nope.
16:29Straight shot into the lateral ventricle.
16:31Tried and true since 1890.
16:34Okay.
16:35Go ahead with the incision.
16:38Hey, you worked with Dr. Ahashimi at the VA.
16:41I did?
16:42For how long?
16:43During my R2 rotation and then one again last year.
16:51Okay.
16:53Handrail's all set.
16:54Maybe you should do this part?
16:55No, no.
16:56There's a safety stop here.
16:57You can't go too deep.
16:58It's not brain surgery.
17:02Okay.
17:07Stay perpendicular.
17:08Okay.
17:09Good.
17:11All right.
17:11Now, four turns to get through the outer table.
17:14Yep.
17:14Then half turns till you penetrate the skull.
17:33Holy smoke.
17:36I thought it was Tom Criss for a second over here.
17:39Nice job.
17:40How's that feel, Digby?
17:42Pretty good.
17:43My bad.
17:44Why don't you say we trim up those gorgeous locks here now?
17:49I don't like having my hair cut.
17:51I get it, Rapunzel.
17:52But you need your ears lowered.
17:54You'll feel better with a fresh summer look that won't go and notice by the ladies.
18:00Maybe just a trim?
18:02Great.
18:02I'm thinking of pixie cut.
18:05What?
18:06I'm kidding.
18:07A couple of husband Benji's here all the time.
18:08Trust me, you're gonna look fabulous.
18:10When's the last time you had a haircut?
18:13Maybe my daughter's wedding a few years ago.
18:16Where?
18:18St. Sebastian, Our Lady of Mount Carmel Parish.
18:21Does your daughter know where you are?
18:23Of course.
18:24We all live in Pittsburgh.
18:26In fact, they live in my old house.
18:31Your daughter lives in your house?
18:34Yep.
18:35Where do you live?
18:38Wherever I want.
18:42You're gonna pass it five to six centimeters from the inner table of the skull.
18:46Okay.
18:49Centered.
18:51Perpendicular.
18:52Another.
18:53Aiming for the medial campus.
18:56All yours.
18:57And just keep going?
18:59You'll feel a pop when you pass through the appendable lining.
19:03All right.
19:03Line is calibrated.
19:04Good to go?
19:04I'll try the nicardine pain to a map of 85, please.
19:08And if we can get the inner cranial pressure down to 20?
19:13Dr. Mohan.
19:14I'm sorry.
19:16Map of 85, ICP of 20.
19:19Um, cerebral perfusion pressure 65.
19:21Which gives him the best shot at survival.
19:24A third of patients like this die half have long-term disability.
19:28We'll know in two weeks if there's a possibility for a good prognosis.
19:32Feel the pop.
19:34Remove the stylet.
19:38Okay.
19:39Let it drain a bit.
19:42And now pinch it shut.
19:46Perfect.
19:47BP is down.
19:48190 over 88.
19:49Heart rate 67.
19:52Okay.
19:54Okay.
19:55Okay.
19:56Okay.
19:57Okay.
19:58Okay.
20:00Okay.
20:01He asked me to see a patient with the night intern.
20:04He said yes.
20:0648-year-old woman.
20:07New onset jaundice.
20:09Elevated liver enzymes.
20:10No history of alcohol use.
20:12Take your pick.
20:13Hepatitis A, B, C, D, or E.
20:16No risk factors.
20:17No fever.
20:18Tylenol?
20:19Never.
20:20No prescription meds.
20:21Does she eat polar bear liver?
20:24It can cause vitamin A toxicity.
20:27No.
20:28She doesn't eat meat.
20:30Kind of a health nut.
20:31Well, maybe she's gulping down cod liver oil to prevent measles.
20:35Vegan, no fish.
20:36Would you mind laying eyes on her?
20:39Seriously.
20:40You have a way of figuring out the weird stuff.
20:42Take the compliment.
20:45Okay, fine.
20:47Five minutes at the bedside.
20:48That's it.
20:49Already going to be here for hours as it is.
20:53What am I doing?
20:58Definitely improving.
21:00Title volume's up.
21:01Wheeze is now expiratory only.
21:03Oh, making some progress.
21:05You feeling better, baby?
21:07You scared the shit out of me.
21:08Language.
21:10Does he have a primary care doctor?
21:12Not anymore.
21:14How do you get his prescriptions renewed?
21:16Neighborhood clinic.
21:18We pay cash.
21:19Poputerol's cheap.
21:20Settle court.
21:21Without Medicaid.
21:21400 bucks.
21:23A month.
21:23Just for a little inhaler.
21:27Trocar's on the tube.
21:29I tunnel underneath the scalp about five centimeters and poke through.
21:34To prevent infection?
21:35Mm-hmm.
21:35Exactly.
21:37Now, you hold the knuckle steady while I pull it through.
21:43And you can staple the wound shut.
21:47That looks like something from Home Depot.
21:49Yeah.
21:50Big 4th of July sale.
21:51The brain pressure is measured by the height of the fluid column.
21:54We need to calibrate it to zero at the level of the tragus.
21:57Stop clock's on.
21:58Ready to attach.
21:59First trip on end's normal, but you need a second to rule out MI.
22:03Hey, can you step out for a second?
22:11I really did do everything I could to try to make Orlando stay.
22:14Yeah, I don't doubt it.
22:15I wanted to ask you about Dr. Alashimi, the VA.
22:18Did you ever notice anything unusual about her behavior?
22:21Um, like what?
22:23Lapses in focus, tension.
22:25No, she was always on top of her game.
22:30But this morning, when she was checking labs on baby Jane Doe,
22:34it was like she zoned out for a few seconds.
22:38Maybe she was just tired.
22:47No congestion, nodules, or cirrhosis.
22:51Good-looking liver.
22:52I should not be sick.
22:54I worked so hard to stay healthy.
22:57Diet, exercise, eight hours of sleep.
23:00I can't remember the last time I got eight hours.
23:04Maybe you should try sleep maxing.
23:06Oh, you definitely should.
23:08Yeah, cold room, white noise, eye shades.
23:11Kiwis before bedtime, lettuce water, mouth taping.
23:14Who do you follow for health?
23:16A few naturopaths and some functional healers.
23:19Do you buy vitamins from them?
23:20Oh, no, no.
23:21I don't take vitamins.
23:22Food is the best medicine.
23:24Kale, blueberries, kidney beans, turmeric.
23:27Turmeric?
23:28How long have you been taking that?
23:29For a few months.
23:30It's an anti-inflammatory.
23:32It detoxes the body and it can prevent Alzheimer's.
23:34How much do you take?
23:36500 milligram capsules.
23:38But I take five a day.
23:41What?
23:42With doses that large of turmeric,
23:44there have been cases of liver failure.
23:47From eating a spice?
23:48All right, Digby.
23:51Good to go.
23:52Would you like to see it?
24:06I haven't looked like this in a long time.
24:08Your family won't recognize you.
24:13How will they find me?
24:15They won't know what I look like.
24:17They won't know this is me.
24:18Of course they will.
24:19They know your voice.
24:20They know where you hang out.
24:22They even remember that you used to look like this.
24:26They remember the wedding.
24:27I mean, did you dance with your daughter at her wedding?
24:36I did.
24:38And she will always remember you.
24:47Hey, I was just looking for you.
24:49What's up?
24:50You tell me.
24:50The asthma patient.
24:52What about him?
24:53It seemed like you were hesitating,
24:54talking about using aerogen.
24:55I was wondering if you were having second thoughts.
24:57No.
24:58Just thinking.
24:59About?
25:00The best treatment plan for the patient.
25:02And I think he's on it.
25:04Anything else?
25:05I don't know.
25:06You tell me.
25:06Anything else I need to know?
25:08I don't think so.
25:11This is Dr. Robbie in the ED.
25:13I'm checking out of patient Eakins.
25:14We can take Larson and Stevens off the dryer race.
25:17Consider it done.
25:18He's in the scanner now?
25:19Oh.
25:20Great.
25:21No, I was just calling to confirm.
25:23Any new information from upstairs?
25:24Nothing we don't already know.
25:27Same old story, huh?
25:28You think we should take up a collection for Jesse?
25:30For bail money?
25:31They don't usually send bail until after you've appeared in front of a judge.
25:35The holiday is not likely to happen until Monday.
25:37So he's going to be locked up all weekend?
25:38That sucks.
25:40It does suck.
25:43Dr. Langdon?
25:44Grady's worse.
25:45Much worse.
25:46Need an attending?
25:47No, we have Shun.
25:48Shots down 83.
25:50What's happening?
25:50Give us a minute.
25:52He's tiring out.
25:53Ketamine and rock.
25:54It's time to intubate.
25:55A couple.
25:56Ma'am, we have to put a tube down your son's windpipe so a machine can breathe for him.
26:01Oh, my God.
26:02Hold on.
26:03Hold on.
26:04No lungs sliding on the right.
26:05Pneumothorax.
26:06No need to intubate.
26:09What's going on?
26:10He has a collapsed lung.
26:12There was no history of trauma that would have caused the pneumothorax.
26:15What about Dr. King?
26:18In asthma, you can get air trapping.
26:20When the lungs can't fully exhale, eventually they overinflate, causing some of the tiny air sacs to burst.
26:25How do you fix it?
26:32Like that.
26:38It's a good thing Dr. Connolly was here.
26:41Yeah.
26:42We should probably try to find him in a neurocritical ICU bed.
26:44We don't want to board a patient like this.
26:46Mm-hmm.
26:46Hey, Robbie.
26:47Hey, how did the scan go?
26:49Fine.
26:50It is probably going to take a little while to get the results from the radiologist.
26:53Well, that's not a problem.
26:54Nurse Devi and I need a little time to coordinate our schedules over the next few months.
26:59Really?
26:59Yeah, I've always wanted to learn how to ride a motorcycle, and Duke offered to teach me.
27:03Well, nobody knows motorcycles like Duke.
27:06He's giving me the health care worker discount.
27:08He's quite the gentleman.
27:09Let's get him back to his room.
27:11How would next Saturday be for you, baby?
27:15Maybe we could have some dinner after.
27:18Dr. Mulhand, Lori Diaz is here.
27:19She wants to see her husband.
27:20She's heading back.
27:21Okay, I'm on my way.
27:25Mrs. Diaz?
27:26Hi.
27:27They don't allow him to go up to his room yet?
27:29No.
27:30I brought him some dinner from Burgatory.
27:33It's a chicken burger.
27:35No bun.
27:35Just lettuce.
27:36Figured it would be better than hospital food.
27:42He's being treated by our top brain injury specialist.
27:46Will he wake up?
27:48We won't know for several weeks.
27:49And then he could be back to normal.
27:52Best case scenario, it would take about a year before he could be independent at home.
27:58And the worst case?
28:00Round-the-clock nursing care for severe disability.
28:07Could you let him leave?
28:09He insisted on leaving to work at a second job.
28:13You didn't make him stink.
28:15He was competent.
28:16He knew the risks.
28:18We honored his decision to leave.
28:20Even if he was a stupid buddy.
28:22I tried to stop him.
28:23Offered to get him all the supplies he'd need to take care of himself at home.
28:26But he left before I could give them to him.
28:29He said he couldn't afford to lose a paycheck.
28:39Dr. Langdon?
28:43Are you okay?
28:45Yeah.
28:46I'm just kind of, uh...
28:48Wondering if I'm really ready to be back here.
28:51Well, of course you are.
28:53Ten months is a long time.
28:55I almost killed that kid with an intubation.
28:59Didn't even occur to me to check for a pneumothorax.
29:02There isn't any trauma to indicate that.
29:04I should have caught it.
29:04Okay.
29:11You know, I, um...
29:15I had a deposition today.
29:18And all the lawyers' questions made me feel like I was a really, really bad doctor.
29:26We don't always get everything right the first time.
29:30You would have caught the collapsed lung.
29:33And it may have taken a minute, but you would have saved him.
29:37Not sure Robbie would agree with you.
29:39He's been rioting me all day.
29:42Well, Robbie's leaving for three months.
29:43And, you know, with Robbie gone, I really don't want you to leave, either.
29:52That which does not kill me makes me stronger.
29:55Wow.
29:56Frederick needs you.
29:58Yeah?
29:59Nici, yeah.
30:01Not Kelly Clarkson.
30:06Hey, that's a thick one.
30:08Yeah, Austin Green, Ogilvy's Triple-A.
30:14Uh, G-R-E-E-N?
30:16Yeah, why?
30:17What are you doing?
30:17Checking to see when we'll get Ogilvy back from the OR.
30:21Oh, shit.
30:22What?
30:23The guy didn't make it.
30:24He died on the table about 40 minutes ago.
30:27Then, where's Ogilvy?
30:30Oh, man.
30:31His patient had a CT a year and a half ago that showed a four-centimeter Triple-A.
30:36It's too small for surgery.
30:38He was supposed to come back every six months for a repeat ultrasound, but looks like he
30:42didn't.
30:42He would have seen that if the computers were working.
30:45Why wouldn't he tell Ogilvy?
30:47Maybe he forgot all about it, or Ogilvy didn't ask the right questions.
30:52Dennis, hey.
30:53Got a minute?
30:54Uh, sure.
30:55What do you need?
30:57Teenager with jewelry magnets stuck to both sides of her nasal septum.
31:00I tried to move them with a plastic cure at too much pain, and then there was bleeding.
31:04Those need to come off before they cause permanent damage.
31:06Yeah, you think, uh, you could find, like, a senior or an attending?
31:10We're really trying to get off the clock here.
31:12They're all busy.
31:15I already took one for the team.
31:18Fine.
31:19Yeah, I lapsed on your yell, lady.
31:23INR is elevated 2.2.
31:25Liver's in trouble, but not dead yet.
31:27Tell her to skip the turmeric, admit for monitoring, and follow the LFTs.
31:31Got it.
31:32Central 10?
31:33Yeah.
31:38Sleep maxing, really?
31:40I'm gonna track the online trends.
31:42Is that your secret for the tough ones?
31:44Eh, I just think, what's the stupidest thing this person could have done?
31:48I'd assume they did it.
31:51Well, I mean, she was trying to be healthy.
31:53Yeah, but I'm taking advice from fools.
31:55Tumoric is recommended by a lot of doctors.
31:57Yeah, then ask your doctor for the dose.
31:59Or check someplace reputable like the CDC.
32:02Oh, right, I forgot.
32:03It's on a medical toxic waste site.
32:05Mm-hmm.
32:06She's in pretty bad shape.
32:08Things get worse.
32:09She could need a liver transplant.
32:11Oh, because she's a big fucking idiot.
32:14Wow.
32:16No, I actually appreciate her.
32:18Our job security depends on all these big fucking idiots.
32:23Okay.
32:28Good night, Perla, Monica.
32:30Good night, Dr. Robby.
32:33Good night.
32:33Bye, Emma.
32:35You could stay to pitch in.
32:37Dana told me to go and get some rest before tomorrow's shift.
32:40Yeah, you had quite a day.
32:41It wasn't so bad.
32:44Why can't I find Duke's results?
32:46Oh, new patient, no EHR yet.
32:49I can run over to radiology, get a printout.
32:52Thank you, Monica.
32:56Ready to pick up a few more.
32:58Lando's all tucked in for now.
32:59How's he doing?
33:00Numbers are good.
33:01CPP 22.
33:03Okay, so he's got a shot at a decent outcome at least.
33:05You think he has a chance?
33:07Oh, I don't know that survival was the outcome he was hoping for.
33:11What?
33:13I told Samir he's got $100,000 in medical debt.
33:15That his life is probably...
33:16Mrs. Diaz!
33:20How can we help you?
33:21The bathroom?
33:23Uh, yeah, Pearlie can show you the way.
33:27What a great idea to have a private conversation about a patient in a public area.
33:32You were about to start yapping...
33:34But I didn't!
33:38Okay.
33:41How long have they been in there?
33:43At least two hours.
33:45How did it happen?
33:46With my earring.
33:47It was supposed to be, uh, red, white, and blue to look cool at the fireworks.
33:52I told her for the nose one side only, but she never listens.
33:55This can be pretty serious.
33:56If we don't get them out quickly, it can cut off the blood supply and cause the septum to collapse.
34:02Like, my nose could be deformed.
34:06Oh my god.
34:07Get them off.
34:08Yeah, that's the plan.
34:09Yeah, she tried already.
34:10It hurt like crazy.
34:11Because they're stuck together by a very strong magnetic force.
34:14Yeah.
34:15No, no, no.
34:16Oh, uh, I'm not gonna use the tips.
34:18I'm gonna flip it around and use the handle.
34:21It's still gonna hurt.
34:22Probably not.
34:23Just, uh, hold still.
34:27Okay.
34:33Voila.
34:35Really?
34:35That was amazing.
34:37I think another half-hour we can send this dry-race for back to storage.
34:41With pleasure.
34:42Dr. Rabinovich, results on your friend.
34:49Fuck.
34:50Duke?
34:55Are you gonna tell him?
34:57I want to talk to a surgeon, please.
34:59Dr. Rabinovich, I have an update on the patient.
35:01That is not a great time.
35:02Oh.
35:03I thought you were going home.
35:04Uh, I was.
35:05Dr. Ogilvy is just sitting out in the ambulance bay, covered in blood.
35:08Sorry, what's he doing out there?
35:10Kind of, uh, staring off into space.
35:12I tried to talk to him, but it was like he couldn't hear me.
35:14Monica, can you stab page-coding with the rest?
35:16Yeah, I'll go check on Ogilvy.
35:18Please.
35:18Oh, no.
35:19I'm here.
35:21Oh.
35:33Hey, Ogilvy.
35:38Ogilvy.
35:40You okay, man?
35:4799 on two liters.
35:49Scattered and expiratory wheezes.
35:51He is so much better.
35:54The steroids should kick in soon.
35:56So he'll keep improving.
35:58Um, we're gonna go home.
36:00In a day or two.
36:02And we will, uh, discharge you with a Symbicort inhaler.
36:05That should last about a month.
36:08Hopefully, we'll be back on Medicaid by then.
36:10How'd you lose it?
36:12They sent a redetermination letter to our old apartment.
36:16It didn't get forwarded.
36:18When I went to pick up his prescription, the pharmacist told me we were no longer covered.
36:24And you haven't been able to get it back since?
36:26I've been trying for months.
36:28To get re-enrolled, you need tax returns, pay stubs.
36:33I cut hair.
36:34My income fluctuates.
36:35A lot of my regulars are struggling.
36:38So, it's been tough.
36:41Well, if you run out of Symbicort before your Medicaid kicks in, you can come back and we'll, uh, set
36:46you up with another one.
36:48Ah, is there a patient in here?
36:50Because everyone in this room looks extremely healthy to me.
36:53Dr. Shen and I will be with Grady all night long.
36:56Hey, day shift. We got this.
36:58We're leaving you in good hands.
37:00Um, I was really scared.
37:07You're very welcome.
37:13Due to his injury, things have changed.
37:16I was looking for Dr. Abbott.
37:19I haven't seen him for a while.
37:22Excuse me.
37:26So now, with a long-term disability, things may be easier.
37:31Easier.
37:32His condition will qualify him for Medicare and Medicaid, so moving forward, costs should be covered, including home health care.
37:39Okay.
37:41Perhaps this isn't the best time to...
37:42I just wanted to reassure you about future costs.
37:54Robbie?
37:55Noel?
37:58You're still here.
37:59It's not the best day to try to get out on time.
38:03So I guess this is it for a while.
38:04Unless you want to come with me.
38:06No.
38:08Even if it isn't a legitimate offer.
38:10What do you mean?
38:11Oh, please.
38:12I know well enough not to get in between a man and his vision quest.
38:17Vision quest.
38:18That is my nice way of putting it.
38:23I probably don't want to hear you not so nice way of putting it.
38:26No, probably not.
38:29I hope that this is not about you running away from me.
38:35I'm a big girl.
38:35You can tell me just to get lost.
38:37This has nothing to do with you.
38:39Oh, right.
38:40It's the old, uh, it's not you, it's me.
38:44In this case, it's actually true.
38:53Excuse me.
39:01I'll see you next week.
39:02It's a three-month sabbatical.
39:03Like I said, I will see you next week.
39:12My first day here as a med student.
39:15There was a patient.
39:18He was a really nice guy.
39:20Came in with belly pain.
39:23I saw a gallstone on the ultrasound.
39:27Normal EKG, troponin.
39:29The pain resolved.
39:30And he was in the hall when he had a cardiac arrest.
39:37I couldn't save him.
39:40People die.
39:43And we do the best we can.
39:46But people die.
39:50You ever get used to that?
39:54No.
39:56No, you...
39:59You try to accept it.
40:03You try to find balance.
40:10I don't know if I can take another day like today.
40:15Primary care specialty sounds way better.
40:18Feeds, maybe.
40:19Yeah, maybe.
40:23I know I'd be bored out of my fucking mind.
40:27Seriously.
40:28I like the challenge of undiagnosed illness.
40:32Of quick decisions.
40:34Of life-saving procedures.
40:36And I like being here for people on the worst days of their lives.
40:49You know what I think?
40:52What?
40:53I think you should go home.
40:56I think you should sleep on it.
40:57And I think you should at least wait till the morning to decide if you want to come back.
41:04I don't really want to go back in there and see anybody.
41:09No.
41:12Okay, pull off your gown.
41:13I'll take it in.
41:15Shift is over.
41:17Go home.
41:32Oh, God.
41:33No, I'm...
41:33Sorry.
41:34I'm good, I'm good, I'm good.
41:35There's a tummy in a wheelchair.
41:37Ah, yeah, he moves around.
41:42I see I've been replaced.
41:44Oh, did I take your spot?
41:46Not really, no.
41:47Are you sure?
41:47Where the hell have you been?
41:49I found Ogilvy.
41:50And?
41:52And he's going home.
41:54That's it?
41:55It's a long story.
41:57Well, I got nothing but time.
41:58I need to respect his privacy.
42:00Where's the fun in that?
42:03Sorry.
42:12Um, does Shredder jam?
42:14Yeah, I'll try putting it in reverse.
42:19Perfect.
42:20Just give it a little love tap.
42:23Kick it.
42:25Jesus Christ.
42:28I guess Mr. Digby got a room upstairs.
42:31In your dreams?
42:32He's not in South 21.
42:34Yeah, he is.
42:36There's a new guy in the bed.
42:38Short hair, clean shaves.
42:40Take care of him.
42:43Scalphim showed off his pathology, so we went to the CT engineering.
42:45The textbook is sending out again, losing eight centimeters, 50% one-year mortality.
42:51So he definitely needs surgery.
42:52If he wants to live.
42:53Okay.
42:54Well, he's a friend, so I will talk to him.
42:56I'll get him admitted to your service.
42:57Not today.
42:58Why not?
42:59He needs to see cardiology and pulmonary first to be cleared for the OR.
43:02They can do a stress echo, TFTs.
43:04He needs to be admitted and evaluated as an inpatient.
43:06Nothing ever gets done over a holiday weekend.
43:08He can take it easy at home.
43:09He's a ticking time bomb.
43:10He's probably been that way for years.
43:12We can get him in early next week with a specialist, get his testing done.
43:15All goes well.
43:15He's on the OR schedule in a week.
43:17What happens if it ruptures before then?
43:18Call 911.
43:20Sorry, Robbie.
43:21Best we can do.
43:22Text me's number.
43:22I'll have my office coordinate.
43:26Fuck!
43:26Hey!
43:27Take a walk.
43:28Come on.
43:33Two for discharge.
43:35Yeah, please don't ring the bell.
43:36The computers are back up and running.
43:38Not for these two.
43:39They don't have electronic health records yet.
43:41Oh, wait.
43:41Hold up.
43:42This kid had a wrist x-ray ordered.
43:44Ugh.
43:45It never happened.
43:46And water skiing lady's still waiting on a knee series.
43:48I canceled the x-rays.
43:49Diagnosed them both with ultrasound.
43:52Really?
43:53Yeah.
43:55The little boy had a simple buccal fracture, distal radius.
43:58He got a Velcro splint.
44:00And Mrs. Stegman had a small medial meniscus tear.
44:03The immobilizer crutches and a follow-up with ortho.
44:05Could have used you on the day shift today.
44:07They don't teach us a lot of musculoskeletal ultrasound.
44:10I know.
44:11That's why I did electives at Harvard and Highland.
44:14Are you applying for an ultrasound fellowship here?
44:17I am, but it is so competitive.
44:20That's what I hear.
44:21Kind of a long shot.
44:22Only I have one publication, but it's a series of case reports diagnosing shoulder dislocations
44:26with ultrasound only.
44:28If you want to learn some MSK, you can tag along.
44:30I got three more to scan.
44:31Maybe some other time.
44:33Cool.
44:38Hey, don't try him in the shredder.
44:40What is that, two charts?
44:41No, it's my ultrasound fellowship application.
44:46Hey.
44:47Uh, sorry about your patient.
44:51Yeah.
44:51Lando's in pretty bad shape.
44:53Oh, no.
44:54Uh, I was talking about the AAA guy you worked on with Ogilvy.
44:59Uh, he didn't make it through surgery.
45:04I tried to talk to Robbie about it, but I think he's busy.
45:08Excuse me.
45:12Oh, shit.
45:18You think I'm on edge?
45:19We're just shaming Samira, then McKay.
45:21They both need to be called out for an exceptional behavior.
45:24Yeah?
45:24Yeah, well, you do that in private.
45:25Same place.
45:25You share your thoughts about a patient's possible suicide and slamming stuff.
45:29Please, sign out all this shit that's bugging you and get out of here.
45:31I can't.
45:33Yes, you can.
45:33When either of my kids was acting like this, I gave them a time out in the room.
45:36Whoa, whoa, whoa.
45:36You're not my mother.
45:37Yeah?
45:38Well, too bad.
45:39You need one.
45:39No, I had one.
45:40She left.
45:40I don't need another one.
45:41And what I need is someone who can actually run this place while I'm gone.
45:43Okay, I'm sorry.
45:44I didn't know.
45:45Nobody knows.
45:46Who needs to know?
45:47Who gives a fuck?
45:48I think you need a break.
45:50That is what the sabbatical is for.
45:51That's started now.
45:52Walk away.
45:53I have too much to do.
45:54Let someone else talk to Duke.
45:56No, that needs to come from me.
45:57Why?
45:59Because I owe him that.
46:00It needs to come from a friend, not a stranger.
46:02Otherwise, he's going to bail and drop dead while I'm gone.
46:04Okay, wrap that up and then leave.
46:07It's not just Duke.
46:09I'm not sure that Alashimi is fit to run this place.
46:10What's that supposed to mean?
46:12I'm not sure.
46:12I'm trying to figure that out.
46:13Did you know that she wants to have two attendings on at all times?
46:16No.
46:16Is that something she's worked out with Gloria?
46:18I don't know.
46:18I also don't know if Langdon is going to relapse.
46:21I don't know if Whitaker is going to be able to take care of my shit.
46:23I don't know if Javadi is going to give up on what she's good at or if Samira is going
46:26to flame out because of some bullshit with her mother.
46:28Is there anything else?
46:29Yeah, you.
46:30I don't know about you running around with a full syringe of Versed in your pocket.
46:34I'm worried about the people that I care about.
46:37We'll all manage until you come back.
46:39We always do.
46:40Yeah, what if I don't come back?
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