- 17 hours ago
The Pitt S02E13
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TVTranscript
00:15You know this guy?
00:16Orlando Diaz, we were treating him for DKA when he looked.
00:19How far did he fall?
00:1920 feet or so.
00:20Anyone see him pass out?
00:21No, they went looking for him after he didn't answer his radio.
00:24He was equal but sluggish.
00:25He left against medical advice.
00:26On my count, three, two, one.
00:31Dr. Ellis on the case.
00:32Case shift, we got this.
00:33I'm safe.
00:34Continuity of care.
00:35Dr. Ellis, why don't you go cover Sunday night rounds with Dr. Abbott, Chen, you two?
00:39Got it.
00:39Okay, let me know if you need anything.
00:41Lungs are up bilaterally.
00:43Pelvis is stable.
00:44Right tib, fib, hematoma.
00:46Deformed right forearm.
00:48Rump through TM on the left, serosanguinous fluid.
00:50I mean, baseless bowel fracture.
00:51We've got a diabetic patient, 20 foot fall.
00:53BP 204 over 98, pulse 56.
00:55Dr. Mohan, what do those numbers indicate?
00:57I'm trying to treat the patient.
00:59The Cushing's reflex.
01:01From increased intracranial pressure.
01:03Yeah, we need to get him to CT right away.
01:05No free fluid in the belly.
01:06Any family to notify?
01:08Wife and three kids.
01:10Is there a card to sign for Robbie?
01:12He said no card, no presents.
01:14Oh, was there a cake?
01:15Oh, he didn't work that either.
01:17That sucks.
01:18I need some cake.
01:19The patient was injured when they raided a restaurant.
01:21And they actually arrested a nurse?
01:23The takedown and zip ties.
01:24Hey, Cruz, you 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 Nasli, new intern.
01:43I don't need to know that.
01:45So nice to meet you.
01:47Looks like you and me, Jack.
01:49Yeah, who's our senior?
01:50Dr. Henderson.
01:53Excellent.
01:54Nightship's on cruise control.
01:56You hear ICE brought us a patient?
01:58Oh, yeah?
01:59How'd that go?
02:00There was some collateral damage.
02:01They arrested Jesse.
02:02For what?
02:03Assaulting federal officer.
02:04Are you fucking kidding me?
02:06Dr. Alshimi, this is Nasli 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, Jesse tried to intervene when a federal agent was handling
02:25this patient, and both he and the patient were taken away by ICE.
02:29Did he punch the guy?
02:30No.
02:30He put out a hand to stop him, made physical contact.
02:32And he was a little bit muddy.
02:34The hospital lawyers are on the case, and we will brief the staff every 12 hours at
02:38sign-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'm fine.
02:47Please don't forget, Code Hula Hoop, and with risky patients, always keep a path to the
02:51door clear.
02:52Sounds like one hell of a day, and we're still dealing with downtime, so day shift should
02:57brief night residents about the protocol.
02:59Yeah.
02:59Hey.
03:00All right.
03:02Oh, thank God.
03:04Yeah, not so fast.
03:06Every chart from the last five hours needs to be scanned into the electronic health record
03:10and checked for accuracy.
03:12Okay, 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.
03:22Gotta help him clean up.
03:24Skipping around.
03:24So do 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.
03:35Smile though, your heart is aching.
03:38Clean films, right tip-fib and right forearm after CT.
03:41Got the Chem-8.
03:42Blood sugar's 284.
03:43That's not too bad.
03:45Patassium looks good.
03:46Mm-hmm.
03:46And he ain't gaps up at 14.
03:48It was 24 this morning.
03:49He'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, or he could have had an NSTEMI or a posterior
04:00CVA.
04:02Ready to roll.
04:04If I could babysit him at CT.
04:08I'll stay in case he needs the OR.
04:11Hey, we're back up.
04:13About time.
04:15Ooh.
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 and then transferred to ice detention in Clearfield.
04:27Clearfield?
04:28That's two hours away.
04:29Mm-hmm.
04:30Okay.
04:30I'll let the hospital attorney know.
04:32How are you doing, Oliver?
04:33Alive and kicking.
04:34Uh, Mr. Haas.
04:35Pulmonary edema after missed dialysis.
04:38Now stable with his son Mason at the bedside.
04:40Hello.
04:41I'm Dr. Shen.
04:42I'll be back.
04:43Dialysis tech says I'm off the machine at 1042.
04:46Got the call light and I'll come running.
04:48South 21 next.
04:52Mr. Digby.
04:54Just Digby.
04:55Dr. Mohan's patient.
04:57Forearm cellulitis.
04:58Admit med-surg awaiting a bed.
05:00I can take him.
05:01Sold.
05:01Dr. Tamarian.
05:03Moving right along.
05:05Good enough to eat.
05:07We'll be back.
05:10Lillian Stegman.
05:11And treat your knee water skiing.
05:13And go 360 off a five foot ramp.
05:15Oof.
05:15Respect.
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.
05:25Heading to north.
05:27It's like our first scanning station is almost ready.
05:30Whitaker Santos.
05:30After rounds, this will be your post.
05:32Seriously?
05:33For how long?
05:35Should we mop up this mess?
05:37And away we go.
05:38All right.
05:40Now you know everything there is to know about rounds.
05:42Fascinating, right?
05:44Uh...
05:45Yeah.
05:45Here.
05:46About something better for you.
05:49So, Digby.
05:51We're gonna find you some new clothes,
05:52but my friend Emma and I wondered if you'd like to get cleaned up a bit first.
05:57I already had a shower.
05:58I know.
05:59And you look good.
06:00But the offer also comes with a shave and a haircut if you're interested.
06:03No pressure.
06:04Like I said, you already look great.
06:07Sure.
06:08I guess.
06:09Fantastic.
06:10All right, kid.
06:11Fill that basin with some warm water and lather him up.
06:17Hey.
06:17Stay 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?
06:28Like, um...
06:29There was a break in the railing or...
06:32There were security cameras.
06:33Too busy working on the guy.
06:35IV, intubation, backboard, splint.
06:38Thanks.
06:39Oh, two names is a start.
06:40Pretty soon we'll retire the clipboards.
06:42Baby Jane Doe and Peds?
06:44Uh, yeah.
06:45Abandoned 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?
06:57Day shift.
06:57Get to work scanning.
06:58Night shift.
06:59The room number's 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 snuck 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.
07:20Full Sox 87 is Mother Naomi.
07:21Okay, trauma two's open.
07:23On our way.
07:24Mom, history of asthma?
07:25His whole life.
07:26Never this fast.
07:27Barely moving there.
07:28Using all his accessory muscles.
07:31Call our team.
07:33Continuous nebs, 20 milligrams an hour.
07:35Yeah, I've been giving him albuterol every hour.
07:39Ready?
07:40On my count.
07:42One, two, three.
07:44Does he take any other medications?
07:45Just the albuterol.
07:46He used to be on Montalukaz and Simmacourt.
07:48Why did you stop that?
07:49Because he lost his Medicaid two months ago.
07:52It's so tight, nothing's getting through.
07:53Mel, EpiPen.
07:54On it.
07:550.3 milligrams.
07:56That may open his lungs so the nebs can work.
08:00All right, Grady, shot in the thigh.
08:06Hi.
08:08Something to scan?
08:10Critical labs on North 3.
08:12Oh, it's not my patients.
08:13She's about to be.
08:16I'm off the clock.
08:19These were ordered three hours ago for triage, so technically she is a day shift patient.
08:24Just get the interns started.
08:25I got a meeting upstairs with admin to 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 for your first rotation?
08:34Just lucky, I guess.
08:36Yeah, I feel like a good horror movie.
08:38Where was med school?
08:39Uh, UC Irvine.
08:41California, right?
08:42Yep.
08:42Pittsburgh's a little different.
08:43Yeah, a lot more humidity.
08:45Yeah, that'll go away with your first foot of snow.
08:48Uh, hi, Mrs. Davis.
08:50I am Dr. McKay.
08:52This is Dr.
08:53To Marion.
08:53Hello.
08:54Uh, your labs show a lot of inflammation in your liver, so 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, so I don't look like a ghost in my bathing suit.
09:09Do you remember the name of the bronzer?
09:11It could have a chemical that can cause it.
09:13Oh, no, no.
09:13It's 100% natural.
09:15It's DHA from sugar beets.
09:17Okay.
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?
09:25God, no.
09:26We have to ask everybody about injection drug use.
09:28Never.
09:29Rock clams or oysters?
09:31I'm a vegan.
09:33One step at a time.
09:35Great.
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?
09:50Duke goes to CT and they bump him.
09:52Yeah, he may end up waiting for hours over there.
09:54Oh, look at that.
09:55715 already.
09:57Just a few more loose ends to tie up.
09:58We've got more loose ends than a macramé wall hanging.
10:02My mom had one.
10:03Took 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.
10:08You sent Lena home.
10:09Are you planning on calling in a replacement or are you just gonna 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.
10:19Excuse 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 contusion, no intradominal hemorrhage.
10:33Which means I'm off the hook.
10:34I'll send neurosurgery down.
10:35If he doesn't need the OR, why neurosurgery?
10:38Wait and see.
10:38Let's get busy.
10:39CVP to the heart line.
10:40Orlando.
10:42Orlando, squeeze my hand.
10:45Open your eyes.
10:46We already know his GCS is going to be free.
10:48Hey, Javadi, anti-seizure prophylaxis.
10:50Cap brush.
10:51Any mix for kilo?
10:52Mixing it now.
10:52Better get this brain swelling down, Samira.
10:54How are we gonna do that?
10:56Samira.
10:57What?
10:58We have to lower the intracranial pressure.
11:01Manitol.
11:02Not the best can cause diuresis and hypertension.
11:04And hypertonic saline.
11:0623%, 50 cc's through a central line.
11:10So tight as a drum.
11:11Good five minutes.
11:12It's the epi.
11:13We can have one more epi pen.
11:14That's our borderline.
11:1587.
11:16How about BiPAP?
11:1710 over five.
11:18Yes.
11:18With inline nebs.
11:20All right, Grady, shot number two.
11:21Might as well throw him some magnesium.
11:2350 per kilo.
11:24I'm sorry, he's not ventilating.
11:25We should be ready to intubate.
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.
11:34We could always break him with a simbacort.
11:35We're gonna give the current treatment a few more minutes to help him drink.
11:42I could probably do this myself now that my cast is off.
11:46That'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.
12:10Shit, you okay?
12:11Yeah, there's water on the floor.
12:13Sorry, I might have spilled.
12:15Yeah, no worries.
12:16We're gonna have to sort these all by patient before we scan them.
12:20Is, uh, Joy still around?
12:23I heard she left at 6.59.
12:26Smart girl.
12:27Mm-hmm.
12:27You know what, find Ogilvy.
12:29He's just an ass kisser.
12:30He might stay and scan all the charts himself.
12:31No, he, 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.
12:52Yeah, when he asked, it was hard to say no.
12:55Sure.
12:58It's gonna 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.
13:08Yeah.
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.
13:23Why would you do that?
13:26I don't know.
13:27Why not?
13:32Hypertonics in.
13:32Maintenance.
13:33LR in the AC.
13:35Looks like a halo sign.
13:36Cerebral spinal fluid from a basilar skull fracture.
13:39Well, the halo sign is neither sensitive nor specific for CSF.
13:43Saline, tap water, and runny noses all separate from blood.
13:47Hello, Linda.
13:47Robbie.
13:48Vision chief working on a holiday weekend.
13:50Somebody's got to.
13:52Saw the scans.
13:54This guy needs an EVD.
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.
14:12CPP from 60 to 70 reduces morbidity and mortality.
14:16Can 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.
14:35You were in utero.
14:38I don't know how she got through motherhood and training.
14:41Feel free to join me.
14:42Oh, my shift was over a while ago.
14:45Okay.
14:46Masks all around.
14:47Two sterile gowns.
14:48We brought the surgical towels.
14:49Just need some beta dye.
14:50This is kind of an amazing opportunity.
14:53I'm exhausted.
14:54Chief of neurosurgery is here.
14:56She's kind of a legend.
14:58Maybe one of the night residents can do it?
15:00Is this about the Mobula's case from earlier?
15:02Because if it is, you made a mistake.
15:04You 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 DVD with me back when I was a brand new assistant professor.
15:22Time flies.
15:26How you doing, Grady?
15:27Still retracting.
15:29Any improvement?
15:30Not really.
15:31You feeling tired?
15:33Do we have aerogen in the ED?
15:35Just in the unit.
15:36How fast can you get back?
15:37Two minutes if I take the stairs.
15:39Go.
15:40Uh, aerogen?
15:41It has a five millimeter mesh that vibrates over 120,000 times per second.
15:51Dr. Ahishimi.
15:57You okay?
16:01Are you telling us about aerogen?
16:04Dr. Shen can explain.
16:07It produces droplets in the two to five micron range.
16:11Dr. Shen.
16:19How's it going?
16:20Just about to start.
16:21Securing the art line here.
16:23Measure twice.
16:24Cut once.
16:25We enter 11 centimeters back from the nasion.
16:29Three centimeters lateral.
16:30Without any direct imagery?
16:32Nope.
16:33Straight shot into the lateral ventricle.
16:35Tried and true since 1890.
16:38Okay.
16:39Go ahead with the incision.
16:42Hey, you worked with Dr. Ahishimi at the VA.
16:45I did?
16:46For how long?
16:47During my R2 rotation and then one again last year.
16:55Okay.
16:57Handrails all set.
16:58Maybe you should do this part?
16:59No, no.
17:00There's a safety stop here.
17:01You can't go too deep.
17:02It's not brain surgery.
17:07Okay.
17:11Stay perpendicular.
17:12Yeah.
17:13Good.
17:15All right.
17:15Now four turns to get through the outer table.
17:18Yep.
17:18And half turns till you penetrate the skull.
17:31Three.
17:34Four.
17:35One.
17:39Holy smoke.
17:40I thought it was Tom Cruise for a second over here.
17:43Nice job.
17:44How's that feel, Digby?
17:46Pretty good.
17:47My bad.
17:48What do you say we trim up those gorgeous locks ears now?
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 the fresh summer look that won't go in notice by the ladies.
18:04Maybe just the trim?
18:06Great.
18:06I'm thinking of pixie cut.
18:09What?
18:10I'm kidding.
18:11A couple of husband Benji's here all the time.
18:12Trust me, you're gonna look fabulous.
18:14When's the last time you had a haircut?
18:17Maybe my daughter's wedding a few years ago?
18:21Where?
18:21St. Sebastian, a 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?
18:42Whatever I want.
18:46You're gonna pass it five to six centimeters from the inner table of the skull.
18:50Okay.
18:53Centered.
18:56Perpendicular.
18:57Aiming for the medial canthus.
19:00All yours.
19:02And just keep going?
19:03You'll feel a pop when you pass through the appendable lining.
19:07All right, line is calibrated. Good to go?
19:09Try the nicardine pain to a map of 85, please.
19:13And if we can get the intracranial pressure down to 20?
19:17Dr. Mohan.
19:18I'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.
19:36Fall to pop.
19:38Remove the stylet.
19:42Okay.
19:43Let it drain a bit.
19:46And now pinch it shut.
19:50Perfect.
19:51BP is down 190 over 88.
19:53Heart rate 67.
19:58How are you guys doing?
20:01Yeah, making some progress.
20:03You seen Abbott?
20:04Not since round.
20:06He asked me to see a patient with the night intern.
20:08He said yeah.
20:1048 year old woman.
20:11New 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 doesn't eat meat.
20:34Kind of a health nut.
20:35Maybe she's gulping down cod liver oil to prevent measles.
20:39Vegan, no fish.
20:41Would you 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.
20:50Five 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.
21:05Weez is now expiratory only.
21:07Making 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 renewed?
21:21Neighborhood clinic.
21:22We pay cash.
21:23Poputerol's cheap.
21:24Sentiment court.
21:25Without Medicaid.
21:26400 bucks.
21:27A month.
21:27Just for a little inhaler?
21:31Choke ours on the tube.
21:34Tunnel 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 4th of July sale.
21:55The brain pressure is measured by the height of the fluid column.
21:58We need to calibrate it to zero at the level of the tragus.
22:01Stop cocks on.
22:02Ready to attach.
22:03First troponin's normal, but you need a second to rule out MI.
22:07Hey, can you step out for a second?
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. Alashimi, 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.
22:51No 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.
23:38How much do you take?
23:40500 milligram capsules.
23:42But I take back a day.
23:45What?
23:47With doses that large of turmeric, there have been cases of liver failure.
23:51From eating a spice?
23:52All right, Digby.
23:55Good to go.
23:56Mm-hmm.
23:56Would you like to see it?
24:10I haven't looked like this in a long time.
24:12Your family won't recognize you.
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.
24:35Did you dance with your daughter at her wedding?
24:40I did.
24:42And she will always remember you.
24:48Yeah.
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.
25:10Anything else I need to know?
25:13I don't think so.
25:15This is Dr. Robbie in the ED.
25:17I'm checking out a patient at Eakins.
25:19We can take Larson and Stevens off the dryer race.
25:21Consider it done.
25:22He's in the scanner now?
25:23Oh.
25:24Great.
25:25No, I was just calling to confirm.
25:27Any new information from upstairs?
25:29Nothing we all already know.
25:31Same old story, huh?
25:32You think we should take up a collection for Jesse?
25:34For bail money?
25:35They don't usually send bail until after you've appeared in front of a judge.
25:39With a holiday, it's not likely to happen until Monday.
25:41So he's gonna be locked up all weekend?
25:43That sucks.
25:44It does suck.
25:47Dr. Langdon?
25:48Grady's worse.
25:49Much worse.
25:50Neen attending?
25:51Uh, no, we have Shen.
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?
26:00Ma'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.
26:20Club up, Dr. King.
26:22In asthma, you can get air trapping.
26:24When 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 Bebe 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, Bebe?
27:19Maybe we could have some dinner after.
27:22Dr. Mohan, Lori Diaz is here. She wants to see your husband.
27:24She's heading back.
27:25Okay, I'm on my way.
27:29Mrs. Diaz?
27:30Hi.
27:31Did you 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.
27:38No bun, just 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.
27:53And 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.
28:11You let him leave.
28:13He insisted on leaving to work at his second job.
28:17You didn't make him stay.
28:19He was competent.
28:21He 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?
28:47Are you okay?
28:49Yeah, I'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 that.
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.
29:59Well, Frederick needs you.
30:02Yeah?
30:03Me too, yeah.
30:06Not Kelly Clarkson.
30:10Hey, that's a thick one.
30:12Austin Green, Ogilvy's AAA.
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 AAA.
30:40It's too small for surgery.
30:42He was supposed to come back every six months for a repeat ultrasound, but looks like he didn't.
30:47He would have seen that if the computers were working.
30:49Why wouldn't he tell Ogilvy?
30:51Maybe he forgot all about it, or Ogilvy didn't ask the right questions.
30:56Dennis.
30:57Hi.
30:57Got a minute?
30:58Uh, sure.
30:59What 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 at 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.
31:19Yeah.
31:20I already took one for the team.
31:21Yeah.
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.
31:42Sleep maxing, really?
31:44I'm gonna track the online trends.
31:46Is that your secret for the tough ones?
31:49Eh, I just think, what's the stupidest thing this person could have done?
31:52I'm gonna assume they did it.
31:55Well, I mean, she was trying to be healthy.
31:57Yeah, but I'm taking advice from fools.
31:59Turmeric 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.
32:09Mm.
32:10She's in pretty bad shape.
32:12Things get worse. She could need a liver transplant.
32:15Oh, because she's a big fucking idiot.
32:18Wow.
32:20No, I actually appreciate her.
32:22Our job security depends on all these big fucking idiots.
32:27Okay.
32:32Good night, Perla. Monica.
32:34Good 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.
32:53I 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?
33:11Oh, I don't know that survival was the outcome he was hoping for.
33:15What?
33:17I told Samiri he's got $100,000 in 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...
33:37But I didn't!
33:42Okay.
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.
33:59Uh, this can be pretty serious. If we don't get them out quickly,
34:01it can cut off the blood supply and cause the septum to collapse.
34:06Like, my nose could be deformed.
34:10Oh, my God. Get them off.
34:12Yeah, that's the plan.
34:13Yeah, she tried already. It 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.
34:41I think another half-hour we can send this dry race to Rebecca's storage.
34:45With pleasure.
34:46Dr. Rominovich?
34:47Yep.
34:47Results on your friend.
34:53Fuck.
34:54Duke?
34:59Are you gonna tell him?
35:02I want to talk to a surgeon, please.
35:03Uh, Dr. Robby?
35:04I have an update on the patient.
35:05But that was not a great time.
35:06Oh.
35:07Thought 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 code with the recipe?
35:20Yeah, I'll go check on Ogilvy.
35:22Please.
35:25Oh.
35:37Hey, Ogilvy.
35:42Ogilvy.
35:44You okay, man?
35:5199 on two liters.
35:53Scattered and expiratory wheezes.
35:55He 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,
36:25pharmacists 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.
36:43So, 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, uh, set you up with another one.
36:52Ah, is there a patient in here?
36:54Because everyone in this room looks extremely healthy to me.
36:58Dr. Shen and I will be with Grady all night long.
37:00Hey, day shift. We got this.
37:02We're leaving you in good hands.
37:04Um, I 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 health care.
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 baby.
38:19It's a vision 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.
40:01No, 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
40:43on the worst days of their lives.
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
41:03to decide if you want to come back.
41:08I don't really want to...
41:10go 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.
42:30Jesus 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 bag.
42:42Short hair clean shaves.
42:44I'll take care of him.
42:47Scalphim showed obvious pathology, so we ordered the CT in gerium.
42:50Textbook is sending out again.
42:51Resume eight centimeters.
42:53Fifty percent 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 see cardiology and pulmonary first to 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.
43:37Two for discharge.
43:39Yeah, please don't ring the bell.
43:40The computer's a backup button running.
43:42Not for these two.
43:43They don't have electronic health records yet.
43:45Wait, wait, wait.
43:45Hold 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, distal radius.
44:02He got a Velcro splint.
44:04And Mrs. Stegman had a small and medial meniscus tear.
44:07The immobilizer crutches and a follow-up with ortho.
44:09Could've 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, but 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 tag.
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.
44:52Sorry about your patient.
44:55Yeah.
44:55Lando's in pretty bad shape.
44:57Oh, no.
44:58I was talking about the triple-A guy you worked on with Ogilvy.
45:06He didn't make it through surgery.
45:08I tried to talk to Robbie about it, but I think he's busy.
45:12Excuse me.
45:16Oh, shit.
45:22You think I'm on edge?
45:23First you're Shaman Samira, then McKay.
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 should share your thoughts about a patient's possible suicide and slamming stuff.
45:33Please, sign out all this shit that's bugging you and get out of here.
45:36I can't.
45:37Yes, you can.
45:38When either of my kids was acting like this, I 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 one.
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 while I'm gone.
45:47Okay, I'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 started now.
45:56Walk away.
45:57I have too much to do.
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, wrap 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?
46:15I'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 Langdon 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 or Verset in your pocket.
46:39I'm worried about the people that I care about.
46:41Who all manage until you come back.
46:43We always do.
46:44Yeah, what if I don't come back?
46:45I wonder if I don't want people that?
47:10How many times are we doinglogs in the world today?
47:15What if I don't think?
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