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00:25Oh, okay.
00:27Where are we now?
00:29Got the VRI for a deaf patient in Central 12.
00:32Still waiting on Pete's for baby Jane Doe.
00:34Central 6 is sitting pretty with his insulin drip,
00:36and the Westbridge Diversions are kindly waiting their turn
00:38to sip our arms in our lovely halls.
00:40You are some kind of savant.
00:42Worthy of a race?
00:43Just more of my love.
00:45But enough of that.
00:46I have a sexual assault victim in triage I called par,
00:49so an advocate is on the way.
00:51Okay, we'll take care of it.
00:53Uh, Dr. McKay, what's going on with your patient in Central 9?
00:56Isn't she good to go?
00:57Oh, she was, but she decided she wanted to stay in the hospital now
01:00because she's in too much pain.
01:02In our loud and overcrowded ED,
01:04with more Westbridge cases arriving every moment,
01:06she would be more comfortable at home.
01:08Your deep breath is lovely.
01:13Hey, would you mind helping Dana with a sexual assault victim who just came in?
01:16Of course, sure.
01:17Why don't you and I go see if we can't convince your patient to leave?
01:20All right, I need to take care of a sexual assault victim in triage
01:23when he needs to hold down the fort.
01:25We can call for a saint.
01:26On a holiday?
01:27Be ours.
01:28We're not going to make this patient wait.
01:29And since I'm the only saint on staff...
01:31Princess, we'll cover.
01:33Hey!
01:34Hey!
01:35You two better not be teaching any bad habits.
01:37Come on.
01:38You ready, dog?
01:39Sure.
01:40A saint is a sexual assault nurse examiner.
01:43We do forensic exams, collect evidence, and hand it over to the police
01:46if a report is made.
01:47We also provide resources, support, sometimes even testimony.
01:51You go to court?
01:52Saints are very valuable in a hospital, especially in the ED.
01:55More nurses should train for it.
01:57It's a not-so-subtle hint.
02:07Looks like this is the new hot spot, huh?
02:09And only getting hotter.
02:11Any word on what's going on with Westbridge?
02:12They got 20 on lanternflies.
02:14No, nothing.
02:16These patient passports have an interesting alternative use.
02:19Where's the sexual assault victim?
02:21She's in triage chair two.
02:22Thanks, Lupin.
02:24Here's her intake.
02:25Got it.
02:33Hi, Miss Miller.
02:35I'm Dana.
02:37How are you doing?
02:39Been better.
02:40Yeah.
02:41You're in a safe place now.
02:42I'm the charge nurse in the ED and a sexual assault nurse examiner.
02:46This is Emma.
02:47I'll be assisting.
02:48And I'm Dr. Al-Hashimi.
02:50I'll be checking you for any injuries that need immediate attention.
02:54You can just call me Alana.
02:56Um, I don't have any injuries.
02:57Okay, that's good.
02:58We're gonna get a room ready for you.
03:00Meanwhile, Dr. Al-Hashimi's gonna ask you a few questions.
03:03How long is this gonna take?
03:05I can't promise an exact time, but we'll try to be as fast as you need.
03:10Yeah.
03:15Okay, Alana.
03:16Do you take any prescription medications?
03:18Just Synthroid.
03:19One tab a day.
03:20Okay.
03:21And any allergies to medications?
03:23No.
03:24Okay.
03:24Dana will come get you when the room is ready, and I'll be back to finish your exam.
03:35Come find me when she's in a gown.
03:37Will do.
03:38We're gonna use triage exam rooms one and two for this.
03:41It's the most private space we have away from the ED.
03:44All right.
03:44This can be a lot.
03:45You up for it?
03:47Yeah.
03:48Yes.
03:49I'm good.
03:50All right.
03:50Let me know if you need to step out.
03:59Oh, yes.
04:04Dr. Ellis.
04:05Oh, no.
04:06Oh, yes.
04:07Need the room.
04:08Find another place to lay your head.
04:11Not even a 20-minute power nap?
04:13No, my double's at 1.30.
04:15I'm tired.
04:15No, we're getting Westbridge diversions.
04:17And chairs is insane.
04:18Didn't you see out there?
04:19Ew.
04:20I do not come in through that mess.
04:21Okay.
04:23Yeah.
04:25People sleep in here?
04:26Yeah.
04:26Night shift doctors need rest.
04:28Especially if they have to come in during the day.
04:30But today we can't waste the space.
04:32I need you to get me a stool on wheels and Esme for a turnover.
04:40So you're having a headache and abdominal pain?
04:47Yeah, that's right.
04:48Okay.
04:48And which would you say is worse?
04:55My headache was terrible last week, but now...
05:00Hey, you're breaking up.
05:01Can you run that back again?
05:03Sure.
05:07My headache was terrible last week, but now my abdominal pain...
05:13God, come on, you piece of shit.
05:16Fuck.
05:17Um...
05:33I'll be right back.
05:35Um...
05:45I'll...
05:46I'll...
05:46I'll...
05:46I'll be right back.
05:48Sorry.
05:55Um...
05:56Dr. Al Hashimi?
05:57Jackson's parents are here.
05:59Okay.
05:59Take that.
06:01Um, Mr. and Mrs. Davis, this is one of my attendings, Dr. Al Hashimi.
06:05Hi.
06:06Nice to meet you.
06:07Demi.
06:07Charles.
06:08What the hell's going on?
06:10He's barely conscious.
06:12Jackson's just a little tired due to the sedative he was given.
06:15You sedated him.
06:16Oh, your son was brought in extremely agitated.
06:18You'd be too if you were tased.
06:20And why the fuck did they do that?
06:22This is bullshit.
06:24We're taking him home.
06:25Why don't we step out for a second?
06:35Right now, Jackson is on an involuntary psych hold.
06:38What?
06:39That's not necessary.
06:41He just needs some rest.
06:42He's been studying for the bar exam.
06:44We can watch him at home.
06:45So far, all of his tests look good, but Jackson has reported hearing voices.
06:50This could be serious.
06:51Dr. Jefferson will come back and speak with you.
06:54He can explain more of what may be going on with Jackson.
06:57And who is Dr. Jefferson?
06:58He's from psychiatry, and he's excellent.
07:00He can explain next steps and answer all of your questions.
07:03Javati, why don't you take the Davises to the family room?
07:05Sure.
07:05Excuse me.
07:06It's just this way.
07:29You have reached the Pittsburgh Neuroscience Group.
07:32If this is a medical emergency, please hang up and dial 9-1-1.
07:37For our address and office hours, press 1.
07:40To refill a prescription, press 2.
07:43To leave a message for the doctor on call...
07:47Hi, this is Dr. Baron Al-Hashimi.
07:50I'm a patient of Dr. Fairgraves.
07:51I need to speak to him if he's on call.
07:56If he's not, I'll take his next available appointment.
07:59And please call me if he has a cancellation.
08:04Like I said, you're more than welcome to stay down here until an inpatient bed opens up upstairs.
08:09But that can take a while.
08:10Sometimes days.
08:12Even longer.
08:14It's going to be really noisy here and you won't get any rest.
08:17At home, you'll be surrounded by your family and be more comfortable.
08:22It's your choice, Roxy.
08:27It's not that I don't want to go home, but...
08:30Hi, Mom.
08:31Mom.
08:32Lena texted me to come back.
08:33I figured I'd bring the boys.
08:35What's going on?
08:36Is everything okay?
08:38Robbie.
08:39Police officer.
08:40Incoming trauma.
08:41Coming.
08:43I'll be right back.
08:44We'll give you a chance to talk.
08:46Oh.
08:48Okay.
08:49You can have a seat.
08:58Do you need anything before we begin?
09:06You are in control now, Alana.
09:09We're here to help and support you.
09:11Once I open this kit, I cannot leave the room.
09:15But if you need a break or some air, just let us know.
09:18Okay?
09:19Emma can go with you if you like.
09:21An advocate from Pittsburgh action against rape has been called and they should arrive soon.
09:26Can we start?
09:27Sure.
09:28I'm gonna put my face shield on so it don't contaminate anything.
09:32Emma's already done the same.
09:35Now, in order for the doctor to do her exam, I need you in a gown but I need to
09:40collect your clothing first.
09:41Is that okay?
09:47I'm gonna need you to undress on top of these pads.
09:50Put each item of clothing on the pads, okay?
09:54Then we'll package each piece in a separate bag.
09:57We'll get you new clothes.
09:58Don't worry.
09:59All right.
10:00Emma's gonna be behind this curtain and I'll be in here with you.
10:04Take off your shoes first.
10:07When you're done, I want you to put on your gown, open in the back.
10:15Okay.
10:39What if the mom doesn't want to leave?
10:41Well, then she's gonna have to put up with us.
10:45I can't imagine.
10:47Her boys.
10:49Oh, don't go there.
10:50I'm gonna see if I can grease the wheels, get her room upstairs soon.
10:53Good luck.
10:54What is that?
10:55A battle plan for a hall space is filling up fast.
10:58Police officers should be here any minute.
10:59Yeah, well, as soon as you can, please.
11:01I need you to fix the VRI.
11:03Thanks.
11:04Santos, I need you to pick up some more of these Westbridge diversions.
11:07Sure.
11:07You want my firstborn, too?
11:09Maybe.
11:10Will they know how to suture?
11:11Intubated neck wounds.
11:12That's not great.
11:13We were diverted here.
11:14Is there a trauma room open?
11:15Trauma one.
11:16What's the story?
11:16My buddy Officer Hero.
11:17High Velocity GSW.
11:19He's getting harder to bag.
11:21Warehouse robbery gone sideways.
11:23One, two, three.
11:25You guys wait here.
11:26We'll take care of them, I promise.
11:28I thought you left us already for the open road.
11:29I miss seeing you in uniform.
11:31You should see me as a flight attendant.
11:32Do you do this intubation?
11:34Under active fire, yeah.
11:35Are you serious?
11:36I go in with the team in case there's an injury.
11:38That's badass.
11:39Dr. Santos, let's make sure these lungs are up.
11:41Can you see the courts?
11:42Yeah, it was a great view, but it was hard to pass after I cleared them.
11:45Yeah, SAT 7085.
11:47Dr. Santos, what could cause respiratory failure in an intubated patient?
11:50There are a lot of possibilities.
11:51I think dope.
11:53Displacement, obstruction, pneumothorax, equipment failure, good lung sliding, no pneumo.
11:59It is displacement.
12:01Okay, that is a transected trachea.
12:05Pulling out.
12:07Bag.
12:08But if he intubate again, won't it just come straight out the wound?
12:11Yup, exactly.
12:12So we didn't need another plan.
12:13Yeah.
12:13Okay.
12:14SAT's down to 83.
12:15Yeah, he's not moving in the air.
12:16Okay, I need a neonatal mask.
12:18Neonatal?
12:19Yep.
12:21I'm just going to finish my initial exam.
12:23Let me know if you feel any pain, okay?
12:29My legs are fine.
12:32Well, it looks good.
12:34No need for x-rays or advanced imaging.
12:36Got it.
12:37Two areas of ecchymosis.
12:39That means bruising.
12:40Over the shoulders bilaterally.
12:41I'll document my photos.
12:43Okay.
12:44Dana will finish up her work and I will be in the ER if you have any questions.
12:47You're in great hands.
12:48You're in great hands.
12:51All right, Alana.
12:54I read your intake.
12:56Why don't you give me your description of exactly what happened?
13:02I was at a 4th of July barbecue with a bunch of friends.
13:08I helped set up.
13:19Where does it hurt?
13:21Like here, under my belly button.
13:24Okay.
13:24Do you have any fever, vomiting, diarrhea?
13:28No.
13:29It's just a stomach ache.
13:31Okay.
13:31Well, still go see the nurse and have her call me.
13:33Okay.
13:34But I'm still having ice cream tonight.
13:37We'll just see how you feel later.
13:39It's not bad.
13:41You don't have to get so sad.
13:43You're not sad.
13:44I'm good.
13:45Your face doesn't look good.
13:48Um.
13:48Well.
13:49Do you still want to watch the fireworks tonight?
13:51I have our headphones.
13:54I'm not being rude.
13:55Sorry, Becca.
13:56I gotta go.
14:02Elliot Green, 17.
14:04Syncopal episode of football practice.
14:06Look, I just got dizzy.
14:07Okay?
14:07It's hell week.
14:08I need to get back.
14:09Yeah.
14:09Okay.
14:09Tough guy.
14:10A&O.
14:11Systolic of 95.
14:13TAC at 122.
14:14No meds.
14:14No allergies.
14:15How long were you at practice?
14:16Started at nine.
14:17So, like, four hours.
14:19Four hours in this heat with all that gear?
14:21No pain.
14:22No gain.
14:26God, I'm hungry.
14:29Hey.
14:30When's our break?
14:32There's no breaks down here.
14:33Always make sure you pack a protein bar.
14:34Something quick.
14:36Ogilvy.
14:37Joy.
14:38Jump in on this.
14:40Syncope at football practice.
14:41I just...
14:42I just need it to hydrate.
14:44Possible heat stroke?
14:46Well, with heat stroke, you would have an altered mental status.
14:48They're usually dry, not sweaty.
14:49Mortality is 50%, especially in the elderly.
14:52And in extreme heat like this...
14:55Landon, can you cover this?
14:57No problem.
14:57Mr. Diaz?
14:58Orlando.
14:59Orlando.
15:00Where are you going?
15:01Home.
15:01We take these out.
15:02Uh, no.
15:03It takes 48 hours for you to get out of DKA.
15:05Your blood is still full of acid.
15:06Look.
15:07I can add thousands of dollars to the 100 grand I already owe.
15:10I'm...
15:10I'm sorry.
15:11100 grand?
15:12Medical debt.
15:12My wife doesn't even know.
15:14I'll never be able to pay it off as it is.
15:16Where are your wife and daughter?
15:17Maybe we can all talk.
15:18I told them to go back to work a couple hours ago.
15:20But the hospital is giving you a big discount.
15:21And Mr. Diaz, I know it's not ideal, but can you stay for at least 12 hours?
15:25It will get you out of the danger zone.
15:27No.
15:28I really can't.
15:29Every minute I stay is a meal, shoes, school supplies.
15:33Plus, I have a second job I have to get to by four.
15:35You need fluids.
15:37I drink plenty of water.
15:38And potassium and insulin.
15:40Okay, how about this?
15:41You stay and I'll get together everything you'll need at home.
15:44Also, a referral to Northside Christian Health Center.
15:48Come on.
15:49You don't work until four.
15:50It'll keep you from passing out on the job again.
15:53Or worse.
15:58Okay, I guess.
16:00Great.
16:02Please.
16:06That's up to 98.
16:07Neonatal mask is working.
16:09Santos, finish the test.
16:10What are you injecting?
16:12Lido with Epi.
16:13It'll clamp off any little bleeders, some skin hooks.
16:15Four Shiley?
16:17I don't like the curve of a Shiley.
16:18I didn't know you were so picky.
16:20Santos, take a break.
16:21Help me cut down a 6-O-E-T tube.
16:23What is going on here?
16:24You have a field medic assisting you?
16:25Dr. Abbott is an attending, and he's also a SWAT physician.
16:29My buddy Hiro here is in bad need of an airway.
16:32I cut it right here.
16:33We can do this.
16:34Oh, no, I got it.
16:35You must be Gloria's new hire.
16:36Yes, Dr. Al-Hashimi.
16:37Well, I'd shake your hand, but my tube is ready.
16:40And if I could find it secure the distant trachea, we have a shot at this.
16:42Okay, keeping an eye on the stats.
16:46Slow, smooth, smooth as fast.
16:47You know, you can call me just to say hi sometimes.
16:50What's up now?
16:51GSW with tracheal transection.
16:53Very retracted, but I think I can get it.
16:56Both lungs are up.
16:58Sat's standing the belly now.
17:01Okay, just...
17:03I got it.
17:04I got it.
17:07I got it.
17:08Gently, gently.
17:09Oh, we're going to lose it.
17:10Down to 89.
17:12Oh.
17:13I'm in.
17:13Balloon up.
17:17End title.
17:17Excellent waveform.
17:19Good breath sounds.
17:22Also the tracheal to the skin, 2-0 silk.
17:25Sats are coming up.
17:26Ooh.
17:27Not bad, Evan.
17:30While you were playing him with that airway, you missed a big bruise in the left upper quadrant.
17:34He was wearing body armor.
17:35High-velocity projectile doesn't have to penetrate to do damage.
17:38There's no fluid in the super-splaining space.
17:41Let me look.
17:43Okay, right there.
17:46Looks like a subcapsular hematoma of the spleen.
17:49Must have been a big impact.
17:50AR-15 muzzle velocity is 3,000 feet per second.
17:53CT angio of the neck ASAP, along with CT chest, abdomen, pelvis.
17:57Yep.
17:58Just as soon as we secure this tube...
18:04Burst leaders in.
18:05Mucous membranes dry.
18:07Pupils, 4 millimeters reactive.
18:09Did you get tackled today?
18:10No.
18:11Just running drills.
18:12Any chest pain?
18:13Palpitations?
18:14No.
18:15Hands off, please.
18:15Running the 12 lead.
18:17How are we looking?
18:18Good.
18:19Healthy kid.
18:20No history.
18:20No trauma.
18:21Differential for syncope in an adolescent.
18:24Cardiac arrhythmia from drugs.
18:26Lung QT, WPW, or brugada.
18:29Brugada is more common in Asian males.
18:31That still should be considered.
18:32Long odds, sir.
18:34Brugada prevalence is 1 in 20,000 in North America,
18:36as high as 1 in 300 in Asia and the Middle East.
18:39And?
18:40First described in 1992,
18:42has a high incidence of sudden death among young patients
18:44with otherwise structurally normal hearts.
18:46Wait.
18:47Did you just say sudden death?
18:48Temp is 1 in 2.5.
18:50Sorry.
18:50Our student doctors are discussing a rare condition you don't have.
18:54I just didn't drink enough water.
18:57I overheated.
19:00Not my type, bud.
19:02Other than standard labs, what else to order?
19:08CK to rule out rhabdo.
19:10To make sure you don't have any muscle breakdown from the heat.
19:13Let's set up a cooling room for Elliot here
19:15in the other heat exhaustions we will inevitably get today.
19:22Last photo.
19:27Okay.
19:28I'll take the SD card and seal it in an evidence envelope with everything else.
19:34Okay.
19:35Next, I'm just gonna turn off the light.
19:39And I'll run a blue light over your skin.
19:42Anything glows, I'll swab it with a wet, then dry Q-tip.
19:48Is that okay?
19:49Yeah.
19:49Sure.
19:50Good.
19:53All right.
19:54Take off your gown on the left side and turn a little bit towards me.
19:57Just to the left.
19:59There you go.
20:01Yep.
20:01There you go.
20:19Okay.
20:26Is that okay?
20:27Some on the left wrist.
20:28A swab.
20:37Sorry.
20:38Don't be.
20:39Just cold.
20:40Yeah.
20:41Almost done.
20:44I know you missed that.
20:49Thanks, Antoine.
20:50No problem.
20:51Keep your head down out there.
20:53What's the story?
20:54Neck angio is negative. Missed the carotids.
20:57It's lucky.
20:58What about the belly?
20:58Small splenic injury, no free fluid in the abdomen.
21:01That should heal on its own.
21:02What's the plan?
21:03Head and neck will have an OR ready with thoracic standing by.
21:05How soon can they take him?
21:07We're a little backed up with Westbridge patients, but let's bring him up.
21:10I'll get him taken care of for you.
21:13Hey.
21:14You're gonna be okay here, or we're getting you to surgery.
21:17I'll write the procedure note.
21:24Swat? Really?
21:26I suck at golf.
21:28You spend time in the Middle East?
21:30More than I would have liked.
21:32I worked in Kabul with Médecins Sans Frontières, and in 2020 at the maternity hospital.
21:37I met the most incredible, bravest doctors there.
21:41Pashti Barchi.
21:43Tragedy.
21:46We should grab a beer sometime. Share war stories.
21:49I'd like that.
21:54She seems cool.
21:55Yep, maybe.
21:57I think I could be around long enough to find out.
22:00Oh, there she is. Vic!
22:03Dad.
22:04Victoria.
22:05Victoria, this is Dr. Amy June.
22:07Dr. June is the smartest person I know.
22:09Don't tell your mother.
22:10Just kidding.
22:11Seriously, don't.
22:13Hello.
22:14Hi, are you here to see a patient?
22:16No, we're here to see you.
22:17Dr. June is chief of dermatology.
22:19And Victoria's first shift in the ER was on the day of the Pit Fest shooting.
22:24I heard all the incredible stories, including your own acts of med student prowess.
22:30Wow, med student prowess.
22:32That's, uh, I'm pretty sure I was just trying to stay out of the way.
22:35She's modest, like her dad.
22:37And her mother?
22:38Oh, sorry.
22:40Dr. June.
22:42Yep.
22:43Coming.
22:44I'm doing a favor for someone at the mayor's office who needs Mohs surgery on a basal cell carcinoma.
22:49And then I'm grilling for 30.
22:52Oh, man.
22:53Happy 4th, all.
22:54Happy 4th.
22:55Thanks for coming down.
22:56My pleasure.
22:57Let's grab a coffee sometime.
22:58Absolutely, yes.
23:01You know mom really wants me to go into surgery.
23:04Your mom wants me to stop drinking and join a pickleball league.
23:07Oh, that's the same.
23:08Yeah, well.
23:09Exactly.
23:10I will risk an Achilles tear before I give up scotch.
23:13Hey, I hope I didn't embarrass you coming down here.
23:15No.
23:16I'm just trying to present you with some options for your residency.
23:19I really appreciate it, Dad.
23:21I do.
23:22I just...
23:23I'm still not sure.
23:25Well, either way, you'll do what's right.
23:27You always do.
23:28Radia.
23:30Talk to Javadi.
23:32You are a man of many talents.
23:33You don't know the half of it.
23:35Your daughter has some high standards to live up to.
23:38Oh, you don't know the half of it.
23:43Mr. and Mrs. Davis, this is Dr. Jefferson from psychiatry.
23:47Please call me Caleb.
23:48Can you tell us what's going on with our son?
23:51All of his labs and x-rays came back normal, given his age and his hearing voices.
23:59Do either of you have a family history of mental illness?
24:03Not mine.
24:11My brother took his own life.
24:13Wait, what?
24:15Uncle Ken?
24:18He said he drank himself to death.
24:20Ma, he did that too.
24:21Was he ever formally diagnosed with a mental health issue?
24:24No.
24:24He was depressed, had mood swings, but he didn't want to see anyone.
24:30Oh, my God.
24:30Okay, why am I just now hearing about this?
24:32Jada, please.
24:33Please what?
24:33Mom, why would you not tell Jackson?
24:36Or me?
24:38I can't believe it.
24:39Jada.
24:40Excuse me.
24:41Jada.
24:47Jada.
24:50What happens next?
24:51We keep your son here for the next three days for observation and therapy, and that'll help
24:57us to understand what is going on.
24:58Jada should really hear this.
25:00Let me see if I can find her.
25:01Bring her back.
25:05Okay, I'm going to swab your mouth now.
25:08My mouth?
25:09Two dry swabs along the inside of your cheek, and then along the gum line.
25:19How are you feeling?
25:23I wish this day never happened.
25:25Would you like some medicine to help you relax?
25:27You've experienced horrific trauma.
25:32You've been doing this a while?
25:33Let's just say Florence Nightingale and I were roommates.
25:37Who?
25:39I rest my case.
25:41She was the founder of Modern Nursing.
25:45Okay, we can have some to eat a drink now.
25:48I'm fine.
25:49You sure?
25:49I'll just keep going.
25:52Okay.
26:00We now have a heat exhaustion treatment area in North Park.
26:05Evaporated cooling.
26:06Great plan.
26:08Yeah, it was Dr. Langdon's idea.
26:12He figured we'd be seeing a lot more patients in this heat.
26:16He's right.
26:18How are you feeling?
26:20It's a loaded question.
26:22It wasn't meant to be.
26:24You have a deposition in a couple hours?
26:26Yes.
26:27How are you feeling about it?
26:28I'm trying to think positively, but feeling less so.
26:33This job's really important to me, and my sister, you know, I support both of us.
26:37It's going to go great.
26:38Just tell them what happened.
26:40You're not at fault.
26:40Your job's not in jeopardy.
26:42I mean, the lawyer said that I could...
26:44The lawyer's job is to try and shake your confidence, so don't let them.
26:47You're a very good doctor.
26:48I have been training residents for years.
26:50You are one of the very best.
26:53Him?
26:54No, we need to stick to the plan.
26:56Promise.
26:57Thanks.
26:57She's not thinking for us, okay?
26:59It's going to be great.
27:00This is not what she wants.
27:01Then I'm taking her home.
27:03That's it.
27:03We have to honor your wife's wishes.
27:05Even if she's loaded up with morphine and can't think straight?
27:08Especially then.
27:09Hello?
27:10Paul Hamler, this is my attending Dr. Rubinovich.
27:12Hi.
27:13Hi.
27:13Uh, my wife is not thinking clearly.
27:16What is it that she's asking for?
27:19It's that she wants to stay here.
27:21Why don't we all go in and talk?
27:24Brian Jenkins is allowed to hunt with a .22 on his grandpa's farm.
27:28Sounds like an accident just waiting to happen.
27:30Mm-hmm.
27:31And you're not Brian Jenkins.
27:33How are we doing in here, Roxy?
27:35Been better?
27:37Rumor has it you're still interested in booking a room with us.
27:41I don't want to go back home yet.
27:43It's all set up, Rox.
27:45You're going to be more comfortable at home.
27:47Paul, I changed my mind.
27:49It is our home.
27:52I don't...
27:54I don't want you living with my ghost.
27:56I will happily live with your ghost.
27:58Can we just all stop talking about ghosts, please?
28:01Yes, I'm sorry.
28:03I'm sorry, sweetie.
28:04You're right.
28:05Got trauma flying in each day of five minutes.
28:08Okay, um, I'm very sorry.
28:10I will be right back.
28:11Excuse me.
28:13It's a boating accident.
28:15Swimmer versus propeller.
28:16Ouch.
28:17What body parts involved?
28:18They didn't say.
28:19How old?
28:20Nope.
28:21Anything?
28:21All I got was boating accident.
28:23Swimmer versus propeller.
28:24Got it.
28:29Here was trauma.
28:30Easy in two minutes.
28:31Here was trauma.
28:32Easy in two minutes.
28:56Picked a hell of a day to come back, huh?
28:59How's Jake?
29:02He's good.
29:04Better.
29:05He's coping.
29:06Gonna be a senior this fall.
29:08That's great.
29:11There's a lot for him to go through.
29:14A lot for all of us to go through.
29:16Yeah.
29:19Okay, I'm just gonna say it.
29:21I'm sorry.
29:23I betrayed your trust.
29:24I betrayed our patient's trust.
29:26And I'm really fucking sorry.
29:28It'll never happen again, I swear.
29:34I'm really glad that you got the help that you need.
29:40But I don't know if I want you working in my ER.
29:43I don't know if I want you to go through.
29:53Why'd you intubate?
29:53He was splitting from the pain.
29:55Barely moving air with sats in the 80s.
29:56How do you get sliced up in the propeller?
29:58He was in the Allegheny trying to untangle a water ski tow line when his buddy started the engine.
30:02Drunk buddy, I assume?
30:03It's 4th of July.
30:04You tell me.
30:05Focus on the patient, please.
30:06Sophie, take over bagging.
30:10Okay, 1, 2, 3.
30:12Watch that buckle.
30:15You need me in here?
30:16Nope.
30:16We have a senior resident and an attending.
30:19Mel, can we start with a...
30:20E-fast, sure.
30:22Yes, please.
30:23Why?
30:23To check and make sure there's no pneumothorax, otherwise it could become a tension.
30:27Exactly.
30:28Oh.
30:30You want Oneg?
30:31Not without a BP first.
30:33108 over 64.
30:34Pulse is 102.
30:35Sats are good.
30:36Okay, let's have Oneg ready, but don't give it just yet.
30:39Anything else?
30:43How about a humo cube?
30:44Uh, yeah.
30:45Yeah, yeah, yeah, of course.
30:54Next step is fingernails.
30:58We'll go under each nail.
31:00First with the wet swab, and then with the dry one.
31:04Do you want to take a break, huh?
31:07No.
31:14How much longer?
31:15After these, we'll get to external and internal vaginal collection.
31:23It's the advocate from PAR.
31:26Okay.
31:27They've been doing this longer than I have.
31:29They provide resources, assistance, and support for sexual assault survivors.
31:35Hey.
31:38This will not define you, okay?
31:40You don't have to talk to them, but I recommend you do.
31:44They're available 24-7.
31:48Okay.
31:49Okay.
31:56Hi.
31:57I'm Paulette Sanderson from Pittsburgh Action Against Rape.
32:01Hi, Paulette.
32:02I'm the same thing, and this is Alana.
32:03Hello.
32:04Hello.
32:04I'm sorry to meet you under these circumstances, but I and my organization are here to help
32:09you navigate everything that comes next.
32:11I brought you some clothes and basic necessities.
32:14I can even stay with you through the rest of your examination if you'd like.
32:20Uh, I don't think that's necessary.
32:22Okay.
32:23No.
32:24That's fine.
32:25Would it be okay if I ask you a few questions?
32:27No.
32:38Sure.
32:42Our, uh, VRI isn't working.
32:45Video relay interpreter?
32:47Yeah, of course I rebooted it.
32:49Wait, how are you going to fix it if you don't know what the hell it is?
32:53Yeah, okay.
32:54Whatever.
32:55Um, I want to do a head and belly scan on Harlow.
32:57Can you try telling her why?
32:58What about the VRI?
32:59It's DOA.
33:02I'm charting every free minute I get.
33:04I wasn't coming over for that.
33:06Good job in the trauma earlier.
33:11What's this?
33:12Daniel Scott, 32.
33:14Weekend dizzy while washing his car.
33:15Tacky at 106.
33:16BP 90 over 60.
33:18Temps too high to register.
33:19We have the coolie room set up at North 5.
33:21Okay, how you feeling, Mr. Scott?
33:23Thirsty.
33:23Let's see if we can't fix that.
33:24He's going to need a core temp, a CMP.
33:26Whoa.
33:27Oh, hey, we need a trauma room.
33:28What's open?
33:29Two.
33:29I'll grab the Ativan.
33:31Any past medical history?
33:32No.
33:32Wife says he's healthy.
33:33No meds, no allergies.
33:35He needs a core temp.
33:41Ready to transfer?
33:43Let's give two of Ativan.
33:44Don't want him seasoned again.
33:46I've got to get back to my patients.
33:47One, two, three.
33:51Orders?
33:52Second IV with saline open.
33:54Sepsis panel, UA, urine drug screen, EKG, and CK.
33:57I don't see any apparent trauma.
34:01People's reactive.
34:02Mr. Scott, Daniel, can you talk to me?
34:05Post-dictal, but moving all extremities.
34:07Pulse 137, BP 88 over 60.
34:09What are you thinking, Dr. Santos?
34:11A heat stroke, but consider sepsis or drugs.
34:17Rectal temp is...
34:19104.6.
34:20Okay, let's start with four ice packs on the groin and axilla.
34:24Should we do a full-body ice bath?
34:26That'll take too long.
34:27You have an arctic sun?
34:28Yeah, we do.
34:28Get pats on the chest, abdomen, and both legs.
34:30I'll check back in.
34:34Ceftazidem is up.
34:36First hemoglobin, 8.2.
34:388's pretty low.
34:38He must have bled down from 14.
34:40Anything you want to do about that?
34:42Young, healthy guy, we transfuse at 7.
34:45Do we?
34:46We'd be in real trouble if he equilibrates from acute blood loss.
34:49Am I interrupting something?
34:50Multiple lacerations.
34:55Jesus, this looks like some Jurassic Park shit.
34:58Is that your official surgical diagnosis?
35:00He is hemodynamically stable.
35:02What else do we know?
35:05Intubated in the field due to poor tidal volume.
35:08E-fast was negative for pneumothorax,
35:10so no need to do a chest tube.
35:13And no free fluid in the abdomen.
35:16Good hemostasis inside the wounds.
35:17Nothing arterial.
35:18I foresee it a hemoglobin of 8.2.
35:20We'll follow that closely.
35:22With no active bleeding, I wouldn't transfuse just yet.
35:27Dr. Langdon agrees with you.
35:29Let's get him to CT.
35:31Jason Stills, 62, was gathering the makings of a salad
35:34when he started feeling dizzy and nauseated.
35:37Vomited once.
35:37How you feeling, Mr. Stills?
35:39I'm gonna die.
35:40Well, you came to the right place to prevent that.
35:43Do you mind if I touch your abdomen?
35:45Yeah, sure.
35:47Does this hurt at all?
35:48No.
35:49Use tachycardic at 124 with a temp of 102.4.
35:52Hey, Joy, what's your suggestion?
35:54Keep hydrating, check electrolytes,
35:56and move him through the cooling room.
35:57Precisely.
35:58Good luck finding a parking spot.
35:59North 5.
36:00What?
36:01No valet?
36:06Jayda.
36:07Hey.
36:09I've been looking all over for you.
36:10I just went for a walk.
36:12I wanted to talk to you.
36:14That's okay?
36:17So does Dr. Jefferson.
36:19It's important that you get to hear what he has to say.
36:21Why?
36:22Because I'm gonna go crazy like my brother?
36:24Or kill myself like my uncle?
36:27Oh, of course not.
36:28Um, but we still have no idea what caused Jackson's episode.
36:34Episode.
36:35Right.
36:37Look, I know this must be so scary for you.
36:41And you probably feel betrayed by your parents.
36:45But they had no way of knowing about Jackson.
36:48You know, and some families just have a difficult time talking about mental health.
36:54Now you can help us take the first steps to finding out what we can do to help your brother.
37:04Mr. Diaz?
37:06I have a surprise for you.
37:08Shh.
37:09Oh.
37:12Sorry.
37:13It's okay.
37:14Have you...
37:14Have you seen my patient?
37:16Orlando?
37:17Mr. Diaz?
37:18Room was empty.
37:21Seriously?
37:22Yeah.
37:28What happened to you?
37:30Oh.
37:32Well, it grazed my vest.
37:34You were shot?
37:35Shot at.
37:36Geniuses thought today was the day to rob a goods warehouse.
37:40Didn't think about how long it would take to load the appliances.
37:42They panicked.
37:43All hell broke loose.
37:45Jesus.
37:49Why do you do this?
37:51My therapist said I needed a hobby.
37:53Funny.
37:56Shit.
37:57This...
37:58This sucks.
37:59Oh, it's nothing.
38:00No, I...
38:01No, don't worry about me.
38:01I'm fine.
38:02Seriously.
38:03My patient, he didn't have any insurance, and he was already in a mountain of medical debt.
38:10But he couldn't afford any of his meds.
38:12Hmm.
38:14What's in the bag?
38:16Insulin, test strips, electrolyte powder.
38:21I got him everything he needed for home care.
38:24So Ubered to his house.
38:26Is the hospital going to pay for that?
38:28I'll pay for it.
38:40What are you doing?
38:42Well, you clearly can't.
38:45Did you make a chart?
38:47No.
38:48This can stay off the books.
38:50Don't need the paperwork from the hospital or the police department.
38:54Okay.
38:56Or a little secret.
39:01How's he doing?
39:02Any more seizures?
39:03Nope.
39:0510.02.9.
39:06Lab spec?
39:07Mostly signs of dehydration, TAD hypernatremic, mild BUN, and creatinine bump.
39:13CK400 something.
39:14Nothing worse than yet.
39:15Okay, good.
39:16Keep cooling.
39:17I'll monitor him.
39:18Great.
39:19That'll give Dr. Santos a chance to get caught up.
39:25Your R2 year can be challenging.
39:28You just have to keep grinding.
39:30What's your dyspo plan for Mr. Scott?
39:33ICU admission.
39:35You should call neurology to consult.
39:37Yeah, done.
39:38Since it was exertional heat illness in a young person, the mortality is low.
39:42But non-exertional heat stroke in an elderly person, you need to worry.
39:47I'll put in orders for repeat labs.
39:50Good work in there.
40:05This 49-year-old woman presents to the emergency department
40:13with the chief complaint of right ear pain.
40:17Hey, Donnie, can you do something about that?
40:20What?
40:22Seriously?
40:23That's not driving you nuts?
40:25The baby.
40:26It won't stop crying.
40:27No, that music's my ears now.
40:29I think Jessie's the nurse.
40:30Well, can't you...
40:46What the hell is going on?
40:48With what?
40:50With her.
40:51Can you make her stop crying?
40:53She's been fed and changed.
40:54She's cranky from rhinovirus.
40:58There's no something you can do.
41:00She's due for her next time, I'll...
41:03Give me a minute.
41:04I'll be right back.
41:04Wait, no, no, no.
41:05I'm not going to stay here.
41:09What is your problem?
41:13That's precisely why I've been going to Peds.
41:18Okay.
41:19Hey, hey.
41:21Hey, little Miss Sunshine.
41:25Oh, it's a time for you to take a little nap.
41:28That would be so fucking nice.
41:30Yes, it would.
41:34Starting to understand why you got left here.
41:48Oh, it's a time for you to take a little nap.
42:00Oh, it's a time for you to take a little nap.
42:06Oh, it's a time for you to take a little nap.
42:30I'm sick, nothing intra-abdominal.
42:31The propeller just missed gutting him.
42:33Very fortunate.
42:34Repeat, hemoglobin is eight.
42:36We're holding off on transfusing.
42:39Plan?
42:40I'll have melanin-langed and suture up the lacerations.
42:43Wait, what?
42:43That could take days.
42:45I...
42:46Calm down, Sadness.
42:47I'm kidding.
42:48This is one for my skilled surgical residents upstairs,
42:51not you Boy Scout butchers.
42:52Boy, I missed you, Yo-Yo.
42:54Can't say the same.
42:56Okay, let's take up this art project.
42:59So, bubble back to it.
43:02Good talk.
43:04How we doing, Princess?
43:06All right, a little bloated.
43:07I want too many hot dogs from the truck.
43:11You meant the board, huh?
43:13Gus, our incarcerated patient got a spot upstairs,
43:16looking for our unhoused patient Digby,
43:18and, of course, we have Whitaker, Donahue,
43:22and the med students on these diversion intakes,
43:24but they just keep coming.
43:25Yeah, we mainly need to start just sending people up
43:27and ask for forgiveness instead of permission.
43:30Hello?
43:32Oh, okay.
43:34Yes, I will be right there.
43:36C-suite wants to see me upstairs.
43:38Ooh, called to the principal's office on your first day.
43:40Not a good sign.
43:42I think I'm a baby whisperer.
43:44Hey, great.
43:45We'll add baby Jane Doe to your patient load.
43:47Forget I said anything.
43:49Where are we with your deaf patient, Harlow?
43:50Uh, the VRI was a bust, but the interpreter's on the way.
43:54Uh, figured I'd just give her a head and belly scan and go from there.
43:57No, wait for the interpreter.
43:59No need to give the patient unnecessary radiation.
44:01And your charting?
44:03Catching up and checking it twice.
44:05Good.
44:06Hey, have you had a chance to speak to Langdon today?
44:08Uh, no.
44:10Why?
44:11Did he say something?
44:12No, just curious.
44:13How is everything at home with you and Whitaker?
44:17He's weirder than you'd expect.
44:19Hmm.
44:20Yeah, but I don't see him all that much.
44:23He spends a lot of time at Amy's.
44:25He has a girlfriend?
44:28I don't know what to call it.
44:30The farmer who got burned last year, the day of the mass cash, his widow, Amy.
44:36Oh, he died?
44:37Yeah, he had burns on 90% of his body.
44:39His chance of survival was very slim.
44:41Okay, so I'm an optimist.
44:43The sun doesn't always come out tomorrow, Annie.
44:45Wait, wasn't she pregnant?
44:47No, she was a young orphan.
44:50No, not Annie, Amy.
44:52Yes, yes, very pregnant and young.
44:56Whitaker's now seeing this Amy?
44:58And her baby.
44:59He got really close to the family when the husband was dying.
45:04He really believed that the guy would pull through.
45:06He helped her through the loss of her husband, and then again when she had the kid, and now he
45:10spends almost every weekend at the farm.
45:13Huh.
45:14Plus, he's on the street team, and he just wants to help everybody, and I just don't want to see
45:20him taken advantage of.
45:21You know, he's just a fucking huckleberry.
45:23Yeah.
45:24But he's our fucking huckleberry.
45:26I'll talk to him.
45:27Hey, your call.
45:29Strong deflection.
45:30Well played.
45:30You're the boss.
45:31Or you are until end of shift today.
45:33Still the boss.
45:34When you see me in here, I'm still the boss.
45:37Copy that.
45:38Boss.
45:39Dr. Robbie, can I grab you for a second?
45:43Yeah.
45:43Sure.
45:44What's up?
45:46Um, can't you order my wife to go home?
45:51I'm sorry.
45:53Yeah.
45:54My wife's dying, and you're telling me there's nothing I can do.
45:59Mr. Hamler, that's not...
46:01No, no.
46:02There's got to be something.
46:05Please.
46:07It may not seem like much, but right now, you being here for her and respecting her wishes is the
46:13best thing that you can do for her.
46:15Supporting her and her choices is the most remarkable gift that you can give her at this time.
46:22The meds we have her on will help her pay, and she may get to a point where she feels
46:27well enough to go home.
46:46Give me one sec.
46:53Okay, I'm going to let you guys get acquainted. I will be right back.
46:56Oh, excuse me.
46:57Okay. I'm waiting for Dr. Mohan. Is she available?
47:01I will try and find her for you, sir.
47:07Whether you choose to report or not, we're here for you. Call me any time.
47:12It could be a month or a year from now. I'll follow up with you, too.
47:18Thanks.
47:23You got a pap smear before?
47:25Yeah, every few years.
47:27Good.
47:28Same position, but I'll start with swabs on the outside, external genitalia.
47:33Then I'll use the speculum to get internal swabs.
47:37You ready?
47:38All right. I'll help you get your feet in the stirrups.
47:41Go.
47:44Okay.
47:45All right.
47:46Now slide your bottom down.
47:49Okay.
47:50Yeah, a little bit more.
47:52A little more.
47:53I'm sorry.
47:54I can't.
47:55Okay. It's okay.
47:56We can take a break.
47:57No problem.
47:58I don't want a break.
47:58I want to stop.
48:01Is this about reporting?
48:03Because you can do this collection without a police report for now, and none of it goes
48:07in your permanent medical record.
48:09I don't want to do this anymore.
48:10Tell me why you want to stop.
48:15He's my friend.
48:18He knows all my friends.
48:22It was just a dumb...
48:25He was drunk.
48:27He didn't mean...
48:27It didn't mean anything.
48:30Okay.
48:31Okay.
48:33It's okay.
48:33I understand.
48:36Me too.
48:39Oh, Lord.
48:40This is a difficult process, to say the least.
48:43Why don't you take a breather and come back, and whatever you want to do, we'll do.
48:56Let's go find the good snacks.
49:22Jesus Christ.
49:23Sorry.
49:25Giving new meaning to the nickname Crash, huh?
49:28I've been trying to get to the bathroom for over an hour now.
49:31Yeah, you and me both, sister.
49:43Uh-oh, this can't be good.
49:46Who's this?
49:47That is hospital CEO Trent Norris.
49:49He's the big boss.
49:51Hmm.
49:52Nice outfit.
49:53Hey, Rockstar.
49:54Gather your staff, please.
49:55Sure.
49:55Anything you want to tell me first?
49:57No.
49:59Hey, everybody, can you, uh, gather around, listen up for a moment, please?
50:04And have your attention, everyone.
50:07The internal disaster at Westbridge has been identified as a cyber attack.
50:14And now Good Dominion Hospital has been hit as well.
50:18Their ambulances are being diverted over to St. Mary's, but we can expect more walk-ins and Westbridge diversions.
50:24Uh, for how long?
50:25We don't know how long.
50:27If the ransom is paid...
50:29W-Ransom?
50:30What?
50:31Are we next?
50:32Our IT protection system has blocked thousands of intrusion attempts in the hours since Westbridge was hit this morning.
50:39But IT believes we're still vulnerable.
50:42So we're going to preemptively shut down all the computer systems.
50:47Oh, jeez.
50:50Patient registration, electronic health records, lab and radiology interfaces, email, internet.
50:56Talk to me first, you want to consult my department?
50:58I consulted your fellow attending.
51:03When are we going down?
51:05Soon.
51:07Very soon.
51:08Okay, hey, somebody get a picture of the board.
51:11Quickly, quickly.
51:13We're about to go analog.
51:15Okay.
51:20Wait, do the phones work?
51:22They don't work.
51:23Oh, my God.
51:24You got the photo?
51:25Yeah, yeah, I got it.
51:28This is going to be fun.
51:57This is going to be fun.
52:27This is going to be fun.
52:58This is going to be fun.
52:59You
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