- 7 hours ago
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00:17You are so true, dirty, soft and hard
00:23You are close to me and you're so far
00:30And I'm thinking the time was spent together
00:34Now I'm carrying this in my backyard
00:40Sometimes I sit and wonder
00:45Will I ever tell your number?
00:51Cause I'm having fun looking out for no more
00:56I'm doing all the things I like to do
01:02I'm having fun cause I knew it all along
01:07I'd be better off without you
01:14I used my cast off
01:16As soon as you park that outside
01:17Morning doc
01:18Olsen
01:19Happy 4th
01:20Excuse me guys
01:21Sorry
01:26Come on through
01:50Hey how's it going dad?
01:52I'm so sleep deprived
01:53My house is starting to feel like a CIA black site
01:55Have you considered hiring a night nurse?
01:57You're looking at him
01:58You got a ripe one coming in
01:59You're gonna have to deal with
01:59Before everybody out there starts puking
02:01Lovely
02:02Your replacement came in early
02:04She brought in a full bagel spread
02:05I'm just saying
02:06She's not my replacement
02:07She's just covering his chief
02:08While I go on my little sabbatical
02:09Three months?
02:10I'll be back before your daughter sleeps with a night
02:12Hey dude, that's cold
02:13Morning
02:13Morning
02:30Morning
02:30Morning, John
02:31Could have sworn it was still around 4am
02:33Did you guys have an easy night last night?
02:35The waiting room actually looks manageable
02:36I wouldn't call it easy
02:38But not too bad
02:39I figured we'd have hands and burns down here a bunch
02:41But so far nobody's blown off any fingers
02:43Oh, you know you just jinxed it
02:45You guys and your jinxes
02:46Please, Jesus, please
02:47Hail Mary again
02:49In the sanctified flesh
02:50Don't let me die alone
02:51Just try to relax, Margaret
02:52I need a priest
02:54Hey, hey, Dr. Robbie
02:55What's the good word, Perla?
02:57All your results came back normal, Mrs. Walker
02:59I'm dying
02:59You're not dying, Mrs. Walker, I promise
03:01Jesus is coming for me
03:03If he is, he hasn't checked on that registration yet
03:05Please don't let me die a sinner
03:06Don't worry, Margaret
03:07We're gonna have the hospital chaplet
03:09Come and see you in a moment
03:10I'm not gonna last that long
03:11Yes, you will
03:12Because we're gonna give you a shot
03:13To keep you alive until they get here
03:15What are you thinking, Dr. Abinovich?
03:17500 mics of cyanocobalamin?
03:18In her condition, I'd push a full thousand
03:20Woo!
03:22You heard the man, Perla
03:23God bless you
03:24God bless all of you
03:26Amen to that
03:29Nothing like the miracle healing powers
03:31Of a good old B-12 shot
03:33She hold down a job
03:34She doesn't
03:36She's wearing a waitress uniform
03:37Yeah, from a diner that closed 20 years ago
03:41And so it begins
03:43My husband is still waiting to see a doctor
03:46I apologize for the wait
03:47But here are two doctors just for you
03:49Mr. Burgess has been complaining of leg cramps for a day
03:52Slightly tacky at 110
03:54BP 128 over 75
03:56Afebrile, good sats
03:58I'm Dr. Shen, but I'm going off shift
04:00Dr. Abinovich will be one of the doctors looking after you
04:02What other medications are you currently taking, Mr. Burgess?
04:05I brought his meds
04:08Thank you
04:09These are his supplements, mostly all natural and organic where possible
04:13And these are his homeopathic prescriptions
04:15I also have a list of his refrigerated probiotics
04:19Thank you
04:23Where the hell is everybody?
04:25Our new attending is torturing our intern and med students in trauma one
04:29She came in early to meet the night shift and put things over
04:33Okay, that takes giant balls of disrespect
04:35Giant balls of disrespect was the name of my band in high school
04:38And my nickname for my ex-husband
04:41Hey, uh, is this your last shift?
04:43For a while, yeah
04:44Oh, I'm so jealous
04:47Hey, I'll pay you a grand if you take my second husband
04:50Tempting
04:51So, tell me about this new attending
04:53Uh, she's pretty, divorced, one kid can already tell she is a strict rule follower
04:59I'm probably going to grow to hate her
05:01What's her name again?
05:02Dr. Buran Al-Hashimi
05:04Al-Hashimi?
05:05Hmm, what is that?
05:08Irish
05:10She's some sort of clinical informatics expert
05:12When she started talking about AI, I started thinking about robots and kind of stopped listening
05:18Clear
05:19Off the chest, Ogilvy
05:21Get ready to step up here, Joy
05:22Ogilvy, off the chest
05:24Clear
05:26Still a V-TAC, but it looks weird
05:28Agreed
05:28No pulse
05:29No effusion
05:30Good lung sliding
05:31Hey, start compressions, Joy
05:32We haven't considered all of the T's
05:34I checked for tamponade and tension pneumo
05:36What if it's thrombosis?
05:36If it's a pulmonary or a cardiac clock, T and K could save it
05:39We are sticking with the algorithm for now
05:41Algorithm's not working
05:42Faster and deeper, please
05:43Uh, you need a break, Joy?
05:45No, I need an attending
05:46I'm right here
05:49Stop compressions, we're calling it
05:52Sorry, the patient's dead
05:57All right, who can tell me what went well?
05:59We followed the V-TAC algorithm, we checked for reversible causes
06:02We limited our rhythm and pulse checks to ten seconds, excellent
06:05Should we have given thrombolytics?
06:07No, you should have recognized that the cardiac rhythm on the monitor was polymorphic, not just V-TAC
06:12It was torsade de pointe, that's French, twisting up the points
06:16From prolonged QT antiarrhythmic electrolyte disorders
06:19Your patient would have lived if you pushed magnesium sulfate
06:22Good news is, he's an organ donor
06:24Parts of him are gonna get used to make frisbees, water bottles, end up as microplastics in our brains and
06:29reproductive organs
06:30Thank you for the words of encouragement, boss
06:32Dr. Alice Shimi, Dr. Michael Obinovich, everybody calls me Robbie
06:34Pardon, please
06:35Welcome to the pit
06:37Yeah, I'm about that
06:37Tom is a minute out
06:38Ooh, who wants to treat a real patient?
06:40Yes, please, things gonna give me nightmares
06:45I hope you don't mind me jumping right into things
06:47I find that a mock code is a great way to assess the students' capabilities
06:52Well, it might have been nice if we'd had a little time to go over how we do things
06:55Did you not get a packet from Dr. Underwood, Gloria?
06:58Gloria, it outlined the quality improvement changes I instituted at the VA
07:02We're adopting the program at all of the university hospitals
07:05You didn't read it?
07:06No, I did
07:07I mean, I will
07:08I'm going to, I want to
07:09I thought I had a little bit more time before you came in today
07:12We've already distributed patient passports to everyone at registration
07:16What is a patient passport?
07:18So glad you asked
07:21Samira
07:21Dr. Al
07:22We worked together at the VA a few years ago
07:25And now you're in R4
07:26Yes, and I'm so excited you're joining us
07:29Dr. Mel King is here too
07:30I think you worked with her as well
07:32I did indeed
07:33John Doe, dishwasher penetrating trauma from a kitchen knife to the right chest
07:37Assault or accident?
07:38Unclear
07:39Initially had a pulse, lost it two blocks away
07:44What do we got, party people?
07:46Dr. Yolanda Garcia, trauma surgery fellow
07:49Meet Dr. Baran Alashimi, new ED attending
07:52She's going to be covering for me while I'm gone
07:54So nice to meet you
07:55That time they replaced you, rabbit bitch
07:57I'm going to miss you too, YOLO
07:59Dr. Garcia has a hard time expressing your feelings
08:01Not all of them
08:02One, two, three
08:05Prep for a left or economy
08:07I'm on it
08:09What's up, white chocolate?
08:11Did you know our farm boy here is a vintage funk freak?
08:16Unfortunately, he also likes to use other people's toothbrushes
08:19It was one time
08:20They were the same color
08:21What's your plan, Samira?
08:24Chest tube to the right
08:25Standby with natural transfusion protocol
08:27I put two units on the infuser
08:28Starek web six and a half
08:29Here we let the fellows and the residents kind of take charge
08:32I'll hold on to them just in case
08:34Is the VA even a trauma sim?
08:37Not for medic runs, but they walk in
08:41Falls, major MBCs, GSWs
08:45Stab wounds on the right
08:46Why are we opening the left chest?
08:48Better access if it's tamponade
08:49And you can cross clamp the aorta
08:52Givadi, Whitaker, sterile gloves
08:53Can I glove up?
08:54That's best if you watch the first one
08:57This guy's dead anyway
09:01Handblade
09:0228 front, turn along, Kelly
09:05Givadi, you're on section
09:06Whitaker, get ready for internal compressions
09:11Sorry, that's my phone
09:15Finished out of a tractor?
09:17Whitaker, give me a little room
09:17I need to get to his heart
09:19I'm in, hook up the thoracic seal
09:22Tell me to get that for you
09:23Not right now
09:34The tamponade, pretty dry in here
09:38Heart's empty, somebody start cardiac massage
09:40I'll cross clamp
09:41Yeah, I got it
09:41You do these one-handed
09:43Pushing up against the breastbone
09:44Four fingers
09:45Very good
09:46Not much blood to suction
09:47Okay, team
09:48Samira, next steps
09:50Keep transfusing
09:51Open the right chest
09:51That is correct
09:52Booty's on, kids
09:53There will be blood
09:56Frank?
10:00Landis
10:03Frank?
10:04Frank?
10:04Oh, boy
10:12You should be good to go now, hon
10:14Thanks, Lupe
10:15Of course
10:16Hey, go get him
10:21Hey, dog
10:23It's been a while
10:27I got a bad toothache today
10:31We'll take care of that, Louis
10:33All right
10:58I got a couple things in there, huh?
10:59Yeah, I see
11:01Looks like you got a couple things in there, huh?
11:07There's too much blood suction
11:10Uh, we're tracking the lung
11:12Try to identify the source
11:13Could be the right ventricle
11:15Or more likely the hilum
11:16Fresh lop pads
11:19Siri, turn on silent mode
11:26Porter
11:50Over
12:14Good morning.
12:15It was a good morning. I'd still be in bed.
12:17So what are you doing here?
12:18Ventry's mom is visiting for the holiday.
12:20Is she still alive?
12:21It was too mean to die.
12:23Plus who else is going to get this place to the Fourth of July weekend?
12:25Sure as hell ain't going to be me.
12:27I rest my case. What am I walking into?
12:30Nothing too bad yet.
12:31These are the ones I'd keep an eye on.
12:36The prodigal son returns.
12:38Too soon?
12:40No, I guess not.
12:42You're back.
12:43It took some time.
12:45Like an old trail horse, always follow a way back out.
12:48You look good, kid. How are you feeling?
12:50Oh, yeah. Great.
12:51You know, it's been, uh, it's been a journey.
12:56I bet.
12:57Thanks. Rob, you're on?
12:58Uh, he's in with the trauma, but if you hurry back, you can catch some of the pass-ons there
13:02in North.
13:03Uh, thanks.
13:07I'll keep an eye on him.
13:11I think we have a lost little lamb.
13:13Uh, excuse me, hon. Can we help you?
13:15Uh, I'm looking for the charge nurse.
13:18Oh, well, you found two of them.
13:20I'm Lena. This is Dana.
13:21I'm night shift going home, but Dana is queen of the day shift.
13:25Emma Nolan.
13:26Nice to meet you both.
13:27I'm a new grad RN here to shadow.
13:29Welcome to the pit, Emma Nolan.
13:31Here, let me put some of your stuff behind the desk and I'll give you a quick tour.
13:34Okay.
13:35Where from, sweetheart?
13:37Sault Ste. Marie.
13:38Oh.
13:39It's in Upper Michigan.
13:40Practically Canada.
13:42My great-grandmother was from up that way.
13:45Nice area.
13:46A lot of bugs.
13:48How about a cup of coffee?
13:51Can't locate the source.
13:53Proximal high-olm is under the sternum, along with most of the right ventricle.
13:56You need better exposure.
13:58Convert to a clamshell.
13:59Exactly.
14:00Trauma shears.
14:02That'd be nice to let them come up with that clam.
14:04Heart's going to need double compressions, just like this.
14:07Squeeze from the apex to the aorta.
14:12Right ventricle looks good.
14:13Massive hemorrhage from the highland.
14:15Second MTP pack's going.
14:17Additional four units.
14:19High laryngeal looks very proximal.
14:21Maybe pulmonary artery and vein.
14:23Clamp's on.
14:24Nope, no good.
14:26Still bleeding like a stuffed pig.
14:28I can give it a check.
14:28Dr. Gersi is a very skilled surgeon.
14:30If she can't get it, we need to think of something else.
14:31Like what?
14:36High laryngeal.
14:37We're going to rotate the lung 180 degrees, like putting a king in the garden hose.
14:41It'll stop the bleeding.
14:42That could possibly work.
14:43Or he'll die when you rip the entire lung off the hilum.
14:47Gently.
14:48Very, very gently.
14:49Very, very slowly.
15:06Blood loss is lying down.
15:07That's a good sign.
15:08The hilum looks dry.
15:09Maybe the heart peels empty.
15:10Okay, we fixed the leak.
15:12Now let's fill the tank.
15:15You are very popular today.
15:18Sorry, I'll turn it off when I can.
15:24Nine-year-old Kylie Connors, riding by her dad's girlfriend, Gina.
15:28Kylie took a tumble on the stairs this morning.
15:31We submitted a chin lac and a chipped front incisor.
15:34Just got lead on a pressure dressing.
15:36Bleeding pretty good on a rival.
15:38Dermabond should do the trick.
15:39All right.
15:40Any questions?
15:42Dr. King?
15:44Mel?
15:45Oh, um, I didn't say anything.
15:51How you feeling, Kylie?
15:53Tired.
15:54I've been here since 5.30.
15:55Oh, that makes two of us.
15:57But don't worry, we'll patch you up good as new, and we will get you out of here as soon
16:01as we can.
16:02Any questions?
16:03No, I'm just her dad's girlfriend, so I'm new to all this.
16:06No worries.
16:07We got you.
16:07Next.
16:1026-year-old Liam Sanders.
16:12Took a fall from his bicycle.
16:14No LLC, non-focal mural.
16:16Lower leg lock with no bony tightness.
16:18Were you wearing a helmet, Liam?
16:20No, I was just writing in my neighborhood.
16:22You should always wear a helmet.
16:24Hey, nice of you to join us.
16:25Hey.
16:26Dr. Langdon!
16:30Sold.
16:30It's Dr. Langdon.
16:33Candace O'Grady, 82.
16:35Brought to buy her son Richard for intractable vomiting.
16:41Hardly any hemorrhage on the right.
16:42Looks like the flip worked.
16:43As a heartbreaker.
16:44Feels full of blood.
16:45First time since we started.
16:46Hold compressions.
16:50Quivering bag of worms.
16:51Woof.
16:52Resume compressions.
16:53When the heart quivers like that, it's obvious if you fit.
16:55Okay.
16:56Internal paddles ready?
16:57Mm-hmm.
16:58Charge, too.
16:5925 joules.
17:00I think it's right the first time.
17:04Charge!
17:04Okay, Whitaker, when you're ready.
17:05Clear!
17:10That's what normal sinus looks like.
17:14Strong carotid.
17:15Saline lap pads and up to the OR.
17:19So how do we start the day?
17:21Unconventional, but a decent outcome.
17:25Why don't we split up for efficiency?
17:27Residents present to either one of us, but not both.
17:31We can certainly discuss that.
17:37Were you feeling weak or dizzy?
17:40No.
17:41I got up to pee and I tripped over a laundry basket that I couldn't see in the dark.
17:44Did you hit your head?
17:46Does my chart say that I hit my head?
17:47No.
17:48We just want to be thorough to make sure you don't miss anything.
17:52Yeah, how about we focus on patching me up?
17:55Ah!
17:56All right, Mr. Williams, we're going to check an x-ray of your wrist.
18:00And try to get you out of here as quickly as possible.
18:02Great.
18:03And let's keep the bullshit extra charges to a minimum, huh?
18:06My deductible is already a bitch.
18:10Sure.
18:20I didn't see you last week.
18:23I'm not trying to stop you.
18:31Sorry.
18:34Bye.
18:35Hey, my mother is trying to destroy my life.
18:38Well, yeah, they seem to take pleasure in that.
18:41I committed to a partnership track position next year at a hospital back in Jersey so I could be close
18:45and support her.
18:46But now she's getting married and selling our house to go on a year-long cruise around the world.
18:52Wow. I mean, that's a...
18:54Pretty fucking stupid idea, if you ask me.
18:57She's known this guy less than a year.
18:58What if he's a player?
19:00What if she disappears at sea?
19:02I mean, what if they're in love?
19:04Lust is more like it.
19:05That is even better.
19:08Man, it has been a while, and I'm solo this weekend.
19:15I need to get laid.
19:21It's a little much before 8 a.m., right?
19:24Yeah.
19:27Forever.
19:34How's it going, Esby?
19:35Oh, just another day in paradise.
19:55Heard you're going on a trip.
19:58I'm taking a sabbatical.
19:59Leave tonight.
20:00Where are you going?
20:02Um, head smashed in buffalo jump.
20:06Captain Crunch flying squirrel socks.
20:08Are we talking in code or do you have a stroke?
20:12It's an aboriginal UNESCO heritage site in Alberta.
20:15I've never seen the Badlands.
20:17What is this, like, uh, some sort of spirit quest?
20:20Uh, yeah.
20:22Something like that.
20:24Look, I, uh, I guess we should talk.
20:26I've got a lot of things I need to...
20:28At some point, not right now.
20:29Right now, I've got to hit the head,
20:30and I would like you to go help Donny out in triage.
20:32Triage?
20:34No, no, no, I already picked up a patient in North, too,
20:37a bicycle...
20:38Pretty sure we can cover for you.
20:39We've been doing it for months.
20:43Right.
20:44No, and I am very, uh, both very sorry and appreciative of that.
20:49I just would hate to think this is some kind of a punishment for...
20:53But, uh, yeah, yeah, no, for sure.
20:55We'll talk later.
20:56Before you go.
20:59Like I said, not right now.
21:00Well, Donny just passed his DDP certification.
21:03He can help you if you get in over your head.
21:09Hey, Mel, can you take over a bike fall leg lack
21:13in North 2 for Langdon while he's out in triage?
21:15Um, you know, I, I can work in triage.
21:17No, I want to keep Langdon out in triage,
21:19and I want to keep you back here.
21:21You okay with that?
21:22Sure.
21:23Great.
21:24Absolutely.
21:33So, who should I pick up?
21:35We're about to get the morning rush.
21:37What do you mean?
21:38Every morning around this time,
21:40the nursing homes and assisted living facilities
21:42do their morning bed checks.
21:44Uh-huh.
21:48It looks pretty quiet to me.
21:54Huh.
21:57Oh, like I said, come on.
22:01Ethan Bostick, 79, found altered this morning
22:03at assisted living.
22:04No history of dementia, has a pulse.
22:07What's a pulse?
22:08Position orders for life-sustaining treatment.
22:10No CPR, no intubation.
22:13Then there's, there's nothing for us to do.
22:15South 15 is open.
22:16Uh, well, do not resuscitate
22:18does not mean do not treat.
22:19He may perk up with fluids, IV antibiotics.
22:28What's the good word, Crash?
22:30You save that ventriloquist dummy?
22:32Yeah.
22:33Really?
22:34No.
22:36Wait, tell me you're not actually
22:38charging about losing a mannequin.
22:39It's part of the exercise.
22:40Dr. Olashimi asked us to do it.
22:42Who's his next of kin, Barbie?
22:44Okay.
22:46What's your, uh, take on the new attending?
22:50Not too soon to tell.
22:53You?
22:54She's already bugging me
22:56about being behind on my charting.
22:57Now I know why everyone says
22:59being a second-year resident sucks.
23:00Because it does.
23:01I must have sat through the part of med school
23:03where they tell you 90% of your time
23:04will be spent typing.
23:06Which is just one more reason
23:08surgery is a better lifestyle choice.
23:10Hey, Dr. Shamsi.
23:11Dr. Trinity Santos.
23:12Oh, yes.
23:14The ER intern who's interested
23:15in my surgery program.
23:16Well, it's me.
23:17But I'm an R2 now,
23:18and thinking of double boarding
23:20in surgery and emergency medicine.
23:22Which I know would sound
23:23ridiculously ambitious
23:24if I didn't have the talent
23:25to back it up.
23:26And a required attitude.
23:29Are you here to see a patient?
23:31I was.
23:32I did.
23:33And now I'm here to learn
23:34why you aren't returning
23:36my calls or texts.
23:37Okay, I'm out.
23:39Nice seeing you again, Dr. Shamsi.
23:41As soon as I get a little free time,
23:42I will make plans for all of us
23:43to do something together.
23:45What about Tuesday?
23:46I'm working.
23:46On your birthday?
23:48I will call you and Dad tomorrow,
23:50and we will come out
23:50this night to do together.
23:51I promise.
23:52But right now,
23:52I just have a bunch
23:54of night shift handoffs.
24:03We have schedules.
24:04You have chaos.
24:07You know she's wasting
24:08her talents down here.
24:09Victoria is a big girl.
24:11She could make
24:11her own decisions.
24:12She's also a young girl
24:13who's still very impressionable.
24:15And you can be very...
24:17Impressionable?
24:21Yes.
24:22Who?
24:24Who?
24:25Oh, for God's sake,
24:27I'll be right there.
24:28We need to talk.
24:31How about same time tomorrow?
24:36Next Tuesday's your birthday?
24:38No.
24:40Yes.
24:41Your 21st birthday?
24:42Please don't say anything.
24:43Okay, I get a little anxious about...
24:45Dr. Santos,
24:45little girl with the chin legs
24:46getting to a gown.
24:47Don't worry,
24:48I want you to know what.
24:50Nothing.
24:53Have a good day.
24:54Me too.
24:59Hey, Duke.
25:00I'm just calling to remind you
25:02that this is my last shift
25:04for a while,
25:05so I need you to come in
25:06before 3 o'clock
25:07in case we need to run
25:10some tests.
25:11Okay?
25:12We had a deal, brother.
25:15Oh.
25:16Hello?
25:17Hi.
25:18I know you're crazy busy.
25:19Always.
25:20But I figured we should
25:21really go over a few things
25:22before you're gone.
25:23Sure.
25:24Where would you like to start?
25:26Well,
25:26one little thing
25:27that I think would have
25:28a big impact
25:28with staff and patients alike
25:30is if we launched a campaign
25:31to eradicate
25:33referring to this
25:34wonderful department
25:35as the pit.
25:37Really?
25:37I know you think
25:38it's silly and petty.
25:40No, I think
25:40it's just kind of endearing.
25:41Pretty damn accurate.
25:43I would argue the opposite.
25:45I think subconsciously
25:47it affects those who work here.
25:48It also lowers expectations,
25:49which in turn
25:50lowers patient satisfaction.
25:52Well, you've been talking
25:53to Gloria.
25:53Yes.
25:54And she agrees with me.
25:55Don't doubt that
25:55for a moment.
25:57You have to see
25:58the man who's done right now.
25:59We see people
26:00in order of severity, ma'am.
26:02I don't know
26:06what you're saying.
26:07I can taste the shit
26:08in the back of my throat.
26:09Actually,
26:09the ladies' rights
26:10are going to make
26:10all of us sick, so...
26:11Yes, please.
26:20All right.
26:21We'll get them back.
26:22Tell Dana
26:23we're bringing the funk.
26:25Oh, my God.
26:28So, when did your eyes
26:29start bothering you,
26:30Miss Matthews?
26:31Sister Grace, please.
26:33I'm only married to God.
26:34Of course.
26:35I'm sorry.
26:36A few days ago,
26:38I thought it was pink eye.
26:40Or maybe I scratched it
26:41while gardening.
26:42It's a very bad case
26:43of conjunctivitis.
26:44We should send a sample
26:45to the lab
26:46to direct her treatment.
26:47Look up for me.
26:53Great.
26:54I'll put a numbing drop
26:55in your eye
26:55and check for a scratch
26:57with a special lamp.
27:01And I'll get you
27:02to look up for me again.
27:05Have you ever considered
27:07serving God?
27:08Which one?
27:09Excuse me?
27:11My family's Hindu,
27:13so we have, like,
27:1433 different kinds
27:15of deities.
27:16Oh, we have the one.
27:18Some people
27:19only need one, right?
27:21Okay.
27:25Most important rule
27:26around here,
27:26be smart, be safe.
27:28Can't warn you enough
27:29about protecting yourself
27:30and your fellow nurses.
27:31We use the STAMP acronym
27:33to assess patients.
27:34You know it?
27:35Uh, S is for staring
27:36or refusal to make eye contact.
27:38If they're staring,
27:38they're scaring.
27:39T?
27:40Tone of voice.
27:41Often the threat level
27:42rises with their voice.
27:43A is for anxiety.
27:45You can also think aggression.
27:47M is mumbling.
27:47If you're listening closely enough,
27:49it's often the same.
27:50What they're thinking of doing
27:51is to talk themselves up to it.
27:52And P?
27:53Pacing.
27:54Good.
27:54We also have a safe word.
27:55Hula hoop.
27:57I guess technically
27:58it's two words,
27:58but whatever.
27:59If there's a threat,
28:00say hula hoop
28:01and we'll all respond.
28:04Yeah?
28:06Lovely.
28:07Okay.
28:08I'll be right there
28:09with reinforcements.
28:12Dirty calls.
28:13We're headed for triage.
28:19I'm going to get your cast off.
28:22I just need you to...
28:41The antibiotics should clear everything up,
28:44but you should try to stay off it for a few days.
28:47I have to work.
28:49I'm late as it is.
28:50Well, um,
28:52take breaks
28:52and elevate when you can.
28:54Tying on Advil for the pain.
28:56If the pain persists
28:57or feel like it's getting worse,
28:59come on back.
28:59We'll get you fixed up.
29:01Thanks.
29:02Listen,
29:03give this to the doctor.
29:05What the hell is it?
29:07Patient passport.
29:09Let's patients know
29:09what they're waiting for
29:10and how long it'll take.
29:11You check off
29:12if he needs labs,
29:13x-rays,
29:14CT.
29:14None of the above.
29:15When do we start this?
29:16Today.
29:17The new attending.
29:20What's up with your tooth, Louie?
29:22It's been going on for a while,
29:25but it got bad last night.
29:28Lower left side.
29:30Okay.
29:32Ah!
29:33Oh.
29:34Ah!
29:34Ah!
29:35It could be an infection at the root.
29:37We can drain it,
29:38but then
29:41you're, uh,
29:42you're breathing kind of fast.
29:43Yeah,
29:44yeah, I've been,
29:44well,
29:46I've been, uh,
29:47walking more,
29:48trying to get in shape,
29:50but sometimes, like,
29:51I get a little short of breath.
29:52Yeah,
29:53you need to walk past
29:54the liquor store,
29:54not into it.
29:55What shape you're getting in
29:57is for a liver transplant.
29:58I don't need a new liver.
29:59Just get rid of this toothache.
30:01Deep breath.
30:06One more?
30:08Is my heart still ticking?
30:09Like a jackrabbit.
30:11How long you been sitting down?
30:12Oh, just for a few minutes.
30:14Not that long.
30:15Um, Louie,
30:19there's something
30:20I need to tell you.
30:23Last time I saw you,
30:25about ten months ago,
30:27I treated you,
30:28and I took some of your medicine.
30:32I'm not sure I follow.
30:34I have an addiction to benzos,
30:37and I helped myself
30:39to some of the librium
30:40I prescribed you
30:41for your withdrawal.
30:42You stole my pills?
30:46Yeah.
30:47Yes.
30:48Um,
30:50I'm sorry.
30:51It was, uh,
30:53it was not only wrong
30:54and utterly unprofessional,
30:56but it was a betrayal
30:57of my Hippocratic oath,
30:58and it was a fucking crime.
31:02That's where I've been.
31:04Rehab and counseling.
31:08Huh.
31:09I'm sorry.
31:10I-I understand
31:12if you'd prefer
31:13a different doctor.
31:13Hey, Doc.
31:14We have a situation.
31:17Excuse me.
31:19What kind of situation?
31:21Someone left the little baby
31:22in the restroom.
31:31Okay.
31:33Let's think about
31:34reversible causes
31:35of confusion
31:36in the elderly.
31:37Uh,
31:37hypo or hypernatremia,
31:39infection,
31:39but he's afebrile,
31:40good or two sats,
31:41and urine dip was negative.
31:42Yeah, great.
31:43Joy, anything to add?
31:46Nah.
31:49V-Tac.
31:49Can I?
31:50Yeah.
31:53No pulse.
31:54Should we call
31:54for a code blue?
31:55No CPR.
31:56No shock.
31:57We honor his pulse
31:58and his wishes.
31:59So,
32:00what does that leave us?
32:02Making sure
32:03he's comfortable.
32:05Pulse action.
32:07Altered mental
32:07in the elderly
32:08can also be
32:09toxicity from
32:09anticholinergic,
32:10sedative hypnotics,
32:11opioids.
32:15Am I missing
32:16something?
32:17Social skills?
32:19What?
32:24You look so
32:24peaceful.
32:25Should we maybe
32:25go find a new patient?
32:26No, stay here.
32:31Asystole.
32:42Quick and painless.
32:44We should all be so lucky.
32:46I'll try to contact
32:46some family.
32:50Yeah,
32:50one of the things
32:51we like to do here
32:56when we have the time
32:58is to take a moment
32:59of silence
33:00when we lose a patient
33:01to respect their humanity.
33:03He was someone's son,
33:05perhaps a father himself,
33:07a brother,
33:09a friend.
33:13Oh,
33:13just make sure
33:15your phones are on silent.
33:20Great, great, great.
33:21Okay.
33:23Is anyone
33:24missing a baby?
33:26Did anyone
33:27leave their child
33:28in the restroom?
33:31You, uh,
33:32remember
33:32seeing a woman
33:33enter with a baby
33:34to leave without one?
33:36No, sorry.
33:38Might be on
33:39the security tapes.
33:40I'll have them.
33:41I'll check it out.
33:42Please.
33:42Yeah.
33:43Harlow Graham
33:44to window one.
33:46Harlow Graham
33:47to window one.
33:50Harlow Graham
33:51to window one,
33:52please.
33:58Donnie Donahue,
33:59nurse practitioner,
34:00and this is Emma,
34:00new grad nurse.
34:01Hey.
34:01Nice to meet you.
34:02What's going on?
34:03Somebody dumped their kid.
34:05Maybe mom just stepped out
34:06for a smoke or something.
34:07What?
34:08I'm being helpful.
34:09Sometimes I just need
34:10a little break
34:10and then they come back.
34:13At least I didn't leave her
34:14in a suitcase
34:15at the bus station.
34:16Does that happen?
34:17If that's a true story,
34:18I don't want to know about it.
34:19The worst of seeing...
34:20Please, don't tell me.
34:21I'm a new dad.
34:22Remember?
34:22Remember?
34:31I'll get Robbie.
34:32Should I come with?
34:33No, stay here.
34:34Donnie, Jesse,
34:35teach her something.
34:39You know how to check
34:40a rectal temp on an infant?
34:44Uh, theoretically.
34:52Mr. Williams,
34:53how's the pain?
34:55Nothing I can't manage
34:56with some Vicodin
34:57and a little scotch.
34:59Well, it's best not
35:00to mix the two.
35:01James here is going to take you
35:02to get an X-ray
35:03at your wrist.
35:03Good morning.
35:04I'm going to be fine.
35:06Well, it'll tell us
35:07if you need a cast.
35:08I doubt it.
35:09I should probably go home,
35:10keep some ice on it.
35:11I know you guys
35:12always need the beds.
35:15Well, it'll only take a minute
35:17and then we'll know for sure.
35:19Yeah, I really don't think
35:20it's necessary
35:20and I have a busy day,
35:21but I appreciate your concern.
35:26I'd really like
35:28to observe you
35:28for a little bit
35:29in case you did
35:30hit your head.
35:31My head?
35:33I have my schnoz
35:34on my arm, I think.
35:35Nothing more.
35:36You think you don't remember?
35:38No.
35:39Yes.
35:41I'm going to be fine.
35:43Really.
35:44Thank you
35:45for your concern.
35:50Okay.
35:52Ha!
35:54How about we
35:55take that x-ray
35:56just to be safe?
35:58Yeah.
36:00Yeah, okay.
36:01Okay.
36:01Good idea.
36:04Somebody found a baby?
36:06Yeah.
36:07Not the first time
36:07it's happened.
36:09So, about those pills
36:10I took.
36:12Don't worry about it, Doc.
36:14If the pills helped you,
36:15great.
36:17I never really liked
36:18taking them.
36:21I appreciate that,
36:22Louie.
36:23That's not really the point,
36:24but you need to lift up
36:26your shirt for a second.
36:27Yeah.
36:34How long has your belly
36:34been hard like that?
36:36I don't know.
36:37I figured I could wait
36:38another week.
36:39You need some lab tests
36:41and a procedure
36:42to drain off
36:43some of this fluid.
36:44Yeah, I know the drill.
36:46I've been tapped
36:47a few times before.
36:49Three times
36:50in the last six months.
36:52You need to give
36:53your liver a break,
36:54Louie.
36:55Yeah, I know.
37:01I just heard somebody
37:02dumped a baby
37:02in the waiting room
37:03bathroom.
37:04How sad is that?
37:05Huh?
37:07What's up with you today,
37:09Mel?
37:09Lynn,
37:10Galia?
37:11What makes you think
37:12there's something up with me?
37:13You're moping around
37:14here all day
37:14like somebody
37:15gunned down
37:15your favorite K-pop band.
37:17I don't really have
37:18a favorite K-pop band.
37:19Not that I don't
37:20like the genre.
37:21Forget K-pop.
37:22What's going on with you?
37:24You usually ride in here
37:25on your unicorn
37:26tossing wildflowers.
37:28Unicorn?
37:28Never mind.
37:30Is everything okay
37:31with your sister?
37:33Oh, yeah,
37:33she's great.
37:34It's just this...
37:38Spill, girl.
37:40Um,
37:42well,
37:43a couple of months ago
37:44I got named
37:44in a
37:46malpractice lawsuit.
37:48And so,
37:48today is the
37:50deposition.
37:52That's it?
37:53Every emergency medicine doc
37:55gets sued
37:55sooner or later.
37:56Seriously,
37:57don't sweat it.
37:58You're still a resident.
37:59We're protected
38:00by the hospital.
38:00You could cut
38:01somebody's head off
38:02and get away with it.
38:04But, you know,
38:05like,
38:06don't.
38:07You won't want
38:07to become known
38:08as the
38:09one who put
38:10Mel in malpractice.
38:11Hey, Santos,
38:13our little girl Kylie
38:14has been in the
38:15West Bend
38:15emergency department
38:16a couple times.
38:18I'm not saying
38:19this is necessarily
38:20the case here,
38:21but recent studies
38:22have linked
38:22bullying behavior
38:23to different
38:24personality disorders.
38:26On the other hand,
38:27though,
38:27I am known
38:28to be a bit
38:29overly sensitive
38:30sometimes.
38:31Yes?
38:31You talk to yourself again.
38:32You need something?
38:34Uh, yeah,
38:34a good lawyer.
38:35I don't know.
38:36I'm kidding.
38:36I'm not...
38:40Yo, Rabinovich,
38:41somebody ditched
38:41a bundle of joy
38:42in chairs.
38:43How old?
38:44A couple months.
38:44Maybe Donahue's
38:45got her in peds.
38:46No one saw
38:46who left her?
38:47Apparently not.
38:48It's so sad.
38:50Tell me about it.
38:50Who throws away
38:51a perfectly good baby?
38:53Make a leg.
38:54Ah!
38:55Sweet baby Jesus, Antoine!
38:57Right to the outdoor shower!
38:58I just drive him.
38:59I'm not a washing
39:00detail service.
39:00Yeah, yeah.
39:01God forbid you
39:02prove useful.
39:03Ah!
39:03Good time, Emma Selma.
39:04Time for you and me
39:05to do the Lord's work
39:06this way.
39:07Oh, God.
39:08What is that?
39:09Okay.
39:09Big breath.
39:13All right.
39:13Lungs sound great.
39:15Can you lean forward
39:16for me?
39:22Uh, did you
39:24hit your back
39:25when you fell
39:25down the stairs?
39:26No.
39:27Okay, there's
39:27a pretty good bruise
39:28here.
39:29I got knocked
39:30down in soccer.
39:33Oh, no,
39:34you broke
39:34your wrist last
39:35year, too, huh?
39:36Fell with my skateboard.
39:37Got a purple cast.
39:39Cool color.
39:40And you were
39:41treated at West Penn.
39:42Is that
39:43your closest hospital?
39:44Uh, I guess
39:46that would make sense.
39:46I've only been
39:47dating your dad
39:48a few months.
39:49Uh, he lived
39:49in Garfield
39:50before the divorce.
39:51And, uh,
39:52what about these?
39:53Soccer.
39:54Do you wear
39:54shin guards?
39:55My dad ordered them.
39:58What does your dad
39:59do for work?
40:00He draws buildings,
40:01but he's not
40:02an architect.
40:03He's a draft
40:04and fur firm
40:05in Newcastle.
40:07Um, Kylie,
40:08any chance
40:08you can pee?
40:11Um, maybe.
40:12Okay.
40:13Well, uh,
40:13with the bruise
40:14on your back,
40:14we need to check
40:15your urine.
40:16Okay.
40:17Okay.
40:21Did you eat
40:21anything out
40:22of the ordinary
40:22recently?
40:23No.
40:24Sorry, but
40:25we went through
40:26this a bunch.
40:27Don't you people
40:28communicate?
40:29You're the third
40:29nurse we've
40:30told her story to.
40:30I'm a doctor,
40:31Bridget.
40:33Would you go
40:34to the cafeteria
40:35and get me
40:35a large chamomile tea?
40:37What can we get
40:38you, my dear?
40:39I'm fine.
40:43Yeah, I'll be right back.
40:49Please excuse my son.
40:52Ever since my husband
40:53died, he's been
40:54a little overprotective.
40:56I think it's sweet.
40:58You're very lucky
40:59to have him.
41:00I am.
41:02Are you still
41:03taking your
41:04loperamide and
41:05cholestyramine?
41:07Um, not so much.
41:09No?
41:11That may be why
41:12you're experiencing
41:13the abdominal pain
41:14and vomiting.
41:15When did you stop
41:16taking your meds?
41:17Last winter or so.
41:21My neighbor Helen and I
41:23bingo in Wintersville.
41:25There's a dispensary
41:27next door.
41:28And we got some
41:29marijuana.
41:30And I swear,
41:31it cleared everything up.
41:34A few cookies
41:35every few hours.
41:37And no more pain.
41:40A few cookies?
41:43How many are you
41:44eating in a day?
41:45Oh, uh,
41:47I don't know.
41:50Probably a dozen or so.
41:52But they're not very big.
41:55There have been
41:56some studies that show
41:57an added dementia risk
41:59with marijuana use
42:00in older adults.
42:03No, that sucks
42:04for old people.
42:07Kylie, there are
42:08some questions
42:09that we ask
42:10every kid
42:11who comes in
42:12with an injury.
42:13Like what?
42:15Like,
42:16sometimes the people
42:17that you live with
42:18can get so mad
42:20that they hit you
42:22or hurt you,
42:23maybe without
42:24even meaning to.
42:25Does that ever happen?
42:27No, not to me.
42:29Or sometimes
42:30kids can get punished
42:32for doing something wrong
42:33with maybe a spanking
42:35or a belt.
42:37I get timeouts.
42:40How about at school, Kylie?
42:42You know,
42:42is anybody being, you know,
42:43mean or bullying you?
42:45No, I have lots of friends.
42:48No, I have lots of friends.
43:08Yo, Whitaker.
43:11Dr. Langdon.
43:14You, uh,
43:15meet Louie here?
43:16Uh, yeah, yeah,
43:17many times.
43:18Good morning,
43:18Mr. Cloverfield.
43:19What's up, Doc?
43:20Where's your new
43:20resident badge buddy, buddy?
43:22Oh, uh, yeah,
43:23they didn't give me
43:24a new one yet.
43:26Bummer.
43:27You and, uh,
43:28your ducklings
43:29got time to tap
43:30a six-pack
43:30off our friend here?
43:31Louie needs
43:31a paracentesis.
43:32Yeah, sure.
43:34It's good to see you
43:35again, Louie.
43:36Not in this condition,
43:37of course.
43:37How you feeling?
43:38Feeling like I need
43:39a drink pretty soon.
43:42Okay, well,
43:43first things first,
43:43we are gonna make you
43:45more comfortable
43:46by draining some fluid.
43:47You're gonna take off
43:48a big volume,
43:49so start with 60 grams
43:50of 25% albumin IV.
43:52You tapped him before?
43:54No.
43:55That's okay, Doc.
43:56I'll talk him through it.
43:58Okay.
44:01Sats, 99 on room air,
44:02normal BP,
44:03normal pulse.
44:07Ah, well hydrated.
44:09No obvious source
44:09of infection.
44:10Could be a benign virus,
44:12but can't assume that.
44:13Is this the abandoned baby?
44:15Mm-hmm.
44:16How old?
44:17How old do you think she is?
44:19Month?
44:19Month and a half?
44:20It's tricky.
44:22Under 28 days
44:23is a safe haven drop-off,
44:24no questions asked.
44:25But over 28 days
44:26is a crime.
44:27Child abandonment.
44:29How should we assess?
44:31Under 28 days
44:32gets everything,
44:33including an LP,
44:34but over 28 days
44:36you can follow PCARN
44:38or step-by-step
44:38to determine risk
44:39of invasive bacterial infection.
44:41This baby looks great.
44:42We know nothing
44:43about the birth history.
44:45Did mom have group B strep,
44:46active HSV lesions?
44:48We should assume the worst.
44:50Put in your orders,
44:51Dr. Mohan.
44:53CBC,
44:54blood culture,
44:56chem panel,
44:58chest x-ray,
44:59UAN culture,
45:00respiratory virus panel,
45:02check inflammatory markers,
45:04procalcitonin,
45:05and CRP,
45:06then
45:07take it from there.
45:09That sounds like a plan.
45:11Dr. Robbie,
45:12Santos needs you,
45:12North One.
45:13Okay,
45:13I'll be right there.
45:15Feel excused?
45:16Feel excused?
45:19Mind if I join with?
45:21Uh, no.
45:22At this?
45:23It will help me get
45:24a better sense
45:25of how you like
45:26to do things
45:26by seeing you
45:27in action
45:27with the residents.
45:29Be my guest.
45:33I will be right back.
45:41Um,
45:42nine-year-old Kylie Connors
45:43took a tumble
45:44running up the stairs
45:45this morning,
45:45chin-lack
45:46and fractured tooth
45:47brought in
45:48by her dad's
45:48girlfriend,
45:49Gina.
45:50Supposedly,
45:50the dad had to
45:51leave early for work.
45:53Kylie has a lot of
45:54bruising on her body.
45:56Some old,
45:56some new.
45:57Are you concerned
45:58about non-accidental trauma?
46:01Or worse?
46:02Her urine sample
46:03shows gross hematuria,
46:05which could be
46:05renal injury
46:06or vaginal bleeding
46:07from trauma
46:08could have
46:08contaminated the specimen.
46:10Lots to consider.
46:12What's your plan?
46:13Labs,
46:14ultrasound,
46:15social work consult,
46:16then decide
46:16if this is reportable.
46:18Mm-hmm.
46:22Let me know
46:23if you can feel this.
46:24No.
46:25Am I supposed to?
46:26No.
46:31Your hair's
46:32such a pretty color.
46:35Reminds me of my mom.
46:37She died
46:38when I was nine.
46:39I'm sorry about that.
46:41She wore glasses
46:42like you, too.
46:43Weird.
46:45And what do you like
46:46to do when you're
46:47not working?
46:48Um, spend some time
46:50with my sister.
46:51Read.
46:53Do you drink coffee?
46:55Uh, no.
46:56I avoid caffeine.
46:58Me, too.
47:01What about boba?
47:04I love boba.
47:10I'll offer you some gum,
47:12but it's laced with nicotine,
47:13trying to quit smoking.
47:16That's good.
47:17Yeah.
47:17Birdie's still out.
47:19Getting all those
47:20nooks and crannies,
47:21Mr. Digby.
47:21Your skin will thank you.
47:23We all will.
47:25I could stay in here
47:27all day.
47:29A miracle what a little
47:30soap water and human decency
47:32can do sometimes.
47:33Don't forget the ears, pal.
47:35I don't want anything
47:35growing in there, either.
47:37Okay.
47:38Okay.
47:39What's your story, Emma?
47:40What do your parents do?
47:41Got siblings, boyfriend,
47:43ever kill a man in a bar fight?
47:48Uh...
47:57So, Mr. Williams,
47:59sometimes a fracture
48:01of the scaphoid bone
48:02doesn't show up
48:02on day one.
48:03So my advice
48:05to be safe
48:06is we're split for two weeks
48:07and then come back
48:08for a repeat x-ray
48:09and we'll see
48:10if it's really there.
48:13My knee hurts.
48:16Oh, did you
48:17hurt your knee?
48:19I must have.
48:27What is this?
48:30That's, um,
48:31for your wrist.
48:33I need this?
48:36Well, um,
48:37if it's a, uh,
48:39John, can you...
48:40If it's a fracture
48:42and we don't immobilize,
48:43the bone might not
48:44heal properly.
48:45Okay.
48:48How long is this
48:49going to take?
48:51Just a few minutes
48:52to fit you.
48:56Is this place new?
49:02Mr. Williams,
49:03do you know
49:04what day it is?
49:09It's Taco Tuesday.
49:12Do you know
49:12where you are?
49:15Yeah, I'm in the
49:16slowest medical clinic
49:17in the West.
49:19Do you know
49:20what year it is?
49:21How about you
49:22just fix my wrist
49:23and you stop
49:25with all the questions?
49:28I am not here
49:29to be profiled.
49:34Yeah, of course.
49:38I'll be back, okay?
49:51All right, Mr. Digby,
49:52looking better already.
49:53Certainly smells a little better.
49:55Do you have any conditioner?
49:56Let's get you dried off
49:57and back inside.
49:59Get him downed up
49:59and put him in South 21
50:00and cross from the old nun.
50:02Maybe some of her
50:02had to find Grace
50:03so we're off on him.
50:05Who do we have here?
50:07Evelyn Bostic,
50:0881, with Alzheimer's.
50:09We brought her husband in
50:10about 30 minutes ago.
50:12She was supposed
50:12to get a ride in
50:13but they found her
50:13wandering in traffic.
50:14Where are we?
50:15You're at the hospital, dear.
50:17I'm not sick.
50:18We brought you
50:18to see your husband.
50:20Oh, no.
50:21Is Ethan okay?
50:22Be in to chat
50:23with you, Mrs. Bostic.
50:25He died.
50:27What you got, Ann, boy?
50:29Alan Billings
50:30had a palate
50:30fall into his outstretched arm.
50:32Looks like an open dislocation.
50:34Yeah, that's gotta hurt.
50:35Don't worry, sir.
50:36We got you.
50:43How's she doing?
50:44Seems happy enough.
50:46Yeah.
50:47I just got a quick
50:48point-of-care CBC.
50:57Is there a problem?
51:03Did I miss something?
51:04Dr. Al?
51:06Dr. Al?
51:14I'm in hurt
51:17But I refuse to cry
51:22I'm in hurt, baby
51:24But I refuse to cry
51:29It's so true
51:30You know, you know, you know, you know
51:33I can't lie
51:34And I said
51:36Yeah, yeah, yeah
51:38Yeah, yeah
51:40Yeah, yeah
51:44Baby, oh, yeah
51:47Yeah, yeah
51:48Yeah, yeah
51:50I won't cry
51:52Oh, you know
51:54I won't cry
51:55I said
51:57I won't cry
51:59Baby, baby
52:00You know
52:01I won't cry
52:03You know, you know
52:05I won't cry, baby
52:06I'm telling you
52:08I won't cry
52:10Oh, I don't lie
52:13Oh, but I refuse to cry
52:16And I say
52:19Sometimes, darling
52:21Your friends, they treat you so cold
52:23But baby, you know they act better
52:27Yeah, yeah
52:28When you have that goal
52:31But I won't lie
52:34You know, you know, you know
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