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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. Day shift, we got this.
00:33I'm staying.
00:34Continuity of care.
00:35Dr. Ellis, give me why don't you go cover sign-out 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. Right tip, fib, hematoma.
00:46Deformed right forearm.
00:48Rupt your TM on the left, sterothanguinous fluid.
00:50That means baseless skull 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.
01:00From 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.
01:18He needs 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!
01:25Cruz, 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?
01:49Who'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. Ahalshimi, 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?
02:29No, he put out a hand to stop him, made physical contact.
02:32He was a little bit more than that.
02:34The hospital lawyers are on the case, and we will brief the staff every 12 hours at sign-out
02:38rounds 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 am fine.
02:47Please don't forget code hula hoop.
02:49And with risky patients, always keep a path to the door clear.
02:52Sounds like one hell of a day, and we're still dealing with downtime.
02:56So day shift should brief night residents about the protocol.
02:59Hey.
03:00Oh, all 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.
03:23Skipping rounds.
03:25Set yourself lucky.
03:26Should we join them?
03:29Might as well witness some 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 film's right tip-fib and right forearm after CT.
03:41Got the Chem-8.
03:42Blood sugar's 284.
03:43That's not too bad.
03:45Tassian looks good.
03:46Mm-hmm.
03:46Any end 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 end STEMI or a posterior CVA.
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.
04:13Out of time.
04:16Ooh, Robbie.
04:17Yep.
04:17I got intel on where ICE has taken 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 a sun mason at the bedside.
04:40Hello.
04:41Uh, I'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.
05:11Tweet your knee water skiing.
05:13You can go 360 off a five-foot ramp.
05:15Ooh, respect.
05:16X-rays ordered in triage.
05:17That was hours ago.
05:19Ma'am, I'm Dr. Cruz Henderson.
05:21Let's get you home real fast.
05:23That would be wonderful.
05:24Okay.
05:25Heading to north.
05:27Looks like our first scanning station is almost ready.
05:29Whitaker Santos.
05:30After rounds, this will be your post.
05:32Seriously?
05:33For how long?
05:35Till we mop up this mess.
05:37And 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.
05:46I've got something better for you.
05:49So, Digby.
05:51We're gonna find you some new clothes, but my friend Emma and I wondered if you'd like to get cleaned
05:54up a bit first.
05:56I 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?
06:27Like, um, if there was a break in the railing or if there 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, get to work scanning.
06:58Night shift.
06:59The room numbers on top of the dry erase board need a doctor.
07:02Who's in BH1?
07:03Psych holds danger 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, walked out into traffic.
07:16Brady Barnhill wheezing and not responding to albuterol.
07:20Whole socks 87 is Mother Naomi.
07:21Okay, trauma 2 is 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.
07:33Uh, continuous 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 Simicor.
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.
07:59All right, Grady, shot in the thigh.
08:02Oh!
08:06Hi.
08:08Something to scan?
08:10Critical labs on North 3.
08:11Oh, it's, uh, it's not my patients.
08:13She's about to be.
08:16I'm, uh, I'm off the clock, so...
08:19These were ordered three hours ago for triage,
08:21so 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.
08:30Well, that's okay.
08:31How'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 mid-school?
08:39Uh, UC Irvine.
08:40In California, 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...
08:52To Marion.
08:53Hello.
08:55Uh, your labs show a lot of inflammation in your liver.
08:58So I am so nauseated.
08:59Definitely, yeah.
09:01Have you noticed a change in your skin coloration?
09:04I've been using this bronzing cream,
09:06so I don't look like a ghost in my bathing suit.
09:09Do 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.
09:18Why would my liver be inflamed?
09:20Uh, there's a lot of possibilities.
09:22Are 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.
09:29Never.
09:30Rock clams or oysters?
09:31I'm a vegan.
09:33One step at a time.
09:35We'll be back.
09:38Digby Haas, now on the big board.
09:40Progress.
09:41So, he's just been waiting in the hall the whole time?
09:43Okay, well, can you maybe get to him next?
09:50Dude 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 macrame 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 Nina home.
10:09Are you planning on calling in a replacement,
10:11or are you just gonna work till sunrise?
10:13I have to.
10:14Oh, so you get to go the extra mile,
10:16and 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'd at Artline.
10:40Orlando.
10:42Orlando, squeeze my hand.
10:45Open your eyes.
10:45We already know his GCS is going to be free.
10:48Hey, Javadi, anti-seizure prophylaxis.
10:50Kepra, 10 weeks per 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 and cause diuresis and hypotension.
11:04And hypertonic saline.
11:0623%, 50 cc's through the central line.
11:10Tight as a drum.
11:11Good five minutes, 60 Epi.
11:13You can have one more EpiPen.
11:14That's a borderline, 87.
11:16How about BiPap, 10 over five?
11:18Yes, with inline nebs.
11:20All right, Grady, shot number two.
11:21Might as well throw him some magnesium, 50 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 simicort.
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.
11:45That's okay.
11:47I don't mind.
11:52How 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.
12:16I'm 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.
12:28He's just an ass kisser.
12:30He might stay in a scan lot and try it to himself.
12:31Oh, he, uh, scrubbed in in the OR.
12:33Scrubbed in on the ruptured AAA.
12:35Or the kidney stone that wasn't.
12:37That'll be four hours at least.
12:41So, are you still going to Amy's after work?
12:44Yeah, maybe just for tonight.
12:46After Robbie briefs me on all the house stuff.
12:49Sounds fun.
12:52When he asked, it was hard to say no.
12:54Sure.
12:58It's gonna be very weird without him here.
13:00Yeah.
13:01You think Dr. Al Hashimi can handle it?
13:04A word, no.
13:06She'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?
13:25I don't know.
13:27Why not?
13:32Hypertonics in?
13:32Maintenance LR in the AC.
13:35It's 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.
13:46Hello, Linda.
13:47Robbie.
13:48Vision chief working on a holiday weekend.
13:50Somebody's got to.
13:53Saw the scans. This guy needs an EBD.
13:54External ventricular drain to take down the pressure.
13:58Because CPP equals MEP minus ICP.
14:01Cerebral perfusion pressure in the brain equals mean arterial blood pressure minus the pressure in the skull.
14:07ICP less than 22 predicts survival and favorable outcome.
14:11CPP from 60 to 70 reduces morbidity and mortality.
14:15Can somebody assist?
14:17Dr. Mohan.
14:18I'm good.
14:20So, Mary, you 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.
14:54The chief 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 vulvulus 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.
15:14Excellent.
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.
15:30You feeling tired?
15:33Do we have aerogen in the ED?
15:35Just in the unit.
15:36How fast can you get back?
15:38Two minutes if I take the stairs, go.
15:40Uh, aerogen?
15:41It has a five millimeter mesh that vibrates over 120,000 times per second.
15:51Dr. Ohashimi.
15:57You okay?
16:01Oh, you're telling us about aerogen?
16:04Dr. Shen can explain.
16:07It produces droplets in the two to five micron range.
16:19how's it going just about to start secure an art line here measure twice cut once
16:24we enter 11 centimeters back from the nasion three centimeters level without any direct
16:32emoji nope straight shot into the lateral ventricle tried and true since 1890 okay go ahead with the
16:40incision hey you worked with dr. alashimi at the va i did for hello during my r2 rotation and then
16:50one again last year okay handrails all set maybe you should do this prick oh no there's a safety
17:00stop here you can't go too deep it's not brain surgery okay stay perpendicular yeah good all right
17:15now four turns to get through the outer table yep and half turns till you penetrate the skull
17:39holy smoke i thought it was tom chris for a second over here nice job how's that feel digby
17:46pretty good my bad well you said we trim up those gorgeous locks here's now
17:53i don't like having my hair cut i get it rapunzel but you need your ears lowered
17:58you'll feel better with the fresh summer look that won't go unnoticed by the ladies
18:04maybe just a trim great i'm thinking of pixie cut what i'm kidding couple husband benji's here all
18:12the time trust me you're gonna look fabulous when's the last time you had a haircut
18:17maybe my daughter's wedding a few years ago where saint sebastian our lady of mount carmel parish
18:24does your daughter know where you are of course well i live in pittsburgh
18:31in fact they live in my old house
18:35your daughter lives in your house yep where do you live wherever i want
18:46you're gonna pass it five to six centimeters from the inner table of the skull okay
18:55centered perpendicular aiming for the medial canthus all yours and just keep going you'll feel a pop
19:04when you pass through the appendible lining all right line is calibrated good to go i try the
19:09nicardine pain to a map of 85 please and if we can get the inner cranial pressure down to 20
19:17dr mohan i'm sorry map of 85 icp of 20 um cerebral profusion pressure 65 which gives him the best
19:27shot
19:27at survival a third of patients like this die half have long-term disability we'll know in two
19:33weeks if there's a possibility for a good prognosis call to pop remove the stylet
19:42okay let it drain a bit
19:46and now pinch it shut perfect bp is down 190 over 88 heart rate 67
19:58how are you guys doing yeah making some progress you've seen abbott not since ralas
20:05you asked me to see a patient with the night intern hey you said yeah 48 year old woman
20:11new onset jaundice elevated liver enzymes no history of alcohol use take your pick hepatitis
20:18a b c d or e no risk factors no fever tylenol never no prescription meds does she eat polar
20:26bear
20:26liver it can cause vitamin a toxicity no she uh doesn't eat meat kind of a
20:34health nut well maybe she's gulping down cod liver oil to prevent measles he can no fish
20:40would you uh mind laying eyes on her seriously you have a way of figuring out the weird stuff
20:46take the compliment
20:49okay fine five minutes at the bedside that's it we're already gonna be here for hours as it is
20:55thank you what am i doing
21:02definitely improving title volumes up wheezes now expiratory only oh making some progress
21:08you feeling better baby you scared the shit out of me language
21:14does he have a primary care doctor not anymore how do you get his prescriptions we need neighborhood
21:21clinic we pay cash op utero is cheap simple court without medicaid 400 bucks a month just for a
21:28little inhaler
21:38to prevent infection exactly now 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 yeah big fourth of july sale the brain pressure is measured by
21:57the height of the fluid column we need to calibrate it to zero at the level of the tragus stop
22:01cox on
22:02ready to attach first troponin's normal but you need a second to rule out am i
22:07make it 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 i wanted to ask you about dr alashimi
22:21the va did you ever notice anything unusual about her behavior um like what lapses in focus attention
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
22:51no congestion nodules or cirrhosis good looking liver i should not be sick
22:58i worked so hard to stay healthy diet exercise eight hours of sleep i can't remember the last time i
23:06got
23:06eight hours maybe you should try sleep maxing oh you definitely should yeah cold room white noise
23:14eye shades kiwis before bedtime lettuce water mouth taping who do you follow for health a few
23:21naturopaths and some functional healers do you buy vitamins from them oh no no i don't take vitamins
23:26food is the best medicine kale blueberries kidney beans turmeric turmeric uh how long you been taking
23:33that for a few months it's an anti-inflammatory it detoxes the body and it can prevent alzheimer's
23:38how much do you take 500 milligram capsules but i take five a day
23:46what with doses that large of turmeric there have been cases of liver failure
23:51from eating a spice all right digby thank you good to go would you like to see
24:10i haven't looked like this in a long time your family won't recognize you
24:17how will they find me they won't know what i look like they won't know this is me of course
24:23they will
24:23they know your voice they know where you hang out they 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 and she will always remember you
24:51hey i was just looking for you what's up you tell me the uh asthma patient what about him
24:56it seemed like you were hesitating talking about using aerogen i was wondering if you're having
25:00second thoughts no just thinking about the best treatment plan for the patient and i think he's
25:07on it anything else i don't know you tell me anything else i need to know i don't think so
25:15this is dr robin the ed i'm checking out a patient eakins we can take larson and stevens off
25:20the dryer race consider it done he's in the scanner now oh great no i was just calling to confirm
25:26thank
25:27any new information from upstairs nothing we already know same old story huh you think we
25:33should take up a collection for jesse for for bail money they don't usually send bail until after
25:37you've appeared in front of a judge with the holiday it's not likely to happen till monday
25:41so he's gonna be locked up all weekend that sucks it does suck all right dr langdon grady's worse much
25:49worse nina tending uh no we have shed shots down 83 what's happening give us a minute
25:56he's tiring out ketamine and rock it's time to intubate a couple ma'am we have to put a tube
26:02down
26:03your son's windpipe so machine can breathe for him oh my god hold on hold on no lung sliding on
26:09the right
26:10pneumothorax no need to intubate what's going on he has a collapsed lung there was no history of
26:17trauma that would have caused the pneumothorax club up dr king in asthma you can get air trapping
26:24when the lungs can't fully exhale eventually they over inflate causing some of the tiny air sacs to
26:28burst how do you fix it
26:36like that
26:42it's a good thing dr connelly was here yeah we should probably try to find him a neurocritical
26:48icu bed we don't want to board a patient like this hey robbie hey how did the scan go fine
26:53it is
26:54probably going to take a little while to get the results from the radiologist well that's not a
26:58problem nurse debbie and i need a little time to coordinate our schedules over the next few
27:03months really yeah i've always wanted to learn how to ride a motorcycle and duke offered to teach me
27:08nobody knows motorcycles like duke he's giving me the health care worker discount
27:12it's quite the gentleman let's get him back to his room how would next saturday be for you baby
27:19maybe we could have some dinner after dr mohan lori diaz is here she wants to see your husband
27:24she's heading back okay i'm on my way
27:29mrs diaz hi they don't let him go up to his room yet no i brought him some dinner from
27:36burglatory
27:37it's a chicken burger no bun just lettuce figure it will be better than hospital food
27:46he's being treated by our top brain injury specialist will he wake up we won't know for
27:53several weeks and then he could be back to normal best case scenario it would take about a year
27:59before he could be independent at home and the worst case round-the-clock nursing care for severe disability
28:11you let him leave he insisted on leaving to work at a second job
28:17you're gonna make him stink he was competent he knew the risks we honored his decision to leave
28:24even if he was a stupid boy i tried to stop him offered to get him all the supplies he'd
28:29need to
28:29take care of himself at home but he left before i could give them to him he said he couldn't
28:34afford to
28:34lose a paycheck dr langton
28:47are you okay yeah i'm just kind of uh wondering if i'm really ready to be back here well of
28:55course
28:55you are 10 months is a long time i almost killed that kid with an intubation didn't even occur to
29:04me
29:04to check for a pneumothorax there isn't any trauma to indicate i should have caught it
29:15you know i am i had a deposition today and all the lawyers questions made me feel like i was
29:25a
29:26really really bad doctor we don't always get everything right first time you would have caught
29:35the collapsed lung that may have taken a minute but you would have saved him not sure robbie would agree
29:42with you he's been riding me all day well robbie's leaving for three months and you know with robbie
29:49gone i really don't want you to leave either that which does not kill me makes me stronger wow
30:10that's a thick one yeah austin green ogilvy's triple a
30:18uh g-r-e-e-n yeah why what are you doing checking to see when we'll get ogilvy back
30:23from the or
30:25oh shit what the guy didn't make it he died on the table about 40 minutes ago
30:31then where's ogilvy oh man his patient had a ct a year and a half ago that showed a four
30:38centimeter
30:39triple a it's too small for surgery he was supposed to come back every six months for a repeat ultrasound
30:45but looks like he didn't he would have seen that if the computers were working why wouldn't he tell
30:50ogilvy maybe forgot all about it or ogilvy didn't ask the right questions venice hey that a minute
30:58uh sure what do you need teenager with jewelry magnets stuck to both sides of her nasal septum
31:04i tried to move them with the plastic cure too much pain and then there was bleeding those need
31:09to come off before they cause permanent damage yeah you think uh you could find like a senior
31:12or an attending we're really trying to get off the clock here they're all busy
31:19i already took one for the team yeah fine yeah labs on your yellow lady
31:27iron is elevated 2.2 liver's in trouble but not dead yet tell you to skip the turmeric
31:32admit for monitoring follow the lfts got it central 10 yeah
31:42sleep maxine really i track the online trends is that your secret for the tough ones
31:48i just think what's the stupidest thing this person could have done and assume they did it
31:55well i mean she was trying to be healthy yeah i'm taking advice from fools turmeric is recommended by a
32:01lot of
32:01doctors yeah then ask your doctor for the dose or check someplace reputable like the cdc all right
32:06i forgot it's not a medical toxic waste site i mean she's in pretty bad shape things get worse
32:13she could need a liver transplant because she's a big fucking idiot wow no i actually appreciate her
32:22our job security depends on all these big fucking idiots okay
32:32good night perla monica good night dr robbie good night bye emma you could stay to pitch in
32:41dana told me to go and get some rest before tomorrow's shift yeah you had quite a day it wasn't
32:46so bad
32:49why can't i find duke's results oh new patient no ehr yet i can run over to radiology get a
32:55printout
32:56thank you monica
33:00ready to pick up a few more glano's all tucked in for now how's he doing numbers are good cpp
33:0622.
33:07okay so he's got a shot at a decent outcome at least you think he has a chance oh i
33:12don't know that
33:13survival was the outcome he was hoping for what he told samir he's got a hundred thousand dollars
33:18of medical debt his life is probably mrs diaz how can we help you in the bathroom uh yeah pearly
33:28can show you the way
33:31what a great idea to have a private conversation about a patient in a public area you were about to
33:37start getting okay how long have they been in there at least two hours how did it happen with
33:50measuring it was supposed to be a red white and blue to look cool with the fireworks i told her
33:56for
33:56the nose one side only but she never listens this can be pretty serious if we don't get them out
34:01quickly
34:01you can cut off the blood supply and cause the septum to collapse like my nose could be deformed
34:10oh my god get them off yeah that's the plan yeah she tried already hurt like crazy because they're
34:15stuck together by a very strong magnetic force yeah no no oh i'm not gonna use the tips i'm gonna
34:22flip
34:23it around and use the handle it's still gonna hurt probably not just uh hold still
34:32okay
34:38voila really that was amazing i think another half hour we can send this dry rice to we're back to
34:44storage with pleasure dr robinovich yep results on your friend
34:53okay
34:55duke
34:59are you gonna tell him i want to talk to a surgeon
35:03uh dr robbie i have an update on the patient but that is not a great time
35:06oh i thought you were going home uh i was
35:09dr ogilvy is just sitting out in the ambulance bay covered in blood sorry what's he doing out
35:14there kind of uh staring off into space i tried to talk to him but it was like he couldn't
35:18hear me
35:18monica can you stay at page code with the recipe yeah i'll go check on ogilvy please
35:24oh
35:37hey bogelvy
35:42what will be you okay man
35:5199 on two liters scattered and expiratory wheezes he is so much better the steroids should kick in
35:59soon so he'll keep improving um where can i go home in a day or two and we will uh
36:07discharge
36:07you with a simbacort inhaler that should last about a month hopefully we'll be back on medicaid by then
36:14how'd you lose it they sent a redetermination letter to our old apartment it didn't get forwarded
36:22when i went to pick up his prescription pharmacist told me we were no longer covered
36:28and you haven't been able to get it back since i've been trying for months to get re-enrolled you
36:34need tax returns pay stubs i cut hair my income fluctuates a lot of my regulars are struggling so
36:43it's been tough well if you run out of simba court before your medicaid kicks in
36:48you can come back and we'll set you up with another one ah is there a patient in here because
36:55everyone in this room looks extremely healthy to me dr shen and i will be with grady all night
36:59long hey day shift we got this we're leaving you in good hands um i was really scared thank you
37:11you're very welcome
37:17due to his injury things have changed
37:21i was looking for dr abbott i haven't seen him for a while excuse me
37:30so now with a long-term disability things may be easier
37:35easier his condition will qualify him for medicare and medicaid so moving forward
37:41costs should be covered including home health care okay perhaps this isn't the best time i just wanted
37:47to reassure you about future costs
37:59robbie noel
38:02you're still here it's not the best day to try to get out on time
38:07hmm so i guess this is it for a while unless you want to come with me
38:09no thank you even if it isn't a legitimate offer what do you mean oh please i know well enough
38:17not
38:17to get in between a man and his vision quest
38:21vision quest that is my nice way of putting it
38:27i probably don't want to hear you not so nice way of putting it no probably not
38:33i i hope that this is not um about you running away from me i'm a big girl you can
38:40tell me just to get
38:40lost this has nothing to do with you oh right it's the old uh it's not you it's me in
38:49this case it's
38:56actually true
38:57excuse me
39:05i'll see you next week it's a three-month sabbatical like i said i will see you next week
39:16my first day here as a med student there was a patient
39:22he was a really nice guy came in with belly pain
39:27i saw a gallstone on the ultrasound normal ekg troponin the pain resolved and he was in the hall
39:36when he had a cardiac arrest
39:41i couldn't save him people die
39:47and we do the best we can but people die
39:54you ever get used to that
39:58no
40:00no you
40:03you try to accept it
40:07you try to find balance
40:14i don't know if i can take another day like today
40:19primary care specialty sounds way better
40:22peds maybe
40:24yeah maybe
40:27i know i'd be bored out of my mind
40:30seriously i like the challenge of undiagnosed illness of quick decisions of life-saving procedures
40:41and i like being here for people on the worst days of their lives
40:53you know what i think
40:56what
40:57i think you should go home
41:00i think you should sleep on it and i think you should at least wait till the morning to decide
41:04if you want to come back
41:08i don't really want to go back in there and see anybody
41:13yeah
41:16okay pull off your gown i'll take it in
41:18the shift is over
41:21go home
41:22i don't mind
41:36No, I'm sorry. I'm good. I'm good. I'm good to tell me in a wheelchair. Yeah, he moves
41:42around. I see I've been replaced. Oh, did I take your spot? Not really. Are you sure?
41:51Where the hell have you been? I found Ogilvy. And? And he's going home. That's it? It's a long
42:00story. Well, I got nothing but time. I need to respect his privacy. Where's the fun in
42:05that? I'm sorry. The shredder jam? Yeah, try putting it in reverse.
42:23Perfect. Just give it a little love tap. Kick it. Jesus Christ.
42:33I guess Mr. Dick B got a room upstairs. In your dreams? He's not in South 21.
42:38Yeah, he is. There's a new guy in the bed. Short hair, clean shaves. I take care of it.
42:47Scout from Shorami's pathology. So we're going to the CT in your room.
42:50Textbook is sending out again. He's an eight centimeters. Fifty percent one-year mortality.
42:55So he definitely needs surgery. If he wants to live. Okay. Well, he's a friend, so I will
42:59talk to him. I'll get him admitted to your service. Not today. Why not? He needs to see cardiology
43:04and pulmonary first to be cleared for the OR. They can do a stress echo, PFGs. He needs to be
43:09admitted and evaluated as an inpatient. Nothing ever gets done over a holiday weekend. He can take it easy
43:13at home. He's a ticking time bomb. He's probably been that way for years. We can get him in early
43:16next week
43:17with a specialist. Get his testing done. All goes well. He's on the OR schedule in a week.
43:21What happens if it ruptures before then? Call 911.
43:24Sorry, Robbie. Best we can do. Text me his number. I'll have my office coordinate.
43:30Fuck! Hey! Take a walk. Come on.
43:38Two for discharge.
43:39Yeah, please don't ring the bell. The computers are like a button running.
43:42Not for these two. They don't have electronic health records yet.
43:44Wait, wait, wait. Hold up. This kid had a wrist x-ray ordered.
43:48Ugh, it never happened. And
43:50water skiing lady's still waiting on a knee series.
43:52I canceled the x-rays. Diagnosed them both
43:54with ultrasound.
43:56Really? Yeah.
43:59The, uh, little boy had
44:00a simple buccal fracture, distal radius.
44:02He got a Velcro splint.
44:04And Mrs. Stegman had a small medial meniscus
44:06tear, immobilizer crutches, and a follow-up
44:08with ortho. Could have used you on the day
44:10shift today. They don't teach us
44:12a lot of musculoskeletal ultrasound.
44:14I know. That's why I did electives
44:16at 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.
44:26Only I have one publication, but it's a series
44:28of case reports diagnosing shoulder dislocations
44:30with ultrasound only.
44:32If you want to learn some MSK, you can tag along.
44:34I've got three more to scan.
44:35Maybe some other time.
44:37Cool.
44:42Hey, don't try him in the shredder.
44:44What is that, two charts?
44:45No, it's my ultrasound fellowship application.
44:50Hey.
44:51Uh, sorry about your patient.
44:54Yeah, Orlando's in pretty bad shape.
44:57Oh, no.
44:58Uh, I was talking about the triple-A guy
45:00you worked on with Ogilvy.
45:06He didn't make it through surgery.
45:08I tried to talk to Robbie about it,
45:10but I think he's busy.
45:12Excuse me.
45:16Oh, shit.
45:22You think I'm on edge?
45:23We're just shaming Samira, then McKay.
45:25They both needed to be called out
45:26for an acceptance of behavior.
45:28Yeah, well, you do that in private.
45:29Same place, you share your thoughts
45:30about a patient's possible suicide
45:31and slamming stuff.
45:33Please, sign out all this shit
45:34that's bugging you and get out of here.
45:35I can't.
45:37Yes, you can.
45:38When either of my kids
45:38was acting like this,
45:39I gave them a time out in their room.
45:40Whoa, whoa, whoa.
45:40You're not my mother.
45:41Yeah?
45:42Well, too bad.
45:43You need one.
45:43No, I had one.
45:44She left.
45:44I don't need another one.
45:45What I need is someone
45:46who could actually run this place
45:47while I'm gone.
45:47Okay, I'm sorry.
45:49I didn't know.
45:49Nobody 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.
45:58Let someone else talk to Duke.
46:00No, that needs to come from me.
46:01Why?
46:03Because I owe him that.
46:04It needs to come from a friend,
46:06not a stranger.
46:06Otherwise, he's going to bail
46:07and drop dead while I'm gone.
46:08Okay, wrap that up
46:10and then leave.
46:12It's not just Duke.
46:13I'm not sure that Alashimi
46:14is 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
46:18to have two attendings on at all times?
46:20No.
46:20Is that something she's worked out
46:21with Gloria?
46:22I don't know.
46:22I also don't know
46:23if Langdon is going to relapse.
46:25I don't know if Whitaker
46:26is going to be able
46:26to take care of my shit.
46:27I don't know if Javadi
46:28is going to give up
46:29on what she's good at
46:29or if Samira is going to flame out
46:31because of some bullshit
46:31with her mother.
46:32Is there anything else?
46:33Yeah, you.
46:34I don't know about you
46:36running around
46:36with a full syringe
46:37or Versed in your pocket.
46:38I'm worried about the people
46:39that I care about.
46:41We'll all manage
46:42until you come back.
46:43We always do.
46:44Yeah, what if I don't come back?
47:03I don't know about you.
47:06I don't know.
47:10I don't know.
47:13I don't know.
47:16I don't know.
47:19I don't know.
47:23I don't know what you're going to do.
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