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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
11:29Oh, boy
12:13Good 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.
12:20She's 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.
12:35The 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 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.
18:23It's very hard.
18:27I'm not going to get drunk.
18:27Because we don't have to get drunk.
18:31Yeah, my husband.
18:33Sayuri.
18:34Bye.
18:36Bye.
18:36My mother is trying to destroy my life.
18:38Well, yeah.
18:39They 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
18:53wow i mean that's a pretty fucking stupid idea if you ask me she's known this guy less than a
18:58year
18:58what if he's a player what if she disappears at sea i mean what if they're in love lust is
19:04more
19:04like it that is even better man 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 yeah
19:27or ever
19:34how's it going esby oh just another day in paradise
19:44how's it going on a trip
19:57taking sabbatical leave tonight
19:59where are you going
20:02um head smashed in buffalo jump
20:05captain crunch flying squirrel socks
20:08are we talking in code or 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
20:21uh yeah something like that
20:24look i uh i guess we should talk
20:26i got a lot of things i need to
20:28at some point not right now right now i gotta hit the head and i would like you to go
20:30help donny out in triage
20:32triage
20:33triage
20:34no no i already picked up a patient in north too a bicycle
20:38pretty sure we can cover for you we've been doing it for months
20:43right
20:44no and i and i am i am very uh both very sorry and appreciative of that i just would
20:49hate to think this is some kind of a punishment for
20:53uh yeah yeah i know for sure we'll we'll talk later
20:56before you go
20:59like i said not right now
21:01donny just passed his db certification he can help you if you get in over your head
21:09hey mal
21:11can you take over a bike fall leg lack in north too from 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 and i want to keep you back here
21:21you okay with that
21:22sure
21:23great
21:24absolutely
21:31so
21:33who should i pick up
21:35we're about to get the morning rush
21:37what do you mean
21:38every morning around this time the nursing homes and assisted living facilities do their morning bed checks
21:44uh-huh
21:48it looks pretty quiet to me
21:54uh-huh
21:56incoming
21:57oh like i said
21:59come on
22:00ethan bostick 79 found altered this morning at assisted living
22:04no history of dementia has a pulse
22:06what'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 south 15 is open uh well do not resuscitate does not mean
22:19do not treat he may perk up with fluids
22:21fluids i have the antibiotics
22:28what's the good word crash you save that ventriloquist dummy
22:32yeah really really no wait tell me you're not actually charting about losing a mannequin
22:39it's part of the exercise don't know unless you may ask us to do it
22:42who's his next of kin barbie
22:46what's your uh take on the new attending
22:50not too soon to tell
22:53you
22:54she's already bugging me about being behind on my charting
22:57now i know why everyone says being a second year resident sucks
23:00because it does
23:01i must have sat through the part of med school where they tell you 90% of your time will
23:05be spent typing
23:05which is just one more reason surgery is a better lifestyle choice
23:10hey dr shamsi
23:11dr trinity santos
23:12oh yes the er intern who's interested in my surgery program
23:16well it's me
23:17but i'm an r2 now
23:18and thinking of double boarding in surgery and emergency medicine
23:21which i know would sound ridiculously ambitious if i didn't have the talent to back it up
23:26and a required attitude
23:29are you here to see a patient
23:30i was
23:32i did
23:33and now i'm here to learn why you aren't returning my calls or texts
23:38okay i'm out
23:39nice seeing you again dr shamsi
23:41as soon as i get a little free time i will make plans for all of us to do something
23:44together
23:45what about tuesday
23:45i'm working
23:46on your birthday
23:48i will call you and dad tomorrow and we will come up this night to do together i promise right
23:52now
23:52i just like have
23:54a bunch of night shift handoffs
24:03we have schedules you have chaos
24:07you know she's wasting her talents down
24:09victoria is a big girl she can make her own decisions she's also a young girl who's still very impressionable
24:15and you can be very impressionable
24:21yes
24:22who
24:24who
24:25oh for god's sake i'll be right there
24:28we need to talk
24:30about same time tomorrow
24:36next tuesday's your birthday
24:37no
24:40yes
24:40your 21st birthday
24:42please don't say anything
24:43okay i i get a little anxious
24:44dr santo's little girl with the chin legs getting to account
24:47don't want him to know what
24:50nothing
24:53have a good day
24:54me too
24:59hey duke
25:00i'm just calling to remind you that this is my last shift for a while
25:04so i need you to come in before three o'clock
25:07in case we need to run some tests
25:10okay
25:11we had a deal brother
25:15oh
25:16hello
25:17hi
25:17i know you're crazy busy
25:19always
25:20but i figured we should really go over a few things before you're gone
25:23sure
25:23where would you like to start
25:25well
25:26one little thing that i think would have a big impact with staff and patients alike
25:30is if we launched a campaign to eradicate referring to this wonderful department as the pit
25:37really
25:37i know you think it's silly and petty
25:39no i think it's just kind of endearing
25:41pretty damn accurate
25:42i would argue the opposite i think subconsciously it affects those who work here
25:48it also lowers expectations which in turn lowers patient satisfaction
25:52well you've been talking to gloria
25:53yes and she agrees with me
25:55don't doubt that for a moment
25:57you have to see the men who are there right now
25:59we see people in order of severity ma'am
26:05i don't know what you're saying
26:06i can taste the shit in the back of my throat
26:09actually the ladies right is going to make all of us sick
26:11yes please
26:19all right
26:20we'll get them back
26:22tell dana
26:23we're bringing the funk
26:28so when did your eyes start bothering you miss matthews
26:30sister grace please
26:32i'm only married to god
26:34of course
26:35i'm sorry
26:36a few days ago
26:37i thought it was pink eye
26:39or maybe i scratched it while gardening
26:42it's a very bad case of conjunctivitis
26:44we should send a sample to the lab to direct your treatment
26:47look up for me
26:48thank you
26:53great
26:53i'll put a numbing drop in your eye
26:55and check for a scratch with a special lamp
27:01and i'll get you to look up for me again
27:03thank you
27:05have you ever considered serving god
27:08which one
27:08excuse me
27:11my family's hindu
27:13so we have like 33 different kinds of deities
27:16oh we have the one
27:17some people only need one right
27:21okay
27:24most important rule around here
27:26be smart be safe
27:28can't warn you enough
27:29about protecting yourself and your fellow nurses
27:31we use the stamp acronym to assess patients
27:34you know it
27:34uh s is for staring or refusal to make eye contact
27:38if they're staring they're scaring
27:39t
27:40tone of voice
27:40often the threat level rises with their voice
27:43a is for anxiety
27:44you can also think aggression
27:46m is mumbling
27:47if you listen 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
27:56i guess technically it's two words
27:58but whatever
27:59if there's a threat
28:00say hula hoop
28:01and we'll all respond
28:04yeah
28:05lovely
28:07okay
28:08i'll be right there
28:09with reinforcements
28:10dirty calls
28:12we're headed for triage
28:40the antibiotics should clear everything up
28:44but
28:44you 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
28:51take breaks
28:52and elevate when you can
28:54tie it 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
29:00thanks
29:02let's say
29:03give this to the doctor
29:05what the hell is it
29:07patient passport
29:08lets 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
29:16the new attending
29:20what's up with your tooth louis
29:22it's been going on for a while
29:25but it got bad last night
29:28lower left side
29:34it could be an infection at the root
29:37we can drain it
29:38but then
29:41you're uh
29:41you're breathing kind of fast
29:43yeah i've been
29:44well
29:45i've been uh
29:46walking more
29:48trying to get in shape
29:50but sometimes like
29:51i get a little short of breath
29:52yeah you need to walk past
29:54the liquor store
29:54not into it
29:55what shape you're getting in
29:57it's 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
30:10how long you been sitting down
30:12oh just for a few minutes
30:14not that long
30:15um louis
30:19there's something i 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
30:31i'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
30:52it was not only wrong
30:54and utterly unprofessional
30:56but
30:56it was a betrayal
30:57of my hippocratic oath
30:58and
30:59it was a fucking crime
31:02that's where i've been
31:04rehab and counseling
31:08huh
31:08i'm sorry
31:10i understand if you
31:12prefer a different doctor
31:13hey doc
31:14we have a situation
31:17excuse me
31:19what kind of situation
31:20someone left the little baby
31:22in the restroom
31:31okay
31:33let's think about
31:34reversible causes
31:35of confusion in the elderly
31:36uh hypo or hypernatremia
31:38infection
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
31:49vtac
31:49can i
31:50yeah
31:53no pulse
31:54should we call for a code blue
31:55no cpr
31:56no shock
31:57we honor his pulse
31:58and his wishes
31:58so what does that leave us
32:02making sure he's comfortable
32:04how suction
32:06altered mental
32:07in the elderly
32:08can also be
32:09toxicity from
32:09anticholinergic
32:10sedative hypnotics
32:11opioids
32:15am i missing something
32:16social skills
32:24he looks so peaceful
32:25should we maybe go find a new patient
32:26no stay here
32:31a systole
32:42quick and painless
32:43quick and painless
32:44we should all be so lucky
32:45i'll try to contact some family
32:50yeah one of the things we like to do here
32:56when we have the time
32:58is to take a moment of 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 or friend
33:12oh uh
33:14just make sure your phones are on silent
33:20great great great
33:21okay
33:23is anyone missing a baby
33:25did anyone leave their child in the restroom
33:31you uh remember seeing a woman enter with a baby believe without one
33:35no sorry
33:38might be on the security tapes
33:40i'll have them i'll check it out
33:41please
33:42yeah
33:43harlow graham to window one
33:46harlow graham to window one
33:50harlow graham to window one
33:52please
33:58donnie donahue nurse practitioner
34:00this is em a new grad nurse
34:01hey
34:01nice to meet you
34:02what's going on
34:03somebody dumped their kid
34:04maybe mom just stepped out for a smoke or something
34:07what
34:08i'm being hopeful
34:09sometimes i just need a little break
34:10and then they come back
34:13at least i didn't leave her in a suitcase at 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
34:31i'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 a rectal temp on an infant
34:42uh
34:45theoretically
34:52mr williams how's the pain
34:55nothing i can't manage with some vicodin and a little scotch
34:59well it's uh
34:59best not to mix the two
35:01james here is going to take you to get an x-ray at your wrist
35:03i'm going to be fine
35:06well it'll tell us if you need a cast
35:07i doubt it
35:09i should probably go home
35:10keep some ice on it
35:11i know you guys always need the beds
35:15well uh
35:16it'll only take a minute
35:17and then we'll know for sure
35:18yeah i i really don't think it's necessary
35:20and i have a busy day
35:21but i appreciate your concern
35:27i'd really like to observe you for a little bit
35:29in case you did hit your head
35:31my head?
35:33i have my schnoz on 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
35:43thank you for your concern
35:50okay
35:51ha
35:54how about we take that x-ray just to be safe
35:58yeah
35:59yeah okay
36:00okay
36:01good idea
36:04somebody found a baby?
36:06yeah
36:06not the first time it's happened
36:09so about those pills i took
36:12don't worry about it doc
36:14if the pills helped you
36:16great
36:17i never really liked taking them
36:21i appreciate that louie
36:23that's not really the point
36:24but
36:25you need to lift up your shirt for a second
36:34how long has your belly been hard like that?
36:36i don't know
36:37i figured i could wait another week
36:39you need uh some lab tests and a procedure to drain off some of this fluid
36:44yeah i know the drill
36:46i've been tapped a few times before
36:49three times in the last six months
36:52you need to give your liver a break louie
36:54yeah i know
37:00i just heard somebody dumped a baby in the waiting room bathroom
37:03how sad is that
37:05huh?
37:07what's up with you today mel?
37:09lynn gallia?
37:11what makes you think there's something up with me?
37:13you're moping around here all day like somebody gunned down your favorite k-pop band
37:16i don't really have a favorite k-pop band
37:19not that i don't like the genre
37:21forget k-pop
37:22what's going on with you?
37:24you usually ride in here on your unicorn tossing wildflowers
37:27unicorn?
37:28never mind
37:30is everything okay with your sister?
37:33oh yeah she's great
37:34it's just this
37:38spill girl
37:40um
37:42well a couple of months ago i got named in a
37:45mel practice lawsuit
37:47and so um today is the
37:49the deposition
37:52that's it?
37:53every emergency medicine doc gets sued sooner or later
37:56seriously don't sweat it
37:58i mean you're still a resident we're protected by the hospital
38:00you could cut somebody's head off and get away with it
38:04but you know like
38:05don't
38:06you won't want to become known as the
38:09one who put mel in mel practice
38:12hey santos
38:12our little girl kylie has been in the west
38:15in the emergency department a couple times
38:18i'm not saying this is necessarily the case here but
38:21recent studies have linked bullying behavior to different personality disorders
38:26on the other hand though i am known to be a bit
38:29overly sensitive sometimes
38:30mel
38:31yes
38:31you talk to yourself again you need something
38:33uh yeah a good lawyer
38:35i don't know i'm kidding
38:36i'm
38:40yeah rabinovich somebody ditched a bundle of joy in chairs
38:42how old
38:43a couple months maybe donahue's got her in peds
38:46no one saw who left her
38:47apparently not
38:48it's so sad
38:49tell me about it
38:50who throws away a perfectly good baby
38:53make a lane
38:55sweet baby jesus antoine right to the outdoor shower
38:58i just drive them i'm not a wash and detail service
39:00yeah yeah god forbid you prove useful
39:03ah good time emma summer time for you and me to do the lord's work this way
39:07oh god what is that
39:09okay big breath
39:13all right lungs sound great can you lean forward for me
39:22uh did you hit your back when you fell down the stairs
39:26no
39:26okay there's a pretty good bruise here
39:28i got knocked down in soccer
39:33oh no you broke your wrist last year too huh
39:35fell with my skateboard
39:37got a purple cast
39:38cool color
39:39and you were treated at west penn
39:42is that your closest hospital
39:44uh i guess that would make sense
39:46i've only been dating your dad a few months
39:48uh he lived in garfield before the divorce
39:51and uh what about these
39:52soccer
39:54do you wear shin guards
39:55my dad ordered them
39:58what does your dad do for work
40:00he draws buildings but he's not an architect
40:03he's a draftsman for a firm in newcastle
40:06um kylie any chance you can pee
40:11um maybe
40:12okay well uh with the bruise on your back we need to check your urine
40:16okay
40:17okay
40:21did you eat anything out of the ordinary recently
40:23no
40:24sorry but
40:25we went through this a bunch
40:27don't you people communicate
40:29you're the third nurse we've told her story to
40:30i'm a doctor
40:32richard
40:33would you go to the cafeteria and get me a large chamomile tea
40:37what can we get you my dear
40:39i'm fine
40:40thank you
40:44i'll be right back
40:49please excuse my son
40:52ever since my husband died he's been a little overprotective
40:56i think it's sweet
40:58you're very lucky to have him
40:59i am
41:02are you still taking your loperamide and cholestyramine
41:07um not so much
41:09no
41:11that may be why you're experiencing the abdominal pain and vomiting
41:15when did you stop taking your meds
41:17last winter or so
41:21my neighbor helen and i bingo in wintersville
41:25there's a dispensary next door
41:27and we got some marijuana
41:29and i swear
41:31it cleared everything up
41:34a few cookies
41:35every few hours
41:38and no more pain
41:40a few cookies
41:43how many are you eating in a day
41:45oh
41:46uh
41:47i don't know
41:50probably a dozen or so
41:51but they're not very big
41:55there have been some studies that show an added dementia risk with marijuana use
42:00in older adults
42:03oh that sucks for old people
42:07kylie there are some questions that we ask every kid who comes in with an injury
42:13like what
42:14like
42:15sometimes the people that you live with
42:18can get so mad that they hit you or hurt you
42:23maybe without even meaning to
42:25does that ever happen
42:27no
42:28not to me
42:29or sometimes kids can get punished for doing something wrong with maybe a spanking or a belt
42:36i get timeouts
42:40how about at school kylie
42:41you know is anybody being you know mean or bullying you
42:45no
42:46i have lots of friends
43:08yo whitaker
43:10dr langdon
43:12you uh
43:14meet louie here
43:15uh yeah yeah many times
43:17good morning mr cloverfield
43:19what's up doc
43:20where's your new resident badge buddy buddy
43:22oh uh yeah they they didn't give me a new one yet
43:26bummer
43:27you and uh your ducklings got time to tap a six pack off our friend here louie needs a paracentesis
43:32yeah
43:33sure
43:33it's good to see you again louie
43:35not in this condition of course
43:37how you feeling
43:38feeling like i need a drink pretty soon
43:42okay well first things first we are gonna make you more comfortable by draining some fluid
43:47you're gonna take off a big volume to start with 60 grams of 25 percent albumin iv
43:52you tapped him before
43:53no
43:54that's okay doc i'll talk him through it
44:01sats 99 on room air normal bp normal plus
44:07uh well hydrated
44:08no obvious source of infection
44:10could be a benign virus but can't assume that
44:13this is the abandoned baby
44:15mm-hmm
44:15how old
44:17how old do you think she is
44:18month month and a half
44:20it's tricky
44:21under 28 days is a safe haven drop off
44:24no questions asked
44:25but over 28 days is a crime
44:27child abandonment
44:28how should we assess
44:30under 28 days gets everything
44:32including an lp
44:34but over 28 days
44:36you can follow p-carn
44:37or step by step to determine risk of invasive bacterial infection
44:41this baby looks great
44:42we know nothing about the birth history
44:44did mom have group b strep
44:46active hsv lesions
44:48we should assume the worst
44:50put in your orders dr mohan
44:53cbc
44:54blood culture
44:55campanil
44:57chest x-ray
44:58uan culture
45:00respiratory virus panel
45:02check inflammatory markers
45:04procalcitonin and crp
45:06then
45:08take it from there
45:08that sounds like a plan
45:10dr robbie
45:11santos needs you
45:12north one
45:13okay i'll be right there
45:14feel excused
45:15feel excused
45:19mind if i join with
45:20uh no
45:22at this
45:23it will help me get a better sense
45:25of how you like to do things
45:26by seeing you in action
45:27with the residents
45:29be my guest
45:33i will be right back
45:42nine-year-old kylie connors
45:43took a tumble running up the stairs this morning
45:45chin lack
45:46and fractured tooth
45:47brought in by her dad's girlfriend gina
45:49supposedly the dad had to leave early for work
45:53kylie has a lot of
45:54bruising
45:55on her body
45:55some old
45:56some new
45:56are you concerned about
45:58non-accidental trauma
46:00or worse
46:02her urine sample shows gross hematuria
46:04which could be renal injury
46:06or vaginal bleeding from trauma
46:08could have contaminated the specimen
46:10lots to consider
46:11what's your plan
46:13labs
46:14ultrasound
46:15social work consult
46:16then decide if this is reportable
46:22let me know if you can feel this
46:24no
46:25am i supposed to
46:26no
46:32your hair is such a pretty color
46:33thank you
46:35reminds me of my mom
46:37she died when i was nine
46:39i'm sorry about that
46:41she wore glasses like you too
46:43weird
46:45what do you like to do when you're not working
46:48um
46:49spend some time with my sister
46:51read
46:53do you drink coffee
46:54uh no i avoid caffeine
46:58me too
47:01what about boba
47:04i love boba
47:10i'll offer you some gum but it's laced with nicotine trying to quit smoking
47:16that's good
47:17birdie's still out
47:18getting all those nooks and crannies mr digby
47:21your skin will thank you
47:23we all will
47:25i could stay in here all day
47:29a miracle what a little soap water and human decency can do sometimes
47:33don't forget the ears pal don't want anything growing in there either
47:36okay okay
47:38what's your story emma
47:40what do your parents do got siblings boyfriend
47:42ever kill a man in a bar fight
47:46uh
47:57so mr williams
47:59sometimes a fracture of the scaphoid bone doesn't show up on day one
48:03so my advice to be safe is we're split for two weeks and then come back for repeat x-ray
48:09and we'll see if it's really there
48:13my knee hurts
48:15oh did you hurt your knee
48:18i must have
48:27what is this
48:30that's um
48:31that's um for your wrist
48:32i need this
48:35well um
48:37if it's a uh john can you
48:40if it's a fracture and we don't immobilize the bone might not heal properly
48:48how long is this going to take
48:51just a few minutes to fit you
48:56is this place new
49:02mr williams
49:03do you know what day it is
49:09it's taco tuesday
49:12do you know where you are
49:15yeah i'm in the slowest medical clinic in the west
49:19do you know what year it is
49:21how about you just fix my wrist
49:23and you stop
49:25with all the questions
49:27i am not here to be profiled
49:35yeah of course
49:38i'll be back okay
49:51all right mr digby looking better already
49:53certainly smells a little better
49:55do you have any conditioner
49:56let's get you dried off and back inside
49:58get him downed up and put him in south 21 across from the old nun
50:01maybe some of her to find grace will wear off on him
50:05who do we have here evelyn bostick 81 with alzheimer's we brought her husband in about 30 minutes ago
50:11she was supposed to get a ride in but they found her wandering in traffic
50:14where are we
50:15you're at the hospital dear
50:16i'm not sick
50:18we brought you to see your husband
50:19oh no is he's in okay
50:22be in to chat with you mrs bostick
50:25he died
50:27what you got am boy
50:28alan billings had a pallet fall into his outstretched arm
50:32looks like an open dislocation
50:34yeah that's gotta hurt
50:35don't worry sir we got you
50:43how's she doing
50:43seems happy enough
50:45yeah
50:47just got a quick point of care cbc
50:57is there a problem
51:02did i miss something
51:04dr l
51:06dr l
51:14i'm in hurt
51:17but i refuse to cry
51:21i'm in hurt baby
51:24but i refuse to cry
51:29and it's so true
51:30i know you know you know you know i can't laugh
51:34and i said yeah yeah yeah
51:37yeah yeah
51:41yeah yeah
51:43yeah yeah
51:44yeah yeah baby
51:46yeah yeah
51:47yeah
51:48yeah
51:50i won't cry
51:52oh
51:53you know i won't cry
51:56I said, I won't cry, baby, baby
52:00You know I won't cry
52:03You know, you know I won't cry, baby
52:06I'm telling you, I won't cry
52:10Oh, I don't like
52:13Oh, but I refuse to cry
52:16And I said, sometimes, darling
52:21Your friends, they treat you so cold
52:24But baby, you know they act better
52:27Yeah, yeah, when you have that goal
52:32But I won't laugh
52:34You know, you know, you know
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