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00:17I'm in.
00:18Bag them.
00:23Defib pads.
00:24We're in place.
00:26Okay.
00:27All your pressures.
00:28Good square line on the end title CO2.
00:30B-fip.
00:30Charge at 200?
00:33Charged.
00:35Clear.
00:38Stand by with that B.
00:44Suction that tube.
00:48I'm not in the esophagus, sir.
00:49Definitely not.
00:50Pass right through the cords.
00:52Good breath sounds.
00:53In tidal CO2 confirmed.
00:55His lungs are filling up with blood.
00:56I know.
01:03Okay, rhythm check.
01:06Asystole.
01:06Push the epi.
01:07Fuck.
01:12Patients with lunch trays have been admitted.
01:15They're boarders.
01:15They're waiting for a bed to open upstairs.
01:17What about the others?
01:18Non-admitted patients.
01:20They can have sandwiches or juice boxes.
01:22Just make sure they're not NPO.
01:24It's nil per os.
01:25It's Latin for nothing by mouth.
01:27NPO's are waiting for surgery.
01:28They'll beg, spit, and curse for food.
01:30But you've got to stay strong.
01:31Hey, I've been waiting for an hour.
01:33When am I going to see a fucking doctor?
01:34Excuse me.
01:37Perhaps you didn't see this, which is strange, because they're all over the place.
01:40Aggressive behavior toward health care workers is a felony.
01:43$2,000 fine, possible jail time.
01:45Got it?
01:46Okay.
01:48I was just asking.
01:49We're busy today.
01:50It's a holiday weekend, and we see the sickest patients first.
01:53So be happy you're still waiting.
01:56Jack off.
01:59P.T.M.C. charge nurse.
02:02Go ahead, medic, ma'am.
02:04Okay.
02:06Got it.
02:07Income in trauma.
02:09Come on.
02:10Three minutes.
02:11Who's the last epi?
02:12Hold compressions.
02:15Asystole.
02:16Resume CPR.
02:17Another amp-epi.
02:18Use no suction.
02:26Pulmonary hemorrhage from liver failure.
02:28Is he going to make it?
02:35Should we get PCC?
02:37Too late for that.
02:40And he's not an ECMO candidate.
02:42Nothing else we can do.
02:48No, I-I think we're done.
02:56I'm going to wait.
03:0212.07?
03:11Should we do a debrief?
03:13We've got another motorcycle injury coming in.
03:16ETA, 10 minutes.
03:17We'll get a little cleaned up.
03:18Into the vehicle, right?
03:20Yeah.
03:20Anybody that wants to pay their respects can join us in there.
03:26Thank you, everyone.
03:35I'll clean them up.
03:36Why don't you take five first?
03:38Or ten?
03:40Yeah.
03:41Yeah.
03:52This is Dr. Jefferson from psychiatry.
03:54Why do I need to see a psychiatrist?
03:57Jada, why do I need to see a psychiatrist?
03:59Oh, it's going to be okay, Jackson.
04:01Dr. Jefferson says he can help.
04:04Do you know how you got here?
04:06The medics brought me.
04:08I don't really remember.
04:10I was in the library.
04:12What were you doing there?
04:14I was studying.
04:17I was trying to study.
04:20But then they wouldn't stop talking.
04:22Who wouldn't stop talking?
04:24They don't want me to pass the bar.
04:26Who doesn't want you to pass the bar?
04:27That's what they told me.
04:28Hey, hey, hey.
04:30Look at me.
04:30Look at me.
04:30Who doesn't want you to pass the bar?
04:32Let's give them some privacy.
04:34Dr. Jefferson will let us know when he's done.
04:37I'll be right outside.
04:40Okay, I'll be right outside, Jackson.
04:44Why don't they want you to pass the bar, Jackson?
04:47You're afraid of me becoming alert?
04:48You're afraid of you becoming alert?
04:51He must have been studying with his law school friends.
04:56They should know what happened.
04:58I'm going to call them.
05:00If you need anything, let me know.
05:02Okay.
05:05What's your name?
05:14Louie.
05:15What?
05:17Pulmonary hemorrhage.
05:20That was quick.
05:22I'm going to go clean them up.
05:25I'll help.
05:29Go.
05:30Go.
05:31Okay, now.
05:34Everything okay, Roxy?
05:38I can't get off the bed, Pam.
05:40That's what I'm here for.
05:47Your husband seems like a saint.
05:50How long have you been married?
05:53Too long.
05:57Almost.
05:58Twenty years.
06:00You put your arm around me,
06:02and I'll pull the bed, Pam.
06:03One, three.
06:04Okay.
06:05One, two, three.
06:08One more.
06:10Great.
06:12Twenty.
06:13Twenty.
06:14Wow.
06:16Yeah.
06:19He's been by my side through all of this.
06:24I've watched the light go out of him.
06:28So have the kids.
06:30That's what happened to my auntie when my uncle Gerald got sick.
06:35But your husband does it because he loves you.
06:39I don't know how you do it.
06:42Care for people day after day.
06:44I'll tell you my secret.
06:47I go home at the end of every shift,
06:50leave this all behind,
06:52and escape to Love Island.
06:55How's it going in here?
06:57The higher demand dose of morphine helped a little,
07:00but she's still in pain.
07:01Okay.
07:02I got your order.
07:03Zero point one per kilo.
07:04Thanks.
07:06This is a very low sub-dissociative dose of ketamine.
07:10You might feel a little weird,
07:11but I think it's going to help with the pain.
07:16Is my husband still in the cafeteria?
07:18I think so.
07:19Want me to get him?
07:21No, no.
07:23It's good for us to have a little time apart.
07:29I'll get you another blanket.
07:35Here.
07:36I'm headed that way.
07:39Back in for good?
07:41Officially out of triage.
07:42They need extra hands with all the Westbridge hullabaloo.
07:45How many cups have you had today?
07:47Don't judge me.
07:48Just asking.
07:49You're judging.
07:52Did you hear about Louis?
07:54No.
07:55Pulmonary hemorrhage.
07:56Didn't make it.
07:57Shit.
08:00He's been here a hundred times.
08:01I know.
08:03Debrief in the viewing room later.
08:06On a happier note,
08:07Pearlie and I are planning a birthday party for Javadi.
08:09She's turning 21.
08:11You two are thick as thieves.
08:13I don't have much of a social life these days.
08:17But I'll be sure to keep an eye out for the partyful.
08:19Let's discuss our incarcerated patient, Gus.
08:22Prison infirmaries tend to be short-stabbed,
08:24so we need to be thorough.
08:26What's in the differential diagnosis for malnutrition?
08:29Inadequate intake,
08:32methamphetamine use,
08:33severe alcoholism,
08:34ADHD medication.
08:36What else?
08:37Cancer of the oropharynx,
08:38esophageal strictures,
08:40prior strokes,
08:41malabsorption,
08:42inflammatory bowel disease,
08:43none of which were in his medical record.
08:45What about psychosocial causes?
08:47It could be an intentional hunger strike.
08:49Or refusing food to get to the infirmary.
08:51It could also be abuse or neglect.
08:53Let's start with the nutrition history
08:55once he's back from CT.
08:56Do you have a second to talk about Westbridge?
08:57Mm-hmm.
08:58Hey, we need to start moving some patients out of here.
09:00These walls are starting to fill up with gurneys.
09:02Santos, Ogilvy, and King
09:03all have patients on the launch of Pat.
09:04I'll check in with them.
09:05How many patients have we had,
09:06re-ratter from Westbridge?
09:08Tim, God knows how many more in the waiting room.
09:09Ambulance will be here in a few minutes
09:11with the accident victim
09:11whilst they came in trauma, too.
09:13What is the story
09:14with your incarcerated patient?
09:15Gus Varney,
09:16three rib fractures
09:17with normal O2 sats currently,
09:18waiting on CT results.
09:20Okay, if he's stable
09:20at the two-hour mark,
09:21I'd say he's good to go.
09:22Let's get the ball rolling on discharge.
09:23Let's wait on the CT results.
09:25We can move him out of trauma one, at least.
09:26Yes, we can.
09:27What's open?
09:2813 and 14 will be discharged soon.
09:3015, once we can move
09:31over to the viewing room
09:32and get it cleaned up.
09:32Our paracentesis patient,
09:34Mr. Cloverfield?
09:35The Thiburist.
09:36We'll do a debrief
09:36when we know how many patients
09:37we're getting from Westbridge.
09:39So Gus goes to 13, 14, or 15.
09:42I kind of want to keep him in plain sight.
09:44What about BH2?
09:45So why not give him some privacy?
09:47Everyone can see him in BH2
09:49like he's a monkey at the zoo.
09:51Because he came in
09:51with an orange jumpsuit
09:52and we need to think about
09:53patient and staff safety.
09:55Safety first,
09:55BH2 beats a prison cell.
09:57Not by much.
09:58Did you guys hear about Louie?
09:59Yeah.
10:00A chronic alcoholic?
10:02Go figure.
10:03Hey, uh,
10:04Fento D and South 20
10:05is ready for discharge,
10:06but could you get Lupe
10:08to call him a ride?
10:08I need to check on Louie.
10:10Uh, actually, Whitaker, he...
10:11He croaked.
10:13What?
10:13Five minutes ago,
10:15Robbie called it.
10:25I'm sorry, man.
10:27We didn't have time to find you.
10:30What happened?
10:32He was apneic,
10:33impulseless.
10:35We started CPR
10:36and intubated him.
10:38He had a massive pulmonary hemorrhage,
10:40Robbie called it.
10:43Found this with his stuff.
10:45Guess he was married at some point.
10:48Never knew that.
10:54Didn't miss this part of the job.
10:56Yeah.
10:58Perla, did Louie ever mention anything
11:00about a wife and kids?
11:03As far as I know,
11:05he only had eyes for Rita Moreno.
11:06Well,
11:08this is not Rita Moreno.
11:11No, it's not.
11:12Can we check to see
11:13if there's emergency contact?
11:17Yeah, there's a number listed.
11:26You were his primary.
11:27Do you want to...
11:32Uh, well...
11:41PTMC charge nurse.
11:44Langdon?
11:44Where are you?
11:48Makes sense that we'd be
11:49his emergency contact.
11:50Sorry to get your hopes up.
11:53My social worker's
11:54going to do their thing.
11:55If Louie had any family left,
11:57they'll find him.
11:59You okay?
12:02I guess it's good
12:03it happened here.
12:04Not out on the street.
12:06You're off the hook with Louie.
12:07I'm going to teach Emma here
12:08how to clean a dead body.
12:12I'm sorry,
12:12but then you mean LMD.
12:14You might want to call
12:14for another interpreter.
12:16Busy day.
12:17Shit,
12:17that's a girl in 12?
12:18She's been waiting
12:19for five hours.
12:20Didn't hear her name
12:21called the first time.
12:22You check on her?
12:23Need to brush up
12:24on my ASL.
12:25You know sign language, too?
12:26Princess here knows
12:27six languages.
12:28I know French.
12:28Okay, it's not a contest.
12:31Ah, très bien.
12:32No shit talking
12:33in front of me.
12:34I get enough of that
12:35from her and Perla.
12:36I guess I'll call
12:37for backup.
12:39Yo, Donnie,
12:40did you discharge
12:40your butt abscess?
12:41Not yet.
12:43What the hell?
12:44Your good friends
12:45upstairs send donuts.
12:46Special thank you
12:47for working the holiday.
12:48You've got to be kidding me.
12:49What are we expecting?
12:50Tacos and tequila?
12:51Every single one of them
12:52can forget about extra shifts.
12:53Won't hire more nurses.
12:55Won't pay us a decent wage.
12:56Won't hire security
12:56that can actually protect us
12:57from patients,
12:58but absolutely send donuts.
12:59Sure you want to go
13:00into this line of work?
13:01Want me to get you one?
13:02Of course I do,
13:03but I'm not taking
13:03admins' blood pastries.
13:05A two, Donnie?
13:08Okay, move it or lose it.
13:09Meet me in South 15
13:10with gowns and gloves.
13:12Looks like happy hour in here.
13:13Don't ask.
13:14What's up with Eva Knievel?
13:15Brandon Lee, 52,
13:16fell off a motorcycle pyramid
13:18at 25 miles per hour.
13:19Motorcycle pyramid?
13:20You recruiting?
13:21Got a fellow rider
13:22in your midst.
13:22No kidding.
13:23How high up were you?
13:24On top of a 3-2-1,
13:25but the bottom guys
13:26are sitting down
13:26driving the choppers.
13:28I'm fine.
13:29I don't need all this.
13:29Are you wearing a helmet?
13:30Of course.
13:31Oh, what do you know?
13:32They're still in style.
13:33Good vitals, tender right wrist,
13:35and big left knee lack.
13:36Hey, Joy, Perla, trauma two.
13:39Who else can I have?
13:40Santos and Whitaker
13:41in with Louie.
13:41Yeah, give me Whitaker.
13:42You could use a distraction,
13:43and Santos has been
13:44ducking traumas all day.
13:45She's behind you in her chart.
13:46Who isn't?
13:50Look, even when
13:51it's not your fault,
13:54sometimes it's worse
13:55knowing that there
13:56was nothing you could do.
14:00Are you?
14:02Robin needs you both
14:03in trauma, too,
14:04and I need you to discharge
14:05Sweet Patty and Thirteen
14:06as soon as you're done.
14:07Can't catch a break.
14:08I push you,
14:09because I know
14:09you can take it.
14:14Okay.
14:22You ever clean
14:23a dead body?
14:26Probably never seen
14:27one either.
14:29No one tells you
14:30what it looks,
14:31feels, or smells like,
14:32but you get used to it
14:34over time.
14:36We pull off the gown,
14:38wipe him down with towels,
14:40and we'll roll him
14:40on his side,
14:42clean his back,
14:43stuff the sheet under him,
14:45wipe down the bed,
14:47roll him the other way,
14:48pull out the sheet,
14:49and repeat,
14:49just follow my lead.
14:52Usually,
14:54leave the ET tube
14:55in for the coroner,
14:56but Louie's a chronic
14:58alcoholic with
14:59end-stage liver disease,
15:00not a coroner's case.
15:04Did he have family?
15:05Everyone has family.
15:07The social worker
15:08always tries to find him.
15:10Sometimes the family
15:11loved him,
15:13tried to get him
15:13to come home.
15:14Other times,
15:15the family wants
15:15nothing to do with him.
15:17That's sad.
15:18That's life.
15:21What happens
15:22if no one claims his body?
15:23He'll be cremated.
15:24Where would his ashes go?
15:26We'll keep him
15:27for a few months,
15:27then he gets buried
15:28in the mass grave
15:29with all the other
15:29unclaimed bodies.
15:33Okay.
15:34Now we roll him.
15:41Oh, my God.
15:43Is he still alive?
15:43No.
15:44That happens.
15:46These frequent flyers
15:48can be a real pain
15:49in the ass,
15:50but
15:52you miss them
15:53when they're gone.
16:01We've been at every
16:02Melville 4th of July
16:03parade since 08.
16:05World record is
16:0640 men on 7 motorcycles.
16:08Plan to beat that someday.
16:10Good lung sliding bilaterally?
16:11Cupils equal and reactive.
16:13What do you ride?
16:14The bullet.
16:15Oh, Royal Enfield,
16:16ankle breaker,
16:17thumper.
16:17BP138 over 80,
16:19pulse 94,
16:20pulse ox 98.
16:21All your vitals
16:22sound really good, Brandon.
16:23They call it an ankle breaker
16:25because you've got to
16:25kick over a big,
16:26fat, single cylinder
16:27to get it started,
16:27sometimes five or six kicks.
16:29Especially on a cold day.
16:31Um, does anyone
16:32have any trauma scissors?
16:33I'll check the knee.
16:34Uh, not yet.
16:35Why not?
16:36Dr. Santos?
16:37Primary survey means
16:38rule out the life threats.
16:40Don't get distracted
16:40by lacerations or fractures.
16:42No free flute in the belly.
16:44Airway, breathing,
16:45circulation are fine.
16:46Okay, that's ABC.
16:47That just leaves two letters.
16:48Tell her about D,
16:49Dr. Santos.
16:50Disability.
16:51Wiggle your toes, sir.
16:53Any pain in your arms or legs?
16:55Not really.
16:56Does it hurt when I push here?
16:57No.
16:58Okay, uh,
16:58no midline tenderness,
17:00nexus negative.
17:01No obvious brain injury
17:02or spinal cord injury.
17:03That just leaves E.
17:04Joy.
17:06Can I buy another vowel?
17:08Dr. Whitaker.
17:09Exposure.
17:10A.K.A. strip and flip.
17:12Cut off his clothes
17:13and we'll log roll him.
17:14What do we have?
17:16Helmeted motorcycle acrobat.
17:18Eight foot falls
17:19standing on top
17:19of five riders.
17:21Primary survey normal.
17:22E-fast negative.
17:22Another motorcycle accident.
17:24Hello, sir.
17:25I'm Dr. Garcia from surgery.
17:26Hello.
17:27Okay.
17:28We will roll him
17:30in three,
17:31two,
17:32one.
17:37Well,
17:37I grew up a block
17:38from Carrick
17:39and my mom was a teacher
17:40at Brashear's
17:41so I had to go there.
17:42The bullets?
17:44That's right.
17:45They were the bullets
17:46when I was there.
17:46They changed to the bulls
17:47when I left.
17:48Oh.
17:49Hey,
17:50you think I could get
17:51something to eat?
17:54Gus here's wondering
17:55if he's clear to eat.
17:57As long as it's a liquid diet.
17:59We have the results
18:00of your CT scan.
18:01Your jaw should heal
18:02without surgery,
18:03which is good news,
18:05but it will be a few weeks.
18:07Before I can eat?
18:08Solid foods, yes.
18:10Or you can have
18:11food purée
18:12with liquid in a blender.
18:14I don't have a blender.
18:17Right.
18:18Sorry.
18:20We have a calorie-rich
18:22supplement drink
18:22called Ensure.
18:23Comes in chocolate,
18:25vanilla, or strawberry.
18:27Chocolate, please.
18:29Good choice.
18:29How many can I have?
18:30Two a day is recommended.
18:32I'll get it for you.
18:34You have an appetite.
18:35It's good.
18:37Mr. Varney,
18:38your blood tests indicate
18:39low levels of protein
18:41and vitamins.
18:42Can we ask you
18:43a few questions
18:43about your diet?
18:46How many meals or snacks
18:47do you have
18:48in a 24-hour period?
18:49I don't know.
18:51Don't count.
18:52Pretty sure it's
18:53three trays a day.
18:56Okay.
18:57How often do you eat
18:58cereals, fruits,
18:59or vegetables?
19:00Not many fruits
19:01and vegetables
19:02and vegetables
19:02in prison.
19:03Slow and steady.
19:07What year
19:08is your Bonneville?
19:0969.
19:11Rescued her
19:11from a motor graveyard
19:12and brought her
19:13back to life
19:13with a buddy of mine
19:14who's supposed
19:15to be coming in today.
19:16How often do you ride?
19:18I ride it
19:18into work every day.
19:20Oh, good for you.
19:21Don't encourage him.
19:23CT's ready for Brandon.
19:24As soon as we
19:25take a look
19:25at this knee.
19:28Whoa.
19:29Through the deep fascia.
19:30How's it look?
19:31Definitely gonna need
19:32stitches.
19:33How many?
19:33A lot.
19:34It could be an open joint.
19:35We'll do a saline load
19:36after CT.
19:39Leave her sign negative,
19:40ACL intact.
19:41Okay, ready to roll.
19:47Are you still
19:48coming over tonight?
19:49I think Whitaker
19:50is gonna be playing
19:51Farm Boy again
19:51this weekend,
19:52so he's not gonna be around.
19:53I may need a rain jacket.
19:54Hey, do you have
19:55an update
19:55on that neck bash patient?
19:57Last I heard,
19:57Miller was doing
19:58an above-the-knee
19:59amputation with ortho.
20:03Langdon's waitress
20:04with the cellulitis?
20:06Man, that took a turn.
20:07Sure did.
20:08Hey, did you
20:09hear about Louis?
20:12Yeah.
20:13You okay?
20:15Um,
20:16one of my uncles
20:17drank himself to death.
20:20Barely recognized him
20:21at the end.
20:23At least Louis
20:24always seemed happy.
20:26Come here,
20:27if you want to talk.
20:33They're not fighting in here.
20:36Still anyone's lunch,
20:37it's a $20 fine.
20:40Made a lot of changes
20:41while you were gone.
20:42I can see that.
20:43Look, I'll let you hide
20:44out a little bit longer,
20:45but then I need you
20:45to pick up more patients.
20:46You're not as fast
20:47as you used to be.
20:48Damn donuts.
20:50Ouch.
20:52First day back,
20:53I get kicked in the nuts.
20:56One dead,
20:56one septic bounce back.
20:58Well, so that's not your fault.
21:02You expecting a party?
21:04No, not really.
21:06Didn't hear from anyone
21:07while I was gone.
21:11Sorry.
21:13They ever, uh,
21:15arrest that guy
21:15who punched you?
21:17Yeah.
21:18I wanted to know
21:19if I wanted to press charges,
21:20but I didn't want
21:21to go through all that.
21:23Thought I was done.
21:24Really did,
21:25but I got bored of him,
21:27so it only lasted
21:29a few weeks.
21:30You?
21:31Ten months is a long time
21:32to be alone
21:32with your thoughts.
21:34I almost lost everything.
21:37I know a lot of women
21:37who would have taken
21:38the kids and left,
21:39but Abby stayed.
21:41Because she's a good woman.
21:42Because you deserve
21:43a second chance.
21:44I'm not sure
21:44everyone agrees with you.
21:46Give it time.
21:48Look, I...
21:55I, um...
21:56I've been working
21:56the 12 steps,
21:57trying to make amends.
22:00I was really selfish.
22:01I lied to myself,
22:02and I lied to you.
22:04I'm really sorry.
22:05You can check me
22:05off your list, kid.
22:06We're good.
22:08Okay?
22:09Yeah.
22:10Got a lovely patient
22:11for you in, too.
22:12Let's get you back
22:12on the horse.
22:17Really need to talk
22:17with Robbie.
22:18I know if today's
22:19the best day for that.
22:20He leaves on vacation tomorrow.
22:21Let him get to the day
22:22in peace.
22:23I'm supposed to be gone
22:23for three months?
22:24So he says.
22:25I give a one.
22:26Go get him, kid.
22:30Dr. Langdon,
22:32this is Rocky.
22:33Great name.
22:34What brings you in, Rocky?
22:38Very sick.
22:40When did it start?
22:42An hour ago.
22:43After he won
22:44a hot dog eating contest.
22:46A hot dog eating contest?
22:47How many he eat?
22:50Three.
22:52351 hot dogs?
22:5836.
22:59Still a lot.
23:02I pulled a data
23:02Zofran.
23:03Go for it.
23:04All right.
23:04This should help.
23:05Stick it under your tongue.
23:06Let it dissolve.
23:06Okay.
23:08Are you taking any...
23:16Thanks.
23:19Santos, what's up
23:19with your earliest patient?
23:21Admitted to medicine
23:22and before you ask,
23:2313 has been discharged.
23:25Great.
23:2512 needs a doctor.
23:27No, don't make me
23:28go back there.
23:29That disimpaction
23:30left a smell
23:31and stuck up
23:31the whole hallway.
23:32So grab some
23:32coffee grounds
23:33from the lounge.
23:34We need to admit
23:35our incarcerated
23:35patient guests.
23:37What did the CT show?
23:38Moderate pulmonary
23:39contusion,
23:40three rib fractures,
23:41no interabdominal bleeding
23:42and oblique fracture
23:43in the body of the mandible
23:45anterior to the angle.
23:46All favorable for healing.
23:48What's the treatment plan?
23:48A pain...
23:51Pain medication,
23:52antibiotics,
23:54liquid diet,
23:56pulse ox a few times a day
23:57and then also
23:58dressing changes
23:59for the laceration.
23:59Which he can get
24:01at his correctional facility.
24:02Or he stays here
24:04for a few days
24:05and we get him
24:05on the right track
24:06to healing.
24:08Why don't you two
24:08go check on your patients?
24:10Sure thing.
24:13What am I missing?
24:14He's not getting enough
24:15to eat at his
24:16correctional facility.
24:17The portions are tiny,
24:19too many carbs,
24:19not enough fruits
24:20or vegetables.
24:21He's lucky he hasn't
24:22developed a chronic illness.
24:24We don't have
24:25any inpatient beds.
24:26He would board down here
24:27for three days.
24:28We're still getting runs
24:28from Westbridge
24:29and we cannot tie
24:30up behavioral
24:30for that long.
24:31Dr. Al-Hashimi,
24:32Dr. Jefferson wants
24:33to talk to you
24:33about our tasered kid.
24:39Why don't I call
24:40the prison doctor
24:40and find out
24:41what they're working
24:41with over there?
24:43My pleasure.
24:46Dr. Jefferson seems
24:47to have a good rapport
24:48with Jackson.
24:49It's excellent.
24:49How's the sister doing?
24:51Still pretty upset.
24:52She's never seen him
24:53like this.
24:54It's a lot to process.
24:56How's he doing?
24:56He's scared.
24:58Dr. Peridol had
24:59a positive effect
24:59but he doesn't understand
25:00what's going on.
25:02He's been experiencing
25:03auditory hallucinations
25:04and paranoid delusions.
25:05Voices are telling him
25:07he isn't safe.
25:08This has been going
25:09on for months.
25:10Months?
25:11Yeah, it turns out
25:11his sister hasn't seen
25:12him in a while.
25:13Family history
25:14of mental illness?
25:15Not that we know of.
25:17I'm going to give him
25:18a break and then
25:20continue the conversation.
25:21Parents are on their way.
25:22We'll let you know
25:22when they get here.
25:23Yes, Steve.
25:25Okay, hospital bed,
25:26wheelchair,
25:27and shower chair
25:27have all been ordered.
25:30What do you say, kid?
25:32Ready to go home?
25:35How's your pain,
25:36Mrs. Hamler?
25:38It's the same.
25:40We're going to write
25:41you a script for Keppra.
25:42You'll take that
25:43to prevent seizures
25:44once a day
25:45starting tomorrow.
25:46Between your broken leg
25:47and the bruises
25:47from your seizure,
25:48the pain will probably
25:49get a little worse.
25:49Yeah, the most important
25:51thing is to let others
25:51help you.
25:52You'll need assistance
25:53showering and getting
25:54to the bathroom.
25:55Yeah, no problem.
25:56I won't leave her side.
25:57Paul, you need a break.
25:59You're taking care of me,
26:02the kids,
26:03the house,
26:04it's too much
26:05for one person.
26:07I'm not the one
26:08battling cancer.
26:10Paul?
26:11Hey, you're in pain
26:13every day,
26:14fighting for your life.
26:16I'm happy to do this
26:17for you.
26:19You're my wife.
26:21Now, let's go home
26:22and forget this day
26:23ever happened.
26:24I'll call the transfer
26:25ambulance.
26:26Thanks, princess.
26:34Hey.
26:35Hmm.
26:37Why don't you go ahead?
26:39What?
26:40Yeah, you can get
26:40the house ready.
26:41I'll be right behind you.
26:44No.
26:45No, I'm riding
26:46in the back with you.
26:49Yeah, I'll stay with her.
26:53You sure?
26:56Yeah.
26:58Okay.
27:01Um, call me
27:03if you need me to come back.
27:11One more day.
27:11Maybe let's be here.
27:13Mr. Francis,
27:15short of breath?
27:15Yeah, I was worried
27:16the clot of my leg
27:17could have gone up
27:18to my lungs.
27:19You're on Eliquis.
27:20That shouldn't happen.
27:21Yeah, I know.
27:21Dying.
27:22I got this.
27:23Don't worry, Mr. Francis.
27:24I'll order the D-dimer.
27:25I'll be back to see you.
27:26Thank you, Dr. Mohan.
27:28Uh, you know,
27:29I'm an MP now.
27:30I can pick up a patient
27:31with dyspnea.
27:32I'm sorry.
27:33I've seen him before
27:34and he's asked for me.
27:36Why even order the test?
27:37He's on Eliquis.
27:38Mr. Francis comes in
27:39every month
27:39and always asks for a D-dimer.
27:41Just, he's worried
27:42and it puts his mind at ease.
27:44Why not?
27:45Yeah, okay.
27:47Donnie's the best.
27:47You learn a lot from him.
27:48That's right.
28:18All right, film me in.
28:20This is Harlow Graham.
28:22She was seen in triage.
28:23CBC and CMP came back normal.
28:25IT was supposed to bring the VRI down
28:27but they're slammed.
28:28I know a bit of sign language.
28:30Harlow, this is Dr. Santos.
28:34Hi, Harlow.
28:35How are you feeling?
28:39She has a headache.
28:41Okay, what else?
28:48What is she saying?
28:50I think she had a stomach ache
28:52and she might have passed out.
28:58I'm not 100% sure.
28:59Okay, we're just going to need
29:01to wait for an interpreter
29:02because I need to ask
29:03a million questions
29:04and I can't do it this way
29:05so just call me when IT comes down.
29:18CT head, neck, chest, abdomen, pelvis
29:21all negative.
29:22It means we can get this collar off.
29:27Roll to your side.
29:28We'll get you off this board.
29:30How long's your trip?
29:322,000 miles all the way
29:34from here to Alberta.
29:35A couple stops along the way.
29:36Got the whole thing mapped out.
29:38Sounds like heaven.
29:39Let's hit you up.
29:40Sorry, I got stuck with a patient.
29:42You know the old saying?
29:43Four wheels move the body,
29:44two wheels move the soul.
29:46You're going to be living the dream.
29:47Thank you, Brandon.
29:48Not everybody down here feels that way.
29:50Okay, what are the course next?
29:51Ortho assessment.
29:53Palpate all long bones
29:54starting with the clavicle.
29:56Got it.
29:57We'll take the lower extremities.
30:04Distal radius tender.
30:05No deformities.
30:06Needs an x-ray.
30:06No bony tenderness down here.
30:08No laxity of the knee.
30:09Any concern about that knee leg?
30:12If it's an open joint,
30:13he'll need to wash out in the OR.
30:15We could try a fluorescein injection.
30:16Okay, we'll need a wood slam.
30:18Wood slam, 1% lighter with epi,
30:19sterile saline,
30:20sterile basin,
30:21sterile fluorostrip,
30:2218 and 27 gauge needles,
30:235 and 60 cc syringes.
30:26How does she know all that?
30:28She just does.
30:31How we feeling, Rocky?
30:33Oh, much better.
30:34She said eight migs of undansetron.
30:36Any pain in the belly?
30:37No, but my mouth is really dry.
30:40No doubt from consuming mass quantities of salty hot dogs.
30:43Can I have another sip of water?
30:45Sure, a little sip.
30:46Take it slow.
30:48Here you go.
30:50Just enough to wet your whistle.
30:53All right.
30:53So, how'd you get your start as a competitive eater?
31:05Any pain here, Mr. Lee?
31:08Can't feel a thing.
31:09Great.
31:09Where's Santos?
31:11Probably catching up on our charting.
31:13Right.
31:14Lights out.
31:15What's the lamp on?
31:15Mm-hmm.
31:18Okay.
31:22I might want to use some of that on Halloween.
31:24That is 250 cc's of sterile saline
31:26with one small touch of a sterile fluorostrip.
31:29Good.
31:31We are going to inject this fluid into your knee, Brandon.
31:34And if there's anything glowing in your wound,
31:37we know we have a leak.
31:40Feeling some pressure?
31:41Yeah, that's normal.
31:42As soon as I finish the test, I'll pull off the fluid.
31:47That looks good.
31:49Laceration did not enter into the joint space.
31:51Surgery not needed.
31:53Excellent.
31:53I can get back to three.
31:54No, we'll still need to stitch you up and splint your wrist.
31:57Hanging a gram of anseph.
31:58Wait, he has a penicillin allergy.
32:00No, penicillin's negative.
32:01We're okay.
32:03My mom said I got a rash with amoxicillin when I was two.
32:05Yeah, probably not a true allergy.
32:08Go ahead and give it a kiss.
32:09But have Epi and Benadryl standing by, right?
32:11Yes, to be on the safe side.
32:13Most people who think they have a penicillin allergy actually don't.
32:17Always listen to the nurses.
32:19They run the ER.
32:20We just try and stay out of their way.
32:29Now we can really clean them up.
32:31Didn't we already do that?
32:32Dry blood on the face, neck, hands.
32:35If anyone comes, they shouldn't have to see that.
32:37Sometimes the local unhoused folks will pay a visit,
32:40but we always make them presentable in case anyone comes.
32:44It's the last thing we can do for them.
32:47Didn't get to do that during COVID.
32:50Once he's spotless, we'll tuck him in nice and tight,
32:53but we always leave one arm outside the sheet.
32:57Because...
32:57So loved ones can hold their hand.
33:06We're ready to discharge our cancer mom, Roxy.
33:08Ambulance is on the way.
33:09We just need to reconcile with homeless.
33:11Hey, I thought I saw another charge nurse around here.
33:13Oh, yeah, we travel in packs.
33:15Aren't you sick of this place yet?
33:16Ah, someone is ready for his sabbatical.
33:19Guilty as charged.
33:20Hey, I just got word that the at-home morphine pump
33:23is going to be delayed.
33:23Hospital pharmacy has to mix it
33:25and then deliver it later today.
33:27Well, should we keep her here until it's ready?
33:29No, you can give her a 200-milligram tablet of MS. Cotton.
33:32200 milligrams?
33:33Biggest pill they make.
33:34Releases over 12 hours for patients with opiate tolerance.
33:37Got it.
33:38And you want to stick around a little bit?
33:39Westbridge is close to internal disaster.
33:41We're getting all their runs.
33:42Yeah, I heard.
33:43I put 20 bucks on a plumbing issue.
33:44I just watched that Poop Cruise documentary.
33:46Oh, I cannot stop thinking about it.
33:48That sounds like something I'll absolutely never watch.
33:50Dr. Robbie,
33:52you gave us a clozapine ileus about an hour ago.
33:54Your resident reported no surgical history,
33:56but the chart says they've had an appendectomy.
33:58We're not admitting the patient without a surgery consult.
34:00Who called it in?
34:01Dr. Trini Santos.
34:03Dr. Santos,
34:04you had an ileus patient.
34:06You neglected to mention a history of appendectomy?
34:08There was no history of appendectomy.
34:10It was in your note.
34:12I may have forgotten to proof check it.
34:15I was using the app that Dr. Al-Hashimi suggested
34:17to catch up on my charting.
34:18Wonderful.
34:19Ah, Dr. Al-Hashimi.
34:21Yes.
34:21Dr. Santos was just using your AI tool for her charting,
34:25and it hallucinated a history of appendicitis.
34:28As I mentioned to Dr. Santos,
34:30generative AI is not perfect.
34:32We still need to proofread every chart it creates.
34:34The patient also has a history of headache,
34:37followed by Dr. Park from urology.
34:39That should probably be neurology.
34:42Unless urologists are now treating migraines.
34:44Another example that should have been caught by proofreading.
34:47AI's 2% error rate is still better than dictation.
34:49Yeah, I don't really give a shit whether or not
34:51you want to use robots down here.
34:53I need accurate information in the medical record.
34:55Understood.
34:56Okay.
34:57Dr. Santos.
34:59Dr. Santos!
35:01Yep, won't have it again.
35:09Thanks, Perla.
35:10Six hours to go.
35:11You got this.
35:14When a wound is gaping like this,
35:17you want to use sub-Q to bring the edges together.
35:20A lot of meat to close.
35:21Well, what would happen if we just did a simple wound closure?
35:25You take the stitches out in 10 days,
35:27the wound opens, dehisses.
35:29Exactly.
35:30So what suture do we use under the skin?
35:32Vicryl provides support for a month.
35:34It takes two months to dissolve.
35:35So, 5-0 nylon on the skin, 4-0 vicryl under the skin.
35:40I go with a 3-0.
35:42Vicryl.
35:43You think?
35:44Most definitely.
35:45Donnie is the master of wound closure.
35:48I do at least 10 lakhs a day out at Triage, so.
35:51Can we see your sub-Q?
35:55You my guest?
35:57If you insist.
36:03So.
36:05The secret is to be sure your entry point
36:09and exit point on both sides of the wound
36:11matches the depth on the other side.
36:14So.
36:19Start deep.
36:21Come up at the dermis.
36:25Big bites help the tissue close.
36:30It's a mirror image on the other side.
36:34Superficial.
36:35It's a deep.
36:38So you bury the knot.
36:40Bingo.
36:41Boy, it's bumps on the scarline.
36:43Three ties.
36:45Not four.
36:47Yeah, that's beautiful.
36:50And then you cut it short.
36:53Not too short.
36:54I like to slide my scissors down on the knot and rotate up 45 degrees before I cut.
37:07You can use two more sub-Qs.
37:09One above, one below.
37:12Have at it.
37:16Interesting ink.
37:17Do they mean anything?
37:21This...
37:22This is death and chaos.
37:24And this is miracles and blessings.
37:27Got this one after the Pit Fest shooting.
37:31And I got this after my daughter was born.
37:37Put the head of the gurney up so people can see him.
37:40But not so high that his head flops to the side.
37:47What do you think?
37:48He looks peaceful.
37:49Well, what's the hardest part of this job?
37:54It's pretty thankless and that can be tough.
37:56We've seen the burnout rates.
37:57I'm sure he teaches that in school.
37:59All my closest friends left after COVID.
38:02Some during.
38:03And I don't blame them.
38:05They had to do what was best for their mental health.
38:09A lot of people broke.
38:11Why do you keep coming back?
38:15Why don't you, um...
38:18Just finish up here and then go help Perla for a bit.
38:25Great.
38:26No, that is exactly what I needed to know.
38:28Okay.
38:30I just got off the phone with the physician assistant.
38:33At the prison, they've got a 16-hour-a-day infirmary
38:35with NP and PA coverage,
38:36giving everything that we need,
38:37and they've got an RN for overnights.
38:39Even so, he's here because they're ignoring his basic needs.
38:43He's here because somebody kicked the shit out of him.
38:45I think you're missing the point.
38:47We have more to offer.
38:48Robbie, there's a floor more coming our way.
38:51Okay, got it.
38:52Um, what you're trying to do is very noble.
38:54We don't have the resources to spare.
38:55Okay, then why admit the unhoused man, Digby?
38:57Why not send him back to the street
38:59with antibiotics and a roll of gauze?
39:01Because Digby lives on the street,
39:02and your incarcerated patient has a mid-level provider
39:05and a nurse looking after him.
39:06We both know the quality of care is not the same.
39:09Sorry, are you waiting for me?
39:10No, uh, Dr. Al-Shimi for the patient in the 7th.
39:12A few days here could make a world of difference
39:14for Gus's health.
39:15We are a safety net.
39:17But nets have holes.
39:18We are not admitting them
39:19because this is not about social justice.
39:20Yeah.
39:23Everything I've done in my career
39:25is an effort to improve the system.
39:27Just because you know it's broken
39:28doesn't mean you stop trying.
39:31Excuse me.
39:37I talked to Jackson's girlfriend.
39:40She told me a lot of stuff.
39:43Um, she wants to come see him,
39:45but I just don't think that's a good idea.
39:48And my parents are asking a lot of questions.
39:50Can I just take him home?
39:52I'm so sorry.
39:54Your breath's on an involuntary side cold.
39:56He can't leave.
39:57Um, it could take us weeks
39:58to figure out what's wrong with him.
39:59What's wrong with him?
40:01I'm so sorry.
40:03I did not mean it like that.
40:04Why don't we go somewhere quiet?
40:06What's wrong with him?
40:08Let's go over here.
40:09What's wrong with him?
40:27How's she doing?
40:29She took three ounces of formula
40:31without vomiting or distress.
40:33Excellent.
40:34Dr. Wolk from Pete's
40:35should be done shortly.
40:37Yeah.
40:37I think I saw her smile.
40:40A true social smile
40:42where the baby is awake,
40:43alert, and responding to facial expressions
40:45usually doesn't happen
40:46until six weeks or older.
40:47It was likely a reflex smile
40:49that happens while they're sleeping.
40:52But some parents have reported
40:55their baby smiled socially
40:57as really as four weeks.
40:58So, who knows?
41:02Jesse, Northport needs a blood draw
41:04when you have a sec.
41:05Got it.
41:06How are we doing in here?
41:07Almost ready to head out.
41:08Looking good.
41:09Heart rate, 91.
41:11BP is 115 over 82.
41:12Oxygen stats, 95 percent.
41:14Great.
41:14I'm sending him home
41:16with some non-stick dressing
41:17in case they don't stalk him.
41:19Grab some bread in that, too.
41:20He's a good guy.
41:21He's a local.
41:23Yeah?
41:24You from Pittsburgh?
41:25Yes, ma'am.
41:26Born and raised.
41:27Whereabouts?
41:28Bloomfield.
41:29Liberty Ave.
41:31Bloomfield?
41:33You know Sonny's Tavern?
41:35Worked there through high school.
41:36No kidding.
41:37You know Sonny's?
41:40I'm a first kiss there.
41:43Hey, Donnie.
41:44My buddy Duke hasn't checked in yet?
41:46No, I told Lupe to keep an eye out.
41:48Yep.
41:48Right, left, right, left.
41:50Yeah.
41:50That's it.
41:55You're back to check our work?
41:56Nope.
41:57I need a silastic loop drain.
41:58That looks great.
42:00It's thanks to your fine instruction.
42:02Yeah, he's gonna need
42:04Curlex in zero form.
42:06You should throw a neoprene sleeve on him.
42:08Limits the range of motion at the knee
42:09so the sutures don't pull out.
42:11That's a good idea.
42:12Must be fun to work here.
42:13Oh, sure is.
42:14First week for these two.
42:16How you guys liking the pit?
42:17I feel like I was born to do this.
42:20Hard pass.
42:21I'm shooting for pathology.
42:23I like medical mysteries,
42:24but I don't really deal well with people.
42:26You have an interest in energy.
42:29What's that for?
42:30Splint starts at the knuckles,
42:32comes up and around the elbow.
42:36And back down to the palm.
42:38It needs to be smaller.
42:40I can't ride with a splint.
42:41Well, no, you shouldn't be riding at all.
42:43Right now, that's a non-displaced fracture.
42:44If you fall on it again,
42:46you're gonna need to go to the OR.
42:48No worries, Doc.
42:49I won't fall again.
42:51Uh-huh.
42:54Robbie, pulse ox just dropped.
42:56What happened?
42:57I don't know.
42:58I stepped out for a minute.
42:59It's down to 85%.
43:00You having some trouble breathing?
43:02A little.
43:04Start him on two liters oxygen nasal cannula,
43:06titrate to five,
43:07keep the pulse ox at 92 or higher,
43:09and have a rebreather stand in by just in case.
43:12He's gonna have to stay.
43:14For how long?
43:16Not sure.
43:19Sorry, boss.
43:19I only stepped out for a second.
43:20Let me know if anything changes.
43:22You were in the room when his pulse ox dropped?
43:24I was.
43:24What were you doing?
43:25D, still can't get a hold of Ortho.
43:26Leave him to me.
43:30Feeling better?
43:30So much better.
43:32Well, I wrote you a script for Zofran just in case.
43:35Thanks.
43:36I think I cleared it all out.
43:38So no more hot dogs, right?
43:39Oh, not today.
43:40But I'll be back next year.
43:42Gotta defend my title.
43:43Okay, well, best of luck to you.
43:44They gotta wean a world truck outside.
43:46You want one?
43:47I think I'm good on hot dogs for the rest of my life.
43:49Wait, didn't I just see you eating a donut?
43:51Don't judge.
43:53See her for a sec.
44:01Transport Ambulance is here.
44:02Thanks, Princess.
44:03This is a 200 milligram MS cotton.
44:06This will give you 12 hours of relief.
44:09Okay.
44:10Yeah.
44:11Thanks.
44:14Whenever you're ready, Rox.
44:16Hey, guys, this is Roxy Hamler.
44:18Hello, ma'am.
44:19Easy on the transfer, guys.
44:21Yeah.
44:28On my count.
44:30No, no, no.
44:31This isn't gonna work out.
44:35I'm sorry.
44:36I can't.
44:37I can't.
44:38I can't.
44:38I can't do this.
44:41It's okay.
44:42I want to stay.
44:45Please.
44:48It's okay.
44:51Can I assume that you've already called upstairs
44:53to get Gus Varnie in bed?
44:55Do you want to tell me what you did?
44:58I don't know what you're talking about.
45:00Yes, Pulse Ox was steady.
45:02We were about to discharge him.
45:03Did Dr. El Hashimi put you up to that?
45:05El Hashimi?
45:06No.
45:08You know he's gonna go back to prison
45:09after they discharged him upstairs.
45:13I thought you didn't go the extra distance
45:15for your patients anymore.
45:22It's Emma, right?
45:23Yeah.
45:25How's your first day going?
45:27Good, I think.
45:28Haven't killed anyone yet.
45:32I'm sorry.
45:33I...
45:33It's okay.
45:35I guess time will tell
45:37if I'm cut out for this.
45:39Well, when in doubt,
45:40stick with her, kid.
45:42She scares me.
45:44No, that's just a...
45:45It's a tough exterior.
45:47She's warm and gooey on the inside.
45:50Looks like they're doing the debrief for Louie.
45:53You coming?
45:54I pay my respects.
45:55Besides, who's gonna hold down the fort?
46:10Remember the day he found him
46:11passed out in the park?
46:12Sure do.
46:13I had to drag his ass over here.
46:15Came and soaked to the bone.
46:16He saved his life.
46:18How about last summer
46:19when we didn't see him for months?
46:20He said he finally quit drinking,
46:21so he didn't need to come in.
46:23How many times did he say
46:24he was gonna quit drinking?
46:26Mm-hmm.
46:27He always asked about Harrison.
46:30Always said thank you.
46:32Mm-hmm.
46:33Found this with his stuff.
46:36Who knew he was married?
46:38Oh.
46:40That's Rhonda Louie's wife.
46:43High school sweetheart.
46:45About five years ago,
46:46I was covering a night shift.
46:48He came in feeling talkative.
46:51Born and raised in Pittsburgh.
46:53Lifelong Steelers fan.
46:56Groundskeeper at Three Rivers Stadium
46:57until 1998.
47:01He never really wanted kids.
47:05But Rhonda wore him down,
47:06and when she finally got pregnant,
47:08he changed his tune.
47:09He got excited.
47:11Mm-hmm.
47:14And then about a month
47:15before the baby was due,
47:16Rhonda and the baby
47:18were killed in a car crash.
47:23though he never really came back from that.
47:29May his memory be a blessing.
47:32May his memory be a blessing.
47:36Yep.
47:44Can you see him tired and shivering?
47:48He's stumbling to the day.
47:50Can you see his lips are quivering
47:53like he's forgotten how to pray?
47:57Can you see the way is perilous?
48:00She's absorbing all the blows.
48:03And who will not take care of us
48:06in the hills and valleys,
48:08the highs and lows?
48:09All I know is you'll need someone
48:16in the by-and-by.
48:19You'll need someone who's gonna cry for you.
48:23Yeah, you'll need someone
48:28in the by-and-by.
48:31You'll need someone who's gonna cry for you.
48:35I need someone who's gonna cry for you.
49:04I need someone who's gonna cry for love.
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