- 2 days ago
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🎞️ EP 2 – Tensions rise as conflicts begin to surface. Every choice carries consequences in this unforgiving world… ⚡🔥
🎞️ EP 2 – Tensions rise as conflicts begin to surface. Every choice carries consequences in this unforgiving world… ⚡🔥
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TVTranscript
00:08You
00:30Collar scheme, respiratory distress is here.
00:32Right.
00:33You okay?
00:33Yep.
00:34I wanted to talk to the patient at Central 12th Summer,
00:37but he took off.
00:38Is there a problem?
00:39Uh, according to Mom, she found a list of high school girls
00:42that he'd like to eliminate.
00:44What the hell is wrong with kids these days?
00:47Uh, you mean besides social media and the worldwide pandemic
00:50and the environmental crisis?
00:52Yeah, yeah, you're a fountain of hope today, aren't you?
00:55Nick Bradley, 19, found unresponsive by parents.
00:58No meds, no allergies. On arrival, he was barely breathing
01:01with pinpoint pupils bradycardic at 38.
01:03Pupils responded to Narcan, but we tubed him
01:05when his respirations didn't pick up.
01:07Any drugs for alcohol on the scene?
01:09No.
01:10Signs of trauma?
01:11Nothing.
01:12Okay, open your eyes, Nick.
01:14On three. One, two, three.
01:18Where was he found?
01:19In bed by his mom.
01:22Pupils are six millimeters, non-reactive.
01:26Heart rate 64, BP is cycling.
01:29No response to pain, GCS-3.
01:31Does that fit any Toxidrome?
01:33No.
01:34If it was just opiates with Narcan, he'd be breathing on his own.
01:39Uh, beta blockers shouldn't give pinpoint pupils.
01:41Maybe parents had some prescription meds in their bathroom.
01:43They're on their way.
01:44ETA five minutes.
01:45Close trauma tier one.
01:46ETA five minutes.
01:47That's a stand-up scooter rider versus car door.
01:50No helmet.
01:50No blood in the belly.
01:52No pericardial effusion.
01:54And lungs are up.
01:57Hema Q's good. 15.
01:59BP 84 over 58.
02:01Okay.
02:02What's your plan, Dr. Collins?
02:03Um, push dose epi.
02:060.1 milligram.
02:07Foley for urine.
02:09Stabilize for CT.
02:10And throw a wide net.
02:17Where are we going now?
02:19We need the room for someone else.
02:20But you can rest in the hall till we get your labs back.
02:25Your parents must be proud.
02:27Having a son who's a doctor?
02:30Yeah, I guess.
02:34You know, I was the first one in my family to go to college.
02:38Now they sacrificed a lot to get me here.
02:42How's your pain, Mr. Milton?
02:44Uh, I'm fine.
02:45Could use a latte, though.
02:47That could bring back the gallstone pain.
02:49How about a bourbon?
02:51It's barely eight o'clock.
02:52Uh, how about some ice chips?
02:55No, thanks.
02:56I prefer my whiskey neat.
02:58Yeah, that's not happening.
03:05Systolic back down to 90.
03:07Another 0.1 of epi.
03:09Flaccid paralysis of all four extremities.
03:14No eye movement with ice water.
03:16So no brainstem function.
03:18Due to?
03:19Hypoxic injury, massive hemorrhage.
03:21Samira, escort him to CT.
03:23Take the drug box with you.
03:26Call me if you need me.
03:27Hey, are you okay?
03:30Yep.
03:30You sure?
03:31Have you ever had to worry about me?
03:34No, but never hurts to check in.
03:36It's part of my job.
03:38Consider yourself checked in.
03:40Okay.
03:45Got something?
03:46Oh, I had a case for Dr. Collins.
03:48May I ask you?
03:49Yeah.
03:51Uh, 68-year-old male.
03:52History of hypertension.
03:54One hour of right upper quadrant pain
03:55after eating a fatty meal now resolved.
03:58A febrile, non-tender.
03:59There was a gallstone present on POCUS.
04:01EKG shows no acute ischemic changes,
04:04but I'm still waiting on LFTs and lipase.
04:06Why did you order the EKG?
04:09The nurse suggested it to rule out any cardiac issues.
04:12Well, good call on both your parts.
04:14Nurses know what they're doing.
04:15Never hesitate to listen to them.
04:17Come find me when those labs are back.
04:18Yeah.
04:19Hey, how's that figure?
04:20Oh, it's nothing.
04:20Dr. Robbie.
04:21Yep.
04:21The son and daughter of Mr. Spencer from Assisted Living.
04:24They're here.
04:24Okay.
04:25I'll be right there.
04:33Your father has pneumonia and a condition called sepsis.
04:37Uh, what is that exactly?
04:38It means that the bacteria has spread from his lung to his bloodstream.
04:42So far, he's been responding well to treatment.
04:45Hey, Pop.
04:48It's Helen and Jeremy.
04:51Jeremy.
04:54Jeremy.
04:54Hillary.
04:56Boob.
04:57What?
05:01It's the Nowhere Man from Yellow Submarine.
05:04It's what he used to call me when I didn't do my homework.
05:06Is this his baseline?
05:08He has good days and bad days.
05:11Why don't we step out for one more second?
05:18Okay.
05:19So your father came in with low blood pressure, which is improving.
05:22Can he go back to assisted living?
05:23Eventually, we hope so.
05:25Your dad has an advanced directive expressing his wishes, which says that IV fluids and medications are okay, but no
05:32artificial life support, no CPU.
05:33He doesn't want a bunch of machines keeping him alive.
05:37Okay.
05:38Then we will continue with oxygen and IV fluids and antibiotics.
05:42But if his lungs stop working, we're not going to place a tube in his windpipe for a breathing machine.
05:47But pneumonia is treatable?
05:49Most of the time it is.
05:52But if he can get better in a week, then put him on a machine.
05:54That's not what he wanted.
05:55Okay.
05:56Do either of you have durable power of attorney for healthcare?
05:59Yes.
06:00We both do.
06:01Okay.
06:02Well, this is a decision that does not need to be made right now.
06:05Why don't you think about it?
06:06Talk about it.
06:09If things get worse, sometimes allowing for a comfortable natural death can be the most humane path.
06:18No routine cases until we assess the Tier 1.
06:21Thanks.
06:22Dr. Langdon?
06:25So, uh, how's the VA?
06:28Yeah.
06:29It was, uh, good.
06:29Uh, you know, challenging.
06:31I learned a ton.
06:32I just think it...
06:33Maybe it should be mandatory that all doctors spend time there, like, on a regular basis,
06:37because of all they've sacrificed for us.
06:39That's a nice thought.
06:40How'd you choose the pit?
06:42Oh, I have a sister with special needs, and she got into this really great facility here in Pittsburgh.
06:46And PTMC has such a great reputation, I thought, you know, I'd be a good fit.
06:50Can I present my headache to you?
06:51Uh, yeah.
06:51What do you got?
06:51What do you got?
06:52A 36-year-old woman with severe headache due to paracervical trigger point.
06:56Her pain went from 11 to zero after two cc's of IMR cane.
07:00Wait, wait, wait.
07:00You did a trigger point injection before presenting the case?
07:03Yeah.
07:04Interns always present first.
07:05I spent a month at the pain clinic at the end.
07:07No, it's not okay.
07:08I'm very comfortable.
07:09It's definitely not okay.
07:1123-year-old Ben Kemper, no helmet, got doored riding an e-scooter.
07:14Neck versus handlebar, then face planted to the pavement.
07:16Obvious facial fractures, but alert and oriented with good vitals.
07:22Here we go.
07:25One, two, three.
07:29How we doing, Ben?
07:31Come on.
07:32Back in my throat.
07:33That's probably from the nosebleed.
07:35Short rapid rhino, please.
07:37Tacky at 120.
07:38Pulse socks borderline at 90.
07:40We'll buy it 15 liters for now.
07:42Neck contusion.
07:43Larynx shifted to the right.
07:44No crepitence.
07:45For morphine.
07:46I'm gonna stick something in your nose to stop the bleeding.
07:52No hemotimpinim.
07:53Inflate the balloon.
07:56How about now, Ben?
07:58Better.
08:00What's up?
08:01Good vitals.
08:02A and O.
08:03Let's have a look.
08:08Whoa, whoa.
08:08Ouch.
08:09Ah, floating face.
08:11The fourth re-fracture.
08:12You don't see that every day.
08:13Okay, let's prep for an airway.
08:15Double set up just in case.
08:31Nice work.
08:33Thanks.
08:34All right, Mr. Chagari, you are good to go.
08:36Oh, thank you.
08:38Remember, 10% off for doctors and nurses.
08:42I'm a student doctor.
08:44All right, sorry.
08:45I hit my head, remember?
08:46Well, my son loves pizza, so I will take you up on it for sure.
08:50Wait for a nurse.
08:51Okay, thanks.
08:54I just realized it sounds like I always feed my kid junk food.
08:57Oh.
08:58No?
08:58Pizza?
08:59S'mores?
09:00No, no, please.
09:01I like pizza and s'mores.
09:02Who doesn't?
09:04Thanks.
09:05How many kids do you have?
09:07Just one.
09:08Harrison.
09:09He's 11 now.
09:11What does your husband do?
09:12No husband.
09:13Just me and my son.
09:15I take it you don't have kids?
09:16I don't mean on account of your age.
09:19Or, I don't know, maybe I do.
09:20I mean, most medical students don't have kids.
09:22Um, yeah.
09:23No, no.
09:24Um, no kids.
09:26Just, I'm not even a boyfriend.
09:27Just, uh, just, it's just school for now.
09:29Yeah.
09:30That'll keep you pretty busy.
09:31I do not miss it.
09:33Must have been difficult as a young mother.
09:35It had its moments, but my life has been full of challenges.
09:39Med school was not one of the hardest, by far.
09:42It was one of the most rewarding, though.
09:44Oh.
09:44Other than having my son.
09:47Hey.
09:48Facial act with a possible foreign object in the eye.
09:51Which is always a solid 7 on the WMMB scale.
09:54What makes Mateo vomit?
09:59You okay?
10:01Yeah.
10:02Yeah, um, he's funny.
10:04The, the nurse.
10:06Oh, Mateo.
10:07You can say his name.
10:10Um, yeah, uh, a foreign object in the eye could be really serious.
10:22Hey, fruitcake.
10:25Hey, I'm talking to you, fruitcake.
10:27Myrna, I've told you a hundred times.
10:29My name is Dr. Robbie.
10:31You want to see my vagina?
10:33I have already seen it.
10:35And once was enough.
10:38Robbie.
10:39Parents of Nick Bradley, the ODT, are here.
10:41Okay, park him in trauma when he's not back from CT yet.
10:44But I'll be right there in a minute.
10:46Behaving yourself, Myrna?
10:47Oh, yes, ma'am.
10:48Mm-hmm.
10:53How we doing?
10:54Ketamine and socks on board.
10:55Pulse socks holding at 94.
10:57Prepping the neck just in case.
10:58Let's have a look.
11:01A little deeper.
11:03Lots of swelling.
11:04I can't see the cords.
11:05To the right?
11:06The left?
11:07Yeah, really distorted from the trauma and the demon's only going to get worse.
11:10Which is why we should crike.
11:11You don't crike a laryngeal fracture.
11:13Don't listen to Edwina scissorhands here.
11:15If they can't cut it, surgery doesn't know how to fix it.
11:17The contusion is high at the thyroid cartilage.
11:19So you just stand there looking pretty, ER Ken, and let me fix this.
11:23We're down to 85.
11:24All right, pull out eye gel.
11:25Bag and crike.
11:26Eye gel, please.
11:27Throw off the alarm.
11:28I've never done a crike before.
11:29No, Mel will do the crike.
11:31You've already had a busy morning.
11:32Glove up, Mel.
11:33No, I'm doing the crike, doctor.
11:35You would be doing it, doctor, if it wasn't an odd day.
11:37Surgery gets even days.
11:38ED gets odd days.
11:39You know this.
11:39For crike's sake.
11:40It's because you're all fucking odd down here.
11:42Okay, teamwork, please.
11:43Let's focus on the patient.
11:44I so appreciate your gracious understanding.
11:46I'll assist in case she screws up.
11:48You're longer.
11:48Plain nice.
11:49Sass are up with the eye gel.
11:51You ready?
11:52Hello.
11:53Oh, uh, hello.
11:55You've done this?
11:57Yes.
11:57In the cadaver lab.
12:00Let's hope that's not where this poor soul ends up.
12:03We'll do an open technique since we have a minute.
12:05Okay.
12:07Okay, you're gonna be making a vertical incision to avoid the jugulars and the carotids.
12:14Mm-hmm.
12:14Good.
12:15If this was a crike that needed to happen in seconds, you could use a ten blade, your finger,
12:18and a bougie.
12:23This is called a wheat laner.
12:25And this is your tracook.
12:27C-spine.
12:28Head CT.
12:29OMF.
12:30Start a propofol drip.
12:31Okay, now we're gonna make a horizontal incision across the cracothyroid membrane.
12:37Yeah.
12:394-0 Shiley next.
12:41Get ready to bag the crac.
12:45Yeah, yeah, yeah.
12:46Good.
12:54Oh, excuse me.
12:55No worries.
12:57End title CO2 is yellow.
12:59Yellow is yes.
12:59Nicely done.
13:00Sew it in.
13:01Okay.
13:01I will be next door.
13:05Does your resident know how to suture or do I need to teach?
13:07You're all class, yo-yo.
13:09I know.
13:10Thanks.
13:10That means a lot of nothing coming from you.
13:13Mel, you okay?
13:14If you're done fighting.
13:15We're not fighting.
13:16This is playing.
13:17Langdon's too soft to fight.
13:19Oh, yeah.
13:19I have nothing but respect for Dr. Garcia.
13:21In fact, I think she would make a wonderful hostess at Applebee's.
13:24Waiter odds.
13:28Let's go.
13:30Okay, thanks.
13:31Just received a word.
13:32Your son's head CT is normal.
13:34And he's maintaining a good heart rate.
13:36You got him back.
13:36Thank you, thank God.
13:38Right now, he's unconscious with a tube in his throat for oxygen.
13:42Why don't we step out for a minute while they get him settled,
13:45and then you can come back and sit with him as long as you want.
13:48Nikki, it's Mama. I'm here, babe.
13:50You're doing great, son.
13:53Blown.
13:56Okay, let's step outside.
13:59I gotta go.
14:06So, we don't know how long he was at home without breathing.
14:09He's breathing now?
14:11Not on his own.
14:13But he's gonna wake up.
14:14We certainly hope so.
14:16We're gonna know better after we get some more test results back.
14:18Nick.
14:18Are you sure that he didn't take anything that could have caused this?
14:22No.
14:23No, he's a good kid.
14:24He's in college.
14:25He has a part-time job.
14:26He even chose to live at home so he could focus on school.
14:30Dr. Robbie from the urine.
14:31What's that?
14:34It's a drug test.
14:35And it is positive for fentanyl.
14:38No, that is impossible.
14:39Nick doesn't do drugs.
14:41There are a lot of pills that are sold illegally that have fentanyl, not just painkillers.
14:45Xanax, out of van.
14:47No.
14:47Not our son.
14:48Honey.
14:49Well, maybe he didn't know that he took something with fentanyl.
14:52I don't know.
14:53The hows and the whys don't really matter.
14:55What matters is spending time with Nick.
14:57We've got some more tests to run.
14:58We'll know our options after that.
14:59But in the meantime, why don't you take a seat and talk to him?
15:05Can he hear us?
15:06You know, we're never really sure, so you should just assume that he can.
15:09And we'll come find you as soon as we know more, okay?
15:12See.
15:19Can we move Nick Bradley to a private room?
15:22Think you're gonna make it?
15:24Didn't he respond to Narcan?
15:26I think his pinpoint pupils just grew into blown pupils from brainstem deaths.
15:30Shit.
15:32Yeah.
15:33Not much older than Jake.
15:35Don't go there.
15:38Hard not to sometimes.
15:41Mr. Spencer's room.
15:44Hey, Robbie.
15:45Teresa, the mother of the young man David who bolted.
15:47She's asking for her son.
15:48Okay, I'll be there in a minute.
15:50What is happening?
15:51Uh, his oxygen levels are dropping.
15:55Mr. Spencer, how are you feeling?
15:57I don't remember where I parked.
15:59Mr. Spencer, do you know where you are?
16:01It's so loud in here.
16:04Dad, do you know where you are?
16:06Dad, look at me.
16:07What's my name?
16:08I don't know where my car is.
16:13IPAP 15 over 5.
16:14Step out.
16:20What's IPAP?
16:21It is a pressurized air mask that can improve his oxygen.
16:25Either his pneumonia is getting worse or his heart couldn't handle the fluids that we gave him to treat the
16:30sepsis.
16:30His lungs are filling up with fluid.
16:32Can't you take the fluid away?
16:34Not without his blood pressure crashing with very bad consequences.
16:37So let's just hope the IPAP works.
16:39And if it doesn't?
16:41Then I would need to know your decision about using a breathing machine.
16:44We're still talking about it.
16:46Well, we know he expressed his wishes in writing.
16:49Do not intubate.
16:51We're thinking try it for a week.
16:54That would be a very painful week.
16:57He wouldn't get a lot of rest with all the monitors and all the blood tests.
17:01He might need to be sedated.
17:02He might need to be restrained because he'd be in an unfamiliar place with a very uncomfortable tube down his
17:07throat.
17:08And he wouldn't really know what was happening.
17:11Elderly patients can often develop psychosis.
17:14But he might get better.
17:15Or he might get worse.
17:18What would you do?
17:20I really can't answer that for you.
17:21This is your father.
17:22That's your decision to make.
17:23I can guarantee you that we will keep him as comfortable as possible if a natural death is what you
17:28choose.
17:28But he's not your father.
17:30And he can recover from us.
17:32What my sister means is that we're still deciding the best thing to do.
17:38Well, the sooner you decide, the better.
17:41I'm really sorry. I wish there was more that I could do.
17:44I'm not sure that he has that much time left.
17:50Dr. Robbie?
18:01You were right.
18:03She can't say whether she was bumped by accident or shoved on purpose.
18:06No other witnesses?
18:06No.
18:08Not really.
18:09Pull security footage.
18:10Maybe we'll find something.
18:11Hopefully she tripped.
18:13I don't mean I hope she tripped.
18:15I mean I hope she wasn't pushed on purpose.
18:17That would make this a hate crime.
18:19Yes, ma'am.
18:22Ma'am.
18:23Doctor.
18:24Sorry.
18:25I'm sorry.
18:26No harm, no foul.
18:28Will you let me know if she says anything else?
18:33Will do.
18:34No.
18:38At the risk of seeing me...
18:40Then you probably shouldn't.
18:41And I just...
18:41No.
18:42Trust me.
18:43How do you know?
18:44I just know.
18:45I just wanted to...
18:46I know.
18:48Look.
18:49I'll let you know if she says anything else that could be important to your investigation.
18:59You know, for the record...
19:00Nope.
19:12Any luck getting our Segwars upstairs?
19:15Yeah, right.
19:16At least the Kraken's still sleeping.
19:19Is it me or was that officer...
19:21Mm-mm.
19:22What?
19:23You don't even know what I...
19:24What you were gonna say?
19:26Maybe you do.
19:29You seem nice.
19:30Absolutely not.
19:31Mm-mm.
19:33There's no possible scenario in which you and I have this conversation.
19:37You of all people should know better.
19:39I was...
19:40Knew.
19:42Just walk away.
19:44Best possible scenario.
19:45Just keep on walking.
19:47Mm-mm.
19:48You gotta lay off mixing Adderall and energy drinks.
19:51Trust me. I will.
19:53All right.
19:54Thanks.
19:56That's the thing about emergency medicine.
19:58You never know what you're gonna get.
19:59And we get everything.
20:01Is that why you chose it?
20:02Ah, maybe a little.
20:04I also get to pick my shifts, which for a single mother is amazing.
20:08But mostly, I just like the people, you know?
20:11They're always there when you need them.
20:12You wouldn't want to be a part of that, you know?
20:17Come on.
20:25This is the monitoring center.
20:27We see that you're not in your inclusion zone.
20:29Do you have permission to be outside this area?
20:31Yes.
20:32I am at work.
20:33Just like last time and the time before that.
20:38I'll be right back.
20:42What is the point of this fucking thing if it doesn't even work?
20:54Sorry.
20:55You're doing great.
20:56Take your time.
20:57You okay?
20:58I am...
20:59I get frustrated when I can't do things really, so it looks like it.
21:03Yeah. You and me both.
21:05Thanks, but my frustration manifests itself emotionally, and then I get upset, and then it looks like I can't handle
21:12things, and then I can't cry in front of the patient because no one wants to see their doctor cry.
21:16That's just a big red flag.
21:17You just did a perfect crike. You're doing great.
21:23Okay.
21:24Hey, you. Pasty white. How about a sandwich?
21:27Uh, what brings you here today, sir?
21:30I'm here for a fucking sandwich.
21:33Okay.
21:35Okay, uh, excuse me.
21:38Perla?
21:38Perla? Can this patient get a sandwich?
21:41I already gave you a sandwich, bro.
21:43I ain't ate this whole week.
21:45Huh.
21:46Sure.
21:47Give him another sandwich.
21:48They're on the food cart.
21:49Just make sure it's not egg salad or he'll throw it on the floor.
21:52Okay. Good to know. Thanks.
22:08Any quick ones up here? It's only 8.30 and Robbie's already on my case for being too slow. I
22:14can usually at least make it a lunch before he starts hounding me.
22:16I got a little slack today, okay? It's the anniversary of Dr. Adamson's death.
22:21That's sad. There's still no reason to take it out on me. I'm just saying.
22:28Dr. Mohan?
22:29Samira, please.
22:30I just wanted to apologize. When my phone went off earlier, that was really unprofessional.
22:35Don't sweat it. Trust me. We'd need to laugh, otherwise we'd never stop crying.
22:41Besides, with all the craziness that comes through here every hour, nobody cares and notices.
22:45Got an unresponsive, unhoused man coming in. Might be a good teaching case, funky music.
22:54Let's go.
22:56Caucasian male, approximately 60 to 70 years old. Found unresponsive. No signs of trauma. No ID.
23:03On three. One, two, three.
23:11Did you take anything?
23:12Smell the alcohol from here.
23:13This guy's wearing the spring, summer, and fall collection.
23:17Ow!
23:17Jeez!
23:18Whoa!
23:19Whoa!
23:21What the...
23:22Uh, what's wrong? What's going on?
23:25Patient tested positive for rats.
23:28No.
23:30If it matters, I only counted three.
23:33Oh, there goes one.
23:39Because your son tested positive for THC, the psychoactive ingredient in cannabis,
23:43we're gonna have to admit him for overnight observation and monitoring.
23:47What about his brain?
23:49Is there a chance that much pot is going to do some damage? I mean, he's only four.
23:53The honest answer is we don't know. There haven't been any long-term studies.
23:56But the fact that this is a one-time occurrence suggests that there should be no long-term effects.
24:00But you don't know.
24:01So my son could end up with learning disabilities, psychiatric problems, or even autism, because there's this...
24:07There's no evidence to suggest any of that.
24:08Hello. I'm Chiara Alfaro. I'm the department social worker.
24:13Chiara will help you navigate the next steps.
24:16What steps?
24:17Well, a case like this requires mandatory reporting to child services and sometimes law enforcement.
24:23No.
24:24Why do you have to involve the police?
24:25It's a controlled substance.
24:26They're not taking my kid away.
24:28They were pot gummies.
24:29They were pot gummies.
24:29Well, fuck your suggestions. No one is touching my child. In fact, we're leaving.
24:33Well, you know, you can't take your son. He can stop breathing.
24:36I'll observe him. At home.
24:37Amanda, please.
24:38Fuck off, Drew.
24:39Get security.
24:40If you can't cooperate, I'm gonna have to ask you to leave.
24:42Amanda, please. He needs to stay here.
24:44And you need to get a fucking hotel.
24:46Your son can't leave the hospital, but I can have you removed.
24:49Don't you dare touch me. Get out of you!
24:51Mrs. Johns, I know this is scary and stressful.
24:54Oh, fuck you. Fuck you. This is my son. My son. And nobody is touching him.
24:58Whoa, whoa, whoa. What's going on?
24:59I was worried about a CYF.
25:01I'm backing the fuck off.
25:01Man, doctor.
25:02Okay, okay.
25:04This is a hospital. It's in the Jerry Springer Show.
25:07Ma'am, nobody's trying to take your child.
25:09So why don't you stay here with him while your husband talks to our social worker outside and straightens all
25:13this out?
25:14Well, I don't want him speaking for me and my son.
25:17Well, it is either you or him.
25:19Your son is not leaving, but you can be escorted out and even arrested if you refuse to cooperate.
25:24Nobody wants that. So you tell us. What do you want to do?
25:30I'm staying with my son.
25:32Okay, great. You do that. We all on the same page here.
25:37Thank you, Olsen. You okay?
25:39Yeah, we got this.
25:41All good.
25:42It's all yours.
25:43So, Mrs. Johns...
25:48Is everything all right out there?
25:50Yeah, just another day in paradise. How are you feeling?
25:53Better. Where's David?
25:55He left. He said he had to get back to school.
25:59What?
26:00Um, maybe you could try calling him. Get him to come back.
26:07What's going to happen to him if I do?
26:10Hopefully, he'll be willing to talk to somebody.
26:12Will you talk to him?
26:13I can try. I don't think he wanted to talk to me.
26:18Have you shared with anyone about the writings of his you found?
26:22No.
26:23I didn't know who to tell. I just don't want to see him get hurt.
26:28Neither do we.
26:38No, he's just going straight to voicemail.
26:40See, maybe if you can text him.
26:54He's not texting back. He's...
26:56Oh, I'm sorry about all this.
26:58It's okay. It's okay.
26:59What you're doing for David is very brave.
27:03I'm his mother.
27:04I'll do anything to protect him.
27:08Do you think he would hurt anyone?
27:10No.
27:10No.
27:13But...
27:17I'm sure a lot of parents felt that way.
27:20Before their children did unspeakable things.
27:26Does he have any history of violence? Has he ever been in any trouble?
27:29No, never.
27:30He's very quiet.
27:33He takes great care of me.
27:35He...
27:37He's...
27:38Struggled...
27:38With his father's death.
27:41We both have.
27:43The flight is ten minutes out within electrocution.
27:45Okay, grab Collins. I'll be right there.
27:48Keep trying to reach him.
27:49If you do, have someone come find me.
27:51Okay.
27:55Of course.
27:56You got some good news for me?
27:57I sure do.
27:58There are two rooms in ICU being cleaned.
28:00They'll be ready by now.
28:01Great.
28:01And I got bagels in the lounge.
28:02Nice job. Thank you.
28:07Is it true?
28:07You have to be more specific.
28:09Are there rats in the ED?
28:11Uh, apparently if somebody already snitched.
28:13Do you know how bad this looks?
28:15One more reason to shutter this place.
28:17Only the emergency department admits rats.
28:20The emergency department would never admit rats.
28:21Unless they have the right insurance.
28:22Did you catch any of them?
28:24One, and I charged him for a full visit.
28:26I'm glad you think this is funny.
28:27I'm sorry that you don't.
28:28Did you call an exterminator?
28:30He's waiting on a second opinion?
28:34You were pushing your luck today.
28:36Don't worry.
28:36Last I heard, they were headed for the cafeteria,
28:38so they should be dead within the hour.
28:40I'll be here all week.
28:41Well, maybe not.
28:48Drug-seeking woman kicked off a city bus
28:49for disrupting and disturbing passengers.
28:51I called 911!
28:51You've been screaming for narcotics non-stop.
28:54You found an empty Percocil bottle
28:55for a few days ago.
28:56What the hell are you doing?
28:56Why are you calling?
28:57He's been uncooperative and combative
28:59since we picked up.
28:59Get off her!
29:00Let her go!
29:01Stop fighting!
29:02Come the fuck down or I'm calling the cops!
29:04My meds at home aren't working!
29:06Please!
29:07I have sickle cells!
29:08Okay, stop.
29:09Everybody stop!
29:10Stop!
29:13What's your name?
29:14It's Joyce.
29:15It's Joyce.
29:16Joyce, is this your sickle cell pain?
29:19Yes!
29:19Ten milligrams of IV morphine.
29:21You really want ten?
29:22Yes.
29:22Repeat it in five minutes if needed.
29:24And she needs a Dilaudidrib.
29:25This is a vaso-occlusive crisis.
29:26I'm so sorry this happened.
29:27We're gonna be okay now.
29:28We're safe here.
29:30Come on.
29:31We're gonna be safe here.
29:32I promise.
29:33Just breathe.
29:34Woohoo!
29:34Woohoo!
29:36Woohoo!
29:37Get down.
29:41Woohoo!
29:50Woohoo!
29:50Good job!
29:52Yeah?
29:52Woohoo!
29:52Digging runs out
29:52Uh-oh!
29:53And a drone,
30:01Hit his left forearm. Shocked him once for V-fib.
30:03Was there a power pole down?
30:05No, abandoned factory.
30:06He found bolt cutters at his side.
30:07Got electrocuted.
30:08Did you try to sip copper?
30:09Most likely.
30:10Power line fried his arm,
30:11and the current through his whole body stopped his life.
30:15Ready?
30:18Steady, lift.
30:21Add a myoglobin and a CK to the labs.
30:24Two liters, normal saline, wide open.
30:26Dr. Santos, what are we worried about?
30:29Robdomyolysis from tissue damage can kill the kidneys.
30:32Ongoing risk of cardiac irritability.
30:34Text me.
30:34AP pads in place.
30:35Guy fell off a telephone pole?
30:37No, he was on a platform.
30:39Boring.
30:39Cut into a live wire.
30:42Tense ventral compartment.
30:44Set up the stick pressure monitor.
30:46V-fib.
30:47I charge the 300.
30:48Am I running this, or are you?
30:49Sorry, reflex response.
30:50Clear.
30:52Ah, fuck.
30:54Sorry.
30:55Sorry.
30:57So, what, what happened?
30:59I bought it for my girlfriend's dog.
31:02I work nights, and he yaps all day long.
31:06And when I woke up, I was wearing it.
31:09Stupid bitch!
31:11Sorry.
31:12Sorry.
31:14I think she must have used crazy glue.
31:17Yeah.
31:17It looks that way.
31:20Have you tried removing the batteries?
31:22Of course.
31:24She glued the case shut.
31:26All right, I think we have a couple options, Gary.
31:29Um, we can try to find a solvent that will dissolve or at least soften the glue enough for you
31:34to peel it off without taking your skin with it.
31:37Or, um, that's your body.
31:40Um, I guess your skin cells on your neck will naturally slough off, and you should just be able to
31:46remove it in time?
31:48How much time?
31:50Um, a couple weeks, maybe?
31:51A couple weeks?!
31:52I think this guy's got scurvy.
31:54What, is he a pirate?
31:55No, he's an unhoused man.
31:57Lives almost exclusively on dollar store ramen.
31:59Uh, there's parafollicular hemorrhage, gingivitis, bleeding gums, and, um, yeah, no fruit or vegetables in his diet.
32:06I suppose that could do it, as long as you've ruled out piracy.
32:08No parrot, no peg leg, doesn't reek of sweat and rum.
32:12When I thought you mentioned it, there was a smell.
32:14Probably a pirate.
32:17Tell him to pick up some vitamin C next time he ducks at a dollar store.
32:22I can't tell if you're joking.
32:24No. Captain Scurvy's got a vitamin C deficiency. Cheapest way to fix it is with a daily supplement.
32:29Captain Scurvy's another joke.
32:31I'd like to think so.
32:32It's a good one.
32:33Dr. Langdon, Dr. King, this is Arthur Carlson from Children, Youth, and Families.
32:36He'd like to speak to the parents of Tyler Jones.
32:38Right. Right. Uh, Mel, would you mind showing him to Chiara and the family?
32:43Yeah, right this way.
32:49Beto?
32:50Hello, Doctor.
32:51What are you doing here?
32:52I'm working dayships now.
32:54Didn't you retire a couple years ago?
32:56No. I have to work today.
33:00Right.
33:01Right. Just stay right here, okay?
33:03I have a lot of cleaning to do.
33:04Yeah, no, I'll be just one second.
33:06Hey, Doc. Doc. How about a salmon?
33:09Sure, Earl. Turkey. No egg salad. I got you. Just give me one minute.
33:15So, Beto said he's working here?
33:17Yeah, he just started wandering. Fortunately, he always winds up back here.
33:20Thinks he still works in the ED.
33:22I called his family. They usually pick him up after a few hours.
33:25Really?
33:26Yeah, gives him a break and look at him. He's talking to people.
33:29Feeling useful. Getting some exercise. Hell, I wish I was that happy.
33:33Think he's any good at catching rats?
33:35Stop.
33:36Oh, Earl wants a sandwich.
33:37Earl always wants a sandwich.
33:39Hey, check it out. I got my kids a puppy.
33:42Cute. Hope that wasn't your idea.
33:44Why?
33:46Seriously? You really think your wife needs anything else to take care of?
33:49Abby loves dogs.
33:50I love penguins. Doesn't mean I wanna take care of one.
33:53Well, I'm pretty sure it's illegal to own a penguin.
33:54Pretty sure you're missing the point.
33:56The point is, Tanner promised you to take care of it.
33:58A four-year-old.
34:00Yeah. Okay.
34:06How's she doing?
34:09Still breathing after 20 of morphine.
34:13How's the pain, Joyce?
34:15Oh, a little better.
34:17You've ordered an exchange transfusion.
34:20Figured I needed that.
34:22What's your normal regimen at home?
34:2590 of extended release morphine every 12 hours.
34:29And oxycodone for breakthrough pain, but it wasn't working.
34:34Starting IV dilaudid of four an hour.
34:36You can press this button if you need a little extra.
34:39That only works once an hour, though, so don't go crazy.
34:43Could I confer with you?
34:44Yeah.
34:54You seem surprised by the opiate dosage.
34:57It seemed a little high.
34:58So was her pain.
35:00How do you know she's not drug-seeking?
35:01You can't fake a hemoglobin of six.
35:03Do you know what sickle cell crisis does to the body?
35:05Blood cells get caught and plug up your capillaries
35:07and deprive all your cells of oxygen.
35:08It's been described as an electrical stabbing pain
35:11that feels like it's breaking your bones
35:13and flushing glass through your body.
35:15I never thought of it like that.
35:17Little empathy goes a long way
35:18with those suffering in real pain.
35:23Yeah.
35:23Don't worry, you'll get good at spotting the fakers,
35:25and half the time all those people need
35:26is someone to really listen to them
35:28and hear their story.
35:32Mm-hmm.
35:33Anterior compartment pressure is...
35:3649.
35:37Burn caused massive swelling.
35:39What does he need, Dr. Santos?
35:40A fasciotomy.
35:41But he still has a radial pulse.
35:43Pressure would have to be over 100 to lose the pulse,
35:45and at that point, he'd lose the arm.
35:4749's enough to destroy all the nerves and muscles
35:49in a matter of hours.
35:51Compartment pressure is 49?
35:52Yeah, gonna make the initial incision down here.
35:55Ortho can finish up in the OR.
35:56Good plan.
35:57I'll let him know.
35:58Hey, Robbie.
35:59Always good to see you, Fred.
36:00Hey, like my rock star.
36:00She's pretty good.
36:01She's a great teacher.
36:02She has a great teacher.
36:04Sterile gloves for Dr. Santos.
36:06Oh, we don't teach forearm fasciotomies to our residents.
36:09What if she's all alone somewhere someday
36:11with no backup?
36:15This is the path to avoid the median nerve
36:18and all major vessels.
36:21Maybe just watch the first time.
36:23She'll hold the blade, I'll cut.
36:24Template to Dr. Santos.
36:30We'll start proximal.
36:32How much pressure?
36:34Just about this much.
36:41Mm-hmm.
36:45Through the skin and sub-Q.
36:53Good.
36:58How are they making out?
37:00They're still talking.
37:03You okay?
37:04Yeah, for sure.
37:05I just hate seeing families torn apart.
37:07Oh, they'll be fine.
37:09How can you be sure?
37:11They're white.
37:12Probably get off with a slap on the wrist.
37:14If they weren't, she'd probably lose her child
37:17and he'd end up going to jail.
37:18But...
37:20Sorry, I did a fellowship in cynicism.
37:23You sure you okay?
37:25100%.
37:25I'm just gonna get some air.
37:32I am a savage.
37:34Classy.
37:35Bougie.
37:35Ratchet.
37:36Sassy.
37:37Moody.
37:38Nasty.
37:39I am a savage.
37:41I need help.
37:43I gotta stop.
37:44Can you guys help?
37:46What's your name?
37:47Alice.
37:48Okay, Alex, let me take a look.
37:51The fuck it hurts.
37:52Oh, I know.
37:53All right.
37:54We're gonna take good care of you.
37:55You guys gotta show up here, Alex.
37:59We got you.
38:00I have an abdominal GSW in the ambulance bay.
38:03Code trauma now.
38:05GSW just got dumped by homeboy ambulance.
38:08Okay, you got this?
38:09Yeah, go.
38:10Two grams of ANSEP.
38:11Ortho's on their way.
38:18Systolic's only AD14 gauge.
38:20Left AC.
38:21We got two units of whole blood going on the rapid diffuser.
38:23Call the OR, we'll be right up.
38:24Lungs up.
38:25Do you take medications every day?
38:27Any allergies?
38:27No.
38:29Morse's is full of blood.
38:30See that?
38:30Yeah.
38:31Torp is liver.
38:32What's his name?
38:33Alex.
38:33Alex, you've lost a lot of blood.
38:35You need to go to surgery right away.
38:36I'm gonna die.
38:37Not now that I'm here.
38:38Spoken with humility in the surge.
38:40Oh, it's ready.
38:40How's he doing?
38:41He's coming up a bit.
38:42Let's go.
38:43Can you call my mom?
38:44Yep.
38:44Of course.
38:45Of course.
38:47So he didn't have to wait for OR?
38:50Nope.
38:51We're a trauma center.
38:52We always keep one OR stocked and ready to go.
38:55Well, that's awesome.
38:58What happens if there are multiple traumas needing OR?
39:01We get a lot busier.
39:04Mr. Milton?
39:05I'm sorry.
39:06We had to move you into the hall.
39:07I know it gets pretty chaotic and noisy out here.
39:10Mr. Milton?
39:12Hey.
39:13Hey, Bennett.
39:13Wake up for me.
39:17Oh, shit, shit, shit.
39:18Um, I need a little help here.
39:20Yeah.
39:21Help!
39:22When did you check on him last?
39:24I don't know.
39:24Around half an hour ago, almost.
39:26I was waiting on labs.
39:26What's going on?
39:27It's my gallstone guy.
39:28You saw his EKG?
39:29Unknown down time.
39:29He was sleeping in the hall.
39:31Crash guard.
39:32Let's go.
39:37I got it.
39:41Hold compressions.
39:45A-sistently.
39:46Resume compressions.
39:48Amp of epi.
39:50Slow, slow temp.
39:51Slow temp.
39:51Should I intubate?
39:52No.
39:53Drop an LMA.
39:53We don't want to hold compressions.
39:56Your pools are fixed and dilated.
39:58He's been down a long time.
40:03Shhh.
40:11How we doing in here?
40:13So much better.
40:14Dr. Mohan, this is my wife, Andeen.
40:17Dr. Samira Mohan, nice to meet you, Andeen.
40:20Thank you for helping her.
40:21Of course.
40:22And, again, I'm so sorry about how you were treated when you first arrived.
40:26Not everyone who works here is accustomed to dealing with sickle cell.
40:29We will be doing everything possible from here on in to manage to erase this crisis.
40:34In the meantime, can I get you anything?
40:36I'm fine.
40:36Andeen?
40:37No, thank you.
40:38Okay.
40:39Well, have the nurses come find me if you need anything.
40:43Take slow, deep breaths for me, Ian.
40:46I ordered a nib.
40:475-albuterol.
40:48And 5-acetyl medrol.
40:49All right.
40:50Keep an eye on him and present to Dr. Langdon.
40:52Okay.
40:53Okay, great.
40:54I'll see you back in triage once he settles down.
40:57Yeah.
40:58Let's take this off.
41:00Hang in there, Ian.
41:01This should really help with your asthma.
41:12How can I help you, hon?
41:14I'm looking for Dr. Langdon.
41:15Yeah, let me see where he is.
41:20Dr. Langdon, we have a med student at Central looking for you.
41:25Copy that.
41:26He's headed this way.
41:27Thanks.
41:30Hey, Crash.
41:31You missed a pretty cool fasciotomy.
41:33I'm not sure I'd be describing a fasciotomy as cool.
41:36You would if you were the one who did it.
41:39How's it going out in the arrivals lounge?
41:44Do you know anything about Dr. McKay?
41:47I've been here for less than two hours.
41:50I don't know anybody.
41:51Including you.
41:53I thought you were some kind of kid genius.
41:55I'm like any other third-year med student.
41:58Clearly.
42:01Hey, I'm just trying to break the ice.
42:02I'm not trying to annoy you.
42:04And yet, you're still calling me Crash when I asked you not to.
42:08Really? You're still on that?
42:09Still on that.
42:12Yeah.
42:13Okay.
42:14Sorry.
42:15I had no idea genius was so sensitive.
42:20But I get it.
42:21Big brain.
42:22Big feelings.
42:23Makes total sense.
42:24I'll try to be softer.
42:29If we want 20 bucks,
42:32we'll have one of them before we finish the shift.
42:37I think I'm more anxious, even if it's small.
42:50We switch out every few minutes. You can take a break.
42:53I'm fine.
42:53All compressions.
42:57Still an asystole.
42:58Resume compressions.
43:01Should we shock him?
43:02You don't shock asystole.
43:04We could be fine V-fib.
43:05Not a chance.
43:07Okay.
43:08When was his last epi?
43:09Three minutes ago.
43:10Okay.
43:10Well, ACLS says every three to five minutes, right?
43:12So let's push another round.
43:14Fine.
43:14Robbie.
43:15Mr. Spencer's adult children are asking for you, and the parents of Nick Bradley, the fentanyl overdose, also want to
43:21speak with you.
43:21Okay.
43:22Three rounds of epi, and then call it.
43:26Mr. Spencer's maxed out on BiPAP, 25 on 10.
43:28Sats?
43:29Not great.
43:30High 80s.
43:34Hi.
43:35I heard you wanted to talk to me.
43:36Yeah.
43:36That alarm kept going off?
43:38Yeah.
43:38Why don't we step outside?
43:41The alarm is for low oxygen.
43:43Does he need more of that BiPAP?
43:45I'm afraid that's as high as we go.
43:47So the decision at this point-
43:49We want you to put our father on the breathing machine.
43:54Even though that goes against his desires to not be intubated?
43:58We're not ready to let go yet.
44:01And if your father is?
44:05He was a stubborn son of a bitch.
44:07He would never have given up on either of us.
44:09We're not giving up on him.
44:12You're absolutely certain you want to put your father through this after everything I've told you?
44:20I may have to honor his advance directive.
44:25No, you have to honor our durable power for healthcare.
44:29If not, we can talk to your hospital attorney.
44:35Jeremy, you're on board with this?
44:37Yeah.
44:38I guess so.
44:41Okay.
44:42You can sit with him until we're ready.
44:44When will that be?
44:45Momentarily.
44:58Please don't tell me you're going to intubate that poor man.
45:00It's what the family wants.
45:02So what? They want to torture him?
45:04I explained all that.
45:06If I co-sign, we can override their durable power.
45:10They're threatening to go to the hospital attorney.
45:12Let them. Call the ethics committee. They'll agree with us.
45:15You're probably right, but we don't have that kind of time.
45:17We are stuck.
45:19What are you talking about?
45:21Shit.
45:24What?
45:26I got to go tell those parents their 18-year-old son is brain dead.
45:30You want me to come with you?
45:31Nope. It's okay.
45:32What are you going to say?
45:34I'm going to say that it's likely, but we still need to do an apnea test and a cerebral perfusion
45:38study.
45:40There's no cranial nerve activity.
45:42Those people need some hope.
45:44False hope.
45:45Hope is hope.
45:46Is it?
45:47What are we praying for miracles today?
45:51They need time to process before they can accept what's happening.
45:55You ever consider taking that advice?
45:59Physician heal thyself?
46:02Don't you have patience?
46:25No, no, no.
46:27People wake up from coma.
46:29People wake them up.
46:31You can do that.
46:32You can do that.
46:33You can do that.
46:33You can do that.
46:34You can do that.
46:36You can do that!
46:52You can do that.
46:59Please.
47:00No!
47:55I'll see you next time.
48:08No change.
48:11No pericardial effusion, no tension, pneumothorax, no cardiac activity.
48:16Let's try calcium. Could be hyperpolemia.
48:19No, his potassium was normal.
48:21Ready to call this?
48:22Not yet. Dr. Robbie said three rounds of epi.
48:25It's time. Let's push another amp. This one could do it.
48:30Yeah. Come on.
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