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💥 EP 5: The story takes a dramatic turn as secrets are exposed. 😨 Tension reaches a breaking point.
💥 EP 5: The story takes a dramatic turn as secrets are exposed. 😨 Tension reaches a breaking point.
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TVTranscript
00:11You sent labs?
00:12No indication, no more vitals, no more neuro exam.
00:15Dude just dropped.
00:16No warning.
00:17What's open?
00:18Drama one.
00:19Grab Langdon or whoever else is available.
00:24What do we got?
00:25Seizure and chairs.
00:28How is it out there?
00:29Chaos.
00:30We're never going to catch up.
00:34Lorazepam's on board.
00:35Okay, drop another four.
00:39Yeah, no history.
00:40Doesn't look like he's been here before.
00:42Satting low 90s on five liters.
00:45Another four milligrams?
00:46Can't get the top off.
00:49It's just the plastic, not the...
00:51No, I know, I know, I know.
00:52Here, give it to me.
00:53No, I got it.
00:55Okay.
00:55All right.
00:57Ordering CBC, CMP, and a straight cath for a urine tox.
01:03Pushing the second four?
01:05If this doesn't work, we need to prep Keppra.
01:07No, we'll give more Lorazepam.
01:09It's already ordered.
01:10He's already had eight milligrams.
01:11He'll stop breathing.
01:12Then we'll intubate.
01:13Sometimes the patient needs a little more.
01:15How long has he been seizing?
01:16About four minutes ago, he started seizing in chairs.
01:18He's already had eight of Lorazepam.
01:20I want to move on to Keppra, but Dr. Langdon disagrees.
01:23Just want to try another two milligrams before moving on.
01:25Dr. Langdon's patient.
01:26Dr. Langdon's call.
01:34Dennis Whitaker.
01:35Meet Bob Chazin, a 53-year-old cyclist who injured his leg about 10 days ago on a trip to
01:40Utah.
01:40I was in Moab, coming downhill fast and jammed my pedal into my leg.
01:46Ooh, ouch.
01:47That's some gnarly road rash.
01:50White rim trail.
01:51I've been putting neosporin on it a couple times a day, but now it hurts the walk.
01:56What do you see, Whitaker?
01:58Um, outside of the wound looks cellulitic.
02:01What's that?
02:02It's a bacterial infection.
02:03We'll need to get you on oral antibiotics.
02:06Figured.
02:06What about the center of the wound?
02:08Uh, it's a simple hematoma.
02:12Which you can now debride.
02:14Whitaker will take off the dead skin covering the blister to help it heal better.
02:17I'll be right back.
02:18Yeah, quick question.
02:19Get some iris scissors, tooth forceps, sterile gauze.
02:22No, it's just, um...
02:27Blister guy?
02:28Really?
02:28Mr. Chazin was the next patient on deck.
02:30I know I screwed up earlier.
02:32You didn't screw up.
02:33Patient died.
02:34It happens.
02:36Just don't amputate Mr. Chazin's leg.
02:43Okay.
02:44Hey.
02:45Another two of lorazepam.
02:47Third total of ten.
02:48I'm all aware.
02:49He's still seizing.
02:52Call respiratory.
02:53I'm setting up an intubation term.
02:54What's he won't need?
02:55Dr. Santos, what is the definition of status epilepticus?
02:59Seizure lasting more than five minutes or at least two seizures without full recovery in between.
03:03Excellent.
03:06Seizure activity has stopped.
03:08Also excellent.
03:10Spontaneous breathing.
03:11Good tidal volume.
03:13Sat's up to 98.
03:15Welcome back, Mr. Marino.
03:17Now we can do a Kepp reload slowly and safely.
03:20Nice work, Dr. Langdon.
03:21I will be in central if you need me.
03:23This must have been a bad vial.
03:25Eight milligrams should have worked.
03:26According to your textbook of emergency medicine, but sometimes they need a little bit more.
03:29You'll learn that with time.
03:30Well, why couldn't I open the vial?
03:31Because you're an intern.
03:34Who also needs to learn to trust your senior resident, especially in front of an attending.
03:40Now, check his labs, babysit him until he goes to CT, and get some blankets on these side rails as
03:47a seizure precaution.
03:56Is this going to hurt?
03:57Oh, no.
03:58Skin's dead.
03:59You don't feel a thing.
04:00First time in Moab?
04:02No, no.
04:03I belong to a club.
04:04Gears and beers.
04:06We started riding to Frick Park during the pandemic.
04:09You know, just something to do to get out of the house.
04:11But we all stuck with it, and now we go on biking trips.
04:19Oh, whoa, oh, how?
04:22Do something, man.
04:23Oh, dude.
04:25Whoa.
04:25I need all the help here.
04:27Jesus.
04:31Hey, what's up?
04:32An arterial pumper under a blood blister.
04:34Let's see.
04:36Oh, Jesus.
04:37Oh, noob.
04:39Hi, I'm Dr. King, and we can fix this.
04:41Did you cut an artery?
04:43No, no.
04:44I punctured the top of the blood blister, but there is an artery hiding under there.
04:47Hiding?
04:48Like you didn't know it was there?
04:50Don't you have to know basic anatomy to become a doctor?
04:53He's a student doctor.
04:54What the fuck?
04:56Student?
04:57Oh, hell no.
04:58No, no, no.
04:59Can you help me?
05:00Can you fix it?
05:01Oh, absolutely.
05:02First, we are going to put this BP cuff on to stop the bleeding.
05:06A little forward.
05:08There we go.
05:13All right, you can let go.
05:15Yeah.
05:15Mm-hmm.
05:17Thank God.
05:18Thank God.
05:19All right, Whitaker, 10 cc's of 1% lidocaine with epi.
05:22No.
05:24The shot is going to numb the area and also constrict any blood vessels so that we can put a
05:28little stitch in there.
05:32What happened in here?
05:34A hidden laceration of an arterial under the vesicle.
05:38Bleeding stopped at 180 on the BP cuff and we are now injecting lidocaine with epi.
05:43Thank you, Dr. King.
05:44Let's set up a suture tray with 3-0 nylon.
05:47Okay.
05:47Pimprick and some burning.
05:48Doc, doc, can you step in here, please?
05:52You got this, Whitaker.
05:56That ambulance chase is on live TV.
05:59What channel?
05:59Every channel.
06:00Oh, what do you think the over-under on clipped cars should be?
06:0315.
06:04Come on.
06:06Can I put it on the TV in the waiting room?
06:08Fine by me.
06:09I just hope wherever it ends up, it's out of our catchment zone.
06:15Got a second?
06:17It's never a second, but shoot.
06:18I think there was an issue with a vial of lorazepam used on our last patient, and it should be
06:23reported to the drug manufacturer.
06:25What kind of issue?
06:26The cap was really hard to take off, almost like it was super sealed shut.
06:30I'm worried it could be a bigger issue.
06:32Like?
06:33Like maybe the temperature wasn't properly controlled during transportation and the seal on the vial melted shut, which could mean
06:40the medication is compromised.
06:42Any other vials affected?
06:44Uh, just this one.
06:47Okay.
06:49Check the manufacturer's website, see if there's been a recall of the lot number.
06:53And what if this is the first regular vial?
06:55Then hold on to the vial in case there are any other issues.
06:58Hey, look who's in the house!
07:00Hey!
07:01Jake the Snake!
07:03It's 11 a.m.
07:04Aren't you supposed to be in school?
07:05Mom, let me dish for Pit Fest.
07:06How's your mama?
07:08Well, she's restoring some house in Squirrel Hill, so, you know, she's pretty busy.
07:11That's cool.
07:12You, uh, you looking for Robbie?
07:13Yeah, he's got our festival passes.
07:14Oh, you going together?
07:15We were supposed to, but, you know, I decided to go with a friend.
07:18What's her name?
07:20Leah.
07:21Okay, okay.
07:22Don't hold down on us.
07:24We need details.
07:25Where'd you meet?
07:26How long have you been together?
07:28We met at Junior Lifeguards this summer, and we've been dating for two months.
07:32Yeah, she's pretty great.
07:33That's sweet.
07:34I'm happy for you, kiddo.
07:36I'm gonna go find Robbie.
07:37Let him know you're here.
07:38Hey.
07:40A little advice, man-to-man.
07:43Always compliment her outfit.
07:45Hold her hand in front of your friends.
07:48And always wrap it before you tap it.
07:51Okay.
07:53So are we letting down the cuff pressure until we can identify the exact spot?
07:58I see it.
07:59I see it.
08:00Right there.
08:02Okay.
08:02Okay.
08:03Now you can place a figure of eight suture.
08:05I've never done one of those before.
08:09Look, maybe you should just do it.
08:10You should definitely do it.
08:12Whitaker's got this.
08:13It's easy.
08:14Just two sutures in one.
08:15Take a big bite, a simple interrupted suture, anterior to the bleeder.
08:18Okay.
08:29Now instead of tying, throw another one posterior.
08:35Looks good.
08:36Now a normal tie for a figure of eight.
08:38What did I miss in here?
08:40I am so sorry.
08:42I just made an excellent catch and saved Mr. Chazen's life.
08:45Really?
08:45Really?
08:46Really?
08:47There was a cut arteriole under a blottable vesicle.
08:50If Mr. Chazen had gone home without debridement, the blister could have eroded with uncontrollable hemorrhage.
08:55Nice work.
08:57Jackson Polycare might want to go hit the scrubs exchange.
09:00Yeah.
09:15All right.
09:17Next up is an ingrown toenail.
09:20It should be pretty quick, though.
09:22And, ah, Sherry, you're back.
09:26The kids get to school okay?
09:28Yeah, thanks.
09:29Okay, cool.
09:29Well, come with me and we'll finish up your wound care, okay?
09:33Earl, what are you doing out here?
09:35I'm hungry.
09:36Head back inside and we'll get you a sandwich.
09:38No egg salad.
09:39Sure.
09:40Excuse me, excuse me.
09:42I've been here for over five hours, okay?
09:43Way longer than that chick.
09:45Can you check the list?
09:46Driscoll?
09:47Doug?
09:47Driscoll?
09:50Everybody is seen as quickly as possible and in order of medical care needed.
09:54Unless they die waiting.
09:56Would you look at that, Mr. Driscoll.
09:57It's actually time to bring you back.
09:58Thank God.
09:59Would you take care of Mr. Driscoll?
10:01Yeah, absolutely.
10:02Um, Sherry, you're with me?
10:05Oh, yeah.
10:07Yeah, let's take care of this.
10:15Hey, I need a minute.
10:17I already put $20 on disgruntled ex-EMT cut outside of our catchment.
10:21And I will gladly take your money when that mess is over, but this is about a patient.
10:26Christy Wheeler, 17 years old, pregnant.
10:29These are Abbott's fetal measurements from yesterday, and these are mine.
10:3310-5 and 11-2.
10:36Well, ultrasound is an art, not a science.
10:38Even in the very best hands, the EGA differential can be within three to five days in the first trimester.
10:43Definitely room for error.
10:44Not if you're here for a medication abortion and you're past the mandated 11-week cutoff.
10:49There can also be interoperator variability.
10:52I measured the gestational sac, 11-3, and the vibratal diameter, 11-1.
10:56I didn't get a single measurement under 11 weeks.
10:59So what are you saying?
11:00That Abbott lowballed his measurements to help a teen get the abortion that she wants?
11:06Maybe.
11:07Well, then you've got two choices.
11:09You can go with Abbott's measurements, or you can redo your measurements, go back in and pick an angle that
11:13shows 11 weeks or less.
11:14Please tell me you're joking.
11:16You were ready to roll up your sleeves at Armwrestle the Ethics Committee a couple hours ago to override Mr.
11:20Spencer's children.
11:21What changed?
11:22Apples and oranges.
11:23There was a clear, bright line that Mr. Spencer was never going to make it.
11:27Falsifying medical records for Christy is flat-out illegal.
11:30She's 17.
11:31She deserves a life.
11:32Of course she does.
11:34But I will not jeopardize my future in the process.
11:37You'll be fine.
11:39Someone finds out I falsified medical records, I'll get booted from the residency program.
11:44You've got tenure.
11:46Worst case, you have to take a job in Youngstown.
11:49The risks are not the same for you as they are for me.
11:57You're right.
11:58I'll do it.
12:00What?
12:00Erase your history of physical and impression from Christy's chart and be like you never saw the patient.
12:04I will take over, I will complete a new chart and upload my own image.
12:08Robbie, I'm not asking you to.
12:09As you're attending, it is my decision.
12:10I am a certified provider for Mephapristo and you are not.
12:13And as a proven physician, I should examine every patient before I order medication.
12:17Robbie.
12:17Yep.
12:18Jake's here.
12:18Hey, great.
12:20Any word back on Nick Bradley's perfusion study results?
12:23Still ain't.
12:23Can you come find me when the imaging's back?
12:25These people have already been through enough.
12:28Is that Mr. Spencer?
12:30Yeah.
12:31Robbie.
12:32Excuse me for one second.
12:33I want to go see if I can find Mr. Spencer's children before they leave.
12:36You're looking a little peaky.
12:36Are you okay?
12:38I just need a good night's sleep.
12:40I want to grab you a grilled cheese before the new lunch rush.
12:42It'll help some color back to your cheeks.
12:45I got you.
12:48Can someone please help?
12:51It's my mother.
12:52She fell.
12:53What happened?
12:54I fell in the yard.
12:56I hurt my arm.
12:57That's all.
12:58Yo, we've been hugging this wall for almost an hour.
13:00Relax.
13:00We're just going to take her vitals.
13:01Oh, Mom, we've got cuts all over.
13:03I fell in the roast, boys.
13:05I'll be fine.
13:10I'm Dr. King.
13:12This is Perla.
13:13What's your name?
13:14Ginger Akitajima.
13:15I'm her daughter, Rita.
13:17Ginger, did you hit your head?
13:19No.
13:20Any chance she could have fainted?
13:22I told you I could.
13:23I was taking a shower and she went outside.
13:26She's not supposed to go outside anywhere without me.
13:29She needs 24-7 assistance with AVLs.
13:31Are you the primary caregiver?
13:32I'm her only caregiver.
13:35Ma'am, what medications are you on?
13:37Oh, just one.
13:41Risperidone.
13:42My mom has schizophrenia.
13:44BP 132 over 78.
13:46Pulse 84.
13:47Sats 98.
13:47Haven't seen this young lady around before.
13:49Somebody new.
13:51Leathery will get you everywhere.
13:53Ground level fall, good vitals.
13:55No head trauma, no AMS, and just an isolated shoulder injury.
13:58Do you have any pain in your belly?
14:00No, but next time buy me dinner before you do that.
14:04Okay, let's order some basic labs and get some pain meds on board and call me when the
14:10x-rays are back.
14:10Your mom's in very good hands.
14:12You're leaving so soon?
14:13Oh, I'm never far away.
14:15I'll save a dance for you.
14:17I'll be counting on it.
14:18Looks like more than just vitals to me.
14:21That's it.
14:21You're on the list, Hurley.
14:23Oh, no.
14:25Hurla, I'm sorry.
14:26I take it back.
14:27Too late.
14:27You're on the list.
14:43Okay.
14:50What?
14:57I like big butts and I cannot lie.
15:01Whoa.
15:02You scared me there.
15:04Want a pony ride, big boy?
15:05What?
15:06Excuse me, Myrna.
15:07I need to discuss a confidential patient issue with my colleague here.
15:10We need more privacy.
15:11Catch you later, sweet cheeks.
15:13Don't mind Myrna.
15:14She's harmless.
15:14She's handcuffed.
15:15That's why she's harmless.
15:21You gotta stay on top of Ozzy's ear infection.
15:24His meds are in the fridge.
15:26Our dog has really bad allergies.
15:29And I changed Ruby's food order to Monday.
15:33Bougie bitch.
15:34She only likes the good stuff.
15:35Mm-hmm.
15:35Like mother, like daughter.
15:42Nice to know you still make each other laugh.
15:44Oh, make each other laugh.
15:45Make each other deliveriously happy.
15:54Sorry.
15:54Didn't mean to get all mushy in front of you.
15:56Are you kidding me?
15:57You two are the sweetest.
15:59I never got to see this kind of love between a married couple.
16:02Parents weren't the lovey-dovey type?
16:05My dad died when I was 13.
16:07Aw.
16:08I'm so sorry.
16:10Yeah, me too.
16:11He's the reason why I got into medicine.
16:13And the reason why I'm conducting research on racial disparity in the ER.
16:17I'm doing a retrospective chart review on our past five years of patients of color.
16:21Is that how you knew it was going on with me?
16:24We don't treat sickle cell here as well as they do in other hospitals, but I'm hoping to change that.
16:29Status, Dr. Moyer?
16:30Still on exchange transfusion and high-flow nasal oxygen, but oxygen sats are dropping.
16:35She's at 84.
16:36That's really low.
16:38Yes, it is.
16:39The goal of exchange transfusion is to reduce the percentage of sickle hemoglobin to under 30%.
16:43That is not happening at the rate that your wife needs, which is causing your blood to be unable to
16:48carry oxygen, causing further blocked blood cells.
16:50What does that mean?
16:51Dr. Mohan.
16:53To prevent stroke or heart attack, we need to get you more oxygen, but we'll need to intubate.
17:03How long can we wait to see if that's really necessary?
17:05Acute chest syndrome can progress very quickly.
17:08It is the most common cause of death for patients with sickle cell.
17:11It is imperative that we intubate.
17:15I, I, I, I don't know.
17:19Why don't we give you and Ondine some privacy so you can talk?
17:27Look, you want to be their friend, but right now you need to be Joyce's doctor, so get her to
17:31sign the consent form and pray for the intubation.
17:36Forty-three, forty-four, forty-five, forty-six, forty-seven, you're not going to beat my record.
17:45Oh, how the hell did you stay on for 80?
17:47I'm 17 and I'm more fit than you.
17:53That kid looks my age.
17:54Yeah, he is.
17:56What happened to him?
17:58Stressed out 18-year-old, took some pills off the internet to help him sleep.
18:02They released with fentanyl.
18:04Is he going to make it?
18:06Mm.
18:17Poor Huckleberry.
18:19Not even 11.30 and you've already been demoted.
18:22I only had morgue scrubs left in my size.
18:24And I guess you better not fuck anything else up today, huh?
18:33Yo, Donahue.
18:34Yo, you get in on that ambulance chase action?
18:36Yeah, $20 on catch, chop-drop, out of our zone.
18:40Bold.
18:41I like it.
18:43What can I do you for?
18:46Hypothetical question.
18:48Would you ever go over a resident's head to the attending?
18:53Hypothetically?
18:54I wouldn't recommend it unless it's a behavioral issue or harassment.
18:57And in that case, you can make a confidential report to HR.
19:00What if it's more patient care related?
19:03Depends.
19:03If it's something minor, leave it alone.
19:05If it's something that endangers a patient, then definitely yes.
19:09Pick your battles.
19:10You don't want to be the intern who cried wolf.
19:15Ah.
19:16Yeah.
19:17Okay, still pretty raw.
19:18Yeah.
19:19Let me put some more anesthetic on there and numb you up some more.
19:22It's my own fault.
19:24I should have known better than to try to make s'mores over a sternum.
19:29They kept asking.
19:31Yeah, the things we do for our kids.
19:33Yeah.
19:34You have a kid, right?
19:35Yeah.
19:36He's 11.
19:39Yeah, when he, um, when he turned eight, he begged me to go camping for his birthday.
19:44We drove four hours to New River Gorge.
19:48Took me an hour to set up the tent.
19:51Is the long we lasted?
19:53Three hours.
19:55Thirty-seven minutes.
19:57A thunderstorm came out of nowhere.
19:59Filled the tent with water so fast, I feel like it was being flushed down a toilet.
20:03I'm so sorry.
20:05Ran out of there like a couple of gutter rats.
20:08Ended up celebrating his birthday at 2 a.m. with a Happy Meal.
20:11Oh, who my kids wouldn't give for a Happy Meal?
20:17Yeah, they must, um, have some pretty fancy McDonald's up there in Shadyside.
20:24Yeah.
20:26That's, uh, that's where you live?
20:28It's the address on your patient file?
20:30Um, technically no.
20:34I just use the address so my kids can go to a decent school.
20:38Right.
20:39I know it's illegal, but it's just temporary.
20:42Oh, God.
20:43No judgment here.
20:45My son always comes first no matter what.
20:47Yeah.
20:47Even if it means I have to do without.
20:54I know I'm a doctor, right?
20:56How bad could it be?
20:58But I, uh, I used to be an addict.
21:02Even lost custody of my kid.
21:05Huh.
21:06I never would have guessed, huh?
21:08Yeah.
21:09I went through some really dark times before I finally got help.
21:13And I've been sober now.
21:15Nine years, five months, and eleven days.
21:19And your son?
21:21He's good.
21:22Good.
21:23You know, we're good.
21:25He gets to stay with me every other weekend, and, um...
21:32We'll be back to joint custody just as soon as I get this stupid thing off next week.
21:44Don't worry, I only killed three people.
21:47Oh, God, I'm kidding.
21:49I'm kidding.
21:50I'm sorry.
21:50It was a bad joke.
21:54The whole thing was just this...
21:58giant misunderstanding.
22:03I guess I'm oversharing, because I want you to know...
22:07Not everybody has it all figured out all the time.
22:11Yeah.
22:18I'm...
22:20I'm struggling.
22:23And I feel like such a bad mom.
22:29And every day is so hard.
22:34And I don't know what's going to happen tomorrow or the next day.
22:41Sometimes I wonder if they would just be better off without me.
22:48Yeah.
22:50Do you?
22:52Not like that.
22:53I just...
22:55I've just messed up so much.
22:57Yeah.
22:58I don't know.
23:05You're their mom.
23:06Yeah.
23:07You love them and nothing, and no one can replace that.
23:11Yeah.
23:14You deserve a little grace.
23:17You know, be kind to yourself.
23:24Well, you had a normal EKG and chest x-ray,
23:27but it looks like you sustained a proximal humorous fracture on the left upper arm.
23:34There goes my back hen.
23:39That was a joke, dear.
23:41Okay.
23:42Um, because the fracture isn't displaced, the good news is you don't need surgery.
23:47Oh, that's a relief.
23:49The bad news is you do need to wear a sling for at least six weeks.
23:53And I have to insist, absolutely no shoulder mobility for the first few weeks.
23:58And that means you're going to have to step up even more,
24:00because on top of your usual ADLs,
24:03you're also going to have to help your mom bathe, dress, and use the toilet.
24:07I'm so sorry, Mom.
24:10This would never have happened if I was more on top of things.
24:13Any more on top, you'll be back in my womb.
24:17It's going to be fine.
24:20I know how hard it can be.
24:23I was my sister's primary caregiver until a few weeks ago.
24:27Where is she now?
24:29Um, she's in an amazing facility in North Hills.
24:34I know I can be a burden.
24:37But I like being in my own home.
24:40Just me and my girl.
24:44You're not a burden.
24:46You're my mom.
24:48I'll refer you to Ortho.
24:50They'll get you set up with PT and exercises.
24:54You're very lucky to have such a caring daughter.
24:57Oh, I know it.
25:00Park Road Subaru in the ambulance bay?
25:02Oh, yes, that's me.
25:03You're going to need to move that to open the space for ambulances.
25:06Oh, I'm so sorry.
25:07Okay.
25:08It's okay.
25:09I'll walk Rita out.
25:10Perla, would you stay with Ginger for a minute?
25:12I'll be right back.
25:13Yeah, no problem.
25:14Okay.
25:14After you.
25:19Look, I put your mom's prescription in at the pharmacy.
25:24And by the time you get back from parking, she should be ready to be discharged.
25:28Just don't worry.
25:31Things will be back to normal in a few weeks.
25:36I'm not sure what normal is anymore.
25:38I can't even remember the last time I slept through the night.
25:41It's just...
25:43It's a lot.
25:46Do you have any support at home?
25:49I wish.
25:51It's just us.
25:53I hired a part-time aide for my sister to cover me when I was at work.
25:57It was really helpful.
26:00It's out of our price range.
26:02I mean, I really work from home.
26:03And then there's the cooking and the cleaning and the doctor's appointments.
26:08It never ends.
26:10You know, caretaker's fatigue is a real thing.
26:14You have to take care of yourself.
26:16Otherwise, you're going to end up in here, too.
26:26I still don't understand why Christy needs to go through this a third time with a third doctor.
26:31Yeah, that's our bad.
26:32Our computerized medical records have been glitching lately, and Dr. Collins' image didn't upload properly.
26:38Okay, crowned a rump.
26:39That's top of the head to the bottom of the butt.
26:40It's how you measure gestational age.
26:42And we are at ten weeks and six days.
26:45I made it by one day.
26:47I will order the medication.
26:49Dr. Collins will go over instructions on taking the pills when they come back from the pharmacy.
26:53Thank you so much, Dr. Albee.
26:55Oh, I'm glad I could help.
26:56Even more glad to see you have such a supportive mom.
26:59Okay, take care.
27:07Appreciate you stepping up.
27:08All good.
27:09I got you.
27:12Robbie, Emma Isaac's on line three for you.
27:14She's the organ donation counselor.
27:16Can I speak to next parents?
27:18What's that all about?
27:19Oh, nothing.
27:20Doesn't look like nothing.
27:21He's...
27:22What?
27:22You two were once a thing.
27:23We dated briefly a million years ago.
27:26Never again.
27:27Never say never.
27:28Settle down, Jane Austen.
27:30The lady doth protest too much.
27:36Jake!
27:37There he is.
27:38The man, the myth, the legend.
27:39This is cute.
27:40Stole my concert pass and gave it to a girl.
27:42Where is she?
27:43Do I get to meet her?
27:45Hold that thought.
27:45Okay.
27:46Travis Johnson, 17.
27:47Had a tonsillectomy ten days ago at St. Michael's.
27:49Started spitting blood about an hour ago.
27:51Good vitals.
27:52Hey, Travis.
27:52I'm Dr. Robbie.
27:53How much blood?
27:54A couple mouthfuls.
27:55Can you open up for me?
27:59Hey, Whitaker.
27:59Jesse.
28:00I've got a post-tonsillectomy hemorrhage.
28:02Nebulize TXA, quick as you can.
28:03Let's go.
28:04Trumber two.
28:04Let's go.
28:05So this can go south pretty quickly.
28:07Are you up for it?
28:08Well, I can...
28:09Of course you are.
28:16Ready?
28:16Here we go.
28:17One, two, three.
28:25Take long, slow, deep breaths on that.
28:27The TXA is going to help your blood clot.
28:28Hey, any medical problems?
28:30No, just a ton of strep.
28:31That's why I had the surgery.
28:32Can you take aspirin?
28:34Any other medications?
28:36Lungs are clear bilaterally, no strider.
28:39Okay, sure.
28:40You feel like throwing up?
28:41Any pain in your belly?
28:42No.
28:44Labs?
28:45Uh, CBC, BMP, maybe coax?
28:48Add a type of screen just in case.
28:50Yeah.
28:51Good stats for 98%.
28:52BP is 115 over 80.
28:55Okay, good.
28:564x4 in the ring forceps.
28:57Let's take a look.
28:58Okay.
28:59Head back.
29:00Open wide for me.
29:03What do you see?
29:04No active bleeding, but there's some white and dark brown stuff where the tonsils used to be.
29:08Oh, that's good.
29:08That's a fibrinous clot.
29:09That means the TXA is working.
29:11Your parents on the way?
29:12They're in Baltimore for a wedding.
29:14I didn't want to bother them.
29:15Trust me.
29:16They're your parents, and you are in an emergency room.
29:18He's never a bother.
29:19Write their number down, and I will call them.
29:21Call head and egg.
29:22Stay with him until they get here, okay?
29:24Good.
29:25Pen?
29:27Can I get the...
29:35Sam Wallace, our good Samaritan who saved a Nepali lady, is in line for a repeat head CT
29:40to be sure there's no extension of the intraparenchymal bleed.
29:43Okay, so we can down down the sedation, and if he's alert, check extubation parameters.
29:47Did you get the consent form signed by Joyce the Sickler for the intubation?
29:50Not yet.
29:50Jesus fucking...
29:51She's scared.
29:52I just want to give her some time to talk to me.
29:54To do what?
29:54Make funeral arrangements?
29:55Joyce is hypoxic at 84.
29:5784.
29:58This goes on much longer.
29:59She runs the risk of permanent lung damage, heart attack, stroke, death.
30:04I know.
30:04And move.
30:05Now.
30:17Just have a seat, and we'll be with you shortly.
30:20I've heard that load of bullshit before.
30:43Take me all the way back there just to stick a goddamn thermometer in my mouth.
30:47You know, repeat vitals every four hours.
30:56Oh, dang.
30:58Saw it swerved and almost hit the taxi?
31:00Mm-hmm.
31:01I gotta get out of here.
31:02I mean, this thing is totally gonna scrub the traffic to Pit Fest.
31:05Nice score.
31:06Going to Robbie?
31:07Well, I was supposed to, but I have this new girlfriend, and she's super excited about
31:10the lineup, so...
31:11So you ditched the old man for a hot piece of ass.
31:14Been there, done that.
31:17Senior year, Lollapalooza.
31:19I met the sky.
31:20I think his name was Rich.
31:21Or was it Rick?
31:22Doesn't matter.
31:23But he looked like Dave Navarro.
31:28Warm breeze.
31:29Cool grass.
31:31Million stars in the sky.
31:35Best sex in my life.
31:37You had sex in public?
31:39We were under a blanket.
31:40Oh, it's turning around.
31:43It's turning around, baby.
31:44Come home to Papa.
31:46Shit.
31:47And money on it crashing in Beaver County.
32:00Better safe than sorry.
32:03It's okay.
32:06Jake, something.
32:08Hey, I'm here.
32:13Where's Rita?
32:16Um, she went to park the car.
32:17Shouldn't have been more than five minutes.
32:19Why don't you dial her number for me?
32:29Yo.
32:30Did she pick up?
32:30Straight to voicemail.
32:32That's weird.
32:33Yo.
32:38Sole caretaker.
32:40Overwhelmed.
32:41Exhausted.
32:45I told her to take a break.
32:46You don't...
32:47You don't think she ditched her mom, do you?
32:50I mean, it happens.
32:55You're gonna need to use the antibiotic ointment twice a day and come in for a wound check in
32:59two days, okay?
33:01Mateo, can you grab me enough samples for the last couple weeks?
33:03Yeah, I'm on.
33:06Thanks.
33:07I really appreciate it.
33:09Yeah.
33:10No problem.
33:11Has Kiara been here yet?
33:14No.
33:15Who's she?
33:15Kiara.
33:16Oh, she's the hospital's social worker.
33:18She can help you out with, like, housing and childcare and food and security.
33:20You told her?
33:21No.
33:21I...
33:22No, no, it's all free.
33:23The system works if you use it.
33:24Enough!
33:27I don't need your help.
33:30Nice speech.
33:32Next time, mind your own business.
33:39You ever heard of impact over intent?
33:44I would never intentionally embarrass anybody.
33:46But you did.
33:48You didn't have a conversation with Sherry.
33:50We were asking her what you needed.
33:52Instead, you walked in here and told her what to do.
33:54You've got to slow down, take a beat, and listen instead of judging people.
34:01I don't judge.
34:02Please, you've been eyeing me sideways all day.
34:07Look, maybe I have a better perspective because I've been on both sides.
34:10But we've got to try to at least put ourselves in their shoes.
34:15Listening and building trust will make us better doctors.
34:19And better people.
34:23Um, I'm sorry.
34:25I'm not telling you this to reprimand you.
34:28I'm trying to teach you.
34:30To help you.
34:33Wait, well, what about Sherry?
34:36I doubt she'll be back.
34:38But sadly, there will be many, many more just like her.
34:46No, no, no, no, no.
34:47He had the surgery at St. Michael's, but he's here now.
34:52No, he doesn't have a car.
34:54His parents are out of town.
34:58Okay, okay, well, how am I supposed to send him back to St. Michael's?
35:01Well, call him an Uber?
35:02You can't, that doesn't make, hey, hello?
35:07Hello?
35:08What's wrong?
35:10Um.
35:14They said it is not their job to fix another hospital's problem.
35:18Don't worry about it, though.
35:19I'll talk to my attendee.
35:22Oh, shit.
35:24I need a little help here.
35:27Okay, come on, open up.
35:29There's a post-pump selectomy hemorrhage.
35:32Uh, gate cover and sponge sticks.
35:34He was stable, then it just opened up.
35:36Hold the blood bank, two units, hold blood, get a second line.
35:40Head and neck wouldn't come down to see him.
35:41Assholes.
35:42It's tacky to 120, his sats are down to 90%.
35:45Okay, get a high-flow nasal cannula, 100 of ketamine, set up the glidescope.
35:52Hold suction.
35:53I'm going to try for direct pressure.
35:56If head and neck still won't come down, call Garcia.
36:00You're good, you're good.
36:02Okay, before we begin, let's take a time out.
36:06This is Joyce St. Clair.
36:07Procedure is endotracheal intubation for hypoxia due to acute chest syndrome.
36:12We'll be using video laryngoscopy and an 80ET tube with a 7.5 on standby.
36:17Induction with 75 of propofol 100 rocaronia.
36:21Got it.
36:22For backup, we have a bougie and an LMA ready.
36:25Yep.
36:26Any questions or concerns before we start?
36:29I want to be awake.
36:30We can't perform an intubation that way.
36:33I mean, after.
36:35After, we will lighten your sedation.
36:37You won't be able to talk, but you can use a pen and paper or an iPad to communicate.
36:45I love you.
36:48It's the end of time.
36:52Robbie, trauma 2 right now.
36:54Coming to the intubation?
36:54Of course.
36:58What happened?
36:59A bleeder opened up.
37:00Ketamine on board to intubate.
37:01Sat's holding at 97.
37:03Can you get an airway?
37:04Come on.
37:05Let's lie him down.
37:06Keep pressure on this gub.
37:09Nothing but blood.
37:11Can't see the cords.
37:13Sat's 94.
37:14Not sure we have room for the tube with the sponge stick.
37:16If I pull out, there's going to be even more blood.
37:18Doesn't look like you secured that airway.
37:19We're working on it.
37:20Bougie.
37:21Open a crack tray and prep the neck.
37:25Hold on.
37:25I'm going in blind with the bougie.
37:26I might be able to feel the tracheal rings.
37:28And I might have a three-way with Madonna.
37:30Move.
37:32Not happening.
37:34Pressure.
37:35Make room for the grown-ups.
37:37Okay.
37:38Okay.
37:38Hold on.
37:39We can try a retrograde intubation.
37:40A what?
37:41There's no obstruction.
37:42We just can't see what we're doing.
37:43So we take a needle and we put it in the cricothyroid.
37:47We run the guide wire up and out the mouth and we slide the ET tube up over the wire.
37:50Never seen one before.
37:51So that's 90.
37:52No time to play MacGyver with this kid.
37:54Time to crank.
37:55It'll be quick.
37:56You got one shot and then I cut.
38:01Propofol and Rock are on board.
38:02Now we wait for the sedative and paralytic to start working.
38:06Should Dr. Robbie be in here?
38:08Between Dr. Mohan and myself, we've done hundreds of these.
38:11I'm getting sleepy.
38:13I'm right here, babe.
38:25Okay, I'm in.
38:27Get out of here.
38:33Let me know when you start to feel it up top.
38:38Nothing yet?
38:39More suction?
38:40I'm trying.
38:42Still can't find it.
38:43Oh, keep feeling in there.
38:44It's got everything somewhere.
38:46It's curling up.
38:47Sat's down to 89.
38:48Guys, this is not working.
38:50Just give me a second.
38:51Until you rest?
38:52Oh my god, I'm gonna lose another patient.
38:53Shut up, Gregor.
38:54He's got this.
38:55Sat's down to 87.
38:57Okay, I'm gonna redirect the wire.
39:01Sat's still dropping.
39:0286.
39:05You got this.
39:12Andine, if you'd like, you can watch on the screen.
39:15Okay.
39:19Excellent view of the cords, Dr. Mohan.
39:22I'm in.
39:25Inflate the balloon.
39:35Good breath sounds bilaterally.
39:37Sat's 92 and rising.
39:40That's it?
39:41You're done?
39:42Yes.
39:43It all went perfectly.
39:48How long until she gets better?
39:50Depends.
39:51It can take anywhere from a few days to a few weeks for the lungs to heal from acute chest
39:55syndrome.
39:56I can ask the ICU to set up a recliner for you in Joyce's room so you can stay with
39:59her.
39:59Thank you both.
40:01So much.
40:02You're welcome.
40:03Take care.
40:11Sat's 84.
40:11We need to bag him.
40:12Still not seeing it.
40:13It's functioning like crazy.
40:14Okay, we're done playing, doctor.
40:15Lose the wire.
40:16I'm correcting this kid.
40:16All right, we tried.
40:17I'm sorry.
40:18No, wait.
40:19Wait.
40:19I've got it.
40:22You still don't have an airway.
40:23Okay, get the laryngoscope in place until the tube passes easily.
40:27Pass the T-T tube over the wire.
40:30Come on.
40:31Hang on to that wire.
40:32Do not let go of that wire.
40:33Okay, good.
40:37Okay, I'm going to give you a little slack so you can get it past the course.
40:42Yeah, yeah.
40:42I feel you at the trachea.
40:4525 centimeters at the lip.
40:46That ought to do it.
40:47Pull the wire.
40:48Bag him.
40:49Bloons up.
40:53Yellow on CO2.
40:54That's good.
40:55That is very good.
40:58Good breath sounds bilaterally.
41:00Sat's coming up.
41:0190.
41:0292.
41:03Guess you're going to have to save that scalpel for another day.
41:05You guys got lucky.
41:07No, we got skills, baby.
41:08We got skills.
41:10You guys on the clock.
41:12Yeah, copy.
41:13Ordering Proprovol and fentanyl drips.
41:17Oh, nice of you to join us, Dr. Flores.
41:19Sorry, got stuck in a nasty radical neck dissection.
41:22Still bleeding?
41:23Not with direct pressure.
41:24We got the airway.
41:25You get the bleeder.
41:26Oh, we're standing by.
41:27So I can cancel the Uber?
41:30Let's get him upstairs.
41:33Fresh sponge stick for you, Whitaker.
41:36You need me to stay with the...
41:37Your patient did a good job.
41:39It's only until the anesthesiologist takes over.
41:41You got it?
41:41Yeah, I got it.
41:41Get yourself a fresh pair of scrubs on your way back down.
41:51I'm sorry that took so long.
41:53I was just...
41:53Don't apologize.
41:54What you did in there, building a relationship with your patients, earning their trust.
41:59It's what this is all about.
42:01Robbie doesn't seem to think so.
42:03Don't worry about him.
42:05You know, I should be apologizing to you.
42:09Slow-mo, you deserve better.
42:13Keep doing you, Dr. Mohan.
42:17Where'd you get that move?
42:19Retrograde intubation lesson.
42:20Adamson's special.
42:21I learned that from the best.
42:22Well, you're not too shabby yourself, Professor.
42:24Yeah, that got kind of rough in there.
42:26You kept your composure, though.
42:28Exactly the kind of candidate they want for the ED Medical Education Fellowship.
42:32Oh, there's probably over 50 applicants for that one slot.
42:34Yeah, probably.
42:36But I know that they like to go with someone that they know from firsthand experience has
42:39the skills to be successful.
42:41At least that's what I told them in my letter of recommendation.
42:47Glad you stuck around.
42:49It's not like I had a choice, did I?
42:51No, not really.
42:54So, how's your day going?
42:56Oh, it's going.
42:57Cool.
43:00Why do you ask?
43:01I can't ask.
43:03You never ask me about my work.
43:05What gives?
43:06Mom wanted me to ask because she just wants to make sure that you're doing okay.
43:10That's very sweet of her.
43:11I'm doing fine.
43:12Thank you for these again.
43:13You thanked me by finally introducing me to your girlfriend.
43:16Not today, but soon.
43:18Have fun.
43:18Hey, I know it goes without saying, but please be safe.
43:22I will.
43:22Seriously, don't take anything from anyone.
43:24I've already seen two fentanyl overdoses today.
43:26It's not even noon.
43:27I promise.
43:28Okay.
43:28Basketball Sunday?
43:29Yep, wouldn't miss it.
43:30Hey, before you go, before you go, please don't hand me a condom.
43:33Condom?
43:34I'm going to give you extra cash.
43:36Are you having sex?
43:37It looks like the driver lost control as the police cars were closing in.
43:44The ambulance has definitely stopped.
43:46Check it out.
43:47It's difficult to tell from this angle, but it does look like they may have hit something.
43:52Damn!
43:53That's in our zone.
43:54Ambulance crashed in our catchment.
43:56Get ready for incoming.
43:57How many you think?
43:58Other than the driver, no idea.
44:01Since you've passed ten weeks, you'll need to take Mithipristone twice.
44:05Once now, and once in 24 hours.
44:08Then 24 hours after that, you'll take Mithiprostol.
44:11Two pills, which dissolve between the cheek and the gum.
44:13Then two more of the same pill six hours later.
44:16That's a lot to remember.
44:17Everything is clearly labeled with the names of the meds, the dose, and the exact time to take them.
44:23Will it hurt?
44:24You can expect some vaginal bleeding.
44:27There may be some cramping, like when you're on your period.
44:29If you're bleeding more than two pads an hour, or the pain gets to be too much, come back in
44:35and see us.
44:36And I'll be with you the whole time.
44:44Christy?
44:46Christy!
44:47What the hell are you doing here?
44:48Hey, language.
44:49And I should be asking you the same thing.
44:51Excuse me, who are you?
44:52I'm her mom.
44:54Mom?
44:55Aren't you her mom?
44:56I can explain.
44:57No, that's my sister, Lynette.
44:59I am Christy's mother.
45:01Chris?
45:03Chris, baby, what are you doing here?
45:06I'm here for an abortion.
45:10Did you do it already?
45:12Not yet.
45:13Okay, thank God.
45:14Okay, okay.
45:15Can we all just take a step back here?
45:16Mom, I want this.
45:18This is my decision.
45:19No.
45:19Just listen to her, Elle.
45:20Okay, shut up.
45:21You have done enough.
45:24My daughter is a minor.
45:25So, she can't get this abortion without my say-so, right?
45:32Is that right?
45:34That's correct.
45:40Then, there is no way this is happening.
45:42Not now, not ever.
46:01You were in a reputation.
46:02You were here for a melodies.
46:02I am a malicious engineer.
46:02You were running.
46:03Are you ever missing from me?
46:03Or are you serious?
46:13You were like, oh God, you were going.
46:13Yeah, I was a disaster.
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