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🏁 EP 11: The story reaches a critical point as everything begins to unfold. 😱 The outcome is closer than ever.
🏁 EP 11: The story reaches a critical point as everything begins to unfold. 😱 The outcome is closer than ever.
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TVTranscript
00:04.
00:04.
00:04.
00:05.
00:23Hey.
00:24Not now, Myrna.
00:24Oh.
00:25Women in labor, ten minutes out.
00:27What are you still doing here?
00:28I have one hour left on my shift.
00:29If I get home before 6, Benji, you'll know something's up.
00:32I'm pretty sure the black eye is going to give you away.
00:34Well, sadly, it's not the first time
00:35I've gone hell with a war wound from a patient.
00:38Hey, Doc, you got a sandwich?
00:41Uh, you know what, Earl? I could do you one better.
00:43I'm going to order Tagari's pizza.
00:45I think we could all use a morale boost around here.
00:47No sandwich.
00:48You could fold it in half New York style just like a sandwich.
00:51Better not be pineapple.
00:52No pineapple. I promise not this time, OK? We good?
00:57I say this with all the love and respect in my heart.
01:00I honestly do.
01:01Get the hell out of here.
01:02You need me.
01:04My CT came back normal.
01:05Nasal bone just has a hairline fracture.
01:06I'm fine. Don't worry about me.
01:08I don't like it.
01:08You sound like me. That's not a good thing.
01:10Just let me finish my day.
01:12OK, I'm not going to argue with you.
01:13Yeah, all that knowledge and still learning.
01:15It really is impressive.
01:16Yes, well, could you at least keep a cold pack on it?
01:18No problem.
01:19I've had so much coffee.
01:21I've got to pee again and walk with me.
01:22I also need to fill you in on something.
01:24What?
01:24So Langdon is gone.
01:26Gone? Where?
01:27Home.
01:29I will handle his caseload.
01:30It won't fall into anybody else.
01:31And Dr. Ellis usually comes in early.
01:33I get punched in the face and he goes somewhere like that?
01:36No, it's not like that.
01:37Trust me, you do not want to be Langdon right now.
01:40And I need a favor.
01:42I need you to run a pharmacy audit on Langdon
01:44for the last three days.
01:45I need a list of all the patients he's treated
01:47and all the medications he's prescribed.
01:50Don't want to know why?
01:51No, you do not.
01:54You sure you're still good to stay?
01:57Yeah.
01:58Are you?
01:59Honestly, I'm beginning to have my doubts.
02:00Yeah, I feel like God's trying to tell you something.
02:02Can we stop talking a long time ago?
02:29Let's go.
02:31Let's go.
02:32Let's go.
02:32I don't know.
03:08I don't know.
03:10It's too heavy.
03:11It's too heavy.
03:14You're a 2-2-8.
03:1620 bucks, that'll be enough.
03:1810 cheese, 10 pepperoni.
03:22God, no, no pineapple.
03:23No.
03:24He's talking about a cigarette.
03:24I don't know.
03:25I don't know.
03:29I don't know.
03:29Okay, thank you very much.
03:34Can I have a word?
03:35With us?
03:36With Dr. Santos.
03:39Sure.
03:39Why don't we just wrap this up?
03:46I told you she was from the Philippines.
03:50So, the situation we discussed earlier hasn't been handled.
03:53I sent Dr. Langdon home.
03:56Well, I wanted to make a big impression of you.
03:58Save it.
03:59Okay.
03:59We're now down to senior resident, so it's all hands on deck.
04:02Got it?
04:03Got it.
04:04And I trust you have not mentioned this to anybody else?
04:08Uh, no.
04:08No, I don't know anyone.
04:10Good.
04:11Let's, um, keep it that way.
04:13RRT 8 West.
04:15RRT 8 West.
04:17RRT 8 West.
04:20Uh, Dr. Garcia.
04:21This is Trinity Santos.
04:23ED intern.
04:25Day one.
04:26Uh, I need to talk to you about something.
04:27So, at your earliest convenience would be great.
04:30Thanks.
04:32Oh, and there's pizza coming.
04:34If you want to, yeah.
04:39Dr. Robbie.
04:41Teresa, did you hear from David?
04:43No.
04:43But he posted this on his Instagram ten minutes ago.
04:46All they ever wanted was to fit in and be loved, but they mocked me and forced me into an
04:51existence of loneliness and pain.
04:53It didn't need to be this way.
04:54Wow.
04:55They did this.
04:56They did this.
04:57I think he's talking about the girls on the list.
05:00But the police said it's not enough for Ebola.
05:02Bolo, it means be on the lookout.
05:05Yeah, well, the police are gone.
05:07I heard Langdon left.
05:11Teresa, why don't you take a deep breath and go have a seat in the waiting room.
05:14I will come and find you.
05:15We will finish this conversation, I promise.
05:18Yes, Langdon left.
05:19I will be covering for him.
05:21There are two hours left in this shift, and if you need to go, I will call somebody to come
05:25in early.
05:27Why would I want to go home?
05:31You tell me.
05:39Okay, I'm only going to say this once.
05:42I had a miscarriage.
05:46Oh.
05:49Oh, Heather, I'm so sorry.
05:51Um...
05:52I'm fine.
05:52And no, I don't want to go home.
05:54And no, I don't want to talk about it.
05:56I was trying on my own with IVF.
06:00I...
06:00I...
06:01I don't know what...
06:03What to say.
06:04I'm ready to get back to work.
06:08Okay.
06:09Okay.
06:09Hey, we need a doctor here!
06:16Natalie Malone, 35-year-old G3P2, 39-week pregnancy and active labor after a trauma.
06:21I'm fine, really.
06:22It's not my first time.
06:23All right, let's get her into trauma, too, for a quick check, and then we'll send her up to labor
06:27and delivery.
06:27Got it.
06:29I'm Dr. Heather Collins.
06:31Nice to meet you.
06:32Justin should be here any minute.
06:33He was right behind me.
06:35Any problems with the pregnancy?
06:37Well, third time's a charm.
06:39Justin's pretty nervous, though.
06:40This is his first time.
06:41VPs 112 over 72, heart rate 84.
06:44Mm-hmm.
06:44Dr. Collins, can I join?
06:46Sure.
06:47Okay.
06:48When did the contraction start?
06:49Yesterday.
06:51Really?
06:52Well, my last two labors are very long, so I decided to wait it out this time.
06:56But then my water broke.
06:58Natalie, I'm here.
06:59Sorry, I got a little lost.
07:01You got traction!
07:02Critton, don't push.
07:04Just breathe.
07:05Check her, Dr. King.
07:08Okay, good.
07:10We got this.
07:11I see hair.
07:15Baby's hair.
07:19Oh.
07:23Natalie?
07:24You're crowning.
07:24You were right.
07:25I waited too long.
07:26I thought I had more time.
07:28It's okay.
07:28It's okay.
07:28Just breathe.
07:29All right, we can try and rush you upstairs to OB, but at the rate you're moving, you may
07:33end up having this baby in the elevator.
07:35So what's my other option?
07:36We deliver your baby here.
07:38Grab a VOA kit and get a baby warmer in here.
07:41Call L&D and tell them this baby is coming now.
07:44Wow.
07:45We're 20 behind in triage.
07:47Mateo, treat him and street him.
07:48See how many you can dispo.
07:50I hear we're down a senior resident.
07:52How can I help?
07:53Oh yeah?
07:53What senior?
07:54Langdon had to go home early to deal with something Robbie's covering.
07:57You can follow Mateo to chairs.
07:58That's why we could really use you.
07:59Chairs is about to be my bitch.
08:03So, Deed, is this all about the fight?
08:07What fight?
08:09Robbie and Langdon got into it at the lockers.
08:11The ship was flying.
08:12You better all shit.
08:14That's enough from you two.
08:15Not another word.
08:20Keep it up.
08:21We both be working the holidays.
08:27What do we got?
08:2839 weeks crowning after a shram.
08:31Hi mom.
08:31I'm the attending.
08:32I'm Dr. Rabinovich.
08:33I'm Natalie, but I'm not the mom.
08:36What's happening?
08:37You got here just in time.
08:38We're the dads.
08:40Natalie's my best friend and surrogate.
08:41We both teach fourth grade and even chair classers.
08:43Same room, same womb.
08:45We've been urging her to stop saying that.
08:48I've got the prenatal bag and let me pull up the birthing playlist on my phone.
08:52It's time.
08:54Fuck Beyonce.
08:55Fucker.
08:58I can take this.
09:00No.
09:02I got it.
09:03Go Dr. Collins.
09:06Okay Natalie, good chance we'll deliver on the next contraction.
09:09Bulb suction is ready.
09:21Right.
09:22Head is out.
09:24Nice.
09:24Take a break.
09:25Catch your breath before the next one.
09:29Alright.
09:30I'm gonna need another big push from you.
09:33You got this.
09:34Three.
09:35Two.
09:36Who do we have in here?
09:39Ivan Puglisi.
09:4155.
09:42Has experienced a day of abdominal cramps, vomiting and diarrhea.
09:458th February.
09:46Tacky at 124.
09:47BP 192 over 100.
09:49I'm Dr. Mohan.
09:51I'm student Dr. Whittaker.
09:53Nice to meet you guys.
09:54I would have called my own doctor, but I'm from New York.
09:58You two kids ever been out there?
10:00Oh, I've never been to New York.
10:02Coming to Pittsburgh was my first time leaving Nebraska.
10:06Uh, how long are you in town?
10:08Just till Monday.
10:09My daughter's getting married.
10:11She's my baby and the only girl.
10:14Congratulations.
10:15Yeah, thanks.
10:16You know, you say you're not supposed to have a favorite kid, but...
10:19I'm an only child, so I was born the favorite.
10:22Whittaker?
10:23Oh, uh, youngest of four.
10:25I'm just happy when my parents remember my name.
10:28No, I meant do you have any questions for the patient?
10:31Oh, uh...
10:32Hey, can I just get something for the pain, you think?
10:34As soon as we're done with this assessment, we just want to do our due diligence.
10:39Any intestinal disease in your past?
10:41Ulcers, gallstones, general stomach ailments, surgeries?
10:45No, no, nothing.
10:46Good bowel sounds.
10:51Abdomen soft? Nothing focal?
10:53Anything else bothering you?
10:55Uh, you know, my back is killing me.
10:57Four-hour car ride will do it.
10:59I mean, the last time I tweaked it, I think they gave me, um...
11:04They gave me morphine, and that worked pretty good.
11:09Do you smoke?
11:10No.
11:10Drink alcohol?
11:11Uh, once, twice a month. I'm not a big drinker.
11:14Any recreational drugs, either pills or by injection?
11:18Tranquilizers, hallucinogens, painkillers?
11:19Uh, all of the above.
11:22Yeah.
11:23I'm kidding, no. No drugs. Never.
11:26And what do you spend your time doing?
11:28Ugh, I'm an actuary. It's, uh, risk management, uh, stats.
11:32It's pretty much a desk job.
11:34I pulled Zofran for the nausea. Start with forward PPR.
11:40Wow, then that's it?
11:41For now, we're gonna start with some blood tests.
11:44We'll be back soon to check in on you.
11:45Alright, fine.
11:49What do you think you're looking at?
11:52A big differential of pretty serious stuff to rule out.
11:55So what's your plan?
11:56Um, besides Zofran, CBC, CMP, IV fluids, morphine, maybe CT.
12:02Good on labs and IV fluids, but no morphine. Treat us simply with clonidine and muscle relaxants.
12:06What if he's...
12:08Look, I, I really can't lose another patient today.
12:13Remember how I said you'd get good at spotting the fakers?
12:16Yeah.
12:17He's exhibiting every sign of opiate withdrawal.
12:19Eyes dilated, tearing, skin has piloerection and goosebumps, hypertension, tachycardia.
12:26Agitation, restlessness, perspiration.
12:29He's checking every box.
12:30Right.
12:31But he said he doesn't take drugs and seldom drinks alcohol, so...
12:36That's exactly what he would want you to believe if he was drug seeking.
12:40Wow.
12:40You're good.
12:42Thanks.
12:43I am.
12:46So, how do we treat him?
12:48By getting him to admit his opiate usage.
12:50Right. How do we do that?
12:51By being smarter than the patient.
12:52Got it.
12:53Another big one.
12:54You said that the last two times.
12:57Shoulder dystocia.
13:02That head's pulling back.
13:03That's called the turtle sign.
13:05Hey, Donahue, can you call an L&D nurse and ask her to bring down a fetal monitor, please?
13:08What's going on?
13:10Baby shoulder might be a little stuck on your pelvic bone.
13:13There's nothing for you to worry about.
13:15We'll just try something different on the next push.
13:17Ready?
13:19Why don't we all take a deep breath, huh?
13:21Everybody.
13:25One more time.
13:26Dad's too.
13:26And in.
13:29If you want him for Halloween, just say it.
13:31I want him for Halloween.
13:32And everything until then.
13:33Give me Thanksgiving.
13:34Fine.
13:35You can celebrate bringing smallpox to wipe out the Native Americans.
13:38You know, I'm the one who's hurt.
13:39A little sympathy wouldn't kill you.
13:41You broke your ankle doing something stupid with our son.
13:47I need surgery.
13:48He wasn't wearing a helmet, Chad.
13:50What if he had fallen and hit his head?
13:52He didn't.
13:53No, but he could have.
13:56Do you know what it's like to watch a child die?
13:59Ah, here we go.
14:00You know how many kids come in here who are messed up because of one stupid parental mistake?
14:05You know I would never let anything happen to our son.
14:07Then act like it.
14:09Be a grown up.
14:10You're his father, not his friend.
14:12Yeah, and you're his mother, not my wife.
14:14Seriously?
14:15Oh my god.
14:16Hey babe.
14:20Where's Harrison?
14:22Staff lounge.
14:23Staff lounge.
14:23Staff lounge.
14:24Is he okay?
14:24He's fine.
14:25He's fine.
14:30I'm gonna go check on Harrison.
14:32I'm pretty sure being in the same room with her violates the restraining order.
14:36So.
14:37I'll go.
14:38I can take him home.
14:40Actually, Chloe, since it'll be hard for me to get around after my surgery, Harrison
14:45is gonna stay with Cassie for a little while.
14:48Right.
14:48No.
14:50I'm here.
14:51I can help take care of him while you're recovering.
14:53Absolutely not.
14:54Hey babe, I don't mind.
14:56I do.
14:57Um, yeah, sure.
14:58If you don't mind, just tell him back on my feet.
15:00Well, hold, Dr. McKay's on.
15:02I don't know.
15:02We're moving central six to trauma one.
15:04We need you.
15:06We are not done here.
15:13ICU border.
15:1448-year-old cirrhotic here for hematomasis.
15:19Intubated overnight and after one unit.
15:21PRBCs and FFP was supposedly stable.
15:23Not anymore.
15:24Weak carotid.
15:24Javadi?
15:25We need you on suction.
15:27Why is she bleeding all of a sudden?
15:29Most likely bleeding is from the esophageal varices.
15:32With cirrhosis, you get enlarged veins under pressure at the entry of the stomach.
15:36Varicose veins and they can burst.
15:38What does that mean?
15:40The cirrhosis from the hepatitis B caused a vein to burst where the esophagus meets the stomach
15:44and that's where the blood is coming from.
15:46In through the nose.
15:47Mel, I'll have you help with the McRoberts maneuver.
15:49Of course.
15:50Hey.
15:51Natalie, we're gonna lift your knees up to your chest now.
15:54Great.
15:56Justin, is this the worst you've ever seen me?
15:59This is the most I've ever seen of you.
16:01You're beautiful.
16:02I have a little suprapubic pressure here.
16:04We got you.
16:05You're gonna feel me pressing on your bladder?
16:08Two minutes since head delivery.
16:09Petal heart rate looks good.
16:10Normal variability.
16:11You're doing great, Nat.
16:12Feel me to step in and take home.
16:15Another one's coming.
16:16Give me a big push.
16:18Okay, Natalie, here we go.
16:19You got this.
16:22You're almost there.
16:23Keep going.
16:24Love you.
16:25Go team Natalie.
16:26Late D-South.
16:27Okay, can you call Dr. Ingram and tell him to come down here, please, from the queue?
16:30What?
16:30What's happening?
16:31The baby's heart rate has slowed, which could be a sign of distress.
16:35So what do we do?
16:36We deliver this baby.
16:37We got this.
16:39We got this.
16:41We got this.
16:42Eusebio, can you page the OR and tell him to prep for a possible crash c-section?
16:46BP's only 82 over 46.
16:48Hey, mom, you're gonna be okay.
16:50Rapid infuser, massive transfusion protocol, octetride bolusentrip, ad-prantropozole and
16:55ceftriaxone.
16:57Perla, get Robbie in here.
17:02Hey, Peggy, where's Robbie?
17:09Robbie, MTP from bleeding varices and trauma one.
17:12A little burning from the local.
17:15Oh, fuck.
17:16That hurts.
17:18If I can get my hand inside, onto the baby's head, I'll release that lower.
17:26Three minutes since I've delivered.
17:27Dr. Robbie.
17:28Yeah, my hands are a little tied up at the moment.
17:31I'll need the Minnesota box.
17:32Who's in there?
17:33Dr. McKay.
17:34Tell her to go ahead and get set up.
17:35She knows what to do.
17:36I'll be there as soon as I can.
17:37Yeah.
17:37I'm Dr. Myers with obstetrics.
17:39Nice to meet you.
17:39And who's a father?
17:41We are.
17:41Oh, and who's a mother?
17:43We are.
17:44Roger that.
17:45OR is prepped and ready.
17:46Do we need to go up?
17:47Uh, not if I can rotate this posterior shoulder.
17:50Alright, there's the elbow.
17:51Make sure it's flexed.
17:54It...it's flexed.
17:55Good call.
17:55We're getting closer.
17:56Just stay with me, okay?
17:57I'm trying.
17:58Okay, I've got control of the hand.
18:01Oh, that hurts.
18:02The arm.
18:03Rotating the posterior shoulder.
18:05Up and...
18:06Ow.
18:07Fuck.
18:09Perfect.
18:09Right there.
18:10Give me one good push.
18:13Yeah, yeah, yeah, yeah.
18:15Good.
18:16Hey!
18:17Look out, baby boy!
18:20Uh, I've got a stubborn set of twins upstairs.
18:23Admitter to postpartum.
18:24Congratulations, everyone.
18:34Good job.
18:35He's pretty quiet.
18:37Sometimes it takes him a minute.
18:38Put the baby on a pulse ox and a heart monitor.
18:41Hey, Amy, swap out with me.
18:42No.
18:43Dry and stimulate.
18:44Vigorously.
18:45Very vigorously.
18:46Shouldn't he be crying by now?
18:47Heart rate is 95.
18:48Too slow.
18:49Dr. Collins PBM.
18:53Tiny volumes.
18:54Once per second.
18:55This kid needs oxygen.
18:57Come on, baby.
18:58Let's breathe.
18:59Section ready?
19:00Ready?
19:00Dr. Ingram?
19:01I'm opening the intubation tray.
19:02Yep.
19:02One minute Apgar is three.
19:04Isn't Apgar supposed to be nine or ten?
19:06What does that mean?
19:07Come on, baby.
19:07Breathe, baby, breathe.
19:10There we go.
19:14That's good, right?
19:15That is very good.
19:16Very good.
19:16Okay, you got this?
19:17Yeah, go.
19:18That would be much better.
19:19Hemorrhagic shock from Pharisees.
19:21Failed medical therapy.
19:23Section stopped working.
19:25Because your canister is full.
19:27I'm on it.
19:27Oh, my God.
19:28Someone please take her out.
19:29Mom.
19:30Thank you very much.
19:31By the way, that is not how you raise patient satisfaction scores.
19:34Okay, Dr. McKay, do you want to explain to Javadi here all about the Minnesota?
19:38Yeah.
19:38So, best way to stop the bleeding is direct pressure.
19:41First balloon goes in the stomach as an anchor.
19:43Second runs the length of the esophagus for direct pressure on the varices.
19:46First, we want to inflate the balloon underwater like a bicycle inner tube to check for any air leaks.
19:51Javadi, subcock in the porch.
19:53You got the CC syringe?
19:54Suction's good and running.
19:55I got it.
19:59What did you give me?
20:00Because I feel worse.
20:02I told you that I got better last time with morphine.
20:06I have a morphine-like drug called bup.
20:08Works the same way and faster.
20:09Goes right under your tongue.
20:10If this doesn't work, we'll switch to morphine.
20:12But let's try this first, okay?
20:13I just want the pain to stop.
20:16Open up.
20:17Lift your tongue.
20:18Leave it there and let it dissolve.
20:20We'll be back in ten minutes.
20:27Just so I'm clear, are Planty is lying to patients?
20:31I didn't lie.
20:33Bup is a morphine-like drug.
20:34Binds to the same receptor.
20:35He said he isn't an addict, so why give him an opiate agonist to treat his withdrawal symptoms?
20:40Because I don't believe him and I know this will work.
20:43Then, once he feels better, we can get him to admit to his addiction and treat him long-term.
20:48If you say so.
20:50First, do no harm.
20:52Then, do what's best for the patient.
20:58Hey, go on.
21:04Langdon called the main line.
21:05You gotta be kidding me.
21:07Princess Anser told me you were busy.
21:08Just wanted you to nap.
21:09Okay, noted.
21:13You see anything?
21:14I don't have to.
21:15I just have to push the tongue out of the way in order to pass the tube.
21:19Okay.
21:20Here we go.
21:28Heart rate's 124. BP's still only 84 over 42.
21:31I'm eating a still risk.
21:32Get another unit on that infuser, please.
21:34How far did you go?
21:3550 centimeters.
21:38Dr. Robbie?
21:41Did you say 50 centimeters?
21:42Yes, that's plenty.
21:43Inflate the gastric balloon.
21:44Start with 50, and then we'll check the placement of stubby with an x-ray.
21:53Apgar is now 10.
21:57Go on.
21:58Yeah?
21:58Yeah.
22:02Okay, little one.
22:05Okay.
22:09All right, support his head right away.
22:11All right.
22:11All right.
22:12There.
22:13There you go.
22:19You're a natural.
22:43Whenever you're ready.
22:47Okay.
22:47I'm gonna take you now.
22:49Okay.
22:51I already missed your dad.
22:53I'll be up soon.
22:54Okay.
22:58Can I put my legs down now?
23:01As soon as your placenta's out.
23:04Good.
23:06Good.
23:07Good.
23:08Good.
23:08Good.
23:09Here it comes.
23:14Oh, wow.
23:16What?
23:17That's a lot of blood.
23:18Starting a second line.
23:19Spike a leader of family.
23:19On it.
23:20What's going on?
23:20This happens sometimes.
23:22We have to help the uterus clamp back down.
23:24Starting uterine massage.
23:2640 of oxytocin in the back.
23:27800 mikes of sublingual misoprostol and 1,000 of TXA.
23:31Two units from the blood bank.
23:32Just in case.
23:33Call OB and get Robbie.
23:34Why?
23:35Is Dana still here?
23:36She refuses to leave.
23:37That's perfect placement.
23:39She wants to finish your shift.
23:41Of course she does.
23:43Never met a charger.
23:44She wasn't a stubborn bitch.
23:45Okay.
23:46In an adorable way, of course.
23:48I honestly don't know what we'd do without her.
23:50The mouth's filling up again.
23:51It's like a fountain.
23:52Dr. Robbie, we need you in trauma, too.
23:54Yeah, okay.
23:55I'll be right there.
23:56She's still bleeding higher up in the esophagus.
23:58Natalie.
23:58Got this?
23:59We got it.
24:00Perla?
24:01She's not bleeding in her stomach.
24:03We have to inflate the second balloon up in the esophagus to do the job.
24:05Dr. Robbie, we need you.
24:07I'm coming.
24:07I'm coming.
24:08Fucking like this.
24:09This port is in the esophagus.
24:13A ton of blood.
24:14Mystery solved.
24:17Pump up the esophageal balloon to 30 millimeters mercury.
24:20That's an insufflator and a manometer.
24:22Yep.
24:22Just like a fancy bike pop.
24:24We are at 30 and shut the stop cock.
24:28Barely any blood coming from the esophageal port.
24:30If the balloon stopped the bleeding tomorrow, GI can cauterize the veins.
24:33That was awesome.
24:35I learned from the best.
24:40Is she gonna be okay?
24:41We are doing everything that we can.
24:43Massive PPH on MTP and all uterotonics.
24:46Any rupture, any inversion, any retained products.
24:49Checked for all. None present.
24:50This is all my fault.
24:51Second unit's going up.
24:52Still tacky at 130, systolic's only 84.
24:55Let's try carboprost, 0.25 milligrams IM, and get a Bakre balloon from Central.
25:00You can talk to her.
25:01Get in there.
25:01Tell her some of your favorite memories with her.
25:03That'll help.
25:06Thanks for coming down.
25:07You said there was pizza.
25:08Do you remember that thing I was worried about?
25:11My foot is fine, but I'll let you make it up to me with a cocktail.
25:14No, about Landon.
25:15What about him?
25:16Unfortunately, I was right and he's been dismissed.
25:19What do you mean dismissed?
25:20Dr. Ravi sent him home.
25:22Why?
25:23You know, it's probably best if we don't talk about it anymore,
25:25but if you could just keep a lid on what I mentioned earlier,
25:28that would be really great.
25:29You called me down to talk about it, but you don't want to talk about it.
25:32What is going on?
25:33He's been stealing meds.
25:36Stop. I don't want to talk about this.
25:38You just...
25:38I said stop.
25:39I don't want any part of this.
25:43You're trouble.
25:52You need a fresh saline bag.
25:54On it.
25:54Third and fourth units are coming up.
25:56FFP is also infusing.
25:57Keep going.
25:57Keep talking.
25:58We want more memories.
25:58It'll help.
25:59There was the time that we got that glass table off of Craigslist
26:02and we went to go pick it up and they mugged us
26:04and they stole it back from us.
26:06Estimated blood loss?
26:07About two liters, maybe three.
26:08What she had?
26:09Oxytocin drip, TXA, carboprost.
26:13Massive transfusion protocol.
26:14Spike the saline.
26:15Palone is past the cervix.
26:18How much should we put in?
26:19Up to $500.
26:20If that doesn't work, she'll need a hysterectomy.
26:23Hysterectomy?
26:23This is going to work.
26:25Come on.
26:25Keep talking.
26:25More memories.
26:26It's good for her.
26:26It's good for all of us.
26:27And the time we binged Game of Thrones two months before the finale because of FOMO.
26:33Natalie.
26:34Hey, Natalie.
26:35Natalie.
26:36Stay with us.
26:39How are you feeling, Mr. Puglisi?
26:40I'm feeling a lot better.
26:42Nausea is gone.
26:46What about your stomach aches, muscle cramps?
26:49I mean, I'd say I'm 75% better.
26:53Blood pressure and heart rate are back to normal.
26:56Incredible.
26:57You sound surprised.
26:59Oh, no.
27:00I'm just relieved for you, so.
27:03Good news is you can have another dose.
27:06That should get you back to 100%.
27:08Tongue up?
27:09I think we did it.
27:13No more blood loss.
27:16Thanks for your help.
27:18I'll tell OR to stand down.
27:20Nice save, Dr. Rupinovich.
27:22Dr. Collins.
27:24Pulse Ox, 99.
27:25BP, 102, over 68.
27:28She doesn't need the mask.
27:31Thank you for being my best friend in the whole world.
27:36We're family.
27:40How long does this thing need to stay in?
27:4312 to 24 hours.
27:45We'll take it out tomorrow.
27:46We're gonna admit you to the ICU for overnight monitoring.
27:49Thanks, Dr. Ravi.
27:50Mm-hmm.
27:51Thank you, Dr. Collins.
27:55Excuse me.
27:59BP is 98 over 70.
28:01Heart rate's 104.
28:10What happens next?
28:12Once she's stabilized, the GI specialist can do an endoscopy to try to cauterize the bleeders,
28:17or they might put in a shunt to take pressure off the bleeding veins.
28:20And she'll go to the top of her transplant list for a new liver.
28:24The top of the list?
28:25It's that?
28:25Serious?
28:26It is, yeah.
28:28But, um, once she gets her new liver, she should be able to return to normal life.
28:36Okay.
28:37I guess I always knew that this day would come, but somewhere in the back of my mind I hoped
28:43that maybe it wouldn't.
28:45It's a lot for someone your age to handle.
28:47Is there anybody we can call, or...?
28:49Oh, no.
28:50No, it's just us.
28:52It's been that way for a long time.
28:55I'm sorry. That's really hard.
28:57Yeah, it's good she has you.
28:59You know, I'm the same age that she was when she first got happy.
29:03I know it's hard to believe when you look at her, but she was a wild child.
29:07And an intravenous drug user.
29:11But she got clean the day that she found out she was pregnant with me, and she has been ever
29:16since.
29:17She sounds like a good mom.
29:19She's the best.
29:21Are you close with your mom?
29:23Um, sure. Yeah.
29:27Like, proximity-wise?
29:29It's just not the first word that comes to mind. It's complicated.
29:32Usually is, right?
29:34Yeah.
29:35I mean, my mom hasn't been perfect.
29:37I mean, sometimes I really hated her.
29:39But I always loved her.
29:43And I knew that she loved me.
29:47Yeah.
29:47It's a long road ahead.
29:49But it's a marathon, not a sprint.
29:52All you can do is take it day by day.
29:54We have a great social worker here, Chiara Faro, if you want to talk to her.
29:59Maybe a little bit later.
30:01I think I just want to be with my mom right now.
30:05Yeah.
30:06Of course.
30:08Yeah.
30:10I know.
30:11Dude, you gotta stop calling me.
30:13Okay.
30:14Yeah.
30:15Okay.
30:16I'll tell him.
30:18Whenever I see him next.
30:22Okay.
30:23All right.
30:25Oh, shit.
30:28Guess who that was?
30:29God.
30:31No, I told you. He never calls.
30:33Well, Langdon's desperate to get a hold of you.
30:35You don't say.
30:36God damn it.
30:39Hey, Jake!
30:41Hey, man. How's it going?
30:42Everybody okay with the passes and the tickets?
30:44Yeah, yeah. It's all good.
30:46I want to say hi.
30:47Hey, Jake.
30:48Long time to stay.
30:49How's the festival?
30:51It's really cool.
30:52I mean, there's tons of people and there's a lot of cool stuff going on.
30:55Good.
30:55Glad you're having a good time.
30:57That was great.
30:58Oh, she actually wanted to thank you personally.
31:01Hi, Dr. Rabinovich.
31:03Just Robbie.
31:04Robbie, I'm Leah, Jake's friend.
31:07Girlfriend.
31:07Stop. You said you weren't going to embarrass me.
31:10I know you were supposed to be here with Jake, so thank you so much for letting me use your
31:13tickets.
31:14We're having a blast.
31:15You're more than welcome.
31:17All right, well, we gotta get out of here, but thanks again for the tickets, man.
31:19Thank you. Nice meeting you.
31:22You too.
31:34Can I get you anything?
31:37No.
31:39I didn't even know that you were trying.
31:41I really didn't tell anyone.
31:46It's not like it's the first time, but I...
31:51It's probably the last.
31:53Why do you say that?
32:03Do you know how much IVF costs?
32:08I should have gone into reproductive endocrinology.
32:13All those fertility doctors are making a killing.
32:19Even if my insurance would pay for more rounds or I could pay out of pocket, I...
32:30Come on.
32:32I'm not sure I could go through this again.
32:38Maybe it's just not meant to be.
32:44I've never known you to give up on anything.
32:50Except maybe me.
32:52Yeah.
32:54Unbelievable.
32:56I had it coming.
32:58Hmm.
33:02Do you want me to go find Ciara anyone?
33:03No, no. Look, I know you mean well, but I just...
33:07I just want to be left alone.
33:09Go home.
33:10You sure?
33:12Absolutely.
33:14It's only an hour left in the shift.
33:16It's not like we're going to get ahead of it.
33:17We never do. Maybe we never can.
33:20So, yeah. Go home.
33:23Turn off your phone. Turn off the TV.
33:25Pour a glass of wine. Have a bath.
33:29Go to bed.
33:31And if you need anything...
33:44I got...
33:46I got pregnant a few years ago.
33:51I wasn't ready to be a mom then.
33:55I wasn't even sure about the relationship.
33:58I never...
34:00told him.
34:07I was afraid.
34:08I was afraid of all...
34:13All of it.
34:17But mostly...
34:19I was afraid he'd hate me for being selfish.
34:26Not selfish.
34:28Heather.
34:30Not selfish.
34:34Do you think he'd forgive me if he knew?
34:44Yes.
34:48And more importantly, I know...
34:51he would want you to forgive yourself.
35:10The mom had nine babies on her back.
35:13That's a big family.
35:15Opossums are marsupials, so they have a pouch like a kangaroo.
35:18You're smart.
35:20I read a lot when I was your age, too.
35:22Hey, Victoria, do you want to show Harrison how an ultrasound works?
35:26Sure, yeah. You want to see inside your guts?
35:28Always.
35:29Okay.
35:32Hi, Mom.
35:33See you in a sec.
35:39This definitely violates the restraining order.
35:42I tried to warn you.
35:44Chad was severely injured.
35:46I wish.
35:49Look.
35:51Whatever's going on between you and Chad,
35:53it's not really my business, okay?
35:55He's yours, believe me.
35:58But mind your place with my son.
36:01Harrison loves living with us.
36:04An 11-year-old needs stability.
36:07I've been Harrison's mother for 11 years.
36:10Okay, I made him.
36:13I've made a lot of mistakes in my life, but I am a damn good mom.
36:19Look, Cassie, it's really about what's best for Harrison.
36:23Chloe, Harrison wants to live with me.
36:26I don't believe that.
36:27That's because at your age, your prefrontal cortex hasn't really even fully formed.
36:30I'll be 25 next month.
36:32Congratulations, you can rent a car.
36:35If you really care what's best for Harrison, you will back the fuck off.
36:41But-
36:41And if I ever, so help me God, see you in that shirt again,
36:49let's just say you will wish you hadn't, okay?
36:52And he still hasn't admitted any opiate use?
36:55No, but again, he exhibited every symptom and now he's 100% better.
37:00And it feels like it was just a few hours ago I was asking you why didn't you consult me
37:03first
37:04and specifically telling you never to do that again, but instead you went beyond my back and-
37:08I did it again.
37:09You did it again for fuck's sake.
37:12Is anybody honest about anything anymore or are we all just bullshitting our way through life?
37:16I think it's just a case of-
37:17That was rhetorical. Why didn't you come and find me?
37:19You were a little busy.
37:21Really?
37:23Do better, Dr. Mohan.
37:26Yes, sir.
37:27Using buke was unconventional and while it wasn't dangerous, it could be subject for scrutiny,
37:31which I really don't need any more of right now from Gloria.
37:34I expect a level of this from medical students. I expect more from an R3.
37:43Just give him to Cindy, have her hold him and then you all gotta think about it.
37:47Because I'm your father, that's why.
37:48Oh, listen, the doctors are back. I gotta go. I'll talk to you later.
37:52Yes, I love you.
37:55How are you feeling, Mr. Pugliese?
37:56Oh, so much better, thank you.
37:58You guys think that I could have a little bit more of that medicine just for the few days that
38:02I'm out here?
38:03I just want to be able to walk my daughter down the aisle without shitting myself.
38:06The medication we gave you wasn't morphine.
38:09It was something called buprenorphine, or bup.
38:11Yeah, no, she said that. I mean, whatever you call it, doc, it worked great.
38:16It's a medicine specifically targeted to treat opioid withdrawal. That's why it worked.
38:22I don't understand.
38:26All indicators are that you have been using opioids. That would include pain medication like hydrocodone, oxycodone.
38:33I told them I don't do drugs.
38:38Well, you lied to me.
38:40I didn't lie. I said I was giving you a morphine-like drug that got rid of your cravings.
38:44Well, you know what? This is bullshit.
38:48I mean, you know, I could sue all of you. You hear me? I'm not some junkie on the street.
38:53Look, look. I got a family. I got a job. I make good money. I, you know, I return my
38:59shopping carts. I pay my taxes. That sound like a drug addict to you?
39:02Yes.
39:04Because anybody can be an addict. You are proof of that.
39:06These pills that you are taking, they're not helping you with your pain. They are keeping you stuck in it.
39:12A lot of really good people struggle with addiction. It is a brain disease, but social environment and personal choice
39:19are also factors.
39:20I don't have a problem.
39:20The good news is that the brain is highly dynamic, as is the environment, but you need to stop now
39:25before the damage is irreparable.
39:27No, screw this hospital, okay? And screw you.
39:30Hey, Dr. Mohan, Dr. Mohan will advise you on our proposed action plan. You can either choose to follow it
39:38or not. That is entirely up to you.
39:42I wish you luck, Mr. Puglisi.
39:49We're giving you a seven-day supply of a drug called Suboxone. We can set you up with a medic
39:54-
39:54Fuck off. I'm not interested.
39:59My father passed away when I was young.
40:03I don't know if I'll ever get married, but if I do, it'll be without him walking me down the
40:07aisle.
40:09I'm glad your daughter has you there on her wedding day.
40:12I hope she gets to have you there for all of her other big days to come, too.
40:21Dr. Mohan, I, uh, I don't always know the exact right thing to say, but I am sorry about your
40:30dad.
40:32It was a long time ago, but thank you.
40:36Dr. Robbie, I've been waiting in the lobby for almost an hour. You said you'd be right there.
40:41Teresa, oh, I am so sorry. Uh, we are a little understaffed, and truthfully, my head has been in a
40:46million different places. Can you forgive me?
40:48I am here now. Please, what's going on?
40:51The psychologist spoke to me about becoming a petitioner to place David on an involuntary psychiatric hold.
40:59Yes.
40:59But can that be anonymous?
41:02No. To call a 302 in the state of Pennsylvania, the petitioner needs to admit to having witnessed the concerning
41:08behavior,
41:08and you need a physician and a social worker to sign off, which both Kiara and I can do.
41:15What if I'm wrong?
41:17Then you apologize. And we will help you explain that this came from concern for his safety.
41:23What if you're right?
41:25What if I become a petitioner? What am I doing to my son?
41:31You are trying to get him the help that it sounds like he needs.
41:36David lost his father. That would affect anyone.
41:38But we are failing young men, because we don't teach them how to express their emotions.
41:42We just tell them to man up, and then we let them get their lessons in manhood from Toxic Podcast.
41:46And these young men then feel isolated from themselves and society, and they find community and comfort in all the
41:53wrong places.
41:55David needs help. We don't want to fail him, too.
42:00You have kids?
42:03I sort of have a stepson, yeah. I'm A's mom, and I dated for a while, but Jake and I
42:09have a great relationship.
42:11Jake's lucky.
42:12Oh, I think I'm the lucky one there.
42:16I'm going to check in with a psychologist and tell her I want to become a petitioner.
42:21Great. And then come find me, and I will sign off on that paperwork.
42:30Knock, knock.
42:32To what do I owe this pleasure?
42:35I found these. You must have dropped them.
42:38Got to be more careful. You don't want these any of the wrong hands.
42:41You can keep them.
42:45You ever think about quitting?
42:49I'm not a quitter.
42:51Oh, I know. You're a happy drunk today.
42:53But one day, when your liver fails, and believe me, it will fail, you won't be so happy.
42:59It's not a nice way to go.
43:02I'm digging my own grave.
43:05Not me.
43:07I don't have to give you the shovel.
43:20Um, have you seen Dr. Langdon?
43:23Uh, he left for the day.
43:27He didn't say goodbye.
43:30Um, I really wanted to tell him about this delivery.
43:32It was really cool.
43:34I mean, the dads were so happy.
43:37And, um...
43:38Great stuff.
43:39Dr. Robbie?
43:41Hi.
43:42I just wanted to apologize for what happened with Langdon.
43:45Apology accepted.
43:45I just, if I hadn't said anything, he would still...
43:47Nobody's fault but Langdon's. No, if you'll excuse me.
43:49Well, it doesn't feel that way.
43:52Some people might have turned a blind eye.
43:55But you didn't.
43:57Took a strong moral compass to do what you did.
44:00On your first date, nonetheless.
44:02I just wondered if...
44:03You did the right thing, Dr. Santos.
44:08Thanks, Dr. Benavich.
44:10Have you seen Dana?
44:12Yeah, she was headed to the ambulance bay.
44:16Keep your distance. I'm already in a bad mood.
44:18I'm just getting some air.
44:20Yeah, right.
44:21You're a terrible liar.
44:23Hope you're better at security.
44:25Hey, now you're just being mean.
44:28You realize that this is the second person to accuse you of that today.
44:32You starting to see a pattern?
44:33No.
44:34But I am starting to see why Gloria's unhappy with your patient satisfaction scores.
44:39You need something or you're just here to ruin one of the few things that still brings me a little
44:42joy in life.
44:43I say Colin's home.
44:46You don't want to work with anybody today.
44:48You must be in a mood.
44:50She's had a rough day.
44:54Just going around.
44:56You should leave too.
44:58Yeah.
44:59You're good.
45:01You're not that good.
45:05You know I was born at this hospital?
45:07I even volunteered here in high school.
45:11I punched, kicked, spit out, pissed on, had feces thrown at me.
45:16I talked to Gloria.
45:17I told her.
45:18Listen.
45:18We gotta do something to beef up security.
45:20This can't happen again.
45:21It will.
45:23It will.
45:24Maybe not to me, but to somebody.
45:27The world's changed.
45:28People are angrier.
45:29Tempest is shorter.
45:30And we're still just trying to help.
45:33You do help.
45:35You do make a difference.
45:37One asshole doesn't get to change that.
45:44I think I'm done.
45:50Yeah.
45:52I know that one.
45:56And I don't blame you.
46:00I, uh...
46:02I-I-I-I don't know.
46:04I don't know.
46:04Maybe what I want and what the patients need isn't what's best for you anymore.
46:07Yeah.
46:10I just honestly don't know what I'm gonna do without you.
46:15You'll figure it out.
46:17You always do.
46:20You're a good man, Rabinovich.
46:23Don't let this place take that from you.
46:28Okay?
46:30Come on.
46:33Yeah?
46:35Go triage.
46:39Multiple GSWs.
46:40There's an active shooter at Pit Fest.
46:46Jake and his girlfriend are there.
46:47Yeah, no.
46:51I don't see him in the same house.
46:53But not in the same house.
46:53Yeah, yeah, yeah.
46:55Oh, yeah.
46:59Yeah, yeah.
47:01Oh, yeah.
47:03Oh, yeah, yeah.
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