- 3 hours ago
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🔥 EP 9: The story builds toward a major turning point. 😱 Secrets begin to surface rapidly.
🔥 EP 9: The story builds toward a major turning point. 😱 Secrets begin to surface rapidly.
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TVTranscript
00:25Can you, um, can you just put him on the phone for a second?
00:30I just want to hear his voice.
00:33There's my guy.
00:36How you doing, buddy?
00:39I would love to hear your song.
01:00You should go home.
01:02Oh, that is the last place I want to be.
01:05Are you sure you shouldn't see your OB?
01:07I checked myself.
01:08Um, your dress is empty.
01:11Barely spotting now.
01:12I'm fine.
01:14Oh, honey.
01:15I'm so sorry.
01:17Oh, I shouldn't have bought that fucking stroller.
01:21Oh, fuck that fucking stroller.
01:30Losing a kid is hard on everybody.
01:33Okay.
01:46That's as hard as it gets.
01:47We do these debriefs to try to give a sense of, um, closure, meaning to difficult cases
01:54so that they won't linger.
01:56But trust me, the kids you'll lose will linger.
02:01So what do you do?
02:04I did my residency at Big Charity in New Orleans.
02:08And day one, I got a kid.
02:10Five-year-old boy, accidentally shot by his brother, playing with Dad's gun.
02:15Worried he was going to get in trouble.
02:17Right up until he coded and died.
02:23And then I asked myself, like, what do I do with this kid?
02:29Where do I put this feeling?
02:31And I found myself walking all night.
02:33I was walking and walking and walking.
02:34And I found myself back at the gates of Big Charity Cemetery.
02:36And I'm looking at all those mausoleums and those crypts.
02:39And I'm thinking to myself, okay, well, that's what I need.
02:41I just need a safe place where I can put these feelings.
02:43Yo, we got patients throwing punches in chairs.
02:46Uh, okay, everybody. Let's get back to it.
02:48Just remember the employee assistance program is available,
02:51as are Kiara and myself, if anybody needs to talk.
02:54Where's McKay?
02:55In Central 11 with our UTI accounting assistant
02:58while we keep her boss on ISA North 2.
03:00Robbie, critical case flying in.
03:02Possible MDMA overdose.
03:04High temp. On route from Pit Fest. Five minutes out.
03:06Stay here. Set up for that. Ahmad and I got chairs.
03:08Hey, Kate. Is everything all right with Collins?
03:10Something's bothering her. I asked her,
03:11but she said she didn't want to talk to me about it.
03:13Oh, imagine that. She probably learned it from you.
03:16Seriously?
03:17You just gave a speech titled
03:18How to Literally Bury Your Feelings.
03:20Now, Phil, excuse me.
03:21I got to break up a fight.
03:23What else is happening?
03:24Hell, you want to control your wife, man?
03:26Shut up, man.
03:26There's a real full of nothing people in here.
03:29Hey, hey, Olsen.
03:30Olsen, what the fuck are you long enough?
03:32Calm down.
03:32No, don't tell me to calm down.
03:34How hard is it to put a mask on your kid?
03:36He has allergies, you fucking Fauci zombies.
03:38What?
03:39Allergies.
03:40Oh!
03:40Hey!
03:43Hey!
03:44That's enough!
03:45Jesus almighty, I don't believe what I'm seeing.
03:47Where do you people think you are?
03:49Huh?
03:50This ain't Philly?
03:51This is a hospital, for Christ's sakes.
03:53What's the matter with you?
03:55You call yourselves adults?
03:57Huh?
03:58There are children in here.
04:00You should be ashamed of yourselves.
04:03Olsen, catching shrapnel.
04:06Craziest shit I've seen since I've been here, but I'm good.
04:09I'm good, seriously.
04:10Jack-offs.
04:10Ladies!
04:12Are we finished with the craziness?
04:14Well, this is fucking ridiculous.
04:16All I did was offer to put a mask on her child who's been coughing for over an hour,
04:20and now I'm miffing out my goddamn-
04:22First of all, masks are bullshit.
04:24And B, it's an allergy.
04:26He's allergic to cat dander like I fucking told you.
04:29My sister-
04:29Shut up!
04:30Shut up right now, please.
04:32And only answer the questions I ask.
04:34What happened to the tooth?
04:36Did you swallow it?
04:37Uh, I don't think so.
04:39I think it's still in my hand.
04:40It sure is.
04:41I hope you both have all your shots.
04:43What do you mean, like vaccines?
04:44Jesus, please don't stir this pot.
04:46Let's take these ladies back and get them treated.
04:48Separately.
04:49Stick with me.
04:50Come on.
04:50Ma'am, it's time to go.
04:51Guess that makes us a team.
04:54I guess it does.
04:55Uh, ma'am?
04:56Uh, come with Mateo and I?
04:58Mateo and me?
04:59Um, yes.
05:00With this tooth.
05:01Okay, Earl.
05:02Let's take a look at ya.
05:03Whoa.
05:04She really tagged ya.
05:05Red's got a left hook like Billy Conn.
05:07Well, let's get you cleaned up.
05:09Come on, baby.
05:12Excuse me, sir.
05:13You're not allowed back there.
05:15Unless what?
05:16I start a fight?
05:17Become homeless?
05:18Apparently that's what it takes.
05:19I understand your frustration.
05:21I promise you'll be seen as soon as a provider is available.
05:23But how can they become available if new people keep cutting the fucking line?
05:27There's no line.
05:28We see patients by severity of need.
05:30As soon as we have your tests and labs, you will be seen.
05:33This place is fucking unbelievable.
05:35Run around after run around.
05:38Hey, what's up, Eric Estrada?
05:40Still keeping your eye on me?
05:41Always, my friend.
05:43Always.
05:45Who's Eric Estrada?
05:46Shame on you, Chips.
05:48Know your television history.
05:49And thank you.
05:50Yup.
05:53Crazy people.
05:55If you do get my tooth out, I don't want it.
05:57I've just been inside.
05:57That woman!
05:58Reattachment wouldn't be possible.
06:00Type 2 fracture into the dentin.
06:02Seal with dental cement.
06:04Prescription for pen VK.
06:05Soft diet.
06:05Follow up with the dentist.
06:06One to three days for the crown.
06:07You handle sphinx while I check on Ali?
06:11You got this.
06:12Don't we, partner?
06:14Yes.
06:15I totally got this.
06:20How we doing in here?
06:21You should write that bitch a script for calcium,
06:23because I didn't even hit her that hard.
06:25Too much almond milk in your soy lattes!
06:29That doesn't even make sense!
06:30You know, most commercial almond and soy milks
06:33are fortified with calcium,
06:34so they end up having a higher percentage of calcium
06:36than cow's milk.
06:37Uh, prepped with betadine and drapes.
06:40Very nice.
06:41Let's have a closer look.
06:42Dr. King, can you please grab me a 10cc syringe,
06:46a 20-gauge needle, and some sterile saline for me?
06:48Pluck it out, stitch me up, and send me home.
06:50I've got to get back out there to my kid,
06:51who is still waiting to be seen, by the way.
06:53I'm afraid it's a little more complicated than that.
06:55You got yourself a fight bite,
06:57which means a couple things.
06:58First, we need to determine if the bite extended
07:00into the joint space.
07:01If it did, you're gonna need IV antibiotics
07:03on a trip to the OR to see a hand surgeon.
07:06Pinprick and a little burning.
07:07An operation?
07:08Well, you were just shouting a minute ago about infection.
07:11And with good reason.
07:12While I am sure you are in the clear for rabies and HIV,
07:16human mouths are filthy.
07:18Some more than others.
07:19How can you tell if it's bad?
07:21Great question, Dr. King.
07:24I'm sorry?
07:25I am going to inject some sterile saline
07:28into your knuckle joint,
07:29which you won't feel because of the anesthetic.
07:31If it comes spraying back out of the bite wound,
07:33we'll know.
07:33Ready?
07:34I guess.
07:37There she blows.
07:39Oh, shit.
07:40Are you serious?
07:42You hear that, you fucking bitch?
07:44I've got to have surgery thanks to you.
07:46Good.
07:47You a thought than me.
07:49Damn right.
07:50And I'll bet next time you'll keep your masks
07:52and opinions to yourself.
07:54You okay?
07:55Yes.
07:57Three grams unison IV.
07:59Call the OR, tell them we have a fight bite
08:01that needs to be washed out,
08:02then go take 20 minutes in the lounge.
08:04I'll come find you if I need you.
08:05Well, I don't need a break.
08:06Yes, you do.
08:09Okay.
08:10Oh, uh, did you want me to tell the surgeons
08:14to go no mask for surgery?
08:16What?
08:16Well, those of us who save lives for living
08:19believe strongly that masks minimize risk
08:21when it comes to spreading disease and infection,
08:23but I...
08:24I want to respect your beliefs, so...
08:26What do you think?
08:27With or without for surgery?
08:28Without?
08:29Um...
08:31I want with.
08:33Good call.
08:36Helicopters here, cafeteria, send the ice?
08:37Yeah, everything they got.
08:38Hey, I hear they're gonna start you working
08:40on the Middle East peace plan.
08:42Not since it's the Dalai Lama or Gandhi.
08:44Baby, fucking ain't right, too.
08:45You should've seen me.
08:46It was inspiring.
08:47Also terrifying, a little bit shamey.
08:49Holy trinity of crowd control.
08:51Hey, can we pick it up in here, please?
08:52Overdose is here.
08:56Pitfest OD.
09:03We gotta cool this lady down.
09:05Get some ice packs.
09:06Head, neck, groin, scent off a rainbow.
09:07On it.
09:09Heart rate, 132.
09:10BP, 210 over 120.
09:11Jesus, that's high.
09:12More of Ativan in the field.
09:14It was a dilated, definitely MDMA overdose.
09:16Dr. Mohan, how do you want to treat the BP?
09:18Uh, beta blockers?
09:18No.
09:19Unopposed to Alpha can kill her.
09:20Four more of Ativan, please.
09:21Seriously?
09:22She might need another 40.
09:24Hypertension and tachycardia from MDMA
09:26is centrally mediated.
09:27Ativan is the drug of choice.
09:29Damn.
09:29Court time, 107.3.
09:31Okay, can we get another hose in here
09:32before she fries her brain, please?
09:34Let's go.
09:34Come on.
09:39I'll be right back.
09:41Hi.
09:42You look lost.
09:43No, it's my assistant who actually seems to have been misplaced.
09:46I mean, how long does a CT take?
09:48Certainly not this long.
09:49You can get pretty backed up.
09:51Can I get you a cup of bag of coffee, dry sandwich?
09:53No, thank you.
09:54How about a cola koi for my secret session?
09:55I'm allowed to go for it myself.
09:56I'm freaking addicted.
09:57I'm good on drinks.
09:58Can you take me to radiology?
10:00Yeah, right this way.
10:07Piper, while we still have a few minutes,
10:09there's some things I want to say.
10:10Yeah, it needs protection, I know.
10:12I'm sorry.
10:13Totally.
10:14It's a mistake.
10:15Totally.
10:16Um, I'm a part of the street team here.
10:19It's a group of doctors and nurses
10:21who go out in the community and help.
10:23People who can't or won't ask for help.
10:28Addicts, unhoused, runaways.
10:30And I'll be honest with you, Piper,
10:32I think you need some help.
10:35What are you talking about?
10:37If you're in trouble, we can help you.
10:40I'm not.
10:41Okay?
10:43And if we're done here, I think I'd like to go.
10:47Will you at least take a look at this?
10:51There's a list of resources on the back.
10:53I don't need that.
10:55I know you don't have a phone.
10:57But if you could just take my number, okay?
11:02You never know.
11:04You're at risk, Laura.
11:06How about taking the pen?
11:07If you ever feel unsafe or in danger, call this number.
11:11It's a national hotline.
11:13There's somebody on the other end 24-7.
11:15A trained professional looking out with anything.
11:17I have all the help I need.
11:18I want to go.
11:20Now.
11:21Okay, on my count.
11:21One, two, three.
11:23Gentle, gentle, gentle.
11:24You, Sim, we have slashed down.
11:27Good luck.
11:27See you on the next one.
11:28Yep.
11:28Temps down to 107.1.
11:30How long does she need to stay in the ice, Dr. Santos?
11:32Why should be in the ice?
11:33It's 13 minutes.
11:33Dr. Santos.
11:34Until her temp is normal.
11:35Wrong.
11:36You pull her out at 102.
11:37Otherwise, we could overshoot and cause hypothermia.
11:39Heart rate 120.
11:40Pressure 198 over 116.
11:42More Ativan?
11:43Another four, please.
11:44Why is she on the ice, Dr. Santos?
11:45To bring her temp down.
11:47Wow.
11:47State the obvious yet still won't answer the question.
11:49The quicker we bring it down, the less of a chance for permanent damage to the brain
11:52and the rear kidneys.
11:53Exactly.
11:53Was she sweating?
11:54Profusely.
11:55What if she wasn't, Dr. Santos?
11:56What if she was dry as a bone?
11:58Then we'd have to think anticholinergic overdose, not sympathetic.
12:04Very good.
12:12Hey.
12:14I found you scrubs that should fit.
12:17Oh.
12:19That's great.
12:20I appreciate that.
12:21But they come with a catch.
12:23Mr. Krakosha's asking to see you.
12:25The guy who peed on me?
12:27Why me?
12:28I didn't ask, but maybe you should wait to put these scrubs on until after you...
12:34That's a good idea.
12:35Oh, God.
12:38Oh, man.
12:39We got a load of the...
12:40Oh, my God.
12:45Yeah, I see you.
12:52Take some number, buddy.
12:55That's another for a Madivan.
12:57Rectal temps down to 105.
12:58Okay, moving in the right direction.
12:59We might get lucky here.
13:01Double trauma at the back door.
13:02Auto versus Pedestrian before getting a telephone pole.
13:04You got this?
13:05Yup.
13:06Dr. Robbie, I finished with Dr. Ozeki, a therapist upstairs.
13:09Yes, yes, yes.
13:10How'd that go?
13:11Well.
13:12Excellent.
13:16Have you heard from David?
13:17No.
13:18That's David's thing as a therapist.
13:26Do you think that he's still gonna pick you up today?
13:28I think so.
13:29Okay, well...
13:29Robbie.
13:30Here they come.
13:31Okay, well, you're medically cleared, so why don't you stay here for a little while longer
13:34in the hopes that he does?
13:36I still would like him to talk to somebody.
13:38Perla, this is Teresa.
13:39She's a friend of mine, so I expect concierge service, yes?
13:42VIP treatment.
13:43You're in good hands.
13:44Just let me know if David shows up or if he calls.
13:46Good boy.
13:47Good boy.
13:48Walter Purnell, 52, walking his dog in the crosswalk, got struck by a Chevy Impala at
13:53low velocity.
13:54Ambulatory on scene, no KO, no neck, chest or belly pain.
13:57Good vitals.
13:58Whoa, major road rash.
13:59Yeah, the car didn't hit me so much as throw me, but I slid for a good 10 feet.
14:04Of course, this is the first day I've worn shorts I'll left in here.
14:07No deformity at the knee or ankle.
14:09Distal pulses intact.
14:11Four of morphine so far.
14:12Yeah, feel free to be more generous.
14:13Don't worry, we will patch you up.
14:15We will get you right.
14:15Who's your friend?
14:16Oh, this is Crosby, who thankfully barked and warned me so I had half a second to try
14:20to move out of the way.
14:21Crosby, you're a hero.
14:23Donnie, you think you can find a milk bone for our little lifesaver here in the doctor's
14:26lounge?
14:26Absolutely.
14:27I'll take good care of you.
14:28Can he stay with me?
14:29He's a very good boy.
14:30No doubt.
14:30Let's get you settled first.
14:31You're going to South 20.
14:32Got it.
14:33Is that the driver?
14:3328-year-old lady, had her seatbelt on, clipped the guy with the dog and went straight
14:37into a telephone pole.
14:38Bloods from a scalped lap.
14:40Also complained of chest pain.
14:41Sleepy butt arousable.
14:42What's your name?
14:43Paula.
14:44Heart rate's a bit tacky.
14:45112.
14:46BP's fine.
14:46Paula, are you in any pain right now?
14:48Yeah, I can't go hurt.
14:50What was to say?
14:51She was driving erratically before the crash.
14:53No ETOH on her breath.
14:54Maybe drugs?
14:55Core tab's 100, 4.2.
14:57Heart rate, 116.
14:58BP, 180 over 110.
15:00Better, but still too high.
15:01Another four at Ativan.
15:03That'll make 20.
15:04Good counting.
15:05Pedestrian itself, 20 needs a doctor.
15:06You got this?
15:08Yep, keep chilling.
15:09All hands on deck.
15:10You ready?
15:10Ready.
15:11Okay, here we go.
15:12One, two, three.
15:17I heard motor vehicle collision with chest pain and altered mental status.
15:20Meet Paula.
15:22Restrained driver versus telephone pole.
15:24Altered before the crash.
15:25Good BP, but tacky.
15:26Second line and run a liter of LR wide open.
15:28Still tacky at 115.
15:30BP's 180 over 72.
15:31Airways patent.
15:32Good breath sounds bilaterally.
15:34Peoples are equal and reactive.
15:36Paula, do you know what today's date is?
15:40Sats, 94%.
15:40How about the city we're in?
15:42It's, well...
15:43Bruising on the chest.
15:45Possible sternal fracture.
15:47Pericardium's clear.
15:48Good, good.
15:49No marked tenderness.
15:50Nothing in Morrison's pouch.
15:53She's a little tachypneic.
15:54I don't think she needs intubation.
15:56Might just be concussed.
15:57Don't worry about her crumping in the scanner.
15:58She's protecting her airway.
16:00I see lungs sliding.
16:01No pneumo.
16:01With a head injury?
16:02You guys are supposed to be the airway experts.
16:04Stop fighting.
16:04Make a decision.
16:06Call me when she goes to CT.
16:07Paula, can you raise your right arm for me?
16:10Good sign.
16:11Follows commands.
16:12You want to intubate with a GC as of 13?
16:14Okay.
16:15We can hold off and monitor.
16:16What's your plan?
16:17Pan scan, head to pelvis, EKG, troponin, straight cath urine for UA and tox screen.
16:22Agreed.
16:22I'm on it.
16:24Gotta bend those knees.
16:26I quit showing off.
16:27Is that what you were doing?
16:28Always.
16:31It's a ten day course of doxycycline.
16:33One pill twice a day.
16:35I'll make sure she takes it on a full stomach.
16:38I can give you your first dose now, Piper.
16:40If you like.
16:41Get you started.
16:42That'd be great.
16:43Actually, I need Piper to answer that one.
16:46Sure.
16:46That'd be great.
16:48Okay.
16:50Hello, everyone.
16:52Looks like we're finishing up here.
16:54I come bearing gifts.
16:55Everything you always wanted to know about STIs but never wanted to read.
16:58No gross pictures, I promise.
17:00I think we're good.
17:01You sure?
17:02Mm-hmm.
17:03Yeah, I learned my lesson.
17:05It won't happen again.
17:09I guess that's it, then.
17:13Well, if you change your mind, it comes with a free pen.
17:17Thank you both so much for your help.
17:19Yeah.
17:20Thanks.
17:23Okay.
17:25Good luck to you both.
17:31Fuck.
17:34Fuck.
17:35That sums it up.
17:38She'll be back.
17:39Only she'll have slipped a little further.
17:41Sometimes it takes a few visits.
17:44How can I keep her here?
17:45You got anything?
17:46Maybe Kiara has a social services card to play.
17:49She was by trauma one last I saw her.
17:51Brilliant.
17:52Brilliant.
17:53That's why I'm here.
17:54To be brilliant.
17:56And bring peace.
17:58Heart rate's 84.
18:00BP 126 over 78.
18:02Pulse Ox 99 on room air.
18:04Good news, Mr. Purnell.
18:05Your heart, lungs, and belly all look good.
18:07Yeah.
18:08Just the leg.
18:10Ooh.
18:10This might be a road rash record.
18:12We might have to bust out the tape.
18:13I'm getting a little worried about Crosby.
18:15Who's Crosby?
18:16His dog.
18:16My dog.
18:17Where's Crosby?
18:18He's in the break room.
18:19In the break room, I think.
18:21I'm sure he's fine.
18:22We got a lot of dog lovers around here.
18:24I'm the new owner of a nine week old golden doodle.
18:26Oh, nice.
18:28Crosby's a terrier.
18:30Great dogs.
18:31Determined, courageous, love to dig.
18:33Who's he named for?
18:34Sidney or David?
18:35David.
18:36Still my Sunday morning soundtrack.
18:38Ow.
18:38Ow.
18:38Sorry.
18:39Yeah, anyways.
18:40Great name.
18:41So the knee looks stable.
18:43There's no laxity to suggest a torn ligament.
18:45I think the pain's probably just from the road rash,
18:47but let's get an x-ray just to be sure.
18:49Some more morphine?
18:50You're a wonderfully human being.
18:51Let's start with lead.
18:52No more than 30 cc's.
18:53We're gonna try a topical anesthetic to numb the raw skin
18:57before we start picking out all the gravel.
18:59Well, my morning horoscope didn't mention any of this.
19:02Well, hey, look on the bright side.
19:04Now you can tell people that you got hit by a car.
19:06Not a lot of people can live to say that.
19:07Yeah, I hope whoever hit me is rich and well insured.
19:14Flag on the play.
19:16Positive pregnancy test.
19:18Still want a scan?
19:19Maybe she's bleeding from an ectopic.
19:21No, she delivered a healthy baby here ten days ago.
19:25Normal vaginal delivery, no complications.
19:28Pregnancy test stayed positive for a few weeks.
19:30So we good to go?
19:31Good to go. We'll let the tech know.
19:38Oh, man.
19:40She was seen here this morning by Dr. McKay.
19:42For what?
19:43Urinary tract infection.
19:45Discharged with oral antibiotics.
19:48Think it has something to do with the crash?
19:49Yes, no, maybe.
19:51Ask me again after I've had the scans, labs, and tox screen.
19:57Okay.
20:00Um, so...
20:01I need to talk to you about something.
20:03About what?
20:04Do me a favor.
20:05Look at me and don't turn around and just walk straight.
20:09I told you not to turn around!
20:15I wish there was a way to keep it, but there just isn't.
20:18Well, then fuck it. We'll just say that we need another urine sample.
20:21That the lab left the last one out too long and couldn't culture it.
20:25Okay, then what?
20:25I'll give Piper the sample cup and send her down the hall to the bathroom.
20:29I'll stay with Laura in the room with some bullshit.
20:31You wait for Piper by the bathroom.
20:33To say what exactly?
20:34I don't know.
20:36It'd just be another voice saying, I see you're in danger?
20:39There are limits to what we can legally do, but I can try to talk to her.
20:46Hi, it's Dr. McKay again. Can I come in?
20:51Oh, sorry.
20:54Yeah.
20:56Well, it was a long shot anyway.
21:00Hi.
21:01I think Piper took a pen.
21:04Yeah.
21:11Temp is 103.2.
21:13Nice. Almost there.
21:15Oh my God. There are literally hundreds of different MDMA pills.
21:19And the milligram dosage range is all over the place.
21:22These names. BMW 5, Jurassic Park, Red Superman.
21:27Well, why is she seizing?
21:29Uh, febrile seizure?
21:30No, her temp is down.
21:31Maybe she needs more Ativan.
21:32No, she's had 20 already and her vitals are stabilizing.
21:35Another four of Ativan and Pipergram pepper.
21:37I don't think this is a CNS problem.
21:40She needs saline.
21:42We don't have her last act yet.
21:43At festivals, you dance for hours, you sweat, you drink gallons of water, but nobody thinks
21:48to replenish their salts.
21:49It's low sodium, hypernatremia.
21:51She needs 100 cc's of hot saline.
21:52We don't know her sodium levels.
21:54Drop 100 cc's of 3% and have it ready.
21:57Okay?
21:58Do it.
21:58And prep a gram of Keppra.
22:00Now.
22:14Start the Keppra, please.
22:15It's not gonna help.
22:17Common one.
22:18What are you doing?
22:20Got it. Thanks.
22:22It's hypernatremia.
22:23Serum sodium is critical.
22:24Only 112.
22:25Knew it.
22:26Okay, I'll push the other 50 cc's.
22:28What the hell?
22:30She's seizing.
22:31You think?
22:31How long?
22:32About three minutes.
22:33Why did you not come get me?
22:35Hello?
22:35I was across the hall.
22:36I was 30 feet away.
22:37What did she have already?
22:41It's hypernatremia.
22:42We pushed 100 cc's of 3% saline.
22:44That did the trick.
22:44Again, why did you not come get me?
22:47It was my fault.
22:48Yeah, I wanted to keep going with Ativan and Keppra,
22:52but Dr. Mohan had an excellent idea to treat for hypernatremia
22:56even before her labs came back.
22:58Time's down to 102.4.
23:00Good call, Dr. Mohan.
23:02Another minute and we'll de-ice her.
23:04I am going to take that minute to try to instill in Dr. Santos
23:08a very clear understanding of what her role is here
23:11and how she's expected to function.
23:13Dr. Langdon.
23:14Dr. Santos.
23:15When I say doctor in such a fashion,
23:18to draw attention to the ridiculous fact
23:20that you have enjoyed that title for, what, 90 days?
23:24So, yeah, I'm confused.
23:26Is it, is it hubris or ignorance that makes you think
23:29that you know more than other residents
23:31that have two to three years more experience
23:34and have helped thousands more patients
23:36in the emergency department than you have?
23:38Not to mention the over 500 hours of advanced training
23:42with lectures in simulation labs with senior faculty instruction.
23:46It doesn't matter!
23:47Stupid or arrogant, you need to realize that you are a beginner,
23:50which means your job is to shut up, listen, and learn,
23:53because so far today the only thing you have been successful at
23:56is proving repeatedly that you know nothing.
23:58Dr. Langdon?
24:01Is the patient stable?
24:05Temps one and two, just about to take her out of the ice.
24:07Proceed.
24:07Dr. Langdon, a word, please.
24:16Look, I know that sounded rough, but you only caught the tail.
24:19I can give you a list of my hands.
24:21She was giving you unsupervised —
24:22Knock it off!
24:23Shut the fuck up!
24:25Where does it say that shaming, belittling, and insulting
24:28are effective teaching tools?
24:30Let me just tell you.
24:31Harassment has zero educational value.
24:33You feeling upset?
24:34She's getting under your skin?
24:35Check yourself, take a break.
24:36I've been watching you ride her.
24:38This kind of behavior will not be tolerated.
24:41I don't want to see it.
24:43I'm, I'm sorry.
24:44It won't happen again.
24:45Where's your other one? Where's Mel?
24:47She's taking a break.
24:48Yeah, well, maybe go find her and see if we can get her back in the game.
24:51You are senior leadership here.
24:54Step up and act like it.
25:07Wow, you came prepared.
25:09Uh, better safe than sorry.
25:12Sorry I took off like that.
25:14I have a thing about rats and cows.
25:16Totally freaked me out.
25:17Really?
25:19Oh, there's plenty of both where I come from.
25:22You know, they're pretty harmless.
25:24Let's hope Mr. Kokosia is now, too.
25:26Yeah, no kidding.
25:28Okay.
25:37Is this the guy?
25:38Yes.
25:40Hey, man.
25:41It's Dennis Whitaker.
25:43I just wanted to say sorry for earlier.
25:46Heard I got you pretty good.
25:48Yeah.
25:50I kind of go out of my head when I'm off my meds.
25:53Then I guess I piss on people.
25:56I'm pretty sure the meth doesn't help.
25:59I'm not using it anymore.
26:01I take Gansai psychotics for the schizophrenia I got from doing meth, but I've been clean a year.
26:08Well, why aren't you taking your meds?
26:11Why don't I take my meds?
26:13Well, Doc, I'm kind of in between houses right now, living in an encampment on Liberty Avenue.
26:19Meds cost money.
26:20I don't have insurance.
26:22Should I go on?
26:24No, no, that's fine.
26:26I'm sorry.
26:32Life isn't always easy.
26:37Have you talked to a social worker yet?
26:39No.
26:40Okay.
26:40Do you think you could go grab...
26:42Chiara?
26:43Chiara in here.
26:47I really am sorry.
26:49It's okay.
26:50Honestly, really, it's okay.
26:53I appreciate the apology.
27:02This must be Crosby.
27:05I've read a lot about you, buddy.
27:08That was my least problematic trainee.
27:11Well, technically, you're all pretty green, but you're growing on me.
27:17So, how are you doing?
27:20Um, good.
27:22Better.
27:23Yeah?
27:25It's, I mean, it's just, it's the, um, the little girl and the sister's just too close to home.
27:34The things we do are hard.
27:36Yeah.
27:38You're, uh, sitting here feeling like, like maybe you're not up to it.
27:46Yeah.
27:48Been there.
27:50We all been there.
27:53Mel.
27:53Mel, you're a sensitive person.
27:57This, this is a, uh, a tough place for sensitive people.
28:02But we need them.
28:04Badly.
28:08Now, if you're ready, I need you.
28:12It's a perfect job.
28:14It's practically a zen exercise.
28:16I've got a thousand pieces of gravel that need to be plucked out of a two-foot-long road rash.
28:23A thousand?
28:24Yeah.
28:25Give or take a hundred.
28:27Sell 20.
28:29Make sure you close the door behind you.
28:32Don't want Crosby getting out.
28:33Yeah.
28:33No, thank you.
28:34No problem.
28:35I'll, I'll be right there.
28:38That's a lot of gravel.
28:40It looks clean to me.
28:42You feel that, Earl?
28:43Feel what?
28:44That's a no.
28:45All right, now I just apply the Dermabond.
28:47Cool.
28:48Um, can I ask you something?
28:52That's why I'm here.
28:54Um, yeah, I was just wondering what the nurses do after their shifts.
28:58In terms of what?
28:59Um, do they ever, like, go out together?
29:02Like, hang out to decompress after a shift or anything?
29:05Yeah, sometimes.
29:07I mean, most of us are just happy to get the hell out of here.
29:11Personally, I'm all about a long, long hot shower, puffy sweats, eating some takeout in front of the TV,
29:18ideally watching something that makes me laugh.
29:22Yeah, I can see that.
29:24I'm not imagining it in my mind, of course.
29:25I just mean that I can, I can see the UPL.
29:28Um, I was just asking because, you know, since we worked together, maybe we could grab a coffee together sometime
29:36and could, like, help me get the lay of the land, so to speak.
29:42You asking him out?
29:43No.
29:44What?
29:44No, no.
29:45No, it's just that I'm, I'm, I'm, I'm new here, so I just thought, thought.
29:48I don't date people in the workplace.
29:51It's nothing personal.
29:52Just, it's never a good idea.
29:55No, no, of course not.
29:56No.
29:56No, I just, no, it's not a good idea.
29:58No, of course, I just thought that since you, you know how everything operates here and you, like, have everything
30:02so dialed in that you would be, like, a valuable resource.
30:04But, um, no, no, it's really fair to think.
30:08Get out on my own.
30:11No shortcuts here.
30:14How'd I train you, Earl?
30:17Huh?
30:18So you're wearing it yourself and had a sandwich?
30:19Feel like I'm washing around, come on.
30:23Just came by to see if I could take Dr. Javadi on a reconnaissance through chairs?
30:26Yes.
30:27I mean, sorry, if you, if you think that's...
30:29No, of course.
30:30Of course, I can finish up my man here.
30:32Great.
30:38You okay?
30:41I feel ridiculous.
30:44I've spoken, like, two complete sentences in the last half hour and both of them have made me sound even
30:50more imbecilate than the incomplete ones.
30:53You attribute that, too.
30:56It's like my parents once took me skiing for Christmas in Utah and from the moment I got off the
31:00plane I just, I could not catch my breath.
31:03No matter how hard I tried to see altitude, it made me feel just, like, awkward and uncoordinated.
31:08I couldn't concentrate.
31:09I couldn't get my bearings.
31:10And I'm a very good skier, but I spent the whole vacation just, like, on my butt.
31:14Dizzy.
31:15And panting.
31:18And Mateo's like a human Utah.
31:20Ha!
31:23Oh, I've worked with a few Utahs.
31:25I wish you many, many Utahs in your life.
31:30Jesse, where are you going?
31:32Trauma 2.
31:32Stop, stop, stop, stop.
31:33Not back in there.
31:35I'm not even going to tell you why.
31:37How's she doing?
31:38Still with some pleuritic pain.
31:40Oh, hey, Paula.
31:41I'm Dr. Collins.
31:42Your CT shows that you have a broken sternum.
31:44That's your breastbone right here.
31:46Probably from the shoulder belt when you crashed your car.
31:49Crashed your car?
31:50Mm-hmm.
31:50And hit your head.
31:51With a concussion, sometimes you don't remember, but your head CT doesn't show anything serious.
31:57So, I saw in your chart you're a new mom.
32:00How's your baby doing?
32:02Oh, he's good.
32:03He's with my mom.
32:05South 15's open.
32:07Oh, hey, Dr. McKay?
32:08Just get the bed out of 15.
32:09A patient you saw this morning came back as an MVC.
32:12Stornal fracture, slightly concussed.
32:13Oh, no.
32:14Paula, do you remember me?
32:15You look familiar.
32:16I was your doctor this morning for your bladder infection.
32:19Sorry.
32:20I'm a little out of it.
32:21Still tachycardic 115.
32:23VPs 124 over 78.
32:25No bleeding anywhere on the CT.
32:27Chest and abdomen clear apart from the sternal fracture.
32:30He'll probably still attack you from the fracture pain.
32:33Crosby grease.
32:33Let's try four of morphine.
32:35Paula?
32:35I'll get it.
32:36We're going to give you some pain meds.
32:37Let me know if it helps.
32:38Okay?
32:40Mr. Pernell, you are in luck.
32:42If I had to have gravel meticulously picked out of my leg, this is the person I'd call.
32:46Dr. Mel King, detail specialist.
32:48Hello.
32:49I love your dog.
32:50Crosby?
32:51How is he?
32:52Oh, he's great.
32:52Here.
32:53Something helps you up close.
32:54Hey, I don't want to be one of those people who say they need an emotional support animal,
32:59but is it possible he could be with me?
33:01We could tie his leash to the bed.
33:03He wouldn't be in any trouble, I swear.
33:04What do you think?
33:05I'm happy to go get him.
33:07Any pain here?
33:08No.
33:09Okay.
33:09You go get the dog.
33:11You get to work.
33:12I am going to get some more gauze from triage.
33:14And just in case, if anybody asks, just say you need him for anxiety.
33:18Okay.
33:19Thanks.
33:21I know you hear me.
33:23You can pretend you don't, but I know you do.
33:27This glass might be bulletproof, but it ain't soundproof, huh?
33:31Hello?
33:32Can you hear me now, huh?
33:34Hello?
33:35Whoa, whoa, whoa, sir.
33:36Sir, what is the issue?
33:37Oh, same issue.
33:38I've been here all day, and you people have done nothing to fucking help me.
33:42We're still waiting on your second troponin.
33:43We can't clear you medically until it comes back.
33:45For instance, if it comes back elevated, that could indicate a silent heart attack, and
33:49you'd need to be admitted for monitoring in a cardiology consult.
33:52That's all I'm asking for.
33:54I'm afraid I've had a silent heart attack.
33:56I just want someone who knows something about hearts to tell me what's happening to me.
34:00You know, unlike most of these losers, I have insurance, good insurance, and I pay my taxes,
34:05which pays for them to not have any insurance.
34:08Sir, you've got about five seconds to change your whole attitude before security and the
34:11police get involved.
34:13Fuck it.
34:14I'm leaving.
34:17Hey!
34:18Hey!
34:19You are absolutely free to go, but if you do, you will be leaving AMA against medical advice.
34:25This form states that I have advised you to stay and complete your evaluation, but you
34:29are choosing to leave, understanding, and accepting all risks of heart attack, stroke, disability,
34:34and death.
34:40Sounds like a CYA form in case I drop dead on the curb.
34:43That's exactly what it is.
34:46I just want to be treated fairly.
34:49I assure you, that is our intention.
34:52We are not back here playing go fish.
34:54We're doing our best to help some very sick people.
34:56You will be seen, okay?
35:04Robby's going to love that patient satisfaction score.
35:07Crazy people.
35:13What's going on?
35:14Car crash picked up Paula, just went south.
35:16BP's crashing, 84 over 62, much less responsive.
35:19Leader of LR wide open?
35:20Putting her on a 100% now, we're married.
35:22Paula, open your eyes.
35:23Paula.
35:24This is the morphine?
35:25She only got a small dose.
35:26Both socks is down to 89.
35:28Set up for intubation, and McKay, get Robby in here.
35:33I'll call ICU and get her bumped ahead of Joyce or Sickler.
35:36She should get the next bed.
35:38Between the hypothermia and the seizure, she's going to be out of it for a while.
35:41A similar thing happened to a friend of mine.
35:43Is that what made you think of hyponatremia?
35:45Look, I know you value evidence-based medicine, but sometimes experience counts for something.
35:54May I ask why you did that?
35:56What?
35:57Took the blame for a delay in care, which didn't belong to you, and gave me credit for a safe
36:03that did belong to you.
36:05You know, I've been on Langdon's shit list all day.
36:08Seemed like he was going to be more upset about us not calling him in than glad that we stopped
36:12the seizure, so...
36:13No reason for him to be pissed at both of us.
36:16Why have you been on his shit list?
36:18Well, I think he made it very clear that he thinks I don't have what it takes to make it
36:23here.
36:24Whether you do or do not, it was completely inappropriate for him to speak to you that way.
36:28Nah.
36:29I've heard worse.
36:30Well, for what it's worth, he's wrong.
36:33You're very good at this.
36:38It's actually worth a lot.
36:41I thought the CTs were normal.
36:43They were.
36:44Systolic's down to 70.
36:44Heart rate's up to 130.
36:46100 of ketamine, 100 of rock.
36:47Does she have delayed bleeding?
36:48It's not the chest.
36:49Pericardium's still clear.
36:50No tamponade.
36:51Good EF.
36:51Lungs are up.
36:53She feels warm.
36:54Well, check her tent.
36:55Meds are on board.
36:56Belly's clear.
36:57No bleeding here.
36:58She's loose.
36:59Okay, go for it.
37:03I see cords.
37:04Looks good.
37:06I'm in.
37:07Connect the bag.
37:08Nice.
37:10Good breath.
37:10Sounds bilaterally.
37:12Temp is 102.4.
37:13What?
37:13Is this septic shock?
37:14Okay, we need to assume the worst here.
37:16Code sepsis.
37:17Two sets of blood cultures.
37:18Lactate.
37:1830 per kilo of LRN4.
37:21Antibiotics.
37:21Ceftriaxone.
37:22No, no.
37:22She was just in the hospital.
37:23Peptazo and Vaco.
37:24Got it.
37:24If this is sepsis, where is it coming from?
37:27What's the source?
37:27Friginary tract infection.
37:29She doesn't have one.
37:29She did when I saw her.
37:30It's not a UTI.
37:31We catheterized a year and a half an hour ago.
37:32There's no nitrates.
37:33Zero WBCs.
37:35Your specimen could have been contaminated this morning.
37:37Pneumonia?
37:38Chest CT, negative.
37:40Abdominal CT, negative for an infectious source.
37:42She was altered meningitis.
37:44She's postpartum.
37:45Ugh, endometritis.
37:47The CT of the uterus shows a thickened endometrium,
37:50but that's normal postpartum.
37:52No retained POCs.
37:53It still could be the source.
37:54We'll do a pelvic after she's stable.
37:57Mr. Krakosia, here's my obvious concern.
38:00I write you a script for 30 days worth of pills.
38:05Then what?
38:06What do you mean?
38:07I'll take them.
38:07Well, you come back for 30 more, right?
38:10I mean, that's the question.
38:12Even if I could give you your dose in a once a month shot,
38:15you still have to come back when the month is over.
38:18What if he didn't have to?
38:20Oh, no, he has to.
38:21If he doesn't, he...
38:22Well, he pees.
38:23We have a street team here.
38:25Mr. Krakosia, are you pretty much in one spot these days?
38:29Yeah, well, we're on Liberty and there's Ben and Dumb.
38:31The alley?
38:32I know it well.
38:33So we could bring the meds to him?
38:36Absolutely.
38:37The once a month injection sounds like the easier option.
38:40We could just put you on our schedule.
38:42Uh, I'd be interested in joining that.
38:45And maybe I can bring out the medicine myself.
38:47That'd be amazing.
38:48We could use all the help we can get.
38:50Thanks, Doc.
38:54Yeah, curulent drainage from the cervix.
38:58Got the culture?
38:59Oh, looks like we have our sores.
39:02The positive urine this morning was contaminated.
39:05Maybe.
39:06Definitely.
39:08Not-so-clean-catch specimen.
39:11This infection's been brewing for a while.
39:13So the car crash was a coincidence?
39:15Not necessarily.
39:16She was probably already septic as the disease progressed.
39:19Dropped her BP and passed out while driving.
39:21She wasn't hypotensive when she arrived.
39:23Adrenaline rush from the car crash and the sternal fracture raised her BP been up for a while.
39:26No.
39:27No history of fever.
39:29Bet she was taking Tylenol for the pain.
39:31Let's call ICU for an admit.
39:32Also one guy to see her.
39:36I mean, she had mild lower abdominal pain and a positive urine dip.
39:41No fever, no back pain to indicate pyelonephritis.
39:45She was alert, walking, talking.
39:48It just seemed like a simple UTI.
39:50I saw no reason to have her wait eight hours for her bed for her pelvic exam.
39:58Um...
39:59McKay.
40:03Every postpartum patient needs a pelvic exam to rule out endometritis.
40:08Wait.
40:09You're saying that with 20-20 hindsight.
40:12Did you ask about Tylenol or ibuprofen use?
40:15Because that could mask a fever.
40:17There was no fever.
40:18Did you do a careful abdominal exam?
40:20It was a quick chair exam and there was only mild tenderness over the bladder.
40:25Perhaps there was something about the patient that made you over-love proper treatment.
40:32Like what?
40:34Other than the obvious health risk factors.
40:37Her size doesn't inherently make her unhealthy.
40:40Are you saying I was biased against the patient because of her weight?
40:43I raise it as a possibility, not as an accusation.
40:47Wow.
40:48I...
40:49I mean, I really don't think that's the case here.
40:52But I will look out for it.
40:55Yeah.
40:57You were good with him.
40:59Do you get a lot of homeless in Pittsburgh?
41:01We call them unhoused.
41:02It's not as bad as Philly or D.C., but it's still pretty bad.
41:05Yeah.
41:05It really is great that you want to help out.
41:08The street team get cool jackets.
41:10Yeah?
41:10Come find me in the shift and I'll give you more information.
41:13I will do.
41:15You made it out unscathed this time.
41:17Yeah.
41:18Yeah.
41:18I'm joining the street team.
41:20Even got a jacket, so...
41:22Oh.
41:25Yeah.
41:26It is cool.
41:27Very cool.
41:33What's Boach?
41:34I'm taking him for a visit.
41:37This is Crosby.
41:38Hello.
41:39I'm going for a smoke if anyone asks.
41:41He's an emotional support animal.
41:43I know.
41:44I got it.
41:50Crosby!
41:52Crosby!
41:53Ow!
41:54Drop it!
41:55Drop it!
41:56Oh, my God.
41:57Whoa.
41:58Hey, how much are you doing?
41:59Yeah, that's right.
42:01Oh, my God.
42:04Oh, my God.
42:05I got you.
42:06Come on.
42:08Crosby!
42:09Crosby!
42:09Come here, buddy.
42:10Come here.
42:11There you go.
42:28You got a rat, didn't you?
42:30Yeah.
42:31He does that.
42:32Yeah.
42:34When do those cops get here?
42:36Uh, I don't know.
42:37Who called him?
42:37I don't know.
42:38Where's Dana?
42:39Again, I don't know.
42:41Anytime.
42:49Hard at work?
42:54I'll take my chances.
43:38I'll take my chances.
43:39I'll take my chances.
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