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00:24I'm sorry. We'll get another nurse to her place, Jesse.
00:27Do we even know when these ice assholes took him?
00:28No, but the hospital trains are all over it.
00:31I know you got your own, babe.
00:33What's going on?
00:34It's a cold hula hoop, Central 14.
00:39Move, move, move, move, move, move, move, move, move.
00:43What the hell happened?
00:44He attacked Emerson. He gave him a shot to sell him down.
00:48You all right?
00:49Yeah, okay. Let's see.
00:52How did he get a bloody nose?
00:54He slipped.
00:55I just...
00:57Let's see?
00:58Yeah, I don't have a look.
01:02Uh, where's Ogilvy?
01:04Upstairs. They let him scrub in on that kidney stone, turned triple-A.
01:07Oh, great. And the one-day med students might actually be useful in the ED.
01:12Oh, uh, present company excluded. You're doing great.
01:16Sure. Hey, uh, can I get a selfie with you?
01:20What, me?
01:20Yeah, you're kind of a legend among med students.
01:23Really?
01:24They call you Phantom of the Pits.
01:26On account of you secretly living in the hospital for months.
01:29What? It wasn't months.
01:31Still waiting on labs, x-rays, meds.
01:34PTMC, go ahead, medic command.
01:36Where are all the nurses?
01:38Uh, there was a cold hula hoop in Central 14.
01:40Oh, no.
01:41What's that?
01:42Hospital worker assault.
01:44Ooh.
01:45Uh, the new nurse, Emma.
01:47Is she okay?
01:48I don't know. I think so.
01:50Smoke them if you got them. This place is going tits up.
01:56Okay. Are we all good in here?
01:58Oh, yeah, boss. We got this.
02:00Are you sure you're all right?
02:02Uh, yeah, I think so.
02:03Good. Come on.
02:07So, what exactly happened?
02:08He grabbed Emma. He threw it up against the wall.
02:11I ran in and gave him a shot.
02:12Right, and did he slip before or after the shot?
02:14Before.
02:16Yeah, he had me in a headlock. I didn't see what happened.
02:19What did you give him?
02:20Four milligrams of Versed.
02:21Who wrote the order?
02:22I had it in my pocket.
02:23I was on my way to waste. It was shit was sideways.
02:27What?
02:28Okay, so now he's altered from alcohol, Versed, and head trauma.
02:32Now he's gonna need a head CT to rule that intracranial bleeding in a fraction.
02:34Would you rather be Emma with a head injury or worse?
02:37Don't worry about it. We got this.
02:38No, there's no we here.
02:40You need to pass this patient off and report him.
02:43Fine. Emma, you're done with this bastard. I'll handle him now.
02:45No, no. This is my emergency department, and I'm telling you to pass it off.
02:48These are my nurses, and I just win cases. They work.
02:50And if you think for one minute, putting anyone else from my staff at risk with that asshole,
02:53you better give your fucking head a shake. Come on. Come on.
02:58MPA coming in?
02:59Okay, I'll be right there. Thank you.
03:05Did I kill my son?
03:08No. He's not dead. He's recovering in pediatric ICU.
03:14We'll be back to check on you again shortly, Massager Mandy.
03:22Has her husband arrived yet?
03:24Yeah, but he went straight upstairs.
03:26Really?
03:27He may have just wanted to see his child first. Let's not jump to conclusions.
03:31Dr. Robbie, can I have a word?
03:34Shoot.
03:35In private.
03:37I think we're going to start to talk.
03:47What is this about?
03:51I'm going to recommend this ED have two attendings on shift at all times moving forward.
03:56This department is clearly too much for one person to handle.
04:00It's not healthy for you or the patients, and I'm very concerned by what I've witnessed today with some of
04:06the staff.
04:08What is going on with Langdon and Santos? I saw them having it out like it was fight night.
04:12Dr. Langdon hasn't even been here for 10 months, and you told me this morning there was nothing to worry
04:16about with Dr. Santos.
04:17There isn't. Santos and Langdon have beef because she's the one who turned out the room for taking meds.
04:22I'm sorry, what?
04:24Santos is responsible for revealing Langdon's benzo addiction.
04:31Was he stealing drugs from this ED?
04:35This ED is the best of the best, and I would put it up against any emergency department in the
04:40country.
04:41And it is going to be yours to fuck up, so don't fuck it up.
04:59You're not supposed to smoke out here.
05:03Really? Seems to be working for me so far.
05:08How old are you, kid?
05:10I'm 21.
05:13I'm Tuesday.
05:14Jeez, it's some kind of idiot savant.
05:18We no longer use that term.
05:21It's derogatory.
05:23You bruise easy millennials.
05:25Actually, I'm Gen Z.
05:27Even worse, I was stripping a purgatory to put myself through school when I was your age.
05:34Snowflake.
05:37Hey, Amy?
05:38Yeah, I'm getting off later than I thought.
05:41I'll give you a call when I get a better idea of when.
05:44I need help!
05:45I gotta go.
05:46I can't breathe!
05:48I got the air away, you take the pulse.
05:50Yeah.
05:52Oh my, I can't try and draw a thrust.
05:55Radio's weak and thready.
05:56What's his name?
05:56My dad.
05:57Uh, Oliver.
05:58Hey, Oliver.
05:59Can you open your eyes for me?
06:01Okay, here we go.
06:06Okay.
06:07One, two, three.
06:10Drive-in with severe respiratory distress.
06:12Left-sided dialysis shunt, probable renal failure and fluid overload.
06:16I'm respiratory center, BiPAP.
06:18When was his last dialysis?
06:19It was supposed to be yesterday morning.
06:21Gonna be nitro drip ASAP.
06:23You got this?
06:24Yeah.
06:25Is that the guy who attacked Emma?
06:27Is he going to CT?
06:28Yeah.
06:28Miss Emma here needs an HMP.
06:30Uh, Cassie, can you give Emma here a workup?
06:32Started chart. Victim of assault.
06:34Really?
06:34I'm fine.
06:35He was choking you.
06:36He had me by the head most.
06:37You're a patient now.
06:38Full exam in South 18.
06:39In case she also needs to make a statement to the police.
06:41Is that really necessary?
06:44Yeah.
06:44Absolutely.
06:46Don't worry.
06:47Be there with you.
06:48Come on, let's get you a spot.
06:49Well, your guy just bought my guy for CT.
06:51No, he's my guy.
06:52A new one because he's been sitting here forever and I'm never going to cry out of here.
06:54Tell it to someone who cares.
06:56You know what?
06:56You should care because if you gave that guy a serious injury with force inflicted from
07:01a sedative, you are not licensed to prescribe him.
07:02Anyone else uses force to stop an assault?
07:04They're a hero, but a nurse does it and we're punished.
07:07You just haven't had a vial of her set in your pocket?
07:09It was extra from the medics.
07:10Good timing, I guess.
07:11Well, we waste a controlled substance.
07:13We need a witness to sign off.
07:14I was on my way to when I spotted that asshole attacking our girl.
07:17Anything else, Nancy Drew?
07:19Where are you going?
07:20Taking a pee.
07:21Do I need your permission to do that too now?
07:31Fuck!
07:32Fuck!
07:33Fuck!
07:33Fuck!
07:41Should we intubate?
07:42Uh, best to avoid that if possible.
07:45Pressure support and afterload reduction buys us time for dialysis.
07:48BiPAP starting at ten over five.
07:49Good heart squeeze, good lung sliding, but there's a ton of B lines.
07:52Pulmonary edema.
07:53Which is best treated by what, Dr. Giovanni?
07:56Uh, nitrates.
07:57Dose?
08:00BP 198 over 132.
08:02Pulse 120.
08:03Pulse talk's only 85.
08:05Good BP.
08:06Let's start at 400 mics per minute for two to five minutes.
08:08I was asking Dr. Giovanni.
08:09Don't you know I start low with nitro then titrate up?
08:12In flash pulmonary edema we do the opposite.
08:14What he really needs is dialysis to get the fluid off.
08:17What's his dialysis schedule?
08:19Uh, Monday, Wednesday, Friday.
08:20He missed yesterday because of a wedding.
08:22We tried to go to the center this morning.
08:23It's usually open on Saturday, but I think they closed for the fourth.
08:26Where do you live?
08:26Uh, Brookville.
08:27It's like an hour and a half away.
08:29Yes, ma'am.
08:29I tried Pine Ridge Hospital in Ford City, but I didn't know they shut down.
08:32Yeah, they sure did.
08:40All right, sister.
08:42How can I help uncluster this clusterfuck?
08:47Ready to finish our conversation?
08:48We talked.
08:49Okay, now I gotta need you.
08:50Please.
08:57Talk to me.
08:58I'm tired of this shit.
08:59Okay.
08:59It's the second time that Emma was attacked by a patient today.
09:02Okay.
09:03I took one of my nurses, and these cyber assholes have turned us back into 1999.
09:08Well, I'm worried about you.
09:09You are not yourself today.
09:11Which two percent?
09:13Do you have something you want to say?
09:16Go ahead.
09:17I can take it.
09:18All right, Danielle.
09:20Sometimes it's like you're just talking to death because you don't give a shit anymore.
09:23So this is about the motorcycle?
09:24It's not just about the motorcycle.
09:25It's about the whole damn thing.
09:26Robbie, you're actually telling people that you're going to a place called Smash My Head In.
09:31Close.
09:32Not quite.
09:33Robbie, your buddy Duke is insisting on leaving, and that MBA is here.
09:37Okay, okay.
09:38I'll be right there.
09:39What's open?
09:40South 15.
09:4178-year-old woman.
09:42Very low speed auto versus pedestrian with ground level full.
09:45Bruising on her left hip.
09:46No head trauma.
09:47Her husband Eddie came along.
09:48Hi.
09:49How do you do, sir?
09:49I'm Dr. Robbie.
09:50Come with us.
09:50I'm going to get you set up right over here.
09:53Ah!
09:54Sorry, we'll get you something for the pain shortly.
09:58Do you have any medical problems, Frida?
10:00Uh, high blood pressure, low thyroid, um, AFib.
10:04Any chest pain, shortness of breath?
10:06No.
10:07Front row seat, sir.
10:08So, um, what happened?
10:10Well, she walked into the car.
10:14You hit me.
10:15No, I didn't hit you.
10:17You hit the car.
10:18You backed up right into me.
10:20I wasn't even moving.
10:23Well, you're both in very good hands now.
10:25Yes?
10:27Before we get you in a gown, we'd like to check your hip.
10:30Of course.
10:34I am sorry.
10:35We had a whole bunch of craziness come in, and you got bumped down a patient or two for CT.
10:40But take comfort in knowing it was for some pretty nasty stuff.
10:43How am I supposed to find comfort in that?
10:46Or anything you've told me since I got here, for that matter.
10:49I don't know.
10:49But everything is supposed to come with a lesson, right?
10:51Oh, this is more of your Zen motorcycle bullshit.
10:55Maybe.
10:56No.
10:56No, the truth is I'm just stalling, because it's going to be a while longer.
10:59Okay, look.
11:00I appreciate the effort, but you guys are obviously jammed up.
11:03And I'll just come back when it's not our nation's birthday.
11:05You're already here.
11:06It's not going to be that much longer, I promise.
11:08Just stay and get your CT.
11:09I will do it all when you get back, and this place is less crazy.
11:13This place is always crazy.
11:14I don't know when I'm going to get back.
11:15Can you just sit the fuck down and wait a little bit longer?
11:17It won't kill you, but leaving might.
11:25Okay.
11:27No problem.
11:32That's a nasty bruise.
11:34Do you take aspirin or any blood thinners?
11:37Uh, eloquist from my AFib.
11:41Any tenderness here?
11:43No, not really.
11:45Here?
11:46Oh, yeah. That hurts.
11:48Four of morphine and Zofrin.
11:50What about up here?
11:52Not really.
11:54All right, so let's start with labs in plain film.
11:56No, CT abdomen pelvis will get a better view of the hip and check for bleeding.
12:01The eloquist is concerning.
12:03Uh, you think she broke her hip?
12:05If it's broken, you broke it.
12:08Usually for a broken hip, the leg is shortened and rotates out.
12:12But we'll just wait for CT results.
12:22Mr. Cohen, I know that you were checked on scene, but I was wondering if I could do a quick
12:28examination of you.
12:29Oh, no, I'm fine. I was in the car.
12:31Just unofficially.
12:33Uh, okay.
12:37Deep breath for me.
12:40Good.
12:42Again?
12:44Great.
12:45Thanks, Eddie.
12:46Next thing.
12:47Would you mind taking your shoes off?
12:51What for?
12:52Just being safe.
12:57My back's not what it used to be.
12:59Let me help you.
13:04I, uh, could use a pedicure.
13:08You and me both.
13:09Dr. King, what do you think about doing a Romberg test?
13:13What is that?
13:14It's a general evaluation of balance.
13:17Um, can you stand up, sir?
13:20Yep.
13:21Okay.
13:23How are you doing, Oliver?
13:24Stats are not coming up.
13:25Pressure's holding on 400 and nitro.
13:26Let's up the BiPAP to 20 on 10.
13:28We could try phlebotomy, decrease the fluid burden on the lungs.
13:31Old school, but right by time.
13:34Hemoglobin's only 9.2.
13:35He's anemic for renal failure.
13:36And he can't afford more blood loss.
13:38We need to intubate. We're losing this war.
13:40Intubation's not a trivial matter for immunosuppressed patients.
13:43Should we just drop a bunch of red tops?
13:45No, we do the collection on the floors if he's giving blood.
13:47We like medieval bloodletting.
13:49Essentially.
13:50And that is something you should step out for, Mason.
13:52Casey, thank you.
13:53Got a good van for 16.
13:54One donor back, 500 cc's, no more.
14:01Okay, let it out.
14:03Same again, deep breath in.
14:07Great. All done.
14:09How's she doing?
14:10Postdocs 100%, normal exam, no evidence of injury.
14:13Great.
14:14I got way worse for my older brothers.
14:15I bet.
14:17All right, I'll go right up her chart.
14:20How about we call it a day?
14:23My shift isn't over.
14:24This was a shift and a half for anyone today, believe me.
14:28If it's all right with you, I'd rather stay.
14:31I'm not a quitter.
14:33Okay, but something good for you.
14:34But stick close to Donnie for the rest of the day, would you?
14:38Sure.
14:39And you also need to make a statement to the police.
14:42If we don't stand up for ourselves, no one else will.
14:44We're here to help.
14:45Not to be punching bags.
14:48Thank you for saving me.
14:50Gotcha, girl.
15:00Something's wrong?
15:01That depends.
15:02Are you a four-month-old in severe diaper rash?
15:05No.
15:05I'm Dorian Cole, and I'm pretty sure that I broke my collarbone.
15:08Okay, we can help with that.
15:09I'll be back.
15:10Wait, wait.
15:10Are you serious?
15:11Can I at least get something from my pain?
15:13Sure.
15:14Sit tight.
15:15This place sucks.
15:16Tell me about it.
15:16Try working here.
15:18Boy, you're really working hard to boost those patient satisfaction scores.
15:21The chart for Central 7 doesn't match the patient that's in there.
15:24Just hang in there.
15:24We're almost over this.
15:25I was over this six hours ago.
15:27Sheriff's is looking like Melanie's on St. Paddy's Day.
15:29They're gonna break through the doors like zombies if you don't start moving more than
15:32me back there.
15:33Dante Casella, 34.
15:35Blunt trauma from a fireworks explosion in his storage unit.
15:38A&O, good vitals, large scalp laceration and bruising to the chest.
15:42No meds or allergies.
15:43Partial or full thickness burns?
15:44No burns.
15:45The blast launched him into a rolled-down garage door frame.
15:48Am I fucking dying here?
15:49I'm Dr. Robbie.
15:50This is Dr. Santos.
15:51I can't hear you.
15:53Try the other side.
15:55I'm Dr. Santos.
15:57Can you hear me?
15:58Yeah, yeah.
15:58Dante.
16:00A lot of ringing.
16:01Hey, McKay!
16:02Joy, you're with us.
16:06One, two, three.
16:10I need, like, four doctors.
16:13Shit, I know it was bad.
16:15This is a teaching hospital.
16:16You need all the extra help you need.
16:19Airway and breathing intact.
16:21Good lung sliding bilaterally.
16:24Tender over the sternum.
16:26Possible fracture.
16:27That's your breastbone.
16:28No ectopy on monitor.
16:30No pericardial effusion.
16:31The heart looks good.
16:32130 over 85.
16:34Pulse 108.
16:34Sats 98 on two liters.
16:36Good enough for 50 of Fent.
16:38He's stuck through his head dressing.
16:39Let's take a peek.
16:40Normally, we don't deal with scap lax on the primary survey, only if there's active bleeding.
16:44Not with glass injuries.
16:46The pressure wave can transmit energy through the body and cause internal damage even without
16:50any external visible signs, especially with organs that are air-filled.
16:54How are we looking, Dr. Santos?
16:55PFAS negative.
16:56No free fluid in the belly.
16:59Fuck me.
17:01What is it?
17:02It's a pretty big flap.
17:03Checking for bleeding source?
17:05Is that through the gale yet?
17:06It is indeed.
17:07Do you want to crack my head open or what?
17:09Don't worry.
17:10Your skull is intact.
17:11It's just a very deep cut.
17:16Okay.
17:17We got a couple arterials that need control.
17:20A figure of eight sutures.
17:21Dr. Santos is 300.
17:22What are rainy clips, Alex?
17:24Quicker than sutures.
17:25Ding, ding, ding, ding.
17:26Okay.
17:26Clamp those bleeders.
17:27Call for CT.
17:28I'll be next door.
17:29And Duke's CT line keeps growing.
17:36500 cc's out.
17:37How you doing, Oliver?
17:38I don't know.
17:39I think it's progress in here.
17:41Can't tell if it was the phlebotomy or if the nitro finally kicked in.
17:44Oh, it could have been both.
17:46Potassium's high, 6.5.
17:48Be expected with a missed dialysis and the added heat stress.
17:51He needs, uh...
17:51Dr. Tavodine?
17:52Uh, he needs insulin and glucose to shift the potassium intracellular.
17:56Exactly.
17:57Uh, 10 units, ampethy 50.
17:58Start with 5 milligrams of nebulized albuterol.
18:00It'll shift some potassium and help his breathing.
18:02He's at risk for arrhythmias.
18:05Mmm, no peach tea waves.
18:07No QRS widening.
18:08Insulin puts him at risk for hypoglycemia.
18:10And you'd tie up nurses with frequent acu-checks.
18:13Dr. Alishimi's right.
18:14The nebs will hold him over until dialysis gets here.
18:16You got this?
18:16Mm-hmm.
18:20All good in here?
18:22Yep.
18:25Uh, I'm gonna go give this guy's kid an update.
18:28He's probably freaking out.
18:29Come find me if you need me.
18:30Uh, yep.
18:34Um, hey.
18:36Where'd you learn that shoe trick?
18:38Oh, I did a clerkship at NJMS Senior Care.
18:42One of the attendees always said you can learn a lot about your patients just by looking at their feet.
18:48Bravo, ladies.
18:49On to the next lucky customers.
18:53Oh.
18:53Probably gonna have to stay late to catch up on all these patients.
18:57NJF reinforcements will be here soon.
18:58We're supposed to be speeding up in the 11th hour, not slowing down.
19:00They don't call it the final sprint for nothing.
19:02Chop, chop.
19:09Is that the, uh, mom of the heat shark?
19:12Yeah.
19:12Do you believe it was just an accident?
19:16Does it matter?
19:18As a doctor?
19:19No.
19:20As a mom?
19:22Sometimes I can't tell if motherhood has made me more understanding or more judgmental.
19:31Dana, I've got a couple of visitors.
19:32Uh, my, my brother?
19:33There was an explosion.
19:34Hi, my mom was in a car accident.
19:36Uh, okay, Monica, can you help these fine folks find their loved ones?
19:39No.
19:40Princess, what are you still doing here?
19:42Don't you got some crazy Lou Alpego's barbecue thing to get to?
19:45It's lichon, but yes I do.
19:46I'm gonna sneak out on a few.
19:48Uh, yeah, yeah.
19:48Go have some fun for both of us, alright?
19:51Don't stay too late.
19:52Okay.
19:54Hello, Miss Stevens, I'm Dr. McKay.
19:57How you feeling?
19:58Stupid.
19:59And really, really sore.
20:02Yeah, we'll, uh, get you something for your pain, okay?
20:06And your last patient left her blanket.
20:10Oh.
20:11Uh, yeah, I...
20:15Yeah, I'll take it.
20:17Thanks.
20:17Miss May.
20:19Um, I'll be right back, Kim.
20:25Fuck.
20:27You good?
20:28Yeah, yeah.
20:29I, uh, I'm just, um, I'm looking for something to put this in.
20:32I, uh, a patient left it.
20:37She died, the, uh, cancer mom with the two kids.
20:41Sounds like a tough one.
20:43Yeah, that one sucked.
20:45Seeing those two young boys said goodbye to their mother was brutal.
20:49It just makes you want to cry.
20:53You should cry, you'll feel better.
20:55I wish I could.
20:58You know, I don't even remember the last time I cried.
21:03I'm not even sure I can anymore.
21:05Is that what this place does to you?
21:07You get pretty good at shutting down our feelings.
21:11Yeah, I'm, uh, a little scared I've shut them off for so long, I don't know how to turn them
21:17back on again.
21:19I just wish I could cry again, you know?
21:23I'll take care of you.
21:25You want a hug?
21:28God, no.
21:30Your mom is stable, but she's still waiting on the imaging of her hip.
21:35Well, no more soon.
21:36You can wait with your dad in the meantime.
21:37I just told him a million times he shouldn't be driving anymore.
21:40May I ask what their home situation's like right now?
21:43I don't know, they live over in Squirrel Hill.
21:45Same house I grew up in, just the two of them.
21:48We noticed your father exhibiting signs of an unsteady gait, along with other balance and mobility issues.
21:54He sees an internist, neurologist, cardiologist, gastroenterologist.
21:58He's got a whole team of ologists.
22:01Both my parents used to be in pretty great shape, but lately it's like they can barely get up the
22:05stairs.
22:06Half their house isn't accessible to them.
22:07Have you looked into assisted living options?
22:10Yes, but they refuse to even talk about it with me.
22:13Mr. Cullen, you have a visitor.
22:16Care Bear.
22:17Care Bear.
22:17Dad.
22:18Feeling okay?
22:19No, I'm feeling dumb.
22:22Carrie, this is Dr. King, who will be assisting with your mother's care.
22:26I was just explaining that the treatment depends on the injuries, but there are complicating factors.
22:32We are required to report impairments that might affect driving, and you will likely have to take another driver's test
22:38to keep your license.
22:40What has that got to do with Frida?
22:41Well, if the hip injury is serious and you're also limited, then it could mean an unsafe to return home
22:49recommendation for your wife.
22:51You'd be looking at a temporary move to some form of assisted living and rehabilitation for Frida's care.
22:56How temporary?
23:00Best case, three to six months, but she may never return to the functionality she had prior to the injury
23:05and recovery.
23:06Okay, well kill me now.
23:09See what I'm dealing with, Dad?
23:10You need to find somewhere to live that is safer and healthier for both of you.
23:14You know, the new communities are not anything like the old scary nursing homes.
23:18They're really nice, and you get your own apartment.
23:21And, you know, my sister actually lives in Munch. She loves it.
23:24When the dog dies, we can talk.
23:27What if you fall?
23:28What if you have a heart attack or a stroke and there's no one there to help you?
23:32You worry too much.
23:33How can I not? Look what happened today.
23:36We're gonna leave you two alone. We'll come back with Mrs. Cohn.
23:45Hey, Robbie. Our scalp victim is back from C2. They're prepping him now.
23:50Shit. Uh, okay. I'm coming. Um...
23:55Is your friend doing okay?
23:56He's on my flight risk radar.
23:57Oh, and Dana put McKay on the guy who attacked the new nurse. She okay?
24:02Physically, yes.
24:03I heard you had a little chat with Langdon earlier.
24:06Yeah, water under the bridge.
24:08You have to figure out a way of working with him now that he's back.
24:10Or until he relapses.
24:12You can be a very good doctor. Don't let old conflicts get in the way.
24:15Speaking of which, I want you and everybody else to see the trauma counselor while I'm gone.
24:19Yes?
24:20Yes.
24:20And I asked Whitaker to house sit for me while I'm gone.
24:23I figured that would distract from the whole farmer's widow thing.
24:25Wait, what?
24:25Bring the mail, water the plants. Cool.
24:28Cool. Yeah, fine.
24:30That looks good. You can start the repair after this one.
24:33Feeling any pain, sir?
24:35No pain, just wet.
24:38You already numbed him up?
24:39I did.
24:41One percent with Epi.
24:42CT back it?
24:43No, not yet.
24:44I watched the slices come up.
24:46Isolated sternal fracture.
24:47Everything else looked normal.
24:48Could send him home, but given the mechanism, should probably watch him overnight.
24:52I agree with Dr. Garcia.
24:55I agree with Dr. Garcia, too.
24:59Three-layer closure.
24:59Galia, sub-Q, skin staples.
25:02Enjoy the fireworks.
25:04And hey, if I don't see you before you leave, don't forget to buy me a souvenir.
25:07Like a custom alchon-carved hunting blade.
25:09Nothing lasts for my favorite butcher.
25:11Aw.
25:12You're gonna make a great ex-husband one day, Rubinovich.
25:17Hospital's got his defense attorney looking for Jess.
25:19You probably took him to an ICE detention center.
25:21Said we shouldn't hold our breath, though.
25:23Whatever happened to we the people, huh?
25:28Anything back on that drunk son of a bitch that attacked Emma?
25:31Not yet.
25:33For Christ's sake.
25:34I'm making a run now.
25:35I'll ask.
25:36That's the guy who attacked Emma?
25:38It's intense.
25:40How you doing?
25:43BG.
25:45That's me.
25:46Hey.
25:47You did what you had to do with that guy.
25:48Everything's gonna be fine.
25:50From your lips.
25:54Class B launch tubes to the van.
25:57Next second.
25:59Kaboom!
25:59I can get launched 10, 15 feet across the garage.
26:04Right up into the lift track.
26:06Hit something hard.
26:09I don't really remember the rest.
26:12Oh.
26:12Just my brother's screaming out of him.
26:15I'm lying there thinking, oh, he must be dying.
26:19Guess it was me who was screaming about.
26:21Your brother is in the family room.
26:23He's waiting to see you.
26:24And he is alive and well.
26:28Oops.
26:29Oops.
26:30What?
26:31What's oops mean?
26:33Hello?
26:34Nothing to worry about.
26:38We never say oops in front of a patient.
26:45All right.
26:45Try again.
26:47You sure?
26:48Mm-hmm.
26:51Better.
26:52Keep going.
26:53You might want to leave the fireworks to the professionals.
26:56We are professionals.
26:57Got our official PDA consumer license a few years back.
27:03Gunpowder's in my blood, man.
27:05Nothing like that.
27:12Ain't no fighting it.
27:14I'm more fatty.
27:16More like my memento mori.
27:19We have a tomorrow.
27:21Am I, like, the only one who didn't study Latin from med school?
27:25Yep.
27:25Yes.
27:27And finished.
27:29Nicely done.
27:31Can I see my brother now?
27:32Yep.
27:33Oh, motherfucker.
27:35Chest pain?
27:36Only when I move.
27:38That would be the fracture in your sternum, which we would give you another four more things
27:40to that.
27:42And try no laughing or sneezing for the next four weeks.
27:47Mr. Haas, we're gonna switch you over to a high-flow nasal oxygen instead of the BiPAP and see how
27:52you do.
27:53This looks promising.
27:55Repeat.
27:55Potassium is at 6.1 with the albuterol.
28:03Oh, I'm feeling a little better.
28:10Don't you ever tell your mother about how fast you drove here.
28:13I thought you were gonna die.
28:15Any longer he might have, so good job.
28:20Boy just got his permit last week.
28:23Felt like I was living in one of those Fast and the Furious movies.
28:27I can't believe Pine Ridge closed. When did that happen?
28:31I read about it a few months ago. Medicare spend make cuts.
28:35Are there any other emergency rooms in the area?
28:38Nope.
28:39It's gonna be a long way to drive for folks out where we live.
28:43Mr. Haas, you'll need to stay here a few hours to get you tuned up.
28:46Yeah. I know the drill.
28:48Yeah.
28:50Hey, you know, Mason, if you're hungry, we've got a pretty good cafeteria.
28:53Don't lie to him.
28:55We have a cafeteria.
28:57I'm just gonna stay here with my dad.
28:59Yeah, sure.
29:02Thank you for saving you.
29:10Are you still thinking rural emergency medicine when you're down here?
29:14I'm not thinking. Doing.
29:17Yeah, I hope there are still some hospitals left for you to work at.
29:19Yeah.
29:23Ah, it's in the March of the Walking Dead nightship again.
29:26First one in Mattel, you get a gold star.
29:28What happened in here?
29:29Left you guys at the layup this morning.
29:30Don't ask.
29:32Speaking of layups, what up, Dr. J?
29:35Right.
29:36That was some sort of basketball player, wasn't it?
29:39Shame on you.
29:40Only the greatest sixer to ever play the game.
29:43Week one of year four of med school.
29:45You'll be ordering me around before you know it.
29:47You enjoy the dark side when you graduate?
29:49The emergency department?
29:51The night shift, baby.
29:52It's wild.
29:55Um, I haven't even decided what residency I'm applying for yet.
29:58We'll figure it out.
29:59Got lots of time.
30:01Tell this to my parents.
30:03Dana, results are back in your guy.
30:05Give me this.
30:12I choked her?
30:14No, I would never do something like that.
30:16But you did.
30:20Can you, uh...
30:22Sorry, can you excuse me for a minute?
30:24Jesus Christ, Dana.
30:26Green.
30:29What's he saying, anyway?
30:31He's in a bit of shock.
30:33Claims he doesn't remember anything.
30:36Says he was on the golf course getting boozy,
30:39maybe a little too boozy.
30:40Things get hazy.
30:41Next thing you know, he's on the floor
30:42and everyone's screaming at him.
30:44How convenient.
30:47Maybe it's better for both of you that he doesn't remember what happened.
30:52Let me know when you're ready to take my statement.
31:01All right, well, the good news is your CT was negative for skull fracture and cranial hemorrhage.
31:07You mean that's good news for you and that blonde nurse lady?
31:11But your lab results were positive for alcohol and cocaine.
31:17Okay, you got me.
31:19I did a couple of birdie bumps on the turn, but we were just having fun on the golf course.
31:22Look, when alcohol is mixed with cocaine, your liver produces a metabolite called cocanethylene.
31:28Well, what does that have to do with me?
31:30Allegedly doing what you said.
31:33It's a psychoactive molecule, more toxic and potent than cocaine.
31:36And it can lead to confusion, paranoia, aggression, and even psychosis.
31:45What happens now?
31:49We're gonna monitor you for a few hours, especially given your likely concussion.
31:53And you need to give a statement to the police outside in the meantime.
32:02Well, you lucky this was just a pope.
32:04Spared the muscle.
32:05See?
32:06It could have been worse.
32:07No shit, Sherman.
32:09The triangular bayonets they created back then were designed to leave wounds that are nearly impossible to stitch.
32:14Those bayonets have never met me.
32:16Oh, wow.
32:17What?
32:18It's all good.
32:19We got it covered.
32:20No, are you guys from the Fort Pitt Museum?
32:23Yeah, you familiar?
32:24Yeah.
32:25I love you guys.
32:27My mom would take me to the fort every time we'd come down and visit family as a kid.
32:30We've been volunteering there as living historians for over 20 years.
32:33I probably saw you then.
32:34Man, I can't wait to tell my parents about this.
32:37Getting stabbed must have been scary.
32:39Yeah, well, point Dexter here stumbled over his boots and nearly impaled me.
32:42It wouldn't have mattered if you weren't out of formation.
32:44Well, you're in good hands.
32:46This guy could have saved a lot of lives with his sutures back in 1776.
32:54Hi again.
32:55Good news, Mrs. Cohen.
32:57Hi.
32:57Your imaging results show no hip fracture and no internal bleeding.
33:01Ah.
33:02But you do have a small hairline fracture of the superior pubic ramus.
33:06Well, that doesn't sound good.
33:07Well, if you're going to have a fracture, it's the best one to have.
33:10Do I need to stay in the hospital?
33:12Not necessarily.
33:14Your recovery should be pretty straightforward if we can control your pain.
33:17But you need to take it easy and stay off your feet for six to eight weeks.
33:22How can she go home if she can't walk?
33:23Oh, she can bear weight and walk with some help.
33:26And we'll get you a walker and schedule physical therapy.
33:29So, so we can go home.
33:32Dad, you can't take care of Momo by yourself?
33:36Oh, we'll manage.
33:37You guys, you need to be realistic.
33:40I don't want strangers hanging around in the house.
33:43It's not strangers, it's helpers.
33:45Mm-mm.
33:45No, no, thanks.
33:47Mm-mm.
33:47Doctors, please.
33:51I am worried about your ability to get the assistance you need, Mrs. Cohen.
33:55It may be time to think about some of those alternative living options we mentioned.
34:01I can take care of her.
34:03Yeah.
34:04Are you going to be able to get her into the bathroom onto the toilet in the middle of the
34:07night?
34:07Are you going to help her change her clothes in the morning?
34:10Are you going to...
34:10We're fine.
34:11Dad.
34:11Okay.
34:12Please.
34:13Just try it.
34:15You don't have to sell the house right away.
34:17Just see if you like it.
34:20You could move in with us.
34:21No, I can't.
34:22I have work.
34:23I have the kids.
34:24I can't.
34:24No, no.
34:26No, okay?
34:27Just no.
34:28No.
34:31Carrie, could I speak with you outside for a minute?
34:41It's like that every time.
34:43It's tough to find the balance between respecting your loved one's needs for agency and doing what's best for their
34:47safety.
34:49I was wondering if you had your parents' medication lists with you or on your phone.
34:55Yeah.
34:56I'd like to take a quick look at it, if that's okay.
34:59Yeah.
35:02My man, how you doing?
35:05Like you better roll in a bar cart and a happy hour buffet if I'm going to be stuck in
35:09this place much longer.
35:10This place is a traffic jam.
35:11We're trying to merge you in.
35:12I promise.
35:13That's no traffic jam.
35:14That's a 20-car pile of.
35:16The sooner you get out, the sooner I get out, so you know I'm not bullshitting you.
35:21Why are you jonesing so hard to get out and start your ride shooting?
35:25I've got a schedule.
35:26I've got places to go.
35:28I've got people to see.
35:33I just have to get going.
35:37You're worried if you don't leave tonight, you won't leave at all?
35:42I get it.
35:43I can feel it in the air here.
35:45This place is like quicksand.
35:48Probably.
35:50Dr. Robbie, Dante the fireworks guy.
35:53Something's wrong.
35:55Okay, shit.
35:57Do not go anywhere.
35:58You are next up.
35:59I'm going to deliver you myself.
36:00I'm starting to feel like a hostage in this place.
36:02How do you think I feel?
36:19What's going on?
36:20Fucking chest hurts.
36:22Systolic's down to 78.
36:25Blood loss from scalp plaque?
36:26That's highly unlikely.
36:27Dr. Santos?
36:28Good rest sounds, but neck veins are up.
36:29Protecting the heart now.
36:31Okay.
36:31500 CC bolus.
36:32100% non-rebreather, please.
36:34Pericardial effusion.
36:35RV collapses.
36:36Yeah, let's prep for a pericardiocentesis.
36:38What's going on?
36:39Is he going to be okay?
36:40He said he was fine.
36:41CT scan was normal.
36:43Things change.
36:45Dante, there is a collection of blood around your heart.
36:48We need to drain it.
36:49Oh, fuck.
36:50Okay, 0.5 per kilo of ketamine, please.
36:53Won't that drop this pressure even more?
36:54We don't have a choice.
36:55We can undo this on a moving target.
36:58Dante, Jesus fucking Christ.
36:59That's my baby brother.
37:00Hey, Perla?
37:01Sir, I'm so sorry, but you can't be in there right now.
37:03What's wrong with him?
37:04Hey, Dante.
37:05Nothing.
37:06Hey, just hang in there.
37:07Okay.
37:08So sorry, you can't be in there right now, okay?
37:10We have to stabilize it.
37:11They said he was fine.
37:12Okay, there's been a complication.
37:13I just need you to take a couple of papers and try to stay calm.
37:16Please.
37:17Just breathe with me.
37:18In.
37:19Okay, out.
37:19Look at me.
37:20Breathe in.
37:22Out.
37:23Very good.
37:24In.
37:25Out.
37:26Okay, stay calm, okay?
37:27We got this.
37:31I can't believe you've been there.
37:32I was alone.
37:33I've been out with shock.
37:34From what?
37:34Uh, I am guessing a small tear in the right atrium from a sterile fracture.
37:37If it was ventricular, he would have crashed in the field.
37:40I'll call cardiothoracic, see if they have an OR.
37:42So it's down to 64.
37:43Okay, have you ever done an apical approach?
37:45Nope.
37:46No time like the present.
37:47Collateral to my probe.
37:49Why not subcostal?
37:50Uh, this is a shorter distance.
37:51There are fewer structures.
37:52If you can see fluid, there's nothing between the probe and the pericardium.
37:56Mm-hmm.
37:56There.
37:56There are the needles in the effusion.
37:58Mm-hmm.
37:58Draw back.
37:59All right.
38:00Good blood return.
38:01Okay, sometimes it only takes 20 cc's to let that heart fill again.
38:05Carotid pulse much stronger.
38:06Thanks.
38:07Gear it up.
38:08We'll have a room ready in five.
38:10All right, that is 40 cc's out.
38:12Blood pressure's up.
38:1390 systolic.
38:13Okay, now we're gonna place the J-wire.
38:15And we're gonna leave the catheter and the three-way stopcock.
38:18Still bleeding from the heart.
38:19He can live with a little blood loss, but not with a pressure bag squeezing his heart so
38:23it can't beat.
38:24Good thing we didn't send him home.
38:25Next day, Robbie.
38:27You too, Trinity.
38:27Is that an actual compliment?
38:29Sometimes you guys get lucky.
38:32Got a couple of bad ones.
38:34How old is he?
38:3584.
38:37Meclizine for vertigo.
38:38Anticholinergic effects can cause drowsiness.
38:40It's PRN, so maybe he doesn't take it all the time.
38:42He's also been prescribed methylcarbamol, another anticholinergic.
38:46Could definitely impair driving.
38:48And metoclopramide for his stomach.
38:50Well, that could cause gate problems.
38:53Exactly.
38:55Dr. Robbie, may we present?
38:57Yeah, what do you got?
38:58Hey, you should probably get started crossing your teeth and dotting your eyes for night shift
39:01handoff.
39:01Right.
39:01Well, vaya con Dios, or whatever the bikers are saying these days.
39:07Our elderly couple, Frieda and Ed, were anxious about their ability to recover at home, or
39:12to remain at home in general.
39:13But a number of Mr. Cohen's medications are on the beers list, and they may be contributing
39:18to his deteriorating health.
39:20Maybe.
39:21We can't be certain, but none of them are critical meds.
39:24We could have him stop them right now, follow up with his PCP, see how he's doing in a few
39:29weeks.
39:29Right by the family, sometimes just affirming a patient's independence, autonomy, can do
39:34a world of good.
39:36Um, hey, Dr. Mohan.
39:39I heard a rumor that you were looking for an elective.
39:42Have you considered geriatrics as much of an art as a science?
39:45There's usually an opening, and you seem to have a predisposition to the pace.
39:57Have you seen Dana?
39:58I think she went out for a smoke, lucky girl.
40:19You ever going to tell me what really happened in there?
40:21Nowhere.
40:25You could lose your nursing license.
40:28Let me guess that violin verset in your pocket.
40:30You drew that up for Doug Driscoll in case he ever came back,
40:34and now you've just been carrying it around ever since.
40:36I did exactly what I needed to.
40:37Now there's a young nurse who gets to go home in one piece because of me.
40:40McKay can sign the verset order for me if you will.
40:42I will sign the order.
40:44I will sign an extra order so you can have one when I'm gone.
40:47That's hardly the point.
40:49It's not exactly like I'm against nurse safety.
40:52I'm trying to advocate for your caution,
40:54because you're the person who's supposed to be here keeping this running while I'm gone,
40:57not roaming the halls like a vigilante with a loaded syringe and a vendetta.
41:01It's always do as I say, not as I do with you, isn't it?
41:03What is wrong with you today?
41:05Samira, Mr. Triple A.
41:07Mel and Alice had deposition McKay Street people in the park.
41:09Fucking Langdon.
41:10At some point, you and Langdon got to work this way.
41:12I don't want him here.
41:13He made a mistake and he paid for it.
41:14Did he?
41:14Did he go to jail?
41:15Because I let him get away with the crime.
41:17So what does that make me?
41:18Human!
41:19Are you angry at him or are you angry at you?
41:21Somebody could have died.
41:22Oh, it's the ED.
41:23Somebody's always angry at him.
41:24All right, make jokes.
41:25Make jokes instead of acknowledging him.
41:26Langdon didn't kill anybody.
41:27That we know of.
41:28And he saved a lot of lives that we do know of.
41:31Our kids disappoint us sometimes.
41:33Langdon is not a kid.
41:34No, but he's your guy and you're taking him personally.
41:37Langdon fucked up and you think that makes you look bad, but it's on him.
41:42How am I supposed to leave this place when it's a shit show?
41:45First you can't stay, now you can't go.
41:47What is it, Rabinovich?
41:49No, I'm going.
41:50I just thought I could leave it a little better when I did.
41:53Oh, don't be such a martyr.
41:54This place is always teetering on the brink of disaster.
41:56With or without you.
41:57We do it every night, every day off.
41:59This place is bigger than one person.
42:01It'll survive without Adamson, it'll survive without me, and it'll survive without you.
42:10My meds are making me worse?
42:12Not worse, but they may be impacting your balance and mobility.
42:16Why would his doctors prescribe drugs that could harm him?
42:20Oh, it's not any one medication.
42:22It's the combination that could be impairing his daily functioning.
42:25We have a case manager that will put together a robust plan that I think will make everyone happy while
42:31allowing you to stay at home.
42:33There's regular physical therapy, an at-home nurse that visits a few times a week, and, oh, even personal shoppers
42:40to help with groceries.
42:42This sounds expensive.
42:45Actually, Medicare covers most of it with some assistance from the Area Agency on Aging.
42:49You know, every old person knows what it is to be young, but no young person can know what it
42:56is to be old.
42:58Thank you for listening.
43:01You guys are still coming with me to visit a few assisted living places, just in case it's ever time.
43:06Well, maybe.
43:23Hey, you, uh, you doing all right?
43:27Never better, thanks.
43:29Bye.
43:36God, you're really just going to keep standing there, aren't you?
43:38Yeah, what's going on?
43:45It was literally my first day of being a doctor.
43:48And Langdon gaslit me and made me question my skills over and over.
43:53And it's taken me a long time to feel like I'm along here.
43:56And now he's back.
43:58And I don't even care that he was an addict.
44:00I care that he was a fucking asshole.
44:01And it's like no one here even remembers any of this.
44:05And everyone here talks about community and family, all while they throw you under the bus.
44:10And I...
44:12Robbie is the only attending who actually sees through the bullshit.
44:15But now he's leaving for some grand ego death spirit quest and robo-doc over there shoots me in the
44:20proverbial dick.
44:22Oh, Garcia's here.
44:24She likes you, right?
44:25She doesn't like me.
44:26She likes getting laid.
44:28And her stress relief squeeze toy, or was.
44:32You know, she and Langdon would make a great couple.
44:35Yeah.
44:36That's dark.
44:38I'm sorry.
44:40Yeah?
44:41Why do you care?
44:43Because we're friends, I thought, I think.
44:45Are we?
44:46Because on top of all of that, you're the one who's being super shady about moving out on me.
44:50Moving out?
44:51Yeah, I heard you were going to go squat at Robbie's sad bachelor pad.
44:54Honestly?
44:55I thought that was your idea, to get me to move out of the apartment.
44:58No, no, I wanted him to give you some fatherly advice about going all farmers only and not giving you
45:03the keys to his fucking house.
45:07Oh, my God.
45:08No, I know.
45:09It was none of my business.
45:10No, it's not that.
45:11It's...
45:14You actually like living with me, don't you?
45:19What are you talking about?
45:21You leave your dirty clothes everywhere.
45:23You eat all of my avocados as soon as they ripen.
45:26You keep pausing the TV to ask the dumbest questions.
45:28And, you know, I'm going back to the avocado thing, because I've never seen someone consume so many, it's disgusting.
45:32Just say it, and I won't move out, okay?
45:35I'm not going to be doing much of Robbie's.
45:37I'm going to be taking in his mail and re-watering his plants.
45:40Say what?
45:45Admit that you like having me as your roommate.
45:49You are such a fuckleberry.
45:51Have fun with Robbie's plants.
45:56You have no idea how much joy that just brought me.
46:02Hey.
46:03How much longer until I get these things off and go home?
46:08Oh.
46:10You assaulted a nurse.
46:12Yeah.
46:13You said it was the cocoa-ethylite thing that made me go crazy.
46:17Well, if you're drunk and you kill someone, you still kill someone.
46:21So after we clear you in a few hours, you're going to take a ride with the uniformed officer outside
46:25who's going to take you in for processing.
46:27No. No, no, no, no. This cannot be happening.
46:29No. Since you golf and can buy cocaine, I assume you can post bail after your arraignment.
46:33You're going to ruin my fucking life!
46:34But it being our nation's big, beautiful birthday, that hearing may take longer than usual.
46:38So I'd cancel any grand plans you have for the fourth.
46:45You know, I... I can leave you with these.
46:50Rehab? Fuck off!
46:52I'm suing this whole hospital and you for personal injury.
46:55Well, good luck convincing a jury of that one.
46:58Oh, fuck this whole place! And fuck all of you!
47:02No, not you, officer.
47:04Fuck!
47:04Make sure discharge charts are bundled and placed in the 2B scan bin with nursing notes, order sheets, lab, and
47:10x-ray results.
47:11Day shift needs completed T-sheets on every patient and to write on the board what tests are pending,
47:16so nothing falls through the cracks while we wait to come back online.
47:21Westbridge and Good Dominion have settled their cyber dispute.
47:25They paid the ransom?
47:26Yeah. Our IT department is confident in our defenses, so they will be rebooting everything soon.
47:32Slowly but surely.
47:33Okay, so when everything comes back on, all the residents have to do is scan all the completed paper charts
47:38and digitize them into the patient's EHRs before they go?
47:41I'm never getting out of this place.
47:44This means you're clear for takeoff.
47:47Nothing here we can't handle with night shift coming in.
47:50Yeah, right. I'm ready to go.
47:53Uh, hey, I told you I would get you up there, and I promise I'm not leaving until you're back
47:58and sent packing.
47:59Robbie, buddy, you got me to come in, got me to take my test. You don't gotta babysit me. That's
48:04why I have a nurse.
48:05What's your name, sweetheart?
48:06Nurse Vivi, sir.
48:07That's what I have the lovely nurse Vivi here.
48:09This will not take very long.
48:11Where have I heard that before?
48:15Hey, so, uh, this is it, huh?
48:18Uh, yeah. Don't let the place burn down.
48:24You know, in a previous life, I had a lot of friends who liked to see how close the edge
48:30was.
48:31As if it was a challenge they were called to meet.
48:35Trouble is, they all inevitably found it.
48:40Okay.
48:44I'm just picking up on a weird vibe from you today, is all.
48:47Yeah.
48:49It's been a weird day.
48:56You leaving?
48:57Uh, yeah.
48:58My shift is over, and I ain't getting paid to be here.
49:01Quite literally the opposite, in fact.
49:03Well, I-I-I don't know if you noticed, but we're sort of, uh, in disaster mode here still.
49:08We put in the extra time if we need it.
49:13You know 62% of VD docs report suffering from burnout?
49:17Painfully where?
49:19So, maybe all you lunatics need to learn how to set some boundaries.
49:23Like me.
49:25Well, see you tomorrow, Doc.
49:30Good luck in there.
49:31Sorry about the mess.
49:32Mess?
49:37Yeah.
49:38Yep.
49:40Head trauma.
49:41Unwitness fall from the warehouse catwalk where he works as a security guard.
49:46Oh, my God.
49:48Orlando.
49:49He left five hours ago.
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