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00:45Transcription by CastingWords
01:00She wants to go out on her own terms.
01:03Very few of us get to do that.
01:05We should pick up more patients.
01:12So Adam lives at Middle Hill?
01:13He lives in Middle Hill.
01:15And he's three years older than you?
01:16He's three years older than me.
01:19And he asked you to be his girlfriend six months ago?
01:24He asked me to be his girlfriend at game night, and I said yes.
01:30Come patient waiting for a doctor.
01:31Ready to go in 13.
01:32Okay, I'll be right there.
01:37Did Adam ask you if you wanted to have sex?
01:40I, Mel, I don't know if I can tell you.
01:43Of course you can tell me I'm your sister.
01:45Well, it's private.
01:47Look, it's just, it's really important that I know.
01:50Why?
01:50Because.
01:52Well, I can tell Dr. Langdon because Dr. Langdon is my doctor, but I don't think I can tell you.
01:59Becca, just tell me.
02:00Why are you yelling?
02:01I'm not yelling.
02:02It's just, look, it's really important that I know.
02:04You're definitely yelling.
02:05Becca.
02:05Maybe we should step outside for a minute.
02:08Why won't you tell me?
02:09Dr. King.
02:11Why don't you get to Mary?
02:16Sorry.
02:19Sorry.
02:25Hey, have you seen any of the x-ray techs around?
02:27Nope.
02:30Got an update for me?
02:31I'm just checking in.
02:33What are the chances of me getting out of here on time, do you think?
02:36It's up to you, Cap.
02:37We can handle this.
02:37Question is where you let us.
02:45Are you two getting along?
02:47I can play nice for another two hours.
02:52Kept calling me Doc.
02:54Didn't know he was the real Doc until a few months in.
02:57He was keeping a secret life from me.
03:00Where are we with his chest this way?
03:02X-rays are still six or seven behind.
03:05When's the last time you checked?
03:07Maybe ten minutes ago.
03:09Stay on them?
03:10Yeah.
03:10Come on, give the kid a break.
03:11It says here it takes an hour to get an x-ray.
03:14I'm the first person who's read this fucking thing all day.
03:19Don't get me started on those.
03:23How are you feeling?
03:25How are you feeling?
03:25I'm good.
03:28You know, I take Luxapro.
03:30It helps with panic attacks, not just depression.
03:32Promise?
03:33I'm fine.
03:35Sorry about that, Mrs. Torres.
03:37Are you okay?
03:38I thought you were going to pass out.
03:39Yep.
03:39All good.
03:40Let's just pick up where we left off.
03:44Mrs. Torres presents with one week of painful, swollen right calf.
03:48No trauma, no fever, no history of hypercoagulable state.
03:53However, she did take a 15-hour bus ride from Orlando to Pittsburgh last week.
03:57Mrs. Torres, we're concerned about a possible blood clot in your leg that can lead to serious
04:03complications.
04:04We need to do an ultrasound, but no need to worry.
04:07If it's positive, we can treat with a blood thinner.
04:10Well, if there's something I learned is to stop worrying.
04:13Can all your worries add a single moment to your life?
04:20Fresh in the lab, they said one's critical.
04:22They're supposed to call those up.
04:24I know, every time they try, the red phone's been busy.
04:25Jesus Christ, this was resulted 25 minutes ago.
04:29Sodium 112.
04:32Mohan, sprinkle some salt on your patient before he sees it.
04:36Where are we?
04:37Kidney stone patient's not obstructed.
04:39Just waiting on meds.
04:41Ortho's performing the replantation on our water slide trauma.
04:44Perforated diverticulitis patient Howard made it through surgery.
04:47And I'm calling the CYF resource navigator to see if we're getting anywhere with emergency
04:52foster care for baby Jane Doe.
04:54Other than that, labs and x-rays are way behind, but our golden girls are getting their steps in.
05:01Does Robbie usually leave as soon as his shift ends, or does he like to stick around for all the
05:06handoffs for night shift?
05:07Depends.
05:08He's usually pretty good about getting out of here.
05:14Shortness of breath and soft 16.
05:16He could totally decompensate.
05:19I'm hoping to catch another intubation before 7.
05:22One more gets me to 3 in my first week.
05:24Probably a record.
05:27I'm looking for an easy one.
05:30Shift ends in two hours.
05:33You're supposed to pick up the stable patients in order.
05:35Do you need a second opinion on that?
05:38No.
05:40Dr. McKay.
05:41Yeah?
05:42A girl named Kiki came into reception looking for you.
05:44Kiki?
05:45She said she'd be in the park.
05:46Yeah, great, thanks.
05:52Hey, I think the labs are back on your PID patient.
05:56Thanks.
05:58Is everything okay?
06:00Ah, fantastic.
06:06Langdon.
06:07I was kind of hoping I would never see him again.
06:10You know, maybe he's changed.
06:15When you got a sec, there's something...
06:17Santos!
06:18I need you to pick up food poisoning in 12.
06:21Yeah, sure, why not?
06:23What?
06:24No snark, no pushback?
06:26What have you done with Santos?
06:27Only two hours to go.
06:29I surrender.
06:31That's the spirit.
06:39How's Becca?
06:40She's good.
06:42I'm trying to call her a living community,
06:44but they are not picking up.
06:46Wake on.
06:48Because I don't know anything about this Adam person.
06:51I mean, they've been dating for six months,
06:53and I don't know anything.
06:56She never said anything about wanting a boyfriend
06:57or even liking anyone.
07:00That doesn't mean she hasn't thought about it.
07:02I don't want to think about my sister thinking about having sex.
07:05I mean, he used to say he didn't take advantage of her.
07:08Middle Hill just let it happen.
07:10Why didn't they tell me?
07:11Well, maybe they didn't know about it.
07:13Six months, they had to have known.
07:16Maybe it was a mistake choosing Middle Hill.
07:19I mean, we saw a lot of good places,
07:21but that is where Becca wanted to go.
07:24Are you Becca's legal guardian?
07:27No, I have durable power of attorney,
07:29but we did this thing called supportive decision-making
07:31where she can make her own decisions.
07:35There you go.
07:36This is different.
07:38Why?
07:39Because it is.
07:40I...
07:46My son, he's not moving.
07:59I got a hot and unresponsive child.
08:02I need a room, Dana.
08:03Trauma two.
08:05We need a core temp asap.
08:08Hi, I'm Dr. Al-Hashimi.
08:09Are you mom?
08:10Brenda Azar, Mindy.
08:11And this is...
08:12Micah?
08:13Has Micah been sick with a fever?
08:15No, he was fine all day.
08:17I found him in the car.
08:19Peoples are sluggish but reactive.
08:22No reaction to pain.
08:26Airway is Peyton with low tidal volume.
08:29Let's set up for intubation.
08:32Heart rate is 22 in 10 seconds.
08:33That's 132.
08:34Do you know his weight?
08:35No.
08:36Joy, the proslo?
08:37The what?
08:38The proslo tape gives us all the drug doses
08:40based on length.
08:41Assisting with ventilation.
08:42Somebody call respiratory.
08:44You said you just found him in the car?
08:45I was working in the garden
08:47while he rode his trike in the driveway.
08:49One minute he was there
08:50and then he wasn't.
08:51I thought he had gone into the house
08:53but I couldn't find him anywhere.
08:54He must have gotten tired
08:56and climbed in and fallen asleep.
08:59By the time I found him,
09:00I couldn't wake him up.
09:02How long was he in there?
09:04Maybe 15 minutes or 20.
09:06And the car was just unlocked?
09:08It's a safe neighborhood.
09:10Joy?
09:10Joy?
09:11Okay.
09:12So, you're going to want to start at the head.
09:17Measure the length.
09:18And then read it off.
09:20Approximate weight is 25 kilograms.
09:22250 bullets of LR.
09:24I have doses for rock and ketamine.
09:26Almost no tone.
09:27I can do this without meds.
09:28It's easy enough to bag.
09:30Let's wait for RT.
09:30When the temperature is this high,
09:32the muscles can lose their strength.
09:34So we're going to help him breathe with a tooth.
09:37Rectal temp is 105.5.
09:39Heat stroke.
09:40Ice packs for the groin and axilla.
09:41See if we have an Arctic sun that's not in use.
09:43We need all the ice we can get.
09:45And a pediatric body bag.
09:51Still waiting on your ketorolac pills.
09:53I will keep following up with the pharmacy.
09:54I told my son I would meet him at the park.
09:56We always watch the fireworks together.
09:57Sorry, Mr. Green.
09:58We won't forget about you.
09:59All right.
10:05Heard you had a heart attack.
10:06I did not have a heart attack.
10:09Hey, Sarah, how are you feeling?
10:11I am totally fine.
10:14I'm glad to hear it.
10:15Hey, do you mind watching my patients for five minutes?
10:17I have to step out for a sec.
10:19No problem.
10:19Ogilvy, you want to get some air?
10:22I've got a good case for you.
10:23Might an intubation be required?
10:26No.
10:27It's an unhoused patient I've treated on the street team.
10:41Hi, Becca.
10:43Hey.
10:54I'm sorry I yelled at you.
10:56I was just...
10:59surprised.
11:00The nurse said I can leave.
11:02Yeah, um...
11:03Can we just finish our conversation first?
11:05About what?
11:07Look, I know you don't have to tell me anything.
11:10I just...
11:11kind of...
11:13you'd want to.
11:17When Adam asked you to have sex...
11:19He didn't ask me.
11:20I asked him.
11:23So you didn't pressure...
11:25No.
11:26So you wanted to have...
11:28sex?
11:30I wanted to have sex.
11:31Sex is great.
11:33We talked about sex in my mind and body class.
11:35I told my therapist, too.
11:39Okay, the pancreatitis in North 3 is still waiting for you.
11:42Okay.
11:43Can I go now?
11:44Uh, just one second.
11:45Uh, I'll be right there.
11:46I'm just going to walk my sister out.
11:54Yep, sorry.
11:54I'm right behind you.
11:58Curtis Larson, 42.
12:00Called to the golf course for combative behavior with his buddies.
12:03No signs of trauma, just alcohol on the breath.
12:05Seems to have calmed down a bit.
12:07He was fighting us so hard we had to give four milligrams of Versed to get vitals in a line.
12:11Good BP.
12:12Pulse Ox 99 on two liters.
12:14Between the booze and the Versed, he'll be sleeping it off for a while.
12:16Central 14, guys.
12:25Roxy's gone.
12:27Is the husband still in there with her?
12:29Yeah, she bodies with him.
12:31She needs a death note.
12:32I can't find McKay.
12:34Okay, I'll be right there.
12:35Okay.
12:36Have you seen McKay anywhere?
12:38No.
12:42Have you ever seen a xylazine wound?
12:44No.
12:45But you know what it is.
12:46Yes.
12:47Then you know its street name is Trank and this shit is nasty and can lead to skin necrosis.
12:52I've never understood drug addiction.
12:54Well, you need to try.
12:57A little empathy goes a long way in this job.
12:59I am empathetic.
13:00I don't understand how an intelligent person allows themselves.
13:03Can make mistakes, heal themselves, take away the pain, hide from the abuse.
13:08We're healers, not judges.
13:11Shouldn't we go to the crosswalk?
13:13No?
13:14Okay.
13:15Okay, this is what we're doing.
13:16I see organ donation in my future.
13:19Sorry.
13:19No.
13:27Shut up.
14:15How's it going, Kiki?
14:18Who's this?
14:19Oh, it's Uncle V. He's a student doctor.
14:22He's here to help me.
14:23What's happening with you?
14:26My leg's getting stinky again.
14:28Yeah.
14:28Okay, let's take a look.
14:35Is that an injection site?
14:37No.
14:38No, xyloxine wounds can show up anywhere.
14:41You, uh, you still using Trink?
14:43Sometimes.
14:45Sometimes it's not good, Kiki.
14:46You know, it's nasty stuff.
14:48I'm trying to quit.
14:49How are you going about that?
14:51I go to meetings, sometimes.
14:53Meetings are good.
14:55And not you seems even better.
15:00Okay, what's your plan, Uncle V?
15:06Uncle V, you okay?
15:08Yes.
15:08Yeah?
15:09Absolutely.
15:10Uh, my plan is clean with saline antibiotics.
15:16Meta, honey, to break down the eschar.
15:18And then?
15:19Um, redress with Xeroform and an ABD pattern acrylics wrap.
15:24Yeah, that will do it.
15:25You need to change this dressing every day, Kiki, okay?
15:28I don't think I can do that.
15:30We'll give you all the supplies you could do it yourself.
15:32You won't even have to come back here.
15:34Yeah.
15:35Okay.
15:36Okay.
15:38Okay, pass the saline.
15:49Hey, I'm Dr. Whitaker.
15:51This is Dr. Santos.
15:53Roberto.
15:54Like Roberto Clemente.
15:56Oh, sorry.
15:57I don't know who that is.
16:00Pirates Hall of Famer, Roberto Clemente.
16:01Hey, you don't watch baseball.
16:05Well, I am from Nebraska.
16:07We went to a few Storm Chasers games as a kid.
16:10That's about it.
16:11No major league team, you know.
16:14All right, what happened to your elbow?
16:17O'Neal Cruz hits a walk-off tater, right?
16:20And I, I, I catch it, you know,
16:23but then somebody fell on top of me.
16:25And I, I think I heard a pop,
16:26but hard to tell with all the screaming.
16:28That sounds pretty dangerous.
16:30You're not one of those guys
16:31who steals balls from kids, are you?
16:34I didn't steal this.
16:35I wouldn't do that.
16:36I would never do that.
16:36I would never do that.
16:39Can you move your fingers for me?
16:43And the thumb?
16:47Uh, no.
16:48Okay, yeah, you know what?
16:49We can put that in a belongings.
16:50Ha, ha, ha, ha.
16:51No, thanks.
16:51I, um, I think I will hold on to this.
16:54Okay, uh, you know what?
16:55We can put you in a sling,
16:57and then you can hold on to the ball
16:59while we examine you.
17:02Okay, yeah, I guess.
17:04Uh, you're gonna throw in an IV
17:07and start with four morphine?
17:08No, no, no, no.
17:09I don't want to be knocked out.
17:11No, it's a low dose.
17:12You won't be knocked out.
17:13It'll just help with the pain.
17:14Might make you a little drowsy.
17:15Oh, I need to stay alert.
17:18Okay.
17:19Uh, we will order you an X-ray.
17:22Just please let us know
17:23if you change your mind.
17:25Okay, yeah.
17:30Temp is down to 103.5.
17:33Long way to 98.6.
17:35102, we take him off the ice.
17:36Otherwise, we can overshoot
17:38and cause hypothermia.
17:39I put in orders for CK.
17:41What does the CK tell us, Julie?
17:43Wrapped over muscle breakdown
17:45can take out the kidneys.
17:46More concerned about his brain.
17:54It's two times a day for three days
17:56and a nurse can push it up.
17:58Dr. Langdon already told me.
18:00Okay, bye, Mel.
18:02I'll see you, uh, I'll see you at fireworks.
18:04Oh, I was going to watch fireworks
18:06with Adam and his parents.
18:09Where?
18:10At the park.
18:11They're picking us up.
18:12They go every year.
18:14We always watch the fireworks together.
18:15I have your headphones.
18:16Adam said he has extra.
18:19Okay, well, um,
18:19do you have Adam's parents' phone number?
18:21Why?
18:23In case I need to reach them.
18:27I want to go now.
18:28Well, I guess I could...
18:29Bye now.
18:30I guess I could...
18:33So how long have you been part
18:34of the street team?
18:35Oh, about a year.
18:37And why do you do it?
18:39Oh, most of these unhoused folks
18:42feel abandoned.
18:42Sorry.
18:43They, uh, don't trust easily.
18:45Meeting them where they're at
18:46makes a big difference.
18:48I've been trying to get Kiki
18:49to come by for months.
18:51You should, uh, volunteer.
18:54It's great training.
18:55Street team could always use the help.
18:58Yeah?
18:58Uh, maybe.
19:01Hey, how did the deposition go?
19:04Um, I'm glad it's over.
19:06But I didn't feel good about it
19:08at all.
19:09You know, I'm still not supposed
19:10to talk about it.
19:11No, but you can talk about
19:12how you feel.
19:13Who do you have to talk to
19:14when things aren't going so good?
19:15Friends?
19:16Family?
19:17Actually, I don't really have...
19:18Hey, McKay, where have you been?
19:20Oh, I, uh, I stepped out.
19:22Did you tell anybody?
19:24I was, uh, treating a young woman
19:25I met on the street team.
19:27Did she check in as a patient?
19:29No.
19:29We treated her in the park.
19:32We?
19:35I, uh, I took Opal V.
19:37Oh, okay, so you treated her
19:39outside the ED on PTMC's diamond.
19:41You brought a medical student with you.
19:43Right when we're in the middle
19:44of crisis mode
19:44and we need all hands on deck.
19:46I'm gone for ten minutes, tops.
19:47When you're here,
19:47I need you to be here.
19:49And while you stepped out,
19:50Roxy died.
19:53What?
19:58Oh, man, I'm sorry.
20:01I didn't think she would be gone
20:03that quickly.
20:07Excuse me?
20:08Um, she took a nasty fall.
20:10Her shoulder screamed in pain
20:12when we put the ties on.
20:13Hello, I'm Dr. Rabinovich.
20:14This is Dr. McKay.
20:15Agents Correa and Russo.
20:18She needs to be looked at
20:19before we process her.
20:20What's your name, ma'am?
20:23Anita.
20:25We're gonna take care of you, okay?
20:27You said she fell?
20:29Well, we'll conduct in a sleep
20:30at a restaurant.
20:31Right when the kitchen took off,
20:33she was shoved down some alley stairs.
20:35Right.
20:36Could be a rotator cuff tear
20:38and AC separation.
20:40Let's put her in a chair,
20:41find her room.
20:42South 19.
20:48Yeah, just a few.
20:51Curtis.
20:52Dude, what happened?
20:54Medics had to sedate him
20:55in the transport.
20:57Didn't realize he was
20:58such an angry drunk.
20:59So you've seen him drunk before?
21:00Sure.
21:01Yeah, but never like this.
21:03He tried to pick a fight
21:04with the guys in front of us.
21:05He said they were going too slow.
21:06That's what they call the cops.
21:08Would he have taken drugs?
21:10If he did,
21:10they were not the performance
21:11enhancing kind.
21:13He shot a 112.
21:16We'll order labs.
21:18See what we can figure out.
21:20Uh, any family we can contact?
21:22I have no idea.
21:22We don't talk about that shit.
21:23How long is he going to be here?
21:25At least three or four hours
21:26until he sobers up.
21:28Cool.
21:28Is it okay if I just come back
21:29around nine?
21:30Sure.
21:31Great, thanks.
21:36Need those removed
21:36so I can check her vital signs.
21:42Okay, tender over the AC.
21:51Can you, uh,
21:52lift your right arm up
21:53above your shoulder
21:54like this?
22:01Heart rate's 110,
22:02pulse ox 98.
22:04Painful heart test is positive.
22:06Try a drop arm test?
22:07I'm going to lift your arm up.
22:10And you just lower it
22:11as slowly as you can, okay?
22:16Positive drop arm test.
22:17What's that mean?
22:18That means that she's going to
22:19require an x-ray.
22:20It's most likely a rotator cuff tear,
22:22which sometimes can come
22:23with a fracture.
22:24We need an x-ray to rule it out.
22:25How long is that going to take?
22:27Our computers are down today.
22:29Everything's moving a little slower than usual,
22:30but we will fast track her.
22:32Is there anyone you want us to call,
22:34Pernita?
22:34No phone calls.
22:36Got a bathroom.
22:47Right there.
22:50I do not want these guys here
22:51any longer than they need to be,
22:53so let's find x-ray
22:53and fast track this one.
22:54Your family might be worried.
22:56Maybe I can call them.
22:57No, no, no.
22:57Just stay with her.
22:58Make sure she has everything she needs.
22:59We treat her injury,
23:00and that's it.
23:01Okay.
23:02Jaime Guerrero to window three, please.
23:06Jaime Guerrero to window three.
23:08Okay.
23:17Jaime Guerrero to window three.
23:34I've got a lateral.
23:36Best I could.
23:38Okay.
23:38Posterior dislocation.
23:39No fracture.
23:40Thanks.
23:41Mm-hmm.
23:42Okay.
23:43Good news, Roberto.
23:44No broken bones,
23:45but the elbow joint is dislocated.
23:47And we need to get the ball back in the socket.
23:49The best way is with sedation and pain meds.
23:52No, no, no.
23:52I know you said no morphine,
23:53but we can put local anesthetic into the joint
23:56to block the pain.
23:57That way you won't be sedated at all.
23:58No, thanks, Doc.
24:00Just give me a bullet to bite on her.
24:07The Red Joe's over in Green Tree.
24:09Oh, man.
24:09I love that place.
24:11I want one of the employees.
24:12So ICE is here.
24:13People are leaving the waiting room.
24:14Ten patients already.
24:15What should I do?
24:16Just tell them the truth
24:17and hope they stay
24:17for the treatment that they need.
24:19Martha took off.
24:20I'm going to call them when I get a chance.
24:21Oh, shit.
24:22Yeah, make sure she's okay.
24:23Will you call the EBS department, too,
24:25and let them know?
24:25Will do.
24:26All right, hold down the fort.
24:27Let us know if you need backup.
24:28You got it.
24:29Can't we just tell the agents to fuck off?
24:32They are not going to leave without their patient.
24:34We just need to treat her.
24:36Even if she's undocumented?
24:37All patients, regardless of immigration status,
24:40have the right to emergency care under MTALA.
24:43Pranita is next in line for X-ray.
24:45Okay, good.
24:49Propofol is down to 100 mics per minute.
24:51Tempest 101.8.
24:53Great.
24:53Let's get him off the ice.
24:55Okay.
24:55Hands on my count.
24:58One, two, three.
25:01What's the latest?
25:03Uh, we got some arm movement.
25:06That's a good sign.
25:10And pupils are minimally reactive.
25:14Planters are down going.
25:16All encouraging signs.
25:21Any luck getting a lawyer for a detainee?
25:23Uh, no.
25:24Keep me posted?
25:26Yeah.
25:33It's a pretty bracelet.
25:36My daughter made it for me.
25:40She doesn't know what I am.
25:41I just wanted to know that I'm okay.
25:46You seriously won't let her make a phone call?
25:48Not until she's processed.
25:51Unbelievable.
25:53Thanks, and just let me know when she gets back.
25:57Uh, one other thing.
25:58Uh, do you have a resident named Adam?
26:01I was wondering if I could get his parents' phone number.
26:03Nope.
26:04I...
26:04Red phone is for emergencies only.
26:06This is kind of an emergency.
26:09Sorry.
26:10Bye.
26:12Hey, Mel, we need an R3 to supervise a reduction in North 4.
26:15Are you free?
26:16Uh, I guess.
26:18Should we move the deceased woman in Central 9 to viewing?
26:22Uh, no.
26:23Let's leave the husband in there for a little while longer.
26:25We need the room.
26:26We're not moving her yet.
26:28Okay.
26:29Sorry.
26:30We can do a room check.
26:32Kate's ICU says they'll have the bed soon.
26:35Okay.
26:41So, what do we think?
26:43About what?
26:44The mom of our heat stroke kid.
26:47Uh, that is not our job.
26:48That is what CYF is for.
26:50So, you think it was on purpose?
26:52No, I did not say that.
26:54I just don't buy it.
26:55She lost her kid at home?
26:57How does she just look?
26:58She looks guilty.
26:59Has anyone seen her cry?
27:02People don't always respond to trauma the way you expect them to.
27:05Stay focused on the kid.
27:12BP78042, SATS87.
27:13You having some pain again, Mr. Green?
27:16Mr. Green?
27:17This one's yours?
27:18Yeah.
27:19Uh, kidney stone.
27:19Possible vasovagal.
27:20Yeah, I assume that we need some help here.
27:22Does he have an IV?
27:23No, he didn't need one.
27:26Hypotensive and hypoxic.
27:28Clear trauma room?
27:29Yes.
27:31He was just waiting on his discharge meds.
27:34Pain-free.
27:36A few more patients are going from chair south 15 to cough 2.
27:40History of renal colic, heme-positive urine, BP crashing.
27:43Heme-positive urine doesn't always mean kidney stone.
27:46Two anticubital lines, biggest ones we've got.
27:48E-fast.
27:49Let's get two units of whole blood hung, please.
27:53Good.
27:55Who worked up this patient?
27:57I did, I did.
27:58Ultrasound showed dilated ureter and mild left hydronephrosis consistent with this history of renal colic.
28:04What about the aorta?
28:05I didn't look at the aorta.
28:07What did you present to?
28:09Dr. Mohan?
28:09You said the rest of the ultrasound was normal.
28:11I meant that the other kidney was wrong.
28:15Eight centimeter triple A with massive free fluid.
28:17Perhaps you don't have any reason he's bleeding out.
28:19Okay, go with the MTP.
28:2016 gauge in the left AC, two units, whole blood on the infuser.
28:26Assisting ventilations.
28:27Rest, diagonal.
28:29Okay, who wants to intubate?
28:33Your body?
28:34Sure.
28:35Get a call for six more units of whole blood.
28:36You said it'd be a call surgery.
28:38If we stay ahead of him, we might get him up to the oar.
28:41Here we go.
28:56We're lightening up his sedation to see if he has any purposeful movement.
29:00If so, that will be an encouraging sign.
29:03He'll be back tomorrow?
29:06There's no certainty as to how much recovery Michael will have.
29:11His response over the next 24 hours will tell.
29:14There is a chance of cognitive impairments.
29:19But also a chance of meaningful recovery.
29:22Dr. Alashimi, the patient in 2022.
29:27I will be right back.
29:45I'm in.
29:46Bag him.
29:47Nicely done.
29:47Good job.
29:48Unit 3 is up and running.
29:49I've got a 16 gauge EJ.
29:51That one goes on the rapid infuser.
29:52Good and tidal waveform.
29:56Strong radio pulse.
29:57That's a very good sign.
29:58BP's up.
29:5886 over 52.
30:00Some progress.
30:01About 2 grams TXA?
30:02Yeah.
30:03What else do we give after 4 units of blood?
30:08Calcium gluconate to counteract hypercalcemia.
30:10Cloud prevents the strain anticoagulant.
30:12Why don't you see if you can't squeeze a unit into that peripheral line?
30:19Should somebody place a central line?
30:21Long central line is slower than short large-bore peripheral.
30:23The flow is proportional to the 4th power of the radius.
30:27Physics.
30:31Okay.
30:33Bite down on this.
30:36Okay.
30:37I'm stabilizing the humerus.
30:39All right.
30:39After I supinate with traction, Dr. Whittaker will apply downward pressure on the proximal forearm.
30:46Okay.
30:46This is going to hurt like hell, Roberto.
30:491, 2, 3.
30:51Ah!
30:52Ah!
30:52Ah!
30:53Okay.
30:54And then, um, flexing at the elbow.
30:56Ah!
31:02This dolly's down to 68.
31:04Minutes 5 and 6 are up and running.
31:08I'm here for Garcia.
31:09Vascular can't come down.
31:11Triple A with hemorrhage he shot.
31:12Most of these die in the field.
31:13He was stable, presented with a history of renal colic.
31:16And nobody saw the triple A on ultrasound?
31:18Was this you?
31:19No.
31:21It was me.
31:23Looks like sinus attack.
31:25Nope.
31:25Lost the pulse.
31:26It's P.E.A.
31:26Bag him.
31:27Ogilvy, start compressions.
31:28We're having a hard time staying out of the blood loss here.
31:30Stereo gloves.
31:31Prep for a thoracotomy.
31:32Dr. Gervati, why don't you glove up and show Dr. Shamsie why you belong in the ED?
31:37We can cross-temp the aorta.
31:39We can stop the blood flow from below the diaphragm.
31:41We can try to use the heart and the brain.
31:46Pen blade.
31:46I'll get it in there.
31:54I'll get it in there.
31:55May I have scissors?
32:04Brick spreader?
32:11let me know when you have enough exposure
32:20right there
32:24can you mean suction no there's no blood in the chest it's all in the belly yeah keep squeezing
32:33it has clamped your heart is empty okay javadi get in there internal compressions go
32:43put two more units on the rabbit infuser please they'll be unit seven and eight
32:54all right neuro is intact so we'll do a posterior splint
32:57a sling and an ortho referral you know i'm actually kind of impressed you did that without
33:01pay meds definitely worth it you know last year i caught mccutcheon's 300th career homer
33:06but uh another fan stole it from me i promised myself i would never let that happen again
33:13ludicare can you write the procedure now yeah you already filled in the t-sheets of me well i'm
33:17already here yeah i kind of had everything else so can you just fill out the trash should probably
33:21finish it well okay someone did this i don't i don't i don't care who
33:27yeah
33:37where's mrs azar mendy she stepped out stepped out
33:47feels like the heart's filling back up let's have a peek
33:52looks good really good strong radial pulse
33:58moist lap pads prep for transfer systolic a 94th sylvester for can i go with you
34:06he's my patient okay by me bring two extra units
34:17ice is in the building word travels fast yeah we have a detainee with a rotator cuff
34:22tap two of our nurses went home they have temporary protected status but they just don't feel safe
34:30um i'm really sorry dr robbie i should have checked the air too easy one to miss
34:34got a heartbeat back though so still smoke
34:41i'm sorry too i i should have asked ogilvy if he'd checked the aorta it's it's my fault
34:46it is you're the senior resident you don't look to others others look to you
34:51i know i'm really sorry this is what happens when you bring your personal life into work
34:55the patient almost died i know
34:58you have to think of these walls like a force field you cannot let anything in
35:02your mother's not in here she is out there you keep everything out there that is the key that
35:06is the difference between the best doctors and the ones that don't make it you're right
35:13maybe i just don't belong here
35:19pranita's x-ray results no fracture okay i'll just have jesse fitter for her sling i guess and
35:25we have to discharge her to the immigration guys i'm afraid so
35:32okay time for you to go i'll just happen to chat when speeders here
35:37you can't see how busy this department is right you've been nothing but a distraction and a
35:41disruption since you've been here i'm already short staffed and i just lost five nurses and
35:45half my environmental services team because you walked in you know patients come in here for help
35:50right because they're either sick or they're injured and documented or undocumented they have a right
35:55to emergency care tb measles fractures none of it's getting treated because everybody's too scared
36:00to come in but then they end up here anyway but then it's too fucking late so please for the
36:03love of
36:03god can you just go wait over there in the room with your detainees so i don't lose any more
36:07patients or staff no problem doc
36:22this is astor mendy
36:27brenda where are you going
36:30brenda
36:36okay okay that's okay let's get you back inside to your son that's okay that's okay
36:45come on she's cleared to go
36:49hold on she needs to sleep let's only take a minute we're leaving hey man you're hurting her
36:56jesus christ what's going on now
37:15don't say anything you don't have to say anything they can't make you say anything we'll get you
37:18an attorney i promise we'll get you out call the hospital attorney again can you at least tell us
37:24where you're taking is there a detention center near pittsburgh that's got to be where they're going
37:29right could be hours before he's processed i'll stay on it what can we do uh hey javadi javadi
37:37please come back everybody just go check on your patients assure them tell them what happened but
37:43please everybody get back to work who's gonna take jesse's patients i can do it d thanks perla
37:49hey you okay yeah i'm okay you okay yeah the lawyers are tied up with the cyber attacks upstairs
37:54they probably won't come down for a while
37:58it was the latest with the heat stroke kit i sent him up the pizza i see you
38:06what's going on i found her outside wandering into the street she almost got hit by a truck
38:12i think it was intentional christ almighty i told nurse kim not to let her out of her site we
38:17need to
38:17call a 302 and observe her danger yourself is she gonna be able to see her kid no if she's
38:22not in
38:22involuntary cycle what happens if he's ready to be discharged before she is does she have a
38:27partner or a relative we can call i can find out why don't you and i talk to her together
38:31sure
38:32i just need to check on a patient and i will meet you there
38:52hey emma have you seen this patient oh i i haven't oh she took off when those ice guys arrested
38:58your
39:00nurse
39:00i tried to get him to help me in the garden but he just wanted to ride his trike
39:13so i let him every time i looked over he was just riding around
39:27have you ever thought about hurting yourself
39:34cbc and blood alcohol are back in your goal for curtis larson 0.14
39:38copy that okay we'll wait for the other labs he'll need to sleep it off in the meantime
39:45hey gabriel can you wait up a sec do you have duke eakin's chest x-ray yeah how's it look
39:50radiologist
39:51still needs to read it can you pull it up for me
40:00shit i gotta call the funeral home start making arrangements you could slow down take some time
40:05time for yourself how you doing oh you know been better i spend so much time with these people
40:13you've become a part of their family it's not like it is here where patients come and go
40:16don't stay for the night shift i got reinforcements coming in i'd rather work i don't know if i want
40:21to sit with this at home try for once just listen to me take the night off i'll cover for
40:25you until i can find someone else to come in now okay you think she's gonna be okay
40:39i don't know i just hope she can forgive herself
40:50i've noticed some tension between you and dr santos you two have history uh yeah she doesn't
40:57like me very much
41:03uh we worked together one time i was a pretty big asshole she called me out on some things that
41:10i wasn't ready to face and i overreacted i'm gonna talk to her i just haven't found right time
41:20good
41:32oh you might be in here what's going on
41:36the deposition my sister coming in it's been a day it's good deposition
41:44your sister okay
41:47yeah it's just a uti so mental clear that's good
41:54she's a boyfriend
41:56she didn't tell me about
41:59and other things she didn't tell me about maybe she didn't know how she's having sex
42:06great sex
42:09and she lied to me i mean she she lied to my face for six months my sister is a
42:14fucking liar
42:16she's just cursed
42:20it's how i feel
42:22well kid
42:24i say this with love
42:27people got their own reasons for keeping secrets
42:30most times it's got nothing to do with you
42:32i've seen elf 164 times
42:35becca loves elf so we watch elf
42:38and she's got everything and now she's got
42:40a boyfriend and they're gonna fall in love
42:42and they're gonna get married and i'm gonna be completely alone
42:49i feel good to say that out loud
42:53no
42:56mel
42:58you're a good egg
43:00but this is not about you
43:03it was a long time ago
43:05i quit feeling sorry for myself
43:06now come on
43:07pity party's over
43:17okay so this is your heart
43:19and these are your lungs
43:21they look okay
43:22yeah it's this part right here
43:24this space right between your lungs
43:26it's called the mediastinum
43:27and it is enlarged
43:29it is too wide
43:30from what
43:32can't really tell from a plain film
43:34could be any number of things
43:35yeah stop the bullshit
43:37it could be an enlarged thyroid
43:39it could be enlarged lymph nodes from an infection
43:43it could possibly be a tumor
43:47you think i have lung cancer
43:48no i don't see that
43:51the cancer of the lymph nodes is called lymphoma
43:53and there are a lot of diseases of the aorta
43:55which is this big artery that comes off the heart
43:57which can get enlarged because of weak spot in the wall
44:00kind of like a bubble in a tire
44:03they can have a blowout
44:05and the only way to make sure
44:07is to do a ct scan of your chest
44:11today
44:12how long does that take
44:15a few hours
44:16a couple of hours
44:19you still gonna be here
44:25yeah
44:26i would not feel good about riding if i rushed this
44:33this is important
44:39hey
44:41i think the uh labs are back on your copd patient
44:45saw him in the rack
44:46thanks
44:48uh
44:48look
44:49i don't know how to say this
44:51um
44:55i know you don't like me
44:57and that's fine
44:58you don't have to
44:59i just
45:00i want to say i'm sorry
45:02for being an asshole on your first day
45:04that was completely inappropriate
45:06and if i could
45:08take back what happened
45:09i would
45:10but i can't
45:13okay
45:17hey i'm sorry
45:18i just
45:19i don't buy it
45:20everyone thinks you're just an addict
45:22who went to rehab
45:22and you've convinced everyone here
45:24that you've changed
45:25and you're owning up to your mistakes
45:27and they welcome you back with open arms
45:28because you're still the golden boy
45:30and i think it's bullshit
45:33i'm genuinely sorry
45:34and i can promise you
45:36i have faced my fair share of punishment for what i did
45:38you fucking stole drugs from the hospital
45:40only three people here actually know that
45:42have you told anyone else what you did
45:44have you
45:45look
45:45i'm just trying to get through my first day back
45:47you shouldn't even be here
45:48i should have reported you to the state medical board
45:51you should have lost your license and gone to prison
45:53you don't know what i've been through
45:54what you've been through
45:55my wife threatened to divorce me okay
45:57i almost lost my kid
45:58yeah that's what happens when you fuck up
46:03you don't have to accept my apology
46:05i just
46:05i wanted to say it
46:07okay
46:08you really want to atone for your sins
46:11tell everyone here you stole drugs
46:12and got kicked out of the ed because of it
46:14until then
46:15stay out of my way
46:29what the fuck
46:31i'm just checking your vital sign
46:33oh
46:34where am i
46:36what are you doing to me
46:38ah
46:39oh
46:40oh
46:45oh
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