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13:08Il y a un therapist upstairs.
13:09Oui, oui, oui.
13:10Comment ça va ?
13:11Wow.
13:12Excellent.
13:16Have you heard from David ?
13:17No.
13:18David, c'est comme un therapist.
13:26Do you think that he's still going to pick you up today ?
13:28I think so.
13:29Okay, well...
13:29Robbie, here they come.
13:31Okay, well, you're medically cleared,
13:33so why don't you stay here for a little while longer
13:34in the hopes that he does ?
13:36Ah, I still would like him to talk to somebody.
13:38Hey, Perla, this is Theresa.
13:39She's a friend of mine,
13:39so I expect concierge service, yes ?
13:41VIP treatment.
13:43Thank you.
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.
13:49Walter Purnell, 52,
13:50walking his dog in the crosswalk,
13:51got struck by a Chevy Impala at low velocity.
13:54Ambulatory on scene, no KO,
13:56no neck, chest, or belly pain.
13:57Good vitals.
13:58Whoa, major road rash.
14:00Yeah, the car didn't hit me so much as throw me,
14:02but I slid for a good 10 feet.
14:04Of course, this is the first day I've worn shorts
14:06I'll have in here.
14:07No deformity at the knee or ankle.
14:09Distal pulses intact.
14:11Bore 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,
14:17who thankfully barked and warned me
14:19so I had half a second to try and move out of the way.
14:21Crosby, you're a hero.
14:23Donnie, you think you can find a milk bone
14:24for our little lifesaver here in the doctor's lounge?
14:26Absolutely.
14:27I'll take good care of you.
14:28Uh, can 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.
14:32Is that the driver?
14:3328-year-old lady had her seatbelt on,
14:36clipped the guy with the dog
14:37and went straight into a telephone pole.
14:38Bloods from a scalp lap.
14:40Also completed 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, you in any pain right now?
14:48Yeah, I can't go hurt.
14:50What does it say?
14:51She was driving erratically before the crash.
14:53No ETOH on her breath.
14:54Maybe drugs?
14:55Core tabs, 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 in South 20 needs a doctor.
15:07You 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
15:19and altered mental status.
15:20Me, 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.
15:34Beagles are equal and reactive.
15:36Paula, do you know what today's date is?
15:40Stats, 94%.
15:41How 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.
15:48No mark of 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.
15:57I'd 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.
16:05Make 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, we 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.
16:30It's a 10-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.
16:46You sure?
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 and it 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?
17:47Maybe Kiara has a social services card to play.
17:49She was by trauma one last I saw her.
17:51Brilliant.
17:52Brilliant.
17:53Thank you.
17:53That's why I'm here.
17:55To 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.
18:20I 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.
18:29Oh, great dogs.
18:31Determined, courageous, love to dig.
18:33Who's he named for, Sidney or David?
18:35David.
18:36Still my Sunday morning soundtrack.
18:38Oh.
18:38Uh, sorry.
18:39Um, yeah, 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, but let's get an x-ray just to be
18:48sure.
18:49Some more morphine?
18:50You're a wonderfully human being.
18:51Let's start with lead.
18:52No more than 30 cc.
18:53We're gonna, we're gonna try a topical anesthetic to numb the raw skin before we start picking
18:58out 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.
19:12I'll let him do it.
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 10 days ago.
19:24Normal vaginal delivery, no complications.
19:28Pregnancy test stayed positive for a few weeks.
19:30So we good to go?
19:31Good to go.
19:32We'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.
19:47Think it has something to do with the crash?
19:49Yes, no, maybe.
19:51Ask me again after I've had the scans, labs, and talk screen.
19:58Okay, um, so I 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 watch the other things.
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.
20:19We'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?
20:26I'll give Piper the sample cup and send it 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.
20:32To say what exactly?
20:34I don't know.
20:36It just be another voice saying, I see you in danger?
20:39There are limits to what we can legally do, but I can try to talk to her.
20:43Thank you.
20:46Hi, it's Dr. McKay again.
20:48Can I come in?
20:52Sorry.
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 ring is all over the place.
21:22These names.
21:23BMW 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 the vitals are stabilized.
21:35Another four of Ativan and Peppergram pepper.
21:37I don't think this is a CNS problem.
21:40She needs saline.
21:42We don't have her labs back 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.
21:54Just drop 100 cc's of 3% and have it ready, okay?
21:58Do it.
21:58And Peppergram pepper, now.
22:14Start the cap route, please.
22:15It's not going to help.
22:17Problem one.
22:18What are you doing?
22:20Got it.
22:21Thanks.
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, but Dr. Mohan had an excellent idea
22:54to treat for hypernatremia even 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 a very clear understanding
23:10of what her role is here and how she's expected to function.
23:13Dr. Langdon.
23:14Dr. Santos.
23:16When I say doctor in such a fashion, to draw attention to the ridiculous fact that you
23:21have enjoyed that title for, what, 90 days?
23:24So, yeah, I'm confused.
23:26Is it hubris or ignorance that makes you think that you know more than other residents that
23:32have two to three years more experience and have helped thousands more patients in the
23:36emergency department than you have?
23:38Not to mention the over 500 hours of advanced training with lectures in simulation labs with
23:44senior faculty instruction.
23:46It doesn't matter.
23:47Stupid or arrogant, you need to realize that you are a beginner, which means your job is
23:52to shut up, listen, and learn.
23:53Because so far today, the only thing you have been successful at is proving repeatedly that
23:57you 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...
24:21Stop talking.
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 are effective teaching tools?
24:30Let me just tell you, harassment has zero educational value.
24:33You feeling upset?
24:34She's getting under your skin?
24:35Check yourself.
24:36Take 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 sorry.
24:44It won't happen again.
24:45Where's your other one?
24:46Where's Mel?
24:47She's taking a break.
24:48Yeah, well, maybe go find her and see if you 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.
25:22They're, you know, 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.
25:49I 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.
26:10Why 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.
26:19That's 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.
26:48I'm sorry.
26:49It's okay.
26:50Honestly, really, it's okay.
26:53I appreciate the apology.
27:02This must be Crosby.
27:05I know 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.
27:15Thank you.
27:17So, how are you doing?
27:20Um, good.
27:22Better.
27:23Yeah?
27:25It's, I mean, it's just...
27:28It's the, um...
27:29The little girl and the sister is just...
27:32Too close to home.
27:34The things we do are hard.
27:36Yeah.
27:37You'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, you're a sensitive person.
27:56This, this is a tough place for sensitive people, but we need them badly.
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.
28:27South 20.
28:29Make sure you close the door behind you.
28:31Don't want Crosby getting out.
28:33Yeah, no, 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.
28:49Um, can I ask you something?
28:52That's why I'm here.
28:53Um, yeah, I was just wondering what the nurses do after their shifts.
28:58In terms of what?
28:59Um, you and they ever, like, go out together.
29:01Or, like, hang out to decompress after a shift, do you think?
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, comfy sweats.
29:16Eating 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 appeal.
29:29Um, I was just asking because,
29:31you know, since we've worked together,
29:34maybe we could grab a coffee together sometime
29:36and could, like, help me get the lay of the land,
29:39so to speak.
29:42You asking him out?
29:43No.
29:44What?
29:44No, no.
29:45It's just that I'm, I'm, I'm, I'm new here.
29:47So I just thought, thought that...
29:48I don't date people in the workplace.
29:50It'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
30:02and you, like, have everything so dialed in
30:03and that you would be, like, a valuable resource.
30:05But, um, no, no.
30:06I just really just figured it out on my own.
30:11No shortcuts here.
30:14How do I train you, Earl?
30:17Huh?
30:17So you rang it yourself and had a sandwich?
30:19Feel like I'm washing around, come.
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.
30:40You okay?
30:42I feel ridiculous.
30:44Spoken, like, two complete sentences in the last half hour
30:48and both of them have made me sound even more imbecilate than the incomplete ones.
30:53You attribute that, too.
30:56It's like my parents once took me skiing for Christmas in Utah
30:59and from the moment I got off the plane, 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.
31:15Dizzy and panting.
31:18Mateo's like a human, Utah.
31:20Ha!
31:22Oh, I mean, 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.
31:33I'm not back in there.
31:35I'm not even going to tell you why.
31:37How's she doing?
31:38Still with some thoracic 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, sternum 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.
32:20Sorry, I'm a little out of here.
32:21Still tachycardic 115, VPs 124 over 78.
32:25No bleeding anywhere on the CT.
32:27Chest and abdomen clear apart from the sternum fracture.
32:30He'll probably still tachycardic from the fracture pain.
32:32I'm not smoking my grease.
32:33Let's try for morphine.
32:35Paula, we're going to give you some pain meds.
32:37Let me know if it helps, okay?
32:40Mr. Pernell, you are in luck.
32:41If 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, something 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.
33:05What 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.
33:30Huh?
33:31Hello?
33:32Can you hear me now?
33:33Huh?
33:34Hello?
33:35Whoa, whoa, whoa.
33:35Sir, sir, what is the issue?
33:37Same 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.
33:46For instance, if it comes back elevated, that could indicate a silent heart attack,
33:49and you'd need to be admitted from 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.
34:03Good insurance.
34:04And I pay my taxes, which 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.
34:57Okay?
35:04Robbie's going to love that patient satisfaction score.
35:07Crazy people.
35:13What's going on?
35:14Car crash, Mr. 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 bringing her.
35:22Paula, open your eyes.
35:23Paula.
35:24This is the morphine?
35:25She only got a small dose.
35:27Both socks is down to 89.
35:29Set up for intubation and...
35:30McKay, get Robbie 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...
35:48Sometimes 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,
36:01and gave me credit for a safe that 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
36:11than glad that we stopped the 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.
36:28Meh.
36:29I've heard worse.
36:30Well, for what it's worth, he's wrong.
36:33You're very good at this.
36:36Thank you.
36:38It's actually worth a lot.
36:41I thought the CTs were normal.
36:43They were.
36:44Systolic's down to 70, heart 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, good EF, lungs are up.
36:53She feels warm.
36:54Well, check her tent.
36:55Meds are on board.
36:56Belly is clear, no 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.
37:08Thanks.
37:10Good breath sounds 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 Beko.
37:24Got it.
37:24If this is sepsis, where is it coming from?
37:27What's the source?
37:28She 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.
37:37Is it pneumonia?
37:38Chest CT negative.
37:40Abdominal CT negative for an infectious source.
37:43She was altered meningitis.
37:44She's postpartum.
37:45Ugh, endometritis.
37:47The CT of the uterus shows a thickened endometrium,
37:51but 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. Krakosha, 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.
38:08Well, 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.
38:24We have a street team here.
38:25Mr. Krakosha, 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.
38:49Thanks, Doc.
38:54Yeah, purulent drainage from the cervix.
38:57Got the culture?
38:59Looks like we have our source.
39:02The positive urine this morning was contaminated.
39:05Maybe.
39:06Definitely.
39:08Not-so-clean catch specimen.
39:12This infection's been brewing for a while.
39:13I saw the car crash was a coincidence.
39:15Not necessarily.
39:17She was probably already septic as the disease progressed.
39:19Dropped her BP and passed out while driving.
39:21And she wasn't hypotensive when she wrecked.
39:23Adrenaline rush from the car crash and the sternal fracture raised her BP, but not for a long.
39:26No.
39:27No history of fever.
39:29Bet she was taking Tylenol for the pain.
39:31Let's call ICU for an admin.
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.
39:58Okay.
40:04Every postpartum patient needs a pelvic exam to rule out endometritis.
40:08Wait, you'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 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?
41:00We call them unhoused.
41:02It's not as bad as Philly or D.C.
41:04But 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.
41:18I'm joining the street team.
41:20Even got a jacket.
41:21All right, Tom.
41:22Welcome.
41:25Yeah.
41:26That is cool.
41:27Very cool.
41:33Who's Boach?
41:34Ralph Twenties.
41:35I'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...
41:42Support 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.
41:58Is that what you're doing?
41:59Yeah, that's right.
42:00Is that what you're doing?
42:01What is that?
42:03Oh, my God.
42:05I got you.
42:06Come on.
42:08Crosby!
42:09Crosby, come here, buddy.
42:10Come here.
42:11There you go.
42:12Shit.
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.
42:40Thank you.
42:41Anytime.
42:49Hard at work?
42:53I'll take my chances.
42:56I'll take my chances.
43:00I'll take my chances.
43:09I'll take my chances.
43:17I'll take my chances.
43:26You're going to take my chances.
43:41I'll take my chances.
44:11...
44:41...
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