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The Pitt - Season 1 - Episode 01: 7:00 A.M.
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00:13Baby
00:30It's all right
00:33Maybe
00:35You can stay here tonight
00:40Out on the street
00:42The loud music
00:44My guitar
00:46It's your mama
00:48Wama
00:48One of those old fancy cars
00:53She said hey boy
00:55Why don't you get on in
00:59For tonight
01:01I'll be your lover
01:03And your friend
01:04He said baby
01:06He said
01:08It's all right
01:16What's your last name?
01:18It's J-A
01:20I mean Jessica
01:22Sorry
01:24R-R-J-4 West
01:26R-R-J-4 West
01:37Is it true?
01:39Simi told Hector that Dr. Durangian said the hospital was up for sale
01:42They might turn into an ortho center
01:44With no ER
01:45Oh they're always threatening to shut us down but they never do
01:49What?
01:49Did you think of her?
01:52I didn't think of the doctors
01:56Gloria is looking for you
01:57No guts, no Gloria
01:59Must be time for my weekly spanking
02:01That'd be nice for all our sakes
02:03You sure you're cool being here today?
02:06Yeah
02:06Where wouldn't I be?
02:09Well if you need to talk
02:10Yeah I won't but thanks
02:12I can't get that information
02:14Where's Abbott?
02:16Getting some air
02:30Hey
02:32You okay in there?
02:35Uh
02:37Awesome
02:39I like to say it goes away but I had morning sickness for six months with my second daughter
02:44Hell, who am I kidding?
02:46No one still worries me sick
02:49Thanks
02:50It was worth it
02:52You tell anybody yet?
02:55Oh no
02:57Not until I passed 12 weeks
02:59Not this time
03:00Nothing but good vibes
03:02But just so you know Robbie's working today
03:05Today's the day Doc Adamson thought he hasn't worked it in four years
03:11So why is he here?
03:13All I know is he still blames himself for Adamson's death
03:16So if he's a little prickly today
03:17Give him a pass, okay?
03:21Great
03:21Thank you
03:23Hang in there kid
03:25Uh
03:25Bye
03:36Morning Jack
03:40What are you doing here?
03:42I'm working
03:44And you?
03:47Oh I don't know
03:49Had a guy come in
03:52Hit by a drunk driver in a crosswalk
03:5539 year old vet
03:57Survived three tours without a scratch
04:02I spent the last two hours coding it
04:07That's always a rough way to end the night
04:09Must have had a reason at one time to keep coming back but
04:14I can't think of it right now
04:17I can't think of it right now
04:18Because this is the job that keeps on giving
04:21Nightmares
04:23Ulcers
04:25Suicidal tendencies
04:29Besides if you jump on my shift
04:32Besides if you jump on my shift
04:32That's just rude man
04:42Hope I'm never one of your patients
04:45That makes two of us
04:46That makes two of us my friend
04:49I got a pregnant teen coming back today for a mifepristone
04:53And a small bowel obstruction waiting on surgery for the last three hours
04:57Oh
04:59And unfortunately the kraken is still boarding at VA
05:02Still?
05:03Guy's been here for a week waiting on a psych bed
05:05Yep
05:06He's only getting worse
05:08He's catching some Zyprex disease at the moment
05:11But when he wakes up God help you all
05:16I wrote a note for the family of my dead vet if anyone shows
05:21Oh
05:21And you got the med students and new interns starting today
05:24So good luck with that
05:26Like you're liking me
05:28Sir, come back here
05:29No more needles
05:30Sir
05:31No more needles
05:32Stop
05:34Sure you want to work today, huh?
05:35They're gonna hurt me
05:36Sir, I promise nobody's going to hurt you
05:41Sir
05:45You left this mess
05:47They had a rough night
05:50Good morning, sunshine
05:52You obviously haven't seen this board
05:54Ah, we've seen worse
05:56Nothing like a little challenge every now and then
05:58To keep everybody on their toes
05:59Dr. Rabinvich?
06:01Melissa King
06:02I will be joining you today
06:03I just came from two months at the VA
06:05Hey, welcome to the pit
06:06This is Dr. Jack Abbott
06:08Nice to meet you
06:09I can't take how excited I am to be here today, so
06:13Talk to me at the end of the day
06:15Ignore him, he had a rough night
06:17And is having an ongoing existential crisis
06:20Don't worry, you'll get there soon enough
06:22I married my second husband Everett in 1964
06:26He unfortunately passed in 1976 from a heart attack while we were vacationing in Kissimmee, Florida
06:34It was awful
06:36Good morning, we're gonna round Dr. Mohan
06:40Excuse me, Estelle
06:40We'll be right back
06:44So, you know we track every residence patients seen for an hour
06:47I was just taking her history
06:48It's a brief backstory about what brought them in, not an autobiography
06:51I was almost done
06:51You hadn't even made it to this century
06:55Patients, they check in for registration here
06:58A nurse eyeballs them, makes sure they're not dying
07:00If not, they're moved to one of two triage rooms for vitals and a quick chair exam
07:05Where you can do your labs and your x-rays
07:07And then they come back to the waiting room
07:09Until the bed opens up
07:11For how long?
07:12Eight hours, if they're lucky
07:14A lot of times, twelve
07:16Uh, is it always this busy?
07:18Uh, no
07:20It gets a lot busier
07:25Take this
07:26Hey, Mateo
07:27Good morning, Cass
07:28This is Sherry
07:30Hi
07:32Sherry
07:32Sherry, I'm Dr. McKay
07:33I have some student doctors with me today
07:35Do you mind if they observe?
07:36Sure
07:37Okay
07:39What's going on, Sherry?
07:41I'm...
07:41Ah
07:43I burned my hand on a sterno
07:46What were you doing with a sterno?
07:48Uh, cooking
07:49You were cooking with a sterno?
07:51Yeah
07:51We were making s'mores
07:54Sweet
07:55This one loves spores
07:58Uh, we've been here for hours
08:00And I have to get them to school
08:02Do you know how much longer this will take?
08:05Uh, yeah
08:07Let's see
08:07You taking anything for the pain?
08:09Uh, not yet
08:10A thousand of Tylenol, 400 ibuprofen, and the saline dressing?
08:13Yes, please
08:14Okay
08:15We're going around
08:16And the fun begins
08:19All right, Sherry
08:19We're gonna patch you up and get you out of here as soon as possible, okay?
08:22I'll be back
08:23Okay
08:28As you can see, we have some new faces with us this morning
08:31Good morning, good morning, come on over
08:32Starting with second year resident Dr. Melissa King, fresh from the VA
08:37Everyone calls me Mel
08:39I'm so happy to be here
08:41Trinity Santos, intern
08:43Victoria Javadi, MS3
08:45Uh, Dennis Whitaker, MS4
08:48Welcome to the pit
08:49We got two traumas from the T, five minutes out
08:51Okay, copy that
08:52Uh, actually, this is the most important person that you're gonna meet today
08:55This is Dana, she's our charge nurse
08:56She is the ringleader of our circus
08:59Do what she says when she says it
09:02As you can see, our house is always packed
09:04And our department is mostly clogged up with borders
09:07Those are admitted patients waiting for a room upstairs, sometimes for days
09:11Beds are a very precious commodity around here
09:13So please be quick and efficient with your workups
09:15What else?
09:17We treat the sicker patients back here
09:18But please keep your eye on that waiting room
09:20Make sure nobody's gonna die out there
09:23Your senior residents are Dr. Collins and Dr. Langdon
09:27You report to them, and they report to me, okay?
09:31Great, senior residents, you got your sign-outs?
09:33Yep
09:33Yep, okay, let's do this
09:38Virgil Straker, nine millimeter GSW to the left shoulder
09:43CT angiogram negative, surgery wants to admit for overnight observation
09:46Good vitals, they repeat a crit?
09:49Stable crits every two hours times three
09:50Discharge it on Sefton, recheck tomorrow, he'll get way more rest at home
09:53Good morning, Mr. Straker, you wanna go home?
09:56Hell yeah
09:57Okay
10:03All right, Murphy Rodenstein, 48 year old woman with cirrhosis and upper GI bleed intubated and stable after one unit
10:11Awaiting ICU bed
10:12Hey doc
10:15And we all know Louis Cloverfield, blood alcohol of 420 at 11pm
10:21I've been cutting back
10:22How is he still breathing?
10:24That's a lethal dose for you and me, that's happy hour for Louis
10:26Sobered up, had two rounds of lorazepam
10:28Hold out your hands for me, Louis
10:31Another two of lorazepam
10:32On it
10:33And a script for Librium
10:34It's good to see you, Louis
10:35It's always a pleasure, Doc
10:37Bar fight with complete avulsion of tooth number eight
10:42Smile, Charlie
10:44Oh, where's your tooth, Charlie?
10:46If I could find out
10:48Cancel the discharge, order a chest x-ray, gotta rule out aspiration
10:52Incoming
10:5542 year old male, Sam Wallace
10:57Blunt head with agonal respiration
10:58Drop down on the T-tracks
11:00Couldn't tube him, LMA in place
11:01Suicide attempt
11:02Rescue
11:03He's a good Samaritan
11:03Took a spill helping a woman who fell off the tracks
11:06She's right behind us
11:07Okay, trauma one
11:07Go ahead
11:09Come on
11:10A woman fall from T-platforms
11:13Good vitals, no head injuries
11:14D-gloving injury
11:15Right lower leg with open fracture dislocation of the ankle
11:18They don't go down
11:19Okay, trauma two, trauma two, let's go
11:21Get out of my way
11:22Get out of my way
11:25Get out of my way
11:25Get out of my way
11:26Get out of my way
11:29How we doing, ready?
11:31Okay, here we go
11:32Ready, one, two, three
11:35Good breath sounds bilaterally
11:37but we need to protect his...
11:38Apparently, he jumped down to save the lady.
11:39When he climbed back up, he slipped,
11:41fell back, and hit his head.
11:42Okay, thanks.
11:42That's more of an R2 procedure.
11:43Uh, Mel, right?
11:44I need you on the 8th fast.
11:46Pupils, 4 millimeters, and reactive.
11:48Okay, that's encouraging.
11:49What do you want for meds?
11:50120 ketamine, 80 of rock.
11:52A-fib on a monitor.
11:53Morrison's clear.
11:54That's a lot more none than expected.
11:56Um, he's probably anti-coagulated for A-fib.
11:59Check his medical record.
12:01See if he's on a DOAC.
12:02Stand by with four-factor PCC.
12:03There's a brain bleed.
12:04This is a PCC, Mel.
12:06Uh, clotting factors 2, 7, 9, and 10.
12:09Okay, be right back.
12:1150 of fan, didn't touch her.
12:13Did she faint, or did she trip off the platform?
12:14No, he moves.
12:15The other guy jumped down, pulled her off the tracks
12:17just as the train was rolling in.
12:18Isolated injury to the foot.
12:20The train ran over her foot.
12:21Got caught between the platform and the incoming train.
12:23Ma'am?
12:24Ma'am, what's your name?
12:26Top three of the temperature, two grams, cephaladol, and four...
12:27Do you speak any English?
12:29Airway and breathing are perfect.
12:32As is circulation, BP 140 over 85.
12:36Students, what might have made her faint on the platform?
12:39TIA, CBA.
12:40Oh, she needs...
12:41PKG and a...
12:42Choponin.
12:43Okay, good, good.
12:43Stop, party people.
12:44Subway train degloved her foot with an open fracture dislocation.
12:47Ooh, and I thought my heels were painful.
12:49They're dynamically stable.
12:50Be fast negative.
12:51Ma'am, I'm Dr. Yolanda Garcia.
12:52Any pain in your chest or belly?
12:54I know.
12:56I know.
12:57Can we please push the morphine?
12:58No, it could cloud for mental status.
13:00I can't do an exam like this.
13:01Push the damn morphine.
13:03We're doing a popliteal block.
13:05Numbs the lower leg.
13:06No side effects.
13:07Wonderful.
13:07Where's the other guy?
13:08Next door.
13:08He's a bit worse.
13:09Pan scanner, let me know when she stops screaming.
13:12Oh, ma'am!
13:15The cords are very anterior.
13:17Yeah, that's because we can't flex the neck.
13:19Keep the hockey stick straight up.
13:22I'm in.
13:23Good.
13:23Well done.
13:24Bring me up to speed.
13:25Intubated for agnal respirations.
13:27GCS-5, probably anticoagulated.
13:30With what?
13:31First time here.
13:32There's no medical records.
13:33Call for FFP?
13:34No, we got four-factor PCC.
13:36AD of Mandatol to reduce brain swelling,
13:38then right up to CT.
13:41Hey, do me a favor.
13:42Swap out with Jessie for me, would you?
13:43Of course.
13:44Dr. Rabinovich, can you have a moment?
13:46I'm just a little busy right now, Gloria.
13:48One sec.
13:51Nerve block complete.
13:52Seems like it's starting to work.
13:54Swapping out, Jessie.
13:54Takes ten minutes for the full effect,
13:56and the mark came.
13:57Lasted a good four hours.
13:58She's next for CT.
14:00Do you have any idea what language that is?
14:01Oh, definitely not Tagalog.
14:03Maybe Hindi or Urdu?
14:04Yeah, I'm gonna go get language services.
14:06Would you speak, like, five languages?
14:07Six, but that's not one of them.
14:09Six?
14:10And I thought Collins was smart.
14:11Oh, that's way too early for you
14:13to start being an ass, London.
14:14Open hostility in front of the patient?
14:16She doesn't speak English.
14:18Judgmental and dismissive.
14:19How we doing?
14:20Vital stable.
14:21I like these two.
14:23Oh, good for you.
14:24Princess made a joke.
14:26And I thank you for that beautiful blessing.
14:28Namaste.
14:29Okay, do we have a phone or anything
14:31with the relative's name on it?
14:32Uh, EMT said the purse got obliterated
14:34when the subway ran over it.
14:36Any way I can speak with her?
14:38Highly doubt it.
14:39We don't know what language she speaks.
14:40Hey, um...
14:41Hi, what's up?
14:42It's a pop-up.
14:43Any chance she jumped?
14:44She may have been pushed.
14:46Jesus.
14:46Yeah.
14:47Could be looking at a possible Hikram.
14:49I take it you're free now?
14:55We need to talk about your numbers.
14:57Uh, people we've saved?
14:59Metrics.
14:59Our door-to-balloon times beat federal standards.
15:02I'm talking about press-gaining scores.
15:04Patient satisfaction?
15:06If you're still alive, you should be satisfied.
15:08Our goal is 36% to very satisfied with their care.
15:12Your department is at eight.
15:14Do you know how likely patients are
15:15to recommend this hospital?
15:17Um, this is an emergency department,
15:18not a Taco Bell.
15:2011%?
15:21Well, if you want people to be happier,
15:22don't make them wait for 12 hours.
15:24There's a nursing shortage across the country.
15:26Most of our patients are boarders
15:28who are waiting for a bed upstairs.
15:31We don't have the beds.
15:32That's bullshit.
15:33The beds are up there.
15:34You just don't want to hire the staff
15:35you need to care for.
15:37Oh, Doc.
15:38Doc.
15:39It ain't working.
15:40And whatever they're giving me,
15:41it's not working.
15:42No response to my citrate.
15:44Should I send in the fleet?
15:46Okay, sir.
15:47We're going to try an enema.
15:49Like I said, there's a nursing shortage.
15:51Well, if you paid them a living wage,
15:53they'd be lying enough to work here.
15:54Our budget can't support that.
15:56Oh, here's a dirty little secret.
15:57The hospital saves money
15:58keeping patients down here in the pit.
16:00It's way cheaper than staffing upstairs.
16:02I have asked you repeatedly
16:04to stop referring to the emergency department
16:06as the pit.
16:07It is derogatory and incompatible
16:09to the institution's image.
16:10You know what's incompatible with the institution's image?
16:12Me, speaking to the media
16:14about people who code in our waiting rooms
16:15and people who get shitty care in our hallways
16:17waiting for an ICU bed for days.
16:19I've heard about doctors who have tried that
16:21and find themselves out of work.
16:23Uh-huh.
16:24I know today is difficult for you.
16:26Every day is difficult down here.
16:27Boarding is a nationwide problem.
16:29Your predecessor, Adamson,
16:31sure as hell knew that.
16:32Or wasn't that something he taught you?
16:33Fuck.
16:34Wow.
16:35Really?
16:36Yes, really.
16:37Other hospitals are managing this crisis
16:39much more effectively.
16:41So you can either step up your game
16:42or you can step aside.
16:55Good Samaritan dude has a small
16:57left temporal intraparenchymal bleed.
16:59No epidural, no subdural,
17:00no midline shift in the brain.
17:01That's good news.
17:03You have to recover.
17:03CT can take her in five.
17:05Let's have a look.
17:05Bandage scissors.
17:06All right.
17:08If an artery is totally transected,
17:10the smooth muscle in the tunica media
17:12contracts with hemostasis.
17:13But if it's a partial cut,
17:15get out your umbrella.
17:16Grab a culture from the open fibula
17:18before you reduce.
17:19You're up.
17:22I'll stabilize the need for the reduction.
17:24Dr. Langdon will be distracting distally
17:26before moving medially to clear the tibia.
17:29Good.
17:31Ready?
17:45Med student down.
17:48Good catch on bar fight Billy.
17:50He has an aspirated tooth on chest x-ray.
17:52Would have been dead in a week
17:53from a lung abscessage.
17:54Let him be discharged.
17:55We're calling the pulmonary.
17:56Cardiac arrest.
17:57TTA.
17:58Ten minutes.
17:58Where should we put it?
17:59Anywhere.
18:00Why have you put somebody in the hall?
18:02Dr. Robbie?
18:03She, uh, took a fall.
18:05I-I tripped on the gurney.
18:07I'm fine.
18:10Why don't you go get a cool drink
18:12in the staff lounge?
18:15I'm fine, really, I swear.
18:16Oh, I know, but it's hospital policy.
18:18Anytime someone gets a paper cut around here,
18:20we have to fill out a workers' comp report.
18:27Another way.
18:30I was fine until about two weeks ago
18:33after the Rochester Marathon.
18:34Okay.
18:35Any falls or injuries?
18:36Just tired, sore muscles.
18:39Yeah, I'd be in bed for a month.
18:41Was this your first triathlon?
18:42God, no.
18:43No, I do one every few months.
18:46Have you seen a doctor yet?
18:47Uh, no.
18:49I went for a run this morning.
18:51Had to quit after a minute.
18:53Pretty short of breath.
18:53This goes under your tongue.
18:56No current meds, no allergies.
18:58We're gonna check a few labs at an EKG.
19:01Draw a red and purple top.
19:02Yep.
19:06Temp 98.2.
19:08Take a deep breath for me, Otis.
19:11I'm gonna want a little pimp right now, okay?
19:17Otis?
19:19Otis?
19:20It didn't take him for a lightweight, huh?
19:25Oh, shit.
19:26No pulse craft card.
19:28Lay him flat.
19:31Let's check a rhythm.
19:32Saline pads.
19:35Quick look paddles.
19:41VTEC.
19:42Charging at 200.
19:44Charged.
19:45Clear.
19:47All right, he's back to normal sinus.
19:50Need a gurney in here.
19:53So what's the plan?
19:55ICU, when we can get a bed
19:57and admit for supportive care.
19:59Repeat head CT in three hours.
20:02Or sooner, if he blows a pupil.
20:04Want a Keppur, Lilla?
20:05Order's already in.
20:08Nice job.
20:11Do you think he'll wake up?
20:13Maybe.
20:15Maybe not.
20:18No good deed goes unpunished.
20:22Oh, has anyone, um, notified the family?
20:29I could try.
20:31Otis Williams.
20:32Healthy 31-year-old.
20:34VTEC arrest two weeks after triathlon.
20:36NSR with one shock.
20:38Pulse 98.
20:39BP 110 over 60.
20:40He's a little young, son of mine, huh?
20:42Exactly, right.
20:42What's the differential, Dr. Collins?
20:44Uh, drug overdose, electrolytes,
20:46SONQT, ooh,
20:47Regatta syndrome, WPW.
20:49How you doing there, Otis?
20:50Okay.
20:51What happened?
20:53VTEC again?
20:54200 joules.
20:56Charged.
20:57And clear.
20:59Back in sinus.
21:01Otis?
21:04Otis?
21:06Oh, groaning's good.
21:075th nasal, O2CBC, CMP, proponent, and D-dimer.
21:12What are you doing?
21:131-gram calcium glutinate, IV push.
21:15We don't have the labs back.
21:16Lick them under.
21:17YNQRS and peak T waves, hyperkalemia.
21:19How do you get that?
21:20Attentance exercise, cause muscle breakdown,
21:21rhabdomyolysis, knocked out his kidneys.
21:23Now he's not clearing potassium.
21:24I bet it's over 7.5.
21:25Wait two minutes for the eye step.
21:27If you're resting, we might not get him back.
21:28Inside the calcini, you could kill him.
21:30Wait.
21:30It's my ass.
21:31Not yours.
21:43Pan scan is negative.
21:44That means you can admit to orthopedics.
21:46But there may have been a medical etiology if she fainted.
21:49That's not surgical.
21:50Get an internal medicine consult,
21:51or admit to medicine with ortho consulting.
21:54Either way, I'm off the case.
21:55Okay, thanks for nothing.
21:57Andsef's in.
21:58I'll grab the chance.
22:00Did we figure out what she's speaking?
22:02Last interpreter thought she might be from Pakistan.
22:05There are 77 languages in Pakistan.
22:07Okay.
22:08Well, I will buy lunch for whoever figures it out.
22:10Good luck.
22:11If you need me, I'll be saving lives.
22:14That was wicked.
22:17That was gross.
22:19Yeah, too much for a little miss crash and burn.
22:21What'd you do with her?
22:22Nothing.
22:23I think she'll be fine.
22:24Are you kidding?
22:25If that took her out, she'll be lucky to make it through this rotation.
22:28I got 50 bucks so she doesn't last through this shift.
22:32Come on.
22:33Put your money where your mouth is.
22:35No, I didn't say anything, okay?
22:38I sure as hell don't have 50 bucks.
22:40I'll be this lady's age by the time I pay off my student loans.
22:43Not that you...
22:45Hey.
22:47You want to sell a kidney?
22:49I could get you 30k as soon as this weekend.
22:53That's just between you and me.
22:56Think about it.
23:02How you doing?
23:04Yeah.
23:06QRS is narrowed.
23:08Much better.
23:09Potassium is 7.7.
23:11Creatinine 5.6.
23:12It's high potassium and renal failure.
23:15Just what you thought.
23:16Must be my lucky day.
23:18Ordering 10 units of regular insulin and 25 grams of glucose.
23:23Why insulin and glucose?
23:25Shift the potassium intracellularly.
23:27Exactly, but the definitive treatment is...
23:29Hemodialysis.
23:30I'll call renal and get a tech down with the machine.
23:32Have you ever seen a dialysis catheter inserted?
23:35Dr. Collins is going to place ephemeral Quentin under ultrasound guidance.
23:38It's an excellent way to learn.
23:40Oh.
23:40Oh, my chest.
23:41Yeah, we had to shock you.
23:43You're going to be sore for a while.
23:45You shocked my heart?
23:46Long story.
23:47Dr. Collins will fill you in.
23:57You got a sec?
24:02You okay?
24:03Why wouldn't I be?
24:04Are you okay?
24:06Why wouldn't I be?
24:08You seem annoyed with me already, and I just got here.
24:13It's not always about you, Robbie.
24:17Am I going to be okay?
24:19Yeah.
24:20Yeah.
24:20You just need to take it easy on yourself.
24:23Muscle breakdown and myoglobin damage your kidneys.
24:26Why did you shock my heart?
24:28When your kidneys don't work, potassium builds up and messes with the electrical activity in your heart.
24:35Can it happen again?
24:37Can it happen again?
24:37We gave you medicine to lower your potassium, and you'll need dialysis to clear it all out.
24:42Then I'll be okay.
24:44Yeah.
24:45You might need a week or two for your kidneys to recover, but yeah.
24:49You really need to hydrate like crazy before and after a triathlon.
24:55Trust me.
24:56I won't let this happen again.
24:58Good.
25:00Be kind to yourself.
25:02Okay?
25:08Uh...
25:14Oh, hey, Abbott's told me that he's got a pregnant teen coming back today from Miffa-Pristo.
25:18Let me know when she gets here.
25:19Yep.
25:20Bowel obstruction.
25:21Still waiting on a surgery consult.
25:22What about Garcia?
25:23She was just here for the traumas.
25:25I think she was waiting for her attending to sign off.
25:29Okay.
25:32Oh, one of the med students took a header.
25:34I parked her in the lounge under the guise of a work comp report.
25:37Will you just go in there eyeballing and make sure she's all right?
25:40She's going to miss the morning arrival of the living dead.
25:42How many are we expecting?
25:43We're getting three, but one died en route.
25:46Who knows luckier, us or them?
25:48What's open?
25:4914.
25:4989-year-old woman from a SNF.
25:51History of emphysema, CHF, MS, B-Fib, unresponsive to three shocks, two rounds of Effie.
25:56What is that?
25:57Lucas' chest compression system.
25:59Robotic CPR.
26:03Anybody get a hold?
26:04One, two, three.
26:11Students are dropping like flies.
26:12Take a break.
26:13Ice the finger.
26:14You can count on getting a couple elderly patients every day around 7.30 after the nursing homes
26:19and assisted living facilities do their morning bed checks.
26:22You can practically set your watch.
26:24Was there an advance directive?
26:25No.
26:26Full coat for the nursing home.
26:27Seriously.
26:29Lucas off.
26:32Still V-Fib.
26:33Lucas on.
26:34One more round of Effie, one more shock, and then we call it.
26:43Joseph Spencer, 79, fever and cough from assisted living.
26:47He has a history of mild Alzheimer's.
26:49One, two, three.
26:52Heart rate 130, BP 90 over 60, gave him 500 cc's, normal saline.
26:56Hi, Mr. Spencer.
26:57I'm Dr. King.
26:58This is Dr. Collins.
26:59How are you feeling today?
27:01Is it dinner time?
27:03I'm not really hungry.
27:04Do we have any paperwork from the facility?
27:06He has a pulse.
27:07IV fluids and medications are fine, but no intubation and no chest compressions.
27:11That's helpful.
27:12Core shrunk right here.
27:14Light middle lobe infiltrate.
27:16Temp 102.
27:18Call a code sepsis.
27:19Mm-hmm.
27:20Code?
27:20To make sure we check all of our boxes.
27:22The federal government audits our sepsis bundle performance and publishes the data online.
27:26Today, it better be perfect.
27:28Two sets of blood cultures, lactic acid, 30 cc's per kilo NS, a gram of ceftriaxone, 500 of azithromycin, repeat
27:37lactic, then three hours.
27:39Nice.
27:43Charging and...
27:44Stop.
27:46Call it.
27:47There's an home just faxed us the DNR.
27:49Are you kidding?
27:51Power out the defibrillator and the lupus.
27:53Complete waste of time and money.
27:54Who the hell works at that place?
27:55A nurse taking care of 60 patients who couldn't find the form.
27:58She called 911 so she could take care of the others.
28:00Okay, let's move her to the viewing room and notify the family.
28:04One of the things we do here is to take a moment of silence when we lose a patient.
28:10To respect their humanity and also to remember that this was somebody's child or sibling or parent or friend.
28:25I like the sound of fucking music!
28:31I am so sorry.
28:34Maybe leave it on vibrate while you're working?
28:39Later, Doc.
28:40You behave yourself now.
28:42Always.
28:45Your med student's back on her feet.
28:48How old's that kid?
28:49I don't know.
28:50I didn't ask.
28:50Is she some sort of savant?
28:52I don't know.
28:52Maybe.
28:53Dr. Binovich, I just wanted to apologize for any trouble my clumsiness might have caused.
28:57I feel ridiculous.
28:59Oh, I can't tell me times I've hit my head on an overhead lamp.
29:01Twice.
29:02I needed to get staples.
29:03Why don't you go work with Dr. McKay in triage?
29:05That would help both of us.
29:07Oh, I don't need special treatment.
29:10Good, because I don't give it.
29:14Look, I know I might look too young, but I studied my ass off to get here.
29:17Probably harder than the others.
29:20I earned this.
29:21Okay, look, I respect your dedication and your determination, but while you're here, you're my responsibility.
29:26And when one of my responsibilities takes a header...
29:29Wow!
29:30Abbott called for a surgical consult on the SBO three hours ago.
29:32You're very lucky they didn't perf.
29:33I'm here to see my daughter.
29:35I'm sorry, is that a patient?
29:37You're talking to her.
29:41Am I interrupting?
29:42No.
29:44No.
29:44We're done.
29:45We're good.
29:46Come find me when you're ready to present your next case.
29:51So, how's your first day going?
29:53It's great.
29:54Yeah?
29:54Yeah, really great.
29:55Hey, Crash.
29:56They're doing a dialysis catheter insertion in North One if you want to check it out.
29:59Mm-hmm.
30:01That thing...
30:01Did she say Crash?
30:03No.
30:04No, no, it's not Crash.
30:06She said Crush because I'm always crushing it.
30:11Thanks for coming down, Mom, but I've got a patient.
30:14Bye.
30:25What do you want?
30:26Um, I, I, I just wanted to make sure you're comfortable.
30:30I am taking a dump in a dustpan.
30:34So what's that fucking tell you?
30:36Um, I'm, I'm clearly, I'm clearly in the wrong room.
30:39I'm sorry.
30:40Mm-hmm.
30:47So, it would have been nice if someone had told me that Eileen Shamsie's daughter was one of our med
30:52students.
30:52And we're on the surprise.
30:54Was it as awkward as I hoped you would be?
30:56You, you have a mean streak in you, you know that?
30:59What's the deal with the body in 19?
31:01Let's have it's NBC vet from last night.
31:03Still waiting on next to Ken, supposedly on their way.
31:05Okay, can we move him to the viewing room at least?
31:07Nursing home DNR's heading there, joining last night's Jane Doe.
31:10Coroner's office is backed up.
31:11Well, then our Mort needs to take her, then.
31:15Perla.
31:18Triathlete, Otis.
31:19Uh, he's stable.
31:20Repeat potassium is 6.1.
31:22Renal wrote the dialysis order.
31:24Tech should be down 15 minutes.
31:26Good, thank you.
31:28Language mystery solved yet?
31:30No.
31:31Hey, what's your take on dogs?
31:35In what context?
31:36For kids.
31:38Kids and puppies go together like fish and chips.
31:40Man's best friend, you know?
31:42Well, you don't have a dog.
31:43I don't have a best friend.
31:45What am I?
31:46You're my best resident, big difference.
31:47Yeah, but we're still friends.
31:50Not if this conversation goes on with Smucker.
31:52I have a lethargic four-year-old.
31:55No PMH, no innocent illness, no fever, vomiting.
31:58Parents just couldn't wake him up this morning.
32:00What, Ren?
32:01Oh, South 15.
32:03There's no nuchal rigidity, no skin lesions.
32:07No, focal narrow.
32:10He looks well-fed and cared for him.
32:13DKA from new-onset diabetes?
32:15No, BG85.
32:16CDC, PR-E, URA, NIDIS.
32:21So what happened?
32:22Did you get ash into the main that branch of the nerve?
32:25Did you step off the face?
32:26Did you put his plastics on the link down?
32:28Can you wake up for me, Tyler?
32:31He's not usually this sleepy?
32:33No, and he barely flinched for the blood test.
32:35He wakes up at 90 miles an hour and doesn't stop until he passes out at night.
32:39He passes out?
32:40No, he just means he goes all day.
32:42Any chance he could have ingested something?
32:44Any pills, vitamins, any prescriptions that may have been left around?
32:49No, that's all kept locked in the medicine cabinet.
32:51The whole house is childproof.
32:53What about alcohol?
32:54Anything left out?
32:56No.
32:56What about pets?
32:58No.
32:59So you're usually quite active?
33:01Very.
33:02Um, any injuries lately?
33:04No.
33:05He hasn't bumped his head recently.
33:07Not that I'm aware of, but he does the roughhousing with Drew.
33:10But he never gets hurt.
33:11Oxygen level is normal.
33:13Good pulse and blood pressure.
33:15No signs of infection.
33:17We're going to start with blood and urine tests.
33:18Check for any metabolic abnormalities.
33:25It's really throbbing.
33:27Yeah, the blood's under pressure.
33:28Got to drain it.
33:31No anesthesia or?
33:32No.
33:33Stop before I hit the nail bed.
33:35I hope.
33:39Hey.
33:40Eyes down here.
33:41Watch and learn.
33:42I'm just looking who to see next.
33:44You're supposed to take them in the order they arrive.
33:47Yeah, I know how it works.
33:48Okay.
33:49No need to cry about it.
33:50Do you want me to choose for you?
33:52No.
33:55Wow.
33:57The pain's gone.
33:58Yeah.
33:59All right.
33:59How about a 20-year-old cough and eight?
34:03Should be easy.
34:04Probably viral.
34:05Yeah.
34:05I don't need an easy one.
34:07Suit yourself, Huckleberry.
34:09I'm going to take the splitting headache.
34:10Maybe I'll catch a subarachnoid hemorrhage or something cool.
34:13Hey, why do you keep calling me that?
34:15Huckleberry?
34:16It's a term of endearment.
34:18That sounds like sarcasm.
34:19You think?
34:20Ordering on harassment.
34:23Where are you from?
34:25Broken bone, Nebraska.
34:27Jesus, where the hell is that?
34:28It's about three and a half hours west of Omaha.
34:31Oh, yeah.
34:32Just a little south of nowhere.
34:33What the hell do you do there?
34:35My parents have a farm, so...
34:37You're a farm boy?
34:40Yeah, I guess.
34:42I rest my case, Huckleberry.
34:50I'm so sorry, ma'am.
34:52We don't understand you.
35:04I'm so sorry, ma'am.
35:16China?
35:18China?
35:18India?
35:19I can't tell where you're pointing.
35:20Tajikistan?
35:23Nepal.
35:26You're from Nepal.
35:27Nepali.
35:34Mom's got a bad burn, needs wound checks and hand therapy, and I got a sneaky suspicion
35:38she may be unhoused.
35:40I'll talk to her.
35:41We can offer some help.
35:43I appreciate it.
35:43Ah, you're back.
35:45Dr. Robby suggests that I might be of assistance?
35:47Yeah.
35:48I could use the company.
35:49Victoria Javadi.
35:50This is Chiara Alfaro.
35:51She's a department social worker, which pretty much makes her an angel.
35:55Welcome.
35:56Thanks.
35:58So, what rotation is this for you?
36:00Um, third.
36:01I've done OBGYN and peds.
36:02Are you any favorites?
36:04Not really.
36:05Well, what are you leaning towards?
36:07I'm not really sure yet.
36:09Okay.
36:09Well, you have time.
36:12Can I actually ask you a personal question?
36:15I'm 20 and I've earned the right to be here.
36:18Oh.
36:19Yeah, I don't doubt that for a minute.
36:21I was actually wondering if Dr. Eileen Shamsie from surgery is a friend or relative of yours.
36:27I saw you talking to her in the hall and I thought that-
36:32Oh.
36:34Oh, wow.
36:35Oh, that's cool.
36:38Are you really only 20?
36:40Yeah.
36:41And for the record, my father also works here.
36:43He's an endocrinologist.
36:44Oh, so it's like a family business.
36:48Um.
36:48I'm sorry.
36:49That was a joke.
36:49That was a joke.
36:50And I'm sure that comes with a lot of pressure.
36:52And as for the H thing, I'm a 42-year-old R2, so I have my own haters.
36:56Trust me.
36:58Okay.
36:59Um, sometimes when it gets busy, we'll help the nurses bring back patients.
37:03Okay.
37:04Um, okay, next to come back is Fred Saida, knee pain after a flaw.
37:08Great.
37:08Fred Saida.
37:09Hi, Doug Driscoll.
37:10Any chance someone can see me now?
37:12I've been here for like two hours.
37:13Unfortunately, Mr. Driscoll, there's a lot of patients still ahead of you.
37:15Some of whom are severely ill.
37:16Yeah, and I got chest pains that woke me up in the middle of the night.
37:19Chest pain.
37:20Yeah.
37:20No, it's not plural.
37:21It's just chest pain, not chest pains.
37:24Yeah, and if I have more than one, it's chest pains.
37:27Are you even a real doctor?
37:28She's a student doctor.
37:29Yeah, well, keep her the hell away from me.
37:30I just need to see someone, okay?
37:32Not her.
37:33Isn't chest pain an emergency?
37:35I don't...
37:35It looks here like you get an EKG five minutes after arrival, so it's not a heart attack.
37:39Yeah, but I'm supposed to get a chest x-ray and blood tests.
37:42Ah.
37:43And you are next in line for lab tech.
37:45Okay, so listen for your name.
37:46Excuse me.
37:48Fred...
37:49Actually, can you get me a wheelchair, please?
37:52Uh, hi.
37:53I'm Dr. McKay.
37:54What's going on?
37:55Uh, I found her on the floor in the bathroom.
37:57She can't stop puking.
37:58What's her name?
37:59Teresa.
38:00She's my mom.
38:01Teresa?
38:02Teresa, are you taking any medication?
38:04No.
38:05Any previous stomach problems?
38:06No.
38:07When did the vomiting begin?
38:09Last night.
38:10Last night.
38:11Last night.
38:12Do you have any dizziness or fatigue?
38:15Mystery solved.
38:16Our lady with the degloved foot is Nipali.
38:20Oh, hey!
38:21Congratulations.
38:22Otis' BP is crashing.
38:2470 over 50.
38:24Still waiting for dialysis.
38:29How you doing there, Otis?
38:31Not good.
38:32Not so good.
38:3215 liters.
38:33Not re-breather, please.
38:40Oh, crap.
38:41Diastolic collapse at the right atrium and right ventricle.
38:44Tampanone from your remake infusion.
38:45That's why his BP is low?
38:46Yep.
38:46Too much fluid and pressure around the heart.
38:48Chambers can't fill.
38:49Otis, you've got some fluid around your heart.
38:51We need to get it off.
38:5325 in propupol.
38:5410 cc's of lidocaine with epi-pericardiocentesis strength.
38:57I have to get that from central.
38:58No, no.
38:58Just open a central line kit.
39:00Dr. Santos, take the head of the bed and bag him if he stops breathing compressions
39:03if we lose the carotid.
39:05Prep and drape the sub-difluid.
39:0610 cc's of 1% width.
39:08Chlorhexidine here.
39:0825 with 27 gauge.
39:09No, long 25.
39:10Long 25.
39:14Ejecting lidocaine.
39:17Pressure down.
39:1760 over 40.
39:19Great.
39:22Wait, you can't ultrasound on place.
39:24I know.
39:24That's why I'm taking the probe.
39:2618 gauge thin wall on a 60 cc syringe.
39:28Please, Dr. Collins.
39:29Let's go.
39:31You're going in right over the center of my probe.
39:35Advancing very slowly.
39:37We're looking for the hypochoic tip.
39:39Very, very slowly.
39:41Do not hit that hard.
39:42Dr. Santos, you see that sea of black?
39:44That's the effusion.
39:44We're looking for a little white dot.
39:47There it is.
39:48Got it.
39:50Aspirating.
39:513 cc should be enough.
39:57Good.
39:57Next, we'll place the guide wire and then the triple lumen catheter.
40:01Pulse ox is 99.
40:02Pressure's up.
40:03124 over 78.
40:05Looks like things are back to normal.
40:09That was cool.
40:10Four Zofrans on board.
40:12That should stop the nausea.
40:14Yeah.
40:15Yeah.
40:15David, have you had any vomiting?
40:17No.
40:18Anyone else sick at home?
40:21It's just us.
40:23My husband passed away a few years ago from COVID.
40:27I'm so sorry.
40:29Potassium 3.1.
40:33Is that bad?
40:34It can cause heart problems, but we're going to correct it.
40:37Okay.
40:3710 in the bag.
40:3820 PO.
40:40Do you want any questions?
40:43Um, uh, David, have you two traveled out of the country recently?
40:48No, I never go anywhere.
40:50Is she enough to stay here?
40:54If the rest of the tests are good and she responds to treatment, she can go home.
41:04Okay.
41:06Mr. Milton.
41:07My name is Dennis Whitaker.
41:09I'm one of the student doctors here.
41:11I'll be seeing you first.
41:12Nice to meet you.
41:13BP's 150 over 90.
41:15Okay.
41:15That's just a touch high.
41:17I forgot to take my damn Inalapro this morning.
41:19Oh, we'll get that for you.
41:21Tell me about this belly pain.
41:23It started about here.
41:26Um, woke me up at like 2 a.m.
41:30Pretty intense.
41:32Lasted about an hour.
41:34Now it's gone.
41:35Any fever? Vomiting?
41:36Nah.
41:37I never get sick.
41:39Okay.
41:40What did you eat last night?
41:42Oh, it was my wife's birthday.
41:44Took her out to Sullivan's for a steak.
41:45Oh, okay.
41:47Well, the exam is pretty benign.
41:49I'm gonna test for gallstones.
41:51If there is a stone and you eat fatty food,
41:56there can be pain when the gallbladder contracts.
42:00Oh!
42:01Uh, bingo!
42:02One stone. There it is.
42:05Do I need surgery?
42:07Uh, you should be able to manage with a low-fat diet,
42:10but we'll send off labs for liver and pancreas.
42:13Just let us know if you have any more pain.
42:16Okay.
42:17Thanks.
42:19Uh, yeah. You bet.
42:21Great.
42:23You want any kg?
42:26For...
42:27Heart attacks can present as upper abdominal pain.
42:30Um, yeah.
42:32No, yeah, that's a great idea. Thank you.
42:48I'm going as fast as I can.
42:50I'm picking up two more patients.
42:51I didn't say anything.
42:54I, uh, I need a fresh set of eyes.
42:56On what?
42:5754-year-old woman brought in with intractable vomiting by your 18-year-old son.
43:02I'm, um...
43:03I'm getting a weird vibe.
43:06How so?
43:07I don't know. Maybe she was given something.
43:10Some sort of elder abuse.
43:12It's just a strange dynamic I can't quite figure out.
43:14You're really good at sussing out that sort of thing.
43:17I don't know about that.
43:21Uh, excuse me, Dr. Langdon?
43:25Almost all of our labs are back on sleeping boy Tyler.
43:28All 100% normal.
43:30What are we missing?
43:35Is he waking up?
43:37No, he's, he's, he's still fast asleep.
43:39Most of the lab results are in and they look great.
43:42No abnormal blood count, no, uh, electrolyte abnormalities,
43:46no diabetes, no, um, kidney disease, so...
43:50Good, so, so what's wrong with him?
43:52We're still trying to figure that out.
43:54Did he have a play date yesterday by chance?
43:57No, he had preschool, but he was fine when I picked him up.
44:00Any kids in his class? Bill?
44:02No, my phone chair would have lit up if someone else was sick.
44:05He eat anything this morning?
44:07No.
44:08Why?
44:10It looks like some sort of gelatin.
44:13Any chance he could have gotten into some, uh,
44:15back boots or laundry pods?
44:17No, and there's no such thing in our house.
44:19What about gummies?
44:20No, we're very strict about candy.
44:23Right?
44:27Oh, shit.
44:30Danny.
44:31What about Danny?
44:32Your brother, he...
44:34He gave me some gummies he got in Cleveland,
44:36they were in my coat pocket.
44:39Are you fucking serious?
44:41Pot gummies?
44:42Yes.
44:43I'm so sorry.
44:45Let me call the lab, maybe the tox cream is back.
44:47Hey, this is Dr. Langdon from the ED.
44:49Can I fast track a lab on a little boy,
44:51last name Jones, first name Tyler, tox cream?
44:53Fuck out, I mean it.
44:54Why don't we step outside and maybe you can help me figure out how much he may have taken.
44:59Thanks, I appreciate that quick turnaround.
45:04Labs confirm it, your son tested positive for cannabis.
45:08It's a fucking nightmare.
45:15Teresa, David, this is my attending, Dr. Rabinovich.
45:18Hi, Dr. Robbie.
45:19We need to do a pelvic exam.
45:22And David, I don't think you want to be in here for that.
45:24Definitely not.
45:25Can you have Nurse Perla come join me please?
45:29You want a coffee or a soda or something?
45:32Why do I need a pelvic exam?
45:33Uh, you don't.
45:36Your son seems like a nice kid.
45:38He's clearly worried about you.
45:40But your exam and your labs are not matching any of the usual diagnoses,
45:44so I'm not really sure what's going on.
45:47I'm not here for me.
45:49I'm here for David.
45:51I don't understand.
45:51He said that you've had persistent vomiting, some dehydration.
45:54I made myself sick with Ipecac.
45:57To induce vomiting?
45:59Why would you do that?
46:00So David would bring me here.
46:02My son has some problems.
46:05He needs professional help.
46:07Okay, what kind of problems?
46:08Drugs? Alcohol?
46:11I found some of his writing.
46:15I thought it was schoolwork, but it wasn't.
46:20It was lists of girls he wanted to hurt.
46:37Heard them how?
46:38He said they should all be eliminated.
46:44Has David seen a therapist?
46:46No.
46:49He's not a bad kid, but I'm afraid he's troubled.
46:52And I didn't want to call the police because I was afraid they'd overreact.
46:55He's just a kid.
46:56How old is David?
46:57He just turned 18 last month.
47:01Then he's considered an adult and he would have to consent to treatment.
47:06Do you have any guns in the house?
47:08No.
47:09My husband did, but I got rid of all of them after he passed.
47:13He's a good soul.
47:15I just don't want to see him hurt anyone or himself.
47:21How you feeling, Crash?
47:23I'd really appreciate it if you didn't call me that.
47:25Why not?
47:26It's a cool nickname.
47:27You earned it.
47:28You should own it.
47:31I don't like it.
47:34It's just a joke.
47:39You know, if it makes you feel any better, I sharted the first time I saw an emergency C-section.
47:48Really?
47:50Of course not.
48:02Excuse me.
48:02I'll be right back.
48:05I got a situation.
48:0718-year-old kid brings in his dehydrated mom.
48:09Dad died during the pandemic.
48:11Mom's vomiting is self-induced for the sole purpose of getting him here
48:14after she finds his death list for classmates.
48:18I...
48:19Okay.
48:20What does she want us to do?
48:22Help him.
48:23Protect him.
48:24Save him.
48:24Where is he now?
48:25Talking to McKay.
48:28How are you doing?
48:29Me?
48:30I'm good.
48:31I'm always good.
48:32You know that.
48:32Do I?
48:33Does anybody?
48:34I'm an open book.
48:35Not even close.
48:37You do know you can always come talk to me, right?
48:39Yeah.
48:43How's it going over here?
48:44Good.
48:45Good.
48:45We're just going over aftercare instructions, prescription medications, special diet for the
48:50next few days.
48:51Dr. McKay, can you check orthostatics on Mom?
48:53I can.
48:53David, I wanted you to meet Kiara.
48:55She's a social worker here who helps in situations like this.
48:59We heard about your father's passing.
49:01We're really sorry.
49:03And we know that can put a lot of pressure on somebody your age, which combined with school
49:08and now having to take care of your mom, that's a lot.
49:11It's fine.
49:12We just want to make sure that when your mom goes home, you can handle it.
49:16We want to make sure you have someone you can talk to if you need to.
49:18I'm okay.
49:20I don't need to talk to anybody.
49:23After a parent dies, the sadness can last a long time.
49:27How's that going for you?
49:29It's not a problem.
49:31What about school?
49:32What about it?
49:34Anything you enjoy there?
49:36Not really.
49:39A lot of people have thoughts that can disturb them.
49:43If you've had any, it's okay to talk about it.
49:45What does that have to do with my mom?
49:47Is she going to be okay?
49:49Yeah, she's going to be fine.
49:50She's probably got a stomach virus, maybe food poisoning.
49:52I think she's more worried about you.
49:55She always worries about me.
49:57Does she have a reason to?
49:58No.
50:00It's almost eight.
50:01I gotta go.
50:04You sure you wouldn't prefer to wait with your mom?
50:06I'm late for school.
50:07She can just call me when she's ready.
50:10It would actually be kind of helpful to talk to you some more.
50:13Hey, David.
50:15David.
50:17Hey, just give me five minutes.
50:18Leave me alone.
50:28Hey, David!
50:31Shit.
50:34Robbie!
50:36Robbie!
50:38I got a college kid.
50:39Respiratory rest.
50:40Coming in hot.
50:43I don't know.
51:12Robby, we need him to be here.
51:15Dr. Adamson just went down with a full sock to 65.
51:27Robby!
52:09Robby, we need him to be here.
52:16Robby, we need him to be here.
52:18You're worst in the desert
52:21You're scourged dead
52:23Your mind can't lose
52:26Your monster back
52:29To all the men who watch
52:32No words
52:36You're not so tough
52:39With no crack
52:42A sudden switch
52:45A constant threat
52:47That you're torched at the place
52:50With a fantastic
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