- 6 hours ago
Episode 01: 7:00 A.M.
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00:17You are so true, dirty, soft and hard
00:23You are close to me and you're so far
00:30And I'm thinking the time was spent together
00:34Now I'm carrying this in my backyard
00:40Sometimes I sit and wonder
00:45Will I ever tell your number?
00:51Cause I'm having fun looking out for no more
00:56I'm doing all the things I like to do
01:02I'm having fun cause I knew it all along
01:07I'd be better off without you
01:14I used my cast off
01:16As soon as you park that outside
01:17Morning doc
01:18Olsen
01:19Happy 4th
01:20Excuse me guys
01:21Sorry
01:26Come on through
01:50Hey how's it going dad?
01:52I'm so sleep deprived
01:53My house is starting to feel like a CIA black site
01:55Have you considered hiring a night nurse?
01:57You're looking at him
01:58You got a ripe one coming in
01:59You're gonna have to deal with
01:59Before everybody out there starts puking
02:01Lovely
02:02Your replacement came in early
02:04She brought in a full bagel spread
02:05I'm just saying
02:06She's not my replacement
02:07She's just covering his chief
02:08While I go on my little sabbatical
02:09Three months?
02:10I'll be back before your daughter sleeps with a night
02:12Hey dude, that's cold
02:13Morning
02:13Morning
02:30Morning
02:30Morning, John
02:31Could have sworn it was still around 4am
02:33Did you guys have an easy night last night?
02:35The waiting room actually looks manageable
02:36I wouldn't call it easy
02:38But not too bad
02:39I figured we'd have hands and burns down here a bunch
02:41But so far nobody's blown off any fingers
02:43Oh, you know you just jinxed it
02:45You guys and your jinxes
02:46Please, Jesus, please
02:47Hail Mary again
02:49In the sanctified flesh
02:50Don't let me die alone
02:51Just try to relax, Margaret
02:52I need a priest
02:54Hey, hey, Dr. Robbie
02:55What's the good word, Perla?
02:57All your results came back normal, Mrs. Walker
02:59I'm dying
02:59You're not dying, Mrs. Walker, I promise
03:01Jesus is coming for me
03:03If he is, he hasn't checked on that registration yet
03:05Please don't let me die a sinner
03:06Don't worry, Margaret
03:07We're gonna have the hospital chaplet
03:09Come and see you in a moment
03:10I'm not gonna last that long
03:11Yes, you will
03:12Because we're gonna give you a shot
03:13To keep you alive until they get here
03:15What are you thinking, Dr. Abinovich?
03:17500 mics of cyanocobalamin?
03:18In her condition, I'd push a full thousand
03:20Woo!
03:22You heard the man, Perla
03:23God bless you
03:24God bless all of you
03:26Amen to that
03:29Nothing like the miracle healing powers
03:31Of a good old B-12 shot
03:33She hold down a job
03:34She doesn't
03:36She's wearing a waitress uniform
03:37Yeah, from a diner that closed 20 years ago
03:41And so it begins
03:43My husband is still waiting to see a doctor
03:46I apologize for the wait
03:47But here are two doctors just for you
03:49Mr. Burgess has been complaining of leg cramps for a day
03:52Slightly tacky at 110
03:54BP 128 over 75
03:56Afebrile, good sats
03:58I'm Dr. Shen, but I'm going off shift
04:00Dr. Abinovich will be one of the doctors looking after you
04:02What other medications are you currently taking, Mr. Burgess?
04:05I brought his meds
04:08Thank you
04:09These are his supplements, mostly all natural and organic where possible
04:13And these are his homeopathic prescriptions
04:15I also have a list of his refrigerated probiotics
04:19Thank you
04:23Where the hell is everybody?
04:25Our new attending is torturing our intern and med students in trauma one
04:29She came in early to meet the night shift and put things over
04:33Okay, that takes giant balls of disrespect
04:35Giant balls of disrespect was the name of my band in high school
04:38And my nickname for my ex-husband
04:41Hey, uh, is this your last shift?
04:43For a while, yeah
04:44Oh, I'm so jealous
04:47Hey, I'll pay you a grand if you take my second husband
04:50Tempting
04:51So, tell me about this new attending
04:53Uh, she's pretty, divorced, one kid can already tell she is a strict rule follower
04:59I'm probably going to grow to hate her
05:01What's her name again?
05:02Dr. Buran Al-Hashimi
05:04Al-Hashimi?
05:05Hmm, what is that?
05:08Irish
05:10She's some sort of clinical informatics expert
05:12When she started talking about AI, I started thinking about robots and kind of stopped listening
05:18Clear
05:19Off the chest, Ogilvy
05:21Get ready to step up here, Joy
05:22Ogilvy, off the chest
05:24Clear
05:26Still a V-TAC, but it looks weird
05:28Agreed
05:28No pulse
05:29No effusion
05:30Good lung sliding
05:31Hey, start compressions, Joy
05:32We haven't considered all of the T's
05:34I checked for tamponade and tension pneumo
05:36What if it's thrombosis?
05:36If it's a pulmonary or a cardiac clock, T and K could save it
05:39We are sticking with the algorithm for now
05:41Algorithm's not working
05:42Faster and deeper, please
05:43Uh, you need a break, Joy?
05:45No, I need an attending
05:46I'm right here
05:49Stop compressions, we're calling it
05:52Sorry, the patient's dead
05:57All right, who can tell me what went well?
05:59We followed the V-TAC algorithm, we checked for reversible causes
06:02We limited our rhythm and pulse checks to ten seconds, excellent
06:05Should we have given thrombolytics?
06:07No, you should have recognized that the cardiac rhythm on the monitor was polymorphic, not just V-TAC
06:12It was torsade de pointe, that's French, twisting up the points
06:16From prolonged QT antiarrhythmic electrolyte disorders
06:19Your patient would have lived if you pushed magnesium sulfate
06:22Good news is, he's an organ donor
06:24Parts of him are gonna get used to make frisbees, water bottles, end up as microplastics in our brains and
06:29reproductive organs
06:30Thank you for the words of encouragement, boss
06:32Dr. Alice Shimi, Dr. Michael Obinovich, everybody calls me Robbie
06:34Pardon, please
06:35Welcome to the pit
06:37Yeah, I'm about that
06:37Tom is a minute out
06:38Ooh, who wants to treat a real patient?
06:40Yes, please, things gonna give me nightmares
06:45I hope you don't mind me jumping right into things
06:47I find that a mock code is a great way to assess the students' capabilities
06:52Well, it might have been nice if we'd had a little time to go over how we do things
06:55Did you not get a packet from Dr. Underwood, Gloria?
06:58Gloria, it outlined the quality improvement changes I instituted at the VA
07:02We're adopting the program at all of the university hospitals
07:05You didn't read it?
07:06No, I did
07:07I mean, I will
07:08I'm going to, I want to
07:09I thought I had a little bit more time before you came in today
07:12We've already distributed patient passports to everyone at registration
07:16What is a patient passport?
07:18So glad you asked
07:21Samira
07:21Dr. Al
07:22We worked together at the VA a few years ago
07:25And now you're in R4
07:26Yes, and I'm so excited you're joining us
07:29Dr. Mel King is here too
07:30I think you worked with her as well
07:32I did indeed
07:33John Doe, dishwasher penetrating trauma from a kitchen knife to the right chest
07:37Assault or accident?
07:38Unclear
07:39Initially had a pulse, lost it two blocks away
07:44What do we got, party people?
07:46Dr. Yolanda Garcia, trauma surgery fellow
07:49Meet Dr. Baran Alashimi, new ED attending
07:52She's going to be covering for me while I'm gone
07:54So nice to meet you
07:55That time they replaced you, rabbit bitch
07:57I'm going to miss you too, YOLO
07:59Dr. Garcia has a hard time expressing your feelings
08:01Not all of them
08:02One, two, three
08:05Prep for a left or economy
08:07I'm on it
08:09What's up, white chocolate?
08:11Did you know our farm boy here is a vintage funk freak?
08:16Unfortunately, he also likes to use other people's toothbrushes
08:19It was one time
08:20They were the same color
08:21What's your plan, Samira?
08:24Chest tube to the right
08:25Standby with natural transfusion protocol
08:27I put two units on the infuser
08:28Starek web six and a half
08:29Here we let the fellows and the residents kind of take charge
08:32I'll hold on to them just in case
08:34Is the VA even a trauma sim?
08:37Not for medic runs, but they walk in
08:41Falls, major MBCs, GSWs
08:45Stab wounds on the right
08:46Why are we opening the left chest?
08:48Better access if it's tamponade
08:49And you can cross clamp the aorta
08:52Givadi, Whitaker, sterile gloves
08:53Can I glove up?
08:54That's best if you watch the first one
08:57This guy's dead anyway
09:01Handblade
09:0228 front, turn along, Kelly
09:05Givadi, you're on section
09:06Whitaker, get ready for internal compressions
09:11Sorry, that's my phone
09:15Finished out of a tractor?
09:17Whitaker, give me a little room
09:17I need to get to his heart
09:19I'm in, hook up the thoracic seal
09:22Tell me to get that for you
09:23Not right now
09:34The tamponade, pretty dry in here
09:38Heart's empty, somebody start cardiac massage
09:40I'll cross clamp
09:41Yeah, I got it
09:41You do these one-handed
09:43Pushing up against the breastbone
09:44Four fingers
09:45Very good
09:46Not much blood to suction
09:47Okay, team
09:48Samira, next steps
09:50Keep transfusing
09:51Open the right chest
09:51That is correct
09:52Booty's on, kids
09:53There will be blood
09:56Frank?
10:00Landis
10:03Frank?
10:04Frank?
10:04Oh, boy
10:12You should be good to go now, hon
10:14Thanks, Lupe
10:15Of course
10:16Hey, go get him
10:21Hey, dog
10:23It's been a while
10:27I got a bad toothache today
10:31We'll take care of that, Louis
10:33All right
10:58I got a couple things in there, huh?
10:59Yeah, I see
11:01Looks like you got a couple things in there, huh?
11:07There's too much blood suction
11:10Uh, we're tracking the lung
11:12Try to identify the source
11:13Could be the right ventricle
11:15Or more likely the hilum
11:16Fresh lop pads
11:19Siri, turn on silent mode
11:22Oh, boy
11:43You should be good to go now, honey
12:13Good morning.
12:15Good morning.
12:15I'd still be in bed.
12:17So what are you doing here?
12:18Ventry's mom is visiting for the holiday.
12:20She's still alive.
12:21Well, it's too mean to die.
12:23Plus, who else is gonna get this place through the Fourth of July weekend?
12:25Sure as hell ain't gonna be me.
12:27I rest my case.
12:28What am I walking into?
12:30Nothing too bad, yet.
12:31Uh, these are the ones I'd keep an eye on.
12:36The prodigal son returns.
12:38Too soon?
12:40No, I guess not.
12:42You're back.
12:43It took some time.
12:45Like an old trail horse, always follow a way back out.
12:48You look good, kid.
12:49How you feeling?
12:50Oh, yeah.
12:50Great.
12:51You know, it's been, uh...
12:54I said something.
12:54It's been a journey.
12:56I bet.
12:57Thanks.
12:57Rob, you're on?
12:58Uh, he's in with the trauma, but if you hurry back, you can catch some of the pass-ons there
13:02in North.
13:03Uh, thanks.
13:07I'll keep an eye on him.
13:11I think we have a lost little lamb.
13:13Uh, excuse me, hon.
13:14Can we help you?
13:15Uh, I'm looking for the charge nurse.
13:18Oh, well, you found two of them.
13:20I'm Lena.
13:21This is Dana.
13:21I'm night shift going home, but Dana is queen of the day shift.
13:25Emma Nolan.
13:26Nice to meet you both.
13:27I-I'm a new grad RN here to shadow.
13:29Welcome to the pit, Emma Nolan.
13:31Here, let me put some of your stuff behind the desk and I'll give you a quick tour.
13:34Okay.
13:36Where you from, sweetheart?
13:37Sault Ste. Marie.
13:38Oh.
13:39It's in Upper Michigan.
13:40Practically Canada.
13:42My great-grandmother was from up that way.
13:45Nice area.
13:46A lot of bugs.
13:48How about a cup of coffee?
13:51I can't locate the source.
13:53Proximal Highland was under Listerna, along with most of the right ventricle.
13:56You need better exposure.
13:58Convert to a clam shell.
14:00Exactly.
14:00Trauma shears.
14:02Might've been nice to let them come up with that clam.
14:04Heart's gonna need double compressions, just like this.
14:07Squeeze from the apex to the aorta.
14:12Right ventricle looks good.
14:13Massive hemorrhage from the highland.
14:15Second MTP pack's going.
14:17Additional four units.
14:19High laryngeal looks very proximal.
14:21Maybe pulmonary artery and vein.
14:23Clamps on.
14:24Nope, no good.
14:26Still bleeding like a stuffed pig.
14:28I can give it a test.
14:28Dr. Gersi is a very skilled surgeon.
14:30If she can't get it, we need to think of something else.
14:31Like what?
14:36Highlerflip.
14:37We're gonna rotate the lung 180 degrees, like putting a king in the garden hose.
14:41It'll stop the bleeding.
14:42That could possibly work.
14:43Or he'll die when you rip the entire lung off the hilum.
14:47Gently.
14:48Very, very gently.
14:49Very, very slowly.
15:06Blood loss is lying down.
15:07That's a good sign.
15:08The hilum looks dry.
15:09Maybe the heart peels empty.
15:10Okay, we fixed the leak.
15:12Now let's fill the tank.
15:15You are very popular today.
15:18Sorry, I'll turn it off when I can.
15:24Nine-year-old Kylie Connors, riding by her dad's girlfriend, Gina.
15:28Kylie took a tumble on the stairs this morning.
15:31We submitted a chin lac and a chipped front incisor.
15:34Just got lead on a pressure dressing.
15:36Bleeding pretty good on a rival.
15:38Dermabond should do the trick.
15:40Any questions?
15:42Dr. King?
15:44Mel?
15:45Oh, um, I didn't say anything.
15:51How you feeling, Kylie?
15:53Tired?
15:54I've been here since 5.30.
15:55Oh, that makes two of us.
15:57But don't worry, we'll patch you up good as new,
15:59and we will get you out of here as soon as we can.
16:02Any questions?
16:02No, I'm just her dad's girlfriend, so I'm new to all this.
16:06No worries.
16:07We got you.
16:07Next.
16:1026-year-old Liam Sanders.
16:12Took a fall from his bicycle.
16:14No LOC, non-focal mural.
16:16Lower leg lock with no bony tightness.
16:18Were you wearing a helmet, Liam?
16:20No, I was just writing in my neighborhood.
16:22You should always wear a helmet.
16:24Hey, nice of you to join us.
16:25Hey.
16:26Dr. Langdon!
16:30Sold to Dr. Langdon.
16:33Candace O'Grady, 82.
16:35Brought a virus on Richard for intractable vomiting.
16:41Hardly any hemorrhage on the right.
16:42Looks like the flip worked.
16:43How's the heart work good?
16:44Feels full of blood.
16:45First time since we started.
16:46Hold compressions.
16:50Quivering bag of worms.
16:52Woof.
16:52Resume compressions.
16:53When the heart quivers like that, it's obvious if you fit.
16:55Okay.
16:56Internal paddles ready?
16:57Mm-hmm.
16:58Charge 2.
16:5925 joules.
17:0050 gets it right the first time.
17:04Charge!
17:04Okay, Whitaker, when you're ready.
17:05Clear!
17:10I think that's what normal sinus looks like.
17:14Strong carotid.
17:15Saline lap pads and up to the OR.
17:19So how do we start the day?
17:21Unconventional, but a decent outcome.
17:25Why don't we split up for efficiency?
17:27Residents present to either one of us, but not both?
17:31We can certainly discuss that.
17:37Were you feeling weak or dizzy?
17:40No.
17:41I got up to pee and I tripped over a laundry basket that I couldn't see in the dark.
17:44Did you hit your head?
17:46Does my chart say that I hit my head?
17:47No.
17:48We just want to be thorough to make sure you don't miss anything.
17:52How about we focus on patching me up?
17:55Ah!
17:56Alright.
17:57Mr. Williams, we're going to check an x-ray of your wrist and try to get you out of here
18:01as quickly as possible.
18:02Great.
18:03And let's keep the bullshit extra charges to a minimum, huh?
18:06My deductible is already a bitch.
18:11Sure.
18:33Sorry.
18:34Bye.
18:36My mother is trying to destroy my life.
18:38Well, yeah.
18:39They seem to take pleasure in that.
18:41I committed to a partnership with her partner.
18:42I got a partnership track position next year at a hospital back in Jersey so I could be close and
18:46support her.
18:46But now she's getting married and selling our house to go on a year-long cruise around the world.
18:52Wow.
18:53I mean, that's a...
18:54Pretty fucking stupid idea if you ask me.
18:56She's known this guy less than a year.
18:58What if he's a player?
18:59What if she disappears at sea?
19:02I mean, what if they're in love?
19:03Lust is more like it.
19:05That is even better.
19:08Man.
19:09It has been a while.
19:12And I'm solo this weekend.
19:15I need to get laid.
19:21It's a little much before 8 a.m., right?
19:24Yeah.
19:27Or ever.
19:34How's it going, Esby?
19:35Oh, just another day in paradise.
19:46Oh, no.
19:55Heard you going on a trip.
19:57Taking a sabbatical.
19:59Leave tonight.
20:00Where you going?
20:03Um...
20:03Head smashed in buffalo jump.
20:06Captain Crunch flying squirrel socks.
20:08Are we talking in code or you have a stroke?
20:12It's an aboriginal UNESCO heritage site in Alberta.
20:15I've never seen the Badlands.
20:17What is this?
20:18Like, uh, some sort of spirit quest?
20:20Uh, yeah.
20:22Something like that.
20:24Look, I, uh, I guess we should talk.
20:27I got a lot of things I need to, uh...
20:28At some point. Not right now.
20:29Right now, I got to hit the head.
20:30And I would like you to go help Donny out in triage.
20:32Triage?
20:34No.
20:35No, I already picked up a patient in North, too.
20:37A bicycle.
20:38Pretty sure we can cover for you.
20:39We've been doing it for months.
20:43Right.
20:44No, and I, and I am, I am very, uh, both very sorry and appreciative of that.
20:49I just would hate to think this is some kind of a punishment for...
20:53But, uh, yeah, yeah, no, for sure.
20:55We'll, we'll talk later.
20:56Before you go.
20:59Like I said, not right now.
21:01Donny just passed his DP certification.
21:03He can help you if you get in over your head.
21:09Hey, Mel, can you take over a bike fall leg-lack in North 2 for Langdon while he's out in
21:15triage?
21:15Um, you know, I, I can work in triage if I want to talk to you.
21:18No, I want to keep Langdon out in triage and I want to keep you back here.
21:21You okay with that?
21:22Sure.
21:23Great.
21:24Absolutely.
21:33So, who should I pick up?
21:35We're about to get the morning rush.
21:37What do you mean?
21:38Every morning around this time, the nursing homes and assisted living facilities do their morning bed checks.
21:44Uh-huh.
21:48It looks pretty quiet to me.
21:54Uh-huh.
21:56Incoming!
21:57Oh, like I said, come on.
22:01Ethan Bostick, 79. Found altered this morning at assisted living.
22:04No history of dementia. Has a pulse.
22:06What's a pulse?
22:08Physician orders for life-sustaining treatment. No CPR, no intubation.
22:13Then there's, there's nothing for us to do.
22:15South 15 is open.
22:16Uh, well, do not resuscitate does not mean do not treat.
22:20He may perk up with fluids, IV antibiotics.
22:28What's the good word, Crash? You save that ventriloquist dummy?
22:32Yeah.
22:33Really?
22:34No.
22:36Wait, tell me you're not actually charting about losing a mannequin.
22:39It's part of the exercise. Dr. Olashimi asked us to do it.
22:42Who's his next of kin? Barbie?
22:44Okay.
22:46What's your, uh, take on the new attending?
22:50Not too soon to tell.
22:53You?
22:54She's already bugging me about being behind on my charting.
22:57Now I know why everyone says being a second year resident sucks.
23:00Because it does.
23:01It must've sat through the part of med school where they tell you 90% of your time will be
23:05spent typing.
23:06Which is just one more reason surgery is a better lifestyle choice.
23:10Hey, Dr. Shamsi. Dr. Trinity Santos.
23:12Oh, yes. The ER intern who's interested in my surgery program.
23:16Well, that's me. But I'm an R2 now. And thinking of double boarding in surgery and emergency medicine.
23:22Which I know would sound ridiculously ambitious if I didn't have the talent to back it up.
23:26And a required attitude.
23:29Are you here to see a patient?
23:31I was. I did. And now I'm here to learn why you aren't returning my calls or texts.
23:37Okay. I'm out. Nice seeing you again, Dr. Shamsi.
23:41As soon as I get a little free time, I will make plans for all of us to do something
23:44together.
23:45What about Tuesday?
23:46I'm working.
23:46On your birthday?
23:48I will call you and dad tomorrow and we will come out this night to do together. I promise.
23:52But right now, I just have a bunch of night shift handoffs.
24:03We have schedules. You have chaos.
24:07You know she's wasting her talents down here.
24:09Victoria is a big girl. She can make her own decisions.
24:12She's also a young girl who's still very impressionable.
24:15And you can be very...
24:17Impressionable?
24:21Yes.
24:22Who?
24:24Oh, for God's sake. I'll be right there.
24:28We need to talk.
24:31About same time tomorrow.
24:36Next Tuesday is your birthday?
24:38No.
24:40Yes.
24:41Your 21st birthday.
24:42Please don't say anything.
24:43Okay, I get a little anxious about...
24:45Dr. Sampso's little girl with the chin legs getting to a gown.
24:47Don't want him, but you know what?
24:50Nothing.
24:53Have a good day.
24:54Me too.
24:59Hey, Duke.
25:00I'm just calling to remind you that this is my last shift for a while.
25:05So I need you to come in before 3 o'clock in case we need to run some tests.
25:11Okay? We had a deal, brother.
25:15Oh.
25:16Hello.
25:17Hi. I know you're crazy busy.
25:19Always.
25:20But I figured we should really go over a few things before you're gone.
25:23Sure. Where would you like to start?
25:25Well, one little thing that I think would have a big impact with staff and patients alike is if we
25:30launched a campaign to eradicate referring to this wonderful department as the pit.
25:37Really?
25:37I know you think it's silly and petty.
25:40No, I think it's just kind of endearing. Pretty damn accurate.
25:43I would argue the opposite.
25:45I think subconsciously it affects those who work here.
25:48It also lowers expectations, which in turn lowers patient satisfaction to us.
25:52Well, you've been talking to Gloria.
25:53Yes. And she agrees with me.
25:55Don't doubt that for a moment.
25:57You have to see the matter right now.
25:59We see people in order of severity, ma'am.
26:04I don't know what you're saying.
26:07I can taste the shit in the back of my throat.
26:09Actually, the ladies' rights want to make all of us sick, so...
26:11Yes, please.
26:20All right. We'll get them back.
26:22Tell Dana we're bringing the funk.
26:28So when did your eyes start bothering you, Miss Matthews?
26:30Sister Grace, please. I'm only married to God.
26:34Of course. I'm sorry.
26:36A few days ago, I thought it was pink eye.
26:40Or maybe I scratched it while gardening.
26:42It's a very bad case of conjunctivitis.
26:44We should send a sample to the lab to direct her treatment.
26:48Look up for me.
26:54I'll put a numbing drop in your eye and check for a scratch with a special lamp.
27:01And I'll get you to look up for me again.
27:05Have you ever considered serving God?
27:08Which one?
27:09Excuse me?
27:12My family's Hindu, so we have like 33 different kinds of deities.
27:16Oh, we have the one.
27:18Some people only need one, right?
27:21Okay.
27:25Most important rule around here, be smart, be safe.
27:28Can't warn you enough about protecting yourself and your fellow nurses.
27:31We use the STAMP acronym to assess patients. You know it?
27:35Uh, S is for staring or refusal to make eye contact.
27:38If they're staring, they're scaring. T?
27:40Tone of voice.
27:41Often the threat level rises with their voice.
27:43A is for anxiety.
27:45You can also think aggression.
27:47M is mumbling.
27:48If you listen closely enough, it's often the same.
27:50What they're thinking of doing is to talk themselves up to it.
27:52And P?
27:53Pacing.
27:54Good. We also have a safe word.
27:55Hula hoop.
27:57I guess technically it's two words, but whatever.
27:59If there's a threat, say hula hoop and we'll all respond.
28:04Yeah?
28:06Lovely.
28:07Okay.
28:08I'll be right there.
28:09With reinforcements.
28:12Dirty calls.
28:13We're headed for triage.
28:20We're gonna get your cast off.
28:22Just be here.
28:41The antibiotics should clear everything up, but you should try to stay off it for a few days.
28:47I have to work.
28:49I'm late as it is.
28:50Well, um, take breaks and elevate when you can.
28:54Tying on Advil for the pain.
28:56If the pain persists or feel like it's getting worse, come on back, we'll get you fixed up.
29:01Thanks.
29:02Listen, give this to the doctor.
29:06What the hell is it?
29:07Patient passport.
29:09Let's patients know what they're waiting for and how long it'll take.
29:11You check off if he needs labs, x-rays, CT.
29:14None of the above.
29:15When do we start this?
29:16Today.
29:17The new attending.
29:20What's up with your tooth, Louie?
29:22It's been going on for a while.
29:25But it got bad last night.
29:28Lower left side.
29:30Okay.
29:32Ah!
29:33Ah!
29:34Ah!
29:35Yeah.
29:35It could be an infection at the root.
29:37We can drain it, but then you're, uh, you're breathing kind of fast.
29:43Yeah, I've been, well, I've been, uh, walking more.
29:48Trying to get in shape.
29:50But sometimes, like, I get a little short of breath.
29:52Yeah, you need to walk past the liquor store, not into it.
29:55What shape you're getting in is for a liver transplant.
29:58I don't need a new liver.
29:59Just get rid of this toothache.
30:01Deep breath.
30:06One more?
30:08Is my heart still ticking?
30:09Like a jackrabbit.
30:11How long you been sitting down?
30:12Oh, just for a few minutes.
30:14Not that long.
30:15Um, Louie.
30:19There's something I need to tell you.
30:23Last time I saw you, about ten months ago, I treated you and I took some of your medicine.
30:31I'm not sure I follow.
30:34I have an addiction to benzos.
30:37And I helped myself to some of the librium I prescribed you for your withdrawal.
30:43You stole my pills?
30:46Yeah.
30:47Yes.
30:48Um, I'm sorry.
30:51It was, uh, it was not only wrong and utterly unprofessional, but it was a betrayal of my
30:57Hippocratic oath, and it was a fucking crime.
31:02That's where I've been.
31:04Rehab and counseling.
31:08Huh.
31:09I'm sorry.
31:10I-I understand if you'd prefer a different doctor.
31:13Hey, Doc.
31:14We have a situation.
31:17Excuse me.
31:19What kind of situation?
31:21Someone left the little baby in the restroom.
31:31Okay.
31:33Let's think about reversible causes of confusion in the elderly.
31:37Uh, hypo or hypernatremia.
31:39Infection, but he's afebrile, good or two sats, and urine dip was negative.
31:42Yeah.
31:43Great.
31:43Joy, anything to add?
31:46Nah.
31:49VTAC, can I?
31:50Yeah.
31:53No pulse.
31:54Should we call for a code blue?
31:55No CPR.
31:56No shock.
31:57We honor his pulse and his wishes.
31:59So, what does that leave us?
32:02Making sure he's comfortable.
32:05Pulse action.
32:06Altered mental in the elderly can also be toxicity from anticholinergic, sedative hypnotics, opioids.
32:15Am I missing something?
32:17Social skills?
32:19What?
32:24He looks so peaceful.
32:25Should we maybe go find a new patient?
32:26No, stay here.
32:31A systole.
32:42Quick and painless.
32:44We should all be so lucky.
32:45I'll try to contact some family.
32:50Yeah, one of the things we like to do here, when we have the time, is to take a moment
32:59of silence when we lose a patient, to respect their humanity.
33:03He was someone's son, perhaps a father himself, a brother or friend.
33:13Oh, uh, just make sure your phones are on silent.
33:20Great, great, great.
33:21Okay.
33:23Is anyone missing a baby?
33:26Did anyone leave their child in the restroom?
33:31You, uh, remember seeing a woman enter with a baby but leave without one?
33:36No.
33:37Sorry.
33:38Might be on the security tapes.
33:41I'll have them.
33:41I'll check it out.
33:42Please.
33:42Yeah.
33:43Harlow Graham to window one.
33:46Harlow Graham to window one.
33:50Harlow Graham to window one, please.
33:58Donnie Donahue, nurse practitioner, and this is Emma, new grad nurse.
34:01Hey.
34:01Nice to meet you.
34:02What's going on?
34:03Somebody dumped their kid.
34:05Well, maybe mom just stepped out for a smoke or something.
34:07What?
34:08I'm being helpful.
34:09Sometimes I just need a little break and then they come back.
34:13At least I didn't leave her in a suitcase at the bus station.
34:16Does that happen?
34:17If that's a true story, I don't want to know about it.
34:19The worst of seeing...
34:20Please, don't tell me.
34:21I'm a new dad.
34:22Remember?
34:22Okay.
34:31I'll get Robbie.
34:32Should I come with?
34:33No, stay here.
34:34Donnie, Jessie, teach her something.
34:39You know how to check a rectal temp on an infant?
34:43Uh...
34:45Theoretically.
34:52Mr. Williams, how's the pain?
34:55Nothing I can't manage with some Vicodin and a little scotch.
34:59Well, it's best not to mix the two.
35:01James here is going to take you to get an x-ray at your wrist.
35:03Good morning.
35:04I'm going to be fine.
35:06Well, it'll tell us if you need a cast.
35:08I doubt it.
35:09I should probably go home, keep some ice on it.
35:11I know you guys always need the beds.
35:15Well, it'll only take a minute and then we'll know for sure.
35:19Yeah, I really don't think it's necessary and I have a busy day,
35:21but I appreciate your concern.
35:26I'd really like to observe you for a little bit in case you did hit your head.
35:31My head?
35:33I have my schnoz on my arm, I think. Nothing more.
35:36You think you don't remember?
35:38No.
35:39Yes.
35:41I'm going to be fine, really.
35:44Thank you for your concern.
35:50Okay.
35:52Ha!
35:54How about we take that x-ray just to be safe?
35:58Yeah.
36:00Yeah, okay.
36:01Okay, good idea.
36:04Somebody found a baby?
36:06Yeah.
36:07Not the first time it's happened.
36:09So, about those pills I took.
36:12Don't worry about it, Doc.
36:14If the pills helped you, great.
36:17I never really liked taking them.
36:21I appreciate that, Louie.
36:23That's not really the point, but I need to lift up your shirt for a second.
36:34How long has your belly been hard like that?
36:36I don't know.
36:37I figured I could wait another week.
36:39You need, uh, some lab tests and a procedure to drain off some of this fluid.
36:44Yeah, I know the drill.
36:46I've been tapped a few times before.
36:49Three times in the last six months.
36:52You need to give your liver a break, Louie.
36:55Yeah, I know.
37:01Just heard somebody dumped a baby in the waiting room bathroom.
37:04How sad is that?
37:05Huh?
37:07What's up with you today, Mel?
37:09Lynn Galia?
37:11What makes you think there's something up with me?
37:13You're moping around here all day like somebody gunned down your favorite K-pop band.
37:17I don't really have a favorite K-pop band.
37:19Not that I don't like the genre.
37:21Forget K-pop.
37:22What's going on with you?
37:24You usually ride in here on your unicorn, tossing wildflowers.
37:28Unicorn?
37:28Never mind.
37:30Is everything okay with your sister?
37:33Oh, yeah, she's great.
37:35It's just this...
37:37Okay.
37:38Spill, girl.
37:41Um...
37:42Well, a couple of months ago I got named in a malpractice lawsuit.
37:47And so, um, today is the deposition.
37:52That's it?
37:53Every emergency medicine doc gets sued sooner or later.
37:56Seriously.
37:57Don't sweat it.
37:58I mean, you're still a resident.
37:59We're protected by the hospital.
38:00You could cut somebody's head off and get away with it.
38:04But, you know, like, don't...
38:06You won't want to become known as the one who put Mel in malpractice.
38:12Hey, Santos.
38:13Our little girl Kylie has been in the West Bend emergency department a couple times.
38:18I'm not saying this is necessarily the case here, but recent studies have linked bullying behavior to different personality disorders.
38:26On the other hand, though, I am known to be a bit overly sensitive sometimes.
38:30Mel.
38:31Yes?
38:31You talk to yourself again.
38:32You need something?
38:34Uh, yeah, a good lawyer.
38:35I don't know.
38:36I'm kidding.
38:37I'm...
38:40Yo, Rabinovich.
38:41Somebody ditched a bundle of joy in chairs.
38:43How old?
38:44A couple months.
38:44Maybe Donahue's got her in peds.
38:46No one saw who left her?
38:47Apparently not.
38:48It's so sad.
38:50Tell me about it.
38:50Who throws away a perfectly good baby?
38:53Make a leg.
38:54Ah!
38:55Sweet baby Jesus, Antoine!
38:57Right to the outdoor shower!
38:58I just drive them.
38:59I'm not a washing detail service.
39:00Yeah, yeah.
39:01God forbid you prove useful.
39:03Ah!
39:03Good timing, Miss Emma.
39:04Time for you and me to do the Lord's work this way.
39:07Oh, God.
39:08What is that?
39:09Okay.
39:09Big breath.
39:13All right.
39:13Lungs sound great.
39:15Can you lean forward for me?
39:22Uh, did you hit your back when you fell down the stairs?
39:26No.
39:26Hey, there's a pretty good bruise here.
39:29I got knocked down in soccer.
39:33Oh, no.
39:34You broke your wrist last year too, huh?
39:36Fell with my skateboard.
39:37Got a purple cast.
39:39Cool color.
39:40And you were treated at West Penn.
39:42Is that your closest hospital?
39:44Uh, I guess that would make sense.
39:46I've only been dating her dad a few months.
39:49Uh, he lived in Garfield before the divorce.
39:51And, uh, what about these?
39:53Soccer.
39:54Do you wear shin guards?
39:55My dad ordered them.
39:58What does your dad do for work?
40:00He draws buildings, but he's not an architect.
40:03He's a draftsman for a firm in Newcastle.
40:07Um, Kylie, any chance you can pee?
40:11Um, maybe.
40:12Okay.
40:13Well, uh, with the bruise on your back, we need to check your urine.
40:16Okay.
40:17Okay.
40:21Did you eat anything out of the ordinary recently?
40:23No.
40:24Sorry, but we went through this.
40:26A bunch.
40:27Don't you people communicate?
40:29You're the third nurse we've told her story to.
40:30I'm a doctor.
40:32Richard.
40:33Would you go to the cafeteria and get me a large chamomile tea?
40:37What can we get you, my dear?
40:39I'm fine.
40:43Yeah, I'll be right back.
40:49Please excuse my son.
40:52Ever since my husband died, he's been a little overprotective.
40:56I think it's sweet.
40:58You're very lucky to have him.
40:59I am.
41:02Are you still taking your loperamide and cholestyramine?
41:07Um, not so much.
41:09No?
41:11That may be why you're experiencing the abdominal pain and vomiting.
41:15When did you stop taking your meds?
41:17Last winter or so.
41:21My neighbor Helen and I bingo in Wintersville.
41:25There's a dispensary next door.
41:28And we got some marijuana.
41:30And I swear.
41:31It cleared everything up.
41:34A few cookies.
41:36Every few hours.
41:38And no more pain.
41:40A few cookies?
41:43How many are you eating in a day?
41:45Oh, uh...
41:46I don't know.
41:50Probably a dozen or so.
41:52But they're not very big.
41:55There have been some studies that show an added dementia risk with marijuana use in older adults.
42:03Oh, that sucks for old people.
42:07Kylie, there are some questions that we ask every kid who comes in with an injury.
42:13Like what?
42:14Like, sometimes the people that you live with can get so mad that they hit you or hurt you.
42:23Maybe without even meaning to.
42:26Does that ever happen?
42:27No, not to me.
42:29Or sometimes kids can get punished for doing something wrong with maybe a spanking or a belt.
42:37I get timeouts.
42:40How about at school, Kylie?
42:42You know, is anybody being, you know, mean or bullying you?
42:45No. I have lots of friends.
43:08Yo Whitaker
43:11Dr. Langdon
43:14You uh meet Louie here
43:15Yeah yeah many times
43:17Good morning
43:18Mr. Cloverfield
43:19What's up doc
43:20Where's your new resident badge buddy
43:22Oh uh yeah
43:23They didn't give me a new one yet
43:26Bummer
43:27You and uh your ducklings got time to
43:29Tap a six pack off our friend here
43:31Louie needs a paracentesis
43:32Yeah sure
43:33It's good to see you again Louie
43:35Not in this condition of course
43:37How you feeling
43:38Feeling like I need a drink pretty soon
43:42Okay well first things first
43:43We are gonna make you more comfortable
43:46By draining some fluid
43:47You're gonna take off a big volume
43:49To start with 60 grams of 25% albumin IV
43:52You tapped him before?
43:54No
43:54That's okay doc
43:55I'll talk him through it
43:58Okay
44:01Sats 99 on room air normal BP normal plus
44:07Well hydrated
44:08No obvious source of infection
44:10Could be a benign virus but can't assume that
44:13Is this the abandoned baby?
44:15Is this the abandoned baby?
44:15Mm-hmm
44:15How old?
44:17How old do you think she is?
44:19Month?
44:19Month and a half?
44:20It's tricky
44:22Under 28 days is a safe haven drop off
44:24No questions asked
44:25But over 28 days is a crime
44:27Child abandonment
44:28How should we assess?
44:31Under 28 days gets everything including an LP
44:34But over 28 days you can follow PCARN or step by step to determine risk of invasive bacterial infection
44:41This baby looks great
44:42We know nothing about the birth history
44:44Did mom have group B strep?
44:46Active HSV lesions?
44:48We should assume the worst
44:50Put in your orders Dr. Mohan
44:53CBC
44:53Blood culture
44:55CAM panel
44:57Chest x-ray
44:58UAN culture
44:59Respiratory virus panel
45:02Check inflammatory markers
45:04Procalcitonin
45:05And CRP
45:06Then
45:07Take it from there
45:08That sounds like a plan
45:10Dr. Robby
45:11Santos needs you
45:12North 1
45:13Okay
45:13I'll be right there
45:15Feel excused?
45:16Feel excused?
45:19Mind if I join with?
45:21Uh
45:21No
45:22At this
45:23It will help me get a better sense of how you like to do things by seeing you in action
45:27with the residents
45:29Be my guest
45:33I will be right back
45:42Nine-year-old Kylie Connors took a tumble running up the stairs this morning
45:45Chin lack and a fractured tooth brought in by her dad's girlfriend, Gina
45:49Supposedly the dad had to leave early for work
45:53Kylie has a lot of bruising on her body
45:55Some old, some new
45:56Are you concerned about non-accidental trauma?
46:01Or worse?
46:02Her urine sample shows gross hematuria
46:04Which could be renal injury
46:06Or vaginal bleeding from trauma could have contaminated the specimen
46:10Lots to consider
46:11What's your plan?
46:13Labs
46:14Ultrasound
46:15Social work consult
46:16Then decide if this is reportable
46:21Let me know if you can feel this
46:24No
46:24Am I supposed to?
46:26No
46:32Your hair is such a pretty color
46:33Thank you
46:35Reminds me of my mom
46:37She died when I was nine
46:39I'm sorry about that
46:41She wore glasses like you too
46:43Weird
46:45And what do you like to do when you're not working?
46:49Um, spend some time with my sister
46:51Read
46:53Do you drink coffee?
46:55Uh, no, I avoid caffeine
46:58Me too
47:01What about boba?
47:04I love boba
47:10I'll offer you some gum, but it's laced with nicotine, trying to quit smoking
47:16That's good
47:17Birdie's still out
47:19Getting all those nooks and crannies, Mr. Digby, your skin will thank you
47:23We all will
47:25I could stay in here all day
47:29It's a miracle what a little soap, water, and human decency can do sometimes
47:33Don't forget the ears, pal
47:35Don't want anything growing in there either
47:36Okay
47:38Okay
47:38So what's your story, Emma?
47:40What do your parents do?
47:41Got siblings, boyfriend
47:43Have a killer man in a bar fight
47:46Uh
47:57So, Mr. Williams
47:59Sometimes a fracture of the scaphoid bone doesn't show up on day one
48:03So my advice to be safe is we're split for two weeks and then come back for a repeat x
48:09-ray
48:09And we'll see if it's really there
48:13My knee hurts
48:15Oh, did you hurt your knee?
48:19I must have
48:27What is this?
48:30That's, um, for your wrist
48:32And I need this?
48:36Well, um, if it's a, uh, John, can you, yeah
48:40If it's a fracture and we don't immobilize, the bone might not heal properly
48:48How long is this going to take?
48:51Just a few minutes to fit you
48:56Is this place new?
49:02Mr. Williams
49:03Do you know what day it is?
49:09It's Taco Tuesday
49:12Do you know where you are?
49:15Yeah, I'm in the slowest medical clinic in the West
49:19Do you know what year it is?
49:21How about you just fix my wrist
49:23And you stop
49:24With all the questions
49:27I am not here to be profiled
49:34Yeah, of course
49:38I'll be back, okay?
49:40Okay
49:51All right, Mr. Dick
49:52We're looking better already
49:53Certainly smells a little better
49:55Do you have any conditioner?
49:56Let's get you dried off and back inside
49:58Get him downed up and put him in South 21
50:00And cross from the old nun
50:01Maybe some of her had to find Grace
50:03So we're off on him
50:05Who do we have here?
50:07Evelyn Bostic, 81, with Alzheimer's
50:09We brought her husband in about 30 minutes ago
50:11She was supposed to get a ride in
50:13But they found her wandering in traffic
50:14Where are we?
50:15You're at the hospital, dear
50:16I'm not sick
50:18We brought you to see your husband
50:19Oh, no
50:21Is Ethan okay?
50:22Be in to chat with you, Mrs. Bostic
50:25He died
50:27What you got, Aunt Boy?
50:29Alan Billings had a palate fall into his outstretched arm
50:32Looks like an open dislocation
50:34Yeah, that's gotta hurt
50:35Don't worry, sir
50:36We got you
50:43How's she doing?
50:44Seems happy enough
50:45Yeah
50:47I just got a quick point of care, CBC
50:56Is there a problem?
51:03Did I miss something?
51:04Dr. Al?
51:06Dr. Al
51:14I've been hurt
51:17But I refuse to cry
51:22I've been hurt, baby
51:24But I refuse to cry
51:29It's so true
51:30You know, you know, you know, you know
51:33I can't lie
51:34And I said, yeah
51:36Yeah, yeah
51:49I won't cry
51:52Oh, you know I won't cry
51:55I said, I won't cry, baby, baby
52:00You know I won't cry
52:03You know, you know I won't cry, baby
52:06I'm telling you, I won't cry
52:10Oh, I don't like
52:13Oh, but I refuse to cry
52:16And I said, sometimes, darling
52:21Your friends, they treat you so cold
52:24But baby, you know they act better
52:27Yeah, yeah, when you have that goal
52:32But I won't lie
52:34You know, you know, you know
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