1 00:00:08,102 --> 00:00:11,010 Sync and corrections by btsix www.addic7ed.com 2 00:00:11,011 --> 00:00:12,302 You sent labs? 3 00:00:12,303 --> 00:00:13,513 No indication. 4 00:00:13,514 --> 00:00:14,972 Normal vitals, normal neuro exam. 5 00:00:14,973 --> 00:00:16,640 Dude just dropped... no warning. 6 00:00:16,641 --> 00:00:19,101 - What's open? - Trauma 1. 7 00:00:19,102 --> 00:00:21,812 Grab Langdon or whoever else is avail. 8 00:00:21,813 --> 00:00:24,273 [TENSE MUSIC] 9 00:00:24,274 --> 00:00:25,607 What have we got? 10 00:00:25,608 --> 00:00:27,151 Seizure in chairs. 11 00:00:27,152 --> 00:00:28,277 Thank you. 12 00:00:28,278 --> 00:00:29,611 How is it out there? 13 00:00:29,612 --> 00:00:31,990 Chaos. We're never gonna catch up. 14 00:00:33,491 --> 00:00:35,159 Lorazepam's on board. 15 00:00:35,160 --> 00:00:36,953 Okay, draw up another 4. 16 00:00:38,913 --> 00:00:40,372 Yeah, no history. 17 00:00:40,373 --> 00:00:42,499 Doesn't look like he's been here before. 18 00:00:42,500 --> 00:00:45,002 Satting low 90s on 5 liters. 19 00:00:45,003 --> 00:00:46,545 Another 4 milligrams. 20 00:00:46,546 --> 00:00:49,214 I can't get the top off. 21 00:00:49,215 --> 00:00:51,175 It's... it's just the plastic, not the metal. 22 00:00:51,176 --> 00:00:52,634 No, I know. I know, I know. 23 00:00:52,635 --> 00:00:53,677 Here, give it to me. 24 00:00:53,678 --> 00:00:55,012 No, I got it. 25 00:00:55,013 --> 00:00:56,847 Okay. [MONITORS BEEPING RAPIDLY] 26 00:00:56,848 --> 00:00:59,183 Ordering CBC, CMP, 27 00:00:59,184 --> 00:01:01,685 and a straight cath for a urine tox. 28 00:01:01,686 --> 00:01:05,147 All right. Pushing the second 4. 29 00:01:05,148 --> 00:01:07,123 If this doesn't work, we need to prep Keppra. 30 00:01:07,124 --> 00:01:08,984 No, we'll give more lorazepam. 31 00:01:08,985 --> 00:01:10,277 It's already ordered. 32 00:01:10,278 --> 00:01:11,862 He's already had 8 milligrams. 33 00:01:11,863 --> 00:01:13,363 - He'll stop breathing. - Then we'll intubate. 34 00:01:13,364 --> 00:01:15,032 Sometimes a patient needs a little more. 35 00:01:15,033 --> 00:01:17,201 - How long has he been seizing? - About four minutes ago. 36 00:01:17,202 --> 00:01:18,702 He started seizing in chairs. 37 00:01:18,703 --> 00:01:20,496 He's already had 8 of lorazepam. 38 00:01:20,497 --> 00:01:22,915 I want to move on to Keppra, but Dr. Langdon disagrees. 39 00:01:22,916 --> 00:01:25,000 I just want us to try another 2 milligrams before moving on. 40 00:01:25,001 --> 00:01:27,961 Dr. Langdon's patient, Dr. Langdon's call. 41 00:01:27,963 --> 00:01:30,424 [GURNEY THUDDING] 42 00:01:33,593 --> 00:01:35,886 Dennis Whitaker, meet Bob Chazen, 43 00:01:35,887 --> 00:01:38,472 a 53-year-old cyclist who injured his leg 44 00:01:38,473 --> 00:01:40,724 about ten days ago on a trip to Utah. 45 00:01:40,725 --> 00:01:43,560 I was in Moab, coming downhill fast, 46 00:01:43,561 --> 00:01:46,355 and jammed my pedal into my leg. 47 00:01:46,356 --> 00:01:47,606 Ooh, ouch. 48 00:01:47,607 --> 00:01:49,566 That's some gnarly road rash. 49 00:01:49,567 --> 00:01:51,401 White Rim Trail. 50 00:01:51,402 --> 00:01:53,904 I've been putting Neosporin on it a couple times a day, 51 00:01:53,905 --> 00:01:56,532 but now it hurts to walk. 52 00:01:56,533 --> 00:01:58,075 What do you see, Whitaker? 53 00:01:58,076 --> 00:02:00,828 Um, outside of the wound looks cellulitic. 54 00:02:00,829 --> 00:02:01,995 What's that? 55 00:02:01,996 --> 00:02:03,539 It's a bacterial infection. 56 00:02:03,540 --> 00:02:05,582 We'll need to get you on oral antibiotics. 57 00:02:05,583 --> 00:02:07,042 Figured. 58 00:02:07,043 --> 00:02:08,335 What about the center of the wound? 59 00:02:08,336 --> 00:02:11,922 Uh, it's a simple hematoma. 60 00:02:11,923 --> 00:02:14,091 Which you can now debride. 61 00:02:14,092 --> 00:02:15,634 Whitaker will take off the dead skin covering the blister 62 00:02:15,635 --> 00:02:16,927 to help it heal better. 63 00:02:16,928 --> 00:02:18,428 I'll be right back. 64 00:02:18,429 --> 00:02:20,264 Yeah, uh, quick question. 65 00:02:20,265 --> 00:02:22,141 Get some Iris scissors, toothed forceps, sterile gauze. 66 00:02:22,142 --> 00:02:24,101 No, it's just, um... 67 00:02:24,102 --> 00:02:26,812 [SIGHS] 68 00:02:26,813 --> 00:02:28,605 Blister guy? Really? 69 00:02:28,606 --> 00:02:30,357 Mr. Chazen was the next patient on deck. 70 00:02:30,358 --> 00:02:31,859 I know I screwed up earlier. 71 00:02:31,860 --> 00:02:32,943 You didn't screw up. 72 00:02:32,944 --> 00:02:34,444 The patient died. 73 00:02:34,445 --> 00:02:35,946 It happens. 74 00:02:35,947 --> 00:02:39,409 Just don't amputate Mr. Chazen's leg. 75 00:02:43,163 --> 00:02:45,414 Okay. Hey. 76 00:02:45,415 --> 00:02:46,915 Another 2 of lorazepam. 77 00:02:46,916 --> 00:02:49,293 - For a total of 10. - I'm well aware. 78 00:02:49,294 --> 00:02:51,837 He's still seizing. [SIGHS] 79 00:02:51,838 --> 00:02:53,088 Call respiratory. 80 00:02:53,089 --> 00:02:54,298 I'm setting up an intubation tray. 81 00:02:54,299 --> 00:02:55,799 Which we won't need. 82 00:02:55,800 --> 00:02:57,426 Dr. Santos, what is the definition 83 00:02:57,427 --> 00:02:59,094 of status epilepticus? 84 00:02:59,095 --> 00:03:00,971 A seizure lasting more than five minutes 85 00:03:00,972 --> 00:03:02,306 or at least two seizures 86 00:03:02,307 --> 00:03:03,640 without full recovery in between. 87 00:03:03,641 --> 00:03:06,435 Excellent. [PATIENT RASPING SOFTLY] 88 00:03:06,436 --> 00:03:07,936 Seizure activity has stopped. 89 00:03:07,937 --> 00:03:09,771 Also excellent. 90 00:03:09,772 --> 00:03:13,317 Spontaneous breathing, good tidal volume. 91 00:03:13,318 --> 00:03:15,152 Sats up to 98. 92 00:03:15,153 --> 00:03:16,820 Welcome back, Mr. Marino. 93 00:03:16,821 --> 00:03:19,656 Now we can do a Keppra load slowly and safely. 94 00:03:19,657 --> 00:03:21,325 Nice work, Dr. Langdon. 95 00:03:21,326 --> 00:03:23,535 I will be at Central if you need me. 96 00:03:23,536 --> 00:03:24,995 This must have been a bad vial. 97 00:03:24,996 --> 00:03:26,705 8 milligrams should have worked. 98 00:03:26,706 --> 00:03:28,290 According to your textbook of emergency medicine. 99 00:03:28,291 --> 00:03:29,541 But sometimes they need a little bit more. 100 00:03:29,542 --> 00:03:30,918 You'll learn that with time. 101 00:03:30,919 --> 00:03:32,127 Well, why couldn't I open the vial? 102 00:03:32,128 --> 00:03:33,921 Because you're an intern 103 00:03:33,922 --> 00:03:35,964 who also needs to learn to trust her senior resident, 104 00:03:35,965 --> 00:03:38,259 especially in front of an attending. 105 00:03:39,552 --> 00:03:41,637 Now check his labs, 106 00:03:41,638 --> 00:03:43,513 babysit him until he goes to CT, 107 00:03:43,514 --> 00:03:46,516 and get some blankets on these side rails 108 00:03:46,517 --> 00:03:48,227 as a seizure precaution. 109 00:03:48,228 --> 00:03:49,895 [MONITOR BEEPING] 110 00:03:49,896 --> 00:03:51,522 [DOOR CLICKS] 111 00:03:56,319 --> 00:03:58,237 - Is this gonna hurt? - Oh, no. 112 00:03:58,238 --> 00:04:00,364 Skin's dead. You won't feel a thing. 113 00:04:00,365 --> 00:04:01,740 First time in Moab? 114 00:04:01,741 --> 00:04:03,116 No, no. 115 00:04:03,117 --> 00:04:06,161 I belong to a club, Gears and Beers. 116 00:04:06,162 --> 00:04:09,206 We started riding to Frick Park during the pandemic... 117 00:04:09,207 --> 00:04:11,625 you know, just something to do to get out of the house. 118 00:04:11,626 --> 00:04:15,545 But we all stuck with it, and now we go on biking trips. 119 00:04:15,546 --> 00:04:17,298 Huh. 120 00:04:19,259 --> 00:04:20,592 Ahh! Ahh! 121 00:04:20,593 --> 00:04:21,760 Oh! Whoa, oh! 122 00:04:21,761 --> 00:04:23,011 Help! Do something, man! 123 00:04:23,012 --> 00:04:24,012 - Um... - Oh! 124 00:04:24,013 --> 00:04:25,013 - Uh... - Dude! 125 00:04:25,014 --> 00:04:26,181 Oh, ow! 126 00:04:26,182 --> 00:04:27,266 I need a little help here! 127 00:04:27,267 --> 00:04:28,267 Jesus! 128 00:04:28,268 --> 00:04:30,769 [GRUNTING] 129 00:04:30,770 --> 00:04:32,396 Hey. What's up? 130 00:04:32,397 --> 00:04:34,564 Arterial pumper under a blood blister. 131 00:04:34,565 --> 00:04:36,191 - Let's see. - Oh. 132 00:04:36,192 --> 00:04:38,068 - Jesus! - Oh, God. 133 00:04:38,069 --> 00:04:39,569 Noob. 134 00:04:39,570 --> 00:04:41,697 Hi, I'm Dr. King. Um, we can fix this. 135 00:04:41,698 --> 00:04:43,865 - Did you cut an artery? - No, no. 136 00:04:43,866 --> 00:04:45,742 I-I punctured the top of the blood blister, 137 00:04:45,743 --> 00:04:47,327 but there was an artery hiding under there. 138 00:04:47,328 --> 00:04:48,787 Hiding? 139 00:04:48,788 --> 00:04:50,622 Like... like you didn't know it was there? 140 00:04:50,623 --> 00:04:53,041 Don't you have to know basic anatomy to become a doctor? 141 00:04:53,042 --> 00:04:54,293 He's a student doctor. 142 00:04:54,294 --> 00:04:56,044 What the fuck? 143 00:04:56,045 --> 00:04:57,296 Student? 144 00:04:57,297 --> 00:04:58,880 Oh, hell, no. No, no, no. 145 00:04:58,881 --> 00:05:00,132 Can... can you help me? 146 00:05:00,133 --> 00:05:02,092 - Can you fix it? - Oh, absolutely. 147 00:05:02,093 --> 00:05:05,512 First, we are going to put this BP cuff on 148 00:05:05,513 --> 00:05:06,930 to stop the bleeding. 149 00:05:06,931 --> 00:05:08,181 A little forward. 150 00:05:08,182 --> 00:05:09,559 There we go. 151 00:05:12,854 --> 00:05:15,105 All right, you can let go. 152 00:05:15,106 --> 00:05:17,232 - Yeah? - Mm-hmm. 153 00:05:17,233 --> 00:05:19,526 - Thank God. - Oh, thank God. 154 00:05:19,527 --> 00:05:22,487 All right, Whitaker, 10 ccs of 1% lidocaine with epi. 155 00:05:22,488 --> 00:05:23,905 Yep. 156 00:05:23,906 --> 00:05:25,657 Uh, the shot is gonna numb the area 157 00:05:25,658 --> 00:05:27,951 and also constrict any blood vessels 158 00:05:27,952 --> 00:05:30,038 so that we can put a little stitch in there. 159 00:05:32,665 --> 00:05:34,499 What happened in here? 160 00:05:34,500 --> 00:05:38,462 Uh, hidden laceration of an arteriole under the vesicle. 161 00:05:38,463 --> 00:05:40,797 Uh, bleeding stopped at 180 on the BP cuff, 162 00:05:40,798 --> 00:05:43,050 and we are now injecting lidocaine with epi. 163 00:05:43,051 --> 00:05:44,593 Thank you, Dr. King. 164 00:05:44,594 --> 00:05:46,887 Let's set up a suture tray with 3-0 nylon. 165 00:05:46,888 --> 00:05:48,638 Okay. A pinprick and some burning... 166 00:05:48,639 --> 00:05:51,641 Doc, Doc, can you step in here, please? 167 00:05:51,642 --> 00:05:53,728 You got this, Whitaker. 168 00:05:56,272 --> 00:05:58,690 That ambulance chase is on live TV. 169 00:05:58,691 --> 00:06:00,192 - What channel? - Every channel. 170 00:06:00,193 --> 00:06:01,777 Ooh, what do you think the over-under 171 00:06:01,778 --> 00:06:03,445 on clipped cars should be? 172 00:06:03,446 --> 00:06:04,654 - BOTH: 15. - Mm! 173 00:06:04,655 --> 00:06:06,198 - Come on. - [LAUGHS] 174 00:06:06,199 --> 00:06:08,036 Can I put it on the TVs in the waiting room? 175 00:06:08,037 --> 00:06:09,159 Fine by me. 176 00:06:09,160 --> 00:06:10,327 I just hope wherever it ends up, 177 00:06:10,328 --> 00:06:12,246 it's out of our catchment zone. 178 00:06:15,416 --> 00:06:17,125 Got a second? 179 00:06:17,126 --> 00:06:19,086 It's never a second, but shoot. 180 00:06:19,087 --> 00:06:21,588 I think there was an issue with a vial of lorazepam used 181 00:06:21,589 --> 00:06:23,340 on our last patient and it should be reported 182 00:06:23,341 --> 00:06:24,674 to the drug manufacturer. 183 00:06:24,675 --> 00:06:26,176 What kind of issue? 184 00:06:26,177 --> 00:06:28,178 The cap was really hard to take off, 185 00:06:28,179 --> 00:06:30,389 almost like it was super-sealed shut. 186 00:06:30,390 --> 00:06:32,015 I'm worried it could be a bigger issue. 187 00:06:32,016 --> 00:06:33,809 Like? 188 00:06:33,810 --> 00:06:35,894 Like maybe the temperature wasn't 189 00:06:35,895 --> 00:06:37,771 properly controlled during transportation 190 00:06:37,772 --> 00:06:40,148 and the seal on the vial melted shut, 191 00:06:40,149 --> 00:06:41,858 which could mean the medication is compromised. 192 00:06:41,859 --> 00:06:44,361 Any other vials affected? 193 00:06:44,362 --> 00:06:47,614 Uh, just this one. 194 00:06:47,615 --> 00:06:49,116 Okay. 195 00:06:49,117 --> 00:06:50,784 Check the manufacturer's website, 196 00:06:50,785 --> 00:06:52,536 see if there's been a recall of the lot number. 197 00:06:52,537 --> 00:06:54,746 And what if this is the first irregular vial? 198 00:06:54,747 --> 00:06:56,081 Then hold on to the vial in case 199 00:06:56,082 --> 00:06:57,874 there are any other issues. 200 00:06:57,875 --> 00:06:59,709 Hey, look who's in the house! 201 00:06:59,710 --> 00:07:01,420 Hey. 202 00:07:01,421 --> 00:07:04,047 Jake the Snake! It's 11:00 a.m. 203 00:07:04,048 --> 00:07:05,549 Aren't you supposed to be in school? 204 00:07:05,550 --> 00:07:06,591 Mom let me ditch for Pittfest. 205 00:07:06,592 --> 00:07:07,926 How's your mama? 206 00:07:07,927 --> 00:07:09,886 Oh, she's restoring some house 207 00:07:09,887 --> 00:07:11,513 in Squirrel Hill, so, you know, she's pretty busy. 208 00:07:11,514 --> 00:07:13,223 That's cool. You, uh... you looking for Robby? 209 00:07:13,224 --> 00:07:14,558 Yeah, he's got our festival passes. 210 00:07:14,559 --> 00:07:15,976 Oh, you going together? 211 00:07:15,977 --> 00:07:17,644 We were supposed to, but, you know, 212 00:07:17,645 --> 00:07:20,647 - I decided to go with a friend. - What's her name? 213 00:07:20,648 --> 00:07:22,232 - Leah. - Okay. Okay. 214 00:07:22,233 --> 00:07:23,900 - Okay, okay. - Don't hold out on us. 215 00:07:23,901 --> 00:07:26,069 We need details. Where'd you meet? 216 00:07:26,070 --> 00:07:28,071 How long have you been together? 217 00:07:28,072 --> 00:07:29,739 We met at junior lifeguards this summer. 218 00:07:29,740 --> 00:07:31,741 And we've been dating for two months. 219 00:07:31,742 --> 00:07:34,119 - Yeah, she's pretty great. - That's sweet. 220 00:07:34,120 --> 00:07:35,745 I'm happy for you, kiddo. 221 00:07:35,746 --> 00:07:38,415 I'm gonna go find Robby, let him know you're here. 222 00:07:38,416 --> 00:07:40,417 Hey. 223 00:07:40,418 --> 00:07:42,836 A little advice, man-to-man... 224 00:07:42,837 --> 00:07:45,046 always compliment her outfit, 225 00:07:45,047 --> 00:07:48,592 hold her hand in front of your friends, 226 00:07:48,593 --> 00:07:50,886 and always wrap it before you tap it. 227 00:07:50,887 --> 00:07:53,513 [LAUGHS] Okay. 228 00:07:53,514 --> 00:07:55,724 Slowly letting down the cuff pressure 229 00:07:55,725 --> 00:07:58,477 until we can identify the exact spot. 230 00:07:58,478 --> 00:08:00,103 Oh, I see it. I see it. 231 00:08:00,104 --> 00:08:01,438 Right... right there. 232 00:08:01,439 --> 00:08:03,064 Okay. 233 00:08:03,065 --> 00:08:04,816 Now you can place a figure-of-eight suture. 234 00:08:04,817 --> 00:08:06,736 Uh, I've never done one of those before. 235 00:08:08,779 --> 00:08:10,238 Look, maybe you should just do it. 236 00:08:10,239 --> 00:08:11,865 You should definitely do it. 237 00:08:11,866 --> 00:08:13,283 Whitaker's got this. 238 00:08:13,284 --> 00:08:15,285 It's easy, just two stitches in one. 239 00:08:15,286 --> 00:08:17,621 Take a big bite, a simple interrupted suture 240 00:08:17,622 --> 00:08:18,872 anterior to the bleeder. 241 00:08:18,873 --> 00:08:20,333 Okay. 242 00:08:22,793 --> 00:08:24,212 Okay. 243 00:08:29,675 --> 00:08:33,054 Now instead of tying, throw another one posterior. 244 00:08:35,139 --> 00:08:36,473 Looks good. 245 00:08:36,474 --> 00:08:38,141 Now a normal tie for a figure-of-eight. 246 00:08:38,142 --> 00:08:40,477 What did I miss in here? 247 00:08:40,478 --> 00:08:42,187 I am so sorry. I-I just... 248 00:08:42,188 --> 00:08:44,481 Made an excellent catch and saved Mr. Chazen's life. 249 00:08:44,482 --> 00:08:46,107 - Really? - Really? 250 00:08:46,108 --> 00:08:47,317 Really? 251 00:08:47,318 --> 00:08:48,777 There was a cut arteriole 252 00:08:48,778 --> 00:08:50,445 under a ballotable vesicle. 253 00:08:50,446 --> 00:08:52,364 If Mr. Chazen had gone home without debridement, 254 00:08:52,365 --> 00:08:55,200 the blister could have eroded with uncontrollable hemorrhage. 255 00:08:55,201 --> 00:08:57,160 Nice work. 256 00:08:57,161 --> 00:09:00,497 Jackson Pollock here might want to go hit the scrubs exchange. 257 00:09:00,498 --> 00:09:02,124 Yeah. 258 00:09:03,334 --> 00:09:06,379 [INDISTINCT CHATTER] 259 00:09:09,840 --> 00:09:11,299 [SCOFFS] 260 00:09:11,300 --> 00:09:15,595 [BABY CRYING] 261 00:09:15,596 --> 00:09:17,097 All right. 262 00:09:17,098 --> 00:09:19,808 Next up is an ingrown toenail. 263 00:09:19,809 --> 00:09:21,518 It should be pretty quick, though. 264 00:09:21,519 --> 00:09:24,271 And... ah. 265 00:09:24,272 --> 00:09:26,189 Sherry, you're back. 266 00:09:26,190 --> 00:09:27,691 The kids get to school okay? 267 00:09:27,692 --> 00:09:29,401 - Yeah. Thanks. - Hey, cool. 268 00:09:29,402 --> 00:09:30,986 Well, come with me, 269 00:09:30,987 --> 00:09:32,654 and we'll finish up your wound care, okay? 270 00:09:32,655 --> 00:09:34,698 Earl, what are you doing out here? 271 00:09:34,699 --> 00:09:36,366 I'm hungry. 272 00:09:36,367 --> 00:09:37,742 Head back inside, and we'll get you a sandwich. 273 00:09:37,743 --> 00:09:40,203 - No egg salad. - Sure. Come on. 274 00:09:40,204 --> 00:09:41,746 Excuse me. Excuse me. 275 00:09:41,747 --> 00:09:43,206 I've been here for over five hours, 276 00:09:43,207 --> 00:09:44,874 okay, way longer than that chick. 277 00:09:44,875 --> 00:09:46,710 Can you check the list? Driscoll? 278 00:09:46,711 --> 00:09:48,462 Doug Driscoll. 279 00:09:50,214 --> 00:09:52,048 E-everybody is seen as quickly as possible 280 00:09:52,049 --> 00:09:54,342 and in order of medical care needed. 281 00:09:54,343 --> 00:09:55,719 Unless they die waiting. 282 00:09:55,720 --> 00:09:57,178 Would you look at that, Mr. Driscoll? 283 00:09:57,179 --> 00:09:58,388 It's actually time to bring you back. 284 00:09:58,389 --> 00:09:59,723 Thank God. 285 00:09:59,724 --> 00:10:01,057 Would you take care of Mr. Driscoll? 286 00:10:01,058 --> 00:10:02,892 - Yeah, absolutely. - [CHUCKLES] 287 00:10:02,893 --> 00:10:05,312 Sherry, you're with me. 288 00:10:05,313 --> 00:10:07,063 Oh, yeah. 289 00:10:07,064 --> 00:10:08,941 Yeah, let's take care of this. 290 00:10:15,281 --> 00:10:17,073 Hey, I need a minute. 291 00:10:17,074 --> 00:10:20,160 I already put $20 on disgruntled ex-EMT 292 00:10:20,161 --> 00:10:22,078 caught outside of our catchment. 293 00:10:22,079 --> 00:10:24,539 And I will gladly take your money when that mess is over, 294 00:10:24,540 --> 00:10:26,374 but this is about a patient. 295 00:10:26,375 --> 00:10:28,710 Kristi Wheeler, 17 years old, pregnant. 296 00:10:28,711 --> 00:10:31,087 These are Abbot's fetal measurements from yesterday, 297 00:10:31,088 --> 00:10:33,757 and these are mine. 298 00:10:33,758 --> 00:10:35,759 10-5 and 11-2. 299 00:10:35,760 --> 00:10:38,303 Well, ultrasound is an art, not a science. 300 00:10:38,304 --> 00:10:40,805 Even in the very best hands, the EGA differential can be 301 00:10:40,806 --> 00:10:42,766 within three to five days in the first trimester. 302 00:10:42,767 --> 00:10:44,309 Definitely room for error. 303 00:10:44,310 --> 00:10:45,935 Not if you're here for a medication abortion 304 00:10:45,936 --> 00:10:48,563 and you're past the mandated 11-week cutoff. 305 00:10:48,564 --> 00:10:51,816 [SIGHS] There can also be inter-operator variability. 306 00:10:51,817 --> 00:10:53,985 I measured the gestational sac, 11-3, 307 00:10:53,986 --> 00:10:56,446 and the biparietal diameter, 11-1. 308 00:10:56,447 --> 00:10:58,657 I didn't get a single measurement under 11 weeks. 309 00:10:58,658 --> 00:11:00,408 So what are you saying, 310 00:11:00,409 --> 00:11:02,327 that Abbot lowballed his measurements to help a teen 311 00:11:02,328 --> 00:11:05,205 get the abortion that she wants? 312 00:11:05,206 --> 00:11:07,374 [SIGHS] Maybe. 313 00:11:07,375 --> 00:11:08,792 Well, then you've got two choices. 314 00:11:08,793 --> 00:11:10,210 You can go with Abbot's measurements, 315 00:11:10,211 --> 00:11:12,087 or you can redo your measurements, 316 00:11:12,088 --> 00:11:14,631 go back in, and pick an angle that shows 11 weeks or less. 317 00:11:14,632 --> 00:11:16,049 Please tell me you're joking. 318 00:11:16,050 --> 00:11:17,801 You were ready to roll up your sleeves 319 00:11:17,802 --> 00:11:19,302 and arm-wrestle the Ethics Committee a couple hours ago 320 00:11:19,303 --> 00:11:20,970 to override Mr. Spencer's children. 321 00:11:20,971 --> 00:11:23,556 - What changed? - Apples and oranges. 322 00:11:23,557 --> 00:11:25,558 There was a clear, bright line that Mr. Spencer 323 00:11:25,559 --> 00:11:27,435 was never going to make it. 324 00:11:27,436 --> 00:11:30,313 Falsifying medical records for Kristi is flat-out illegal. 325 00:11:30,314 --> 00:11:32,607 She's 17. She deserves a life. 326 00:11:32,608 --> 00:11:34,275 Of course she does. 327 00:11:34,276 --> 00:11:36,778 But I will not jeopardize my future in the process. 328 00:11:36,779 --> 00:11:38,988 - You'll be fine. - [SCOFFS] 329 00:11:38,989 --> 00:11:42,367 Someone finds out I falsified medical records, 330 00:11:42,368 --> 00:11:44,327 I'll get booted from the residency program. 331 00:11:44,328 --> 00:11:45,995 You've got tenure. 332 00:11:45,996 --> 00:11:49,833 Worst case, you have to take a job in Youngstown. 333 00:11:49,834 --> 00:11:53,671 The risks are not the same for you as they are for me. 334 00:11:56,716 --> 00:11:58,174 You're right. 335 00:11:58,175 --> 00:12:00,051 I'll do it. 336 00:12:00,052 --> 00:12:01,720 - What? - Erase your history, physical, 337 00:12:01,721 --> 00:12:03,179 and impression from Kristi's chart. 338 00:12:03,180 --> 00:12:05,430 It'll be like you never saw the patient. I will take over. 339 00:12:05,431 --> 00:12:07,642 I will complete a new chart and upload my own image. 340 00:12:07,643 --> 00:12:09,185 Robby, I'm not asking you to... 341 00:12:09,186 --> 00:12:10,603 As your attending, it is my decision. 342 00:12:10,604 --> 00:12:12,188 I am a certified provider for Mifepristone. 343 00:12:12,189 --> 00:12:13,690 You are not. 344 00:12:13,691 --> 00:12:15,358 And as a prudent physician, I should examine 345 00:12:15,359 --> 00:12:16,609 every patient before I order medication... 346 00:12:16,610 --> 00:12:18,111 - Robby. - Yeah. 347 00:12:18,112 --> 00:12:20,029 - Jake's here. - Hey. Great. 348 00:12:20,030 --> 00:12:21,990 Uh, any word back on Nick Bradley's 349 00:12:21,991 --> 00:12:23,616 - perfusion study results? - Still waiting. 350 00:12:23,617 --> 00:12:25,160 Will you come find me when the imaging's back? 351 00:12:25,161 --> 00:12:27,954 These people have already been through enough. 352 00:12:27,955 --> 00:12:30,832 - Is that Mr. Spencer? - Yeah. 353 00:12:30,833 --> 00:12:33,334 - Robby? - Excuse me for one second. 354 00:12:33,335 --> 00:12:35,129 I want to go see if I can find Mr. Spencer's children 355 00:12:35,130 --> 00:12:36,254 before they leave. 356 00:12:36,255 --> 00:12:38,214 You look a little peaked. You okay? 357 00:12:38,215 --> 00:12:40,175 I just need a good night's sleep. 358 00:12:40,176 --> 00:12:41,885 I'm gonna grab you a grilled cheese 359 00:12:41,886 --> 00:12:43,219 before the noon lunch rush, it'll help some color 360 00:12:43,220 --> 00:12:44,929 - back to your cheeks. - Thank you. 361 00:12:44,930 --> 00:12:46,307 I got you. 362 00:12:47,933 --> 00:12:50,393 Uh, can someone please help? 363 00:12:50,394 --> 00:12:51,686 It's my mother. 364 00:12:51,687 --> 00:12:52,896 She fell. 365 00:12:52,897 --> 00:12:54,355 What happened? 366 00:12:54,356 --> 00:12:55,732 I fell in the yard. 367 00:12:55,733 --> 00:12:58,067 I hurt my arm. That's all. 368 00:12:58,068 --> 00:12:59,944 Yo, we've been hugging this wall for almost an hour. 369 00:12:59,945 --> 00:13:01,863 Relax. We're just gonna take her vitals. 370 00:13:01,864 --> 00:13:03,406 Oh, Mom, you've got cuts all over. 371 00:13:03,407 --> 00:13:05,450 I fell in the rose bush. 372 00:13:05,451 --> 00:13:07,536 I'll be fine. 373 00:13:10,664 --> 00:13:12,999 I'm Dr. King. This is Perlah. 374 00:13:13,000 --> 00:13:15,084 - What's your name? - Ginger Kitajima. 375 00:13:15,085 --> 00:13:17,212 Uh, I'm her daughter, Rita. 376 00:13:17,213 --> 00:13:18,755 Ginger, did you hit your head? 377 00:13:18,756 --> 00:13:20,089 No. 378 00:13:20,090 --> 00:13:21,758 Any chance she could have fainted? 379 00:13:21,759 --> 00:13:24,260 - I told you. I tripped. - I don't know. 380 00:13:24,261 --> 00:13:26,262 I was taking a shower, and she went outside. 381 00:13:26,263 --> 00:13:28,723 She's not supposed to go outside anywhere without me. 382 00:13:28,724 --> 00:13:31,351 [SIGHS] She needs 24-7 assistance with ADLs. 383 00:13:31,352 --> 00:13:32,727 Are you the primary caregiver? 384 00:13:32,728 --> 00:13:34,938 I'm her only caregiver. 385 00:13:34,939 --> 00:13:37,732 Ma'am, what medications are you on? 386 00:13:37,733 --> 00:13:40,401 Oh, uh, just one. 387 00:13:40,402 --> 00:13:42,111 Risperidone. 388 00:13:42,112 --> 00:13:43,822 My mom has schizophrenia. 389 00:13:43,823 --> 00:13:46,241 BP 132 over 78. 390 00:13:46,242 --> 00:13:47,784 Pulse 84. Sats 98. 391 00:13:47,785 --> 00:13:49,452 I haven't seen this young lady around before. 392 00:13:49,453 --> 00:13:50,829 Somebody new? 393 00:13:50,830 --> 00:13:52,747 Flattery will get you everywhere. 394 00:13:52,748 --> 00:13:54,999 Ground-level fall. Good vitals. 395 00:13:55,000 --> 00:13:56,459 No head trauma, no AMS, 396 00:13:56,460 --> 00:13:58,169 and just an isolated shoulder injury. 397 00:13:58,170 --> 00:13:59,754 You have any pain in your belly? 398 00:13:59,755 --> 00:14:01,297 No, but next time, 399 00:14:01,298 --> 00:14:03,132 buy me dinner before you do that. 400 00:14:03,133 --> 00:14:04,467 [CHUCKLES] 401 00:14:04,468 --> 00:14:06,845 Okay, let's order some basic labs 402 00:14:06,846 --> 00:14:09,097 and get some pain meds on board. 403 00:14:09,098 --> 00:14:10,473 And call me when the X-rays are back. 404 00:14:10,474 --> 00:14:11,975 Your mom's in very good hands. 405 00:14:11,976 --> 00:14:13,268 You're leaving so soon? 406 00:14:13,269 --> 00:14:14,978 Oh, I'm never far away. 407 00:14:14,979 --> 00:14:16,604 I'll save a dance for you. 408 00:14:16,605 --> 00:14:18,648 I'll be counting on it. 409 00:14:18,649 --> 00:14:20,817 Looks like more than just vitals to me. 410 00:14:20,818 --> 00:14:22,735 That's it. You're on the list, Harley. 411 00:14:22,736 --> 00:14:24,571 Aw, shit. No. 412 00:14:24,572 --> 00:14:26,155 Perlah, I'm sorry! 413 00:14:26,156 --> 00:14:27,448 - I take it back! - Too late! 414 00:14:27,449 --> 00:14:28,992 You're on the list. 415 00:14:28,993 --> 00:14:30,452 [SIGHS] 416 00:14:35,499 --> 00:14:36,958 [SIGHS] 417 00:14:36,959 --> 00:14:38,459 [MACHINE WHIRRING] 418 00:14:38,460 --> 00:14:39,753 Mm. 419 00:14:41,297 --> 00:14:43,048 [CARD READER BEEPS] 420 00:14:44,425 --> 00:14:45,800 Okay. 421 00:14:45,801 --> 00:14:47,803 [MACHINE WHIRS, CLICKS] 422 00:14:50,514 --> 00:14:52,141 What? 423 00:14:53,475 --> 00:14:54,852 Oh. 424 00:14:57,688 --> 00:15:00,982 I like big butts, and I cannot lie. 425 00:15:00,983 --> 00:15:02,191 Whoa. [LAUGHS] 426 00:15:02,192 --> 00:15:03,693 You scared me there. 427 00:15:03,694 --> 00:15:05,486 Want a pony ride, big boy? 428 00:15:05,487 --> 00:15:07,363 - What? - Excuse me, Myrna. 429 00:15:07,364 --> 00:15:08,865 I need to discuss a confidential patient issue 430 00:15:08,866 --> 00:15:10,074 with my colleague here. 431 00:15:10,075 --> 00:15:11,409 We need a little privacy. 432 00:15:11,410 --> 00:15:13,036 Catch you later, sweet cheeks. 433 00:15:13,037 --> 00:15:14,787 Don't mind Myrna. She's harmless. 434 00:15:14,788 --> 00:15:15,997 She's handcuffed. 435 00:15:15,998 --> 00:15:17,833 That's why she's harmless. 436 00:15:21,629 --> 00:15:24,631 You gotta stay on top of Ozzie's ear infection. 437 00:15:24,632 --> 00:15:26,466 His meds are in the fridge. 438 00:15:26,467 --> 00:15:28,217 Our dog has really bad allergies. 439 00:15:28,218 --> 00:15:29,802 [LAUGHS] 440 00:15:29,803 --> 00:15:31,721 And I changed Ruby's food order to Monday. 441 00:15:31,722 --> 00:15:33,723 [CLEARS THROAT] Bougie bitch. 442 00:15:33,724 --> 00:15:35,558 - She only likes the good stuff. - Mm-hmm. 443 00:15:35,559 --> 00:15:37,060 Like mother, like daughter. 444 00:15:37,061 --> 00:15:38,394 [LAUGHTER] 445 00:15:38,395 --> 00:15:40,730 [COUGHING] 446 00:15:40,731 --> 00:15:42,315 [BOTH CHUCKLE] 447 00:15:42,316 --> 00:15:44,400 Nice to know you still make each other laugh. 448 00:15:44,401 --> 00:15:45,902 Make each other laugh. 449 00:15:45,903 --> 00:15:47,988 Make each other deliriously happy. 450 00:15:53,410 --> 00:15:56,412 Sorry. Didn't mean to get all mushy in front of you. 451 00:15:56,413 --> 00:15:57,580 Are you kidding me? 452 00:15:57,581 --> 00:15:59,582 You two are the sweetest. 453 00:15:59,583 --> 00:16:02,418 I never got to see this kind of love between a married couple. 454 00:16:02,419 --> 00:16:05,213 Your parents weren't the lovey-dovey type? 455 00:16:05,214 --> 00:16:07,215 My dad died when I was 13. 456 00:16:07,216 --> 00:16:08,257 Aw. 457 00:16:08,258 --> 00:16:09,592 I'm so sorry. 458 00:16:09,593 --> 00:16:11,094 Yeah, me too. 459 00:16:11,095 --> 00:16:13,429 He's the reason why I got into medicine 460 00:16:13,430 --> 00:16:15,682 and the reason why I'm conducting research 461 00:16:15,683 --> 00:16:17,558 on racial disparity in the ER. 462 00:16:17,559 --> 00:16:19,102 I'm doing a retrospective chart review 463 00:16:19,103 --> 00:16:21,437 on our past five years of patients of color. 464 00:16:21,438 --> 00:16:24,232 Is that how you knew what was going on with me? 465 00:16:24,233 --> 00:16:26,025 We don't treat sickle cell here 466 00:16:26,026 --> 00:16:27,568 as well as they do in other hospitals, 467 00:16:27,569 --> 00:16:29,278 but I'm hoping to change that. 468 00:16:29,279 --> 00:16:31,239 Status, Dr. Mohan? 469 00:16:31,240 --> 00:16:33,616 Still on exchange transfusion and high flow nasal oxygen, 470 00:16:33,617 --> 00:16:34,951 but oxygen sats are dropping. 471 00:16:34,952 --> 00:16:36,411 She's at 84. 472 00:16:36,412 --> 00:16:38,621 - That's really low. - Yes, it is. 473 00:16:38,622 --> 00:16:40,790 The goal of exchange transfusion is 474 00:16:40,791 --> 00:16:43,960 to reduce the percentage of sickle hemoglobin to under 30%. 475 00:16:43,961 --> 00:16:45,378 That is not happening at the rate 476 00:16:45,379 --> 00:16:46,796 that your wife needs, which is causing 477 00:16:46,797 --> 00:16:48,506 your blood to be unable to carry oxygen, 478 00:16:48,507 --> 00:16:49,966 causing further blocked blood cells. 479 00:16:49,967 --> 00:16:52,844 - What does that mean? - Dr. Mohan. 480 00:16:52,845 --> 00:16:55,138 To prevent stroke or heart attack, 481 00:16:55,139 --> 00:17:00,185 we need to get you more oxygen, but we will need to intubate. 482 00:17:02,855 --> 00:17:05,314 How long can we wait to see if that's really necessary? 483 00:17:05,315 --> 00:17:07,817 Acute chest syndrome can progress very quickly. 484 00:17:07,818 --> 00:17:09,485 It is the most common cause of death 485 00:17:09,486 --> 00:17:10,820 for patients with sickle cell. 486 00:17:10,821 --> 00:17:13,990 It is imperative that we intubate. 487 00:17:13,991 --> 00:17:15,783 I-I... [COUGHS] 488 00:17:15,784 --> 00:17:18,494 I-I-I don't know. 489 00:17:18,495 --> 00:17:20,580 Why don't we give you and Ondine 490 00:17:20,581 --> 00:17:22,666 some privacy so you can talk? 491 00:17:27,671 --> 00:17:29,172 Look, you want to be their friend, but right now, 492 00:17:29,173 --> 00:17:30,506 you need to be Joyce's doctor. 493 00:17:30,507 --> 00:17:31,758 So get her to sign the consent form 494 00:17:31,759 --> 00:17:33,385 and prep for the intubation. 495 00:17:36,597 --> 00:17:39,182 - 43, 44, 45... - [BREATHING HEAVILY] 496 00:17:39,183 --> 00:17:41,267 - Whoa! - 46, 47. 497 00:17:41,268 --> 00:17:42,852 [LAUGHS] Ugh. 498 00:17:42,853 --> 00:17:44,270 You're not gonna beat my record. 499 00:17:44,271 --> 00:17:45,688 Ohh. 500 00:17:45,689 --> 00:17:47,648 How the hell did you stay on for 80? 501 00:17:47,649 --> 00:17:50,277 I'm 17, and I'm more fit than you. 502 00:17:52,988 --> 00:17:54,697 That kid looks my age. 503 00:17:54,698 --> 00:17:56,240 Yeah, he is. 504 00:17:56,241 --> 00:17:58,409 What happened to him? 505 00:17:58,410 --> 00:18:00,745 Stressed-out 18-year-old took some pills off the internet 506 00:18:00,746 --> 00:18:02,371 to help him sleep. 507 00:18:02,372 --> 00:18:04,832 They were laced with fentanyl. 508 00:18:04,833 --> 00:18:07,211 - Is he gonna make it? - Mm. 509 00:18:14,760 --> 00:18:17,261 [SNICKERING] 510 00:18:17,262 --> 00:18:18,888 Poor Huckleberry. 511 00:18:18,889 --> 00:18:22,058 Not even 11:30 and you've already been demoted. 512 00:18:22,059 --> 00:18:24,393 They had only morgue scrubs left in my size. 513 00:18:24,394 --> 00:18:25,728 Then I guess you better not 514 00:18:25,729 --> 00:18:27,523 fuck anything else up today, huh? 515 00:18:32,820 --> 00:18:34,737 - Yo, Donahue. - Yo. 516 00:18:34,738 --> 00:18:36,697 You get in on that ambulance-chase action? 517 00:18:36,698 --> 00:18:39,992 Yeah, $20 on catch, chop shop, out of our zone. 518 00:18:39,993 --> 00:18:41,536 Bold. 519 00:18:41,537 --> 00:18:43,412 I like it. 520 00:18:43,413 --> 00:18:46,165 What can I do you for? 521 00:18:46,166 --> 00:18:48,084 Hypothetical question... 522 00:18:48,085 --> 00:18:50,169 would you ever go over a resident's head 523 00:18:50,170 --> 00:18:52,547 to the attending? 524 00:18:52,548 --> 00:18:54,924 Hypothetically, I wouldn't recommend it 525 00:18:54,925 --> 00:18:57,426 unless it's a behavioral issue or harassment. 526 00:18:57,427 --> 00:19:00,429 And in that case, you can make a confidential report to HR. 527 00:19:00,430 --> 00:19:02,473 What if it's more patient care related? 528 00:19:02,474 --> 00:19:03,933 Depends. 529 00:19:03,934 --> 00:19:05,476 If it's something minor, leave it alone. 530 00:19:05,477 --> 00:19:07,645 If it's something that endangers the patient, 531 00:19:07,646 --> 00:19:09,480 then definitely yes. 532 00:19:09,481 --> 00:19:11,107 Pick your battles. 533 00:19:11,108 --> 00:19:13,360 You don't want to be the intern who cried wolf. 534 00:19:15,612 --> 00:19:16,988 - Ahh! - Yeah? 535 00:19:16,989 --> 00:19:19,157 - Okay, still pretty raw. - Yeah. 536 00:19:19,158 --> 00:19:20,908 Let me put some more anesthetic on there, 537 00:19:20,909 --> 00:19:22,577 numb you up some more. 538 00:19:22,578 --> 00:19:24,787 It's my own fault. 539 00:19:24,788 --> 00:19:26,622 I should have known better than to try to make 540 00:19:26,623 --> 00:19:28,791 s'mores over a Sterno, 541 00:19:28,792 --> 00:19:30,751 but they kept asking. 542 00:19:30,752 --> 00:19:32,920 Yeah. The things we do for our kids. 543 00:19:32,921 --> 00:19:34,213 Yeah. 544 00:19:34,214 --> 00:19:36,090 - You have a kid, right? - Yeah. 545 00:19:36,091 --> 00:19:39,218 He's 11. 546 00:19:39,219 --> 00:19:41,220 And when he, um... when he turned 8, 547 00:19:41,221 --> 00:19:43,139 he begged me to go camping for his birthday. 548 00:19:43,140 --> 00:19:44,724 [CHUCKLES] 549 00:19:44,725 --> 00:19:47,768 We drove four hours to New River Gorge. 550 00:19:47,769 --> 00:19:51,063 Took me an hour to set up the tent. 551 00:19:51,064 --> 00:19:53,649 Guess how long we lasted. 552 00:19:53,650 --> 00:19:55,484 Three hours? 553 00:19:55,485 --> 00:19:57,486 - 37 minutes. - [LAUGHS] 554 00:19:57,487 --> 00:19:58,946 A thunderstorm came out of nowhere, 555 00:19:58,947 --> 00:20:00,531 filled the tent with water so fast, 556 00:20:00,532 --> 00:20:03,201 I felt like I was being flushed down a toilet. 557 00:20:03,202 --> 00:20:05,494 I'm so sorry. 558 00:20:05,495 --> 00:20:08,539 Ran out of there like a couple of gutter rats. 559 00:20:08,540 --> 00:20:09,999 Ended up celebrating his birthday 560 00:20:10,000 --> 00:20:11,834 at 2:00 a.m. with a Happy Meal. 561 00:20:11,835 --> 00:20:14,378 Oh, what my kids wouldn't give for a Happy Meal. 562 00:20:14,379 --> 00:20:17,006 [BOTH CHUCKLE] 563 00:20:17,007 --> 00:20:21,552 Yeah, they must, um, have some pretty fancy McDonald's 564 00:20:21,553 --> 00:20:24,180 up there in Shadyside. 565 00:20:24,181 --> 00:20:26,015 Yeah. 566 00:20:26,016 --> 00:20:27,975 That's, uh... that's where you live? 567 00:20:27,976 --> 00:20:29,977 It's the address on your patient file. 568 00:20:29,978 --> 00:20:34,023 Um, technically, no. 569 00:20:34,024 --> 00:20:38,486 I just use the address so my kids can go to a decent school. 570 00:20:38,487 --> 00:20:40,029 Right. 571 00:20:40,030 --> 00:20:41,697 I know it's illegal, but it's just temporary. 572 00:20:41,698 --> 00:20:42,865 - Oh, God. - I promise. 573 00:20:42,866 --> 00:20:44,700 No judgment here. 574 00:20:44,701 --> 00:20:46,535 My son always comes first, no matter what. 575 00:20:46,536 --> 00:20:48,037 Yeah. 576 00:20:48,038 --> 00:20:49,998 Even If it means I have to do without. 577 00:20:53,043 --> 00:20:54,335 [CHUCKLES] 578 00:20:54,336 --> 00:20:56,170 I know, I'm a doctor, right? 579 00:20:56,171 --> 00:20:58,714 How bad could it be? 580 00:20:58,715 --> 00:21:01,884 But I, uh... I used to be an addict. 581 00:21:01,885 --> 00:21:03,929 I even lost custody of my kid. 582 00:21:05,514 --> 00:21:07,431 Huh, I never would have guessed. 583 00:21:07,432 --> 00:21:09,767 Mm. Yeah. 584 00:21:09,768 --> 00:21:11,394 I went through some really dark times 585 00:21:11,395 --> 00:21:13,771 before I finally got help. 586 00:21:13,772 --> 00:21:15,940 And I've been sober now 9 years, 587 00:21:15,941 --> 00:21:18,610 5 months, and 11 days. 588 00:21:19,861 --> 00:21:21,445 And your son? 589 00:21:21,446 --> 00:21:22,780 He's good. 590 00:21:22,781 --> 00:21:25,741 - Okay. - You know, we're good. 591 00:21:25,742 --> 00:21:27,910 He gets to stay with me every other weekend. 592 00:21:27,911 --> 00:21:29,830 And, um... 593 00:21:32,082 --> 00:21:34,542 We'll be back to joint custody 594 00:21:34,543 --> 00:21:38,380 just as soon as I get this stupid thing off next week. 595 00:21:42,426 --> 00:21:44,427 - [CHUCKLES] - Oh. 596 00:21:44,428 --> 00:21:47,054 Don't worry. I only killed three people. 597 00:21:47,055 --> 00:21:48,389 Oh, God, I'm kidding. [LAUGHS] 598 00:21:48,390 --> 00:21:49,765 - Oh. - I'm kidding. 599 00:21:49,766 --> 00:21:51,810 I'm sorry. It was a bad joke. 600 00:21:54,271 --> 00:21:57,898 The whole thing was just this... 601 00:21:57,899 --> 00:22:00,027 giant misunderstanding. 602 00:22:03,697 --> 00:22:07,408 I guess I'm oversharing because I want you to know, 603 00:22:07,409 --> 00:22:10,494 not everybody has it all figured out all the time. 604 00:22:10,495 --> 00:22:12,539 [SNIFFLES] Yeah. 605 00:22:16,043 --> 00:22:18,085 [CRYING SOFTLY] 606 00:22:18,086 --> 00:22:22,174 Um, I'm struggling. 607 00:22:23,717 --> 00:22:26,178 And I feel like such a bad mom. 608 00:22:29,473 --> 00:22:33,726 And every day is so hard. 609 00:22:33,727 --> 00:22:36,145 And I don't know what's gonna happen tomorrow 610 00:22:36,146 --> 00:22:38,023 or the next day. 611 00:22:41,026 --> 00:22:43,069 Sometimes I wonder if they would 612 00:22:43,070 --> 00:22:45,238 just be better off without me. 613 00:22:48,742 --> 00:22:50,409 Yeah? 614 00:22:50,410 --> 00:22:51,994 Do you... 615 00:22:51,995 --> 00:22:53,579 Not like that. 616 00:22:53,580 --> 00:22:54,997 I just... [SNIFFLES] 617 00:22:54,998 --> 00:22:56,832 I've just messed up so much. 618 00:22:56,833 --> 00:22:59,168 - Yeah. - And I don't know. 619 00:22:59,169 --> 00:23:01,296 [SIGHS, SNIFFLES] 620 00:23:05,133 --> 00:23:07,551 You're their mom. 621 00:23:07,552 --> 00:23:10,679 You love them, and nothing and no one can replace that. 622 00:23:10,680 --> 00:23:13,349 Yeah. [CHUCKLES] 623 00:23:13,350 --> 00:23:15,017 [SNIFFLES] 624 00:23:15,018 --> 00:23:18,896 You deserve a little grace, you know. 625 00:23:18,897 --> 00:23:21,358 Be kind to yourself. 626 00:23:24,611 --> 00:23:27,196 Well, you had a normal EKG and chest X-ray. 627 00:23:27,197 --> 00:23:30,366 But it looks like you sustained 628 00:23:30,367 --> 00:23:34,537 a proximal humerus fracture on the left upper arm. 629 00:23:34,538 --> 00:23:37,666 There goes my backhand. 630 00:23:39,626 --> 00:23:41,293 That was a joke, dear. 631 00:23:41,294 --> 00:23:44,547 Okay, um, because the fracture isn't displaced, 632 00:23:44,548 --> 00:23:46,841 the good news is, you don't need surgery. 633 00:23:46,842 --> 00:23:49,301 Oh, that's a relief. 634 00:23:49,302 --> 00:23:51,720 The bad news is, you do need to wear a sling 635 00:23:51,721 --> 00:23:53,722 for at least six weeks. 636 00:23:53,723 --> 00:23:56,559 And I have to insist, absolutely no shoulder mobility 637 00:23:56,560 --> 00:23:58,352 for the first few weeks. 638 00:23:58,353 --> 00:24:01,063 And that means you're gonna have to step up even more, 639 00:24:01,064 --> 00:24:02,940 because on top of your usual ADLs, 640 00:24:02,941 --> 00:24:04,942 you're also gonna have to help your mom bathe, 641 00:24:04,943 --> 00:24:07,570 dress, and use the toilet. 642 00:24:07,571 --> 00:24:09,572 I'm so sorry, Mom. 643 00:24:09,573 --> 00:24:12,575 This would never have happened if I was more on top of things. 644 00:24:12,576 --> 00:24:17,371 Any more on top, you'd be back in my womb. 645 00:24:17,372 --> 00:24:20,374 It's going to be fine. 646 00:24:20,375 --> 00:24:22,960 I know how hard it can be. 647 00:24:22,961 --> 00:24:24,795 I was my sister's primary caregiver 648 00:24:24,796 --> 00:24:27,214 until a few weeks ago. 649 00:24:27,215 --> 00:24:28,883 Where is she now? 650 00:24:28,884 --> 00:24:31,553 Um, she's in an amazing facility in North Hills. 651 00:24:34,473 --> 00:24:37,266 I know I can be a burden, 652 00:24:37,267 --> 00:24:41,103 but I like being in my own home, 653 00:24:41,104 --> 00:24:43,898 just me and my girl. 654 00:24:43,899 --> 00:24:46,108 You're not a burden. 655 00:24:46,109 --> 00:24:48,444 You're my mom. 656 00:24:48,445 --> 00:24:50,529 I'll refer you to Ortho. 657 00:24:50,530 --> 00:24:54,116 They'll get you set up with PT and exercises. 658 00:24:54,117 --> 00:24:57,411 You're very lucky to have such a caring daughter. 659 00:24:57,412 --> 00:24:59,914 Don't I know it. 660 00:24:59,915 --> 00:25:01,916 Park a red Subaru in the ambulance bay? 661 00:25:01,917 --> 00:25:03,792 Oh. Yes, that's me. 662 00:25:03,793 --> 00:25:05,753 Gonna need to move that to open the space for ambulances. 663 00:25:05,754 --> 00:25:07,296 Oh. I'm so sorry. 664 00:25:07,297 --> 00:25:08,797 - Okay. - Um... 665 00:25:08,798 --> 00:25:10,424 I'll walk Rita out. 666 00:25:10,425 --> 00:25:11,967 Perlah, would you stay with Ginger for a minute? 667 00:25:11,968 --> 00:25:13,802 - I'll be right back. - Yeah, no problem. 668 00:25:13,803 --> 00:25:15,555 Okay. Um, after you. 669 00:25:19,518 --> 00:25:22,144 Look, I-I put your mom's prescription in 670 00:25:22,145 --> 00:25:25,439 at the pharmacy, and, uh, by the time 671 00:25:25,440 --> 00:25:26,982 you get back from parking, 672 00:25:26,983 --> 00:25:28,484 she should be ready to be discharged. 673 00:25:28,485 --> 00:25:31,111 Just don't worry. 674 00:25:31,112 --> 00:25:34,365 Things will be back to normal in a few weeks. 675 00:25:34,366 --> 00:25:36,116 [CHUCKLES] 676 00:25:36,117 --> 00:25:38,619 I'm not sure what normal is anymore. 677 00:25:38,620 --> 00:25:41,163 I can't even remember the last time I slept through the night. 678 00:25:41,164 --> 00:25:42,790 It's just... 679 00:25:42,791 --> 00:25:44,333 [SNIFFLES] It's a lot. 680 00:25:44,334 --> 00:25:45,918 [CRYING] 681 00:25:45,919 --> 00:25:48,504 Um, do you have any support at home? 682 00:25:48,505 --> 00:25:50,839 [SIGHS] I wish. 683 00:25:50,840 --> 00:25:53,092 It's just us. 684 00:25:53,093 --> 00:25:55,928 You know, I hired a part-time aide for my sister 685 00:25:55,929 --> 00:25:57,346 to cover me when I was at work. 686 00:25:57,347 --> 00:26:00,182 It was really helpful. 687 00:26:00,183 --> 00:26:02,101 It's out of our price range. 688 00:26:02,102 --> 00:26:03,686 I mean, I already work from home. 689 00:26:03,687 --> 00:26:05,688 And then there's the cooking and the cleaning 690 00:26:05,689 --> 00:26:08,148 and the doctor's appointments. 691 00:26:08,149 --> 00:26:10,234 It never ends. 692 00:26:10,235 --> 00:26:14,154 You know, caretaker's fatigue is a real thing. 693 00:26:14,155 --> 00:26:15,864 You have to take care of yourself. 694 00:26:15,865 --> 00:26:18,743 Otherwise, you're gonna end up in here, too. 695 00:26:20,829 --> 00:26:22,872 [SIGHS] 696 00:26:25,917 --> 00:26:28,210 I still don't understand why Kristi needs 697 00:26:28,211 --> 00:26:30,754 to go through this a third time with a third doctor. 698 00:26:30,755 --> 00:26:32,214 Yeah, that's our bad. 699 00:26:32,215 --> 00:26:33,924 Our computerized medical records 700 00:26:33,925 --> 00:26:36,093 have been glitching lately, and Dr. Collins' image 701 00:26:36,094 --> 00:26:38,053 didn't upload properly. 702 00:26:38,054 --> 00:26:39,555 Okay, crown to rump... that's top of the head 703 00:26:39,556 --> 00:26:40,889 to the bottom of the butt... 704 00:26:40,890 --> 00:26:42,224 is how you measure gestational age. 705 00:26:42,225 --> 00:26:45,477 And we are at 10 weeks and 6 days. 706 00:26:45,478 --> 00:26:47,479 I made it by one day? 707 00:26:47,480 --> 00:26:48,981 I will order the medication. 708 00:26:48,982 --> 00:26:50,858 Dr. Collins will go over instructions 709 00:26:50,859 --> 00:26:52,985 on taking the pills when they come back from the pharmacy. 710 00:26:52,986 --> 00:26:54,486 Thank you so much, Dr. Robby. 711 00:26:54,487 --> 00:26:56,238 Oh, I'm glad I could help. 712 00:26:56,239 --> 00:26:59,074 Even more glad to see you have such a supportive mom. 713 00:26:59,075 --> 00:27:01,036 Okay, take care. 714 00:27:06,791 --> 00:27:08,709 Appreciate you stepping up. 715 00:27:08,710 --> 00:27:10,462 All good. I got you. 716 00:27:12,255 --> 00:27:14,465 Robby, I have Emma Isaacs on line 3 for you. 717 00:27:14,466 --> 00:27:15,966 She's the organ donation counselor coming 718 00:27:15,967 --> 00:27:17,635 - to speak to Nick's parents. - Thank you. 719 00:27:17,636 --> 00:27:19,219 What was that all about? 720 00:27:19,220 --> 00:27:20,804 - Oh, nothing. - Didn't look like nothing. 721 00:27:20,805 --> 00:27:22,139 - Please. - What? 722 00:27:22,140 --> 00:27:23,599 You two were once a thing. 723 00:27:23,600 --> 00:27:26,268 We dated briefly a million years ago. 724 00:27:26,269 --> 00:27:28,395 - Never again. - Never say never. 725 00:27:28,396 --> 00:27:30,272 Settle down, Jane Austen. 726 00:27:30,273 --> 00:27:32,316 The lady doth protest too much. 727 00:27:32,317 --> 00:27:33,693 - Mm. - Mm. 728 00:27:35,654 --> 00:27:37,446 Jake! 729 00:27:37,447 --> 00:27:39,657 There he is... the man, the myth, the legend. 730 00:27:39,658 --> 00:27:41,283 And there's the kid who stole my concert pass 731 00:27:41,284 --> 00:27:42,785 - and gave it to a girl. - [CHUCKLES] 732 00:27:42,786 --> 00:27:45,037 - Where is she? Do I get to meet her? - Need an assist! 733 00:27:45,038 --> 00:27:46,580 - Hold that thought. - Okay. 734 00:27:46,581 --> 00:27:47,956 Travis Johnson, 17, had a tonsillectomy 735 00:27:47,957 --> 00:27:49,458 ten days ago at St. Michael's. 736 00:27:49,459 --> 00:27:51,210 Started spitting blood about an hour ago. 737 00:27:51,211 --> 00:27:53,295 - Good vitals. - Hey, Travis. I'm Dr. Robby. 738 00:27:53,296 --> 00:27:54,963 - How much blood? - Couple mouthfuls. 739 00:27:54,964 --> 00:27:56,174 Can you open up for me? 740 00:27:58,843 --> 00:28:00,219 Hey, Whitaker, Jesse. 741 00:28:00,220 --> 00:28:01,637 Got a post-tonsillectomy hemorrhage. 742 00:28:01,638 --> 00:28:03,555 Nebulized TXA, quick as you can. 743 00:28:03,556 --> 00:28:05,391 - I'm on it. Let's go. - Let's go, Trauma 2. 744 00:28:05,392 --> 00:28:07,142 So this can go south pretty quickly. 745 00:28:07,143 --> 00:28:08,477 - You up for it? - Well, I can... 746 00:28:08,478 --> 00:28:09,562 Of course you are. 747 00:28:15,777 --> 00:28:17,361 Ready? Here we go. 748 00:28:17,362 --> 00:28:19,613 One, two, three. 749 00:28:19,614 --> 00:28:21,199 [GRUNTS] 750 00:28:25,203 --> 00:28:26,662 Take long, slow, deep breaths on that. 751 00:28:26,663 --> 00:28:28,497 The TXA is gonna help your blood clot. 752 00:28:28,498 --> 00:28:30,165 Uh, any medical problems? 753 00:28:30,166 --> 00:28:31,458 No, just a ton of strep. 754 00:28:31,459 --> 00:28:32,626 That's why I had the surgery. 755 00:28:32,627 --> 00:28:33,836 You take aspirin? 756 00:28:33,837 --> 00:28:36,213 - Any other medications? - Mm-mm. 757 00:28:36,214 --> 00:28:38,507 Lungs are clear bilaterally, no stridor. 758 00:28:38,508 --> 00:28:40,134 Okay, sure. 759 00:28:40,135 --> 00:28:42,302 You feel like throwing up? Any pain in your belly? 760 00:28:42,303 --> 00:28:44,096 No. 761 00:28:44,097 --> 00:28:45,264 Labs? 762 00:28:45,265 --> 00:28:48,267 Uh, CBC, BMP, maybe coags? 763 00:28:48,268 --> 00:28:49,810 Add a type and screen, just in case. 764 00:28:49,811 --> 00:28:50,853 Yeah. 765 00:28:50,854 --> 00:28:52,438 Good sats at 98%. 766 00:28:52,439 --> 00:28:54,523 BP is 115 over 80. 767 00:28:54,524 --> 00:28:55,691 Okay, good. 768 00:28:55,692 --> 00:28:57,025 Four by four on a ring forceps. 769 00:28:57,026 --> 00:28:59,361 - Let's take a look. - Okay. 770 00:28:59,362 --> 00:29:01,948 Head back, open wide for me. 771 00:29:03,450 --> 00:29:05,701 - What do you see? - No active bleeding, 772 00:29:05,702 --> 00:29:07,369 but there's some white and dark brown stuff 773 00:29:07,370 --> 00:29:09,037 - where the tonsils used to be. - Oh, that's good. 774 00:29:09,038 --> 00:29:11,123 That's a fibrinous clot. That means the TXA is working. 775 00:29:11,124 --> 00:29:12,541 Your parents on the way? 776 00:29:12,542 --> 00:29:13,876 They're in Baltimore for a wedding. 777 00:29:13,877 --> 00:29:15,210 I didn't want to bother them. 778 00:29:15,211 --> 00:29:16,670 Trust me. They're your parents, 779 00:29:16,671 --> 00:29:18,380 and you are in an emergency room. 780 00:29:18,381 --> 00:29:19,923 It is never a bother. 781 00:29:19,924 --> 00:29:21,341 Write their numbers down, and I will call them. 782 00:29:21,342 --> 00:29:22,843 Call Head and Neck. 783 00:29:22,844 --> 00:29:24,178 Stay with him until they get here, okay? 784 00:29:24,179 --> 00:29:25,220 Good. 785 00:29:25,221 --> 00:29:26,847 Pen. 786 00:29:26,848 --> 00:29:28,850 Can I get the... 787 00:29:33,188 --> 00:29:35,773 [SIGHS] 788 00:29:35,774 --> 00:29:37,858 Sam Wallace, our Good Samaritan who saved 789 00:29:37,859 --> 00:29:40,611 a Nepali lady, is in line for a repeat head CT 790 00:29:40,612 --> 00:29:43,238 to be sure there's no extension of the intraparenchymal bleed. 791 00:29:43,239 --> 00:29:44,907 Okay, so we can dial down the sedation, and, 792 00:29:44,908 --> 00:29:46,742 if he's alert, check extubation parameters. 793 00:29:46,743 --> 00:29:47,993 - Copy. - Did you get the consent form 794 00:29:47,994 --> 00:29:49,244 signed by Joyce the sickler 795 00:29:49,245 --> 00:29:50,579 - for the intubation? - Not yet. 796 00:29:50,580 --> 00:29:52,247 - Jesus fucking... - She's scared. 797 00:29:52,248 --> 00:29:53,895 I just wanted to give her some time to talk to her... 798 00:29:53,896 --> 00:29:55,442 To do what, make funeral arrangements? 799 00:29:55,443 --> 00:29:57,169 Joyce is hypoxic at 84. 800 00:29:57,170 --> 00:29:59,505 84. This goes on much longer, 801 00:29:59,506 --> 00:30:01,423 she runs the risk of permanent lung damage, 802 00:30:01,424 --> 00:30:02,674 - heart attack... - I know. 803 00:30:02,675 --> 00:30:04,176 - Stroke, death. - I know. 804 00:30:04,177 --> 00:30:05,260 Then move! 805 00:30:05,261 --> 00:30:06,763 Now. 806 00:30:17,440 --> 00:30:19,775 Just have a seat, and we'll be with you shortly. 807 00:30:19,776 --> 00:30:22,237 Oh, I've heard that load of bullshit before. 808 00:30:25,532 --> 00:30:27,909 [SIGHS] My fucking God. 809 00:30:33,873 --> 00:30:35,875 [SCOFFS] 810 00:30:43,341 --> 00:30:45,175 Took me all the way back there just to 811 00:30:45,176 --> 00:30:48,303 stick a goddamn thermometer in my mouth, you know. 812 00:30:48,304 --> 00:30:51,307 Repeat vitals every four hours. 813 00:30:55,687 --> 00:30:57,938 - [PEOPLE EXCLAIMING] - Oh, dang! 814 00:30:57,939 --> 00:30:59,940 Saw how it swerved and almost hit the taxi? 815 00:30:59,941 --> 00:31:01,483 - Mm-hmm. - [SIGHS] 816 00:31:01,484 --> 00:31:02,985 I gotta get out of here, I mean, this thing is 817 00:31:02,986 --> 00:31:04,778 totally gonna screw up the traffic to Pittfest. 818 00:31:04,779 --> 00:31:06,780 Nice score. You going with Robby? 819 00:31:06,781 --> 00:31:08,282 Well, I was supposed to. 820 00:31:08,283 --> 00:31:09,950 But I have this new girlfriend, 821 00:31:09,951 --> 00:31:11,660 and she's super excited about the lineup, so... 822 00:31:11,661 --> 00:31:14,496 So you ditched the old man for a hot piece of ass. 823 00:31:14,497 --> 00:31:17,165 Been there, done that. 824 00:31:17,166 --> 00:31:19,793 Senior year, Lollapalooza, I met this guy. 825 00:31:19,794 --> 00:31:21,211 Think his name was Rich... 826 00:31:21,212 --> 00:31:22,379 or was it Rick? 827 00:31:22,380 --> 00:31:23,797 Doesn't matter. 828 00:31:23,798 --> 00:31:25,967 But he looked like Dave Navarro. 829 00:31:27,802 --> 00:31:31,513 Warm breeze, cool grass, 830 00:31:31,514 --> 00:31:34,267 a million stars in the sky. 831 00:31:35,602 --> 00:31:37,394 Best sex of my life. 832 00:31:37,395 --> 00:31:39,354 You had sex in public? 833 00:31:39,355 --> 00:31:41,064 We were under a blanket. 834 00:31:41,065 --> 00:31:43,066 Oh! It's turning around. 835 00:31:43,067 --> 00:31:44,568 It's turning around, baby. 836 00:31:44,569 --> 00:31:47,154 - Come home to Papa. - Shit. 837 00:31:47,155 --> 00:31:49,949 I had money on it crashing in Beaver County. 838 00:31:52,869 --> 00:31:54,579 [KNOCKING] [BUZZER BLARES] 839 00:32:00,793 --> 00:32:02,711 Better safe than sorry. 840 00:32:02,712 --> 00:32:05,173 Okay. [BUZZER BLARES] 841 00:32:06,716 --> 00:32:08,927 - Jake, what's up? - Hey, how are you? 842 00:32:12,889 --> 00:32:15,724 Where's Rita? 843 00:32:15,725 --> 00:32:17,392 Um, she went to park the car. 844 00:32:17,393 --> 00:32:19,019 Shouldn't have been more than five minutes. 845 00:32:19,020 --> 00:32:21,856 Why don't you dial her number for me? 846 00:32:29,822 --> 00:32:31,949 - Did she pick up? - Straight to voicemail. 847 00:32:31,950 --> 00:32:33,993 - That's weird. - Yo. 848 00:32:37,413 --> 00:32:40,248 Sole caretaker, overwhelmed, 849 00:32:40,249 --> 00:32:42,085 exhausted. 850 00:32:44,963 --> 00:32:47,464 I told her to take a break, but you don't... 851 00:32:47,465 --> 00:32:49,925 you don't think she ditched her mom, do you? 852 00:32:49,926 --> 00:32:51,970 [SIGHS] I mean, it happens. 853 00:32:54,847 --> 00:32:57,599 You're gonna need to use the antibiotic ointment twice a day 854 00:32:57,600 --> 00:33:00,771 and come in for a wound check in two days, okay? 855 00:33:00,772 --> 00:33:02,388 Mateo, can you grab me enough samples 856 00:33:02,389 --> 00:33:03,899 - to last a couple weeks? - Yeah, I'm on it. 857 00:33:03,900 --> 00:33:06,108 Thank you. 858 00:33:06,109 --> 00:33:07,609 Thanks. 859 00:33:07,610 --> 00:33:09,361 I really appreciate it. 860 00:33:09,362 --> 00:33:11,446 Yeah. No problem. 861 00:33:11,447 --> 00:33:14,074 Has Kiara been here yet? 862 00:33:14,075 --> 00:33:16,076 No, who's Kiara? 863 00:33:16,077 --> 00:33:17,869 Oh, she's the hospital social worker. 864 00:33:17,870 --> 00:33:19,621 She can help you out with, like, housing and childcare 865 00:33:19,622 --> 00:33:21,039 - and food and security... - You told her? 866 00:33:21,040 --> 00:33:23,291 - No, I-I... - No, no, it's all free. 867 00:33:23,292 --> 00:33:24,626 The system works if you use it. 868 00:33:24,627 --> 00:33:25,837 - You just have to... - Enough! 869 00:33:27,046 --> 00:33:28,923 I don't need your help. 870 00:33:30,550 --> 00:33:31,925 Nice speech. 871 00:33:31,926 --> 00:33:34,095 Next time, mind your own business. 872 00:33:39,726 --> 00:33:42,270 You ever heard of impact over intent? 873 00:33:44,063 --> 00:33:46,440 I would never intentionally embarrass anybody. 874 00:33:46,441 --> 00:33:48,358 But you did. 875 00:33:48,359 --> 00:33:50,819 You didn't have a conversation with Sherry 876 00:33:50,820 --> 00:33:52,487 or ask her what she needed. 877 00:33:52,488 --> 00:33:54,573 Instead, you walked in here and told her what to do. 878 00:33:54,574 --> 00:33:58,493 You gotta slow down, take a beat, and listen 879 00:33:58,494 --> 00:34:00,371 instead of judging people. 880 00:34:01,748 --> 00:34:03,123 - I don't judge. - Please. 881 00:34:03,124 --> 00:34:05,418 You've been eyeing me sideways all day. 882 00:34:07,170 --> 00:34:09,671 Look, maybe I have a better perspective because I've been 883 00:34:09,672 --> 00:34:12,340 on both sides, but we gotta try to at least 884 00:34:12,341 --> 00:34:15,177 put ourselves in their shoes. 885 00:34:15,178 --> 00:34:18,930 Listening and building trust will make us better doctors... 886 00:34:18,931 --> 00:34:20,558 and better people. 887 00:34:22,351 --> 00:34:25,479 Um, I'm sorry. 888 00:34:25,480 --> 00:34:28,231 I'm not telling you this to reprimand you. 889 00:34:28,232 --> 00:34:31,944 I'm trying to teach you to help you. 890 00:34:33,654 --> 00:34:36,823 Wait, uh, what about Sherry? 891 00:34:36,824 --> 00:34:38,825 I doubt she'll be back. 892 00:34:38,826 --> 00:34:41,954 But sadly, there will be many, many more just like her. 893 00:34:46,250 --> 00:34:47,584 No. No, no, no. 894 00:34:47,585 --> 00:34:49,169 He... he had the surgery at St. Michael's, 895 00:34:49,170 --> 00:34:50,922 but he's here now. 896 00:34:51,964 --> 00:34:53,840 No, he doesn't have a car. 897 00:34:53,841 --> 00:34:55,593 His parents are out of town. 898 00:34:57,720 --> 00:34:59,070 Okay, okay, well, 899 00:34:59,071 --> 00:35:00,837 how am I to send him back to St. Michael's, 900 00:35:00,838 --> 00:35:02,557 call him an Uber? 901 00:35:02,558 --> 00:35:05,143 You can't... that doesn't make... 902 00:35:05,144 --> 00:35:07,187 hey, hello. 903 00:35:07,188 --> 00:35:08,522 Hello! 904 00:35:08,523 --> 00:35:10,398 What's wrong? 905 00:35:10,399 --> 00:35:14,152 Um...[SIGHS] 906 00:35:14,153 --> 00:35:16,488 They said it is not their job to fix 907 00:35:16,489 --> 00:35:18,365 another hospital's problem. 908 00:35:18,366 --> 00:35:20,408 Don't worry about it, though. I'll talk to my attending... 909 00:35:20,409 --> 00:35:21,535 [COUGHS] 910 00:35:21,536 --> 00:35:23,537 Oh, shit! 911 00:35:23,538 --> 00:35:26,331 Uh, I need a little help here! 912 00:35:26,332 --> 00:35:27,582 [MONITOR BEEPING RAPIDLY] 913 00:35:27,583 --> 00:35:29,292 Okay, come on, open up. 914 00:35:29,293 --> 00:35:31,753 It's a post-tonsillectomy hemorrhage. 915 00:35:31,754 --> 00:35:34,214 Uh, Yankauer and sponge stick. 916 00:35:34,215 --> 00:35:35,924 He was stable. Then it just opened. 917 00:35:35,925 --> 00:35:37,425 Call the blood bank. 918 00:35:37,426 --> 00:35:40,095 Two units, whole blood. Get a second line. 919 00:35:40,096 --> 00:35:41,555 Head and Neck wouldn't come down to see him. 920 00:35:41,556 --> 00:35:43,265 - Assholes. - Tachy to 120. 921 00:35:43,266 --> 00:35:45,142 His sats are down to 90%. 922 00:35:45,143 --> 00:35:47,269 Okay, get a high-flow nasal cannula, 923 00:35:47,270 --> 00:35:48,645 100 of ketamine. 924 00:35:48,646 --> 00:35:50,772 Set up the GlideScope. 925 00:35:50,773 --> 00:35:52,315 [TENSE MUSIC] 926 00:35:52,316 --> 00:35:53,733 Hold suction. 927 00:35:53,734 --> 00:35:55,944 I'm gonna try for direct pressure. 928 00:35:55,945 --> 00:36:00,073 If Head and Neck still won't come down, call Garcia. 929 00:36:00,074 --> 00:36:02,409 You're good. You're good. 930 00:36:02,410 --> 00:36:05,620 Okay, before we begin, let's take a time-out. 931 00:36:05,621 --> 00:36:07,581 This is Joyce St. Claire. 932 00:36:07,582 --> 00:36:09,875 Procedure is endotracheal intubation 933 00:36:09,876 --> 00:36:12,294 for hypoxia due to acute chest syndrome. 934 00:36:12,295 --> 00:36:14,129 We'll be using video laryngoscopy 935 00:36:14,130 --> 00:36:17,132 and an 8-0 ET tube with a 7.5 on standby. 936 00:36:17,133 --> 00:36:20,969 Induction with 75 of propofol, 100 rocuronium. 937 00:36:20,970 --> 00:36:22,637 Got it. 938 00:36:22,638 --> 00:36:25,307 For backup, we have a bougie and an LMA ready. 939 00:36:25,308 --> 00:36:26,808 Yep. 940 00:36:26,809 --> 00:36:28,894 Any questions or concerns before we start? 941 00:36:28,895 --> 00:36:30,812 I wanna be awake. 942 00:36:30,813 --> 00:36:33,106 We can't perform an intubation that way. 943 00:36:33,107 --> 00:36:34,858 I mean after. 944 00:36:34,859 --> 00:36:37,485 After, we will lighten your sedation. 945 00:36:37,486 --> 00:36:40,488 You won't be able to talk, but you can use a pen and paper 946 00:36:40,489 --> 00:36:42,533 or an iPad to communicate. 947 00:36:45,244 --> 00:36:48,538 I love you. 948 00:36:48,539 --> 00:36:50,458 Till the end of time. 949 00:36:51,918 --> 00:36:53,668 Robby, Trauma 2 right now. 950 00:36:53,669 --> 00:36:56,338 - Cover the intubation? - Of course. 951 00:36:56,339 --> 00:36:58,298 ♪ ♪ 952 00:36:58,299 --> 00:37:00,342 - What happened? - Bleeder opened up. 953 00:37:00,343 --> 00:37:01,509 Ketamine on board to intubate. 954 00:37:01,510 --> 00:37:02,928 Sats holding at 97. 955 00:37:02,929 --> 00:37:04,930 - Can you get an airway? - Come on. 956 00:37:04,931 --> 00:37:06,348 Let's lie him down. 957 00:37:06,349 --> 00:37:08,016 Keep pressure on the scab. 958 00:37:08,017 --> 00:37:09,434 [MONITORS BEEPING RAPIDLY] 959 00:37:09,435 --> 00:37:10,852 Nothing but blood. 960 00:37:10,853 --> 00:37:12,687 Can't see the cords. 961 00:37:12,688 --> 00:37:14,038 Sats 94. 962 00:37:14,039 --> 00:37:16,191 Not sure we have room for the tube with the sponge stick. 963 00:37:16,192 --> 00:37:17,943 If I pull out, there's gonna be even more blood. 964 00:37:17,944 --> 00:37:19,444 Doesn't look like you secured that airway. 965 00:37:19,445 --> 00:37:21,029 - He's working on it. - Bougie. 966 00:37:21,030 --> 00:37:22,657 Open a crike tray and prep the neck. 967 00:37:24,742 --> 00:37:26,534 Hold on, I'm going in blind with the bougie. 968 00:37:26,535 --> 00:37:28,161 I might be able to feel the tracheal rings. 969 00:37:28,162 --> 00:37:30,205 And I might have a three-way with Madonna. 970 00:37:30,206 --> 00:37:32,540 Move. 971 00:37:32,541 --> 00:37:33,708 Not happening. 972 00:37:33,709 --> 00:37:34,876 Pressure. 973 00:37:34,877 --> 00:37:36,420 Make room for the grown-ups. 974 00:37:37,588 --> 00:37:38,922 Okay, okay. Hold on, hold on. 975 00:37:38,923 --> 00:37:40,382 We can try a retrograde intubation. 976 00:37:40,383 --> 00:37:41,841 - A what? - There's no obstruction. 977 00:37:41,842 --> 00:37:43,218 We just can't see what we're doing. 978 00:37:43,219 --> 00:37:44,761 So we take a needle, 979 00:37:44,762 --> 00:37:46,680 and we put it in the cricothyroid. 980 00:37:46,681 --> 00:37:48,556 We run a guide wire up and out the mouth, 981 00:37:48,557 --> 00:37:50,558 and we slide the ET tube up over the wire. 982 00:37:50,559 --> 00:37:52,560 - Never seen one before. - Sats 90. 983 00:37:52,561 --> 00:37:53,895 No time to play MacGyver with this kid. 984 00:37:53,896 --> 00:37:55,897 - Time to crike. - It'll be quick. 985 00:37:55,898 --> 00:37:57,565 You got one shot, and then I cut. 986 00:37:57,566 --> 00:38:00,110 ♪ ♪ 987 00:38:00,111 --> 00:38:02,279 Propofol and rock are on board. 988 00:38:02,280 --> 00:38:05,573 Now we wait for the sedative and paralytic to start working. 989 00:38:05,574 --> 00:38:08,201 Should Dr. Robby be in here? 990 00:38:08,202 --> 00:38:11,246 Between Dr. Mohan and myself, we've done hundreds of these. 991 00:38:11,247 --> 00:38:13,748 I'm getting sleepy. 992 00:38:13,749 --> 00:38:15,500 I'm right here, babe. 993 00:38:15,501 --> 00:38:18,837 ♪ ♪ 994 00:38:18,838 --> 00:38:21,089 [MONITORS BEEPING RAPIDLY] 995 00:38:21,090 --> 00:38:25,051 ♪ ♪ 996 00:38:25,052 --> 00:38:27,095 Okay, I'm in. 997 00:38:27,096 --> 00:38:29,723 Guide wire. 998 00:38:29,724 --> 00:38:33,435 ♪ ♪ 999 00:38:33,436 --> 00:38:36,105 Let me know when you start to feel it up top. 1000 00:38:37,815 --> 00:38:39,441 Nothing yet. 1001 00:38:39,442 --> 00:38:41,443 - More suction. - I'm trying. 1002 00:38:41,444 --> 00:38:43,111 Mm. Still can't find it. 1003 00:38:43,112 --> 00:38:44,321 Well, keep feeling in there. 1004 00:38:44,322 --> 00:38:45,780 It's gotta be there somewhere. 1005 00:38:45,781 --> 00:38:48,491 - Maybe it's curling up. - Sats down to 89. 1006 00:38:48,492 --> 00:38:50,785 - Guys, this is not working. - Just give me a second. 1007 00:38:50,786 --> 00:38:52,162 - Until he arrests? - Oh, my God. 1008 00:38:52,163 --> 00:38:53,621 I'm gonna lose another patient. 1009 00:38:53,622 --> 00:38:55,248 Shut up, Whitaker. Let's get on this. 1010 00:38:55,249 --> 00:38:56,624 Sats down to 87. 1011 00:38:56,625 --> 00:38:58,668 Okay, I'm gonna redirect the wire. 1012 00:38:58,669 --> 00:39:01,004 ♪ ♪ 1013 00:39:01,005 --> 00:39:03,257 Sats still dropping. 86. 1014 00:39:05,092 --> 00:39:06,968 - You got this. - Mm-hmm. 1015 00:39:06,969 --> 00:39:11,806 ♪ ♪ 1016 00:39:11,807 --> 00:39:15,060 Ondine, if you'd like, you can watch on the screen. 1017 00:39:15,061 --> 00:39:16,812 I'm okay. 1018 00:39:18,731 --> 00:39:20,900 Excellent view of the cords, Dr. Mohan. 1019 00:39:22,818 --> 00:39:25,153 I'm in. 1020 00:39:25,154 --> 00:39:26,988 Inflate the balloon. 1021 00:39:26,989 --> 00:39:34,121 ♪ ♪ 1022 00:39:35,664 --> 00:39:37,207 Good breath sounds bilaterally. 1023 00:39:37,208 --> 00:39:39,834 Sats 92 and rising. 1024 00:39:39,835 --> 00:39:42,170 That's it? You're done? 1025 00:39:42,171 --> 00:39:43,213 Yes. 1026 00:39:43,214 --> 00:39:45,799 It all went perfectly. 1027 00:39:45,800 --> 00:39:48,009 [SIGHS] 1028 00:39:48,010 --> 00:39:49,803 How long until she gets better? 1029 00:39:49,804 --> 00:39:51,179 Depends. 1030 00:39:51,180 --> 00:39:52,750 It can take anywhere from a few days 1031 00:39:52,751 --> 00:39:55,684 to a few weeks for the lungs to heal from acute chest syndrome. 1032 00:39:55,685 --> 00:39:57,560 I can ask the ICU to set up a recliner for you 1033 00:39:57,561 --> 00:39:59,646 in Joyce's room so you can stay with her. 1034 00:39:59,647 --> 00:40:02,148 Thank you both so much. 1035 00:40:02,149 --> 00:40:03,316 You're welcome. 1036 00:40:03,317 --> 00:40:05,319 Take care. 1037 00:40:10,699 --> 00:40:12,367 Sats 84. We need to bag him. 1038 00:40:12,368 --> 00:40:14,202 - Still not seeing it. - I'm suctioning like crazy. 1039 00:40:14,203 --> 00:40:15,662 Okay, we're done playing doctor. 1040 00:40:15,663 --> 00:40:16,996 Lose the wire. I'm criking this kid. 1041 00:40:16,997 --> 00:40:18,164 All right, we tried. I'm sorry. 1042 00:40:18,165 --> 00:40:19,666 No, wait. Wait. 1043 00:40:19,667 --> 00:40:22,168 I've got it. 1044 00:40:22,169 --> 00:40:23,795 You still don't have an airway. 1045 00:40:23,796 --> 00:40:25,046 Okay, keep the laryngoscope in place 1046 00:40:25,047 --> 00:40:26,840 so the tube passes easily. 1047 00:40:26,841 --> 00:40:30,051 Pass the T, the T tube over the wire. 1048 00:40:30,052 --> 00:40:31,719 - Come on. - Hang on to that wire. 1049 00:40:31,720 --> 00:40:33,972 Do not let go of that wire. 1050 00:40:33,973 --> 00:40:37,183 Okay. 1051 00:40:37,184 --> 00:40:38,518 Okay, I'm gonna give you a little slack 1052 00:40:38,519 --> 00:40:40,354 so you can get past the cords. 1053 00:40:41,939 --> 00:40:43,773 Yeah, yeah. I feel you at the trachea. 1054 00:40:43,774 --> 00:40:45,942 25 centimeters at the lips. 1055 00:40:45,943 --> 00:40:47,068 That ought to do it. 1056 00:40:47,069 --> 00:40:49,237 Pull the wire, bag him. 1057 00:40:49,238 --> 00:40:50,780 Balloon's up. 1058 00:40:50,781 --> 00:40:53,241 ♪ ♪ 1059 00:40:53,242 --> 00:40:54,951 Yellow on CO2. That's good. 1060 00:40:54,952 --> 00:40:57,871 That is very good. 1061 00:40:57,872 --> 00:40:59,622 Good breath sounds bilaterally. 1062 00:40:59,623 --> 00:41:00,874 Sats coming up. 1063 00:41:00,875 --> 00:41:03,418 90, 92. 1064 00:41:03,419 --> 00:41:04,878 Guess you're gonna have to save that scalpel 1065 00:41:04,879 --> 00:41:06,713 - for another day. - You guys got lucky. 1066 00:41:06,714 --> 00:41:08,214 No, we got skills, baby. 1067 00:41:08,215 --> 00:41:10,758 We got skills! 1068 00:41:10,759 --> 00:41:11,885 Keep gauze on the clot. 1069 00:41:11,886 --> 00:41:13,386 Yeah, copy. 1070 00:41:13,387 --> 00:41:15,264 Ordering propofol and fentanyl drips. 1071 00:41:16,932 --> 00:41:19,100 Oh, nice of you to join us, Dr. Flores. 1072 00:41:19,101 --> 00:41:22,353 Sorry, I got stuck in a nasty radical neck dissection. 1073 00:41:22,354 --> 00:41:24,022 - Still bleeding? - Not with direct pressure. 1074 00:41:24,023 --> 00:41:25,940 We got the airway. You get the bleeder. 1075 00:41:25,941 --> 00:41:27,275 OR's standing by. 1076 00:41:27,276 --> 00:41:30,528 So I can cancel the Uber? 1077 00:41:30,529 --> 00:41:32,364 Let's get him upstairs. 1078 00:41:33,782 --> 00:41:35,950 Fresh sponge stick for you, Whitaker. 1079 00:41:35,951 --> 00:41:37,368 You need me to stay with the... 1080 00:41:37,369 --> 00:41:38,953 Your patient. You did a good job. 1081 00:41:38,954 --> 00:41:40,413 It's only till the anesthesiologist takes over. 1082 00:41:40,414 --> 00:41:41,789 - You got it? - Yeah, I got it. 1083 00:41:41,790 --> 00:41:43,124 Get yourself a fresh pair of scrubs 1084 00:41:43,125 --> 00:41:44,710 on your way back down. 1085 00:41:51,050 --> 00:41:52,967 Um, I'm sorry that took so long. 1086 00:41:52,968 --> 00:41:54,761 - I was just... - Don't apologize. 1087 00:41:54,762 --> 00:41:56,763 What you did in there, building a relationship 1088 00:41:56,764 --> 00:41:59,349 with your patients, earning their trust, 1089 00:41:59,350 --> 00:42:01,017 that's what this is all about. 1090 00:42:01,018 --> 00:42:03,186 Robby doesn't seem to think so. 1091 00:42:03,187 --> 00:42:05,313 Don't worry about him. 1092 00:42:05,314 --> 00:42:09,192 You know, I should be apologizing to you. 1093 00:42:09,193 --> 00:42:13,238 Slo-Mo, you deserve better. 1094 00:42:13,239 --> 00:42:15,241 Keep doing you, Dr. Mohan. 1095 00:42:17,243 --> 00:42:18,826 Where'd you get that move? 1096 00:42:18,827 --> 00:42:21,120 Retrograde intubation, that's an Adamson special. 1097 00:42:21,121 --> 00:42:22,830 I learned that from the best. 1098 00:42:22,831 --> 00:42:24,499 Well, you're not too shabby yourself, Professor. 1099 00:42:24,500 --> 00:42:26,417 Yeah, that got kind of rough in there. 1100 00:42:26,418 --> 00:42:28,127 You kept your composure, though... 1101 00:42:28,128 --> 00:42:29,754 exactly the kind of candidate they want 1102 00:42:29,755 --> 00:42:31,839 for the ED Medical Education Fellowship. 1103 00:42:31,840 --> 00:42:34,300 Oh, there's probably over 50 applicants for that one slot. 1104 00:42:34,301 --> 00:42:35,769 Yeah, probably. 1105 00:42:35,770 --> 00:42:37,738 But I know that they like to go with someone that they 1106 00:42:37,739 --> 00:42:39,347 know from firsthand experience has 1107 00:42:39,348 --> 00:42:41,349 the skills to be successful. 1108 00:42:41,350 --> 00:42:42,809 At least that's what I told them in my letter 1109 00:42:42,810 --> 00:42:44,352 of recommendation. 1110 00:42:44,353 --> 00:42:45,520 Thank you. 1111 00:42:45,521 --> 00:42:46,814 Mm-hmm. 1112 00:42:47,815 --> 00:42:49,190 Glad you stuck around. 1113 00:42:49,191 --> 00:42:50,692 It's not like I had a choice, did I? 1114 00:42:50,693 --> 00:42:53,069 No, not really. 1115 00:42:53,070 --> 00:42:55,572 So how's your day going? 1116 00:42:55,573 --> 00:42:57,490 Uh, it's going. 1117 00:42:57,491 --> 00:43:00,201 Cool, cool, cool. 1118 00:43:00,202 --> 00:43:01,661 Why do you ask? 1119 00:43:01,662 --> 00:43:03,079 Guy can't ask? 1120 00:43:03,080 --> 00:43:04,664 You never ask me about my work. 1121 00:43:04,665 --> 00:43:06,708 What gives? 1122 00:43:06,709 --> 00:43:08,501 Mom wanted me to ask because she just wants 1123 00:43:08,502 --> 00:43:10,044 to make sure that you're doing okay. 1124 00:43:10,045 --> 00:43:12,088 That's very sweet of her. I'm doing fine. 1125 00:43:12,089 --> 00:43:13,590 Thank you for these again. 1126 00:43:13,591 --> 00:43:14,882 You can thank me by finally introducing me 1127 00:43:14,883 --> 00:43:16,217 to your girlfriend. 1128 00:43:16,218 --> 00:43:18,386 - Not today but soon. - Have fun. 1129 00:43:18,387 --> 00:43:21,723 Hey, I know it goes without saying, but please be safe. 1130 00:43:21,724 --> 00:43:23,141 - I will. - Seriously. 1131 00:43:23,142 --> 00:43:24,726 Don't take anything from anyone. 1132 00:43:24,727 --> 00:43:26,227 I've already seen two fentanyl overdoses today. 1133 00:43:26,228 --> 00:43:27,812 - It's not even noon. - I promise. 1134 00:43:27,813 --> 00:43:29,022 - Okay. - Basketball Sunday? 1135 00:43:29,023 --> 00:43:30,398 Yep, wouldn't miss it. 1136 00:43:30,399 --> 00:43:31,733 Hey, before you go, before you go. 1137 00:43:31,734 --> 00:43:33,067 Please don't hand me a condom. 1138 00:43:33,068 --> 00:43:34,402 Condom? 1139 00:43:34,403 --> 00:43:35,862 I was gonna give you extra cash. 1140 00:43:35,863 --> 00:43:36,863 Wait, are you having sex? 1141 00:43:36,864 --> 00:43:38,449 Thank you. 1142 00:43:40,159 --> 00:43:42,910 Looks like the driver lost control as the police cars 1143 00:43:42,911 --> 00:43:44,579 - were closing in. - Oh. 1144 00:43:44,580 --> 00:43:46,372 Uh, the ambulance has definitely stopped. 1145 00:43:46,373 --> 00:43:47,874 Check it out. 1146 00:43:47,875 --> 00:43:49,751 It's difficult to tell from this angle, 1147 00:43:49,752 --> 00:43:51,753 but it does look like they may have hit something. 1148 00:43:51,754 --> 00:43:54,255 - Damn! - That's in our zone. 1149 00:43:54,256 --> 00:43:55,923 Ambulance crashed in our catchment. 1150 00:43:55,924 --> 00:43:57,258 Get ready for incoming. 1151 00:43:57,259 --> 00:43:58,593 How many you think? 1152 00:43:58,594 --> 00:44:01,137 Other than the driver? No idea. 1153 00:44:01,138 --> 00:44:03,306 Since you're past ten weeks, 1154 00:44:03,307 --> 00:44:05,433 you'll need to take mifepristone twice, 1155 00:44:05,434 --> 00:44:08,102 once now and once in 24 hours. 1156 00:44:08,103 --> 00:44:10,772 Then 24 hours after that, you'll take misoprostol, 1157 00:44:10,773 --> 00:44:13,399 two pills which dissolve between the cheek and the gum, 1158 00:44:13,400 --> 00:44:15,985 then two more of the same pills six hours later. 1159 00:44:15,986 --> 00:44:17,945 That's a lot to remember. 1160 00:44:17,946 --> 00:44:19,614 Everything is clearly labeled with the names of the meds, 1161 00:44:19,615 --> 00:44:22,867 the dose, and the exact time to take them. 1162 00:44:22,868 --> 00:44:24,452 Will it hurt? 1163 00:44:24,453 --> 00:44:27,246 You can expect some vaginal bleeding. 1164 00:44:27,247 --> 00:44:28,456 There may be some cramping, 1165 00:44:28,457 --> 00:44:30,124 like when you're on your period. 1166 00:44:30,125 --> 00:44:32,251 If you're bleeding more than two pads an hour 1167 00:44:32,252 --> 00:44:34,462 or the pain gets to be too much, 1168 00:44:34,463 --> 00:44:36,130 come back in and see us. 1169 00:44:36,131 --> 00:44:38,425 And I'll be with you the whole time. 1170 00:44:43,639 --> 00:44:45,306 Kristi? 1171 00:44:45,307 --> 00:44:47,392 Kristi! 1172 00:44:47,393 --> 00:44:48,476 What the hell are you doing here? 1173 00:44:48,477 --> 00:44:50,019 Hey, language! 1174 00:44:50,020 --> 00:44:51,521 And I should be asking you the same thing. 1175 00:44:51,522 --> 00:44:52,772 Excuse me. Who are you? 1176 00:44:52,773 --> 00:44:55,149 - I'm her mom. - Mom? 1177 00:44:55,150 --> 00:44:56,192 Aren't you her mom? 1178 00:44:56,193 --> 00:44:57,652 I can explain. 1179 00:44:57,653 --> 00:44:59,028 No, that's my sister, Lynette. 1180 00:44:59,029 --> 00:45:00,780 I am Kristi's mother. 1181 00:45:00,781 --> 00:45:04,992 Kris... Kris, baby, what are you doing here? 1182 00:45:04,993 --> 00:45:06,828 [DRAMATIC MUSIC] 1183 00:45:06,829 --> 00:45:09,206 I'm here for an abortion. 1184 00:45:10,332 --> 00:45:12,041 Did you do it already? 1185 00:45:12,042 --> 00:45:14,335 - Not yet. - Okay. Thank God. 1186 00:45:14,336 --> 00:45:16,629 Okay, okay, can we all just take a step back here and... 1187 00:45:16,630 --> 00:45:19,072 Mom, I want this. This is my decision. 1188 00:45:19,073 --> 00:45:20,341 - No. - Just listen to her, El. 1189 00:45:20,342 --> 00:45:21,592 You can shut up! 1190 00:45:21,593 --> 00:45:23,845 You have done enough. 1191 00:45:23,846 --> 00:45:25,680 My daughter is a minor, 1192 00:45:25,681 --> 00:45:28,766 so she can't get this abortion 1193 00:45:28,767 --> 00:45:30,644 without my say-so, right? 1194 00:45:32,229 --> 00:45:34,522 - Is that right? - [SIGHS] 1195 00:45:34,523 --> 00:45:37,024 That's correct. 1196 00:45:37,025 --> 00:45:39,485 ♪ ♪ 1197 00:45:39,486 --> 00:45:42,530 Then there is no way this is happening. 1198 00:45:42,531 --> 00:45:44,157 Not now, not ever. 1199 00:45:44,158 --> 00:45:47,328 ♪ ♪ 1200 00:45:47,330 --> 00:45:48,507 [SIGHS] 1201 00:45:48,508 --> 00:45:51,582 Sync and corrections by btsix www.addic7ed.com 1202 00:46:03,320 --> 00:46:06,262 [LIGHT MUSIC] 1203 00:46:06,263 --> 00:46:13,395 ♪ ♪