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Sync and corrections by btsix
www.addic7ed.com
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- Robby.
- Yep.
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Cellulitis on the dorsum of the foot,
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now spreading up the leg.
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Hello, I'm Dr. Robby.
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Mind if I take a look?
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How long do you think
this is gonna take?
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I took an early lunch break.
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I don't know that you're gonna
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make it back to work today.
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Erythema and warmth halfway up her knee.
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When did you see her, Donnie?
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He didn't. I did.
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- When?
- About four hours ago.
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Gave her a dose of Keflex,
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told her to come back
if things got worse.
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Things have definitely gotten worse.
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Dana, what's open?
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Trauma Two.
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Jesse, can you get her
started in Trauma Two
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with some vanco
and blood cultures, please?
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- Got it, boss.
- I'm coming with.
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Suit yourself.
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Santos, you want in on Trauma Two?
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Too much charting, too little time.
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62-year-old male presents
with chief complaint
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of left lower back pain.
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- Considered the diagnosis...
- Hey.
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Oh, Jesus Christ.
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I'm charting.
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Sorry.
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Did I do something wrong?
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Besides interrupting me? Probably.
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Then I apologize.
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I know that second year
of residency can be stressful,
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so if there's anything
I can do to help you...
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like stop talking.
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- That's a great idea.
- Yeah.
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Considered the diagnosis of
aortic aneurysm or dissection.
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Got a new one for you in 13.
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I'm 20 charts behind,
and the new attending
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is threatening to make me repeat
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a year if I can't catch up.
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Cry me a river.
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Old lady with bad abdominal pain.
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Somebody's gotta see her.
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Dana, please do me a solid.
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Holiday weekend.
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Westbridge is down, and our
waiting room's on overdrive.
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I'm sorry, but your charting's
gonna have to wait
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until after your shift.
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Ogilvie.
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Dr. Santos needs you to pick up
a new patient in 13.
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Y-yes, ma'am. I'm on it.
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Chart while you supervise.
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Best I can do.
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Setting up a GoFundMe, that's
what her generation does.
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That's how they support each other.
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Doctor, tell him.
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Your wife's right.
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Staying here's gonna cost
more than we can afford.
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Look, I'm feeling better.
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I'll just leave.
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Mr. Diaz, even if your
blood sugar is back to normal,
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we have to continue
with the insulin drip
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until we clear the ketones
from your bloodstream.
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Otherwise, you could experience
electrolyte disorders,
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heart and kidney problems...
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Mi amor, your health is what matters.
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I'll make you a deal.
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You agree to stay on the insulin drip,
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and I'll go find our case manager
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to discuss cost-cutting options
for your stay.
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Deal.
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And I'm sitting here
making sure he doesn't move.
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- You should go look for Ana.
- Mm-hmm.
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I can find her.
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BRB.
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Hanging vanco.
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What's vanco?
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A really strong antibiotic
to kill skin germs.
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- Need a hand?
- No. We got this.
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I'll just observe.
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Pretend I'm not even here.
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Let's send off a CBC,
blood cultures, and CMP.
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And also a lactic acid,
CRP, and calcitonin.
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Wait, she's not febrile,
not tachycardic.
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No evidence of SIRS.
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00:03:05,080 --> 00:03:07,040
- Yet.
- What's SIRS?
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Systemic inflammatory response syndrome.
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Sorry.
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An exaggerated defense response.
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A what?
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Sometimes the human body
can have an overreaction
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to an infection,
so we're gonna monitor you
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to make sure
that this does not progress.
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It's my boss.
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Sorry, I have to take this,
or he's gonna fire me.
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OK.
100
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Hello.
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No, I'm still at the hospital.
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Being seen right now.
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Ow.
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No, they just stuck me with a needle.
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I don't know.
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You wanna talk to them?
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They're kind of busy right now.
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I know you are.
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Second IV's in.
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No, I'm not overreacting.
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My body's overreacting.
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Please... please don't fire me.
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I...
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This is Dr. Michael Robinavitch.
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I am the chief
of emergency medicine at PTMC.
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If you fire her, she will sue you,
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and I will testify on her behalf.
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OK.
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Don't worry about it. We got you.
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Do you know how long
Jackson's gonna be asleep?
121
00:04:16,819 --> 00:04:20,071
So there's no exact timeline
with the sedatives we gave him,
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but he should be awake soon.
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Have you spoken to your parents yet?
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Yeah, they're on their way
back from Columbus.
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Maybe you should take
some time for yourself
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before they arrive.
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Yeah, cafeteria's right down the hall.
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Decent grilled cheese.
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Stay away from the tuna.
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Thanks, but I'm not hungry.
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You know, I just can't believe
that a campus security guard
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tased my brother.
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Aren't they supposed
to be helping students
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and protect them, not shoot at them?
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You have every right to be upset,
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and you should absolutely
pursue accountability.
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But right now, we are
taking care of your brother.
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And you should really
take care of yourself.
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I... I have your number.
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I'll text you as soon as
Jackson's LP results get back
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or if he wakes up.
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OK.
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OK, thank you.
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Of course.
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- Oh.
- OK.
146
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Hypoactive bowel sounds.
147
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Soft, with moderate tenderness
in the left lower quadrant.
148
00:05:10,164 --> 00:05:13,416
Mrs. Randolph, do you
take Percocet every day?
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00:05:13,417 --> 00:05:15,335
- No.
- Huh.
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And what about your
water intake, 'cause...
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Pause.
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Mrs. Randolph, you said you
don't take Percocet every day,
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but when was the last time
you took some?
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Maybe three or four times last week.
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Assisted living had
a ballroom dance competition,
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- and I tweaked my back.
- Mm.
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Any further questions, Ogilvie?
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When was your last bowel movement?
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I don't know. Sometime last week.
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I've been stopped up
for at least five or six days.
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00:05:44,948 --> 00:05:48,409
Mm-hmm, painkillers
can cause constipation.
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I know.
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That's why they put me
on a stool softener,
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and then they tried an enema.
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- And... and no movements?
- Yep.
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And then they gave me
this horrible drink.
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Mag citrate.
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Yeah.
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Mag citrate.
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Made me puke.
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All right, what's next, Ogilvie?
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00:06:07,429 --> 00:06:09,472
Let's get you an X-ray
and see how we can help you,
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Mrs. Randolph.
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- Thank you.
- Yeah.
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Differential?
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Probable stool impaction.
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But with her history of cholecystectomy,
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it could be small bowel obstruction.
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Or worse.
180
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Sigmoid volvulus?
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00:06:22,903 --> 00:06:25,279
But that's a surgical emergency.
182
00:06:25,280 --> 00:06:26,823
Wouldn't she have tons of pain?
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00:06:26,824 --> 00:06:30,327
Not always, especially when
you're in your 80s.
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00:06:35,916 --> 00:06:37,583
I am getting concerned.
185
00:06:37,584 --> 00:06:40,128
This is a millimeter past the line.
186
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Or my line was sloppy.
187
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- Any increase in pain?
- Oh.
188
00:06:43,090 --> 00:06:45,633
OK, sorry. Let's try four morphine.
189
00:06:45,634 --> 00:06:46,968
White count's only 10,000.
190
00:06:46,969 --> 00:06:49,011
It'd be over 12,000 for SIRS.
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There are other criteria.
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00:06:50,806 --> 00:06:52,265
Still afebrile.
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00:06:52,266 --> 00:06:53,850
Did you ask about past history of MRSA?
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Not specifically, but she's
never been hospitalized.
195
00:06:55,644 --> 00:06:57,145
Any evidence
of an immunocompromised state?
196
00:06:57,146 --> 00:06:58,396
- No, she's healthy.
- Steroid use?
197
00:06:58,397 --> 00:06:59,397
Never.
198
00:06:59,398 --> 00:07:00,940
Maximum heart rate's only 89.
199
00:07:00,941 --> 00:07:02,108
Is that OK?
200
00:07:02,109 --> 00:07:04,193
That's good, very good.
201
00:07:04,194 --> 00:07:05,194
Stay with her.
202
00:07:05,195 --> 00:07:06,779
Monitor her closely.
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00:07:06,780 --> 00:07:08,614
If there's any change in her
condition, come find me.
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00:07:08,615 --> 00:07:09,783
I mean any change.
205
00:07:12,870 --> 00:07:15,538
Roxie Hamler, 42, home hospice patient
206
00:07:15,539 --> 00:07:17,123
with a history of lung cancer.
207
00:07:17,124 --> 00:07:20,334
New-onset tonic-clonic seizure
with right lower leg pain.
208
00:07:20,335 --> 00:07:22,462
She hit it on the coffee table.
209
00:07:24,131 --> 00:07:25,923
Initially nonverbal, now coming around.
210
00:07:25,924 --> 00:07:27,425
That's normal after a seizure.
211
00:07:27,426 --> 00:07:29,010
- Hi, I'm Dr. Al-Hashimi.
- Do you need a hand?
212
00:07:29,011 --> 00:07:30,803
- Nope, we got it.
- She hit her head?
213
00:07:30,804 --> 00:07:31,971
No. I was there.
214
00:07:31,972 --> 00:07:33,598
- I caught her.
- No IV?
215
00:07:33,599 --> 00:07:34,891
Couldn't get one in.
216
00:07:34,892 --> 00:07:36,392
Gave her four of IM versed
for the seizure,
217
00:07:36,393 --> 00:07:37,935
- 25 of fent for the pain.
- OK.
218
00:07:37,936 --> 00:07:39,812
- Dana, where to?
- Trauma One.
219
00:07:39,813 --> 00:07:41,063
This way.
220
00:07:41,064 --> 00:07:43,399
Haven't seen you guys in a hot minute.
221
00:07:43,400 --> 00:07:45,985
Pickup from SCI Jones Forge.
222
00:07:45,986 --> 00:07:47,487
Was supposed to go to Westbridge but got
223
00:07:47,488 --> 00:07:48,488
diverted to you.
224
00:07:48,489 --> 00:07:49,906
Yeah, you and everybody else.
225
00:07:49,907 --> 00:07:51,491
Princess, I need you pivot to Central 9.
226
00:07:51,492 --> 00:07:52,825
Got it.
227
00:07:52,826 --> 00:07:54,494
Gus Varney, 54, victim of assault
228
00:07:54,495 --> 00:07:55,870
with diffuse blunt trauma.
229
00:07:55,871 --> 00:07:57,872
He's got bruising to the face,
the right chest,
230
00:07:57,873 --> 00:07:59,540
10-centimeter laceration
to the left arm.
231
00:07:59,541 --> 00:08:01,125
BP's 136 over 84, pulse 102,
232
00:08:01,126 --> 00:08:03,878
good sats, 95 on room air.
233
00:08:03,879 --> 00:08:05,588
How you feeling there, Mr. Varney?
234
00:08:05,589 --> 00:08:07,089
- Fucking hurts.
- Where?
235
00:08:07,090 --> 00:08:09,425
- Everywhere.
- I am Dr. Robby.
236
00:08:09,426 --> 00:08:10,718
This is Dr. Al-Hashimi.
237
00:08:10,719 --> 00:08:12,178
We'll get you something for the pain.
238
00:08:12,179 --> 00:08:13,721
I've got a progressing
cellulitis in Trauma Two.
239
00:08:13,722 --> 00:08:15,348
- Go. I'm good.
- Thank you.
240
00:08:15,349 --> 00:08:17,391
Gus, do you know who hurt you?
241
00:08:17,392 --> 00:08:20,061
One of the fine, upstanding
citizens of cell block 6.
242
00:08:20,062 --> 00:08:23,022
It's a deep lac
through the muscle fascia.
243
00:08:23,023 --> 00:08:24,524
Can we get the cuffs off
once he settles?
244
00:08:24,525 --> 00:08:25,691
Not a chance.
245
00:08:25,692 --> 00:08:27,652
Orange jumpsuit.
He's cuffed for a reason.
246
00:08:27,653 --> 00:08:29,738
Let's go.
247
00:08:40,082 --> 00:08:43,626
OK, everyone, on my count.
248
00:08:43,627 --> 00:08:45,253
1, 2...
249
00:08:45,254 --> 00:08:46,755
Hold on.
250
00:08:50,342 --> 00:08:53,928
- Go.
- 1, 2, 3.
251
00:08:53,929 --> 00:08:55,429
Mel, E-FAST.
252
00:08:55,430 --> 00:08:57,014
Whitaker, primary assessment.
253
00:08:57,015 --> 00:08:58,267
On it.
254
00:09:03,397 --> 00:09:04,564
Oh, weird bruise.
255
00:09:04,565 --> 00:09:05,898
Did he fall on something?
256
00:09:05,899 --> 00:09:07,400
Footprint, got stomped.
257
00:09:07,401 --> 00:09:09,319
Jesus.
258
00:09:10,571 --> 00:09:12,280
Is it... is that necessary?
259
00:09:12,281 --> 00:09:14,448
Afraid so.
260
00:09:14,449 --> 00:09:17,076
Airway's patent.
261
00:09:17,077 --> 00:09:19,829
Good lung sliding on the left.
262
00:09:19,830 --> 00:09:21,080
Sorry.
263
00:09:21,081 --> 00:09:22,331
Good on the right, too.
264
00:09:22,332 --> 00:09:23,749
How are the lungs?
265
00:09:23,750 --> 00:09:24,834
Good breath sounds.
266
00:09:24,835 --> 00:09:27,587
- No crepitus.
- No effusion.
267
00:09:27,588 --> 00:09:30,881
Pulse ox 97, BP 118 over 78,
heart rate 112.
268
00:09:30,882 --> 00:09:32,258
Tachycardic from the pain.
269
00:09:32,259 --> 00:09:33,801
Start with four of morphine. Repeat prn.
270
00:09:33,802 --> 00:09:34,802
On it.
271
00:09:34,803 --> 00:09:36,929
OK. Swollen mandible.
272
00:09:36,930 --> 00:09:38,347
Open your mouth for me, Gus.
273
00:09:38,348 --> 00:09:40,182
Little wider.
274
00:09:40,183 --> 00:09:41,434
Can't.
275
00:09:41,435 --> 00:09:42,810
Whitaker, you know
the tongue blade exam?
276
00:09:42,811 --> 00:09:44,270
Yeah.
277
00:09:44,271 --> 00:09:45,730
It's a great test for mandible fracture.
278
00:09:45,731 --> 00:09:48,941
Gus, bite down hard on this for me.
279
00:09:51,153 --> 00:09:52,528
Sorry, Gus.
280
00:09:52,529 --> 00:09:54,655
Positive test.
281
00:09:54,656 --> 00:09:56,198
No free fluid in the belly.
282
00:09:56,199 --> 00:09:57,199
Any idea how long this will take?
283
00:09:57,200 --> 00:09:58,576
Too soon to tell.
284
00:09:58,577 --> 00:09:59,660
Whitaker, your assessment?
285
00:09:59,661 --> 00:10:01,120
Fractured left mandible,
286
00:10:01,121 --> 00:10:03,289
multiple rib fractures.
287
00:10:03,290 --> 00:10:04,790
Complex forearm lac.
288
00:10:04,791 --> 00:10:06,792
OK, log roll to the left, then pan scan.
289
00:10:06,793 --> 00:10:08,711
Where were you when
Mr. Varney got assaulted?
290
00:10:08,712 --> 00:10:10,296
I just move 'em.
I don't get to know 'em.
291
00:10:10,297 --> 00:10:12,048
CT's ready for us.
292
00:10:12,049 --> 00:10:13,883
Cycling the BP.
293
00:10:13,884 --> 00:10:16,552
OK, this redness is now
a centimeter over that line,
294
00:10:16,553 --> 00:10:18,054
and this might be a bulla forming.
295
00:10:18,055 --> 00:10:19,347
The vanco takes a little time to work.
296
00:10:19,348 --> 00:10:22,892
Vital signs are still stable,
122 over 78.
297
00:10:22,893 --> 00:10:23,976
I got it.
298
00:10:23,977 --> 00:10:26,979
How are you feeling, Debbie?
299
00:10:26,980 --> 00:10:28,648
I'm feeling a little warm.
300
00:10:28,649 --> 00:10:30,066
That can happen with vanco.
301
00:10:30,067 --> 00:10:32,026
Thanks, man.
302
00:10:32,027 --> 00:10:35,071
Lactic acid 4.2.
303
00:10:35,072 --> 00:10:36,864
- OK.
- What's wrong?
304
00:10:36,865 --> 00:10:39,575
That can be a sign
of a more serious infection,
305
00:10:39,576 --> 00:10:41,202
but the good news is,
we know what to do.
306
00:10:41,203 --> 00:10:44,914
Jesse, 2 liters of LR wide open.
307
00:10:44,915 --> 00:10:46,374
This is severe sepsis.
308
00:10:46,375 --> 00:10:48,000
I know, but at 7:00 AM,
it was a simple cellulitis.
309
00:10:48,001 --> 00:10:49,627
Anyone would have given her Keflex.
310
00:10:49,628 --> 00:10:51,629
We could add carbapenem
or Zosyn to broaden
311
00:10:51,630 --> 00:10:52,672
our antibiotic coverage.
312
00:10:52,673 --> 00:10:53,839
OK, I got it.
313
00:10:53,840 --> 00:10:55,257
Thanks.
314
00:10:55,258 --> 00:10:58,260
Jesse, 1 gram meropenem,
900 milligrams clinda,
315
00:10:58,261 --> 00:11:00,304
and page Dr. Garcia, please.
316
00:11:00,305 --> 00:11:01,722
What's going on?
317
00:11:01,723 --> 00:11:03,182
We're adding new antibiotics.
318
00:11:03,183 --> 00:11:04,600
It's serious?
319
00:11:04,601 --> 00:11:05,851
We wanna get ahead of it and make sure
320
00:11:05,852 --> 00:11:07,646
it doesn't become serious.
321
00:11:09,272 --> 00:11:10,356
What else can I do?
322
00:11:10,357 --> 00:11:11,524
I think you've done enough.
323
00:11:11,525 --> 00:11:12,693
You can go.
324
00:11:16,405 --> 00:11:17,405
All good in there?
325
00:11:17,406 --> 00:11:18,531
Code sepsis.
326
00:11:18,532 --> 00:11:19,865
Stable for the moment.
327
00:11:19,866 --> 00:11:21,200
How about you?
328
00:11:21,201 --> 00:11:23,536
Perfect vitals,
E-FAST negative, off to CT.
329
00:11:23,537 --> 00:11:24,745
Good.
330
00:11:24,746 --> 00:11:26,372
Keep me posted.
331
00:11:26,373 --> 00:11:27,666
Ditto.
332
00:11:31,253 --> 00:11:32,712
How's it going?
333
00:11:32,713 --> 00:11:34,672
Great, if you ignore
the hot mess in chairs.
334
00:11:34,673 --> 00:11:36,590
Any update on our little baby Jane Doe?
335
00:11:36,591 --> 00:11:38,592
Security's reviewing
the CCTV from last night
336
00:11:38,593 --> 00:11:39,845
and this morning.
337
00:11:42,180 --> 00:11:43,639
You two kiss and make up yet?
338
00:11:43,640 --> 00:11:45,224
I think someone needs
to smoke a cigarette.
339
00:11:45,225 --> 00:11:46,642
I'm trying to quit.
340
00:11:46,643 --> 00:11:48,185
Why don't you quit when I'm on my trip?
341
00:11:48,186 --> 00:11:49,437
Everyone's glad to have you back.
342
00:11:49,438 --> 00:11:51,940
- Asshole.
- Well, not everyone.
343
00:11:53,400 --> 00:11:55,860
Hey, you want in on this betting board?
344
00:11:55,861 --> 00:11:58,821
Look, all you gotta do is
pick why Westbridge went down,
345
00:11:58,822 --> 00:12:00,448
how many of their patients
we're gonna get,
346
00:12:00,449 --> 00:12:02,074
and when they'll be back in action.
347
00:12:02,075 --> 00:12:04,827
Hey, already up to $500.
348
00:12:04,828 --> 00:12:07,163
Oh, ah, gotta pass.
349
00:12:07,164 --> 00:12:09,331
Still catching up on rehab bills.
350
00:12:09,332 --> 00:12:11,835
Respect.
351
00:12:13,420 --> 00:12:14,587
All right.
352
00:12:14,588 --> 00:12:16,255
What's the rules on me changing my bet?
353
00:12:16,256 --> 00:12:18,466
Only if you double down.
354
00:12:20,510 --> 00:12:21,928
Sinkhole.
355
00:12:24,598 --> 00:12:28,100
You watch too many movies, man.
356
00:12:28,101 --> 00:12:31,145
Considered the diagnosis
of aortic aneurysm
357
00:12:31,146 --> 00:12:33,439
or dissection, but the
point-of-care ultrasound was...
358
00:12:33,440 --> 00:12:35,983
You done want that gridlocked granny?
359
00:12:35,984 --> 00:12:37,902
Ordered an acute abdominal series
360
00:12:37,903 --> 00:12:39,153
to rule out obstruction.
361
00:12:39,154 --> 00:12:40,404
- Still waiting on the X-rays.
- Great.
362
00:12:40,405 --> 00:12:41,530
Then you're free to treat our latest
363
00:12:41,531 --> 00:12:42,740
and greatest in South 16.
364
00:12:42,741 --> 00:12:45,534
Oh, come on, D, it's like, every time
365
00:12:45,535 --> 00:12:47,119
I get a moment to chart, I barely get
366
00:12:47,120 --> 00:12:49,830
- a sentence out before I get...
- Interrupted?
367
00:12:49,831 --> 00:12:51,874
Sucks to be you,
but trust me, it sucks worse
368
00:12:51,875 --> 00:12:53,793
for the poor gal in 16.
369
00:12:53,794 --> 00:12:56,545
I'm beginning to think
you enjoy torturing me.
370
00:12:56,546 --> 00:12:58,672
Perks of the job.
371
00:12:58,673 --> 00:13:00,008
Ogilvie, let's go.
372
00:13:03,595 --> 00:13:06,348
Hold out your hand, Louie.
373
00:13:07,307 --> 00:13:08,974
A little shaky.
374
00:13:08,975 --> 00:13:09,975
No surprise.
375
00:13:09,976 --> 00:13:12,144
I've been here since 4:00 AM.
376
00:13:12,145 --> 00:13:13,521
We can get you something for that.
377
00:13:13,522 --> 00:13:14,855
Or I can take care of it myself
378
00:13:14,856 --> 00:13:16,982
if you cut me loose right now.
379
00:13:16,983 --> 00:13:19,151
Let's get Louie
50 milligrams of Librium.
380
00:13:19,152 --> 00:13:20,737
I'll put in the order.
381
00:13:22,823 --> 00:13:25,617
I will get it from the PDS.
382
00:13:29,162 --> 00:13:31,705
I'm already assigned
as Louie's treating physician.
383
00:13:31,706 --> 00:13:34,166
Just makes sense that I put it in.
384
00:13:34,167 --> 00:13:36,253
Yeah. Yeah, yeah. Of course.
385
00:13:41,341 --> 00:13:43,843
Any changes with our septic waitress?
386
00:13:43,844 --> 00:13:44,969
Not yet.
387
00:13:44,970 --> 00:13:46,053
Wait, if you have a second, I...
388
00:13:46,054 --> 00:13:47,221
I don't.
389
00:13:47,222 --> 00:13:48,639
But the point-of-care ultrasound
390
00:13:48,640 --> 00:13:50,057
was negative for both.
391
00:13:50,058 --> 00:13:52,476
I considered the diagnosis
of cauda equina syndrome.
392
00:13:52,477 --> 00:13:55,604
You writing the great American novel?
393
00:13:55,605 --> 00:13:57,565
Charting and supervising.
394
00:13:57,566 --> 00:13:58,607
It's Dana's idea.
395
00:13:58,608 --> 00:14:00,150
Who's the lucky patient?
396
00:14:00,151 --> 00:14:02,027
Unhoused woman with a bad cough.
397
00:14:02,028 --> 00:14:03,821
Ogilvie's all over it.
398
00:14:03,822 --> 00:14:05,197
OK.
399
00:14:05,198 --> 00:14:06,740
Say "eee."
400
00:14:06,741 --> 00:14:08,492
Eee.
401
00:14:08,493 --> 00:14:10,244
OK, deep breath in.
402
00:14:10,245 --> 00:14:12,204
Blow it out real hard.
403
00:14:12,205 --> 00:14:13,914
You haven't heard enough already?
404
00:14:13,915 --> 00:14:17,960
I need to check for wheezing
with forced exhalation.
405
00:14:21,131 --> 00:14:23,090
Fucking cough is killing me.
406
00:14:23,091 --> 00:14:24,717
You smoke, Mrs. Yardley?
407
00:14:24,718 --> 00:14:26,886
Yeah, but I haven't been able to
408
00:14:26,887 --> 00:14:28,304
for a couple days 'cause of this cough.
409
00:14:28,305 --> 00:14:30,556
Mm. You ever consider quitting?
410
00:14:30,557 --> 00:14:34,019
You ever considered
minding your own business?
411
00:14:37,898 --> 00:14:40,149
Well, the good news
is that your test from earlier
412
00:14:40,150 --> 00:14:42,359
came back negative for both
COVID and influenza,
413
00:14:42,360 --> 00:14:44,028
but I'm gonna order a chest X-ray
414
00:14:44,029 --> 00:14:45,571
so that we can see what's
really going on in those lungs.
415
00:14:45,572 --> 00:14:47,532
You got time to let us do that?
416
00:14:48,783 --> 00:14:51,744
Where the fuck else
you think I gotta be?
417
00:14:51,745 --> 00:14:53,537
And we're in.
418
00:14:53,538 --> 00:14:55,205
3 grams Keppra over 10 minutes.
419
00:14:55,206 --> 00:14:56,916
That'll prevent another seizure.
420
00:14:56,917 --> 00:14:58,000
Thank you.
421
00:14:58,001 --> 00:14:59,919
Nobody can ever get an IV in her.
422
00:14:59,920 --> 00:15:01,879
Yeah, midline cath is the way to go
423
00:15:01,880 --> 00:15:03,505
when your veins are shot.
424
00:15:03,506 --> 00:15:08,093
Tachy to 114, BP 94 over 70,
sat 91 on 2 liters.
425
00:15:08,094 --> 00:15:10,804
- OK.
- Cold.
426
00:15:10,805 --> 00:15:14,266
Is it possible to get her
a blanket and some socks?
427
00:15:14,267 --> 00:15:16,018
Can do.
428
00:15:16,019 --> 00:15:18,604
When was she diagnosed?
429
00:15:18,605 --> 00:15:20,522
Seven years ago.
430
00:15:20,523 --> 00:15:23,108
Resected a lobe.
431
00:15:23,109 --> 00:15:25,653
Four cycles of platinum chemo
gave us a couple good years,
432
00:15:25,654 --> 00:15:28,113
but then it spread to the bones.
433
00:15:28,114 --> 00:15:30,324
Has she had radiation therapy?
434
00:15:30,325 --> 00:15:32,785
Shrunk down the mets,
but they're still there.
435
00:15:32,786 --> 00:15:34,787
That's why you're at hospice at home.
436
00:15:34,788 --> 00:15:35,788
Yep.
437
00:15:35,789 --> 00:15:37,790
I'm sorry.
438
00:15:37,791 --> 00:15:39,124
Me too.
439
00:15:39,125 --> 00:15:41,669
Ah.
440
00:15:41,670 --> 00:15:42,795
Sorry.
441
00:15:42,796 --> 00:15:44,338
You have kids?
442
00:15:44,339 --> 00:15:46,799
Yeah, two boys.
443
00:15:46,800 --> 00:15:48,884
15 and 9.
444
00:15:48,885 --> 00:15:50,469
My son's 12.
445
00:15:50,470 --> 00:15:52,680
Goes fast.
446
00:15:52,681 --> 00:15:54,515
Too fast.
447
00:15:54,516 --> 00:15:59,144
Swelling and bruising
over the distal tibia.
448
00:15:59,145 --> 00:16:01,772
50 of fentanyl
once her systolic's over 100.
449
00:16:01,773 --> 00:16:04,359
What do you usually take for pain?
450
00:16:07,320 --> 00:16:10,531
MS Contin, 30 milligrams twice a day,
451
00:16:10,532 --> 00:16:12,950
oxycodone for breakthrough,
and sublingual Actiq
452
00:16:12,951 --> 00:16:16,745
for when it gets really bad.
453
00:16:16,746 --> 00:16:17,913
That's a lot.
454
00:16:17,914 --> 00:16:19,707
You handle her pain meds?
455
00:16:19,708 --> 00:16:20,833
Sometimes.
456
00:16:20,834 --> 00:16:22,668
All the time.
457
00:16:22,669 --> 00:16:25,546
A hospice nurse comes by
a few times a week,
458
00:16:25,547 --> 00:16:27,923
but I was alone
when she had the seizure.
459
00:16:27,924 --> 00:16:29,883
They told us that it could happen,
460
00:16:29,884 --> 00:16:31,510
but she couldn't breathe.
461
00:16:31,511 --> 00:16:35,931
And I freaked out, and I called 911.
462
00:16:35,932 --> 00:16:38,225
I'm so sorry.
463
00:16:38,226 --> 00:16:40,185
I'm sorry.
464
00:16:40,186 --> 00:16:42,022
I'm sorry.
465
00:16:51,656 --> 00:16:54,825
Due to your family income,
you make too much
466
00:16:54,826 --> 00:16:56,702
to be eligible for either PENNIE
467
00:16:56,703 --> 00:16:59,121
or the hospital's "charity care."
468
00:16:59,122 --> 00:17:01,248
But we can't afford
health-care premiums.
469
00:17:01,249 --> 00:17:04,043
It's unfortunately
very common for people
470
00:17:04,044 --> 00:17:05,335
to fall between the cracks.
471
00:17:05,336 --> 00:17:07,463
It's an imperfect system.
472
00:17:07,464 --> 00:17:09,631
Can PTMC help with the costs in any way?
473
00:17:09,632 --> 00:17:12,092
We can offer financial assistance.
474
00:17:12,093 --> 00:17:13,927
You'd pay the same that Medicare
475
00:17:13,928 --> 00:17:15,554
and Medicaid would pay.
476
00:17:15,555 --> 00:17:16,722
How much is that?
477
00:17:16,723 --> 00:17:20,601
You pay 60%, we cover 40%.
478
00:17:20,602 --> 00:17:21,977
Thank you.
479
00:17:21,978 --> 00:17:23,855
Uh-huh.
480
00:17:25,065 --> 00:17:27,107
Where have you been?
481
00:17:27,108 --> 00:17:29,610
- How are you doing?
- I'm sorry, mijita.
482
00:17:29,611 --> 00:17:32,738
You were being thoughtful,
and I just blew up.
483
00:17:32,739 --> 00:17:35,616
Well, Ms. Noelle was just
telling us that the hospital
484
00:17:35,617 --> 00:17:37,326
is gonna give us a big discount.
485
00:17:37,327 --> 00:17:39,995
We can knock 40% off your final bill.
486
00:17:39,996 --> 00:17:41,955
- That's great.
- Mm-hmm.
487
00:17:41,956 --> 00:17:43,832
I stay here for a few days,
488
00:17:43,833 --> 00:17:46,086
my bill could be over $100,000, right?
489
00:17:47,754 --> 00:17:49,505
Yes, unfortunately.
490
00:17:49,506 --> 00:17:51,590
It could end up being lower,
491
00:17:51,591 --> 00:17:54,009
depending on your level of needed care.
492
00:17:54,010 --> 00:17:56,011
Or higher?
493
00:17:56,012 --> 00:17:59,973
So we would still have to pay $60,000?
494
00:17:59,974 --> 00:18:01,517
Which we don't have.
495
00:18:01,518 --> 00:18:03,727
He has to stay here
to get better, right?
496
00:18:03,728 --> 00:18:06,105
- Yes.
- No.
497
00:18:06,106 --> 00:18:07,356
Excuse me?
498
00:18:07,357 --> 00:18:09,566
I mean, not necessarily.
499
00:18:09,567 --> 00:18:12,236
Couldn't we just admit him
to med-surg instead of ICU?
500
00:18:12,237 --> 00:18:14,071
Wouldn't that be a lot cheaper?
501
00:18:14,072 --> 00:18:16,198
Med-surg won't accept him
with an insulin drip.
502
00:18:16,199 --> 00:18:17,991
Usually true.
503
00:18:17,992 --> 00:18:21,662
But let me talk to the charge
nurse upstairs, and I'll...
504
00:18:21,663 --> 00:18:22,830
I'll see what she says.
505
00:18:22,831 --> 00:18:24,332
Thank you.
506
00:18:26,292 --> 00:18:28,335
Food poisoning in the hall's
asking to leave,
507
00:18:28,336 --> 00:18:30,379
wants to take her kids
to the water park.
508
00:18:30,380 --> 00:18:32,965
Those places are cesspools.
509
00:18:32,966 --> 00:18:34,466
Preaching to the choir.
510
00:18:34,467 --> 00:18:36,051
If she's feeling fine
on Zofran, she's good to go.
511
00:18:36,052 --> 00:18:37,511
All right.
512
00:18:37,512 --> 00:18:39,471
Louie's in South 15.
Meds are coming down.
513
00:18:39,472 --> 00:18:41,473
Another couple hours of
monitoring, and he can broom.
514
00:18:41,474 --> 00:18:42,724
Straight to the liquor store.
515
00:18:42,725 --> 00:18:43,851
Don't pass "go."
516
00:18:43,852 --> 00:18:44,852
What about that clamshell case
517
00:18:44,853 --> 00:18:46,311
that went up... anything?
518
00:18:46,312 --> 00:18:48,313
Out of surgery,
in recovery, still sedated.
519
00:18:48,314 --> 00:18:50,190
Good. Keep me posted on that.
520
00:18:50,191 --> 00:18:51,568
Will do.
521
00:18:53,736 --> 00:18:55,070
Three times in one day.
522
00:18:55,071 --> 00:18:56,655
To what do we owe the pleasure?
523
00:18:56,656 --> 00:18:58,365
I came down for a consult
524
00:18:58,366 --> 00:19:00,784
and to persuade Ahmad
to start a new betting board.
525
00:19:00,785 --> 00:19:02,369
Why, is the Westbridge board
full already?
526
00:19:02,370 --> 00:19:04,413
Mm-hmm, was gonna ask him
to start one about you
527
00:19:04,414 --> 00:19:06,707
and your midlife crisis trip.
528
00:19:06,708 --> 00:19:08,709
I give it four weeks.
529
00:19:08,710 --> 00:19:11,253
Seven, tops.
530
00:19:11,254 --> 00:19:12,504
Ye of little faith.
531
00:19:12,505 --> 00:19:15,257
Not about faith, just facts.
532
00:19:15,258 --> 00:19:16,550
Facts?
533
00:19:16,551 --> 00:19:18,468
Based on my experience,
you're a seven-week-itch
534
00:19:18,469 --> 00:19:19,928
kind of guy.
535
00:19:19,929 --> 00:19:22,181
Hey, Robby, med student's
got a pickleball player
536
00:19:22,182 --> 00:19:24,099
in the North Hall
with possible Achilles rupture,
537
00:19:24,100 --> 00:19:25,100
asking for your opinion.
538
00:19:25,101 --> 00:19:26,685
Thank you, Perlah.
539
00:19:26,686 --> 00:19:28,854
At least somebody down here
has a little faith in me.
540
00:19:31,441 --> 00:19:34,193
You know what Motorcycle Mike's
sabbatical is really about?
541
00:19:34,194 --> 00:19:37,029
I never try to guess what's
going on in that head of his.
542
00:19:37,030 --> 00:19:40,240
Three months being
on the open road by himself.
543
00:19:40,241 --> 00:19:42,409
Man can't stand to be alone
for more than a few hours.
544
00:19:42,410 --> 00:19:45,454
He sleeps with the TV on in his bedroom.
545
00:19:45,455 --> 00:19:48,291
I really don't think
I needed to know that.
546
00:19:49,709 --> 00:19:52,878
Look, maybe he's looking
for something new
547
00:19:52,879 --> 00:19:55,797
or trying to outrun some old ghosts.
548
00:19:55,798 --> 00:19:59,092
Well, I hope he finds
what he's looking for.
549
00:19:59,093 --> 00:20:01,261
Man deserves some peace.
550
00:20:01,262 --> 00:20:02,638
Amen.
551
00:20:02,639 --> 00:20:05,307
I considered the diagnosis
of cauda equina syndrome,
552
00:20:05,308 --> 00:20:07,142
but the motor and sensory exam
553
00:20:07,143 --> 00:20:09,519
were both intact
in the sacral nerve root...
554
00:20:09,520 --> 00:20:10,854
Our unhoused cougher has pneumonia.
555
00:20:10,855 --> 00:20:13,732
I'm cursed, fucking cursed.
556
00:20:13,733 --> 00:20:15,234
Fuck.
557
00:20:15,235 --> 00:20:16,985
What?
558
00:20:16,986 --> 00:20:19,404
That is a cavitary lesion
in the right upper lobe.
559
00:20:19,405 --> 00:20:21,198
Active TB.
560
00:20:21,199 --> 00:20:23,575
What's next?
561
00:20:23,576 --> 00:20:25,118
AFB stain to confirm,
562
00:20:25,119 --> 00:20:27,663
move her to a negative airflow
room, start her on meds.
563
00:20:27,664 --> 00:20:29,790
Call infection control
and public health.
564
00:20:29,791 --> 00:20:32,084
And now you get to sign in as a patient
565
00:20:32,085 --> 00:20:34,586
and get your blood drawn
for a QuantiFERON Gold.
566
00:20:34,587 --> 00:20:36,588
It's too soon to be positive.
567
00:20:36,589 --> 00:20:37,756
Yeah, but you were exposed.
568
00:20:37,757 --> 00:20:39,341
You need a baseline test
569
00:20:39,342 --> 00:20:42,594
and then again in eight weeks
to see if you convert.
570
00:20:42,595 --> 00:20:43,929
And if I do?
571
00:20:43,930 --> 00:20:46,014
Then meds every day
for three or four months
572
00:20:46,015 --> 00:20:48,934
with regular blood tests
to check for toxicity.
573
00:20:48,935 --> 00:20:50,269
- Jesus.
- All right.
574
00:20:50,270 --> 00:20:51,770
Let Dana know what's up.
575
00:20:51,771 --> 00:20:54,815
And for the love of God,
mask up when you move her.
576
00:21:03,283 --> 00:21:05,492
- Dr. Langdon.
- Hey, man. Alex.
577
00:21:05,493 --> 00:21:06,661
Let's take a look.
578
00:21:09,247 --> 00:21:12,207
Ah.
579
00:21:12,208 --> 00:21:13,208
Is it bad?
580
00:21:13,209 --> 00:21:14,751
It's not good.
581
00:21:14,752 --> 00:21:17,379
Sorry, your chart says
you were burned with dry ice?
582
00:21:17,380 --> 00:21:19,423
- What happened?
- My jack-off brother.
583
00:21:19,424 --> 00:21:21,008
Does he not like you?
584
00:21:21,009 --> 00:21:24,636
I asked him to do it,
just not like this exactly.
585
00:21:24,637 --> 00:21:26,221
What? Why?
586
00:21:26,222 --> 00:21:27,889
He was gonna brand me
like I branded him.
587
00:21:27,890 --> 00:21:29,725
Branded? Like cattle?
588
00:21:29,726 --> 00:21:32,853
Instead of hot branding,
you stick the iron in dry ice,
589
00:21:32,854 --> 00:21:35,814
let it get super cold, and then
you put it on your skin.
590
00:21:35,815 --> 00:21:37,482
Cool, huh?
591
00:21:38,693 --> 00:21:39,985
Let's get some LET on this.
592
00:21:39,986 --> 00:21:41,696
I'll get some snips to debride.
593
00:21:44,157 --> 00:21:45,824
You good?
594
00:21:45,825 --> 00:21:48,160
Yeah. Yeah, good.
595
00:21:48,161 --> 00:21:49,578
You sure?
596
00:21:49,579 --> 00:21:52,664
Doesn't seem like Robby's
all that happy I'm back.
597
00:21:52,665 --> 00:21:55,334
Well, he's not going to be here,
598
00:21:55,335 --> 00:21:57,085
and I'm happy you're back.
599
00:21:57,086 --> 00:21:59,005
Thanks.
600
00:22:03,343 --> 00:22:07,513
Head and neck CT is negative,
except for mandible fracture.
601
00:22:08,431 --> 00:22:09,806
OK, let's get him off the board.
602
00:22:09,807 --> 00:22:11,099
Roll him, right side up.
603
00:22:11,100 --> 00:22:12,852
Hey, we're gonna need the cuffs off.
604
00:22:15,855 --> 00:22:18,690
Ready. And 1, 2, 3.
605
00:22:18,691 --> 00:22:21,068
Ah, gentle.
606
00:22:21,069 --> 00:22:22,736
Dr. King, how are the chest and belly?
607
00:22:22,737 --> 00:22:25,989
We have three anterior rib fractures
608
00:22:25,990 --> 00:22:27,908
and a small pulmonary contusion.
609
00:22:27,909 --> 00:22:29,201
- Not too bad.
- Mm-mm.
610
00:22:29,202 --> 00:22:30,869
When do pulmonary contusions peak?
611
00:22:30,870 --> 00:22:32,287
After a few hours.
612
00:22:32,288 --> 00:22:33,872
And do we always admit
for three-rib fractures?
613
00:22:33,873 --> 00:22:35,207
In the elderly, yes,
614
00:22:35,208 --> 00:22:36,958
but not if a patient can manage the pain
615
00:22:36,959 --> 00:22:38,960
and doesn't need supplemental oxygen.
616
00:22:40,213 --> 00:22:41,713
OK, he's really hurting here.
617
00:22:41,714 --> 00:22:43,382
You think you could set us up
with a serratus anterior
618
00:22:43,383 --> 00:22:44,591
- field block?
- No problem.
619
00:22:44,592 --> 00:22:46,718
Oh, as long as that's OK
620
00:22:46,719 --> 00:22:47,886
with Dr. Al-Hashimi.
621
00:22:47,887 --> 00:22:50,055
If the patient consents.
622
00:22:50,056 --> 00:22:53,892
Mr. Varney, we wanna give you
a shot to numb your broken ribs
623
00:22:53,893 --> 00:22:55,060
so you can breathe easier.
624
00:22:55,061 --> 00:22:56,311
Uh-huh.
625
00:22:56,312 --> 00:22:57,979
OK, get Mr. Varney prepped and draped.
626
00:22:57,980 --> 00:22:59,564
Dr. Mohan, you're in charge.
627
00:22:59,565 --> 00:23:01,400
Let's identify the landmarks.
628
00:23:01,401 --> 00:23:02,527
Cuffs.
629
00:23:03,861 --> 00:23:05,529
Yeah, you can just leave them off, man.
630
00:23:05,530 --> 00:23:08,448
He's clearly not moving on his own.
631
00:23:08,449 --> 00:23:10,033
We follow protocol,
632
00:23:10,034 --> 00:23:13,412
for his safety and yours.
633
00:23:15,123 --> 00:23:16,790
Do you need to get that?
634
00:23:16,791 --> 00:23:19,626
Nope. It's my mom.
635
00:23:19,627 --> 00:23:21,878
Ignore it. Just ignore it.
636
00:23:21,879 --> 00:23:23,713
- Amen, sister.
- Forearm is numb.
637
00:23:23,714 --> 00:23:25,006
We can irrigate.
638
00:23:25,007 --> 00:23:26,591
If I ignore a problem for long enough,
639
00:23:26,592 --> 00:23:28,218
it just goes away, right?
640
00:23:28,219 --> 00:23:30,470
I wish I could ignore my deposition.
641
00:23:30,471 --> 00:23:32,764
That, you can't ignore.
642
00:23:32,765 --> 00:23:33,974
But you'll be fine.
643
00:23:33,975 --> 00:23:35,517
What's up with you, Whitaker?
644
00:23:35,518 --> 00:23:37,018
Trouble in roomie land?
645
00:23:37,019 --> 00:23:38,603
No, not really.
646
00:23:38,604 --> 00:23:41,857
I think I overstepped
with Dr. Langdon earlier.
647
00:23:41,858 --> 00:23:43,108
Oh.
648
00:23:43,109 --> 00:23:45,777
He was trying to prescribe
a patient benzos,
649
00:23:45,778 --> 00:23:48,655
and I told Langdon that
it'd be better if I did it.
650
00:23:48,656 --> 00:23:50,115
Oof.
651
00:23:50,116 --> 00:23:52,492
Only because I was already
the assigned physician.
652
00:23:52,493 --> 00:23:54,327
But yeah, now I feel like an asshole.
653
00:23:54,328 --> 00:23:55,620
Langdon's fine.
654
00:23:55,621 --> 00:23:57,956
He went to rehab,
he's working the steps,
655
00:23:57,957 --> 00:24:02,502
and hopefully it's all behind him.
656
00:24:02,503 --> 00:24:04,212
Place the needle in-plane,
657
00:24:04,213 --> 00:24:06,089
superficial to the serratus anterior,
658
00:24:06,090 --> 00:24:08,341
between it and the latissimus dorsi.
659
00:24:08,342 --> 00:24:09,676
Mm-hmm.
660
00:24:09,677 --> 00:24:11,845
You can see the fluid
dissect and diffuse...
661
00:24:11,846 --> 00:24:13,180
Dr. Mohan, we need you.
662
00:24:13,181 --> 00:24:14,806
We've got two more rigs from Westbridge
663
00:24:14,807 --> 00:24:17,017
pulling up right now.
664
00:24:17,018 --> 00:24:18,518
Go. We got this.
665
00:24:18,519 --> 00:24:19,519
Thanks.
666
00:24:19,520 --> 00:24:22,022
How we doing in here?
667
00:24:22,023 --> 00:24:25,650
Spiked a temp to 102, gave Tylenol.
668
00:24:25,651 --> 00:24:27,402
Check out her leg.
669
00:24:27,403 --> 00:24:29,321
That is a definite bulla.
670
00:24:29,322 --> 00:24:30,780
Did surgery come down yet?
671
00:24:30,781 --> 00:24:32,532
- Not yet.
- I need surgery?
672
00:24:32,533 --> 00:24:33,658
Page them again.
673
00:24:33,659 --> 00:24:35,410
Surgery would be a last resort.
674
00:24:35,411 --> 00:24:37,746
We would like them to come down
and check out your leg
675
00:24:37,747 --> 00:24:40,332
in case we need to remove
this infected skin.
676
00:24:40,333 --> 00:24:41,833
I thought it was just a little swelling
677
00:24:41,834 --> 00:24:43,034
'cause I'm on my feet all day.
678
00:24:44,754 --> 00:24:46,671
BP's down to 85 over 40.
679
00:24:46,672 --> 00:24:48,340
- How much LR is in?
- Full bolus.
680
00:24:48,341 --> 00:24:50,008
Do another liter
and then start Levophed.
681
00:24:50,009 --> 00:24:51,510
Titrate to a MAP of 65.
682
00:24:52,762 --> 00:24:54,346
Can someone please
tell me what's going on?
683
00:24:54,347 --> 00:24:55,388
Pulse ox down to 89.
684
00:24:55,389 --> 00:24:56,890
100% non-rebreather.
685
00:24:56,891 --> 00:24:59,935
Sometimes an infection
can cause your blood pressure
686
00:24:59,936 --> 00:25:02,854
to drop and lower the amount
of oxygen in your blood.
687
00:25:02,855 --> 00:25:04,022
Am I gonna be OK?
688
00:25:04,023 --> 00:25:05,232
We're doing everything that we can
689
00:25:05,233 --> 00:25:06,525
to make sure that you are.
690
00:25:06,526 --> 00:25:07,777
Jesse.
691
00:25:10,154 --> 00:25:11,530
What's up?
692
00:25:11,531 --> 00:25:12,864
Be ready to intubate if you need to.
693
00:25:12,865 --> 00:25:14,366
- You want me to call Langdon?
- No.
694
00:25:14,367 --> 00:25:15,951
I will be right back,
and you can call surgery
695
00:25:15,952 --> 00:25:17,661
and tell them to get
their heads out of their asses
696
00:25:17,662 --> 00:25:19,288
and get down here.
697
00:25:27,797 --> 00:25:29,214
Did you bring Langdon back here?
698
00:25:29,215 --> 00:25:30,966
No, Al-Hashimi did.
699
00:25:30,967 --> 00:25:32,342
You banished him to scut purgatory.
700
00:25:32,343 --> 00:25:33,510
He did everything you would've done
701
00:25:33,511 --> 00:25:35,136
with that cellulitis patient.
702
00:25:35,137 --> 00:25:36,638
If you think he missed
something, tell him.
703
00:25:36,639 --> 00:25:38,223
Well, we're probably
gonna need to intubate.
704
00:25:38,224 --> 00:25:39,808
We're definitely gonna need an ICU bed.
705
00:25:39,809 --> 00:25:41,059
What happened?
706
00:25:41,060 --> 00:25:43,228
She is in septic shock, on pressors.
707
00:25:43,229 --> 00:25:45,063
Open shoulder dislocation is back.
708
00:25:45,064 --> 00:25:46,898
Westbridge shut down
all their ORs, so they told us
709
00:25:46,899 --> 00:25:48,733
- to bring them back here.
- You joking?
710
00:25:48,734 --> 00:25:49,734
This ain't the Radisson.
711
00:25:49,735 --> 00:25:50,902
Not my problem.
712
00:25:50,903 --> 00:25:52,445
- Where should we park him?
- Grab a wall.
713
00:25:52,446 --> 00:25:53,905
Call Noelle. Call ortho.
714
00:25:53,906 --> 00:25:55,156
Call the OR and tell them
we got a patient back
715
00:25:55,157 --> 00:25:56,741
that needs surgery and admission.
716
00:25:56,742 --> 00:25:58,743
Hey, so sorry about this ambulance tour
717
00:25:58,744 --> 00:26:00,745
of Allegheny County, Mr. Billings,
718
00:26:00,746 --> 00:26:02,330
but we got you from here, I promise.
719
00:26:02,331 --> 00:26:03,748
Yeah, I'm starving.
720
00:26:03,749 --> 00:26:05,250
Is there any way I can
get something to eat?
721
00:26:05,251 --> 00:26:07,043
Sorry, not before surgery.
722
00:26:07,044 --> 00:26:08,295
Can I have a visitor?
723
00:26:08,296 --> 00:26:09,796
Sure.
724
00:26:09,797 --> 00:26:11,590
Any word from Gloria about
what's going on at Westbridge?
725
00:26:11,591 --> 00:26:13,216
Radio silence from the ivory tower.
726
00:26:13,217 --> 00:26:14,884
And the charge nurse
over there isn't responding.
727
00:26:14,885 --> 00:26:16,511
Must be bad.
728
00:26:16,512 --> 00:26:17,887
I wonder if it's something that
security needs to know about.
729
00:26:17,888 --> 00:26:19,389
I'll keep you posted.
730
00:26:19,390 --> 00:26:21,182
Hey, you're kind of buds with Gloria.
731
00:26:21,183 --> 00:26:22,475
Did she say anything to you about what's
732
00:26:22,476 --> 00:26:24,227
- happening at Westbridge?
- No. You?
733
00:26:24,228 --> 00:26:26,771
Nope. How are your patients?
734
00:26:26,772 --> 00:26:29,190
Our prisoner, Gus, has stable injuries,
735
00:26:29,191 --> 00:26:31,401
and our law student
in Central 10 is awake,
736
00:26:31,402 --> 00:26:33,612
normal LP, and awaiting a psych consult.
737
00:26:33,613 --> 00:26:34,946
Good.
738
00:26:34,947 --> 00:26:36,615
Quicker we can treat 'em,
street 'em, move 'em
739
00:26:36,616 --> 00:26:38,116
up the food chain, the better.
740
00:26:38,117 --> 00:26:40,160
Question.
741
00:26:40,161 --> 00:26:44,456
Why are you treating me
like one of your residents?
742
00:26:44,457 --> 00:26:45,624
I'm not.
743
00:26:45,625 --> 00:26:47,459
As the attending,
I like to know the status
744
00:26:47,460 --> 00:26:49,169
of all the patients
and doctors in the ED
745
00:26:49,170 --> 00:26:51,463
in case I need to jump in quickly.
746
00:26:51,464 --> 00:26:52,464
Makes sense.
747
00:26:52,465 --> 00:26:54,883
Now your turn.
748
00:26:54,884 --> 00:26:56,217
What?
749
00:26:56,218 --> 00:26:58,345
As your fellow attending in our ED,
750
00:26:58,346 --> 00:27:00,138
it only makes sense
for me to know the status
751
00:27:00,139 --> 00:27:02,223
of all the patients and all the doctors
752
00:27:02,224 --> 00:27:05,810
in case I need to jump in
on a moment's notice.
753
00:27:05,811 --> 00:27:07,271
Touché.
754
00:27:09,940 --> 00:27:12,567
You have a non-displaced
fracture, distal tibia.
755
00:27:12,568 --> 00:27:14,736
So if you look at the bone
here, it's pretty well aligned.
756
00:27:14,737 --> 00:27:16,112
Sorry. Hi.
757
00:27:16,113 --> 00:27:18,490
Hi, I was in the shower,
and I came as soon
758
00:27:18,491 --> 00:27:19,616
as I got Paul's message.
759
00:27:19,617 --> 00:27:21,242
- Lena?
- Hi.
760
00:27:21,243 --> 00:27:23,119
What happened?
761
00:27:23,120 --> 00:27:24,579
I had a seizure.
762
00:27:24,580 --> 00:27:26,206
You load her with Keppra?
763
00:27:26,207 --> 00:27:27,582
Yeah.
764
00:27:27,583 --> 00:27:29,584
Yeah, she's back
to baseline mental status.
765
00:27:29,585 --> 00:27:31,836
I'm sorry, I'm confused.
Aren't you off duty?
766
00:27:31,837 --> 00:27:35,006
- I'm Roxie's death doula.
- Oh.
767
00:27:35,007 --> 00:27:36,716
Her... her what?
768
00:27:36,717 --> 00:27:38,718
I help advocate for people like Roxie
769
00:27:38,719 --> 00:27:41,721
to make their transition to
death a more peaceful process.
770
00:27:41,722 --> 00:27:44,724
It's like a birth doula
but for the end of life.
771
00:27:44,725 --> 00:27:48,353
She's been a real lifesaver
for our family.
772
00:27:48,354 --> 00:27:51,189
My husband cracking jokes
while I'm dying.
773
00:27:51,190 --> 00:27:52,941
See why I married him?
774
00:27:52,942 --> 00:27:54,776
Whatever you have to say
about my condition,
775
00:27:54,777 --> 00:27:56,695
you can share with Lena too.
776
00:27:56,696 --> 00:27:58,697
We were just explaining that Roxie
777
00:27:58,698 --> 00:28:01,866
has a pathological fracture
through a metastatic lesion.
778
00:28:01,867 --> 00:28:03,368
Can you fix that?
779
00:28:03,369 --> 00:28:06,204
The bones are well aligned,
so she won't need surgery.
780
00:28:06,205 --> 00:28:07,706
The treatment is immobilization
781
00:28:07,707 --> 00:28:08,873
and a long leg boot.
782
00:28:08,874 --> 00:28:10,583
Oh!
783
00:28:10,584 --> 00:28:12,127
Maybe we up her pain meds.
784
00:28:12,128 --> 00:28:13,670
Yeah, sure.
785
00:28:13,671 --> 00:28:15,046
We can do that.
786
00:28:15,047 --> 00:28:17,340
The bones should heal
in about six weeks.
787
00:28:17,341 --> 00:28:19,927
If I live that long.
788
00:28:21,804 --> 00:28:22,846
Still numb here?
789
00:28:22,847 --> 00:28:24,431
Yeah, bro.
790
00:28:24,432 --> 00:28:26,766
Great.
791
00:28:26,767 --> 00:28:28,643
You think it's gonna leave a scar?
792
00:28:28,644 --> 00:28:32,689
I don't think it. I know it.
793
00:28:32,690 --> 00:28:34,482
Holy shit.
794
00:28:34,483 --> 00:28:36,025
Fuck are you doing here?
795
00:28:36,026 --> 00:28:37,026
I'm sorry, who are you?
796
00:28:37,027 --> 00:28:38,153
Concerned brother.
797
00:28:38,154 --> 00:28:40,655
That looks not too bad.
798
00:28:40,656 --> 00:28:42,031
You gooning me?
799
00:28:42,032 --> 00:28:43,658
Yeah, it's nasty.
800
00:28:43,659 --> 00:28:45,076
Thanks to you.
801
00:28:45,077 --> 00:28:46,244
You did this?
802
00:28:46,245 --> 00:28:47,645
Oh, yeah. You wanna see the video?
803
00:28:49,790 --> 00:28:51,750
- Yes.
- Definitely.
804
00:28:51,751 --> 00:28:53,169
Got you.
805
00:28:54,420 --> 00:28:56,921
All right.
All right, get in close.
806
00:28:56,922 --> 00:28:58,590
Brothers unite!
807
00:28:58,591 --> 00:29:00,258
- Ooh!
- Ooh!
808
00:29:00,259 --> 00:29:02,093
Dude, why in the world
809
00:29:02,094 --> 00:29:03,762
would you ask to have that done to you?
810
00:29:03,763 --> 00:29:07,349
He was trying to brand me
with our family crest.
811
00:29:09,685 --> 00:29:11,936
Your family crest is the Penguins logo?
812
00:29:11,937 --> 00:29:13,688
We were gonna be bonded for life.
813
00:29:13,689 --> 00:29:15,523
You already are, with DNA.
814
00:29:15,524 --> 00:29:16,691
Yeah.
815
00:29:16,692 --> 00:29:18,234
I love you, man.
816
00:29:18,235 --> 00:29:20,069
- I'm real sorry.
- It's OK.
817
00:29:20,070 --> 00:29:23,740
Doc said it's gonna take
some time, but it'll heal OK.
818
00:29:23,741 --> 00:29:25,283
Awesome.
819
00:29:25,284 --> 00:29:27,076
So maybe we can try again
in a couple of months or...
820
00:29:27,077 --> 00:29:28,537
No.
821
00:29:29,955 --> 00:29:31,665
OK, bag her.
822
00:29:33,667 --> 00:29:35,126
Yellow on the end-tidal.
823
00:29:35,127 --> 00:29:36,878
- Sorry, got backed up.
- Sounds a little wet.
824
00:29:36,879 --> 00:29:38,004
Someone asked for a surgical consult?
825
00:29:38,005 --> 00:29:39,255
That's because all the fluid.
826
00:29:39,256 --> 00:29:40,673
TKO the lines for now.
827
00:29:40,674 --> 00:29:43,009
Vent settings 50%,
tidal volume 500, AC 12?
828
00:29:43,010 --> 00:29:44,385
Yep, that's perfect.
829
00:29:44,386 --> 00:29:45,720
Surgery here. Hello.
830
00:29:45,721 --> 00:29:47,305
Hey, it's about time. Where's Garcia?
831
00:29:47,306 --> 00:29:49,140
Stuck in the ER.
She sent me down. What you got?
832
00:29:49,141 --> 00:29:50,642
Septic shock, respiratory failure,
833
00:29:50,643 --> 00:29:52,310
and possible necrotizing fasciitis.
834
00:29:52,311 --> 00:29:54,020
She needs to go to the OR ASAP.
835
00:29:54,021 --> 00:29:56,314
The infection was isolated
to the dorsum of the foot
836
00:29:56,315 --> 00:29:57,899
five hours ago, but now
we're almost to the knee
837
00:29:57,900 --> 00:29:59,567
with bullae, crepitus, and edema.
838
00:29:59,568 --> 00:30:01,236
- Yeah.
- You seen nec fasc before?
839
00:30:01,237 --> 00:30:02,487
In a textbook.
840
00:30:02,488 --> 00:30:04,656
I was a med student two weeks ago.
841
00:30:06,492 --> 00:30:09,035
- Gotta show this to Dr. Garcia.
- OK. OK. Jesus Christ.
842
00:30:09,036 --> 00:30:10,703
Go get anybody else
from your service down here...
843
00:30:10,704 --> 00:30:11,996
Shamsi, Miller, Walsh...
844
00:30:11,997 --> 00:30:13,164
I don't know any of this people, but...
845
00:30:13,165 --> 00:30:14,499
Don't take this personally.
846
00:30:14,500 --> 00:30:17,544
I just need a fucking grown-up
down here.
847
00:30:17,545 --> 00:30:19,504
Nice job on the sub-Qs.
848
00:30:19,505 --> 00:30:21,256
Really took the tension off the wound.
849
00:30:21,257 --> 00:30:22,340
Thanks.
850
00:30:22,341 --> 00:30:24,008
I can help with the skin layer.
851
00:30:24,009 --> 00:30:26,011
Four hands are faster than two.
852
00:30:28,430 --> 00:30:29,848
- Whoa.
- Whoa.
853
00:30:29,849 --> 00:30:32,183
That just tore right through the skin.
854
00:30:32,184 --> 00:30:33,518
You may need to take bigger bites
855
00:30:33,519 --> 00:30:35,228
farther away from the wound edges.
856
00:30:35,229 --> 00:30:37,564
Yep.
857
00:30:37,565 --> 00:30:40,901
Skin seems pretty fragile.
858
00:30:44,989 --> 00:30:46,447
Oh.
859
00:30:46,448 --> 00:30:48,116
Yeah, this is not working.
860
00:30:48,117 --> 00:30:50,076
He has the skin strength
of an 80-year-old.
861
00:30:50,077 --> 00:30:52,245
Put down Steri-Strips with benzoin,
862
00:30:52,246 --> 00:30:55,540
not across the wound but along
each wound edge, both sides.
863
00:30:55,541 --> 00:30:57,083
It'll hold the sutures.
864
00:30:57,084 --> 00:31:00,545
- Yup.
- What say you, Dr. Robby?
865
00:31:00,546 --> 00:31:02,547
Great. MacGyver move.
866
00:31:02,548 --> 00:31:05,425
Go for it.
867
00:31:05,426 --> 00:31:09,220
Does a Dr. MacGyver work here?
868
00:31:09,221 --> 00:31:11,723
I don't know.
869
00:31:11,724 --> 00:31:13,641
The patient symptoms
are consistent with lumbar
870
00:31:13,642 --> 00:31:17,604
radiculopathy at L4, L5, most
likely due to disc herniation.
871
00:31:17,605 --> 00:31:19,105
Coughing patient admitted to isolation
872
00:31:19,106 --> 00:31:21,065
for verified medication administration
873
00:31:21,066 --> 00:31:22,442
and started on RIPE therapy.
874
00:31:22,443 --> 00:31:23,985
Yeah, why do I even bother?
875
00:31:23,986 --> 00:31:25,028
Just fail me now.
876
00:31:25,029 --> 00:31:26,195
OK.
877
00:31:26,196 --> 00:31:27,697
Get in touch with a social worker.
878
00:31:27,698 --> 00:31:29,198
They're gonna wanna do contact tracing
879
00:31:29,199 --> 00:31:31,034
and help her figure out
transitional housing
880
00:31:31,035 --> 00:31:32,410
for when she's discharged.
881
00:31:32,411 --> 00:31:33,745
Got it.
882
00:31:33,746 --> 00:31:35,705
And make sure
infection control responded.
883
00:31:35,706 --> 00:31:37,165
The people in the waiting room
could have been exposed.
884
00:31:37,166 --> 00:31:40,501
They need to be notified and tested.
885
00:31:40,502 --> 00:31:41,753
OK.
886
00:31:41,754 --> 00:31:44,672
Relax.
887
00:31:44,673 --> 00:31:46,925
You can take the mask off.
You don't have TB.
888
00:31:46,926 --> 00:31:50,094
At least not yet.
889
00:31:50,095 --> 00:31:52,639
Oh, great.
890
00:31:52,640 --> 00:31:55,600
This is fucked up.
891
00:31:55,601 --> 00:31:57,852
How are you so calm?
892
00:31:57,853 --> 00:31:59,520
Expected job hazard.
893
00:31:59,521 --> 00:32:00,772
You get used to it.
894
00:32:00,773 --> 00:32:02,357
Yeah, no, thanks.
895
00:32:02,358 --> 00:32:04,943
70% of doctors in training
at urban hospitals
896
00:32:04,944 --> 00:32:07,278
get exposed to TB and wind up on meds.
897
00:32:07,279 --> 00:32:09,614
- Jesus.
- Mm-hmm.
898
00:32:09,615 --> 00:32:11,991
They don't teach you that in med school.
899
00:32:11,992 --> 00:32:14,160
Mrs. Randolph's back.
900
00:32:14,161 --> 00:32:16,037
Pulled up her X-ray.
901
00:32:16,038 --> 00:32:17,205
OK.
902
00:32:17,206 --> 00:32:19,332
No volvulus, no air fluid levels.
903
00:32:19,333 --> 00:32:21,918
What do you think of this?
904
00:32:21,919 --> 00:32:24,003
Fecal material?
905
00:32:24,004 --> 00:32:25,713
A shit ton.
906
00:32:25,714 --> 00:32:27,340
Sorry, had to be said.
907
00:32:27,341 --> 00:32:28,925
So, what, she needs an enema?
908
00:32:28,926 --> 00:32:30,510
No. Tried and failed, remember?
909
00:32:30,511 --> 00:32:31,511
Yeah.
910
00:32:31,512 --> 00:32:33,179
Time to dig in.
911
00:32:33,180 --> 00:32:34,806
How are we gonna do that?
912
00:32:34,807 --> 00:32:38,769
Oh, there is no "we" in disimpaction.
913
00:32:43,691 --> 00:32:45,942
I haven't done one before.
914
00:32:45,943 --> 00:32:48,903
Shouldn't I observe first?
915
00:32:48,904 --> 00:32:51,490
I know just the guy to teach you.
916
00:33:00,708 --> 00:33:03,543
I spoke to the charge nurse in med-surg.
917
00:33:03,544 --> 00:33:04,836
They can take Orlando today.
918
00:33:04,837 --> 00:33:06,671
- Yes!
- That's wonderful.
919
00:33:06,672 --> 00:33:08,214
They know he's on an insulin drip?
920
00:33:08,215 --> 00:33:10,758
They know, and they can
change to a SQUID protocol.
921
00:33:10,759 --> 00:33:11,759
SQUID?
922
00:33:11,760 --> 00:33:13,511
Sub-Q insulin in DKA.
923
00:33:13,512 --> 00:33:15,221
So no IV drip?
924
00:33:15,222 --> 00:33:18,016
Just shots of short-acting
insulin every four hours prn.
925
00:33:18,017 --> 00:33:21,436
The med-surg nurses have time
to check a glucose every hour?
926
00:33:21,437 --> 00:33:22,437
They say so.
927
00:33:22,438 --> 00:33:24,480
And five days on med-surge
928
00:33:24,481 --> 00:33:28,234
is gonna cut your hospital bill
down by 2/3.
929
00:33:28,235 --> 00:33:30,111
OK.
930
00:33:30,112 --> 00:33:31,988
So what's that gonna cost?
931
00:33:31,989 --> 00:33:33,406
Well, I can't give you an exact amount,
932
00:33:33,407 --> 00:33:35,491
but roughly $35,000.
933
00:33:35,492 --> 00:33:38,619
So after about 40%,
I'll still have to pay,
934
00:33:38,620 --> 00:33:40,455
what, like, 20 grand?
935
00:33:40,456 --> 00:33:42,707
The hospital can work out
a payment plan.
936
00:33:42,708 --> 00:33:44,417
Orlando, we'll be OK.
937
00:33:44,418 --> 00:33:45,960
We'll figure it out.
938
00:33:45,961 --> 00:33:48,421
I'll take on extra shifts
at the coffee shop.
939
00:33:48,422 --> 00:33:51,424
We got you, Dad.
940
00:33:51,425 --> 00:33:54,635
Let's give you some private
time with your family.
941
00:33:54,636 --> 00:33:57,138
Thanks.
942
00:33:57,139 --> 00:33:58,765
Sorry. Thank you.
943
00:33:58,766 --> 00:34:00,391
I was worried he might bail.
944
00:34:00,392 --> 00:34:01,601
My pleasure.
945
00:34:01,602 --> 00:34:03,311
The real thanks goes to the newbie here
946
00:34:03,312 --> 00:34:05,022
for thinking outside the box.
947
00:34:07,733 --> 00:34:09,650
Sorry I doubted your med-surg pitch.
948
00:34:09,651 --> 00:34:11,235
Oh, no sweat.
949
00:34:11,236 --> 00:34:13,446
How'd you think of that?
950
00:34:13,447 --> 00:34:16,115
My family had to think
of a lot of creative ways
951
00:34:16,116 --> 00:34:19,160
to help my uninsured grandma.
952
00:34:19,161 --> 00:34:20,745
Leukemia.
953
00:34:20,746 --> 00:34:24,082
System doesn't work for you,
you gotta work the system.
954
00:34:24,083 --> 00:34:26,292
She survive?
955
00:34:26,293 --> 00:34:28,503
For a while, till she didn't.
956
00:34:28,504 --> 00:34:30,963
She died before my freshman
year in college.
957
00:34:30,964 --> 00:34:33,299
Sorry.
958
00:34:33,300 --> 00:34:35,468
Her death taught me a lot.
959
00:34:35,469 --> 00:34:38,388
Mainly that I don't wanna
be around people dying.
960
00:34:40,224 --> 00:34:42,892
So they got her, and we
can get out of here soon?
961
00:34:42,893 --> 00:34:44,352
Yeah. Oh, I think so.
962
00:34:44,353 --> 00:34:45,770
- I think so, yeah.
- OK.
963
00:34:45,771 --> 00:34:49,023
Hi.
964
00:34:49,024 --> 00:34:51,609
Morphine PCA looks ready to go.
965
00:34:51,610 --> 00:34:53,611
This should do the trick.
966
00:34:53,612 --> 00:34:55,029
Do you notice a difference?
967
00:34:55,030 --> 00:34:56,030
Better.
968
00:34:56,031 --> 00:34:58,533
Oh, great. Great.
969
00:34:58,534 --> 00:35:00,284
How does this thing work?
970
00:35:00,285 --> 00:35:02,703
There's a baseline rate of morphine.
971
00:35:02,704 --> 00:35:04,789
And if you're having pain,
you can push this button.
972
00:35:04,790 --> 00:35:05,790
You'll get some extra.
973
00:35:05,791 --> 00:35:07,125
And you can push for another dose
974
00:35:07,126 --> 00:35:08,543
every 10 minutes if needed.
975
00:35:08,544 --> 00:35:10,754
Your very own morphine butler.
976
00:35:13,298 --> 00:35:14,465
Amazing.
977
00:35:14,466 --> 00:35:16,008
She can go home with this?
978
00:35:16,009 --> 00:35:17,552
Yeah.
979
00:35:17,553 --> 00:35:19,679
Though you'll need
more equipment for the house
980
00:35:19,680 --> 00:35:21,889
now that she can't
bear weight on her leg.
981
00:35:21,890 --> 00:35:23,808
OK. Like what?
982
00:35:23,809 --> 00:35:27,979
A wheelchair to go to
the bathroom, a shower chair,
983
00:35:27,980 --> 00:35:30,189
wall bars, if you
don't already have them.
984
00:35:30,190 --> 00:35:33,317
And a hospital bed could be helpful too.
985
00:35:33,318 --> 00:35:34,652
How do we get all that?
986
00:35:34,653 --> 00:35:36,529
You don't. I do.
987
00:35:36,530 --> 00:35:38,406
I will get everything
so that the two of you
988
00:35:38,407 --> 00:35:40,616
can get out of here
and back to the kids.
989
00:35:40,617 --> 00:35:42,744
- At home.
- Thank you.
990
00:35:49,793 --> 00:35:51,752
Nice of you to join us, Huckleberry.
991
00:35:51,753 --> 00:35:53,045
What do you need?
992
00:35:53,046 --> 00:35:54,840
Some help with a disimpaction.
993
00:35:56,675 --> 00:35:58,718
That is a med student procedure.
994
00:35:58,719 --> 00:36:00,178
Oh, you know the old adage...
995
00:36:00,179 --> 00:36:02,388
see one, do one, teach one.
996
00:36:02,389 --> 00:36:04,682
Say hello to teaching
young Ogilvie here.
997
00:36:04,683 --> 00:36:07,351
OK.
998
00:36:07,352 --> 00:36:09,437
- Double glove, Ogilvie.
- All right.
999
00:36:09,438 --> 00:36:10,938
Mrs. Randolph, we're going to need
1000
00:36:10,939 --> 00:36:13,566
to manually unblock
your rectum so that we can
1001
00:36:13,567 --> 00:36:15,067
get your bowels moving again.
1002
00:36:15,068 --> 00:36:16,068
I know.
1003
00:36:16,069 --> 00:36:18,863
Here we go.
1004
00:36:18,864 --> 00:36:21,949
Mrs. Randolph, I would like you to relax
1005
00:36:21,950 --> 00:36:24,869
like you're having a bowel movement.
1006
00:36:24,870 --> 00:36:27,455
Nice and deep.
1007
00:36:27,456 --> 00:36:29,749
OK.
1008
00:36:29,750 --> 00:36:33,961
Curve the finger
like an ice cream scoop.
1009
00:36:33,962 --> 00:36:38,591
And bring it out.
1010
00:36:38,592 --> 00:36:40,385
You're up, Ogilvie.
1011
00:36:44,640 --> 00:36:46,849
Some more pressure, Mrs. Randolph.
1012
00:36:46,850 --> 00:36:48,352
I'm ready.
1013
00:36:55,067 --> 00:36:59,195
And here I thought
you weren't a quick study.
1014
00:36:59,196 --> 00:37:01,113
Keep going.
1015
00:37:01,114 --> 00:37:03,324
Mrs. Randolph, in order to prevent this
1016
00:37:03,325 --> 00:37:04,742
from happening again, I think you
1017
00:37:04,743 --> 00:37:06,327
need a better stool softener.
1018
00:37:06,328 --> 00:37:07,912
You can try MiraLAX.
1019
00:37:07,913 --> 00:37:10,414
Just a tablespoon with a big
glass of water every morning
1020
00:37:10,415 --> 00:37:11,415
should do the trick.
1021
00:37:11,416 --> 00:37:12,625
OK.
1022
00:37:14,836 --> 00:37:15,836
Oh.
1023
00:37:15,837 --> 00:37:17,421
Sorry.
1024
00:37:17,422 --> 00:37:18,589
Passing gas is good.
1025
00:37:18,590 --> 00:37:20,299
Means we're making progress.
1026
00:37:20,300 --> 00:37:22,009
Does that mean that I can... I can stop?
1027
00:37:22,010 --> 00:37:23,804
No. Nope. Keep going.
1028
00:37:28,809 --> 00:37:32,061
OK, Ogilvie, you... you might wanna...
1029
00:37:32,062 --> 00:37:33,814
Oh!
1030
00:37:37,651 --> 00:37:39,194
Much better.
1031
00:37:40,195 --> 00:37:42,196
MAP's holding on Levophed.
1032
00:37:42,197 --> 00:37:44,156
1 mike per kg per minute.
1033
00:37:44,157 --> 00:37:45,366
Do me a favor.
1034
00:37:45,367 --> 00:37:46,575
Give me some 4x4s on some Betadine.
1035
00:37:46,576 --> 00:37:47,868
Sorry, we're getting killed
1036
00:37:47,869 --> 00:37:49,287
with transfers from Westbridge.
1037
00:37:49,288 --> 00:37:51,455
Mesenteric ischemia, perforated bowel.
1038
00:37:51,456 --> 00:37:52,456
Got a hot one here.
1039
00:37:52,457 --> 00:37:53,457
Yeah.
1040
00:37:53,458 --> 00:37:54,583
Possible nec fasc.
1041
00:37:54,584 --> 00:37:55,960
Possible?
1042
00:37:55,961 --> 00:37:57,336
Need CT with contrast to confirm.
1043
00:37:57,337 --> 00:37:59,046
This is spreading like wildfire.
1044
00:37:59,047 --> 00:38:00,423
By the time you get your CT,
it's gonna be up to her waist.
1045
00:38:00,424 --> 00:38:01,507
She's gonna need a hemicorporectomy.
1046
00:38:01,508 --> 00:38:02,842
She needs a CT scan.
1047
00:38:02,843 --> 00:38:05,511
How about a stainless steel scan?
1048
00:38:05,512 --> 00:38:07,722
For Christ's sake. Robinavitch!
1049
00:38:07,723 --> 00:38:11,183
Robby, what the fuck are you doing?
1050
00:38:11,184 --> 00:38:12,893
Oh, God, I think I might puke.
1051
00:38:12,894 --> 00:38:15,354
That's called dirty dishwater
exudate without purulence.
1052
00:38:15,355 --> 00:38:17,565
There's a gray appearance
to the fascia, and in the OR,
1053
00:38:17,566 --> 00:38:19,817
you'll see easy separation
in the tissue planes.
1054
00:38:19,818 --> 00:38:21,152
When do you start your sabbatical?
1055
00:38:21,153 --> 00:38:22,862
- Tomorrow.
- Not a moment too soon.
1056
00:38:22,863 --> 00:38:24,823
Thanks for coming down.
1057
00:38:27,993 --> 00:38:31,579
I'm catching up on my
charting as fast as I can.
1058
00:38:31,580 --> 00:38:34,457
Why don't you give
my generative AI app a try?
1059
00:38:34,458 --> 00:38:36,959
It's 30% more efficient,
and providers report
1060
00:38:36,960 --> 00:38:38,836
increased job satisfaction.
1061
00:38:38,837 --> 00:38:41,839
And you'll rarely have to stay
overtime to complete charts.
1062
00:38:41,840 --> 00:38:43,591
Yeah?
1063
00:38:43,592 --> 00:38:44,884
OK.
1064
00:38:44,885 --> 00:38:46,469
Yeah, I'm usually here
at least a couple hours
1065
00:38:46,470 --> 00:38:48,346
after every shift
trying to catch up, so...
1066
00:38:48,347 --> 00:38:50,765
Sure, AI will make
doctors more efficient,
1067
00:38:50,766 --> 00:38:53,059
but hospitals will expect us
to treat more patients
1068
00:38:53,060 --> 00:38:55,061
without any extra pay, of course,
1069
00:38:55,062 --> 00:38:56,854
all the while eliminating
staff positions
1070
00:38:56,855 --> 00:38:58,564
for attending and residents.
1071
00:38:58,565 --> 00:39:00,149
Oh, Dr. Robby, I am not an advocate
1072
00:39:00,150 --> 00:39:02,276
for erasing my own profession.
1073
00:39:02,277 --> 00:39:05,780
But I am advocating for getting
to spend more time with my son.
1074
00:39:05,781 --> 00:39:08,741
Nothing can replace family.
1075
00:39:08,742 --> 00:39:10,743
What's the status
of your septic patient?
1076
00:39:10,744 --> 00:39:13,537
Nec fasc. Surgery's taking her up.
1077
00:39:13,538 --> 00:39:16,082
Think they'll be able to save her leg?
1078
00:39:16,083 --> 00:39:18,042
Right now, I'm just hoping
they can save her life.
1079
00:39:18,043 --> 00:39:20,628
Hey, how's Ogilvie doing?
1080
00:39:20,629 --> 00:39:24,465
A little TB exposure,
a touch of ass-plosion.
1081
00:39:24,466 --> 00:39:26,592
All in all, pretty good day so far.
1082
00:39:26,593 --> 00:39:27,885
Kaison, you came.
1083
00:39:27,886 --> 00:39:29,428
Hey, ain't no way I was gonna let you
1084
00:39:29,429 --> 00:39:31,389
miss Peter and Aubrey's
epic Fourth of July party.
1085
00:39:31,390 --> 00:39:33,557
Come on, now. Hey.
1086
00:39:33,558 --> 00:39:35,226
Brought some brew.
1087
00:39:35,227 --> 00:39:36,602
Oh, you are the man.
1088
00:39:36,603 --> 00:39:38,062
Appreciate the bromance over here,
1089
00:39:38,063 --> 00:39:40,398
but no food 'cause you
might go into surgery.
1090
00:39:40,399 --> 00:39:43,026
And no beer 'cause we're
a goddamn hospital.
1091
00:39:46,613 --> 00:39:48,823
Starting your sabbatical early?
1092
00:39:48,824 --> 00:39:50,658
I know someone who could
really use a drink right now.
1093
00:39:50,659 --> 00:39:51,951
In the hospital?
1094
00:39:51,952 --> 00:39:54,413
As a parting gift.
1095
00:39:58,417 --> 00:40:00,042
How's it looking?
1096
00:40:00,043 --> 00:40:01,293
Good.
1097
00:40:01,294 --> 00:40:03,254
The Steri-Strips did the trick.
1098
00:40:03,255 --> 00:40:04,380
CT's ready.
1099
00:40:04,381 --> 00:40:06,006
We already scanned him.
1100
00:40:06,007 --> 00:40:08,426
Head and neck want thin cuts
and a 3D reconstruction
1101
00:40:08,427 --> 00:40:10,428
of the mandible before they decide
1102
00:40:10,429 --> 00:40:11,846
if Mr. Varney needs surgery.
1103
00:40:11,847 --> 00:40:13,764
Have they even come down
to examine him in person?
1104
00:40:13,765 --> 00:40:15,349
No, they must be backed up.
1105
00:40:15,350 --> 00:40:19,145
Or there's a July Fourth sale
at the BMW dealership.
1106
00:40:19,146 --> 00:40:20,438
Labs are back.
1107
00:40:20,439 --> 00:40:22,273
Albumin's low. Total protein's low.
1108
00:40:22,274 --> 00:40:23,858
He also has megaloblastic anemia.
1109
00:40:23,859 --> 00:40:25,109
- Malnutrition.
- Probably.
1110
00:40:25,110 --> 00:40:26,277
Jail cuisine.
1111
00:40:26,278 --> 00:40:27,653
Whitaker, what labs should we add?
1112
00:40:27,654 --> 00:40:29,780
B12, folate, iron levels.
1113
00:40:29,781 --> 00:40:31,282
Good.
1114
00:40:31,283 --> 00:40:32,950
We're gonna run some more
tests, Mr. Varney.
1115
00:40:32,951 --> 00:40:34,286
Hang in there.
1116
00:40:38,874 --> 00:40:41,375
I have to pee.
1117
00:40:41,376 --> 00:40:42,835
There's no PureWick here.
1118
00:40:42,836 --> 00:40:44,086
But here you go, hon.
1119
00:40:44,087 --> 00:40:46,046
- I'll help you get on.
- No. No.
1120
00:40:46,047 --> 00:40:48,466
No bedpan. I can walk to the bathroom.
1121
00:40:48,467 --> 00:40:50,134
- I just need a little help.
- Are you sure?
1122
00:40:50,135 --> 00:40:51,218
I'm here, babe.
1123
00:40:51,219 --> 00:40:52,720
Oh, we got this Mr. Hamler.
1124
00:40:52,721 --> 00:40:55,973
You'll have to bring
your IV and portable oxygen.
1125
00:40:55,974 --> 00:40:57,975
Please?
1126
00:40:57,976 --> 00:41:00,394
I'll grab a wheelchair.
1127
00:41:00,395 --> 00:41:02,354
Let's try to sit you up
and dangle your legs.
1128
00:41:02,355 --> 00:41:03,857
OK.
1129
00:41:06,526 --> 00:41:09,905
1, 2, 3.
1130
00:41:15,577 --> 00:41:17,328
This is not a good idea.
1131
00:41:17,329 --> 00:41:19,413
I don't think we're gonna need this.
1132
00:41:19,414 --> 00:41:21,040
Hey, Paul, Paul,
1133
00:41:21,041 --> 00:41:23,209
why don't you come
grab a cup of coffee with me?
1134
00:41:23,210 --> 00:41:25,169
I'm still zonked from my all-nighter,
1135
00:41:25,170 --> 00:41:28,839
and I wanna go over some
delivery instructions with you.
1136
00:41:28,840 --> 00:41:31,509
Sure.
1137
00:41:31,510 --> 00:41:33,385
Rox, you OK?
1138
00:41:33,386 --> 00:41:36,264
- Mm-hmm.
- Yeah. It's OK.
1139
00:41:42,938 --> 00:41:44,940
Bedpan it is.
1140
00:41:52,906 --> 00:41:54,782
You lose your pulse ox again, bud?
1141
00:42:00,330 --> 00:42:01,747
Louie.
1142
00:42:01,748 --> 00:42:03,624
Louie!
1143
00:42:03,625 --> 00:42:06,210
He kept pulling off his pulse ox.
1144
00:42:06,211 --> 00:42:07,628
It's on. It's at 71.
1145
00:42:07,629 --> 00:42:09,089
Louie, wake up.
1146
00:42:10,674 --> 00:42:12,466
- I'm not getting a carotid.
- I got the airway.
1147
00:42:12,467 --> 00:42:15,636
Hey, Perlah, crash cart,
intubation tray, please.
1148
00:42:24,406 --> 00:42:29,345
Sync and corrections by btsix
www.addic7ed.com