1 00:00:03,725 --> 00:00:07,527 Sync and corrections by btsix www.addic7ed.com 2 00:00:07,528 --> 00:00:09,863 [INDISTINCT ANNOUNCEMENT OVER P.A. SYSTEM] 3 00:00:09,864 --> 00:00:11,990 - Robby. - Yep. 4 00:00:11,991 --> 00:00:14,117 Cellulitis on the dorsum of the foot, 5 00:00:14,118 --> 00:00:16,119 now spreading up the leg. 6 00:00:16,120 --> 00:00:17,328 Hello, I'm Dr. Robby. 7 00:00:17,329 --> 00:00:19,039 Mind if I take a look? 8 00:00:19,040 --> 00:00:21,124 How long do you think this is gonna take? 9 00:00:21,125 --> 00:00:22,709 I took an early lunch break. 10 00:00:22,710 --> 00:00:23,877 [GASPS] 11 00:00:23,878 --> 00:00:25,045 I don't know that you're gonna 12 00:00:25,046 --> 00:00:26,921 make it back to work today. 13 00:00:26,922 --> 00:00:28,590 Erythema and warmth halfway up her knee. 14 00:00:28,591 --> 00:00:29,716 When did you see her, Donnie? 15 00:00:29,717 --> 00:00:32,218 He didn't. I did. 16 00:00:32,219 --> 00:00:33,720 - When? - About four hours ago. 17 00:00:33,721 --> 00:00:35,096 Gave her a dose of Keflex, 18 00:00:35,097 --> 00:00:36,639 told her to come back if things got worse. 19 00:00:36,640 --> 00:00:38,600 Things have definitely gotten worse. 20 00:00:38,601 --> 00:00:39,601 Dana, what's open? 21 00:00:39,602 --> 00:00:41,061 Trauma Two. 22 00:00:41,062 --> 00:00:42,562 Jesse, can you get her started in Trauma Two 23 00:00:42,563 --> 00:00:43,855 with some vanco and blood cultures, please? 24 00:00:43,856 --> 00:00:45,315 - Got it, boss. - I'm coming with. 25 00:00:45,316 --> 00:00:47,400 Suit yourself. 26 00:00:47,401 --> 00:00:50,695 Santos, you want in on Trauma Two? 27 00:00:50,696 --> 00:00:53,656 Too much charting, too little time. 28 00:00:53,657 --> 00:00:57,410 62-year-old male presents with chief complaint 29 00:00:57,411 --> 00:00:58,578 of left lower back pain. 30 00:00:58,579 --> 00:01:00,080 - Considered the diagnosis... - Hey. 31 00:01:00,081 --> 00:01:01,247 Oh, Jesus Christ. 32 00:01:01,248 --> 00:01:02,749 I'm charting. 33 00:01:02,750 --> 00:01:04,250 Sorry. 34 00:01:04,251 --> 00:01:05,251 [SIGHS] 35 00:01:05,252 --> 00:01:06,795 Did I do something wrong? 36 00:01:06,796 --> 00:01:08,588 Besides interrupting me? Probably. 37 00:01:08,589 --> 00:01:10,173 Then I apologize. 38 00:01:10,174 --> 00:01:13,802 I know that second year of residency can be stressful, 39 00:01:13,803 --> 00:01:17,013 so if there's anything I can do to help you... 40 00:01:17,014 --> 00:01:18,264 like stop talking. 41 00:01:18,265 --> 00:01:20,600 - That's a great idea. - Yeah. 42 00:01:20,601 --> 00:01:24,771 Considered the diagnosis of aortic aneurysm or dissection. 43 00:01:24,772 --> 00:01:26,481 Got a new one for you in 13. 44 00:01:26,482 --> 00:01:29,109 I'm 20 charts behind, and the new attending 45 00:01:29,110 --> 00:01:30,276 is threatening to make me repeat 46 00:01:30,277 --> 00:01:31,444 a year if I can't catch up. 47 00:01:31,445 --> 00:01:32,654 Cry me a river. 48 00:01:32,655 --> 00:01:33,780 Old lady with bad abdominal pain. 49 00:01:33,781 --> 00:01:34,948 Somebody's gotta see her. 50 00:01:34,949 --> 00:01:36,449 Dana, please do me a solid. 51 00:01:36,450 --> 00:01:38,118 Holiday weekend. 52 00:01:38,119 --> 00:01:39,786 Westbridge is down, and our waiting room's on overdrive. 53 00:01:39,787 --> 00:01:41,121 I'm sorry, but your charting's gonna have to wait 54 00:01:41,122 --> 00:01:43,581 until after your shift. 55 00:01:43,582 --> 00:01:45,041 Ogilvie. 56 00:01:45,042 --> 00:01:48,920 Dr. Santos needs you to pick up a new patient in 13. 57 00:01:48,921 --> 00:01:52,799 Y-yes, ma'am. I'm on it. 58 00:01:52,800 --> 00:01:54,092 Chart while you supervise. 59 00:01:54,093 --> 00:01:55,885 Best I can do. 60 00:01:55,886 --> 00:01:58,972 [BOTH SPEAKING SPANISH] 61 00:01:58,973 --> 00:02:01,891 Setting up a GoFundMe, that's what her generation does. 62 00:02:01,892 --> 00:02:03,810 That's how they support each other. 63 00:02:03,811 --> 00:02:04,853 Doctor, tell him. 64 00:02:04,854 --> 00:02:06,479 Your wife's right. 65 00:02:06,480 --> 00:02:08,815 Staying here's gonna cost more than we can afford. 66 00:02:08,816 --> 00:02:10,650 Look, I'm feeling better. 67 00:02:10,651 --> 00:02:12,193 I'll just leave. 68 00:02:12,194 --> 00:02:15,155 Mr. Diaz, even if your blood sugar is back to normal, 69 00:02:15,156 --> 00:02:17,115 we have to continue with the insulin drip 70 00:02:17,116 --> 00:02:19,033 until we clear the ketones from your bloodstream. 71 00:02:19,034 --> 00:02:21,578 Otherwise, you could experience electrolyte disorders, 72 00:02:21,579 --> 00:02:22,912 heart and kidney problems... 73 00:02:22,913 --> 00:02:26,457 Mi amor, your health is what matters. 74 00:02:26,458 --> 00:02:27,917 I'll make you a deal. 75 00:02:27,918 --> 00:02:29,752 You agree to stay on the insulin drip, 76 00:02:29,753 --> 00:02:31,254 and I'll go find our case manager 77 00:02:31,255 --> 00:02:33,173 to discuss cost-cutting options for your stay. 78 00:02:33,174 --> 00:02:34,549 Deal. 79 00:02:34,550 --> 00:02:36,843 And I'm sitting here making sure he doesn't move. 80 00:02:36,844 --> 00:02:38,928 - You should go look for Ana. - Mm-hmm. 81 00:02:38,929 --> 00:02:40,013 I can find her. 82 00:02:40,014 --> 00:02:41,640 BRB. 83 00:02:43,767 --> 00:02:44,976 Hanging vanco. 84 00:02:44,977 --> 00:02:46,519 What's vanco? 85 00:02:46,520 --> 00:02:49,022 A really strong antibiotic to kill skin germs. 86 00:02:49,023 --> 00:02:51,566 - Need a hand? - No. We got this. 87 00:02:51,567 --> 00:02:53,401 I'll just observe. 88 00:02:53,402 --> 00:02:54,861 Pretend I'm not even here. 89 00:02:54,862 --> 00:02:58,323 Let's send off a CBC, blood cultures, and CMP. 90 00:02:58,324 --> 00:03:01,367 And also a lactic acid, CRP, and calcitonin. 91 00:03:01,368 --> 00:03:03,453 Wait, she's not febrile, not tachycardic. 92 00:03:03,454 --> 00:03:05,079 No evidence of SIRS. 93 00:03:05,080 --> 00:03:07,040 - Yet. - What's SIRS? 94 00:03:07,041 --> 00:03:10,793 Systemic inflammatory response syndrome. 95 00:03:10,794 --> 00:03:11,878 Sorry. 96 00:03:11,879 --> 00:03:13,546 An exaggerated defense response. 97 00:03:13,547 --> 00:03:14,881 A what? 98 00:03:14,882 --> 00:03:16,925 Sometimes the human body can have an overreaction 99 00:03:16,926 --> 00:03:18,843 to an infection, so we're gonna monitor you 100 00:03:18,844 --> 00:03:20,470 to make sure that this does not progress. 101 00:03:20,471 --> 00:03:23,223 [PHONE BUZZING] 102 00:03:23,224 --> 00:03:24,682 It's my boss. 103 00:03:24,683 --> 00:03:26,684 Sorry, I have to take this, or he's gonna fire me. 104 00:03:26,685 --> 00:03:28,770 OK. 105 00:03:28,771 --> 00:03:30,313 Hello. 106 00:03:30,314 --> 00:03:33,942 No, I'm still at the hospital. 107 00:03:33,943 --> 00:03:35,443 Being seen right now. 108 00:03:35,444 --> 00:03:36,736 Ow. 109 00:03:36,737 --> 00:03:39,906 No, they just stuck me with a needle. 110 00:03:39,907 --> 00:03:41,616 I don't know. 111 00:03:41,617 --> 00:03:44,077 You wanna talk to them? 112 00:03:44,078 --> 00:03:47,080 They're kind of busy right now. 113 00:03:47,081 --> 00:03:48,539 I know you are. 114 00:03:48,540 --> 00:03:49,999 Second IV's in. 115 00:03:50,000 --> 00:03:51,709 No, I'm not overreacting. 116 00:03:51,710 --> 00:03:54,045 My body's overreacting. 117 00:03:54,046 --> 00:03:56,047 Please... please don't fire me. 118 00:03:56,048 --> 00:03:57,340 I... 119 00:03:57,341 --> 00:03:58,800 This is Dr. Michael Robinavitch. 120 00:03:58,801 --> 00:04:00,843 I am the chief of emergency medicine at PTMC. 121 00:04:00,844 --> 00:04:02,804 If you fire her, she will sue you, 122 00:04:02,805 --> 00:04:05,807 and I will testify on her behalf. 123 00:04:05,808 --> 00:04:08,101 OK. 124 00:04:08,102 --> 00:04:10,020 Don't worry about it. We got you. 125 00:04:14,858 --> 00:04:16,818 Do you know how long Jackson's gonna be asleep? 126 00:04:16,819 --> 00:04:20,071 So there's no exact timeline with the sedatives we gave him, 127 00:04:20,072 --> 00:04:21,781 but he should be awake soon. 128 00:04:21,782 --> 00:04:23,449 Have you spoken to your parents yet? 129 00:04:23,450 --> 00:04:25,076 Yeah, they're on their way back from Columbus. 130 00:04:25,077 --> 00:04:27,537 Maybe you should take some time for yourself 131 00:04:27,538 --> 00:04:28,955 before they arrive. 132 00:04:28,956 --> 00:04:30,623 Yeah, cafeteria's right down the hall. 133 00:04:30,624 --> 00:04:31,666 Decent grilled cheese. 134 00:04:31,667 --> 00:04:32,792 Stay away from the tuna. 135 00:04:32,793 --> 00:04:34,836 Thanks, but I'm not hungry. 136 00:04:34,837 --> 00:04:37,547 You know, I just can't believe that a campus security guard 137 00:04:37,548 --> 00:04:39,007 tased my brother. 138 00:04:39,008 --> 00:04:40,508 Aren't they supposed to be helping students 139 00:04:40,509 --> 00:04:42,635 and protect them, not shoot at them? 140 00:04:42,636 --> 00:04:44,304 You have every right to be upset, 141 00:04:44,305 --> 00:04:46,973 and you should absolutely pursue accountability. 142 00:04:46,974 --> 00:04:49,267 But right now, we are taking care of your brother. 143 00:04:49,268 --> 00:04:52,103 And you should really take care of yourself. 144 00:04:52,104 --> 00:04:53,688 I... I have your number. 145 00:04:53,689 --> 00:04:56,065 I'll text you as soon as Jackson's LP results get back 146 00:04:56,066 --> 00:04:58,276 or if he wakes up. 147 00:04:58,277 --> 00:04:59,986 OK. 148 00:04:59,987 --> 00:05:01,321 OK, thank you. 149 00:05:01,322 --> 00:05:02,488 Of course. 150 00:05:02,489 --> 00:05:05,658 - Oh. - OK. 151 00:05:05,659 --> 00:05:07,327 Hypoactive bowel sounds. 152 00:05:07,328 --> 00:05:10,163 Soft, with moderate tenderness in the left lower quadrant. 153 00:05:10,164 --> 00:05:13,416 Mrs. Randolph, do you take Percocet every day? 154 00:05:13,417 --> 00:05:15,335 - No. - Huh. 155 00:05:15,336 --> 00:05:16,836 And what about your water intake, 'cause... 156 00:05:16,837 --> 00:05:18,338 Pause. 157 00:05:18,339 --> 00:05:20,506 Mrs. Randolph, you said you don't take Percocet every day, 158 00:05:20,507 --> 00:05:22,508 but when was the last time you took some? 159 00:05:22,509 --> 00:05:25,803 Maybe three or four times last week. 160 00:05:25,804 --> 00:05:29,432 Assisted living had a ballroom dance competition, 161 00:05:29,433 --> 00:05:31,642 - and I tweaked my back. - Mm. 162 00:05:31,643 --> 00:05:35,730 Any further questions, Ogilvie? 163 00:05:35,731 --> 00:05:39,442 When was your last bowel movement? 164 00:05:39,443 --> 00:05:41,944 I don't know. Sometime last week. 165 00:05:41,945 --> 00:05:44,947 I've been stopped up for at least five or six days. 166 00:05:44,948 --> 00:05:48,409 Mm-hmm, painkillers can cause constipation. 167 00:05:48,410 --> 00:05:49,702 I know. 168 00:05:49,703 --> 00:05:52,246 That's why they put me on a stool softener, 169 00:05:52,247 --> 00:05:53,581 and then they tried an enema. 170 00:05:53,582 --> 00:05:55,625 - And... and no movements? - Yep. 171 00:05:55,626 --> 00:05:58,920 And then they gave me this horrible drink. 172 00:05:58,921 --> 00:06:00,546 Mag citrate. 173 00:06:00,547 --> 00:06:01,589 Yeah. 174 00:06:01,590 --> 00:06:03,925 Mag citrate. 175 00:06:03,926 --> 00:06:05,218 Made me puke. 176 00:06:05,219 --> 00:06:07,428 All right, what's next, Ogilvie? 177 00:06:07,429 --> 00:06:09,472 Let's get you an X-ray and see how we can help you, 178 00:06:09,473 --> 00:06:10,473 Mrs. Randolph. 179 00:06:10,474 --> 00:06:12,392 - Thank you. - Yeah. 180 00:06:12,393 --> 00:06:14,560 Differential? 181 00:06:14,561 --> 00:06:16,229 Probable stool impaction. 182 00:06:16,230 --> 00:06:17,772 But with her history of cholecystectomy, 183 00:06:17,773 --> 00:06:19,565 it could be small bowel obstruction. 184 00:06:19,566 --> 00:06:20,650 Or worse. 185 00:06:20,651 --> 00:06:22,902 Sigmoid volvulus? 186 00:06:22,903 --> 00:06:25,279 But that's a surgical emergency. 187 00:06:25,280 --> 00:06:26,823 Wouldn't she have tons of pain? 188 00:06:26,824 --> 00:06:30,327 Not always, especially when you're in your 80s. 189 00:06:35,916 --> 00:06:37,583 I am getting concerned. 190 00:06:37,584 --> 00:06:40,128 This is a millimeter past the line. 191 00:06:40,129 --> 00:06:41,504 Or my line was sloppy. 192 00:06:41,505 --> 00:06:43,089 - Any increase in pain? - Oh. 193 00:06:43,090 --> 00:06:45,633 OK, sorry. Let's try four morphine. 194 00:06:45,634 --> 00:06:46,968 White count's only 10,000. 195 00:06:46,969 --> 00:06:49,011 It'd be over 12,000 for SIRS. 196 00:06:49,012 --> 00:06:50,805 There are other criteria. 197 00:06:50,806 --> 00:06:52,265 Still afebrile. 198 00:06:52,266 --> 00:06:53,850 Did you ask about past history of MRSA? 199 00:06:53,851 --> 00:06:55,643 Not specifically, but she's never been hospitalized. 200 00:06:55,644 --> 00:06:57,145 Any evidence of an immunocompromised state? 201 00:06:57,146 --> 00:06:58,396 - No, she's healthy. - Steroid use? 202 00:06:58,397 --> 00:06:59,397 Never. 203 00:06:59,398 --> 00:07:00,940 Maximum heart rate's only 89. 204 00:07:00,941 --> 00:07:02,108 Is that OK? 205 00:07:02,109 --> 00:07:04,193 That's good, very good. 206 00:07:04,194 --> 00:07:05,194 Stay with her. 207 00:07:05,195 --> 00:07:06,779 Monitor her closely. 208 00:07:06,780 --> 00:07:08,614 If there's any change in her condition, come find me. 209 00:07:08,615 --> 00:07:09,783 I mean any change. 210 00:07:12,870 --> 00:07:15,538 Roxie Hamler, 42, home hospice patient 211 00:07:15,539 --> 00:07:17,123 with a history of lung cancer. 212 00:07:17,124 --> 00:07:20,334 New-onset tonic-clonic seizure with right lower leg pain. 213 00:07:20,335 --> 00:07:22,462 She hit it on the coffee table. 214 00:07:22,463 --> 00:07:24,130 [MOANING SOFTLY] 215 00:07:24,131 --> 00:07:25,923 Initially nonverbal, now coming around. 216 00:07:25,924 --> 00:07:27,425 That's normal after a seizure. 217 00:07:27,426 --> 00:07:29,010 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 218 00:07:29,011 --> 00:07:30,803 - Nope, we got it. - She hit her head? 219 00:07:30,804 --> 00:07:31,971 No. I was there. 220 00:07:31,972 --> 00:07:33,598 - I caught her. - No IV? 221 00:07:33,599 --> 00:07:34,891 Couldn't get one in. 222 00:07:34,892 --> 00:07:36,392 Gave her four of IM versed for the seizure, 223 00:07:36,393 --> 00:07:37,935 - 25 of fent for the pain. - OK. 224 00:07:37,936 --> 00:07:39,812 - Dana, where to? - Trauma One. 225 00:07:39,813 --> 00:07:41,063 This way. 226 00:07:41,064 --> 00:07:43,399 Haven't seen you guys in a hot minute. 227 00:07:43,400 --> 00:07:45,985 Pickup from SCI Jones Forge. 228 00:07:45,986 --> 00:07:47,487 Was supposed to go to Westbridge but got 229 00:07:47,488 --> 00:07:48,488 diverted to you. 230 00:07:48,489 --> 00:07:49,906 Yeah, you and everybody else. 231 00:07:49,907 --> 00:07:51,491 Princess, I need you pivot to Central 9. 232 00:07:51,492 --> 00:07:52,825 Got it. 233 00:07:52,826 --> 00:07:54,494 Gus Varney, 54, victim of assault 234 00:07:54,495 --> 00:07:55,870 with diffuse blunt trauma. 235 00:07:55,871 --> 00:07:57,872 He's got bruising to the face, the right chest, 236 00:07:57,873 --> 00:07:59,540 10-centimeter laceration to the left arm. 237 00:07:59,541 --> 00:08:01,125 BP's 136 over 84, pulse 102, 238 00:08:01,126 --> 00:08:03,878 good sats, 95 on room air. 239 00:08:03,879 --> 00:08:05,588 How you feeling there, Mr. Varney? 240 00:08:05,589 --> 00:08:07,089 - Fucking hurts. - Where? 241 00:08:07,090 --> 00:08:09,425 - Everywhere. - I am Dr. Robby. 242 00:08:09,426 --> 00:08:10,718 This is Dr. Al-Hashimi. 243 00:08:10,719 --> 00:08:12,178 We'll get you something for the pain. 244 00:08:12,179 --> 00:08:13,721 I've got a progressing cellulitis in Trauma Two. 245 00:08:13,722 --> 00:08:15,348 - Go. I'm good. - Thank you. 246 00:08:15,349 --> 00:08:17,391 Gus, do you know who hurt you? 247 00:08:17,392 --> 00:08:20,061 One of the fine, upstanding citizens of cell block 6. 248 00:08:20,062 --> 00:08:23,022 It's a deep lac through the muscle fascia. 249 00:08:23,023 --> 00:08:24,524 Can we get the cuffs off once he settles? 250 00:08:24,525 --> 00:08:25,691 Not a chance. 251 00:08:25,692 --> 00:08:27,652 Orange jumpsuit. He's cuffed for a reason. 252 00:08:27,653 --> 00:08:29,738 Let's go. 253 00:08:40,082 --> 00:08:43,626 OK, everyone, on my count. 254 00:08:43,627 --> 00:08:45,253 1, 2... 255 00:08:45,254 --> 00:08:46,755 Hold on. 256 00:08:50,342 --> 00:08:53,928 - Go. - 1, 2, 3. 257 00:08:53,929 --> 00:08:55,429 - [GROANS] - Mel, E-FAST. 258 00:08:55,430 --> 00:08:57,014 Whitaker, primary assessment. 259 00:08:57,015 --> 00:08:58,267 On it. 260 00:09:03,397 --> 00:09:04,564 Oh, weird bruise. 261 00:09:04,565 --> 00:09:05,898 Did he fall on something? 262 00:09:05,899 --> 00:09:07,400 Footprint, got stomped. 263 00:09:07,401 --> 00:09:09,319 Jesus. 264 00:09:10,571 --> 00:09:12,280 Is it... is that necessary? 265 00:09:12,281 --> 00:09:14,448 Afraid so. 266 00:09:14,449 --> 00:09:17,076 Airway's patent. 267 00:09:17,077 --> 00:09:19,829 Good lung sliding on the left. 268 00:09:19,830 --> 00:09:21,080 - [YELLS] - Sorry. 269 00:09:21,081 --> 00:09:22,331 Good on the right, too. 270 00:09:22,332 --> 00:09:23,749 How are the lungs? 271 00:09:23,750 --> 00:09:24,834 Good breath sounds. 272 00:09:24,835 --> 00:09:27,587 - No crepitus. - No effusion. 273 00:09:27,588 --> 00:09:30,881 Pulse ox 97, BP 118 over 78, heart rate 112. 274 00:09:30,882 --> 00:09:32,258 Tachycardic from the pain. 275 00:09:32,259 --> 00:09:33,801 Start with four of morphine. Repeat prn. 276 00:09:33,802 --> 00:09:34,802 On it. 277 00:09:34,803 --> 00:09:36,929 OK. Swollen mandible. 278 00:09:36,930 --> 00:09:38,347 Open your mouth for me, Gus. 279 00:09:38,348 --> 00:09:40,182 Little wider. 280 00:09:40,183 --> 00:09:41,434 Can't. 281 00:09:41,435 --> 00:09:42,810 Whitaker, you know the tongue blade exam? 282 00:09:42,811 --> 00:09:44,270 Yeah. 283 00:09:44,271 --> 00:09:45,730 It's a great test for mandible fracture. 284 00:09:45,731 --> 00:09:48,941 Gus, bite down hard on this for me. 285 00:09:48,942 --> 00:09:51,152 [YELLING] 286 00:09:51,153 --> 00:09:52,528 Sorry, Gus. 287 00:09:52,529 --> 00:09:54,655 - Positive test. - [GROANS] 288 00:09:54,656 --> 00:09:56,198 No free fluid in the belly. 289 00:09:56,199 --> 00:09:57,199 Any idea how long this will take? 290 00:09:57,200 --> 00:09:58,576 Too soon to tell. 291 00:09:58,577 --> 00:09:59,660 Whitaker, your assessment? 292 00:09:59,661 --> 00:10:01,120 Fractured left mandible, 293 00:10:01,121 --> 00:10:03,289 multiple rib fractures. 294 00:10:03,290 --> 00:10:04,790 Complex forearm lac. 295 00:10:04,791 --> 00:10:06,792 OK, log roll to the left, then pan scan. 296 00:10:06,793 --> 00:10:08,711 Where were you when Mr. Varney got assaulted? 297 00:10:08,712 --> 00:10:10,296 I just move 'em. I don't get to know 'em. 298 00:10:10,297 --> 00:10:12,048 CT's ready for us. 299 00:10:12,049 --> 00:10:13,883 Cycling the BP. 300 00:10:13,884 --> 00:10:16,552 OK, this redness is now a centimeter over that line, 301 00:10:16,553 --> 00:10:18,054 and this might be a bulla forming. 302 00:10:18,055 --> 00:10:19,347 The vanco takes a little time to work. 303 00:10:19,348 --> 00:10:22,892 Vital signs are still stable, 122 over 78. 304 00:10:22,893 --> 00:10:23,976 I got it. 305 00:10:23,977 --> 00:10:26,979 How are you feeling, Debbie? 306 00:10:26,980 --> 00:10:28,648 I'm feeling a little warm. 307 00:10:28,649 --> 00:10:30,066 That can happen with vanco. 308 00:10:30,067 --> 00:10:32,026 Thanks, man. 309 00:10:32,027 --> 00:10:35,071 Lactic acid 4.2. 310 00:10:35,072 --> 00:10:36,864 - OK. - What's wrong? 311 00:10:36,865 --> 00:10:39,575 That can be a sign of a more serious infection, 312 00:10:39,576 --> 00:10:41,202 but the good news is, we know what to do. 313 00:10:41,203 --> 00:10:44,914 Jesse, 2 liters of LR wide open. 314 00:10:44,915 --> 00:10:46,374 This is severe sepsis. 315 00:10:46,375 --> 00:10:48,000 I know, but at 7:00 AM, it was a simple cellulitis. 316 00:10:48,001 --> 00:10:49,627 Anyone would have given her Keflex. 317 00:10:49,628 --> 00:10:51,629 We could add carbapenem or Zosyn to broaden 318 00:10:51,630 --> 00:10:52,672 our antibiotic coverage. 319 00:10:52,673 --> 00:10:53,839 OK, I got it. 320 00:10:53,840 --> 00:10:55,257 Thanks. 321 00:10:55,258 --> 00:10:58,260 Jesse, 1 gram meropenem, 900 milligrams clinda, 322 00:10:58,261 --> 00:11:00,304 and page Dr. Garcia, please. 323 00:11:00,305 --> 00:11:01,722 What's going on? 324 00:11:01,723 --> 00:11:03,182 We're adding new antibiotics. 325 00:11:03,183 --> 00:11:04,600 It's serious? 326 00:11:04,601 --> 00:11:05,851 We wanna get ahead of it and make sure 327 00:11:05,852 --> 00:11:07,646 it doesn't become serious. 328 00:11:09,272 --> 00:11:10,356 What else can I do? 329 00:11:10,357 --> 00:11:11,524 I think you've done enough. 330 00:11:11,525 --> 00:11:12,693 You can go. 331 00:11:16,405 --> 00:11:17,405 All good in there? 332 00:11:17,406 --> 00:11:18,531 Code sepsis. 333 00:11:18,532 --> 00:11:19,865 Stable for the moment. 334 00:11:19,866 --> 00:11:21,200 How about you? 335 00:11:21,201 --> 00:11:23,536 Perfect vitals, E-FAST negative, off to CT. 336 00:11:23,537 --> 00:11:24,745 Good. 337 00:11:24,746 --> 00:11:26,372 Keep me posted. 338 00:11:26,373 --> 00:11:27,666 Ditto. 339 00:11:31,253 --> 00:11:32,712 How's it going? 340 00:11:32,713 --> 00:11:34,672 Great, if you ignore the hot mess in chairs. 341 00:11:34,673 --> 00:11:36,590 Any update on our little baby Jane Doe? 342 00:11:36,591 --> 00:11:38,592 Security's reviewing the CCTV from last night 343 00:11:38,593 --> 00:11:39,845 and this morning. 344 00:11:42,180 --> 00:11:43,639 You two kiss and make up yet? 345 00:11:43,640 --> 00:11:45,224 I think someone needs to smoke a cigarette. 346 00:11:45,225 --> 00:11:46,642 I'm trying to quit. 347 00:11:46,643 --> 00:11:48,185 Why don't you quit when I'm on my trip? 348 00:11:48,186 --> 00:11:49,437 Everyone's glad to have you back. 349 00:11:49,438 --> 00:11:51,940 - Asshole. - Well, not everyone. 350 00:11:53,400 --> 00:11:55,860 Hey, you want in on this betting board? 351 00:11:55,861 --> 00:11:58,821 Look, all you gotta do is pick why Westbridge went down, 352 00:11:58,822 --> 00:12:00,448 how many of their patients we're gonna get, 353 00:12:00,449 --> 00:12:02,074 and when they'll be back in action. 354 00:12:02,075 --> 00:12:04,827 Hey, already up to $500. 355 00:12:04,828 --> 00:12:07,163 Oh, ah, gotta pass. 356 00:12:07,164 --> 00:12:09,331 Still catching up on rehab bills. 357 00:12:09,332 --> 00:12:11,835 Respect. 358 00:12:13,420 --> 00:12:14,587 All right. 359 00:12:14,588 --> 00:12:16,255 What's the rules on me changing my bet? 360 00:12:16,256 --> 00:12:18,466 Only if you double down. 361 00:12:18,467 --> 00:12:20,509 [CHUCKLES] 362 00:12:20,510 --> 00:12:21,928 Sinkhole. 363 00:12:24,598 --> 00:12:28,100 You watch too many movies, man. 364 00:12:28,101 --> 00:12:31,145 Considered the diagnosis of aortic aneurysm 365 00:12:31,146 --> 00:12:33,439 or dissection, but the point-of-care ultrasound was... 366 00:12:33,440 --> 00:12:35,983 You done want that gridlocked granny? 367 00:12:35,984 --> 00:12:37,902 Ordered an acute abdominal series 368 00:12:37,903 --> 00:12:39,153 to rule out obstruction. 369 00:12:39,154 --> 00:12:40,404 - Still waiting on the X-rays. - Great. 370 00:12:40,405 --> 00:12:41,530 Then you're free to treat our latest 371 00:12:41,531 --> 00:12:42,740 and greatest in South 16. 372 00:12:42,741 --> 00:12:45,534 Oh, come on, D, it's like, every time 373 00:12:45,535 --> 00:12:47,119 I get a moment to chart, I barely get 374 00:12:47,120 --> 00:12:49,830 - a sentence out before I get... - Interrupted? 375 00:12:49,831 --> 00:12:51,874 Sucks to be you, but trust me, it sucks worse 376 00:12:51,875 --> 00:12:53,793 for the poor gal in 16. 377 00:12:53,794 --> 00:12:56,545 I'm beginning to think you enjoy torturing me. 378 00:12:56,546 --> 00:12:58,672 Perks of the job. 379 00:12:58,673 --> 00:13:00,008 Ogilvie, let's go. 380 00:13:03,595 --> 00:13:06,348 Hold out your hand, Louie. 381 00:13:07,307 --> 00:13:08,974 A little shaky. 382 00:13:08,975 --> 00:13:09,975 No surprise. 383 00:13:09,976 --> 00:13:12,144 I've been here since 4:00 AM. 384 00:13:12,145 --> 00:13:13,521 We can get you something for that. 385 00:13:13,522 --> 00:13:14,855 Or I can take care of it myself 386 00:13:14,856 --> 00:13:16,982 if you cut me loose right now. 387 00:13:16,983 --> 00:13:19,151 Let's get Louie 50 milligrams of Librium. 388 00:13:19,152 --> 00:13:20,737 I'll put in the order. 389 00:13:22,823 --> 00:13:25,617 I will get it from the PDS. 390 00:13:29,162 --> 00:13:31,705 I'm already assigned as Louie's treating physician. 391 00:13:31,706 --> 00:13:34,166 Just makes sense that I put it in. 392 00:13:34,167 --> 00:13:36,253 Yeah. Yeah, yeah. Of course. 393 00:13:41,341 --> 00:13:43,843 Any changes with our septic waitress? 394 00:13:43,844 --> 00:13:44,969 Not yet. 395 00:13:44,970 --> 00:13:46,053 Wait, if you have a second, I... 396 00:13:46,054 --> 00:13:47,221 I don't. 397 00:13:47,222 --> 00:13:48,639 But the point-of-care ultrasound 398 00:13:48,640 --> 00:13:50,057 was negative for both. 399 00:13:50,058 --> 00:13:52,476 I considered the diagnosis of cauda equina syndrome. 400 00:13:52,477 --> 00:13:55,604 You writing the great American novel? 401 00:13:55,605 --> 00:13:57,565 Charting and supervising. 402 00:13:57,566 --> 00:13:58,607 It's Dana's idea. 403 00:13:58,608 --> 00:14:00,150 Who's the lucky patient? 404 00:14:00,151 --> 00:14:02,027 Unhoused woman with a bad cough. 405 00:14:02,028 --> 00:14:03,821 Ogilvie's all over it. 406 00:14:03,822 --> 00:14:05,197 OK. 407 00:14:05,198 --> 00:14:06,740 Say "eee." 408 00:14:06,741 --> 00:14:08,492 Eee. 409 00:14:08,493 --> 00:14:10,244 OK, deep breath in. 410 00:14:10,245 --> 00:14:12,204 Blow it out real hard. 411 00:14:12,205 --> 00:14:13,914 You haven't heard enough already? 412 00:14:13,915 --> 00:14:17,960 I need to check for wheezing with forced exhalation. 413 00:14:17,961 --> 00:14:21,130 [BREATHES DEEPLY, COUGHS] 414 00:14:21,131 --> 00:14:23,090 Fucking cough is killing me. 415 00:14:23,091 --> 00:14:24,717 You smoke, Mrs. Yardley? 416 00:14:24,718 --> 00:14:26,886 Yeah, but I haven't been able to 417 00:14:26,887 --> 00:14:28,304 for a couple days 'cause of this cough. 418 00:14:28,305 --> 00:14:30,556 Mm. You ever consider quitting? 419 00:14:30,557 --> 00:14:34,019 You ever considered minding your own business? 420 00:14:37,898 --> 00:14:40,149 Well, the good news is that your test from earlier 421 00:14:40,150 --> 00:14:42,359 came back negative for both COVID and influenza, 422 00:14:42,360 --> 00:14:44,028 but I'm gonna order a chest X-ray 423 00:14:44,029 --> 00:14:45,571 so that we can see what's really going on in those lungs. 424 00:14:45,572 --> 00:14:47,532 You got time to let us do that? 425 00:14:48,783 --> 00:14:51,744 Where the fuck else you think I gotta be? 426 00:14:51,745 --> 00:14:53,537 And we're in. 427 00:14:53,538 --> 00:14:55,205 3 grams Keppra over 10 minutes. 428 00:14:55,206 --> 00:14:56,916 That'll prevent another seizure. 429 00:14:56,917 --> 00:14:58,000 Thank you. 430 00:14:58,001 --> 00:14:59,919 Nobody can ever get an IV in her. 431 00:14:59,920 --> 00:15:01,879 Yeah, midline cath is the way to go 432 00:15:01,880 --> 00:15:03,505 when your veins are shot. 433 00:15:03,506 --> 00:15:08,093 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 434 00:15:08,094 --> 00:15:10,804 - OK. - Cold. 435 00:15:10,805 --> 00:15:14,266 Is it possible to get her a blanket and some socks? 436 00:15:14,267 --> 00:15:16,018 Can do. 437 00:15:16,019 --> 00:15:18,604 When was she diagnosed? 438 00:15:18,605 --> 00:15:20,522 Seven years ago. 439 00:15:20,523 --> 00:15:23,108 Resected a lobe. 440 00:15:23,109 --> 00:15:25,653 Four cycles of platinum chemo gave us a couple good years, 441 00:15:25,654 --> 00:15:28,113 but then it spread to the bones. 442 00:15:28,114 --> 00:15:30,324 Has she had radiation therapy? 443 00:15:30,325 --> 00:15:32,785 Shrunk down the mets, but they're still there. 444 00:15:32,786 --> 00:15:34,787 That's why you're at hospice at home. 445 00:15:34,788 --> 00:15:35,788 Yep. 446 00:15:35,789 --> 00:15:37,790 I'm sorry. 447 00:15:37,791 --> 00:15:39,124 Me too. 448 00:15:39,125 --> 00:15:41,669 Ah. 449 00:15:41,670 --> 00:15:42,795 Sorry. 450 00:15:42,796 --> 00:15:44,338 You have kids? 451 00:15:44,339 --> 00:15:46,799 Yeah, two boys. 452 00:15:46,800 --> 00:15:48,884 15 and 9. 453 00:15:48,885 --> 00:15:50,469 My son's 12. 454 00:15:50,470 --> 00:15:52,680 Goes fast. 455 00:15:52,681 --> 00:15:54,515 Too fast. 456 00:15:54,516 --> 00:15:59,144 Swelling and bruising over the distal tibia. 457 00:15:59,145 --> 00:16:01,772 50 of fentanyl once her systolic's over 100. 458 00:16:01,773 --> 00:16:04,359 What do you usually take for pain? 459 00:16:07,320 --> 00:16:10,531 MS Contin, 30 milligrams twice a day, 460 00:16:10,532 --> 00:16:12,950 oxycodone for breakthrough, and sublingual Actiq 461 00:16:12,951 --> 00:16:16,745 for when it gets really bad. 462 00:16:16,746 --> 00:16:17,913 That's a lot. 463 00:16:17,914 --> 00:16:19,707 You handle her pain meds? 464 00:16:19,708 --> 00:16:20,833 Sometimes. 465 00:16:20,834 --> 00:16:22,668 All the time. 466 00:16:22,669 --> 00:16:25,546 A hospice nurse comes by a few times a week, 467 00:16:25,547 --> 00:16:27,923 but I was alone when she had the seizure. 468 00:16:27,924 --> 00:16:29,883 They told us that it could happen, 469 00:16:29,884 --> 00:16:31,510 but she couldn't breathe. 470 00:16:31,511 --> 00:16:35,931 And I freaked out, and I called 911. 471 00:16:35,932 --> 00:16:38,225 I'm so sorry. 472 00:16:38,226 --> 00:16:40,185 I'm sorry. 473 00:16:40,186 --> 00:16:42,022 I'm sorry. 474 00:16:51,656 --> 00:16:54,825 Due to your family income, you make too much 475 00:16:54,826 --> 00:16:56,702 to be eligible for either PENNIE 476 00:16:56,703 --> 00:16:59,121 or the hospital's "charity care." 477 00:16:59,122 --> 00:17:01,248 But we can't afford health-care premiums. 478 00:17:01,249 --> 00:17:04,043 It's unfortunately very common for people 479 00:17:04,044 --> 00:17:05,335 to fall between the cracks. 480 00:17:05,336 --> 00:17:07,463 It's an imperfect system. 481 00:17:07,464 --> 00:17:09,631 Can PTMC help with the costs in any way? 482 00:17:09,632 --> 00:17:12,092 We can offer financial assistance. 483 00:17:12,093 --> 00:17:13,927 You'd pay the same that Medicare 484 00:17:13,928 --> 00:17:15,554 and Medicaid would pay. 485 00:17:15,555 --> 00:17:16,722 How much is that? 486 00:17:16,723 --> 00:17:20,601 You pay 60%, we cover 40%. 487 00:17:20,602 --> 00:17:21,977 Thank you. 488 00:17:21,978 --> 00:17:23,855 Uh-huh. 489 00:17:25,065 --> 00:17:27,107 Where have you been? 490 00:17:27,108 --> 00:17:29,610 - How are you doing? - I'm sorry, mijita. 491 00:17:29,611 --> 00:17:32,738 You were being thoughtful, and I just blew up. 492 00:17:32,739 --> 00:17:35,616 Well, Ms. Noelle was just telling us that the hospital 493 00:17:35,617 --> 00:17:37,326 is gonna give us a big discount. 494 00:17:37,327 --> 00:17:39,995 We can knock 40% off your final bill. 495 00:17:39,996 --> 00:17:41,955 - That's great. - Mm-hmm. 496 00:17:41,956 --> 00:17:43,832 I stay here for a few days, 497 00:17:43,833 --> 00:17:46,086 my bill could be over $100,000, right? 498 00:17:47,754 --> 00:17:49,505 Yes, unfortunately. 499 00:17:49,506 --> 00:17:51,590 It could end up being lower, 500 00:17:51,591 --> 00:17:54,009 depending on your level of needed care. 501 00:17:54,010 --> 00:17:56,011 Or higher? 502 00:17:56,012 --> 00:17:59,973 So we would still have to pay $60,000? 503 00:17:59,974 --> 00:18:01,517 Which we don't have. 504 00:18:01,518 --> 00:18:03,727 He has to stay here to get better, right? 505 00:18:03,728 --> 00:18:06,105 - Yes. - No. 506 00:18:06,106 --> 00:18:07,356 Excuse me? 507 00:18:07,357 --> 00:18:09,566 I mean, not necessarily. 508 00:18:09,567 --> 00:18:12,236 Couldn't we just admit him to med-surg instead of ICU? 509 00:18:12,237 --> 00:18:14,071 Wouldn't that be a lot cheaper? 510 00:18:14,072 --> 00:18:16,198 Med-surg won't accept him with an insulin drip. 511 00:18:16,199 --> 00:18:17,991 Usually true. 512 00:18:17,992 --> 00:18:21,662 But let me talk to the charge nurse upstairs, and I'll... 513 00:18:21,663 --> 00:18:22,830 I'll see what she says. 514 00:18:22,831 --> 00:18:24,332 Thank you. 515 00:18:26,292 --> 00:18:28,335 Food poisoning in the hall's asking to leave, 516 00:18:28,336 --> 00:18:30,379 wants to take her kids to the water park. 517 00:18:30,380 --> 00:18:32,965 Those places are cesspools. 518 00:18:32,966 --> 00:18:34,466 Preaching to the choir. 519 00:18:34,467 --> 00:18:36,051 If she's feeling fine on Zofran, she's good to go. 520 00:18:36,052 --> 00:18:37,511 All right. 521 00:18:37,512 --> 00:18:39,471 Louie's in South 15. Meds are coming down. 522 00:18:39,472 --> 00:18:41,473 Another couple hours of monitoring, and he can broom. 523 00:18:41,474 --> 00:18:42,724 Straight to the liquor store. 524 00:18:42,725 --> 00:18:43,851 Don't pass "go." 525 00:18:43,852 --> 00:18:44,852 What about that clamshell case 526 00:18:44,853 --> 00:18:46,311 that went up... anything? 527 00:18:46,312 --> 00:18:48,313 Out of surgery, in recovery, still sedated. 528 00:18:48,314 --> 00:18:50,190 Good. Keep me posted on that. 529 00:18:50,191 --> 00:18:51,568 Will do. 530 00:18:53,736 --> 00:18:55,070 Three times in one day. 531 00:18:55,071 --> 00:18:56,655 To what do we owe the pleasure? 532 00:18:56,656 --> 00:18:58,365 I came down for a consult 533 00:18:58,366 --> 00:19:00,784 and to persuade Ahmad to start a new betting board. 534 00:19:00,785 --> 00:19:02,369 Why, is the Westbridge board full already? 535 00:19:02,370 --> 00:19:04,413 Mm-hmm, was gonna ask him to start one about you 536 00:19:04,414 --> 00:19:06,707 and your midlife crisis trip. 537 00:19:06,708 --> 00:19:08,709 I give it four weeks. 538 00:19:08,710 --> 00:19:11,253 Seven, tops. 539 00:19:11,254 --> 00:19:12,504 Ye of little faith. 540 00:19:12,505 --> 00:19:15,257 Not about faith, just facts. 541 00:19:15,258 --> 00:19:16,550 Facts? 542 00:19:16,551 --> 00:19:18,468 Based on my experience, you're a seven-week-itch 543 00:19:18,469 --> 00:19:19,928 kind of guy. 544 00:19:19,929 --> 00:19:22,181 Hey, Robby, med student's got a pickleball player 545 00:19:22,182 --> 00:19:24,099 in the North Hall with possible Achilles rupture, 546 00:19:24,100 --> 00:19:25,100 asking for your opinion. 547 00:19:25,101 --> 00:19:26,685 Thank you, Perlah. 548 00:19:26,686 --> 00:19:28,854 At least somebody down here has a little faith in me. 549 00:19:28,855 --> 00:19:31,440 [CHUCKLES] 550 00:19:31,441 --> 00:19:34,193 You know what Motorcycle Mike's sabbatical is really about? 551 00:19:34,194 --> 00:19:37,029 I never try to guess what's going on in that head of his. 552 00:19:37,030 --> 00:19:40,240 Three months being on the open road by himself. 553 00:19:40,241 --> 00:19:42,409 Man can't stand to be alone for more than a few hours. 554 00:19:42,410 --> 00:19:45,454 He sleeps with the TV on in his bedroom. 555 00:19:45,455 --> 00:19:48,291 I really don't think I needed to know that. 556 00:19:49,709 --> 00:19:52,878 Look, maybe he's looking for something new 557 00:19:52,879 --> 00:19:55,797 or trying to outrun some old ghosts. 558 00:19:55,798 --> 00:19:59,092 Well, I hope he finds what he's looking for. 559 00:19:59,093 --> 00:20:01,261 Man deserves some peace. 560 00:20:01,262 --> 00:20:02,638 Amen. 561 00:20:02,639 --> 00:20:05,307 I considered the diagnosis of cauda equina syndrome, 562 00:20:05,308 --> 00:20:07,142 but the motor and sensory exam 563 00:20:07,143 --> 00:20:09,519 were both intact in the sacral nerve root... 564 00:20:09,520 --> 00:20:10,854 Our unhoused cougher has pneumonia. 565 00:20:10,855 --> 00:20:13,732 I'm cursed, fucking cursed. 566 00:20:13,733 --> 00:20:15,234 Fuck. 567 00:20:15,235 --> 00:20:16,985 What? 568 00:20:16,986 --> 00:20:19,404 That is a cavitary lesion in the right upper lobe. 569 00:20:19,405 --> 00:20:21,198 Active TB. 570 00:20:21,199 --> 00:20:23,575 What's next? 571 00:20:23,576 --> 00:20:25,118 AFB stain to confirm, 572 00:20:25,119 --> 00:20:27,663 move her to a negative airflow room, start her on meds. 573 00:20:27,664 --> 00:20:29,790 Call infection control and public health. 574 00:20:29,791 --> 00:20:32,084 And now you get to sign in as a patient 575 00:20:32,085 --> 00:20:34,586 and get your blood drawn for a QuantiFERON Gold. 576 00:20:34,587 --> 00:20:36,588 It's too soon to be positive. 577 00:20:36,589 --> 00:20:37,756 Yeah, but you were exposed. 578 00:20:37,757 --> 00:20:39,341 You need a baseline test 579 00:20:39,342 --> 00:20:42,594 and then again in eight weeks to see if you convert. 580 00:20:42,595 --> 00:20:43,929 And if I do? 581 00:20:43,930 --> 00:20:46,014 Then meds every day for three or four months 582 00:20:46,015 --> 00:20:48,934 with regular blood tests to check for toxicity. 583 00:20:48,935 --> 00:20:50,269 - Jesus. - All right. 584 00:20:50,270 --> 00:20:51,770 Let Dana know what's up. 585 00:20:51,771 --> 00:20:54,815 And for the love of God, mask up when you move her. 586 00:20:54,816 --> 00:20:58,861 [INDISTINCT ANNOUNCEMENT OVER P.A. SYSTEM] 587 00:21:03,283 --> 00:21:05,492 - Dr. Langdon. - Hey, man. Alex. 588 00:21:05,493 --> 00:21:06,661 Let's take a look. 589 00:21:09,247 --> 00:21:12,207 Ah. 590 00:21:12,208 --> 00:21:13,208 Is it bad? 591 00:21:13,209 --> 00:21:14,751 It's not good. 592 00:21:14,752 --> 00:21:17,379 Sorry, your chart says you were burned with dry ice? 593 00:21:17,380 --> 00:21:19,423 - What happened? - My jack-off brother. 594 00:21:19,424 --> 00:21:21,008 Does he not like you? 595 00:21:21,009 --> 00:21:24,636 I asked him to do it, just not like this exactly. 596 00:21:24,637 --> 00:21:26,221 What? Why? 597 00:21:26,222 --> 00:21:27,889 He was gonna brand me like I branded him. 598 00:21:27,890 --> 00:21:29,725 Branded? Like cattle? 599 00:21:29,726 --> 00:21:32,853 Instead of hot branding, you stick the iron in dry ice, 600 00:21:32,854 --> 00:21:35,814 let it get super cold, and then you put it on your skin. 601 00:21:35,815 --> 00:21:37,482 Cool, huh? 602 00:21:37,483 --> 00:21:38,692 [SPEAKING TAGALOG] 603 00:21:38,693 --> 00:21:39,985 Let's get some LET on this. 604 00:21:39,986 --> 00:21:41,696 I'll get some snips to debride. 605 00:21:44,157 --> 00:21:45,824 You good? 606 00:21:45,825 --> 00:21:48,160 Yeah. Yeah, good. 607 00:21:48,161 --> 00:21:49,578 You sure? 608 00:21:49,579 --> 00:21:52,664 Doesn't seem like Robby's all that happy I'm back. 609 00:21:52,665 --> 00:21:55,334 Well, he's not going to be here, 610 00:21:55,335 --> 00:21:57,085 and I'm happy you're back. 611 00:21:57,086 --> 00:21:59,005 Thanks. 612 00:22:03,343 --> 00:22:07,513 Head and neck CT is negative, except for mandible fracture. 613 00:22:08,431 --> 00:22:09,806 OK, let's get him off the board. 614 00:22:09,807 --> 00:22:11,099 Roll him, right side up. 615 00:22:11,100 --> 00:22:12,852 Hey, we're gonna need the cuffs off. 616 00:22:14,062 --> 00:22:15,854 [HANDCUFFS CLATTER] 617 00:22:15,855 --> 00:22:18,690 Ready. And 1, 2, 3. 618 00:22:18,691 --> 00:22:21,068 - Ah, gentle. - [GROANS] 619 00:22:21,069 --> 00:22:22,736 Dr. King, how are the chest and belly? 620 00:22:22,737 --> 00:22:25,989 We have three anterior rib fractures 621 00:22:25,990 --> 00:22:27,908 and a small pulmonary contusion. 622 00:22:27,909 --> 00:22:29,201 - Not too bad. - Mm-mm. 623 00:22:29,202 --> 00:22:30,869 When do pulmonary contusions peak? 624 00:22:30,870 --> 00:22:32,287 After a few hours. 625 00:22:32,288 --> 00:22:33,872 And do we always admit for three-rib fractures? 626 00:22:33,873 --> 00:22:35,207 In the elderly, yes, 627 00:22:35,208 --> 00:22:36,958 but not if a patient can manage the pain 628 00:22:36,959 --> 00:22:38,960 and doesn't need supplemental oxygen. 629 00:22:38,961 --> 00:22:40,212 [GROANS] 630 00:22:40,213 --> 00:22:41,713 OK, he's really hurting here. 631 00:22:41,714 --> 00:22:43,382 You think you could set us up with a serratus anterior 632 00:22:43,383 --> 00:22:44,591 - field block? - No problem. 633 00:22:44,592 --> 00:22:46,718 Oh, as long as that's OK 634 00:22:46,719 --> 00:22:47,886 with Dr. Al-Hashimi. 635 00:22:47,887 --> 00:22:50,055 If the patient consents. 636 00:22:50,056 --> 00:22:53,892 Mr. Varney, we wanna give you a shot to numb your broken ribs 637 00:22:53,893 --> 00:22:55,060 so you can breathe easier. 638 00:22:55,061 --> 00:22:56,311 Uh-huh. 639 00:22:56,312 --> 00:22:57,979 OK, get Mr. Varney prepped and draped. 640 00:22:57,980 --> 00:22:59,564 Dr. Mohan, you're in charge. 641 00:22:59,565 --> 00:23:01,400 Let's identify the landmarks. 642 00:23:01,401 --> 00:23:02,527 Cuffs. 643 00:23:03,861 --> 00:23:05,529 Yeah, you can just leave them off, man. 644 00:23:05,530 --> 00:23:08,448 He's clearly not moving on his own. 645 00:23:08,449 --> 00:23:10,033 We follow protocol, 646 00:23:10,034 --> 00:23:13,412 for his safety and yours. 647 00:23:13,413 --> 00:23:15,122 [PHONE BUZZING] 648 00:23:15,123 --> 00:23:16,790 - Do you need to get that? - [GROANING] 649 00:23:16,791 --> 00:23:19,626 Nope. It's my mom. 650 00:23:19,627 --> 00:23:21,878 Ignore it. Just ignore it. 651 00:23:21,879 --> 00:23:23,713 - Amen, sister. - Forearm is numb. 652 00:23:23,714 --> 00:23:25,006 We can irrigate. 653 00:23:25,007 --> 00:23:26,591 If I ignore a problem for long enough, 654 00:23:26,592 --> 00:23:28,218 it just goes away, right? 655 00:23:28,219 --> 00:23:30,470 I wish I could ignore my deposition. 656 00:23:30,471 --> 00:23:32,764 That, you can't ignore. 657 00:23:32,765 --> 00:23:33,974 But you'll be fine. 658 00:23:33,975 --> 00:23:35,517 What's up with you, Whitaker? 659 00:23:35,518 --> 00:23:37,018 Trouble in roomie land? 660 00:23:37,019 --> 00:23:38,603 No, not really. 661 00:23:38,604 --> 00:23:41,857 I think I overstepped with Dr. Langdon earlier. 662 00:23:41,858 --> 00:23:43,108 Oh. 663 00:23:43,109 --> 00:23:45,777 He was trying to prescribe a patient benzos, 664 00:23:45,778 --> 00:23:48,655 and I told Langdon that it'd be better if I did it. 665 00:23:48,656 --> 00:23:50,115 Oof. 666 00:23:50,116 --> 00:23:52,492 Only because I was already the assigned physician. 667 00:23:52,493 --> 00:23:54,327 But yeah, now I feel like an asshole. 668 00:23:54,328 --> 00:23:55,620 Langdon's fine. 669 00:23:55,621 --> 00:23:57,956 He went to rehab, he's working the steps, 670 00:23:57,957 --> 00:24:02,502 and hopefully it's all behind him. 671 00:24:02,503 --> 00:24:04,212 Place the needle in-plane, 672 00:24:04,213 --> 00:24:06,089 superficial to the serratus anterior, 673 00:24:06,090 --> 00:24:08,341 between it and the latissimus dorsi. 674 00:24:08,342 --> 00:24:09,676 Mm-hmm. 675 00:24:09,677 --> 00:24:11,845 You can see the fluid dissect and diffuse... 676 00:24:11,846 --> 00:24:13,180 Dr. Mohan, we need you. 677 00:24:13,181 --> 00:24:14,806 We've got two more rigs from Westbridge 678 00:24:14,807 --> 00:24:17,017 pulling up right now. 679 00:24:17,018 --> 00:24:18,518 Go. We got this. 680 00:24:18,519 --> 00:24:19,519 Thanks. 681 00:24:19,520 --> 00:24:22,022 How we doing in here? 682 00:24:22,023 --> 00:24:25,650 Spiked a temp to 102, gave Tylenol. 683 00:24:25,651 --> 00:24:27,402 Check out her leg. 684 00:24:27,403 --> 00:24:29,321 That is a definite bulla. 685 00:24:29,322 --> 00:24:30,780 Did surgery come down yet? 686 00:24:30,781 --> 00:24:32,532 - Not yet. - I need surgery? 687 00:24:32,533 --> 00:24:33,658 Page them again. 688 00:24:33,659 --> 00:24:35,410 Surgery would be a last resort. 689 00:24:35,411 --> 00:24:37,746 We would like them to come down and check out your leg 690 00:24:37,747 --> 00:24:40,332 in case we need to remove this infected skin. 691 00:24:40,333 --> 00:24:41,833 I thought it was just a little swelling 692 00:24:41,834 --> 00:24:42,876 'cause I'm on my feet all day. 693 00:24:42,877 --> 00:24:44,753 [MONITOR BEEPS] 694 00:24:44,754 --> 00:24:46,671 BP's down to 85 over 40. 695 00:24:46,672 --> 00:24:48,340 - How much LR is in? - Full bolus. 696 00:24:48,341 --> 00:24:50,008 Do another liter and then start Levophed. 697 00:24:50,009 --> 00:24:51,510 Titrate to a MAP of 65. 698 00:24:51,511 --> 00:24:52,761 [MONITOR BEEPS] 699 00:24:52,762 --> 00:24:54,346 Can someone please tell me what's going on? 700 00:24:54,347 --> 00:24:55,388 Pulse ox down to 89. 701 00:24:55,389 --> 00:24:56,890 100% non-rebreather. 702 00:24:56,891 --> 00:24:59,935 Sometimes an infection can cause your blood pressure 703 00:24:59,936 --> 00:25:02,854 to drop and lower the amount of oxygen in your blood. 704 00:25:02,855 --> 00:25:04,022 Am I gonna be OK? 705 00:25:04,023 --> 00:25:05,232 We're doing everything that we can 706 00:25:05,233 --> 00:25:06,525 to make sure that you are. 707 00:25:06,526 --> 00:25:07,777 Jesse. 708 00:25:10,154 --> 00:25:11,530 What's up? 709 00:25:11,531 --> 00:25:12,864 Be ready to intubate if you need to. 710 00:25:12,865 --> 00:25:14,366 - You want me to call Langdon? - No. 711 00:25:14,367 --> 00:25:15,951 I will be right back, and you can call surgery 712 00:25:15,952 --> 00:25:17,661 and tell them to get their heads out of their asses 713 00:25:17,662 --> 00:25:19,288 and get down here. 714 00:25:27,797 --> 00:25:29,214 Did you bring Langdon back here? 715 00:25:29,215 --> 00:25:30,966 No, Al-Hashimi did. 716 00:25:30,967 --> 00:25:32,342 You banished him to scut purgatory. 717 00:25:32,343 --> 00:25:33,510 He did everything you would've done 718 00:25:33,511 --> 00:25:35,136 with that cellulitis patient. 719 00:25:35,137 --> 00:25:36,638 If you think he missed something, tell him. 720 00:25:36,639 --> 00:25:38,223 Well, we're probably gonna need to intubate. 721 00:25:38,224 --> 00:25:39,808 We're definitely gonna need an ICU bed. 722 00:25:39,809 --> 00:25:41,059 What happened? 723 00:25:41,060 --> 00:25:43,228 She is in septic shock, on pressors. 724 00:25:43,229 --> 00:25:45,063 Open shoulder dislocation is back. 725 00:25:45,064 --> 00:25:46,898 Westbridge shut down all their ORs, so they told us 726 00:25:46,899 --> 00:25:48,733 - to bring them back here. - You joking? 727 00:25:48,734 --> 00:25:49,734 This ain't the Radisson. 728 00:25:49,735 --> 00:25:50,902 Not my problem. 729 00:25:50,903 --> 00:25:52,445 - Where should we park him? - Grab a wall. 730 00:25:52,446 --> 00:25:53,905 Call Noelle. Call ortho. 731 00:25:53,906 --> 00:25:55,156 Call the OR and tell them we got a patient back 732 00:25:55,157 --> 00:25:56,741 that needs surgery and admission. 733 00:25:56,742 --> 00:25:58,743 Hey, so sorry about this ambulance tour 734 00:25:58,744 --> 00:26:00,745 of Allegheny County, Mr. Billings, 735 00:26:00,746 --> 00:26:02,330 but we got you from here, I promise. 736 00:26:02,331 --> 00:26:03,748 Yeah, I'm starving. 737 00:26:03,749 --> 00:26:05,250 Is there any way I can get something to eat? 738 00:26:05,251 --> 00:26:07,043 Sorry, not before surgery. 739 00:26:07,044 --> 00:26:08,295 Can I have a visitor? 740 00:26:08,296 --> 00:26:09,796 Sure. 741 00:26:09,797 --> 00:26:11,590 Any word from Gloria about what's going on at Westbridge? 742 00:26:11,591 --> 00:26:13,216 Radio silence from the ivory tower. 743 00:26:13,217 --> 00:26:14,884 And the charge nurse over there isn't responding. 744 00:26:14,885 --> 00:26:16,511 Must be bad. 745 00:26:16,512 --> 00:26:17,887 I wonder if it's something that security needs to know about. 746 00:26:17,888 --> 00:26:19,389 I'll keep you posted. 747 00:26:19,390 --> 00:26:21,182 Hey, you're kind of buds with Gloria. 748 00:26:21,183 --> 00:26:22,475 Did she say anything to you about what's 749 00:26:22,476 --> 00:26:24,227 - happening at Westbridge? - No. You? 750 00:26:24,228 --> 00:26:26,771 Nope. How are your patients? 751 00:26:26,772 --> 00:26:29,190 Our prisoner, Gus, has stable injuries, 752 00:26:29,191 --> 00:26:31,401 and our law student in Central 10 is awake, 753 00:26:31,402 --> 00:26:33,612 normal LP, and awaiting a psych consult. 754 00:26:33,613 --> 00:26:34,946 Good. 755 00:26:34,947 --> 00:26:36,615 Quicker we can treat 'em, street 'em, move 'em 756 00:26:36,616 --> 00:26:38,116 up the food chain, the better. 757 00:26:38,117 --> 00:26:40,160 Question. 758 00:26:40,161 --> 00:26:44,456 Why are you treating me like one of your residents? 759 00:26:44,457 --> 00:26:45,624 I'm not. 760 00:26:45,625 --> 00:26:47,459 As the attending, I like to know the status 761 00:26:47,460 --> 00:26:49,169 of all the patients and doctors in the ED 762 00:26:49,170 --> 00:26:51,463 in case I need to jump in quickly. 763 00:26:51,464 --> 00:26:52,464 Makes sense. 764 00:26:52,465 --> 00:26:54,883 Now your turn. 765 00:26:54,884 --> 00:26:56,217 What? 766 00:26:56,218 --> 00:26:58,345 As your fellow attending in our ED, 767 00:26:58,346 --> 00:27:00,138 it only makes sense for me to know the status 768 00:27:00,139 --> 00:27:02,223 of all the patients and all the doctors 769 00:27:02,224 --> 00:27:05,810 in case I need to jump in on a moment's notice. 770 00:27:05,811 --> 00:27:07,271 Touché. 771 00:27:09,940 --> 00:27:12,567 You have a non-displaced fracture, distal tibia. 772 00:27:12,568 --> 00:27:14,736 So if you look at the bone here, it's pretty well aligned. 773 00:27:14,737 --> 00:27:16,112 Sorry. Hi. 774 00:27:16,113 --> 00:27:18,490 Hi, I was in the shower, and I came as soon 775 00:27:18,491 --> 00:27:19,616 as I got Paul's message. 776 00:27:19,617 --> 00:27:21,242 - Lena? - Hi. 777 00:27:21,243 --> 00:27:23,119 What happened? 778 00:27:23,120 --> 00:27:24,579 I had a seizure. 779 00:27:24,580 --> 00:27:26,206 You load her with Keppra? 780 00:27:26,207 --> 00:27:27,582 Yeah. 781 00:27:27,583 --> 00:27:29,584 Yeah, she's back to baseline mental status. 782 00:27:29,585 --> 00:27:31,836 I'm sorry, I'm confused. Aren't you off duty? 783 00:27:31,837 --> 00:27:35,006 - I'm Roxie's death doula. - Oh. 784 00:27:35,007 --> 00:27:36,716 Her... her what? 785 00:27:36,717 --> 00:27:38,718 I help advocate for people like Roxie 786 00:27:38,719 --> 00:27:41,721 to make their transition to death a more peaceful process. 787 00:27:41,722 --> 00:27:44,724 It's like a birth doula but for the end of life. 788 00:27:44,725 --> 00:27:48,353 She's been a real lifesaver for our family. 789 00:27:48,354 --> 00:27:51,189 My husband cracking jokes while I'm dying. 790 00:27:51,190 --> 00:27:52,941 See why I married him? 791 00:27:52,942 --> 00:27:54,776 Whatever you have to say about my condition, 792 00:27:54,777 --> 00:27:56,695 you can share with Lena too. 793 00:27:56,696 --> 00:27:58,697 We were just explaining that Roxie 794 00:27:58,698 --> 00:28:01,866 has a pathological fracture through a metastatic lesion. 795 00:28:01,867 --> 00:28:03,368 Can you fix that? 796 00:28:03,369 --> 00:28:06,204 The bones are well aligned, so she won't need surgery. 797 00:28:06,205 --> 00:28:07,706 The treatment is immobilization 798 00:28:07,707 --> 00:28:08,873 and a long leg boot. 799 00:28:08,874 --> 00:28:10,583 Oh! 800 00:28:10,584 --> 00:28:12,127 Maybe we up her pain meds. 801 00:28:12,128 --> 00:28:13,670 Yeah, sure. 802 00:28:13,671 --> 00:28:15,046 We can do that. 803 00:28:15,047 --> 00:28:17,340 The bones should heal in about six weeks. 804 00:28:17,341 --> 00:28:19,927 If I live that long. 805 00:28:21,804 --> 00:28:22,846 Still numb here? 806 00:28:22,847 --> 00:28:24,431 Yeah, bro. 807 00:28:24,432 --> 00:28:26,766 Great. 808 00:28:26,767 --> 00:28:28,643 You think it's gonna leave a scar? 809 00:28:28,644 --> 00:28:32,689 I don't think it. I know it. 810 00:28:32,690 --> 00:28:34,482 Holy shit. 811 00:28:34,483 --> 00:28:36,025 Fuck are you doing here? 812 00:28:36,026 --> 00:28:37,026 I'm sorry, who are you? 813 00:28:37,027 --> 00:28:38,153 Concerned brother. 814 00:28:38,154 --> 00:28:40,655 That looks not too bad. 815 00:28:40,656 --> 00:28:42,031 You gooning me? 816 00:28:42,032 --> 00:28:43,658 Yeah, it's nasty. 817 00:28:43,659 --> 00:28:45,076 Thanks to you. 818 00:28:45,077 --> 00:28:46,244 You did this? 819 00:28:46,245 --> 00:28:47,645 Oh, yeah. You wanna see the video? 820 00:28:49,790 --> 00:28:51,750 - Yes. - Definitely. 821 00:28:51,751 --> 00:28:53,169 Got you. 822 00:28:54,420 --> 00:28:56,921 All right. All right, get in close. 823 00:28:56,922 --> 00:28:58,590 Brothers unite! 824 00:28:58,591 --> 00:29:00,258 - Ooh! - Ooh! 825 00:29:00,259 --> 00:29:02,093 Dude, why in the world 826 00:29:02,094 --> 00:29:03,762 would you ask to have that done to you? 827 00:29:03,763 --> 00:29:07,349 He was trying to brand me with our family crest. 828 00:29:09,685 --> 00:29:11,936 Your family crest is the Penguins logo? 829 00:29:11,937 --> 00:29:13,688 We were gonna be bonded for life. 830 00:29:13,689 --> 00:29:15,523 You already are, with DNA. 831 00:29:15,524 --> 00:29:16,691 Yeah. 832 00:29:16,692 --> 00:29:18,234 I love you, man. 833 00:29:18,235 --> 00:29:20,069 - I'm real sorry. - It's OK. 834 00:29:20,070 --> 00:29:23,740 Doc said it's gonna take some time, but it'll heal OK. 835 00:29:23,741 --> 00:29:25,283 Awesome. 836 00:29:25,284 --> 00:29:27,076 So maybe we can try again in a couple of months or... 837 00:29:27,077 --> 00:29:28,537 BOTH: No. 838 00:29:29,955 --> 00:29:31,665 OK, bag her. 839 00:29:33,667 --> 00:29:35,126 Yellow on the end-tidal. 840 00:29:35,127 --> 00:29:36,878 - Sorry, got backed up. - Sounds a little wet. 841 00:29:36,879 --> 00:29:38,004 Someone asked for a surgical consult? 842 00:29:38,005 --> 00:29:39,255 That's because all the fluid. 843 00:29:39,256 --> 00:29:40,673 TKO the lines for now. 844 00:29:40,674 --> 00:29:43,009 Vent settings 50%, tidal volume 500, AC 12? 845 00:29:43,010 --> 00:29:44,385 Yep, that's perfect. 846 00:29:44,386 --> 00:29:45,720 Surgery here. Hello. 847 00:29:45,721 --> 00:29:47,305 Hey, it's about time. Where's Garcia? 848 00:29:47,306 --> 00:29:49,140 Stuck in the ER. She sent me down. What you got? 849 00:29:49,141 --> 00:29:50,642 Septic shock, respiratory failure, 850 00:29:50,643 --> 00:29:52,310 and possible necrotizing fasciitis. 851 00:29:52,311 --> 00:29:54,020 She needs to go to the OR ASAP. 852 00:29:54,021 --> 00:29:56,314 The infection was isolated to the dorsum of the foot 853 00:29:56,315 --> 00:29:57,899 five hours ago, but now we're almost to the knee 854 00:29:57,900 --> 00:29:59,567 with bullae, crepitus, and edema. 855 00:29:59,568 --> 00:30:01,236 - Yeah. - You seen nec fasc before? 856 00:30:01,237 --> 00:30:02,487 In a textbook. 857 00:30:02,488 --> 00:30:04,656 I was a med student two weeks ago. 858 00:30:04,657 --> 00:30:06,491 [CAMERA SHUTTER SNAPPING] 859 00:30:06,492 --> 00:30:09,035 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 860 00:30:09,036 --> 00:30:10,703 Go get anybody else from your service down here... 861 00:30:10,704 --> 00:30:11,996 Shamsi, Miller, Walsh... 862 00:30:11,997 --> 00:30:13,164 I don't know any of this people, but... 863 00:30:13,165 --> 00:30:14,499 Don't take this personally. 864 00:30:14,500 --> 00:30:17,544 I just need a fucking grown-up down here. 865 00:30:17,545 --> 00:30:19,504 Nice job on the sub-Qs. 866 00:30:19,505 --> 00:30:21,256 Really took the tension off the wound. 867 00:30:21,257 --> 00:30:22,340 Thanks. 868 00:30:22,341 --> 00:30:24,008 I can help with the skin layer. 869 00:30:24,009 --> 00:30:26,011 Four hands are faster than two. 870 00:30:28,430 --> 00:30:29,848 - Whoa. - Whoa. 871 00:30:29,849 --> 00:30:32,183 That just tore right through the skin. 872 00:30:32,184 --> 00:30:33,518 You may need to take bigger bites 873 00:30:33,519 --> 00:30:35,228 farther away from the wound edges. 874 00:30:35,229 --> 00:30:37,564 Yep. 875 00:30:37,565 --> 00:30:40,901 Skin seems pretty fragile. 876 00:30:44,989 --> 00:30:46,447 Oh. 877 00:30:46,448 --> 00:30:48,116 Yeah, this is not working. 878 00:30:48,117 --> 00:30:50,076 He has the skin strength of an 80-year-old. 879 00:30:50,077 --> 00:30:52,245 Put down Steri-Strips with benzoin, 880 00:30:52,246 --> 00:30:55,540 not across the wound but along each wound edge, both sides. 881 00:30:55,541 --> 00:30:57,083 It'll hold the sutures. 882 00:30:57,084 --> 00:31:00,545 - Yup. - What say you, Dr. Robby? 883 00:31:00,546 --> 00:31:02,547 Great. MacGyver move. 884 00:31:02,548 --> 00:31:05,425 Go for it. 885 00:31:05,426 --> 00:31:09,220 Does a Dr. MacGyver work here? 886 00:31:09,221 --> 00:31:11,723 I don't know. 887 00:31:11,724 --> 00:31:13,641 The patient symptoms are consistent with lumbar 888 00:31:13,642 --> 00:31:17,604 radiculopathy at L4, L5, most likely due to disc herniation. 889 00:31:17,605 --> 00:31:19,105 Coughing patient admitted to isolation 890 00:31:19,106 --> 00:31:21,065 for verified medication administration 891 00:31:21,066 --> 00:31:22,442 and started on RIPE therapy. 892 00:31:22,443 --> 00:31:23,985 Yeah, why do I even bother? 893 00:31:23,986 --> 00:31:25,028 Just fail me now. 894 00:31:25,029 --> 00:31:26,195 OK. 895 00:31:26,196 --> 00:31:27,697 Get in touch with a social worker. 896 00:31:27,698 --> 00:31:29,198 They're gonna wanna do contact tracing 897 00:31:29,199 --> 00:31:31,034 and help her figure out transitional housing 898 00:31:31,035 --> 00:31:32,410 for when she's discharged. 899 00:31:32,411 --> 00:31:33,745 Got it. 900 00:31:33,746 --> 00:31:35,705 And make sure infection control responded. 901 00:31:35,706 --> 00:31:37,165 The people in the waiting room could have been exposed. 902 00:31:37,166 --> 00:31:40,501 They need to be notified and tested. 903 00:31:40,502 --> 00:31:41,753 OK. 904 00:31:41,754 --> 00:31:44,672 - [COUGHS] - Relax. 905 00:31:44,673 --> 00:31:46,925 You can take the mask off. You don't have TB. 906 00:31:46,926 --> 00:31:50,094 At least not yet. 907 00:31:50,095 --> 00:31:52,639 Oh, great. 908 00:31:52,640 --> 00:31:55,600 This is fucked up. 909 00:31:55,601 --> 00:31:57,852 How are you so calm? 910 00:31:57,853 --> 00:31:59,520 Expected job hazard. 911 00:31:59,521 --> 00:32:00,772 You get used to it. 912 00:32:00,773 --> 00:32:02,357 Yeah, no, thanks. 913 00:32:02,358 --> 00:32:04,943 70% of doctors in training at urban hospitals 914 00:32:04,944 --> 00:32:07,278 get exposed to TB and wind up on meds. 915 00:32:07,279 --> 00:32:09,614 - Jesus. - Mm-hmm. 916 00:32:09,615 --> 00:32:11,991 They don't teach you that in med school. 917 00:32:11,992 --> 00:32:14,160 Mrs. Randolph's back. 918 00:32:14,161 --> 00:32:16,037 Pulled up her X-ray. 919 00:32:16,038 --> 00:32:17,205 OK. 920 00:32:17,206 --> 00:32:19,332 No volvulus, no air fluid levels. 921 00:32:19,333 --> 00:32:21,918 What do you think of this? 922 00:32:21,919 --> 00:32:24,003 Fecal material? 923 00:32:24,004 --> 00:32:25,713 A shit ton. 924 00:32:25,714 --> 00:32:27,340 Sorry, had to be said. 925 00:32:27,341 --> 00:32:28,925 So, what, she needs an enema? 926 00:32:28,926 --> 00:32:30,510 No. Tried and failed, remember? 927 00:32:30,511 --> 00:32:31,511 Yeah. 928 00:32:31,512 --> 00:32:33,179 Time to dig in. 929 00:32:33,180 --> 00:32:34,806 How are we gonna do that? 930 00:32:34,807 --> 00:32:38,769 Oh, there is no "we" in disimpaction. 931 00:32:43,691 --> 00:32:45,942 I haven't done one before. 932 00:32:45,943 --> 00:32:48,903 Shouldn't I observe first? 933 00:32:48,904 --> 00:32:51,490 I know just the guy to teach you. 934 00:33:00,708 --> 00:33:03,543 I spoke to the charge nurse in med-surg. 935 00:33:03,544 --> 00:33:04,836 They can take Orlando today. 936 00:33:04,837 --> 00:33:06,671 - Yes! - That's wonderful. 937 00:33:06,672 --> 00:33:08,214 They know he's on an insulin drip? 938 00:33:08,215 --> 00:33:10,758 They know, and they can change to a SQUID protocol. 939 00:33:10,759 --> 00:33:11,759 SQUID? 940 00:33:11,760 --> 00:33:13,511 Sub-Q insulin in DKA. 941 00:33:13,512 --> 00:33:15,221 So no IV drip? 942 00:33:15,222 --> 00:33:18,016 Just shots of short-acting insulin every four hours prn. 943 00:33:18,017 --> 00:33:21,436 The med-surg nurses have time to check a glucose every hour? 944 00:33:21,437 --> 00:33:22,437 They say so. 945 00:33:22,438 --> 00:33:24,480 And five days on med-surge 946 00:33:24,481 --> 00:33:28,234 is gonna cut your hospital bill down by 2/3. 947 00:33:28,235 --> 00:33:30,111 OK. 948 00:33:30,112 --> 00:33:31,988 So what's that gonna cost? 949 00:33:31,989 --> 00:33:33,406 Well, I can't give you an exact amount, 950 00:33:33,407 --> 00:33:35,491 but roughly $35,000. 951 00:33:35,492 --> 00:33:38,619 So after about 40%, I'll still have to pay, 952 00:33:38,620 --> 00:33:40,455 what, like, 20 grand? 953 00:33:40,456 --> 00:33:42,707 The hospital can work out a payment plan. 954 00:33:42,708 --> 00:33:44,417 Orlando, we'll be OK. 955 00:33:44,418 --> 00:33:45,960 We'll figure it out. 956 00:33:45,961 --> 00:33:48,421 I'll take on extra shifts at the coffee shop. 957 00:33:48,422 --> 00:33:51,424 We got you, Dad. 958 00:33:51,425 --> 00:33:54,635 Let's give you some private time with your family. 959 00:33:54,636 --> 00:33:57,138 Thanks. 960 00:33:57,139 --> 00:33:58,765 Sorry. Thank you. 961 00:33:58,766 --> 00:34:00,391 I was worried he might bail. 962 00:34:00,392 --> 00:34:01,601 My pleasure. 963 00:34:01,602 --> 00:34:03,311 The real thanks goes to the newbie here 964 00:34:03,312 --> 00:34:05,022 for thinking outside the box. 965 00:34:07,733 --> 00:34:09,650 Sorry I doubted your med-surg pitch. 966 00:34:09,651 --> 00:34:11,235 Oh, no sweat. 967 00:34:11,236 --> 00:34:13,446 How'd you think of that? 968 00:34:13,447 --> 00:34:16,115 My family had to think of a lot of creative ways 969 00:34:16,116 --> 00:34:19,160 to help my uninsured grandma. 970 00:34:19,161 --> 00:34:20,745 Leukemia. 971 00:34:20,746 --> 00:34:24,082 System doesn't work for you, you gotta work the system. 972 00:34:24,083 --> 00:34:26,292 She survive? 973 00:34:26,293 --> 00:34:28,503 For a while, till she didn't. 974 00:34:28,504 --> 00:34:30,963 She died before my freshman year in college. 975 00:34:30,964 --> 00:34:33,299 Sorry. 976 00:34:33,300 --> 00:34:35,468 Her death taught me a lot. 977 00:34:35,469 --> 00:34:38,388 Mainly that I don't wanna be around people dying. 978 00:34:40,224 --> 00:34:42,892 So they got her, and we can get out of here soon? 979 00:34:42,893 --> 00:34:44,352 Yeah. Oh, I think so. 980 00:34:44,353 --> 00:34:45,770 - I think so, yeah. - OK. 981 00:34:45,771 --> 00:34:49,023 Hi. 982 00:34:49,024 --> 00:34:51,609 Morphine PCA looks ready to go. 983 00:34:51,610 --> 00:34:53,611 This should do the trick. 984 00:34:53,612 --> 00:34:55,029 Do you notice a difference? 985 00:34:55,030 --> 00:34:56,030 Better. 986 00:34:56,031 --> 00:34:58,533 Oh, great. Great. 987 00:34:58,534 --> 00:35:00,284 How does this thing work? 988 00:35:00,285 --> 00:35:02,703 There's a baseline rate of morphine. 989 00:35:02,704 --> 00:35:04,789 And if you're having pain, you can push this button. 990 00:35:04,790 --> 00:35:05,790 You'll get some extra. 991 00:35:05,791 --> 00:35:07,125 And you can push for another dose 992 00:35:07,126 --> 00:35:08,543 every 10 minutes if needed. 993 00:35:08,544 --> 00:35:10,754 Your very own morphine butler. 994 00:35:13,298 --> 00:35:14,465 Amazing. 995 00:35:14,466 --> 00:35:16,008 She can go home with this? 996 00:35:16,009 --> 00:35:17,552 Yeah. 997 00:35:17,553 --> 00:35:19,679 Though you'll need more equipment for the house 998 00:35:19,680 --> 00:35:21,889 now that she can't bear weight on her leg. 999 00:35:21,890 --> 00:35:23,808 OK. Like what? 1000 00:35:23,809 --> 00:35:27,979 A wheelchair to go to the bathroom, a shower chair, 1001 00:35:27,980 --> 00:35:30,189 wall bars, if you don't already have them. 1002 00:35:30,190 --> 00:35:33,317 And a hospital bed could be helpful too. 1003 00:35:33,318 --> 00:35:34,652 How do we get all that? 1004 00:35:34,653 --> 00:35:36,529 You don't. I do. 1005 00:35:36,530 --> 00:35:38,406 I will get everything so that the two of you 1006 00:35:38,407 --> 00:35:40,616 can get out of here and back to the kids. 1007 00:35:40,617 --> 00:35:42,744 - At home. - Thank you. 1008 00:35:49,793 --> 00:35:51,752 Nice of you to join us, Huckleberry. 1009 00:35:51,753 --> 00:35:53,045 What do you need? 1010 00:35:53,046 --> 00:35:54,840 Some help with a disimpaction. 1011 00:35:56,675 --> 00:35:58,718 That is a med student procedure. 1012 00:35:58,719 --> 00:36:00,178 Oh, you know the old adage... 1013 00:36:00,179 --> 00:36:02,388 see one, do one, teach one. 1014 00:36:02,389 --> 00:36:04,682 Say hello to teaching young Ogilvie here. 1015 00:36:04,683 --> 00:36:07,351 [SIGHS] OK. 1016 00:36:07,352 --> 00:36:09,437 - Double glove, Ogilvie. - All right. 1017 00:36:09,438 --> 00:36:10,938 Mrs. Randolph, we're going to need 1018 00:36:10,939 --> 00:36:13,566 to manually unblock your rectum so that we can 1019 00:36:13,567 --> 00:36:15,067 get your bowels moving again. 1020 00:36:15,068 --> 00:36:16,068 I know. 1021 00:36:16,069 --> 00:36:18,863 Here we go. 1022 00:36:18,864 --> 00:36:21,949 Mrs. Randolph, I would like you to relax 1023 00:36:21,950 --> 00:36:24,869 like you're having a bowel movement. 1024 00:36:24,870 --> 00:36:27,455 Nice and deep. 1025 00:36:27,456 --> 00:36:29,749 [CLEARS THROAT] OK. 1026 00:36:29,750 --> 00:36:33,961 Curve the finger like an ice cream scoop. 1027 00:36:33,962 --> 00:36:38,591 And bring it out. 1028 00:36:38,592 --> 00:36:40,385 You're up, Ogilvie. 1029 00:36:44,640 --> 00:36:46,849 Some more pressure, Mrs. Randolph. 1030 00:36:46,850 --> 00:36:48,352 I'm ready. 1031 00:36:52,481 --> 00:36:55,066 [INHALES SHARPLY] 1032 00:36:55,067 --> 00:36:59,195 And here I thought you weren't a quick study. 1033 00:36:59,196 --> 00:37:01,113 Keep going. 1034 00:37:01,114 --> 00:37:03,324 Mrs. Randolph, in order to prevent this 1035 00:37:03,325 --> 00:37:04,742 from happening again, I think you 1036 00:37:04,743 --> 00:37:06,327 need a better stool softener. 1037 00:37:06,328 --> 00:37:07,912 You can try MiraLAX. 1038 00:37:07,913 --> 00:37:10,414 Just a tablespoon with a big glass of water every morning 1039 00:37:10,415 --> 00:37:11,415 should do the trick. 1040 00:37:11,416 --> 00:37:12,625 OK. 1041 00:37:12,626 --> 00:37:14,002 [FLATULENCE] 1042 00:37:14,836 --> 00:37:15,836 Oh. 1043 00:37:15,837 --> 00:37:17,421 Sorry. 1044 00:37:17,422 --> 00:37:18,589 Passing gas is good. 1045 00:37:18,590 --> 00:37:20,299 Means we're making progress. 1046 00:37:20,300 --> 00:37:22,009 Does that mean that I can... I can stop? 1047 00:37:22,010 --> 00:37:23,804 No. Nope. Keep going. 1048 00:37:26,098 --> 00:37:28,808 [STOMACH RUMBLING] 1049 00:37:28,809 --> 00:37:32,061 OK, Ogilvie, you... you might wanna... 1050 00:37:32,062 --> 00:37:33,814 Oh! 1051 00:37:34,773 --> 00:37:37,650 [SIGHS] 1052 00:37:37,651 --> 00:37:39,194 Much better. 1053 00:37:40,195 --> 00:37:42,196 MAP's holding on Levophed. 1054 00:37:42,197 --> 00:37:44,156 1 mike per kg per minute. 1055 00:37:44,157 --> 00:37:45,366 Do me a favor. 1056 00:37:45,367 --> 00:37:46,575 Give me some 4x4s on some Betadine. 1057 00:37:46,576 --> 00:37:47,868 Sorry, we're getting killed 1058 00:37:47,869 --> 00:37:49,287 with transfers from Westbridge. 1059 00:37:49,288 --> 00:37:51,455 Mesenteric ischemia, perforated bowel. 1060 00:37:51,456 --> 00:37:52,456 Got a hot one here. 1061 00:37:52,457 --> 00:37:53,457 Yeah. 1062 00:37:53,458 --> 00:37:54,583 Possible nec fasc. 1063 00:37:54,584 --> 00:37:55,960 Possible? 1064 00:37:55,961 --> 00:37:57,336 Need CT with contrast to confirm. 1065 00:37:57,337 --> 00:37:59,046 This is spreading like wildfire. 1066 00:37:59,047 --> 00:38:00,423 By the time you get your CT, it's gonna be up to her waist. 1067 00:38:00,424 --> 00:38:01,507 She's gonna need a hemicorporectomy. 1068 00:38:01,508 --> 00:38:02,842 She needs a CT scan. 1069 00:38:02,843 --> 00:38:05,511 How about a stainless steel scan? 1070 00:38:05,512 --> 00:38:07,722 For Christ's sake. Robinavitch! 1071 00:38:07,723 --> 00:38:11,183 Robby, what the fuck are you doing? 1072 00:38:11,184 --> 00:38:12,893 Oh, God, I think I might puke. 1073 00:38:12,894 --> 00:38:15,354 That's called dirty dishwater exudate without purulence. 1074 00:38:15,355 --> 00:38:17,565 There's a gray appearance to the fascia, and in the OR, 1075 00:38:17,566 --> 00:38:19,817 you'll see easy separation in the tissue planes. 1076 00:38:19,818 --> 00:38:21,152 When do you start your sabbatical? 1077 00:38:21,153 --> 00:38:22,862 - Tomorrow. - Not a moment too soon. 1078 00:38:22,863 --> 00:38:24,823 Thanks for coming down. 1079 00:38:27,993 --> 00:38:31,579 I'm catching up on my charting as fast as I can. 1080 00:38:31,580 --> 00:38:34,457 Why don't you give my generative AI app a try? 1081 00:38:34,458 --> 00:38:36,959 It's 30% more efficient, and providers report 1082 00:38:36,960 --> 00:38:38,836 increased job satisfaction. 1083 00:38:38,837 --> 00:38:41,839 And you'll rarely have to stay overtime to complete charts. 1084 00:38:41,840 --> 00:38:43,591 Yeah? 1085 00:38:43,592 --> 00:38:44,884 OK. 1086 00:38:44,885 --> 00:38:46,469 Yeah, I'm usually here at least a couple hours 1087 00:38:46,470 --> 00:38:48,346 after every shift trying to catch up, so... 1088 00:38:48,347 --> 00:38:50,765 Sure, AI will make doctors more efficient, 1089 00:38:50,766 --> 00:38:53,059 but hospitals will expect us to treat more patients 1090 00:38:53,060 --> 00:38:55,061 without any extra pay, of course, 1091 00:38:55,062 --> 00:38:56,854 all the while eliminating staff positions 1092 00:38:56,855 --> 00:38:58,564 for attending and residents. 1093 00:38:58,565 --> 00:39:00,149 Oh, Dr. Robby, I am not an advocate 1094 00:39:00,150 --> 00:39:02,276 for erasing my own profession. 1095 00:39:02,277 --> 00:39:05,780 But I am advocating for getting to spend more time with my son. 1096 00:39:05,781 --> 00:39:08,741 Nothing can replace family. 1097 00:39:08,742 --> 00:39:10,743 What's the status of your septic patient? 1098 00:39:10,744 --> 00:39:13,537 Nec fasc. Surgery's taking her up. 1099 00:39:13,538 --> 00:39:16,082 Think they'll be able to save her leg? 1100 00:39:16,083 --> 00:39:18,042 Right now, I'm just hoping they can save her life. 1101 00:39:18,043 --> 00:39:20,628 Hey, how's Ogilvie doing? 1102 00:39:20,629 --> 00:39:24,465 A little TB exposure, a touch of ass-plosion. 1103 00:39:24,466 --> 00:39:26,592 All in all, pretty good day so far. 1104 00:39:26,593 --> 00:39:27,885 Kaison, you came. 1105 00:39:27,886 --> 00:39:29,428 Hey, ain't no way I was gonna let you 1106 00:39:29,429 --> 00:39:31,389 miss Peter and Aubrey's epic Fourth of July party. 1107 00:39:31,390 --> 00:39:33,557 Come on, now. Hey. 1108 00:39:33,558 --> 00:39:35,226 Brought some brew. 1109 00:39:35,227 --> 00:39:36,602 Oh, you are the man. 1110 00:39:36,603 --> 00:39:38,062 Appreciate the bromance over here, 1111 00:39:38,063 --> 00:39:40,398 but no food 'cause you might go into surgery. 1112 00:39:40,399 --> 00:39:43,026 And no beer 'cause we're a goddamn hospital. 1113 00:39:46,613 --> 00:39:48,823 Starting your sabbatical early? 1114 00:39:48,824 --> 00:39:50,658 I know someone who could really use a drink right now. 1115 00:39:50,659 --> 00:39:51,951 In the hospital? 1116 00:39:51,952 --> 00:39:54,413 As a parting gift. 1117 00:39:58,417 --> 00:40:00,042 How's it looking? 1118 00:40:00,043 --> 00:40:01,293 Good. 1119 00:40:01,294 --> 00:40:03,254 The Steri-Strips did the trick. 1120 00:40:03,255 --> 00:40:04,380 CT's ready. 1121 00:40:04,381 --> 00:40:06,006 We already scanned him. 1122 00:40:06,007 --> 00:40:08,426 Head and neck want thin cuts and a 3D reconstruction 1123 00:40:08,427 --> 00:40:10,428 of the mandible before they decide 1124 00:40:10,429 --> 00:40:11,846 if Mr. Varney needs surgery. 1125 00:40:11,847 --> 00:40:13,764 Have they even come down to examine him in person? 1126 00:40:13,765 --> 00:40:15,349 No, they must be backed up. 1127 00:40:15,350 --> 00:40:19,145 Or there's a July Fourth sale at the BMW dealership. 1128 00:40:19,146 --> 00:40:20,438 Labs are back. 1129 00:40:20,439 --> 00:40:22,273 Albumin's low. Total protein's low. 1130 00:40:22,274 --> 00:40:23,858 He also has megaloblastic anemia. 1131 00:40:23,859 --> 00:40:25,109 - Malnutrition. - Probably. 1132 00:40:25,110 --> 00:40:26,277 Jail cuisine. 1133 00:40:26,278 --> 00:40:27,653 Whitaker, what labs should we add? 1134 00:40:27,654 --> 00:40:29,780 B12, folate, iron levels. 1135 00:40:29,781 --> 00:40:31,282 Good. 1136 00:40:31,283 --> 00:40:32,950 We're gonna run some more tests, Mr. Varney. 1137 00:40:32,951 --> 00:40:34,286 Hang in there. 1138 00:40:38,874 --> 00:40:41,375 I have to pee. 1139 00:40:41,376 --> 00:40:42,835 There's no PureWick here. 1140 00:40:42,836 --> 00:40:44,086 But here you go, hon. 1141 00:40:44,087 --> 00:40:46,046 - I'll help you get on. - No. No. 1142 00:40:46,047 --> 00:40:48,466 No bedpan. I can walk to the bathroom. 1143 00:40:48,467 --> 00:40:50,134 - I just need a little help. - Are you sure? 1144 00:40:50,135 --> 00:40:51,218 I'm here, babe. 1145 00:40:51,219 --> 00:40:52,720 Oh, we got this Mr. Hamler. 1146 00:40:52,721 --> 00:40:55,973 You'll have to bring your IV and portable oxygen. 1147 00:40:55,974 --> 00:40:57,975 Please? 1148 00:40:57,976 --> 00:41:00,394 I'll grab a wheelchair. 1149 00:41:00,395 --> 00:41:02,354 Let's try to sit you up and dangle your legs. 1150 00:41:02,355 --> 00:41:03,857 OK. 1151 00:41:06,526 --> 00:41:09,905 1, 2, 3. 1152 00:41:12,657 --> 00:41:15,576 [GASPS, YELPS] 1153 00:41:15,577 --> 00:41:17,328 This is not a good idea. 1154 00:41:17,329 --> 00:41:19,413 I don't think we're gonna need this. 1155 00:41:19,414 --> 00:41:21,040 Hey, Paul, Paul, 1156 00:41:21,041 --> 00:41:23,209 why don't you come grab a cup of coffee with me? 1157 00:41:23,210 --> 00:41:25,169 I'm still zonked from my all-nighter, 1158 00:41:25,170 --> 00:41:28,839 and I wanna go over some delivery instructions with you. 1159 00:41:28,840 --> 00:41:31,509 Sure. 1160 00:41:31,510 --> 00:41:33,385 Rox, you OK? 1161 00:41:33,386 --> 00:41:36,264 - Mm-hmm. - Yeah. It's OK. 1162 00:41:42,938 --> 00:41:44,940 Bedpan it is. 1163 00:41:46,441 --> 00:41:49,736 [ALARM BEEPING] 1164 00:41:52,906 --> 00:41:54,782 You lose your pulse ox again, bud? 1165 00:41:54,783 --> 00:41:57,953 [SUSTAINED BEEP] 1166 00:42:00,330 --> 00:42:01,747 Louie. 1167 00:42:01,748 --> 00:42:03,624 Louie! 1168 00:42:03,625 --> 00:42:06,210 He kept pulling off his pulse ox. 1169 00:42:06,211 --> 00:42:07,628 It's on. It's at 71. 1170 00:42:07,629 --> 00:42:09,089 Louie, wake up. 1171 00:42:10,674 --> 00:42:12,466 - I'm not getting a carotid. - I got the airway. 1172 00:42:12,467 --> 00:42:15,636 Hey, Perlah, crash cart, intubation tray, please. 1173 00:42:15,637 --> 00:42:18,806 [SUSTAINED BEEP] 1174 00:42:18,807 --> 00:42:21,809 [DRAMATIC MUSIC] 1175 00:42:24,406 --> 00:42:29,345 Sync and corrections by btsix www.addic7ed.com