1 00:00:13,984 --> 00:00:16,028 - Robby. - Yep. 2 00:00:16,112 --> 00:00:18,155 Cellulitis on the dorsum of the foot, 3 00:00:18,239 --> 00:00:20,157 now spreading up the leg. 4 00:00:20,241 --> 00:00:21,367 Hello, I'm Dr. Robby. 5 00:00:21,450 --> 00:00:23,077 Mind if I take a look? 6 00:00:23,160 --> 00:00:25,162 How long do you think this is gonna take? 7 00:00:25,246 --> 00:00:26,747 I took an early lunch break. 8 00:00:27,957 --> 00:00:29,083 I don't know that you're gonna 9 00:00:29,166 --> 00:00:30,960 make it back to work today. 10 00:00:31,043 --> 00:00:32,628 Erythema and warmth halfway up her knee. 11 00:00:32,711 --> 00:00:33,754 When did you see her, Donnie? 12 00:00:33,838 --> 00:00:36,215 He didn't. I did. 13 00:00:36,298 --> 00:00:37,716 - When? - About four hours ago. 14 00:00:37,800 --> 00:00:39,135 Gave her a dose of Keflex, 15 00:00:39,218 --> 00:00:40,678 told her to come back if things got worse. 16 00:00:40,761 --> 00:00:42,638 Things have definitely gotten worse. 17 00:00:42,721 --> 00:00:43,707 Dana, what's open? 18 00:00:43,722 --> 00:00:45,099 Trauma Two. 19 00:00:45,182 --> 00:00:46,600 Jesse, can you get her started in Trauma Two 20 00:00:46,684 --> 00:00:47,893 with some vanco and blood cultures, please? 21 00:00:47,977 --> 00:00:49,353 - Got it, boss. - I'm coming with. 22 00:00:49,436 --> 00:00:51,438 Suit yourself. 23 00:00:51,522 --> 00:00:54,733 Santos, you want in on Trauma Two? 24 00:00:54,817 --> 00:00:57,695 Too much charting, too little time. 25 00:00:57,778 --> 00:01:01,448 62-year-old male presents with chief complaint 26 00:01:01,532 --> 00:01:02,616 of left lower back pain. 27 00:01:02,700 --> 00:01:04,076 - Considered the diagnosis… - Hey. 28 00:01:04,160 --> 00:01:05,286 Oh, Jesus Christ. 29 00:01:05,369 --> 00:01:06,745 I'm charting. 30 00:01:06,829 --> 00:01:08,247 Sorry. 31 00:01:09,331 --> 00:01:10,833 Did I do something wrong? 32 00:01:10,916 --> 00:01:12,585 Besides interrupting me? Probably. 33 00:01:12,668 --> 00:01:14,211 Then I apologize. 34 00:01:14,295 --> 00:01:17,840 I know that second year of residency can be stressful, 35 00:01:17,923 --> 00:01:21,051 so if there's anything I can do to help you… 36 00:01:21,135 --> 00:01:22,303 like stop talking. 37 00:01:22,386 --> 00:01:24,638 - That's a great idea. - Yeah. 38 00:01:24,722 --> 00:01:28,809 Considered the diagnosis of aortic aneurysm or dissection. 39 00:01:28,893 --> 00:01:30,519 Got a new one for you in 13. 40 00:01:30,603 --> 00:01:33,147 I'm 20 charts behind, and the new attending 41 00:01:33,230 --> 00:01:34,315 is threatening to make me repeat 42 00:01:34,398 --> 00:01:35,441 a year if I can't catch up. 43 00:01:35,524 --> 00:01:36,692 Cry me a river. 44 00:01:36,775 --> 00:01:37,818 Old lady with bad abdominal pain. 45 00:01:37,902 --> 00:01:38,986 Somebody's gotta see her. 46 00:01:39,069 --> 00:01:40,487 Dana, please do me a solid. 47 00:01:40,571 --> 00:01:42,156 Holiday weekend. 48 00:01:42,239 --> 00:01:43,782 Westbridge is down, and our waiting room's on overdrive. 49 00:01:43,866 --> 00:01:45,159 I'm sorry, but your charting's gonna have to wait 50 00:01:45,242 --> 00:01:47,620 until after your shift. 51 00:01:47,703 --> 00:01:49,079 Ogilvie. 52 00:01:49,163 --> 00:01:52,958 Dr. Santos needs you to pick up a new patient in 13. 53 00:01:53,042 --> 00:01:56,837 Y-yes, ma'am. I'm on it. 54 00:01:56,921 --> 00:01:58,130 Chart while you supervise. 55 00:01:58,214 --> 00:01:59,924 Best I can do. 56 00:02:03,052 --> 00:02:05,930 Setting up a GoFundMe, that's what her generation does. 57 00:02:06,013 --> 00:02:07,806 That's how they support each other. 58 00:02:07,890 --> 00:02:08,891 Doctor, tell him. 59 00:02:08,974 --> 00:02:10,476 Your wife's right. 60 00:02:10,559 --> 00:02:12,811 Staying here's gonna cost more than we can afford. 61 00:02:12,895 --> 00:02:14,688 Look, I'm feeling better. 62 00:02:14,772 --> 00:02:16,232 I'll just leave. 63 00:02:16,315 --> 00:02:19,193 Mr. Diaz, even if your blood sugar is back to normal, 64 00:02:19,276 --> 00:02:21,153 we have to continue with the insulin drip 65 00:02:21,237 --> 00:02:23,072 until we clear the ketones from your bloodstream. 66 00:02:23,155 --> 00:02:25,616 Otherwise, you could experience electrolyte disorders, 67 00:02:25,699 --> 00:02:26,951 heart and kidney problems… 68 00:02:27,034 --> 00:02:30,496 Mi amor, your health is what matters. 69 00:02:30,579 --> 00:02:31,956 I'll make you a deal. 70 00:02:32,039 --> 00:02:33,791 You agree to stay on the insulin drip, 71 00:02:33,874 --> 00:02:35,292 and I'll go find our case manager 72 00:02:35,376 --> 00:02:37,211 to discuss cost-cutting options for your stay. 73 00:02:37,294 --> 00:02:38,587 Deal. 74 00:02:38,671 --> 00:02:40,839 And I'm sitting here making sure he doesn't move. 75 00:02:40,923 --> 00:02:42,967 - You should go look for Ana. - Mm-hmm. 76 00:02:43,050 --> 00:02:44,051 I can find her. 77 00:02:44,134 --> 00:02:45,719 BRB. 78 00:02:47,888 --> 00:02:49,014 Hanging vanco. 79 00:02:49,098 --> 00:02:50,557 What's vanco? 80 00:02:50,641 --> 00:02:53,060 A really strong antibiotic to kill skin germs. 81 00:02:53,143 --> 00:02:55,604 - Need a hand? - No. We got this. 82 00:02:55,688 --> 00:02:57,439 I'll just observe. 83 00:02:57,523 --> 00:02:58,899 Pretend I'm not even here. 84 00:02:58,983 --> 00:03:02,361 Let's send off a CBC, blood cultures, and CMP. 85 00:03:02,444 --> 00:03:05,406 And also a lactic acid, CRP, and calcitonin. 86 00:03:05,489 --> 00:03:07,491 Wait, she's not febrile, not tachycardic. 87 00:03:07,574 --> 00:03:09,118 No evidence of SIRS. 88 00:03:09,201 --> 00:03:11,078 - Yet. - What's SIRS? 89 00:03:11,161 --> 00:03:14,832 Systemic inflammatory response syndrome. 90 00:03:14,915 --> 00:03:15,915 Sorry. 91 00:03:15,958 --> 00:03:17,543 An exaggerated defense response. 92 00:03:17,626 --> 00:03:18,877 A what? 93 00:03:18,961 --> 00:03:20,963 Sometimes the human body can have an overreaction 94 00:03:21,046 --> 00:03:22,881 to an infection, so we're gonna monitor you 95 00:03:22,965 --> 00:03:24,508 to make sure that this does not progress. 96 00:03:27,344 --> 00:03:28,721 It's my boss. 97 00:03:28,804 --> 00:03:30,723 Sorry, I have to take this, or he's gonna fire me. 98 00:03:30,806 --> 00:03:32,808 OK. 99 00:03:32,891 --> 00:03:34,351 Hello. 100 00:03:34,435 --> 00:03:37,980 No, I'm still at the hospital. 101 00:03:38,063 --> 00:03:39,481 Being seen right now. 102 00:03:39,565 --> 00:03:40,774 Ow. 103 00:03:40,858 --> 00:03:43,944 No, they just stuck me with a needle. 104 00:03:44,028 --> 00:03:45,654 I don't know. 105 00:03:45,738 --> 00:03:48,073 You wanna talk to them? 106 00:03:48,157 --> 00:03:51,118 They're kind of busy right now. 107 00:03:51,201 --> 00:03:52,578 I know you are. 108 00:03:52,661 --> 00:03:54,038 Second IV's in. 109 00:03:54,121 --> 00:03:55,748 No, I'm not overreacting. 110 00:03:55,831 --> 00:03:58,083 My body's overreacting. 111 00:03:58,167 --> 00:04:00,085 Please…please don't fire me. 112 00:04:00,169 --> 00:04:01,378 I… 113 00:04:01,462 --> 00:04:02,838 This is Dr. Michael Robinavitch. 114 00:04:02,921 --> 00:04:04,882 I am the chief of emergency medicine at PTMC. 115 00:04:04,965 --> 00:04:06,842 If you fire her, she will sue you, 116 00:04:06,925 --> 00:04:09,845 and I will testify on her behalf. 117 00:04:09,928 --> 00:04:12,139 OK. 118 00:04:12,222 --> 00:04:14,099 Don't worry about it. We got you. 119 00:04:18,979 --> 00:04:20,856 Do you know how long Jackson's gonna be asleep? 120 00:04:20,939 --> 00:04:24,109 So there's no exact timeline with the sedatives we gave him, 121 00:04:24,193 --> 00:04:25,819 but he should be awake soon. 122 00:04:25,903 --> 00:04:27,488 Have you spoken to your parents yet? 123 00:04:27,571 --> 00:04:29,114 Yeah, they're on their way back from Columbus. 124 00:04:29,198 --> 00:04:31,575 Maybe you should take some time for yourself 125 00:04:31,658 --> 00:04:32,993 before they arrive. 126 00:04:33,077 --> 00:04:34,661 Yeah, cafeteria's right down the hall. 127 00:04:34,745 --> 00:04:35,745 Decent grilled cheese. 128 00:04:35,788 --> 00:04:36,830 Stay away from the tuna. 129 00:04:36,914 --> 00:04:38,874 Thanks, but I'm not hungry. 130 00:04:38,957 --> 00:04:41,585 You know, I just can't believe that a campus security guard 131 00:04:41,668 --> 00:04:43,045 tased my brother. 132 00:04:43,128 --> 00:04:44,546 Aren't they supposed to be helping students 133 00:04:44,630 --> 00:04:46,632 and protect them, not shoot at them? 134 00:04:46,715 --> 00:04:48,342 You have every right to be upset, 135 00:04:48,425 --> 00:04:51,011 and you should absolutely pursue accountability. 136 00:04:51,095 --> 00:04:53,305 But right now, we are taking care of your brother. 137 00:04:53,389 --> 00:04:56,141 And you should really take care of yourself. 138 00:04:56,225 --> 00:04:57,726 I…I have your number. 139 00:04:57,810 --> 00:05:00,104 I'll text you as soon as Jackson's LP results get back 140 00:05:00,187 --> 00:05:02,314 or if he wakes up. 141 00:05:02,398 --> 00:05:04,024 OK. 142 00:05:04,108 --> 00:05:05,359 OK, thank you. 143 00:05:05,442 --> 00:05:06,527 Of course. 144 00:05:06,610 --> 00:05:09,696 - Oh. - OK. 145 00:05:09,780 --> 00:05:11,323 Hypoactive bowel sounds. 146 00:05:11,407 --> 00:05:14,201 Soft, with moderate tenderness in the left lower quadrant. 147 00:05:14,284 --> 00:05:17,454 Mrs. Randolph, do you take Percocet every day? 148 00:05:17,538 --> 00:05:19,373 - No. - Huh. 149 00:05:19,456 --> 00:05:20,833 And what about your water intake, 'cause… 150 00:05:20,916 --> 00:05:22,376 Pause. 151 00:05:22,459 --> 00:05:24,545 Mrs. Randolph, you said you don't take Percocet every day, 152 00:05:24,628 --> 00:05:26,547 but when was the last time you took some? 153 00:05:26,630 --> 00:05:29,842 Maybe three or four times last week. 154 00:05:29,925 --> 00:05:33,470 Assisted living had a ballroom dance competition, 155 00:05:33,554 --> 00:05:35,681 - and I tweaked my back. - Mm. 156 00:05:35,764 --> 00:05:39,768 Any further questions, Ogilvie? 157 00:05:39,852 --> 00:05:43,480 When was your last bowel movement? 158 00:05:43,564 --> 00:05:45,983 I don't know. Sometime last week. 159 00:05:46,066 --> 00:05:48,986 I've been stopped up for at least five or six days. 160 00:05:49,069 --> 00:05:52,448 Mm-hmm, painkillers can cause constipation. 161 00:05:52,531 --> 00:05:53,740 I know. 162 00:05:53,824 --> 00:05:56,285 That's why they put me on a stool softener, 163 00:05:56,368 --> 00:05:57,619 and then they tried an enema. 164 00:05:57,703 --> 00:05:59,663 - And…and no movements? - Yep. 165 00:05:59,746 --> 00:06:02,958 And then they gave me this horrible drink. 166 00:06:03,041 --> 00:06:04,585 Mag citrate. 167 00:06:04,668 --> 00:06:05,668 Yeah. 168 00:06:05,711 --> 00:06:07,963 Mag citrate. 169 00:06:08,046 --> 00:06:09,256 Made me puke. 170 00:06:09,339 --> 00:06:11,467 All right, what's next, Ogilvie? 171 00:06:11,550 --> 00:06:13,510 Let's get you an X-ray and see how we can help you, 172 00:06:13,594 --> 00:06:14,580 Mrs. Randolph. 173 00:06:14,595 --> 00:06:16,388 - Thank you. - Yeah. 174 00:06:16,472 --> 00:06:18,557 Differential? 175 00:06:18,640 --> 00:06:20,225 Probable stool impaction. 176 00:06:20,309 --> 00:06:21,810 But with her history of cholecystectomy, 177 00:06:21,894 --> 00:06:23,562 it could be small bowel obstruction. 178 00:06:23,645 --> 00:06:24,688 Or worse. 179 00:06:24,771 --> 00:06:26,940 Sigmoid volvulus? 180 00:06:27,024 --> 00:06:29,318 But that's a surgical emergency. 181 00:06:29,401 --> 00:06:30,861 Wouldn't she have tons of pain? 182 00:06:30,944 --> 00:06:34,406 Not always, especially when you're in your 80s. 183 00:06:40,037 --> 00:06:41,580 I am getting concerned. 184 00:06:41,663 --> 00:06:44,166 This is a millimeter past the line. 185 00:06:44,249 --> 00:06:45,542 Or my line was sloppy. 186 00:06:45,626 --> 00:06:47,085 - Any increase in pain? - Oh. 187 00:06:47,169 --> 00:06:49,671 OK, sorry. Let's try four morphine. 188 00:06:49,755 --> 00:06:51,006 White count's only 10,000. 189 00:06:51,089 --> 00:06:53,050 It'd be over 12,000 for SIRS. 190 00:06:53,133 --> 00:06:54,843 There are other criteria. 191 00:06:54,927 --> 00:06:56,303 Still afebrile. 192 00:06:56,386 --> 00:06:57,888 Did you ask about past history of MRSA? 193 00:06:57,971 --> 00:06:59,681 Not specifically, but she's never been hospitalized. 194 00:06:59,765 --> 00:07:01,183 Any evidence of an immunocompromised state? 195 00:07:01,266 --> 00:07:02,434 - No, she's healthy. - Steroid use? 196 00:07:02,518 --> 00:07:03,504 Never. 197 00:07:03,519 --> 00:07:04,978 Maximum heart rate's only 89. 198 00:07:05,062 --> 00:07:06,146 Is that OK? 199 00:07:06,230 --> 00:07:08,232 That's good, very good. 200 00:07:08,315 --> 00:07:09,301 Stay with her. 201 00:07:09,316 --> 00:07:10,817 Monitor her closely. 202 00:07:10,901 --> 00:07:12,653 If there's any change in her condition, come find me. 203 00:07:12,736 --> 00:07:13,862 I mean any change. 204 00:07:16,990 --> 00:07:19,576 Roxie Hamler, 42, home hospice patient 205 00:07:19,660 --> 00:07:21,161 with a history of lung cancer. 206 00:07:21,245 --> 00:07:24,373 New-onset tonic-clonic seizure with right lower leg pain. 207 00:07:24,456 --> 00:07:26,500 She hit it on the coffee table. 208 00:07:28,210 --> 00:07:29,962 Initially nonverbal, now coming around. 209 00:07:30,045 --> 00:07:31,463 That's normal after a seizure. 210 00:07:31,547 --> 00:07:33,048 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 211 00:07:33,131 --> 00:07:34,841 - Nope, we got it. - She hit her head? 212 00:07:34,925 --> 00:07:36,009 No. I was there. 213 00:07:36,093 --> 00:07:37,636 - I caught her. - No IV? 214 00:07:37,719 --> 00:07:38,929 Couldn't get one in. 215 00:07:39,012 --> 00:07:40,430 Gave her four of IM versed for the seizure, 216 00:07:40,514 --> 00:07:41,974 - 25 of fent for the pain. - OK. 217 00:07:42,057 --> 00:07:43,850 - Dana, where to? - Trauma One. 218 00:07:43,934 --> 00:07:45,102 This way. 219 00:07:45,185 --> 00:07:47,437 Haven't seen you guys in a hot minute. 220 00:07:47,521 --> 00:07:50,023 Pickup from SCI Jones Forge. 221 00:07:50,107 --> 00:07:51,525 Was supposed to go to Westbridge but got 222 00:07:51,608 --> 00:07:52,594 diverted to you. 223 00:07:52,609 --> 00:07:53,944 Yeah, you and everybody else. 224 00:07:54,027 --> 00:07:55,487 Princess, I need you pivot to Central 9. 225 00:07:55,571 --> 00:07:56,822 Got it. 226 00:07:56,905 --> 00:07:58,532 Gus Varney, 54, victim of assault 227 00:07:58,615 --> 00:07:59,908 with diffuse blunt trauma. 228 00:07:59,992 --> 00:08:01,910 He's got bruising to the face, the right chest, 229 00:08:01,994 --> 00:08:03,579 10-centimeter laceration to the left arm. 230 00:08:03,662 --> 00:08:05,163 BP's 136 over 84, pulse 102, 231 00:08:05,247 --> 00:08:07,916 good sats, 95 on room air. 232 00:08:08,000 --> 00:08:09,626 How you feeling there, Mr. Varney? 233 00:08:09,710 --> 00:08:11,128 - Fucking hurts. - Where? 234 00:08:11,211 --> 00:08:13,463 - Everywhere. - I am Dr. Robby. 235 00:08:13,547 --> 00:08:14,756 This is Dr. Al-Hashimi. 236 00:08:14,840 --> 00:08:16,216 We'll get you something for the pain. 237 00:08:16,300 --> 00:08:17,759 I've got a progressing cellulitis in Trauma Two. 238 00:08:17,843 --> 00:08:19,386 - Go. I'm good. - Thank you. 239 00:08:19,469 --> 00:08:21,430 Gus, do you know who hurt you? 240 00:08:21,513 --> 00:08:24,099 One of the fine, upstanding citizens of cell block 6. 241 00:08:24,182 --> 00:08:27,019 It's a deep lac through the muscle fascia. 242 00:08:27,102 --> 00:08:28,562 Can we get the cuffs off once he settles? 243 00:08:28,645 --> 00:08:29,730 Not a chance. 244 00:08:29,813 --> 00:08:31,690 Orange jumpsuit. He's cuffed for a reason. 245 00:08:31,773 --> 00:08:33,817 Let's go. 246 00:08:44,202 --> 00:08:47,664 OK, everyone, on my count. 247 00:08:47,748 --> 00:08:49,291 1, 2… 248 00:08:49,374 --> 00:08:50,834 Hold on. 249 00:08:54,463 --> 00:08:57,966 - Go. - 1, 2, 3. 250 00:08:58,050 --> 00:08:59,468 Mel, E-FAST. 251 00:08:59,551 --> 00:09:01,053 Whitaker, primary assessment. 252 00:09:01,136 --> 00:09:02,346 On it. 253 00:09:07,476 --> 00:09:08,602 Oh, weird bruise. 254 00:09:08,685 --> 00:09:09,895 Did he fall on something? 255 00:09:09,978 --> 00:09:11,396 Footprint, got stomped. 256 00:09:11,480 --> 00:09:13,398 Jesus. 257 00:09:14,691 --> 00:09:16,318 Is it…is that necessary? 258 00:09:16,401 --> 00:09:18,487 Afraid so. 259 00:09:18,570 --> 00:09:21,114 Airway's patent. 260 00:09:21,198 --> 00:09:23,867 Good lung sliding on the left. 261 00:09:23,950 --> 00:09:25,077 Sorry. 262 00:09:25,160 --> 00:09:26,370 Good on the right, too. 263 00:09:26,453 --> 00:09:27,746 How are the lungs? 264 00:09:27,829 --> 00:09:28,872 Good breath sounds. 265 00:09:28,955 --> 00:09:31,625 - No crepitus. - No effusion. 266 00:09:31,708 --> 00:09:34,920 Pulse ox 97, BP 118 over 78, heart rate 112. 267 00:09:35,003 --> 00:09:36,296 Tachycardic from the pain. 268 00:09:36,380 --> 00:09:37,839 Start with four of morphine. Repeat prn. 269 00:09:37,923 --> 00:09:38,909 On it. 270 00:09:38,924 --> 00:09:40,967 OK. Swollen mandible. 271 00:09:41,051 --> 00:09:42,386 Open your mouth for me, Gus. 272 00:09:42,469 --> 00:09:44,221 Little wider. 273 00:09:44,304 --> 00:09:45,472 Can't. 274 00:09:45,555 --> 00:09:46,848 Whitaker, you know the tongue blade exam? 275 00:09:46,932 --> 00:09:48,308 Yeah. 276 00:09:48,392 --> 00:09:49,768 It's a great test for mandible fracture. 277 00:09:49,851 --> 00:09:52,979 Gus, bite down hard on this for me. 278 00:09:55,273 --> 00:09:56,566 Sorry, Gus. 279 00:09:56,650 --> 00:09:58,694 Positive test. 280 00:09:58,777 --> 00:10:00,237 No free fluid in the belly. 281 00:10:00,320 --> 00:10:01,306 Any idea how long this will take? 282 00:10:01,321 --> 00:10:02,614 Too soon to tell. 283 00:10:02,698 --> 00:10:03,699 Whitaker, your assessment? 284 00:10:03,782 --> 00:10:05,117 Fractured left mandible, 285 00:10:05,200 --> 00:10:07,285 multiple rib fractures. 286 00:10:07,369 --> 00:10:08,787 Complex forearm lac. 287 00:10:08,870 --> 00:10:10,789 OK, log roll to the left, then pan scan. 288 00:10:10,872 --> 00:10:12,749 Where were you when Mr. Varney got assaulted? 289 00:10:12,833 --> 00:10:14,334 I just move 'em. I don't get to know 'em. 290 00:10:14,418 --> 00:10:16,086 CT's ready for us. 291 00:10:16,169 --> 00:10:17,921 Cycling the BP. 292 00:10:18,004 --> 00:10:20,590 OK, this redness is now a centimeter over that line, 293 00:10:20,674 --> 00:10:22,092 and this might be a bulla forming. 294 00:10:22,175 --> 00:10:23,385 The vanco takes a little time to work. 295 00:10:23,468 --> 00:10:26,930 Vital signs are still stable, 122 over 78. 296 00:10:27,013 --> 00:10:28,014 I got it. 297 00:10:28,098 --> 00:10:31,017 How are you feeling, Debbie? 298 00:10:31,101 --> 00:10:32,686 I'm feeling a little warm. 299 00:10:32,769 --> 00:10:34,104 That can happen with vanco. 300 00:10:34,187 --> 00:10:36,064 Thanks, man. 301 00:10:36,148 --> 00:10:39,109 Lactic acid 4.2. 302 00:10:39,192 --> 00:10:40,902 - OK. - What's wrong? 303 00:10:40,986 --> 00:10:43,613 That can be a sign of a more serious infection, 304 00:10:43,697 --> 00:10:45,240 but the good news is, we know what to do. 305 00:10:45,323 --> 00:10:48,952 Jesse, 2 liters of LR wide open. 306 00:10:49,035 --> 00:10:50,412 This is severe sepsis. 307 00:10:50,495 --> 00:10:52,038 I know, but at 7:00 AM, it was a simple cellulitis. 308 00:10:52,122 --> 00:10:53,665 Anyone would have given her Keflex. 309 00:10:53,749 --> 00:10:55,667 We could add carbapenem or Zosyn to broaden 310 00:10:55,751 --> 00:10:56,751 our antibiotic coverage. 311 00:10:56,793 --> 00:10:57,878 OK, I got it. 312 00:10:57,961 --> 00:10:59,296 Thanks. 313 00:10:59,379 --> 00:11:02,299 Jesse, 1 gram meropenem, 900 milligrams clinda, 314 00:11:02,382 --> 00:11:04,342 and page Dr. Garcia, please. 315 00:11:04,426 --> 00:11:05,761 What's going on? 316 00:11:05,844 --> 00:11:07,220 We're adding new antibiotics. 317 00:11:07,304 --> 00:11:08,638 It's serious? 318 00:11:08,722 --> 00:11:09,848 We wanna get ahead of it and make sure 319 00:11:09,931 --> 00:11:11,725 it doesn't become serious. 320 00:11:13,393 --> 00:11:14,394 What else can I do? 321 00:11:14,478 --> 00:11:15,562 I think you've done enough. 322 00:11:15,645 --> 00:11:16,772 You can go. 323 00:11:20,525 --> 00:11:21,511 All good in there? 324 00:11:21,526 --> 00:11:22,569 Code sepsis. 325 00:11:22,652 --> 00:11:23,904 Stable for the moment. 326 00:11:23,987 --> 00:11:25,197 How about you? 327 00:11:25,280 --> 00:11:27,574 Perfect vitals, E-FAST negative, off to CT. 328 00:11:27,657 --> 00:11:28,784 Good. 329 00:11:28,867 --> 00:11:30,368 Keep me posted. 330 00:11:30,452 --> 00:11:31,745 Ditto. 331 00:11:35,373 --> 00:11:36,708 How's it going? 332 00:11:36,792 --> 00:11:38,710 Great, if you ignore the hot mess in chairs. 333 00:11:38,794 --> 00:11:40,629 Any update on our little baby Jane Doe? 334 00:11:40,712 --> 00:11:42,631 Security's reviewing the CCTV from last night 335 00:11:42,714 --> 00:11:43,924 and this morning. 336 00:11:46,301 --> 00:11:47,677 You two kiss and make up yet? 337 00:11:47,761 --> 00:11:49,262 I think someone needs to smoke a cigarette. 338 00:11:49,346 --> 00:11:50,680 I'm trying to quit. 339 00:11:50,764 --> 00:11:52,224 Why don't you quit when I'm on my trip? 340 00:11:52,307 --> 00:11:53,475 Everyone's glad to have you back. 341 00:11:53,558 --> 00:11:56,019 - Asshole. - Well, not everyone. 342 00:11:57,521 --> 00:11:59,898 Hey, you want in on this betting board? 343 00:11:59,981 --> 00:12:02,859 Look, all you gotta do is pick why Westbridge went down, 344 00:12:02,943 --> 00:12:04,486 how many of their patients we're gonna get, 345 00:12:04,569 --> 00:12:06,112 and when they'll be back in action. 346 00:12:06,196 --> 00:12:08,865 Hey, already up to $500. 347 00:12:08,949 --> 00:12:11,201 Oh, ah, gotta pass. 348 00:12:11,284 --> 00:12:13,370 Still catching up on rehab bills. 349 00:12:13,453 --> 00:12:15,914 Respect. 350 00:12:17,499 --> 00:12:18,583 All right. 351 00:12:18,667 --> 00:12:20,293 What's the rules on me changing my bet? 352 00:12:20,377 --> 00:12:22,504 Only if you double down. 353 00:12:24,631 --> 00:12:26,007 Sinkhole. 354 00:12:28,677 --> 00:12:32,097 You watch too many movies, man. 355 00:12:32,180 --> 00:12:35,183 Considered the diagnosis of aortic aneurysm 356 00:12:35,267 --> 00:12:37,435 or dissection, but the point-of-care ultrasound was… 357 00:12:37,519 --> 00:12:40,021 You done want that gridlocked granny? 358 00:12:40,105 --> 00:12:41,940 Ordered an acute abdominal series 359 00:12:42,023 --> 00:12:43,191 to rule out obstruction. 360 00:12:43,275 --> 00:12:44,442 - Still waiting on the X-rays. - Great. 361 00:12:44,526 --> 00:12:45,569 Then you're free to treat our latest 362 00:12:45,652 --> 00:12:46,778 and greatest in South 16. 363 00:12:46,862 --> 00:12:49,573 Oh, come on, D, it's like, every time 364 00:12:49,656 --> 00:12:51,157 I get a moment to chart, I barely get 365 00:12:51,241 --> 00:12:53,869 - a sentence out before I get… - Interrupted? 366 00:12:53,952 --> 00:12:55,912 Sucks to be you, but trust me, it sucks worse 367 00:12:55,996 --> 00:12:57,831 for the poor gal in 16. 368 00:12:57,914 --> 00:13:00,584 I'm beginning to think you enjoy torturing me. 369 00:13:00,667 --> 00:13:02,711 Perks of the job. 370 00:13:02,794 --> 00:13:04,087 Ogilvie, let's go. 371 00:13:07,716 --> 00:13:10,427 Hold out your hand, Louie. 372 00:13:11,386 --> 00:13:13,013 A little shaky. 373 00:13:13,096 --> 00:13:14,082 No surprise. 374 00:13:14,097 --> 00:13:16,182 I've been here since 4:00 AM. 375 00:13:16,266 --> 00:13:17,559 We can get you something for that. 376 00:13:17,642 --> 00:13:18,894 Or I can take care of it myself 377 00:13:18,977 --> 00:13:21,021 if you cut me loose right now. 378 00:13:21,104 --> 00:13:23,189 Let's get Louie 50 milligrams of Librium. 379 00:13:23,273 --> 00:13:24,816 I'll put in the order. 380 00:13:26,943 --> 00:13:29,696 I will get it from the PDS. 381 00:13:33,241 --> 00:13:35,744 I'm already assigned as Louie's treating physician. 382 00:13:35,827 --> 00:13:38,163 Just makes sense that I put it in. 383 00:13:38,246 --> 00:13:40,332 Yeah. Yeah, yeah. Of course. 384 00:13:45,462 --> 00:13:47,881 Any changes with our septic waitress? 385 00:13:47,964 --> 00:13:49,007 Not yet. 386 00:13:49,090 --> 00:13:50,091 Wait, if you have a second, I… 387 00:13:50,175 --> 00:13:51,259 I don't. 388 00:13:51,343 --> 00:13:52,677 But the point-of-care ultrasound 389 00:13:52,761 --> 00:13:54,095 was negative for both. 390 00:13:54,179 --> 00:13:56,514 I considered the diagnosis of cauda equina syndrome. 391 00:13:56,598 --> 00:13:59,643 You writing the great American novel? 392 00:13:59,726 --> 00:14:01,603 Charting and supervising. 393 00:14:01,686 --> 00:14:02,686 It's Dana's idea. 394 00:14:02,729 --> 00:14:04,189 Who's the lucky patient? 395 00:14:04,272 --> 00:14:06,066 Unhoused woman with a bad cough. 396 00:14:06,149 --> 00:14:07,859 Ogilvie's all over it. 397 00:14:07,943 --> 00:14:09,235 OK. 398 00:14:09,319 --> 00:14:10,779 Say "eee." 399 00:14:10,862 --> 00:14:12,530 Eee. 400 00:14:12,614 --> 00:14:14,282 OK, deep breath in. 401 00:14:14,366 --> 00:14:16,201 Blow it out real hard. 402 00:14:16,284 --> 00:14:17,953 You haven't heard enough already? 403 00:14:18,036 --> 00:14:21,998 I need to check for wheezing with forced exhalation. 404 00:14:25,251 --> 00:14:27,128 Fucking cough is killing me. 405 00:14:27,212 --> 00:14:28,713 You smoke, Mrs. Yardley? 406 00:14:28,797 --> 00:14:30,924 Yeah, but I haven't been able to 407 00:14:31,007 --> 00:14:32,342 for a couple days 'cause of this cough. 408 00:14:32,425 --> 00:14:34,594 Mm. You ever consider quitting? 409 00:14:34,678 --> 00:14:38,098 You ever considered minding your own business? 410 00:14:42,018 --> 00:14:44,187 Well, the good news is that your test from earlier 411 00:14:44,270 --> 00:14:46,398 came back negative for both COVID and influenza, 412 00:14:46,481 --> 00:14:48,066 but I'm gonna order a chest X-ray 413 00:14:48,149 --> 00:14:49,609 so that we can see what's really going on in those lungs. 414 00:14:49,693 --> 00:14:51,611 You got time to let us do that? 415 00:14:52,904 --> 00:14:55,782 Where the fuck else you think I gotta be? 416 00:14:55,865 --> 00:14:57,575 And we're in. 417 00:14:57,659 --> 00:14:59,244 3 grams Keppra over 10 minutes. 418 00:14:59,327 --> 00:15:00,954 That'll prevent another seizure. 419 00:15:01,037 --> 00:15:02,038 Thank you. 420 00:15:02,122 --> 00:15:03,957 Nobody can ever get an IV in her. 421 00:15:04,040 --> 00:15:05,917 Yeah, midline cath is the way to go 422 00:15:06,001 --> 00:15:07,544 when your veins are shot. 423 00:15:07,627 --> 00:15:12,132 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 424 00:15:12,215 --> 00:15:14,843 - OK. - Cold. 425 00:15:14,926 --> 00:15:18,304 Is it possible to get her a blanket and some socks? 426 00:15:18,388 --> 00:15:20,056 Can do. 427 00:15:20,140 --> 00:15:22,600 When was she diagnosed? 428 00:15:22,684 --> 00:15:24,561 Seven years ago. 429 00:15:24,644 --> 00:15:27,147 Resected a lobe. 430 00:15:27,230 --> 00:15:29,691 Four cycles of platinum chemo gave us a couple good years, 431 00:15:29,774 --> 00:15:32,152 but then it spread to the bones. 432 00:15:32,235 --> 00:15:34,362 Has she had radiation therapy? 433 00:15:34,446 --> 00:15:36,823 Shrunk down the mets, but they're still there. 434 00:15:36,906 --> 00:15:38,783 That's why you're at hospice at home. 435 00:15:38,867 --> 00:15:39,853 Yep. 436 00:15:39,868 --> 00:15:41,828 I'm sorry. 437 00:15:41,911 --> 00:15:43,121 Me too. 438 00:15:43,204 --> 00:15:45,707 Ah. 439 00:15:45,790 --> 00:15:46,833 Sorry. 440 00:15:46,916 --> 00:15:48,376 You have kids? 441 00:15:48,460 --> 00:15:50,837 Yeah, two boys. 442 00:15:50,920 --> 00:15:52,922 15 and 9. 443 00:15:53,006 --> 00:15:54,507 My son's 12. 444 00:15:54,591 --> 00:15:56,718 Goes fast. 445 00:15:56,801 --> 00:15:58,553 Too fast. 446 00:15:58,636 --> 00:16:03,183 Swelling and bruising over the distal tibia. 447 00:16:03,266 --> 00:16:05,810 50 of fentanyl once her systolic's over 100. 448 00:16:05,894 --> 00:16:08,438 What do you usually take for pain? 449 00:16:11,441 --> 00:16:14,569 MS Contin, 30 milligrams twice a day, 450 00:16:14,652 --> 00:16:16,988 oxycodone for breakthrough, and sublingual Actiq 451 00:16:17,072 --> 00:16:20,784 for when it gets really bad. 452 00:16:20,867 --> 00:16:21,951 That's a lot. 453 00:16:22,035 --> 00:16:23,745 You handle her pain meds? 454 00:16:23,828 --> 00:16:24,829 Sometimes. 455 00:16:24,913 --> 00:16:26,706 All the time. 456 00:16:26,790 --> 00:16:29,584 A hospice nurse comes by a few times a week, 457 00:16:29,667 --> 00:16:31,961 but I was alone when she had the seizure. 458 00:16:32,045 --> 00:16:33,922 They told us that it could happen, 459 00:16:34,005 --> 00:16:35,507 but she couldn't breathe. 460 00:16:35,590 --> 00:16:39,969 And I freaked out, and I called 911. 461 00:16:40,053 --> 00:16:42,263 I'm so sorry. 462 00:16:42,347 --> 00:16:44,182 I'm sorry. 463 00:16:44,265 --> 00:16:46,101 I'm sorry. 464 00:16:55,777 --> 00:16:58,863 Due to your family income, you make too much 465 00:16:58,947 --> 00:17:00,740 to be eligible for either PENNIE 466 00:17:00,824 --> 00:17:03,159 or the hospital's "charity care." 467 00:17:03,243 --> 00:17:05,286 But we can't afford health-care premiums. 468 00:17:05,370 --> 00:17:08,081 It's unfortunately very common for people 469 00:17:08,164 --> 00:17:09,374 to fall between the cracks. 470 00:17:09,457 --> 00:17:11,501 It's an imperfect system. 471 00:17:11,584 --> 00:17:13,670 Can PTMC help with the costs in any way? 472 00:17:13,753 --> 00:17:16,131 We can offer financial assistance. 473 00:17:16,214 --> 00:17:17,966 You'd pay the same that Medicare 474 00:17:18,049 --> 00:17:19,592 and Medicaid would pay. 475 00:17:19,676 --> 00:17:20,718 How much is that? 476 00:17:20,802 --> 00:17:24,639 You pay 60%, we cover 40%. 477 00:17:24,722 --> 00:17:26,015 Thank you. 478 00:17:26,099 --> 00:17:27,934 Uh-huh. 479 00:17:29,144 --> 00:17:31,146 Where have you been? 480 00:17:31,229 --> 00:17:33,648 - How are you doing? - I'm sorry, mijita. 481 00:17:33,731 --> 00:17:36,734 You were being thoughtful, and I just blew up. 482 00:17:36,818 --> 00:17:39,654 Well, Ms. Noelle was just telling us that the hospital 483 00:17:39,737 --> 00:17:41,364 is gonna give us a big discount. 484 00:17:41,447 --> 00:17:44,033 We can knock 40% off your final bill. 485 00:17:44,117 --> 00:17:45,994 - That's great. - Mm-hmm. 486 00:17:46,077 --> 00:17:47,871 I stay here for a few days, 487 00:17:47,954 --> 00:17:50,165 my bill could be over $100,000, right? 488 00:17:51,875 --> 00:17:53,543 Yes, unfortunately. 489 00:17:53,626 --> 00:17:55,628 It could end up being lower, 490 00:17:55,712 --> 00:17:58,047 depending on your level of needed care. 491 00:17:58,131 --> 00:18:00,049 Or higher? 492 00:18:00,133 --> 00:18:04,012 So we would still have to pay $60,000? 493 00:18:04,095 --> 00:18:05,555 Which we don't have. 494 00:18:05,638 --> 00:18:07,765 He has to stay here to get better, right? 495 00:18:07,849 --> 00:18:10,143 - Yes. - No. 496 00:18:10,226 --> 00:18:11,394 Excuse me? 497 00:18:11,477 --> 00:18:13,605 I mean, not necessarily. 498 00:18:13,688 --> 00:18:16,274 Couldn't we just admit him to med-surg instead of ICU? 499 00:18:16,357 --> 00:18:18,109 Wouldn't that be a lot cheaper? 500 00:18:18,193 --> 00:18:20,236 Med-surg won't accept him with an insulin drip. 501 00:18:20,320 --> 00:18:22,030 Usually true. 502 00:18:22,113 --> 00:18:25,700 But let me talk to the charge nurse upstairs, and I'll… 503 00:18:25,783 --> 00:18:26,868 I'll see what she says. 504 00:18:26,951 --> 00:18:28,411 Thank you. 505 00:18:30,413 --> 00:18:32,373 Food poisoning in the hall's asking to leave, 506 00:18:32,457 --> 00:18:34,417 wants to take her kids to the water park. 507 00:18:34,500 --> 00:18:36,961 Those places are cesspools. 508 00:18:37,045 --> 00:18:38,463 Preaching to the choir. 509 00:18:38,546 --> 00:18:40,089 If she's feeling fine on Zofran, she's good to go. 510 00:18:40,173 --> 00:18:41,549 All right. 511 00:18:41,633 --> 00:18:43,468 Louie's in South 15. Meds are coming down. 512 00:18:43,551 --> 00:18:45,470 Another couple hours of monitoring, and he can broom. 513 00:18:45,553 --> 00:18:46,763 Straight to the liquor store. 514 00:18:46,846 --> 00:18:47,889 Don't pass "go." 515 00:18:47,972 --> 00:18:48,958 What about that clamshell case 516 00:18:48,973 --> 00:18:50,350 that went up…anything? 517 00:18:50,433 --> 00:18:52,310 Out of surgery, in recovery, still sedated. 518 00:18:52,393 --> 00:18:54,229 Good. Keep me posted on that. 519 00:18:54,312 --> 00:18:55,647 Will do. 520 00:18:57,857 --> 00:18:59,108 Three times in one day. 521 00:18:59,192 --> 00:19:00,693 To what do we owe the pleasure? 522 00:19:00,777 --> 00:19:02,403 I came down for a consult 523 00:19:02,487 --> 00:19:04,822 and to persuade Ahmad to start a new betting board. 524 00:19:04,906 --> 00:19:06,407 Why, is the Westbridge board full already? 525 00:19:06,491 --> 00:19:08,451 Mm-hmm, was gonna ask him to start one about you 526 00:19:08,534 --> 00:19:10,745 and your midlife crisis trip. 527 00:19:10,828 --> 00:19:12,747 I give it four weeks. 528 00:19:12,830 --> 00:19:15,291 Seven, tops. 529 00:19:15,375 --> 00:19:16,542 Ye of little faith. 530 00:19:16,626 --> 00:19:19,295 Not about faith, just facts. 531 00:19:19,379 --> 00:19:20,588 Facts? 532 00:19:20,672 --> 00:19:22,507 Based on my experience, you're a seven-week-itch 533 00:19:22,590 --> 00:19:23,967 kind of guy. 534 00:19:24,050 --> 00:19:26,177 Hey, Robby, med student's got a pickleball player 535 00:19:26,261 --> 00:19:28,137 in the North Hall with possible Achilles rupture, 536 00:19:28,221 --> 00:19:29,207 asking for your opinion. 537 00:19:29,222 --> 00:19:30,723 Thank you, Perlah. 538 00:19:30,807 --> 00:19:32,892 At least somebody down here has a little faith in me. 539 00:19:35,561 --> 00:19:38,189 You know what Motorcycle Mike's sabbatical is really about? 540 00:19:38,273 --> 00:19:41,067 I never try to guess what's going on in that head of his. 541 00:19:41,150 --> 00:19:44,279 Three months being on the open road by himself. 542 00:19:44,362 --> 00:19:46,447 Man can't stand to be alone for more than a few hours. 543 00:19:46,531 --> 00:19:49,492 He sleeps with the TV on in his bedroom. 544 00:19:49,575 --> 00:19:52,370 I really don't think I needed to know that. 545 00:19:53,830 --> 00:19:56,916 Look, maybe he's looking for something new 546 00:19:57,000 --> 00:19:59,836 or trying to outrun some old ghosts. 547 00:19:59,919 --> 00:20:03,131 Well, I hope he finds what he's looking for. 548 00:20:03,214 --> 00:20:05,300 Man deserves some peace. 549 00:20:05,383 --> 00:20:06,676 Amen. 550 00:20:06,759 --> 00:20:09,345 I considered the diagnosis of cauda equina syndrome, 551 00:20:09,429 --> 00:20:11,180 but the motor and sensory exam 552 00:20:11,264 --> 00:20:13,558 were both intact in the sacral nerve root… 553 00:20:13,641 --> 00:20:14,892 Our unhoused cougher has pneumonia. 554 00:20:14,976 --> 00:20:17,770 I'm cursed, fucking cursed. 555 00:20:17,854 --> 00:20:19,272 Fuck. 556 00:20:19,355 --> 00:20:21,024 What? 557 00:20:21,107 --> 00:20:23,443 That is a cavitary lesion in the right upper lobe. 558 00:20:23,526 --> 00:20:25,236 Active TB. 559 00:20:25,320 --> 00:20:27,572 What's next? 560 00:20:27,655 --> 00:20:29,157 AFB stain to confirm, 561 00:20:29,240 --> 00:20:31,701 move her to a negative airflow room, start her on meds. 562 00:20:31,784 --> 00:20:33,828 Call infection control and public health. 563 00:20:33,911 --> 00:20:36,122 And now you get to sign in as a patient 564 00:20:36,205 --> 00:20:38,583 and get your blood drawn for a QuantiFERON Gold. 565 00:20:38,666 --> 00:20:40,585 It's too soon to be positive. 566 00:20:40,668 --> 00:20:41,753 Yeah, but you were exposed. 567 00:20:41,836 --> 00:20:43,379 You need a baseline test 568 00:20:43,463 --> 00:20:46,591 and then again in eight weeks to see if you convert. 569 00:20:46,674 --> 00:20:47,925 And if I do? 570 00:20:48,009 --> 00:20:50,053 Then meds every day for three or four months 571 00:20:50,136 --> 00:20:52,930 with regular blood tests to check for toxicity. 572 00:20:53,014 --> 00:20:54,265 - Jesus. - All right. 573 00:20:54,349 --> 00:20:55,767 Let Dana know what's up. 574 00:20:55,850 --> 00:20:58,853 And for the love of God, mask up when you move her. 575 00:21:07,403 --> 00:21:09,530 - Dr. Langdon. - Hey, man. Alex. 576 00:21:09,614 --> 00:21:10,740 Let's take a look. 577 00:21:13,368 --> 00:21:16,245 Ah. 578 00:21:16,329 --> 00:21:17,315 Is it bad? 579 00:21:17,330 --> 00:21:18,790 It's not good. 580 00:21:18,873 --> 00:21:21,417 Sorry, your chart says you were burned with dry ice? 581 00:21:21,501 --> 00:21:23,461 - What happened? - My jack-off brother. 582 00:21:23,544 --> 00:21:25,046 Does he not like you? 583 00:21:25,129 --> 00:21:28,674 I asked him to do it, just not like this exactly. 584 00:21:28,758 --> 00:21:30,259 What? Why? 585 00:21:30,343 --> 00:21:31,928 He was gonna brand me like I branded him. 586 00:21:32,011 --> 00:21:33,763 Branded? Like cattle? 587 00:21:33,846 --> 00:21:36,891 Instead of hot branding, you stick the iron in dry ice, 588 00:21:36,974 --> 00:21:39,852 let it get super cold, and then you put it on your skin. 589 00:21:39,936 --> 00:21:41,687 Cool, huh? 590 00:21:41,771 --> 00:21:42,771 You're stupid. 591 00:21:42,814 --> 00:21:43,981 Let's get some LET on this. 592 00:21:44,065 --> 00:21:45,775 I'll get some snips to debride. 593 00:21:48,277 --> 00:21:49,862 You good? 594 00:21:49,946 --> 00:21:52,198 Yeah. Yeah, good. 595 00:21:52,281 --> 00:21:53,616 You sure? 596 00:21:53,699 --> 00:21:56,702 Doesn't seem like Robby's all that happy I'm back. 597 00:21:56,786 --> 00:21:59,330 Well, he's not going to be here, 598 00:21:59,414 --> 00:22:01,124 and I'm happy you're back. 599 00:22:01,207 --> 00:22:03,084 Thanks. 600 00:22:07,463 --> 00:22:11,592 Head and neck CT is negative, except for mandible fracture. 601 00:22:12,552 --> 00:22:13,845 OK, let's get him off the board. 602 00:22:13,928 --> 00:22:15,138 Roll him, right side up. 603 00:22:15,221 --> 00:22:16,931 Hey, we're gonna need the cuffs off. 604 00:22:19,976 --> 00:22:22,728 Ready. And 1, 2, 3. 605 00:22:22,812 --> 00:22:25,106 Ah, gentle. 606 00:22:25,189 --> 00:22:26,774 Dr. King, how are the chest and belly? 607 00:22:26,858 --> 00:22:30,027 We have three anterior rib fractures 608 00:22:30,111 --> 00:22:31,946 and a small pulmonary contusion. 609 00:22:32,029 --> 00:22:33,197 - Not too bad. - Mm-mm. 610 00:22:33,281 --> 00:22:34,907 When do pulmonary contusions peak? 611 00:22:34,991 --> 00:22:36,325 After a few hours. 612 00:22:36,409 --> 00:22:37,869 And do we always admit for three-rib fractures? 613 00:22:37,952 --> 00:22:39,203 In the elderly, yes, 614 00:22:39,287 --> 00:22:40,997 but not if a patient can manage the pain 615 00:22:41,080 --> 00:22:42,999 and doesn't need supplemental oxygen. 616 00:22:44,292 --> 00:22:45,751 OK, he's really hurting here. 617 00:22:45,835 --> 00:22:47,420 You think you could set us up with a serratus anterior 618 00:22:47,503 --> 00:22:48,629 - field block? - No problem. 619 00:22:48,713 --> 00:22:50,756 Oh, as long as that's OK 620 00:22:50,840 --> 00:22:51,924 with Dr. Al-Hashimi. 621 00:22:52,008 --> 00:22:54,051 If the patient consents. 622 00:22:54,135 --> 00:22:57,930 Mr. Varney, we wanna give you a shot to numb your broken ribs 623 00:22:58,014 --> 00:22:59,098 so you can breathe easier. 624 00:22:59,182 --> 00:23:00,349 Uh-huh. 625 00:23:00,433 --> 00:23:02,018 OK, get Mr. Varney prepped and draped. 626 00:23:02,101 --> 00:23:03,603 Dr. Mohan, you're in charge. 627 00:23:03,686 --> 00:23:05,438 Let's identify the landmarks. 628 00:23:05,521 --> 00:23:06,606 Cuffs. 629 00:23:07,982 --> 00:23:09,567 Yeah, you can just leave them off, man. 630 00:23:09,650 --> 00:23:12,487 He's clearly not moving on his own. 631 00:23:12,570 --> 00:23:14,071 We follow protocol, 632 00:23:14,155 --> 00:23:17,450 for his safety and yours. 633 00:23:19,243 --> 00:23:20,828 Do you need to get that? 634 00:23:20,912 --> 00:23:23,664 Nope. It's my mom. 635 00:23:23,748 --> 00:23:25,917 Ignore it. Just ignore it. 636 00:23:26,000 --> 00:23:27,752 - Amen, sister. - Forearm is numb. 637 00:23:27,835 --> 00:23:29,045 We can irrigate. 638 00:23:29,128 --> 00:23:30,630 If I ignore a problem for long enough, 639 00:23:30,713 --> 00:23:32,256 it just goes away, right? 640 00:23:32,340 --> 00:23:34,509 I wish I could ignore my deposition. 641 00:23:34,592 --> 00:23:36,761 That, you can't ignore. 642 00:23:36,844 --> 00:23:38,012 But you'll be fine. 643 00:23:38,095 --> 00:23:39,555 What's up with you, Whitaker? 644 00:23:39,639 --> 00:23:41,057 Trouble in roomie land? 645 00:23:41,140 --> 00:23:42,600 No, not really. 646 00:23:42,683 --> 00:23:45,895 I think I overstepped with Dr. Langdon earlier. 647 00:23:45,978 --> 00:23:47,146 Oh. 648 00:23:47,230 --> 00:23:49,774 He was trying to prescribe a patient benzos, 649 00:23:49,857 --> 00:23:52,693 and I told Langdon that it'd be better if I did it. 650 00:23:52,777 --> 00:23:54,153 Oof. 651 00:23:54,237 --> 00:23:56,531 Only because I was already the assigned physician. 652 00:23:56,614 --> 00:23:58,366 But yeah, now I feel like an asshole. 653 00:23:58,449 --> 00:23:59,617 Langdon's fine. 654 00:23:59,700 --> 00:24:01,994 He went to rehab, he's working the steps, 655 00:24:02,078 --> 00:24:06,541 and hopefully it's all behind him. 656 00:24:06,624 --> 00:24:08,251 Place the needle in-plane, 657 00:24:08,334 --> 00:24:10,127 superficial to the serratus anterior, 658 00:24:10,211 --> 00:24:12,380 between it and the latissimus dorsi. 659 00:24:12,463 --> 00:24:13,714 Mm-hmm. 660 00:24:13,798 --> 00:24:15,883 You can see the fluid dissect and diffuse… 661 00:24:15,967 --> 00:24:17,218 Dr. Mohan, we need you. 662 00:24:17,301 --> 00:24:18,844 We've got two more rigs from Westbridge 663 00:24:18,928 --> 00:24:21,055 pulling up right now. 664 00:24:21,138 --> 00:24:22,557 Go. We got this. 665 00:24:22,640 --> 00:24:23,626 Thanks. 666 00:24:23,641 --> 00:24:26,060 How we doing in here? 667 00:24:26,143 --> 00:24:29,689 Spiked a temp to 102, gave Tylenol. 668 00:24:29,772 --> 00:24:31,440 Check out her leg. 669 00:24:31,524 --> 00:24:33,359 That is a definite bulla. 670 00:24:33,442 --> 00:24:34,819 Did surgery come down yet? 671 00:24:34,902 --> 00:24:36,571 - Not yet. - I need surgery? 672 00:24:36,654 --> 00:24:37,655 Page them again. 673 00:24:37,738 --> 00:24:39,448 Surgery would be a last resort. 674 00:24:39,532 --> 00:24:41,784 We would like them to come down and check out your leg 675 00:24:41,867 --> 00:24:44,370 in case we need to remove this infected skin. 676 00:24:44,453 --> 00:24:45,871 I thought it was just a little swelling 677 00:24:45,955 --> 00:24:46,955 'cause I'm on my feet all day. 678 00:24:48,874 --> 00:24:50,710 BP's down to 85 over 40. 679 00:24:50,793 --> 00:24:52,378 - How much LR is in? - Full bolus. 680 00:24:52,461 --> 00:24:54,005 Do another liter and then start Levophed. 681 00:24:54,088 --> 00:24:55,506 Titrate to a MAP of 65. 682 00:24:56,882 --> 00:24:58,342 Can someone please tell me what's going on? 683 00:24:58,426 --> 00:24:59,427 Pulse ox down to 89. 684 00:24:59,510 --> 00:25:00,928 100% non-rebreather. 685 00:25:01,012 --> 00:25:03,973 Sometimes an infection can cause your blood pressure 686 00:25:04,056 --> 00:25:06,892 to drop and lower the amount of oxygen in your blood. 687 00:25:06,976 --> 00:25:08,060 Am I gonna be OK? 688 00:25:08,144 --> 00:25:09,270 We're doing everything that we can 689 00:25:09,353 --> 00:25:10,563 to make sure that you are. 690 00:25:10,646 --> 00:25:11,856 Jesse. 691 00:25:14,275 --> 00:25:15,568 What's up? 692 00:25:15,651 --> 00:25:16,902 Be ready to intubate if you need to. 693 00:25:16,986 --> 00:25:18,404 - You want me to call Langdon? - No. 694 00:25:18,487 --> 00:25:19,989 I will be right back, and you can call surgery 695 00:25:20,072 --> 00:25:21,699 and tell them to get their heads out of their asses 696 00:25:21,782 --> 00:25:23,367 and get down here. 697 00:25:31,917 --> 00:25:33,252 Did you bring Langdon back here? 698 00:25:33,336 --> 00:25:35,004 No, Al-Hashimi did. 699 00:25:35,087 --> 00:25:36,380 You banished him to scut purgatory. 700 00:25:36,464 --> 00:25:37,548 He did everything you would've done 701 00:25:37,632 --> 00:25:39,175 with that cellulitis patient. 702 00:25:39,258 --> 00:25:40,676 If you think he missed something, tell him. 703 00:25:40,760 --> 00:25:42,261 Well, we're probably gonna need to intubate. 704 00:25:42,345 --> 00:25:43,846 We're definitely gonna need an ICU bed. 705 00:25:43,929 --> 00:25:45,097 What happened? 706 00:25:45,181 --> 00:25:47,266 She is in septic shock, on pressors. 707 00:25:47,350 --> 00:25:49,101 Open shoulder dislocation is back. 708 00:25:49,185 --> 00:25:50,895 Westbridge shut down all their ORs, so they told us 709 00:25:50,978 --> 00:25:52,730 - to bring them back here. - You joking? 710 00:25:52,813 --> 00:25:53,799 This ain't the Radisson. 711 00:25:53,814 --> 00:25:54,940 Not my problem. 712 00:25:55,024 --> 00:25:56,484 - Where should we park him? - Grab a wall. 713 00:25:56,567 --> 00:25:57,902 Call Noelle. Call ortho. 714 00:25:57,985 --> 00:25:59,195 Call the OR and tell them we got a patient back 715 00:25:59,278 --> 00:26:00,738 that needs surgery and admission. 716 00:26:00,821 --> 00:26:02,740 Hey, so sorry about this ambulance tour 717 00:26:02,823 --> 00:26:04,742 of Allegheny County, Mr. Billings, 718 00:26:04,825 --> 00:26:06,369 but we got you from here, I promise. 719 00:26:06,452 --> 00:26:07,745 Yeah, I'm starving. 720 00:26:07,828 --> 00:26:09,246 Is there any way I can get something to eat? 721 00:26:09,330 --> 00:26:11,082 Sorry, not before surgery. 722 00:26:11,165 --> 00:26:12,333 Can I have a visitor? 723 00:26:12,416 --> 00:26:13,834 Sure. 724 00:26:13,918 --> 00:26:15,628 Any word from Gloria about what's going on at Westbridge? 725 00:26:15,711 --> 00:26:17,254 Radio silence from the ivory tower. 726 00:26:17,338 --> 00:26:18,923 And the charge nurse over there isn't responding. 727 00:26:19,006 --> 00:26:20,549 Must be bad. 728 00:26:20,633 --> 00:26:21,926 I wonder if it's something that security needs to know about. 729 00:26:22,009 --> 00:26:23,427 I'll keep you posted. 730 00:26:23,511 --> 00:26:25,221 Hey, you're kind of buds with Gloria. 731 00:26:25,304 --> 00:26:26,514 Did she say anything to you about what's 732 00:26:26,597 --> 00:26:28,265 - happening at Westbridge? - No. You? 733 00:26:28,349 --> 00:26:30,810 Nope. How are your patients? 734 00:26:30,893 --> 00:26:33,229 Our prisoner, Gus, has stable injuries, 735 00:26:33,312 --> 00:26:35,439 and our law student in Central 10 is awake, 736 00:26:35,523 --> 00:26:37,650 normal LP, and awaiting a psych consult. 737 00:26:37,733 --> 00:26:38,984 Good. 738 00:26:39,068 --> 00:26:40,653 Quicker we can treat 'em, street 'em, move 'em 739 00:26:40,736 --> 00:26:42,113 up the food chain, the better. 740 00:26:42,196 --> 00:26:44,198 Question. 741 00:26:44,281 --> 00:26:48,452 Why are you treating me like one of your residents? 742 00:26:48,536 --> 00:26:49,662 I'm not. 743 00:26:49,745 --> 00:26:51,455 As the attending, I like to know the status 744 00:26:51,539 --> 00:26:53,207 of all the patients and doctors in the ED 745 00:26:53,290 --> 00:26:55,501 in case I need to jump in quickly. 746 00:26:55,584 --> 00:26:56,570 Makes sense. 747 00:26:56,585 --> 00:26:58,921 Now your turn. 748 00:26:59,004 --> 00:27:00,256 What? 749 00:27:00,339 --> 00:27:02,383 As your fellow attending in our ED, 750 00:27:02,466 --> 00:27:04,176 it only makes sense for me to know the status 751 00:27:04,260 --> 00:27:06,262 of all the patients and all the doctors 752 00:27:06,345 --> 00:27:09,807 in case I need to jump in on a moment's notice. 753 00:27:09,890 --> 00:27:11,350 Touché. 754 00:27:14,061 --> 00:27:16,605 You have a non-displaced fracture, distal tibia. 755 00:27:16,689 --> 00:27:18,774 So if you look at the bone here, it's pretty well aligned. 756 00:27:18,858 --> 00:27:20,151 Sorry. Hi. 757 00:27:20,234 --> 00:27:22,528 Hi, I was in the shower, and I came as soon 758 00:27:22,611 --> 00:27:23,654 as I got Paul's message. 759 00:27:23,738 --> 00:27:25,281 - Lena? - Hi. 760 00:27:25,364 --> 00:27:27,158 What happened? 761 00:27:27,241 --> 00:27:28,617 I had a seizure. 762 00:27:28,701 --> 00:27:30,244 You load her with Keppra? 763 00:27:30,327 --> 00:27:31,620 Yeah. 764 00:27:31,704 --> 00:27:33,622 Yeah, she's back to baseline mental status. 765 00:27:33,706 --> 00:27:35,875 I'm sorry, I'm confused. Aren't you off duty? 766 00:27:35,958 --> 00:27:39,044 - I'm Roxie's death doula. - Oh. 767 00:27:39,128 --> 00:27:40,755 Her…her what? 768 00:27:40,838 --> 00:27:42,757 I help advocate for people like Roxie 769 00:27:42,840 --> 00:27:45,760 to make their transition to death a more peaceful process. 770 00:27:45,843 --> 00:27:48,763 It's like a birth doula but for the end of life. 771 00:27:48,846 --> 00:27:52,391 She's been a real lifesaver for our family. 772 00:27:52,475 --> 00:27:55,227 My husband cracking jokes while I'm dying. 773 00:27:55,311 --> 00:27:56,979 See why I married him? 774 00:27:57,062 --> 00:27:58,814 Whatever you have to say about my condition, 775 00:27:58,898 --> 00:28:00,733 you can share with Lena too. 776 00:28:00,816 --> 00:28:02,693 We were just explaining that Roxie 777 00:28:02,777 --> 00:28:05,863 has a pathological fracture through a metastatic lesion. 778 00:28:05,946 --> 00:28:07,406 Can you fix that? 779 00:28:07,490 --> 00:28:10,242 The bones are well aligned, so she won't need surgery. 780 00:28:10,326 --> 00:28:11,702 The treatment is immobilization 781 00:28:11,786 --> 00:28:12,870 and a long leg boot. 782 00:28:14,705 --> 00:28:16,165 Maybe we up her pain meds. 783 00:28:16,248 --> 00:28:17,708 Yeah, sure. 784 00:28:17,792 --> 00:28:19,084 We can do that. 785 00:28:19,168 --> 00:28:21,378 The bones should heal in about six weeks. 786 00:28:21,462 --> 00:28:24,006 If I live that long. 787 00:28:25,925 --> 00:28:26,925 Still numb here? 788 00:28:26,967 --> 00:28:28,469 Yeah, bro. 789 00:28:28,552 --> 00:28:30,805 Great. 790 00:28:30,888 --> 00:28:32,681 You think it's gonna leave a scar? 791 00:28:32,765 --> 00:28:36,727 I don't think it. I know it. 792 00:28:36,811 --> 00:28:38,521 Holy shit. 793 00:28:38,604 --> 00:28:40,064 Fuck are you doing here? 794 00:28:40,147 --> 00:28:41,133 I'm sorry, who are you? 795 00:28:41,148 --> 00:28:42,191 Concerned brother. 796 00:28:42,274 --> 00:28:44,693 That looks not too bad. 797 00:28:44,777 --> 00:28:46,070 You gooning me? 798 00:28:46,153 --> 00:28:47,696 Yeah, it's nasty. 799 00:28:47,780 --> 00:28:49,114 Thanks to you. 800 00:28:49,198 --> 00:28:50,241 You did this? 801 00:28:50,324 --> 00:28:51,700 Oh, yeah. You wanna see the video? 802 00:28:53,911 --> 00:28:55,788 - Yes. - Definitely. 803 00:28:55,871 --> 00:28:57,248 Got you. 804 00:28:58,541 --> 00:29:00,918 All right. All right, get in close. 805 00:29:01,001 --> 00:29:02,586 Brothers unite! 806 00:29:02,670 --> 00:29:04,296 - Ooh! - Ooh! 807 00:29:04,380 --> 00:29:06,131 Dude, why in the world 808 00:29:06,215 --> 00:29:07,758 would you ask to have that done to you? 809 00:29:07,842 --> 00:29:11,428 He was trying to brand me with our family crest. 810 00:29:13,806 --> 00:29:15,933 Your family crest is the Penguins logo? 811 00:29:16,016 --> 00:29:17,726 We were gonna be bonded for life. 812 00:29:17,810 --> 00:29:19,562 You already are, with DNA. 813 00:29:19,645 --> 00:29:20,729 Yeah. 814 00:29:20,813 --> 00:29:22,273 I love you, man. 815 00:29:22,356 --> 00:29:24,108 - I'm real sorry. - It's OK. 816 00:29:24,191 --> 00:29:27,778 Doc said it's gonna take some time, but it'll heal OK. 817 00:29:27,862 --> 00:29:29,321 Awesome. 818 00:29:29,405 --> 00:29:31,115 So maybe we can try again in a couple of months or… 819 00:29:31,198 --> 00:29:32,616 No. 820 00:29:34,076 --> 00:29:35,744 OK, bag her. 821 00:29:37,788 --> 00:29:39,164 Yellow on the end-tidal. 822 00:29:39,248 --> 00:29:40,916 - Sorry, got backed up. - Sounds a little wet. 823 00:29:41,000 --> 00:29:42,042 Someone asked for a surgical consult? 824 00:29:42,126 --> 00:29:43,294 That's because all the fluid. 825 00:29:43,377 --> 00:29:44,712 TKO the lines for now. 826 00:29:44,795 --> 00:29:47,047 Vent settings 50%, tidal volume 500, AC 12? 827 00:29:47,131 --> 00:29:48,424 Yep, that's perfect. 828 00:29:48,507 --> 00:29:49,758 Surgery here. Hello. 829 00:29:49,842 --> 00:29:51,343 Hey, it's about time. Where's Garcia? 830 00:29:51,427 --> 00:29:53,178 Stuck in the ER. She sent me down. What you got? 831 00:29:53,262 --> 00:29:54,638 Septic shock, respiratory failure, 832 00:29:54,722 --> 00:29:56,307 and possible necrotizing fasciitis. 833 00:29:56,390 --> 00:29:58,058 She needs to go to the OR ASAP. 834 00:29:58,142 --> 00:30:00,311 The infection was isolated to the dorsum of the foot 835 00:30:00,394 --> 00:30:01,937 five hours ago, but now we're almost to the knee 836 00:30:02,021 --> 00:30:03,606 with bullae, crepitus, and edema. 837 00:30:03,689 --> 00:30:05,274 - Yeah. - You seen nec fasc before? 838 00:30:05,357 --> 00:30:06,483 In a textbook. 839 00:30:06,567 --> 00:30:08,694 I was a med student two weeks ago. 840 00:30:10,571 --> 00:30:13,073 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 841 00:30:13,157 --> 00:30:14,742 Go get anybody else from your service down here… 842 00:30:14,825 --> 00:30:16,035 Shamsi, Miller, Walsh… 843 00:30:16,118 --> 00:30:17,161 I don't know any of this people, but… 844 00:30:17,244 --> 00:30:18,537 Don't take this personally. 845 00:30:18,621 --> 00:30:21,582 I just need a fucking grown-up down here. 846 00:30:21,665 --> 00:30:23,542 Nice job on the sub-Qs. 847 00:30:23,626 --> 00:30:25,294 Really took the tension off the wound. 848 00:30:25,377 --> 00:30:26,378 Thanks. 849 00:30:26,462 --> 00:30:28,047 I can help with the skin layer. 850 00:30:28,130 --> 00:30:30,090 Four hands are faster than two. 851 00:30:32,551 --> 00:30:33,886 - Whoa. - Whoa. 852 00:30:33,969 --> 00:30:36,221 That just tore right through the skin. 853 00:30:36,305 --> 00:30:37,556 You may need to take bigger bites 854 00:30:37,640 --> 00:30:39,266 farther away from the wound edges. 855 00:30:39,350 --> 00:30:41,602 Yep. 856 00:30:41,685 --> 00:30:44,980 Skin seems pretty fragile. 857 00:30:49,109 --> 00:30:50,486 Oh. 858 00:30:50,569 --> 00:30:52,154 Yeah, this is not working. 859 00:30:52,237 --> 00:30:54,114 He has the skin strength of an 80-year-old. 860 00:30:54,198 --> 00:30:56,283 Put down Steri-Strips with benzoin, 861 00:30:56,367 --> 00:30:59,578 not across the wound but along each wound edge, both sides. 862 00:30:59,662 --> 00:31:01,121 It'll hold the sutures. 863 00:31:01,205 --> 00:31:04,583 - Yup. - What say you, Dr. Robby? 864 00:31:04,667 --> 00:31:06,543 Great. MacGyver move. 865 00:31:06,627 --> 00:31:09,463 Go for it. 866 00:31:09,546 --> 00:31:13,217 Does a Dr. MacGyver work here? 867 00:31:13,300 --> 00:31:15,719 I don't know. 868 00:31:15,803 --> 00:31:17,680 The patient symptoms are consistent with lumbar 869 00:31:17,763 --> 00:31:21,642 radiculopathy at L4, L5, most likely due to disc herniation. 870 00:31:21,725 --> 00:31:23,143 Coughing patient admitted to isolation 871 00:31:23,227 --> 00:31:25,104 for verified medication administration 872 00:31:25,187 --> 00:31:26,480 and started on RIPE therapy. 873 00:31:26,563 --> 00:31:28,023 Yeah, why do I even bother? 874 00:31:28,107 --> 00:31:29,107 Just fail me now. 875 00:31:29,149 --> 00:31:30,234 OK. 876 00:31:30,317 --> 00:31:31,735 Get in touch with a social worker. 877 00:31:31,819 --> 00:31:33,237 They're gonna wanna do contact tracing 878 00:31:33,320 --> 00:31:35,072 and help her figure out transitional housing 879 00:31:35,155 --> 00:31:36,448 for when she's discharged. 880 00:31:36,532 --> 00:31:37,783 Got it. 881 00:31:37,866 --> 00:31:39,743 And make sure infection control responded. 882 00:31:39,827 --> 00:31:41,203 The people in the waiting room could have been exposed. 883 00:31:41,286 --> 00:31:44,540 They need to be notified and tested. 884 00:31:44,623 --> 00:31:45,791 OK. 885 00:31:45,874 --> 00:31:48,711 Relax. 886 00:31:48,794 --> 00:31:50,963 You can take the mask off. You don't have TB. 887 00:31:51,046 --> 00:31:54,091 At least not yet. 888 00:31:54,174 --> 00:31:56,677 Oh, great. 889 00:31:56,760 --> 00:31:59,596 This is fucked up. 890 00:31:59,680 --> 00:32:01,890 How are you so calm? 891 00:32:01,974 --> 00:32:03,559 Expected job hazard. 892 00:32:03,642 --> 00:32:04,810 You get used to it. 893 00:32:04,893 --> 00:32:06,395 Yeah, no, thanks. 894 00:32:06,478 --> 00:32:08,981 70% of doctors in training at urban hospitals 895 00:32:09,064 --> 00:32:11,316 get exposed to TB and wind up on meds. 896 00:32:11,400 --> 00:32:13,652 - Jesus. - Mm-hmm. 897 00:32:13,736 --> 00:32:16,030 They don't teach you that in med school. 898 00:32:16,113 --> 00:32:18,198 Mrs. Randolph's back. 899 00:32:18,282 --> 00:32:20,075 Pulled up her X-ray. 900 00:32:20,159 --> 00:32:21,243 OK. 901 00:32:21,326 --> 00:32:23,370 No volvulus, no air fluid levels. 902 00:32:23,454 --> 00:32:25,956 What do you think of this? 903 00:32:26,040 --> 00:32:28,042 Fecal material? 904 00:32:28,125 --> 00:32:29,752 A shit ton. 905 00:32:29,835 --> 00:32:31,378 Sorry, had to be said. 906 00:32:31,462 --> 00:32:32,963 So, what, she needs an enema? 907 00:32:33,047 --> 00:32:34,548 No. Tried and failed, remember? 908 00:32:34,631 --> 00:32:35,617 Yeah. 909 00:32:35,632 --> 00:32:37,217 Time to dig in. 910 00:32:37,301 --> 00:32:38,844 How are we gonna do that? 911 00:32:38,927 --> 00:32:42,848 Oh, there is no "we" in disimpaction. 912 00:32:47,811 --> 00:32:49,980 I haven't done one before. 913 00:32:50,064 --> 00:32:52,941 Shouldn't I observe first? 914 00:32:53,025 --> 00:32:55,569 I know just the guy to teach you. 915 00:33:04,828 --> 00:33:07,581 I spoke to the charge nurse in med-surg. 916 00:33:07,664 --> 00:33:08,874 They can take Orlando today. 917 00:33:08,957 --> 00:33:10,667 - Yes! - That's wonderful. 918 00:33:10,751 --> 00:33:12,252 They know he's on an insulin drip? 919 00:33:12,336 --> 00:33:14,797 They know, and they can change to a SQUID protocol. 920 00:33:14,880 --> 00:33:15,866 SQUID? 921 00:33:15,881 --> 00:33:17,549 Sub-Q insulin in DKA. 922 00:33:17,633 --> 00:33:19,259 So no IV drip? 923 00:33:19,343 --> 00:33:22,054 Just shots of short-acting insulin every four hours prn. 924 00:33:22,137 --> 00:33:25,474 The med-surg nurses have time to check a glucose every hour? 925 00:33:25,557 --> 00:33:26,543 They say so. 926 00:33:26,558 --> 00:33:28,519 And five days on med-surge 927 00:33:28,602 --> 00:33:32,272 is gonna cut your hospital bill down by 2/3. 928 00:33:32,356 --> 00:33:34,149 OK. 929 00:33:34,233 --> 00:33:36,026 So what's that gonna cost? 930 00:33:36,110 --> 00:33:37,444 Well, I can't give you an exact amount, 931 00:33:37,528 --> 00:33:39,530 but roughly $35,000. 932 00:33:39,613 --> 00:33:42,658 So after about 40%, I'll still have to pay, 933 00:33:42,741 --> 00:33:44,493 what, like, 20 grand? 934 00:33:44,576 --> 00:33:46,745 The hospital can work out a payment plan. 935 00:33:46,829 --> 00:33:48,455 Orlando, we'll be OK. 936 00:33:48,539 --> 00:33:49,998 We'll figure it out. 937 00:33:50,082 --> 00:33:52,459 I'll take on extra shifts at the coffee shop. 938 00:33:52,543 --> 00:33:55,462 We got you, Dad. 939 00:33:55,546 --> 00:33:58,674 Let's give you some private time with your family. 940 00:33:58,757 --> 00:34:01,176 Thanks. 941 00:34:01,260 --> 00:34:02,803 Sorry. Thank you. 942 00:34:02,886 --> 00:34:04,388 I was worried he might bail. 943 00:34:04,471 --> 00:34:05,639 My pleasure. 944 00:34:05,722 --> 00:34:07,349 The real thanks goes to the newbie here 945 00:34:07,432 --> 00:34:09,101 for thinking outside the box. 946 00:34:11,854 --> 00:34:13,689 Sorry I doubted your med-surg pitch. 947 00:34:13,772 --> 00:34:15,274 Oh, no sweat. 948 00:34:15,357 --> 00:34:17,484 How'd you think of that? 949 00:34:17,568 --> 00:34:20,154 My family had to think of a lot of creative ways 950 00:34:20,237 --> 00:34:23,198 to help my uninsured grandma. 951 00:34:23,282 --> 00:34:24,741 Leukemia. 952 00:34:24,825 --> 00:34:28,078 System doesn't work for you, you gotta work the system. 953 00:34:28,162 --> 00:34:30,330 She survive? 954 00:34:30,414 --> 00:34:32,541 For a while, till she didn't. 955 00:34:32,624 --> 00:34:35,002 She died before my freshman year in college. 956 00:34:35,085 --> 00:34:37,337 Sorry. 957 00:34:37,421 --> 00:34:39,506 Her death taught me a lot. 958 00:34:39,590 --> 00:34:42,467 Mainly that I don't wanna be around people dying. 959 00:34:44,344 --> 00:34:46,930 So they got her, and we can get out of here soon? 960 00:34:47,014 --> 00:34:48,390 Yeah. Oh, I think so. 961 00:34:48,473 --> 00:34:49,808 - I think so, yeah. - OK. 962 00:34:49,892 --> 00:34:53,061 Hi. 963 00:34:53,145 --> 00:34:55,647 Morphine PCA looks ready to go. 964 00:34:55,731 --> 00:34:57,649 This should do the trick. 965 00:34:57,733 --> 00:34:59,067 Do you notice a difference? 966 00:34:59,151 --> 00:35:00,137 Better. 967 00:35:00,152 --> 00:35:02,571 Oh, great. Great. 968 00:35:02,654 --> 00:35:04,323 How does this thing work? 969 00:35:04,406 --> 00:35:06,742 There's a baseline rate of morphine. 970 00:35:06,825 --> 00:35:08,785 And if you're having pain, you can push this button. 971 00:35:08,869 --> 00:35:09,855 You'll get some extra. 972 00:35:09,870 --> 00:35:11,121 And you can push for another dose 973 00:35:11,205 --> 00:35:12,581 every 10 minutes if needed. 974 00:35:12,664 --> 00:35:14,833 Your very own morphine butler. 975 00:35:17,419 --> 00:35:18,503 Amazing. 976 00:35:18,587 --> 00:35:20,047 She can go home with this? 977 00:35:20,130 --> 00:35:21,590 Yeah. 978 00:35:21,673 --> 00:35:23,717 Though you'll need more equipment for the house 979 00:35:23,800 --> 00:35:25,928 now that she can't bear weight on her leg. 980 00:35:26,011 --> 00:35:27,846 OK. Like what? 981 00:35:27,930 --> 00:35:32,017 A wheelchair to go to the bathroom, a shower chair, 982 00:35:32,100 --> 00:35:34,228 wall bars, if you don't already have them. 983 00:35:34,311 --> 00:35:37,356 And a hospital bed could be helpful too. 984 00:35:37,439 --> 00:35:38,690 How do we get all that? 985 00:35:38,774 --> 00:35:40,567 You don't. I do. 986 00:35:40,651 --> 00:35:42,444 I will get everything so that the two of you 987 00:35:42,527 --> 00:35:44,655 can get out of here and back to the kids. 988 00:35:44,738 --> 00:35:46,823 - At home. - Thank you. 989 00:35:53,914 --> 00:35:55,791 Nice of you to join us, Huckleberry. 990 00:35:55,874 --> 00:35:57,084 What do you need? 991 00:35:57,167 --> 00:35:58,919 Some help with a disimpaction. 992 00:36:00,796 --> 00:36:02,756 That is a med student procedure. 993 00:36:02,839 --> 00:36:04,174 Oh, you know the old adage… 994 00:36:04,258 --> 00:36:06,426 see one, do one, teach one. 995 00:36:06,510 --> 00:36:08,679 Say hello to teaching young Ogilvie here. 996 00:36:08,762 --> 00:36:11,348 OK. 997 00:36:11,431 --> 00:36:13,475 - Double glove, Ogilvie. - All right. 998 00:36:13,558 --> 00:36:14,977 Mrs. Randolph, we're going to need 999 00:36:15,060 --> 00:36:17,604 to manually unblock your rectum so that we can 1000 00:36:17,688 --> 00:36:19,106 get your bowels moving again. 1001 00:36:19,189 --> 00:36:20,175 I know. 1002 00:36:20,190 --> 00:36:22,859 Here we go. 1003 00:36:22,943 --> 00:36:25,988 Mrs. Randolph, I would like you to relax 1004 00:36:26,071 --> 00:36:28,907 like you're having a bowel movement. 1005 00:36:28,991 --> 00:36:31,493 Nice and deep. 1006 00:36:31,576 --> 00:36:33,787 OK. 1007 00:36:33,870 --> 00:36:38,000 Curve the finger like an ice cream scoop. 1008 00:36:38,083 --> 00:36:42,629 And bring it out. 1009 00:36:42,713 --> 00:36:44,464 You're up, Ogilvie. 1010 00:36:48,760 --> 00:36:50,887 Some more pressure, Mrs. Randolph. 1011 00:36:50,971 --> 00:36:52,431 I'm ready. 1012 00:36:59,187 --> 00:37:03,233 And here I thought you weren't a quick study. 1013 00:37:03,317 --> 00:37:05,152 Keep going. 1014 00:37:05,235 --> 00:37:07,362 Mrs. Randolph, in order to prevent this 1015 00:37:07,446 --> 00:37:08,780 from happening again, I think you 1016 00:37:08,864 --> 00:37:10,365 need a better stool softener. 1017 00:37:10,449 --> 00:37:11,908 You can try MiraLAX. 1018 00:37:11,992 --> 00:37:14,453 Just a tablespoon with a big glass of water every morning 1019 00:37:14,536 --> 00:37:15,522 should do the trick. 1020 00:37:15,537 --> 00:37:16,663 OK. 1021 00:37:18,957 --> 00:37:19,943 Oh. 1022 00:37:19,958 --> 00:37:21,460 Sorry. 1023 00:37:21,543 --> 00:37:22,627 Passing gas is good. 1024 00:37:22,711 --> 00:37:24,338 Means we're making progress. 1025 00:37:24,421 --> 00:37:26,048 Does that mean that I can… I can stop? 1026 00:37:26,131 --> 00:37:27,883 No. Nope. Keep going. 1027 00:37:32,929 --> 00:37:36,099 OK, Ogilvie, you… you might wanna… 1028 00:37:41,772 --> 00:37:43,273 Much better. 1029 00:37:44,316 --> 00:37:46,234 MAP's holding on Levophed. 1030 00:37:46,318 --> 00:37:48,195 1 mike per kg per minute. 1031 00:37:48,278 --> 00:37:49,404 Do me a favor. 1032 00:37:49,488 --> 00:37:50,614 Give me some 4x4s on some Betadine. 1033 00:37:50,697 --> 00:37:51,907 Sorry, we're getting killed 1034 00:37:51,990 --> 00:37:53,325 with transfers from Westbridge. 1035 00:37:53,408 --> 00:37:55,494 Mesenteric ischemia, perforated bowel. 1036 00:37:55,577 --> 00:37:56,563 Got a hot one here. 1037 00:37:56,578 --> 00:37:57,564 Yeah. 1038 00:37:57,579 --> 00:37:58,622 Possible nec fasc. 1039 00:37:58,705 --> 00:37:59,998 Possible? 1040 00:38:00,082 --> 00:38:01,375 Need CT with contrast to confirm. 1041 00:38:01,458 --> 00:38:03,085 This is spreading like wildfire. 1042 00:38:03,168 --> 00:38:04,461 By the time you get your CT, it's gonna be up to her waist. 1043 00:38:04,544 --> 00:38:05,545 She's gonna need a hemicorporectomy. 1044 00:38:05,629 --> 00:38:06,880 She needs a CT scan. 1045 00:38:06,963 --> 00:38:09,549 How about a stainless steel scan? 1046 00:38:09,633 --> 00:38:11,760 For Christ's sake. Robinavitch! 1047 00:38:11,843 --> 00:38:15,222 Robby, what the fuck are you doing? 1048 00:38:15,305 --> 00:38:16,932 Oh, God, I think I might puke. 1049 00:38:17,015 --> 00:38:19,393 That's called dirty dishwater exudate without purulence. 1050 00:38:19,476 --> 00:38:21,603 There's a gray appearance to the fascia, and in the OR, 1051 00:38:21,686 --> 00:38:23,814 you'll see easy separation in the tissue planes. 1052 00:38:23,897 --> 00:38:25,148 When do you start your sabbatical? 1053 00:38:25,232 --> 00:38:26,900 - Tomorrow. - Not a moment too soon. 1054 00:38:26,983 --> 00:38:28,902 Thanks for coming down. 1055 00:38:32,114 --> 00:38:35,617 I'm catching up on my charting as fast as I can. 1056 00:38:35,700 --> 00:38:38,495 Why don't you give my generative AI app a try? 1057 00:38:38,578 --> 00:38:40,997 It's 30% more efficient, and providers report 1058 00:38:41,081 --> 00:38:42,874 increased job satisfaction. 1059 00:38:42,958 --> 00:38:45,877 And you'll rarely have to stay overtime to complete charts. 1060 00:38:45,961 --> 00:38:47,629 Yeah? 1061 00:38:47,712 --> 00:38:48,922 OK. 1062 00:38:49,005 --> 00:38:50,507 Yeah, I'm usually here at least a couple hours 1063 00:38:50,590 --> 00:38:52,384 after every shift trying to catch up, so… 1064 00:38:52,467 --> 00:38:54,803 Sure, AI will make doctors more efficient, 1065 00:38:54,886 --> 00:38:57,097 but hospitals will expect us to treat more patients 1066 00:38:57,180 --> 00:38:59,099 without any extra pay, of course, 1067 00:38:59,182 --> 00:39:00,892 all the while eliminating staff positions 1068 00:39:00,976 --> 00:39:02,602 for attending and residents. 1069 00:39:02,686 --> 00:39:04,187 Oh, Dr. Robby, I am not an advocate 1070 00:39:04,271 --> 00:39:06,314 for erasing my own profession. 1071 00:39:06,398 --> 00:39:09,818 But I am advocating for getting to spend more time with my son. 1072 00:39:09,901 --> 00:39:12,779 Nothing can replace family. 1073 00:39:12,863 --> 00:39:14,781 What's the status of your septic patient? 1074 00:39:14,865 --> 00:39:17,576 Nec fasc. Surgery's taking her up. 1075 00:39:17,659 --> 00:39:20,120 Think they'll be able to save her leg? 1076 00:39:20,203 --> 00:39:22,080 Right now, I'm just hoping they can save her life. 1077 00:39:22,164 --> 00:39:24,666 Hey, how's Ogilvie doing? 1078 00:39:24,749 --> 00:39:28,503 A little TB exposure, a touch of ass-plosion. 1079 00:39:28,587 --> 00:39:30,630 All in all, pretty good day so far. 1080 00:39:30,714 --> 00:39:31,923 Kaison, you came. 1081 00:39:32,007 --> 00:39:33,467 Hey, ain't no way I was gonna let you 1082 00:39:33,550 --> 00:39:35,385 miss Peter and Aubrey's epic Fourth of July party. 1083 00:39:35,469 --> 00:39:37,596 Come on, now. Hey. 1084 00:39:37,679 --> 00:39:39,264 Brought some brew. 1085 00:39:39,347 --> 00:39:40,640 Oh, you are the man. 1086 00:39:40,724 --> 00:39:42,100 Appreciate the bromance over here, 1087 00:39:42,184 --> 00:39:44,436 but no food 'cause you might go into surgery. 1088 00:39:44,519 --> 00:39:47,105 And no beer 'cause we're a goddamn hospital. 1089 00:39:50,734 --> 00:39:52,861 Starting your sabbatical early? 1090 00:39:52,944 --> 00:39:54,696 I know someone who could really use a drink right now. 1091 00:39:54,779 --> 00:39:55,989 In the hospital? 1092 00:39:56,072 --> 00:39:58,492 As a parting gift. 1093 00:40:02,537 --> 00:40:04,080 How's it looking? 1094 00:40:04,164 --> 00:40:05,332 Good. 1095 00:40:05,415 --> 00:40:07,292 The Steri-Strips did the trick. 1096 00:40:07,375 --> 00:40:08,418 CT's ready. 1097 00:40:08,502 --> 00:40:10,045 We already scanned him. 1098 00:40:10,128 --> 00:40:12,422 Head and neck want thin cuts and a 3D reconstruction 1099 00:40:12,506 --> 00:40:14,424 of the mandible before they decide 1100 00:40:14,508 --> 00:40:15,884 if Mr. Varney needs surgery. 1101 00:40:15,967 --> 00:40:17,802 Have they even come down to examine him in person? 1102 00:40:17,886 --> 00:40:19,387 No, they must be backed up. 1103 00:40:19,471 --> 00:40:23,183 Or there's a July Fourth sale at the BMW dealership. 1104 00:40:23,266 --> 00:40:24,476 Labs are back. 1105 00:40:24,559 --> 00:40:26,311 Albumin's low. Total protein's low. 1106 00:40:26,394 --> 00:40:27,896 He also has megaloblastic anemia. 1107 00:40:27,979 --> 00:40:29,147 - Malnutrition. - Probably. 1108 00:40:29,231 --> 00:40:30,315 Jail cuisine. 1109 00:40:30,398 --> 00:40:31,691 Whitaker, what labs should we add? 1110 00:40:31,775 --> 00:40:33,818 B12, folate, iron levels. 1111 00:40:33,902 --> 00:40:35,320 Good. 1112 00:40:35,403 --> 00:40:36,947 We're gonna run some more tests, Mr. Varney. 1113 00:40:37,030 --> 00:40:38,365 Hang in there. 1114 00:40:42,994 --> 00:40:45,413 I have to pee. 1115 00:40:45,497 --> 00:40:46,873 There's no PureWick here. 1116 00:40:46,957 --> 00:40:48,124 But here you go, hon. 1117 00:40:48,208 --> 00:40:50,085 - I'll help you get on. - No. No. 1118 00:40:50,168 --> 00:40:52,504 No bedpan. I can walk to the bathroom. 1119 00:40:52,587 --> 00:40:54,172 - I just need a little help. - Are you sure? 1120 00:40:54,256 --> 00:40:55,257 I'm here, babe. 1121 00:40:55,340 --> 00:40:56,758 Oh, we got this Mr. Hamler. 1122 00:40:56,841 --> 00:41:00,011 You'll have to bring your IV and portable oxygen. 1123 00:41:00,095 --> 00:41:02,013 Please? 1124 00:41:02,097 --> 00:41:04,432 I'll grab a wheelchair. 1125 00:41:04,516 --> 00:41:06,393 Let's try to sit you up and dangle your legs. 1126 00:41:06,476 --> 00:41:07,936 OK. 1127 00:41:10,647 --> 00:41:13,984 1, 2, 3. 1128 00:41:19,698 --> 00:41:21,324 This is not a good idea. 1129 00:41:21,408 --> 00:41:23,451 I don't think we're gonna need this. 1130 00:41:23,535 --> 00:41:25,078 Hey, Paul, Paul, 1131 00:41:25,161 --> 00:41:27,247 why don't you come grab a cup of coffee with me? 1132 00:41:27,330 --> 00:41:29,207 I'm still zonked from my all-nighter, 1133 00:41:29,291 --> 00:41:32,877 and I wanna go over some delivery instructions with you. 1134 00:41:32,961 --> 00:41:35,547 Sure. 1135 00:41:35,630 --> 00:41:37,424 Rox, you OK? 1136 00:41:37,507 --> 00:41:40,343 - Mm-hmm. - Yeah. It's OK. 1137 00:41:47,058 --> 00:41:49,019 Bedpan it is. 1138 00:41:57,027 --> 00:41:58,820 You lose your pulse ox again, bud? 1139 00:42:04,451 --> 00:42:05,785 Louie. 1140 00:42:05,869 --> 00:42:07,662 Louie! 1141 00:42:07,746 --> 00:42:10,248 He kept pulling off his pulse ox. 1142 00:42:10,332 --> 00:42:11,666 It's on. It's at 71. 1143 00:42:11,750 --> 00:42:13,168 Louie, wake up. 1144 00:42:14,794 --> 00:42:16,504 - I'm not getting a carotid. - I got the airway. 1145 00:42:16,588 --> 00:42:19,674 Hey, Perlah, crash cart, intubation tray, please.