1 00:00:09,484 --> 00:00:13,953 Sync and corrections by btsix www.addic7ed.com 2 00:00:15,414 --> 00:00:18,368 Next time, maybe inform the department chair before the shit hits the fan. 3 00:00:18,393 --> 00:00:19,890 I was on my way to tell you. 4 00:00:19,891 --> 00:00:21,413 Make sure you get everything you need. 5 00:00:21,438 --> 00:00:22,521 OK, let's do this. 6 00:00:22,522 --> 00:00:24,106 IT called me up because 7 00:00:24,107 --> 00:00:26,359 I've trained in cyberattack prevention and response. 8 00:00:26,360 --> 00:00:28,740 - Then you can tell everybody what to do. - No, thank you. 9 00:00:28,740 --> 00:00:29,899 Best if it comes from the 10 00:00:29,900 --> 00:00:31,473 - department chair. - Oh, you think? 11 00:00:33,908 --> 00:00:35,993 All right, everybody, circle up. 12 00:00:35,994 --> 00:00:37,286 What the fuck? 13 00:00:37,287 --> 00:00:39,247 We may have had a cyberattack. 14 00:00:39,248 --> 00:00:41,775 No, we shut down to prevent a cyberattack. 15 00:00:43,110 --> 00:00:45,461 OK, everybody, settle down. Listen up. 16 00:00:45,462 --> 00:00:46,712 As you can see, we're doing a little 17 00:00:46,713 --> 00:00:49,090 redecorating in the central work area. 18 00:00:49,091 --> 00:00:52,093 Our hospital computers are at risk for a cyberattack, 19 00:00:52,094 --> 00:00:54,279 so we are going old school, analog. 20 00:00:54,304 --> 00:00:55,596 - For how long? - Great question. 21 00:00:55,597 --> 00:00:57,599 Our IT department has shut everything down 22 00:00:57,599 --> 00:01:00,017 to give them time to bolster our cyber defenses. 23 00:01:00,018 --> 00:01:01,936 I believe the question was, for how long? 24 00:01:01,937 --> 00:01:03,229 Uh, hard to say. 25 00:01:03,230 --> 00:01:04,605 Could be up to 24 hours. 26 00:01:04,606 --> 00:01:06,148 Jesus Christ. 27 00:01:06,149 --> 00:01:08,710 So first order of business, we need to replicate 28 00:01:08,735 --> 00:01:10,945 the electronic patient boards on these dry-erase boards. 29 00:01:10,946 --> 00:01:13,322 So please, somebody tell me they got a photo of the boards. 30 00:01:13,323 --> 00:01:15,616 Uh, yeah, yeah, yeah. Right here. OK. 31 00:01:15,617 --> 00:01:17,144 Oh, uh... 32 00:01:18,812 --> 00:01:20,747 It's a little blurry. 33 00:01:20,970 --> 00:01:23,317 No, more than a little blurry. 34 00:01:23,609 --> 00:01:25,694 - Sorry. - Oh, my God. 35 00:01:26,445 --> 00:01:28,421 - I remember. - Great. 36 00:01:28,422 --> 00:01:30,339 If everybody else can remember their patient names 37 00:01:30,340 --> 00:01:31,798 and their room numbers, that would be awesome. 38 00:01:31,799 --> 00:01:33,551 No, I mean I can remember all of it. 39 00:01:33,552 --> 00:01:34,803 All of what? 40 00:01:34,803 --> 00:01:36,747 Names, doctors, room numbers. 41 00:01:36,955 --> 00:01:39,473 I kind of have a photographic memory. 42 00:01:39,474 --> 00:01:41,351 Seriously? The whole board? 43 00:01:41,351 --> 00:01:43,811 Central 12, Harlow Graham, headache, 44 00:01:43,812 --> 00:01:46,564 - abdominal pain, ASL only. - Oh, shit. 45 00:01:46,565 --> 00:01:48,807 I have an interpreter waiting for me. 46 00:01:48,832 --> 00:01:50,791 - Go. - OK, for patient privacy, 47 00:01:50,860 --> 00:01:52,569 all chief complaints will be abbreviated. 48 00:01:52,570 --> 00:01:53,904 So HA for headache, 49 00:01:53,905 --> 00:01:55,698 AP for abdominal pain, and so forth. 50 00:01:55,699 --> 00:01:58,993 Central 10, Jackson Davis, new-onset psychosis. 51 00:01:58,994 --> 00:02:00,411 Javadi, psych admission. 52 00:02:00,412 --> 00:02:02,372 Greek letter psi for psych. 53 00:02:02,372 --> 00:02:04,831 Pedes is Baby Jane Doe, fever, Dr. Mohan, 54 00:02:04,832 --> 00:02:06,167 awaiting admission orders. 55 00:02:06,168 --> 00:02:07,961 Nurses need to convert to a zone defense... 56 00:02:07,961 --> 00:02:09,396 north, central, south, trauma. 57 00:02:09,421 --> 00:02:11,714 - Where's Dana? - In with a sexual assault case. 58 00:02:11,715 --> 00:02:13,507 She can't leave until the exam is finished. 59 00:02:13,508 --> 00:02:16,178 - Yeah, it could be a while. - Princess has charge nurse experience. 60 00:02:16,178 --> 00:02:17,637 - Not really. - That's a great idea. 61 00:02:17,638 --> 00:02:19,722 Princess it is. You can make the nursing assignments. 62 00:02:19,723 --> 00:02:21,141 - Next. - Central 9, 63 00:02:21,141 --> 00:02:23,142 Roxie Hamler, end-stage lung cancer. 64 00:02:23,143 --> 00:02:24,560 Sorry, do we have to stand here while 65 00:02:24,561 --> 00:02:25,955 - she recites the whole board? - No. 66 00:02:25,979 --> 00:02:27,104 In fact, go check on your patients 67 00:02:27,105 --> 00:02:28,481 and then please come back here. 68 00:02:28,482 --> 00:02:29,716 Thank you. 69 00:02:29,925 --> 00:02:32,052 How many hours a day are you on your laptop? 70 00:02:34,685 --> 00:02:36,031 At least eight hours. 71 00:02:36,032 --> 00:02:37,323 I work from home. 72 00:02:37,324 --> 00:02:39,351 And are you at a desk all day? 73 00:02:41,214 --> 00:02:42,454 No, no. 74 00:02:42,454 --> 00:02:44,081 I will either sit on the sofa, 75 00:02:44,081 --> 00:02:46,248 or sometimes I'll be in bed, 76 00:02:46,249 --> 00:02:49,061 kind of sitting up with the computer on my lap, 77 00:02:49,086 --> 00:02:50,087 that kind of thing. 78 00:02:50,087 --> 00:02:52,155 So you're always looking down at the screen? 79 00:02:52,698 --> 00:02:54,215 - Yeah. - OK. 80 00:02:54,216 --> 00:02:56,785 I'm going to check the muscles in your neck. 81 00:03:03,225 --> 00:03:04,351 - Ooh! - Ooh! 82 00:03:04,376 --> 00:03:05,919 Ow, that hurts. 83 00:03:06,628 --> 00:03:08,964 All right. Well, I think we can help. 84 00:03:09,605 --> 00:03:10,799 Come on over. 85 00:03:11,466 --> 00:03:12,942 OK, gather up. 86 00:03:12,943 --> 00:03:15,362 Listen up, everybody. This is our chart rack. 87 00:03:15,362 --> 00:03:17,529 So as you can see, each slot and clipboard 88 00:03:17,530 --> 00:03:18,613 has a room number on it. 89 00:03:18,614 --> 00:03:19,865 When you pick up a new patient, 90 00:03:19,866 --> 00:03:22,201 you grab a fresh chart from the T-system. 91 00:03:22,202 --> 00:03:24,938 Pick your chart by chief complaint. 92 00:03:25,188 --> 00:03:27,622 Use the cartoon to find it. 93 00:03:27,623 --> 00:03:29,041 Why are there two bodies? 94 00:03:29,042 --> 00:03:31,252 Trauma on the left, medical on the right. 95 00:03:31,253 --> 00:03:32,854 So head injury, you go left. 96 00:03:32,879 --> 00:03:34,213 Headache, go right. 97 00:03:34,214 --> 00:03:35,881 Are those fish swimming in seaweed? 98 00:03:35,882 --> 00:03:38,258 No. That is bees and grass. 99 00:03:38,259 --> 00:03:39,427 That's the section for insect bites, 100 00:03:39,428 --> 00:03:40,928 skin rash, allergies. 101 00:03:40,929 --> 00:03:42,263 OK, let's say, for example, 102 00:03:42,264 --> 00:03:44,516 Dr. Al-Hashimi has a new patient with belly pain. 103 00:03:44,516 --> 00:03:47,184 For the history, circle the positives, 104 00:03:47,185 --> 00:03:49,145 like vomiting and diarrhea. 105 00:03:49,146 --> 00:03:51,856 Backslash the negative, such as recent travel, 106 00:03:51,857 --> 00:03:53,642 sick contacts, fever. 107 00:03:53,667 --> 00:03:57,236 For physical exam, checkmark normals on the left, 108 00:03:57,237 --> 00:03:59,613 and circle any abnormal findings on the right. 109 00:03:59,614 --> 00:04:00,449 Questions? 110 00:04:00,450 --> 00:04:02,032 Is your generative AI program 111 00:04:02,033 --> 00:04:03,033 still gonna be working? 112 00:04:04,286 --> 00:04:05,536 Not for a while. 113 00:04:05,537 --> 00:04:07,414 And ditch your SpectraLink phones. 114 00:04:07,414 --> 00:04:08,956 Those are voice over internet. 115 00:04:11,793 --> 00:04:13,128 PTMC Emergency. 116 00:04:13,128 --> 00:04:14,253 Go ahead, Medic Command. 117 00:04:14,254 --> 00:04:16,273 That is how we will hear about incoming runs. 118 00:04:16,298 --> 00:04:18,841 Thanks. Two minutes out with abdominal pain and fever. 119 00:04:18,842 --> 00:04:20,385 OK, has everybody got that so far? 120 00:04:20,385 --> 00:04:22,052 How do we write orders? 121 00:04:22,053 --> 00:04:23,679 Physician order form in triplicate. 122 00:04:23,680 --> 00:04:26,390 Labs, X-rays, IV fluid, medication. 123 00:04:26,391 --> 00:04:28,368 Will the labs still be able to run blood tests? 124 00:04:28,393 --> 00:04:29,186 Yes. 125 00:04:29,187 --> 00:04:30,811 Are the CT scanners still working? 126 00:04:30,812 --> 00:04:32,330 Yes, but the results will come back 127 00:04:32,355 --> 00:04:34,357 on paper from the radiologist. 128 00:04:34,357 --> 00:04:35,691 This is the dark ages. 129 00:04:35,692 --> 00:04:38,151 So if you have orders with labs or X-rays, 130 00:04:38,152 --> 00:04:39,612 they go into the clerk file here. 131 00:04:39,613 --> 00:04:40,905 They will sign them off. 132 00:04:40,906 --> 00:04:42,489 They will add a downtime slip on them, 133 00:04:42,491 --> 00:04:43,782 make sure they go to the correct department. 134 00:04:43,783 --> 00:04:45,201 I'm sorry, who are the clerks? 135 00:04:45,202 --> 00:04:46,618 - You're looking at them. - At your service. 136 00:04:46,619 --> 00:04:47,869 Larry and Antoine are filling in 137 00:04:47,870 --> 00:04:49,330 - until more help arrives. - We got this. 138 00:04:49,331 --> 00:04:51,373 After the clerk orders, chart gets moved 139 00:04:51,374 --> 00:04:53,477 to the nursing order rack here for IVs, 140 00:04:53,502 --> 00:04:54,835 medications, procedures. 141 00:04:54,836 --> 00:04:57,046 Medications are locked up in the PDS. 142 00:04:57,047 --> 00:04:59,883 The PDS is getting unlocked by a clinical pharmacist, 143 00:04:59,883 --> 00:05:01,592 - Dr. Megan Nordt. - We've got your back. 144 00:05:01,593 --> 00:05:04,079 This is a lot. Any questions? Yes. 145 00:05:04,329 --> 00:05:05,722 Uh, no. 146 00:05:05,722 --> 00:05:07,264 What's up with the third rack? 147 00:05:07,265 --> 00:05:08,974 When your patient is ready to be discharged, 148 00:05:08,975 --> 00:05:10,183 chart goes here. 149 00:05:10,184 --> 00:05:11,476 This lets everybody know 150 00:05:11,477 --> 00:05:12,561 we're about to have an open bed. 151 00:05:12,562 --> 00:05:14,021 Or that your tuna melt is up. 152 00:05:14,022 --> 00:05:15,090 Jesse? 153 00:05:17,390 --> 00:05:18,902 - What is that? - What is that? 154 00:05:18,902 --> 00:05:20,694 That is a fax machine. 155 00:05:20,695 --> 00:05:22,154 They still make those? 156 00:05:22,155 --> 00:05:23,906 This is our lifeline to labs and X-rays. 157 00:05:23,907 --> 00:05:26,032 When the results come back, they will fax to us, 158 00:05:26,033 --> 00:05:27,742 and the clerks will put them on the charts. 159 00:05:27,743 --> 00:05:29,077 - Yes? - If you say so. 160 00:05:29,078 --> 00:05:30,120 Incoming. 161 00:05:30,121 --> 00:05:33,999 OK, Dr. McKay, Dr. Whitaker, Ogilvie, you're with me. 162 00:05:34,000 --> 00:05:36,278 The rest of you, build your clipboards. 163 00:05:38,959 --> 00:05:41,842 Howard Knox, 52, abdominal pain and fever. 164 00:05:41,842 --> 00:05:44,426 152 over 90, tachy at 120. 165 00:05:44,427 --> 00:05:46,304 - Couldn't get an IV. - I wonder why. 166 00:05:46,304 --> 00:05:48,031 Hello, sir. My name is Dr. Robby. 167 00:05:48,056 --> 00:05:50,349 - Howard. - This is a teaching hospital. 168 00:05:50,350 --> 00:05:52,517 I'll be supervising Doctors McKay and Dr. Whitaker 169 00:05:52,518 --> 00:05:53,727 - and student Dr. Ogilvie. - Hey. 170 00:05:53,728 --> 00:05:54,812 - Hello. - How are you feeling? 171 00:05:54,813 --> 00:05:56,146 - Not so great. - OK. 172 00:05:56,147 --> 00:05:57,814 - Princess, what's free? - Trauma 1. 173 00:05:57,815 --> 00:05:59,009 Perlah? 174 00:06:01,386 --> 00:06:04,990 All right, orders for Mylanta and bupivacaine, Central 12. 175 00:06:04,990 --> 00:06:06,532 Wrong spot, Dr. Santos. 176 00:06:06,533 --> 00:06:08,576 And you need a sticker. 177 00:06:09,994 --> 00:06:11,579 Put it in the nursing orders rack. 178 00:06:11,580 --> 00:06:12,997 And meet me over at PDS. 179 00:06:12,998 --> 00:06:14,373 How much does this suck? 180 00:06:14,374 --> 00:06:16,167 I didn't think today could get any worse. 181 00:06:16,167 --> 00:06:18,111 This is how we rolled when I was a resident. 182 00:06:18,361 --> 00:06:19,921 Was that in the 1900s? 183 00:06:19,921 --> 00:06:22,032 Yeah, when charts were written by candlelight. 184 00:06:22,240 --> 00:06:24,174 Hey, today will be an adventure. 185 00:06:24,175 --> 00:06:26,328 Think of it like "Back to the Future." 186 00:06:28,705 --> 00:06:30,665 Or possibly "Titanic." 187 00:06:30,916 --> 00:06:32,893 Here is your antacid. 188 00:06:32,893 --> 00:06:33,976 Cheers. 189 00:06:33,977 --> 00:06:35,936 And I marked the trigger point 190 00:06:35,937 --> 00:06:37,438 that is bringing out your headache, 191 00:06:37,439 --> 00:06:39,316 and a shot of local anesthetic in that area 192 00:06:39,316 --> 00:06:40,926 could really help. 193 00:06:42,282 --> 00:06:43,570 Yeah, let's do it. 194 00:06:43,571 --> 00:06:44,763 All right. 195 00:06:45,806 --> 00:06:48,517 You are going to feel a little pinprick 196 00:06:48,725 --> 00:06:50,393 and some burning. 197 00:06:56,525 --> 00:06:57,917 OK. 198 00:06:57,918 --> 00:06:59,919 Oh, ow, ow, that really hurts. 199 00:06:59,920 --> 00:07:04,673 Temp 101.4, tachy at 128, pulse ox 92 on 2 liters. 200 00:07:04,674 --> 00:07:05,925 When did the pain start? 201 00:07:05,926 --> 00:07:07,593 It's been on and off for about a week. 202 00:07:07,594 --> 00:07:09,261 - And where do you feel it? - All over. 203 00:07:09,262 --> 00:07:11,805 It started on the left, and now there's some on the right. 204 00:07:11,806 --> 00:07:12,973 How about that fever? 205 00:07:12,974 --> 00:07:14,266 Since last night. 206 00:07:14,267 --> 00:07:15,643 I was burning up. 207 00:07:15,644 --> 00:07:17,436 Then I had chills pretty bad. 208 00:07:17,437 --> 00:07:19,605 - I can't find a vein here. - We'll try for a midline. 209 00:07:19,606 --> 00:07:21,049 Let us know if this hurts. 210 00:07:21,258 --> 00:07:22,691 - Ah, ah. - Sorry. 211 00:07:22,692 --> 00:07:24,652 - And on this side? - Yeah, yeah! 212 00:07:24,653 --> 00:07:25,403 Sorry, sir. 213 00:07:25,404 --> 00:07:26,905 Guarding with no rigidity. 214 00:07:26,905 --> 00:07:28,781 For pain, 100 of fent IM? 215 00:07:28,782 --> 00:07:30,199 Plan, Dr. Whitaker? 216 00:07:30,200 --> 00:07:33,159 Blood cultures, lactate, Zosyn. 217 00:07:33,160 --> 00:07:35,272 We're gonna need a CT to figure out what's going on. 218 00:07:35,438 --> 00:07:36,773 Ah-ah. 219 00:07:37,023 --> 00:07:39,000 - Yeah, it's not gonna work. - Yep. 220 00:07:39,000 --> 00:07:40,500 Write neatly. Penmanship counts. 221 00:07:40,501 --> 00:07:41,835 Howard, for the scan, we're gonna have 222 00:07:41,836 --> 00:07:43,879 to lay you flat on your back. Can you do that? 223 00:07:43,880 --> 00:07:45,380 I could ten years ago, 224 00:07:45,381 --> 00:07:47,007 but now it's too hard to breathe. 225 00:07:47,008 --> 00:07:48,467 If we can't lay you flat, 226 00:07:48,468 --> 00:07:50,279 then we're gonna have to put a tube in your windpipe 227 00:07:50,303 --> 00:07:51,678 to help you breathe... are you OK with that? 228 00:07:51,679 --> 00:07:53,055 Intubation with rapid sequence induction? 229 00:07:53,056 --> 00:07:54,390 No, we can't lay him down. 230 00:07:54,391 --> 00:07:55,642 The tube will go in your nose 231 00:07:55,642 --> 00:07:56,767 while you're awake, sir. 232 00:07:56,768 --> 00:07:57,686 - Well... - Right. 233 00:07:57,687 --> 00:07:58,769 Does it hurt? 234 00:07:58,770 --> 00:08:00,229 You'll be numbed up completely. 235 00:08:00,230 --> 00:08:01,563 You won't feel any discomfort. 236 00:08:01,564 --> 00:08:04,359 Do you happen to know your weight? 237 00:08:04,359 --> 00:08:06,110 A little over 400. 238 00:08:06,111 --> 00:08:07,610 When was the last time you checked? 239 00:08:07,611 --> 00:08:08,821 It's been a while. 240 00:08:08,822 --> 00:08:11,057 Is it possible that you might be over 450? 241 00:08:11,308 --> 00:08:12,684 Possibly. 242 00:08:13,351 --> 00:08:15,353 Perlah, let's call for the Hoyer. 243 00:08:15,562 --> 00:08:18,356 So we're gonna place the tube and get you ready for the scan. 244 00:08:18,732 --> 00:08:20,416 Is this something serious? 245 00:08:20,417 --> 00:08:22,126 Well, it's hard to tell without a CT. 246 00:08:22,127 --> 00:08:23,878 You could just need antibiotics, 247 00:08:23,878 --> 00:08:25,671 or you could require an operation. 248 00:08:25,672 --> 00:08:27,090 If surgery is necessary, 249 00:08:27,090 --> 00:08:28,257 then your weight could make things 250 00:08:28,258 --> 00:08:29,800 - a little bit more complicated. - I know. 251 00:08:29,801 --> 00:08:31,010 - I'm sorry. - Not to worry. 252 00:08:31,011 --> 00:08:32,636 We're gonna take very good care of you. 253 00:08:32,637 --> 00:08:33,705 Team. 254 00:08:33,730 --> 00:08:34,730 OK. 255 00:08:34,831 --> 00:08:36,641 Pain medication for you, OK? 256 00:08:36,641 --> 00:08:38,476 Let's try for a midline, 257 00:08:38,476 --> 00:08:40,394 basilic vein with ultrasound guidance. 258 00:08:40,395 --> 00:08:41,978 Can ultrasound check for an appy? 259 00:08:41,979 --> 00:08:43,731 He's a little too large for an ultrasound. 260 00:08:43,732 --> 00:08:46,274 Plus, our CT can only handle 450 pounds. 261 00:08:46,275 --> 00:08:48,345 And so if he's over that, we send him to the zoo? 262 00:08:49,596 --> 00:08:51,155 He's right there. 263 00:08:53,277 --> 00:08:56,285 I... I heard that there's a large animal CT at the zoo. 264 00:08:56,286 --> 00:08:58,245 Presby's CT can handle 650. 265 00:08:58,246 --> 00:09:00,273 Yeah, if Presby's still up and running. 266 00:09:00,523 --> 00:09:01,650 Wh... 267 00:09:01,942 --> 00:09:04,043 That... that's not a jinx. It's... 268 00:09:04,044 --> 00:09:06,613 Have any of you ever done an awake naso-tracheal? 269 00:09:06,879 --> 00:09:07,880 OK. 270 00:09:07,881 --> 00:09:10,299 Perlah, can you also ask Dr. Al-Hashimi to come in? 271 00:09:10,300 --> 00:09:11,300 I'm gonna need an assist. 272 00:09:11,301 --> 00:09:12,593 Yep. You got it. 273 00:09:12,594 --> 00:09:14,845 Ah, sorry. Signed. 274 00:09:15,684 --> 00:09:19,142 Hall bed F, George Francis, shortness of breath, 275 00:09:19,142 --> 00:09:21,519 Dr. Mohan, awaiting D-dimer. 276 00:09:21,519 --> 00:09:23,187 Wow. She's still going? 277 00:09:23,188 --> 00:09:24,965 Yeah. Remarkable, really. 278 00:09:25,173 --> 00:09:26,940 Dr. Al, Robby's asking for you. 279 00:09:26,941 --> 00:09:28,067 Uh, OK. 280 00:09:28,068 --> 00:09:29,818 In Trauma if you need me, Princess. 281 00:09:29,819 --> 00:09:30,887 Got it. 282 00:09:32,577 --> 00:09:34,157 Who's supposed to run the downtime slips 283 00:09:34,157 --> 00:09:35,300 to X-ray and lab? 284 00:09:35,325 --> 00:09:37,018 Uh, the charge nurse? 285 00:09:37,655 --> 00:09:39,062 Don't look at me. 286 00:09:39,521 --> 00:09:41,247 My plate's full! 287 00:09:43,039 --> 00:09:45,694 Uh, parents of Roxie Hamler? 288 00:09:45,924 --> 00:09:46,960 Central 9. 289 00:09:46,961 --> 00:09:48,087 Oh, I got it, Donnie. 290 00:09:48,088 --> 00:09:49,588 Hi, I'm Victoria Javadi, 291 00:09:49,589 --> 00:09:51,048 one of the student doctors here. 292 00:09:51,049 --> 00:09:52,799 I've been assisting with Roxie's care. 293 00:09:52,800 --> 00:09:53,842 Oh, thank you so much. 294 00:09:53,843 --> 00:09:55,954 - I'm Lloyd. - Cora. 295 00:09:56,038 --> 00:09:57,388 It's nice to meet you. 296 00:09:57,471 --> 00:09:58,638 She broke her leg? 297 00:09:58,639 --> 00:10:01,225 Um, yeah. There's a fracture down by the ankle. 298 00:10:01,226 --> 00:10:04,019 She's in a boot now, so there's not quite so much pain. 299 00:10:04,020 --> 00:10:06,339 But I'll take you. She's just in 9. 300 00:10:11,744 --> 00:10:13,404 The hospital Wi-Fi isn't working. 301 00:10:13,404 --> 00:10:14,696 Oh, it'll be down for a while. 302 00:10:14,697 --> 00:10:15,765 Sorry. 303 00:10:16,433 --> 00:10:18,059 Mom broke her leg, Grandpa. 304 00:10:18,768 --> 00:10:20,145 We heard. 305 00:10:21,021 --> 00:10:22,731 How are you, honey? 306 00:10:24,870 --> 00:10:26,501 You've got this, kiddo. 307 00:10:27,413 --> 00:10:28,486 Yeah. 308 00:10:29,571 --> 00:10:31,781 How long will she stay in the ER? 309 00:10:32,006 --> 00:10:34,868 Oh, until a bed opens up upstairs. 310 00:10:35,593 --> 00:10:36,911 Could be a while. 311 00:10:42,251 --> 00:10:43,976 You know, it's getting pretty crowded in here. 312 00:10:43,977 --> 00:10:45,894 Maybe we should take Tucker and Shane out for ice cream. 313 00:10:45,895 --> 00:10:48,840 - Yes, please. - No, no. I'm OK. 314 00:10:49,215 --> 00:10:52,260 Maybe your mom would like some time to rest. 315 00:10:52,568 --> 00:10:54,429 Yeah. Go. 316 00:10:56,095 --> 00:10:57,724 Can she have ice cream? 317 00:10:58,475 --> 00:11:00,435 She can have anything she wants. 318 00:11:02,036 --> 00:11:03,688 Come on, let's go. 319 00:11:04,647 --> 00:11:06,566 Bye, Mom. 320 00:11:08,359 --> 00:11:10,570 Ice cream, ice cream. 321 00:11:14,048 --> 00:11:15,215 Yep. 322 00:11:15,216 --> 00:11:16,785 Listen up. 323 00:11:17,160 --> 00:11:19,721 This is Oxymetazoline. This will open up the passage. 324 00:11:20,889 --> 00:11:22,389 What medication do you take? 325 00:11:22,390 --> 00:11:24,767 Uh, Lisinopril and Metformin. 326 00:11:25,143 --> 00:11:27,145 Ozempic? Wegovy? 327 00:11:27,145 --> 00:11:29,104 No. Kind of expensive. 328 00:11:29,105 --> 00:11:31,023 I'm going to squirt some numbing gel in your nose. 329 00:11:31,024 --> 00:11:33,384 If it drips back in your throat, that's OK. 330 00:11:34,385 --> 00:11:36,304 Here, in case you need it. 331 00:11:36,805 --> 00:11:38,655 Do you smoke? 332 00:11:38,656 --> 00:11:39,865 Alcohol? 333 00:11:39,866 --> 00:11:41,684 - Never. - Do you exercise? 334 00:11:41,935 --> 00:11:44,062 Moving from the bedroom to the kitchen. 335 00:11:44,312 --> 00:11:45,914 No, I'd walk more, 336 00:11:45,914 --> 00:11:48,457 but I need a bench to rest on every block. 337 00:11:48,458 --> 00:11:50,042 What about water aerobics? 338 00:11:50,043 --> 00:11:52,252 Let's focus on helping Mr. Knox. 339 00:11:52,253 --> 00:11:53,363 Agreed. 340 00:11:53,696 --> 00:11:55,798 It took me 25 years to get this way. 341 00:11:55,798 --> 00:11:57,951 Car crash, burn unit, 342 00:11:58,326 --> 00:12:00,912 four leg surgeries over ten years. 343 00:12:01,162 --> 00:12:03,348 Laid me up so much, I lost my job. 344 00:12:03,348 --> 00:12:05,182 I need to numb the back of your tongue. 345 00:12:05,183 --> 00:12:06,934 This is gonna taste pretty bad. 346 00:12:06,935 --> 00:12:08,393 Is there anyone you'd like us to call? 347 00:12:08,394 --> 00:12:09,519 No. 348 00:12:09,520 --> 00:12:11,063 Any family? 349 00:12:11,064 --> 00:12:13,508 Mm. My parents passed. 350 00:12:13,758 --> 00:12:14,858 I'm single. 351 00:12:14,859 --> 00:12:15,818 Go figure. 352 00:12:15,818 --> 00:12:16,985 Siblings? 353 00:12:16,986 --> 00:12:18,596 Sister in Arizona. 354 00:12:18,930 --> 00:12:21,057 We don't talk much. 355 00:12:21,391 --> 00:12:23,492 Now that we've numbed up the back of your tongue, 356 00:12:23,493 --> 00:12:25,495 we can anesthetize a bit deeper. 357 00:12:26,545 --> 00:12:27,997 Um, sorry to interrupt. 358 00:12:27,998 --> 00:12:30,540 I have a middle-aged woman with sudden onset blindness. 359 00:12:30,541 --> 00:12:32,043 - I can go. - OK. 360 00:12:32,043 --> 00:12:33,418 Will you see if Abbot's still around? 361 00:12:33,419 --> 00:12:34,419 - Yeah. - Thank you. 362 00:12:34,420 --> 00:12:35,671 What's your sister's name? 363 00:12:35,672 --> 00:12:37,282 Lauren Milford. 364 00:12:37,532 --> 00:12:39,007 Where in Arizona? 365 00:12:39,008 --> 00:12:40,410 Flagstaff, I think. 366 00:12:40,435 --> 00:12:41,886 Just gonna go over your tongue 367 00:12:41,886 --> 00:12:43,303 and numb your vocal cords. 368 00:12:43,304 --> 00:12:44,055 Ah. 369 00:12:44,056 --> 00:12:46,166 Ah... 370 00:12:46,416 --> 00:12:47,599 How many fingers? 371 00:12:47,600 --> 00:12:49,169 I don't see any fingers. 372 00:12:49,669 --> 00:12:51,129 And now? 373 00:12:51,713 --> 00:12:53,715 I can see a little bit of light. 374 00:12:54,215 --> 00:12:56,316 Um, Brooke, you've met Dr. King. 375 00:12:56,317 --> 00:12:57,609 This is Dr. Al-Hashimi. 376 00:12:57,610 --> 00:12:59,111 - Nice to meet you. - And her wife, Wendy. 377 00:12:59,112 --> 00:13:00,195 - Hello. - Hello. 378 00:13:00,196 --> 00:13:01,863 OK if we discuss your symptoms? 379 00:13:01,864 --> 00:13:04,284 As long as I can correct you if you get anything wrong. 380 00:13:04,284 --> 00:13:05,826 Trust me, she will. 381 00:13:05,827 --> 00:13:09,079 One hour of sudden, painless vision loss in the left eye. 382 00:13:09,080 --> 00:13:10,957 No history of hypercoagulable state 383 00:13:10,957 --> 00:13:12,292 or vascular disease. 384 00:13:12,317 --> 00:13:13,667 Could you look straight ahead, please? 385 00:13:13,668 --> 00:13:15,987 Could be a central retinal artery occlusion. 386 00:13:16,279 --> 00:13:17,713 In English, please? 387 00:13:17,714 --> 00:13:20,048 A little blood clot can block the artery 388 00:13:20,049 --> 00:13:22,384 at the back of the eye and decrease your vision. 389 00:13:22,385 --> 00:13:24,177 Sometimes it's called an eye stroke. 390 00:13:24,178 --> 00:13:25,096 Stroke? 391 00:13:25,097 --> 00:13:26,555 Like she could be paralyzed? 392 00:13:26,556 --> 00:13:28,182 No, this would be limited to the eye. 393 00:13:28,182 --> 00:13:29,433 Is it permanent? 394 00:13:29,434 --> 00:13:31,502 First, we have to make the diagnosis. 395 00:13:31,794 --> 00:13:33,103 Retinal exam? 396 00:13:33,104 --> 00:13:34,230 Hard to get a good look. 397 00:13:34,230 --> 00:13:35,548 We need the FOP. 398 00:13:35,898 --> 00:13:37,217 The what? 399 00:13:39,694 --> 00:13:40,944 Oh, Princess. 400 00:13:40,945 --> 00:13:43,323 We need patient stickers on each of these order sheets, 401 00:13:43,323 --> 00:13:45,532 or the pharmacy won't know who to give meds to. 402 00:13:45,533 --> 00:13:46,867 We're on it. 403 00:13:46,868 --> 00:13:48,853 Princess, smartphone fundoscope? 404 00:13:49,062 --> 00:13:50,745 Equipment corridor, eye cart. 405 00:13:50,746 --> 00:13:53,483 - Thanks. - You seem a little confused. 406 00:13:53,691 --> 00:13:55,626 How do I figure out which new patient to pick up? 407 00:13:55,626 --> 00:13:56,586 Top of the board. 408 00:13:56,587 --> 00:13:58,045 They're listed in the order they arrive. 409 00:13:58,046 --> 00:13:59,462 You erase the first one, then put 410 00:13:59,463 --> 00:14:00,839 your initials in the MD box. 411 00:14:00,840 --> 00:14:01,991 OK. Thanks. 412 00:14:02,101 --> 00:14:03,634 - Caleb. - Michael. 413 00:14:03,634 --> 00:14:05,344 Are you managing this chaos OK? 414 00:14:05,345 --> 00:14:07,455 Well, it's all pretty easy when you're a short-timer. 415 00:14:08,039 --> 00:14:10,974 Any more comatose patients for me to have a chat with? 416 00:14:12,359 --> 00:14:13,693 I'm kidding. 417 00:14:13,741 --> 00:14:14,771 OK. 418 00:14:14,771 --> 00:14:17,189 Victoria, this is Nicole Steadman. 419 00:14:17,190 --> 00:14:18,483 I run the parent support group 420 00:14:18,483 --> 00:14:19,900 for the psychiatric service. 421 00:14:19,901 --> 00:14:21,776 Yeah. Nicole's daughter was diagnosed 422 00:14:21,777 --> 00:14:23,195 sophomore year in college. 423 00:14:23,196 --> 00:14:26,182 You think Jackson's parents might have a chat with her? 424 00:14:26,391 --> 00:14:28,017 We can certainly ask. 425 00:14:28,351 --> 00:14:30,161 Now we can see the whole retina 426 00:14:30,161 --> 00:14:31,744 without dilating the pupil. 427 00:14:32,706 --> 00:14:34,247 You're looking in the wrong eye. 428 00:14:34,248 --> 00:14:36,484 Oh, we start with the good eye for comparison. 429 00:14:36,509 --> 00:14:37,652 Oh. 430 00:14:38,444 --> 00:14:39,753 Retina looks great. 431 00:14:39,754 --> 00:14:41,087 Now for the bad eye? 432 00:14:41,088 --> 00:14:42,423 Eyes wide open. 433 00:14:44,440 --> 00:14:46,135 How's it look? 434 00:14:46,176 --> 00:14:47,760 Extremely pale, no blood flow. 435 00:14:47,761 --> 00:14:49,763 Digital massage, 10 seconds on, 5 seconds off. 436 00:14:49,764 --> 00:14:51,666 Order non-contrast head CT. 437 00:14:54,836 --> 00:14:56,170 Come in. 438 00:14:56,796 --> 00:14:57,939 Hi. 439 00:14:57,939 --> 00:14:59,439 Heard your patient took off. 440 00:14:59,440 --> 00:15:00,983 She's taking a little break. 441 00:15:00,983 --> 00:15:02,385 How long are you gonna wait? 442 00:15:03,303 --> 00:15:05,195 You know about the cyber shutdown thing? 443 00:15:05,196 --> 00:15:06,014 Yeah. 444 00:15:06,197 --> 00:15:07,994 Wish I could help, but I gotta stay here 445 00:15:08,019 --> 00:15:09,824 till all the evidence is collected, so... 446 00:15:09,825 --> 00:15:11,451 It's a hot mess out there. 447 00:15:11,452 --> 00:15:12,827 This whole day is. 448 00:15:14,063 --> 00:15:15,815 Sorry. I was just leaving. 449 00:15:16,065 --> 00:15:17,233 You OK? 450 00:15:18,318 --> 00:15:19,652 I'm good. 451 00:15:19,861 --> 00:15:21,321 I'm glad to hear it. 452 00:15:21,571 --> 00:15:22,796 You get something to eat? 453 00:15:22,797 --> 00:15:23,906 No. 454 00:15:25,450 --> 00:15:26,868 Let's keep going. 455 00:15:27,493 --> 00:15:28,870 OK. 456 00:15:29,261 --> 00:15:30,304 Yeah. 457 00:15:40,502 --> 00:15:42,383 Why don't we keep one in the ER? 458 00:15:42,884 --> 00:15:45,970 Because our intubated patients are usually sedated. 459 00:15:46,637 --> 00:15:47,637 Right. 460 00:15:47,764 --> 00:15:50,031 Maybe you could ease up 461 00:15:50,032 --> 00:15:51,801 with your comments about his weight. 462 00:15:52,994 --> 00:15:54,911 I was just wondering how he got so big 463 00:15:54,912 --> 00:15:56,204 and how we could help. 464 00:15:56,205 --> 00:15:59,291 We can help by finding out what's wrong with him and treating him with respect. 465 00:15:59,292 --> 00:16:00,293 How's your belly now? 466 00:16:00,293 --> 00:16:01,834 Second pain shot helped. 467 00:16:01,835 --> 00:16:03,420 OK. There's more if you need it. 468 00:16:03,421 --> 00:16:04,755 Diminished bowel sounds. 469 00:16:04,755 --> 00:16:07,174 - VidaTalk from the ICU. - Great. 470 00:16:07,175 --> 00:16:09,175 Howard, we need to open up that passageway now 471 00:16:09,176 --> 00:16:10,302 so we can pass the tube. 472 00:16:10,303 --> 00:16:11,511 I'm gonna start with my pinky. 473 00:16:11,512 --> 00:16:13,305 Slowly, over a few minutes, I'm gonna go deeper, 474 00:16:13,306 --> 00:16:14,847 all the way to the back of my knuckle. 475 00:16:14,848 --> 00:16:16,659 Once the tube's through your vocal cords, 476 00:16:16,684 --> 00:16:17,934 you won't be able to talk. 477 00:16:17,935 --> 00:16:19,728 But this is a communication device. 478 00:16:19,729 --> 00:16:22,314 Swipe through the screen for anything you want to say. 479 00:16:22,315 --> 00:16:24,775 Hit the icon, and it talks to us. 480 00:16:24,775 --> 00:16:26,761 I would like some pain medicine. 481 00:16:27,095 --> 00:16:28,905 My pain is a nine. 482 00:16:28,905 --> 00:16:30,447 Can I get it to order a pizza? 483 00:16:32,517 --> 00:16:34,785 There's cell service in the ambulance bay. 484 00:16:34,785 --> 00:16:37,287 I found his sister's new number, left a voicemail. 485 00:16:37,288 --> 00:16:38,663 OK, I'm gonna start. 486 00:16:38,664 --> 00:16:39,789 You ready? 487 00:16:39,790 --> 00:16:40,983 Not really. 488 00:16:41,192 --> 00:16:42,334 Go ahead. 489 00:16:42,335 --> 00:16:43,669 Robby, over here. 490 00:16:43,669 --> 00:16:45,488 Here we go. Head back. 491 00:16:47,240 --> 00:16:48,466 You thinking it's surgical? 492 00:16:48,466 --> 00:16:49,925 I'm hoping for a non-perfed appy. 493 00:16:49,926 --> 00:16:51,511 - Can you do it with a scope? - Possibly, 494 00:16:51,511 --> 00:16:53,469 but he could be treated with antibiotics alone. 495 00:16:53,470 --> 00:16:55,305 And if he needs surgery? 496 00:16:55,306 --> 00:16:58,226 With his size, an emergency open laparotomy, 497 00:16:58,226 --> 00:17:00,435 death rate's close to 50%. 498 00:17:00,436 --> 00:17:01,978 OK, one step at a time. 499 00:17:01,979 --> 00:17:04,340 Let's keep trying his sister every 15 minutes. 500 00:17:04,549 --> 00:17:05,883 She'll get it. 501 00:17:09,829 --> 00:17:11,889 Half the downtime slips are blank. 502 00:17:12,640 --> 00:17:14,308 What are you talking about? 503 00:17:14,892 --> 00:17:16,853 Here and here. 504 00:17:17,103 --> 00:17:19,579 Larry, are you using a felt tip pen? 505 00:17:19,580 --> 00:17:20,731 Maybe. 506 00:17:21,357 --> 00:17:24,569 It's not going through for the copies. 507 00:17:24,861 --> 00:17:26,612 Ballpoint pen only. 508 00:17:26,920 --> 00:17:28,297 OK. 509 00:17:30,302 --> 00:17:31,967 Digby still MIA? 510 00:17:31,968 --> 00:17:33,261 Is that the homeless guy? 511 00:17:33,261 --> 00:17:35,163 We need the bed if he eloped. 512 00:17:36,471 --> 00:17:38,306 - What do you need? - An attending. 513 00:17:38,307 --> 00:17:40,141 - Or a senior resident? - Nope, I'm good. 514 00:17:40,142 --> 00:17:42,227 - Dr. Al-Hashimi, can I present? - Yes. 515 00:17:42,228 --> 00:17:44,854 32-year-old deaf woman with myofascial headache. 516 00:17:44,855 --> 00:17:47,232 Ibuprofen caused gastritis and epigastric pain, 517 00:17:47,233 --> 00:17:49,526 and she vasovagalled, but now pain-free 518 00:17:49,527 --> 00:17:51,528 after Mylanta and a trigger point injection. 519 00:17:51,529 --> 00:17:52,965 Excellent. That can take care of the pain 520 00:17:52,989 --> 00:17:54,447 - for several months. - Yeah. 521 00:17:54,448 --> 00:17:56,575 It shouldn't recur if she keeps her screen at eye level. 522 00:17:56,576 --> 00:17:58,076 There was a delay 523 00:17:58,077 --> 00:17:59,661 in getting an ASL interpreter. 524 00:17:59,662 --> 00:18:01,329 And I almost gave up and ordered 525 00:18:01,330 --> 00:18:03,415 an unnecessary brain and abdominal CT. 526 00:18:03,416 --> 00:18:04,666 Good thing you didn't. 527 00:18:04,667 --> 00:18:06,235 Dr. Al-Hashimi, for you. 528 00:18:07,413 --> 00:18:10,005 - Nice job on the trigger point. - Yeah, I know. 529 00:18:10,006 --> 00:18:11,382 How's the T-system going? 530 00:18:11,574 --> 00:18:13,883 - Quick and easy. - Yeah. 531 00:18:13,884 --> 00:18:15,969 On these MDMs, don't just circle your diagnosis. 532 00:18:15,970 --> 00:18:17,887 Also put a backslash through all the ones 533 00:18:17,888 --> 00:18:18,972 that you've ruled out. 534 00:18:18,973 --> 00:18:20,056 No problem. 535 00:18:20,057 --> 00:18:21,391 Thank you very much. 536 00:18:21,392 --> 00:18:23,685 Princess, bump Central 13 to the front of the CT line. 537 00:18:23,686 --> 00:18:24,686 What do you got? 538 00:18:24,687 --> 00:18:26,187 Sudden onset blindness patient 539 00:18:26,188 --> 00:18:27,732 has central retinal artery occlusion. 540 00:18:27,732 --> 00:18:29,357 I just spoke to an ophthalmologist 541 00:18:29,358 --> 00:18:30,900 at the VA, principal investigator 542 00:18:30,901 --> 00:18:32,695 for thrombolytics in cases like this. 543 00:18:32,695 --> 00:18:34,154 Not exactly standard of care. 544 00:18:34,155 --> 00:18:35,196 Kind of risky. 545 00:18:35,197 --> 00:18:36,656 We'll do informed consent. 546 00:18:36,657 --> 00:18:38,533 It's our best shot at saving some of her vision. 547 00:18:38,534 --> 00:18:39,784 Your patient, your call. 548 00:18:39,785 --> 00:18:42,482 I'm not gonna be around long enough for any complications. 549 00:18:44,918 --> 00:18:47,568 I'll be taking two swabs from the vagina, 550 00:18:48,527 --> 00:18:50,837 two swabs from the cervix. 551 00:18:53,932 --> 00:18:56,202 Let me know if you feel any discomfort. 552 00:18:56,702 --> 00:18:57,995 OK. 553 00:18:58,955 --> 00:19:03,183 Each swab gets labeled... first vaginal, second vaginal. 554 00:19:03,184 --> 00:19:05,310 Smear a slide with both, and let it air dry. 555 00:19:05,311 --> 00:19:06,603 Same for the cervix? 556 00:19:06,604 --> 00:19:07,646 Yeah. 557 00:19:07,647 --> 00:19:09,106 No slide needed. 558 00:19:10,378 --> 00:19:12,093 How you doing, Ilana? 559 00:19:12,635 --> 00:19:14,095 Hanging in there. 560 00:19:14,887 --> 00:19:16,013 OK. 561 00:19:16,305 --> 00:19:17,948 Almost done. 562 00:19:20,390 --> 00:19:23,225 All these samples go in the vaginal contact envelope. 563 00:19:23,226 --> 00:19:24,601 - I can help with that. - No. 564 00:19:24,602 --> 00:19:26,065 It's gotta be me. 565 00:19:26,354 --> 00:19:28,025 I'm gonna pull this out. 566 00:19:29,732 --> 00:19:31,028 OK. 567 00:19:31,659 --> 00:19:34,119 All good here. Legs can come down. 568 00:19:37,641 --> 00:19:39,328 Are we done? 569 00:19:39,704 --> 00:19:40,970 One last thing. 570 00:19:40,971 --> 00:19:42,999 Four more swabs inside your mouth. 571 00:19:43,457 --> 00:19:45,017 Didn't you do that already? 572 00:19:45,206 --> 00:19:48,328 This one's different... inside your cheek for your DNA, 573 00:19:48,379 --> 00:19:49,922 not for his. 574 00:19:52,838 --> 00:19:57,944 So it could be bipolar or schizophrenia? 575 00:19:58,139 --> 00:20:00,262 Those are the two most likely possibilities. 576 00:20:00,263 --> 00:20:01,805 How do they know which it is? 577 00:20:01,806 --> 00:20:03,853 Based on response to medicine, 578 00:20:03,975 --> 00:20:06,601 but also with therapy and observation on the ward. 579 00:20:06,602 --> 00:20:09,625 They'll monitor his mood and interactions with others. 580 00:20:11,777 --> 00:20:14,897 Is there a blood test or a brain scan 581 00:20:14,922 --> 00:20:16,357 that will tell us for sure? 582 00:20:16,382 --> 00:20:17,717 Unfortunately not. 583 00:20:17,742 --> 00:20:20,945 When properly medicated, people with bipolar disorder 584 00:20:20,970 --> 00:20:23,122 can have successful careers. 585 00:20:23,414 --> 00:20:25,207 So we hope for bipolar? 586 00:20:25,416 --> 00:20:27,516 You can hope for your son's happiness. 587 00:20:27,517 --> 00:20:30,019 With early treatment, 20% of people 588 00:20:30,020 --> 00:20:32,757 with schizophrenia have a complete recovery. 589 00:20:32,940 --> 00:20:34,383 So 80% don't? 590 00:20:34,525 --> 00:20:37,069 This is a new version of Jackson. 591 00:20:39,614 --> 00:20:41,907 - How old was your daughter? - 20. 592 00:20:42,589 --> 00:20:45,603 Studying architecture at Georgetown. 593 00:20:46,145 --> 00:20:47,813 Schizophrenia. 594 00:20:48,038 --> 00:20:49,956 I'm sorry. 595 00:20:49,957 --> 00:20:51,484 Oh, she's good. 596 00:20:51,734 --> 00:20:55,363 Living at home, working as a cashier at Giant Eagle. 597 00:20:56,838 --> 00:20:58,324 Employee of the Month. 598 00:20:59,075 --> 00:21:00,826 We still have struggles, 599 00:21:01,327 --> 00:21:04,246 but there's also laughter and love. 600 00:21:11,604 --> 00:21:12,755 Good to go. 601 00:21:12,963 --> 00:21:14,188 How'd that feel? 602 00:21:14,189 --> 00:21:15,607 Very weird. 603 00:21:15,608 --> 00:21:17,692 There's no pain. Just weird. 604 00:21:17,693 --> 00:21:20,204 OK, the next step is, we're gonna take this tube 605 00:21:20,229 --> 00:21:22,031 and pass it through your nose, 606 00:21:22,032 --> 00:21:24,449 stopping at the back of your tongue. 607 00:21:24,450 --> 00:21:26,075 Best not to talk for that. 608 00:21:26,076 --> 00:21:28,813 Tube's soaking in warm water to make it more flexible. 609 00:21:29,772 --> 00:21:31,524 Do you wanna try it? 610 00:21:32,692 --> 00:21:34,584 What day and time is it? 611 00:21:34,585 --> 00:21:36,570 4th of July, 2:31 p.m. 612 00:21:36,904 --> 00:21:38,823 When is my tube coming out? 613 00:21:39,047 --> 00:21:41,717 We have to put it in first. 614 00:21:42,197 --> 00:21:44,303 I know. Just practicing. 615 00:21:44,553 --> 00:21:46,831 Sounds like you're an expert already. 616 00:21:47,790 --> 00:21:49,834 Before I can't talk, 617 00:21:50,835 --> 00:21:52,878 I just wanna say 618 00:21:53,462 --> 00:21:56,590 thank you for everything. 619 00:21:57,476 --> 00:21:59,260 You're very welcome. 620 00:22:04,843 --> 00:22:06,261 Here we go. 621 00:22:10,794 --> 00:22:12,330 STI prevention. 622 00:22:12,331 --> 00:22:13,790 One shot treats gonorrhea, 623 00:22:13,791 --> 00:22:16,235 then pills for chlamydia and trichomonas. 624 00:22:16,301 --> 00:22:17,585 Thank you. 625 00:22:17,586 --> 00:22:19,587 We also have morning-after contraception. 626 00:22:19,588 --> 00:22:20,880 She has an IUD. 627 00:22:20,881 --> 00:22:23,384 Over 99% effective, not 100%. 628 00:22:23,384 --> 00:22:24,843 We still offer. 629 00:22:24,844 --> 00:22:26,386 I'll pass. 630 00:22:26,387 --> 00:22:29,973 For HIV, we got PEP, Post-Exposure Prophylaxis. 631 00:22:29,974 --> 00:22:31,266 28 days. 632 00:22:31,267 --> 00:22:33,377 The sooner you start, the more effective. 633 00:22:34,545 --> 00:22:36,521 Emma, I'm pretty sure they could use 634 00:22:36,522 --> 00:22:38,482 an extra set of hands out there. 635 00:22:39,548 --> 00:22:41,677 It's nice to meet you, Ilana. 636 00:22:41,969 --> 00:22:43,486 You're a very brave woman. 637 00:22:43,487 --> 00:22:44,696 Yeah. 638 00:22:51,520 --> 00:22:53,205 She's a good nurse. 639 00:22:53,397 --> 00:22:56,358 She's still learning, but she will be. 640 00:22:57,818 --> 00:22:59,627 After this, we're done? 641 00:22:59,628 --> 00:23:00,863 Yeah. 642 00:23:04,633 --> 00:23:06,494 I'm glad you were here today. 643 00:23:11,016 --> 00:23:12,500 Me too. 644 00:23:13,834 --> 00:23:16,337 We have a decision to make. 645 00:23:16,754 --> 00:23:18,938 Studies have shown that some vision 646 00:23:18,939 --> 00:23:21,609 can be restored with a clot-busting medication. 647 00:23:21,609 --> 00:23:22,968 So give it. 648 00:23:23,235 --> 00:23:25,221 But there are possible risks. 649 00:23:25,554 --> 00:23:29,824 For eye stroke, only 17% get better without any treatment. 650 00:23:29,825 --> 00:23:31,826 - Only 17%? - Yes. 651 00:23:31,827 --> 00:23:35,356 But with the medicine, another 20% can improve. 652 00:23:36,232 --> 00:23:38,484 But there can be complications. 653 00:23:38,692 --> 00:23:42,363 2% of patients who receive the medication get worse, 654 00:23:42,504 --> 00:23:46,408 and 1% have severe disability or death. 655 00:23:52,742 --> 00:23:56,126 Honey, this one has to be your call. 656 00:23:57,503 --> 00:23:59,839 No, it's our call. 657 00:24:00,548 --> 00:24:02,524 What would you do without me? 658 00:24:02,858 --> 00:24:04,802 I'd figure out how to get by. 659 00:24:06,679 --> 00:24:09,598 And I'd probably cry for two years solid. 660 00:24:10,099 --> 00:24:11,976 Two years? That's all? 661 00:24:13,394 --> 00:24:15,035 I want the medication. 662 00:24:15,036 --> 00:24:16,438 OK. 663 00:24:20,322 --> 00:24:22,335 OK, we need your full name to make a chart. 664 00:24:22,336 --> 00:24:24,420 Jackie Liddell. 665 00:24:24,421 --> 00:24:25,823 Jackie Liddell. 666 00:24:26,031 --> 00:24:27,256 And you are? 667 00:24:27,257 --> 00:24:28,591 Her friend Jaquie. 668 00:24:28,592 --> 00:24:30,511 - You have the same name? - No, no. 669 00:24:30,511 --> 00:24:32,679 She's Jackie with a C-K. I'm Jaquie with a Q. 670 00:24:32,680 --> 00:24:34,514 You can call me CK. 671 00:24:34,515 --> 00:24:35,640 Oh. 672 00:24:35,641 --> 00:24:37,057 Best not to talk, CK, OK? 673 00:24:37,058 --> 00:24:38,434 - Just chill. - Chill? 674 00:24:38,435 --> 00:24:41,688 - Q, I bit off half my tongue! - What? 675 00:24:41,689 --> 00:24:43,731 She said, I bit off half my tongue. 676 00:24:43,732 --> 00:24:44,982 You can understand that? 677 00:24:44,983 --> 00:24:46,734 Oh, you should hear her when she's had 678 00:24:46,735 --> 00:24:48,694 two pitchers of margaritas, fucked up and slurring. 679 00:24:48,695 --> 00:24:51,114 Ooh, you are such an idiot! 680 00:24:51,115 --> 00:24:52,740 Princess, what's open? 681 00:24:52,741 --> 00:24:54,367 South 15's clean. 682 00:24:54,368 --> 00:24:56,035 Deep tongue laceration. 683 00:24:56,036 --> 00:24:57,771 I can jump on this. 684 00:24:58,647 --> 00:25:01,582 Robby and Al-Hashimi are both with critical patients. 685 00:25:01,583 --> 00:25:02,776 Hello. 686 00:25:02,985 --> 00:25:04,210 I'm Dr. Langdon. 687 00:25:04,211 --> 00:25:06,030 I'll be supervising your care. 688 00:25:07,911 --> 00:25:10,758 Jesus, CK, your doctor's fucking hot. 689 00:25:13,370 --> 00:25:15,972 Tube's at 14 centimeters, just above the airway. 690 00:25:15,973 --> 00:25:18,474 OK, Howard, I'm going to start. 691 00:25:18,475 --> 00:25:22,421 If you want me to stop, you just put your hand up, OK? 692 00:25:22,796 --> 00:25:25,341 Blue mark tells me I'm in the tube. 693 00:25:28,344 --> 00:25:30,220 Looks like he cleared it. 694 00:25:30,679 --> 00:25:32,806 If he inhales, we should see chords. 695 00:25:33,140 --> 00:25:35,200 OK, deep breath for me, Howard. 696 00:25:38,562 --> 00:25:40,439 - OK. - Beautiful. 697 00:25:40,689 --> 00:25:42,540 Chords are sensitive, so we spray lidocaine 698 00:25:42,541 --> 00:25:44,360 - in the scope. - OK. 699 00:25:45,085 --> 00:25:48,113 1 cc going in now. 700 00:25:48,364 --> 00:25:50,658 And we'll just give that a second to work. 701 00:25:50,950 --> 00:25:52,801 How you doing, Howard? 702 00:25:53,863 --> 00:25:55,763 Once the tube's in, you'll have to breathe 703 00:25:55,763 --> 00:25:57,096 through your nose. 704 00:25:57,097 --> 00:25:58,598 OK, Howard, hold still. 705 00:25:58,599 --> 00:26:02,018 I am now going in past your vocal cords 706 00:26:02,019 --> 00:26:04,729 until we see the carina. 707 00:26:06,100 --> 00:26:07,733 Ogilvie. 708 00:26:07,733 --> 00:26:09,025 Uh, there. 709 00:26:09,026 --> 00:26:10,317 Right and left mainstem. 710 00:26:10,318 --> 00:26:12,805 And the tube slides in. 711 00:26:16,677 --> 00:26:20,020 And then the scope comes out. 712 00:26:21,844 --> 00:26:23,107 Great. 713 00:26:23,399 --> 00:26:26,168 OK, inflate the balloon. Deep breath through your nose. 714 00:26:26,168 --> 00:26:27,319 Amazing. 715 00:26:27,418 --> 00:26:28,856 You good? 716 00:26:29,480 --> 00:26:31,174 Great end-tidal waveform. 717 00:26:31,245 --> 00:26:32,589 Does he need a vent? 718 00:26:32,590 --> 00:26:34,884 He's breathing on his own, but a little CPAP wouldn't hurt. 719 00:26:34,885 --> 00:26:36,787 Starting at 5, titrate to 10. 720 00:26:37,246 --> 00:26:39,347 OK, that went really well, Howard. 721 00:26:39,348 --> 00:26:41,182 Now we're going to check your weight. 722 00:26:42,996 --> 00:26:44,727 So the nurse examiner is supposed 723 00:26:44,728 --> 00:26:46,645 to lock up the rape kit in this fridge, 724 00:26:46,646 --> 00:26:49,690 where it stays until it gets turned over to law enforcement. 725 00:26:49,691 --> 00:26:52,011 It's called preserving the chain of evidence. 726 00:26:52,386 --> 00:26:54,304 Are you fucking kidding me? 727 00:26:54,596 --> 00:26:56,697 Is there a problem? 728 00:26:56,698 --> 00:26:58,783 Jesus Christ. 729 00:26:58,784 --> 00:27:01,954 Police are supposed to pick up the rape kits within 72 hours. 730 00:27:02,037 --> 00:27:04,106 This one I did two weeks ago. 731 00:27:04,940 --> 00:27:06,400 God damn it. 732 00:27:08,235 --> 00:27:10,628 So how exactly did this happen? 733 00:27:10,629 --> 00:27:13,714 We were in between pubs taking a selfie. 734 00:27:13,715 --> 00:27:14,799 Very nice. 735 00:27:14,800 --> 00:27:17,036 Until she jerked her head up. 736 00:27:17,286 --> 00:27:18,579 Ooh. 737 00:27:18,604 --> 00:27:19,762 Ouch. 738 00:27:19,763 --> 00:27:21,889 OK, topical epi did the trick. 739 00:27:21,890 --> 00:27:23,265 - No more bleeding. - Sweet. 740 00:27:23,266 --> 00:27:24,517 I can go home now? 741 00:27:24,518 --> 00:27:26,060 I don't think so. 742 00:27:26,061 --> 00:27:28,164 It looks like the Grand Canyon across the back of your tongue. 743 00:27:28,188 --> 00:27:29,857 We need to put in some stitches. 744 00:27:29,857 --> 00:27:31,375 I don't want stitches. 745 00:27:31,400 --> 00:27:33,135 Oh. Listen to the doctor. 746 00:27:33,234 --> 00:27:34,943 Don't tell me what to do. 747 00:27:34,944 --> 00:27:36,445 This is all your fault. 748 00:27:36,446 --> 00:27:38,489 - No, it's not. - Uh, yes, it is. 749 00:27:38,490 --> 00:27:40,116 - Uh, Princess. - No, it's not. 750 00:27:40,117 --> 00:27:41,534 Princess, hey, why don't you show Q 751 00:27:41,535 --> 00:27:43,577 where she can wait while we patch up her friend? 752 00:27:43,578 --> 00:27:44,787 Of course. 753 00:27:44,788 --> 00:27:47,247 OK, this is a numbing shot for the tip. 754 00:27:47,248 --> 00:27:48,248 The tip? 755 00:27:48,249 --> 00:27:50,084 That's not where I bit it. 756 00:27:50,085 --> 00:27:51,628 One step at a time. 757 00:27:58,802 --> 00:28:00,871 That's 20 migs of TNK. 758 00:28:01,079 --> 00:28:03,373 In at 14:39. 759 00:28:03,999 --> 00:28:05,667 Feeling anything? 760 00:28:06,168 --> 00:28:07,518 Not yet. 761 00:28:07,519 --> 00:28:09,421 Could take an hour or two. 762 00:28:10,422 --> 00:28:12,124 We're going to move you to another room 763 00:28:12,149 --> 00:28:13,675 for better monitoring. 764 00:28:13,942 --> 00:28:15,485 Dr. King. 765 00:28:18,279 --> 00:28:19,990 I'd like you to stay with her. 766 00:28:21,475 --> 00:28:22,617 Why? 767 00:28:22,618 --> 00:28:24,535 In case there are complications. 768 00:28:24,536 --> 00:28:26,245 You'll be there to respond quickly 769 00:28:26,246 --> 00:28:28,956 to a blown pupil, a seizure, altered mental status. 770 00:28:28,957 --> 00:28:30,943 Or I could catch up on my charts. 771 00:28:31,151 --> 00:28:32,903 And my deposition's coming up. 772 00:28:33,112 --> 00:28:35,713 Think of this as a great way to steal some quiet time 773 00:28:35,714 --> 00:28:37,131 and get mentally prepared. 774 00:28:37,132 --> 00:28:38,909 Jesse, Mel's with you. 775 00:28:40,953 --> 00:28:43,137 Oh, excuse me, Dr. Mohan. 776 00:28:43,456 --> 00:28:45,222 Excuse me. Dr. Mohan. 777 00:28:45,223 --> 00:28:46,640 Uh, in a minute, George. 778 00:28:46,641 --> 00:28:47,642 I've got this. 779 00:28:47,643 --> 00:28:48,893 Thank you. 780 00:28:48,894 --> 00:28:50,587 Oh, uh, I, um... 781 00:28:51,171 --> 00:28:53,480 D-dimer is back normal. 782 00:28:53,481 --> 00:28:54,481 Oh. 783 00:28:54,482 --> 00:28:55,816 I'm ready to go. 784 00:28:55,817 --> 00:28:57,344 Are you feeling better? 785 00:28:57,594 --> 00:29:00,848 I... I really wasn't short of breath this time. 786 00:29:02,266 --> 00:29:03,851 Then why'd you come in? 787 00:29:05,494 --> 00:29:07,786 When I found out about the blood clot in my leg, 788 00:29:07,787 --> 00:29:10,581 I just kept thinking it's gonna go to my lung and kill me. 789 00:29:10,582 --> 00:29:13,834 We've talked before about how the Eliquis would prevent that. 790 00:29:13,835 --> 00:29:15,279 I know. 791 00:29:16,280 --> 00:29:18,657 Well, I finally took your advice. 792 00:29:18,923 --> 00:29:21,647 I got out of the house, and I joined 793 00:29:21,672 --> 00:29:23,678 the Frick Park Lawn Bowling Club. 794 00:29:23,679 --> 00:29:24,922 Wonderful. 795 00:29:24,947 --> 00:29:27,374 Yeah. I mean, you're right, you know? 796 00:29:27,557 --> 00:29:29,293 We all need a community. 797 00:29:33,227 --> 00:29:34,940 You're gonna do what? 798 00:29:34,940 --> 00:29:36,524 In order to fix your tongue, 799 00:29:36,525 --> 00:29:39,110 we need to move it forward to access the laceration. 800 00:29:39,111 --> 00:29:40,736 You're just gonna feel some pulling, OK? 801 00:29:40,737 --> 00:29:42,514 I guess so. 802 00:29:44,240 --> 00:29:45,726 Go for it. 803 00:29:46,685 --> 00:29:48,202 What size suture is that? 804 00:29:48,203 --> 00:29:50,480 O-silk, the biggest one we got. 805 00:29:51,901 --> 00:29:55,043 As soon as I cut the needle, you're on traction, Joy. 806 00:30:03,583 --> 00:30:04,703 Oh. 807 00:30:04,995 --> 00:30:07,388 That is pretty deep. 808 00:30:07,389 --> 00:30:09,181 And now we can numb up the cut. 809 00:30:09,206 --> 00:30:10,516 It's best to start with... 810 00:30:10,517 --> 00:30:11,892 Proximal side first so she doesn't 811 00:30:11,893 --> 00:30:13,921 feel the distal injection. 812 00:30:14,887 --> 00:30:17,515 Give it ten minutes. I'll be back for the repair. 813 00:30:21,638 --> 00:30:23,654 I got a rape kit sitting here for two weeks 814 00:30:23,655 --> 00:30:25,807 that was supposed to be picked up within 72 hours. 815 00:30:26,016 --> 00:30:27,282 I don't care! 816 00:30:27,283 --> 00:30:29,243 Get someone over here now! No. 817 00:30:29,244 --> 00:30:30,887 You expect us to treat your officers 818 00:30:30,912 --> 00:30:32,121 as soon as they come in, 819 00:30:32,122 --> 00:30:34,206 you get a detective to pick these kits up ASAP. 820 00:30:34,207 --> 00:30:35,290 I gotta go. 821 00:30:35,291 --> 00:30:36,228 - Dana... - Hey, Dana. 822 00:30:36,253 --> 00:30:38,062 South 19 got their head CT before we went down. 823 00:30:38,086 --> 00:30:39,253 No results yet. 824 00:30:39,254 --> 00:30:40,546 All right, I'll send a reminder. 825 00:30:40,547 --> 00:30:41,547 - Hey, Dana. - Dana. 826 00:30:41,548 --> 00:30:42,741 Hang on. 827 00:30:43,804 --> 00:30:44,884 What's up? 828 00:30:44,885 --> 00:30:47,636 We put in an order for more pain meds for Roxie. 829 00:30:47,637 --> 00:30:49,680 All right, so put it in the nursing racks. 830 00:30:49,681 --> 00:30:51,750 Oh, I did, a long time ago. 831 00:30:52,626 --> 00:30:54,268 All right. I'll bump it to the front. 832 00:30:54,269 --> 00:30:55,770 Thank you. 833 00:30:55,771 --> 00:30:57,438 Uh, what's that noise? 834 00:30:57,439 --> 00:30:58,482 UFO landed. 835 00:30:58,482 --> 00:30:59,708 Aliens are invading. 836 00:30:59,733 --> 00:31:00,983 Hey, Dana. 837 00:31:00,984 --> 00:31:02,985 Chem 7's not back on Trauma 2 yet. 838 00:31:02,986 --> 00:31:04,471 Let me see the chart. 839 00:31:05,547 --> 00:31:08,282 Oh, Jesus. I bet your Chem 7 rec went to Radiology. 840 00:31:08,283 --> 00:31:09,810 Larry, Antoine. 841 00:31:09,835 --> 00:31:12,720 You put labs and chest X-ray on the same downtime form. 842 00:31:12,745 --> 00:31:15,562 You need two slips... one for labs, one for radiology. 843 00:31:15,624 --> 00:31:16,933 - Got it. - Won't happen again. 844 00:31:16,958 --> 00:31:19,043 - I'll run it down myself. - Use the iStat at bedside. 845 00:31:19,044 --> 00:31:20,837 They won't take him to CT without a creatinine. 846 00:31:20,837 --> 00:31:21,962 Oh, perfect. 847 00:31:21,963 --> 00:31:23,214 Nice to have you back. 848 00:31:23,215 --> 00:31:24,423 Thrilled to be here. 849 00:31:24,424 --> 00:31:25,591 You trying to text? 850 00:31:25,592 --> 00:31:27,135 I am just composing. 851 00:31:27,135 --> 00:31:28,552 I'm gonna send it from the bay. 852 00:31:28,553 --> 00:31:31,013 My mechanic friend, Duke, never showed up. 853 00:31:31,014 --> 00:31:32,348 I thought he was coming in this morning. 854 00:31:32,349 --> 00:31:33,807 That was the plan. 855 00:31:33,809 --> 00:31:35,419 I guess he got busy. 856 00:31:35,694 --> 00:31:37,211 What if he's a no-show? 857 00:31:37,312 --> 00:31:39,688 Tell me what he needs. I'll pass it on to the night shift. 858 00:31:39,689 --> 00:31:41,208 That won't be necessary. 859 00:31:43,485 --> 00:31:45,095 Oh, Princess. 860 00:31:45,303 --> 00:31:47,696 Ask and you shall receive. Normal head CT. 861 00:31:47,697 --> 00:31:49,725 Thanks. I'll get him discharged. 862 00:31:50,158 --> 00:31:51,685 How's your day going? 863 00:31:51,893 --> 00:31:54,062 I think I'm getting writer's cramp. 864 00:31:54,087 --> 00:31:55,645 You with the big guy? 865 00:31:55,670 --> 00:31:57,963 Yeah. It's sad. 866 00:31:58,124 --> 00:32:02,002 Bad car accident, multiple operations, tons of stress. 867 00:32:03,797 --> 00:32:05,798 Lidocaine shot to a sensitive area. 868 00:32:05,799 --> 00:32:08,068 I got a binge-drinking party girl with a tongue lac. 869 00:32:08,093 --> 00:32:08,927 Mm. 870 00:32:08,927 --> 00:32:10,218 Sounds like she needs some help. 871 00:32:10,219 --> 00:32:12,289 In more ways than one. 872 00:32:12,831 --> 00:32:16,126 How's, uh... how's your first shift back going? 873 00:32:16,376 --> 00:32:18,003 One day at a time. 874 00:32:18,670 --> 00:32:20,271 First year sober is the hardest. 875 00:32:20,272 --> 00:32:21,688 That's what they keep telling me. 876 00:32:21,923 --> 00:32:24,384 I'm nine years and counting. 877 00:32:26,563 --> 00:32:27,846 Oh. 878 00:32:28,138 --> 00:32:30,640 Special delivery for my guy. 879 00:32:31,558 --> 00:32:33,867 If you, um... if you need anything, call me. 880 00:32:33,868 --> 00:32:35,270 Thanks. 881 00:32:41,217 --> 00:32:42,843 Where are you going? 882 00:32:42,868 --> 00:32:44,337 Blisters in North 3. 883 00:32:44,337 --> 00:32:45,754 That's where I'm going. 884 00:32:45,755 --> 00:32:47,631 Did you sign up for the patient? 885 00:32:47,632 --> 00:32:49,176 I pulled the chart from the rack. 886 00:32:49,176 --> 00:32:50,926 You're supposed to sign up on the dry-erase board. 887 00:32:50,927 --> 00:32:52,967 You're supposed to have a clipboard for the patient. 888 00:32:53,080 --> 00:32:54,805 I thought the nurses had that. 889 00:32:54,806 --> 00:32:56,124 Whatever. 890 00:32:56,978 --> 00:32:59,143 Hi. I'm Student Doctor Ogilvie. 891 00:32:59,144 --> 00:33:01,187 And this is... wow. 892 00:33:01,188 --> 00:33:02,854 That is some rash. 893 00:33:02,855 --> 00:33:05,732 - Yeah. Tell me about it. - Student Doctor Javadi. 894 00:33:05,733 --> 00:33:07,776 - When did this start? - Last night. 895 00:33:07,777 --> 00:33:10,751 And have you been on any hikes recently around poison ivy? 896 00:33:10,776 --> 00:33:12,548 Nope. Haven't left the house. 897 00:33:12,573 --> 00:33:15,075 What about new medications, lotions, 898 00:33:15,076 --> 00:33:16,577 soaps, detergents, even? 899 00:33:16,578 --> 00:33:17,828 I don't take medicine. 900 00:33:17,829 --> 00:33:19,205 Nothing new with all that other stuff. 901 00:33:19,206 --> 00:33:20,456 Uh-huh. And where did this start? 902 00:33:20,457 --> 00:33:21,875 Everywhere, all at once. 903 00:33:21,875 --> 00:33:24,736 Just a lot of pain, really itchy. 904 00:33:25,195 --> 00:33:26,696 What is it? 905 00:33:26,905 --> 00:33:28,407 I'm not sure yet. 906 00:33:28,824 --> 00:33:31,050 Um, be back in a second. 907 00:33:31,051 --> 00:33:32,926 Can't... will you... 908 00:33:36,777 --> 00:33:38,308 What are you thinking? 909 00:33:39,000 --> 00:33:40,267 I have no idea. 910 00:33:40,268 --> 00:33:41,503 Agreed. 911 00:33:43,271 --> 00:33:44,855 Bullous pemphigoid? 912 00:33:44,856 --> 00:33:46,398 Autoimmune severe pruritis? 913 00:33:46,399 --> 00:33:47,983 Yeah, but not as deadly as pemphigus vulgaris. 914 00:33:47,984 --> 00:33:50,193 Untreated, the death rate is over 90%. 915 00:33:50,194 --> 00:33:52,655 We need to check for pustules, mucous membrane involvement... 916 00:33:52,656 --> 00:33:54,349 And the Nikolsky sign. 917 00:33:56,768 --> 00:33:58,035 Here you go. 918 00:33:59,582 --> 00:34:00,707 What? 919 00:34:00,740 --> 00:34:02,284 For your progress note. 920 00:34:03,305 --> 00:34:06,069 Did I hear we're making progress? 921 00:34:06,502 --> 00:34:08,712 Oh, um, it's just what we call it 922 00:34:08,713 --> 00:34:11,966 when we write down things to describe a clinical course. 923 00:34:13,222 --> 00:34:14,468 Any changes? 924 00:34:15,346 --> 00:34:16,638 Not so far. 925 00:34:16,638 --> 00:34:18,623 It's time for the next neuro check. 926 00:34:19,040 --> 00:34:21,209 Excuse me, Dr. King, do you have a minute? 927 00:34:21,494 --> 00:34:23,078 Um, no. 928 00:34:23,103 --> 00:34:24,687 I'm observing a patient right now. 929 00:34:24,688 --> 00:34:26,715 60 seconds tops. 930 00:34:28,467 --> 00:34:29,676 I'll check pupils. 931 00:34:29,701 --> 00:34:31,244 We're good here. 932 00:34:36,924 --> 00:34:38,018 Hey. 933 00:34:38,894 --> 00:34:40,896 I just finished my deposition. 934 00:34:41,146 --> 00:34:43,872 Oh, should I go up now? 935 00:34:43,873 --> 00:34:45,582 Yeah. Just wait until you get a call. 936 00:34:45,583 --> 00:34:46,750 OK. 937 00:34:46,751 --> 00:34:48,335 Well, I'd ask how it went, 938 00:34:48,336 --> 00:34:50,170 but we're not supposed to discuss the case. 939 00:34:50,171 --> 00:34:51,923 This isn't a discussion. 940 00:34:52,006 --> 00:34:54,534 It's a monologue, so shut up and listen. 941 00:34:55,118 --> 00:34:57,427 The malpractice case is frivolous. 942 00:34:57,428 --> 00:34:59,012 The mother of the measles kid claims 943 00:34:59,013 --> 00:35:00,388 we caused intellectual decline 944 00:35:00,389 --> 00:35:02,250 by performing a spinal tap. 945 00:35:02,394 --> 00:35:05,253 But the tap was perfect with no complications. 946 00:35:05,504 --> 00:35:07,479 Her son presented with altered mental status 947 00:35:07,480 --> 00:35:10,733 due to low oxygen from measles pneumonia. 948 00:35:10,734 --> 00:35:13,360 Any change in intellect was due to hypoxic brain injury. 949 00:35:13,361 --> 00:35:15,805 It had nothing to do with your spinal tap. 950 00:35:16,806 --> 00:35:18,600 End of monologue. 951 00:35:18,741 --> 00:35:20,769 We never discussed the case. 952 00:35:21,353 --> 00:35:22,938 I gotta get some sleep. 953 00:35:23,688 --> 00:35:26,775 Thanks, I guess. 954 00:35:28,443 --> 00:35:30,362 OK, are you ready to lay down? 955 00:35:30,737 --> 00:35:31,962 I got your head. 956 00:35:31,963 --> 00:35:33,131 Nice and slow. 957 00:35:35,762 --> 00:35:36,913 One, two, three. 958 00:35:36,914 --> 00:35:39,037 OK. How's that feel? 959 00:35:41,541 --> 00:35:43,056 Lifting up now. 960 00:35:52,942 --> 00:35:54,261 Keep going. 961 00:35:57,238 --> 00:36:00,491 And... that ought to do it right about there. 962 00:36:02,243 --> 00:36:03,895 215? 963 00:36:04,078 --> 00:36:06,231 Oh, that's in kilos. 964 00:36:08,149 --> 00:36:09,917 OK, team. 965 00:36:15,381 --> 00:36:17,217 It's not that much over 450. 966 00:36:17,217 --> 00:36:20,052 No, we can't risk breaking our CT on a holiday weekend. 967 00:36:20,053 --> 00:36:22,096 Would the medics take him while he's intubated? 968 00:36:22,097 --> 00:36:24,598 If I go along for the ride, I could still get a nap in 969 00:36:24,599 --> 00:36:26,334 before my night shift. 970 00:36:29,676 --> 00:36:32,007 474. 971 00:36:32,799 --> 00:36:34,941 Our CT can't handle your weight, 972 00:36:34,942 --> 00:36:37,429 but we're gonna take you over to Presbyterian Hospital. 973 00:36:38,221 --> 00:36:40,115 Road trip. 974 00:36:40,281 --> 00:36:42,575 I'll keep you company the whole time. 975 00:36:44,812 --> 00:36:46,646 Sorry for all this trouble. 976 00:36:46,980 --> 00:36:48,231 It's OK. 977 00:36:48,372 --> 00:36:49,832 This is what we do. 978 00:36:54,909 --> 00:36:56,839 So sub Q starts deep. 979 00:36:56,840 --> 00:36:59,467 - You want to bury the knot. - Yeah, I've done these before. 980 00:36:59,550 --> 00:37:01,511 Joy, how do we cut the ends? 981 00:37:01,946 --> 00:37:04,582 Short. Slide to the knot. Turn 45 degrees. 982 00:37:04,607 --> 00:37:05,874 Excellent. 983 00:37:06,291 --> 00:37:08,451 Um, Dr. Langdon, we have a case. 984 00:37:08,476 --> 00:37:10,352 - It'll have to wait. - It could be urgent. 985 00:37:10,353 --> 00:37:12,797 Find Robby or Al-Hashimi. 986 00:37:14,382 --> 00:37:16,442 This girl is wasted. 987 00:37:16,443 --> 00:37:18,569 Drunk as a skunk. 988 00:37:18,570 --> 00:37:20,363 Should we check her blood alcohol level? 989 00:37:20,363 --> 00:37:21,989 No, it won't change what we do. 990 00:37:21,990 --> 00:37:23,657 She can go home when she has a steady gait. 991 00:37:23,658 --> 00:37:25,143 I already sent one off. 992 00:37:25,644 --> 00:37:28,371 Joy, do you want to guess her blood alcohol? 993 00:37:28,605 --> 00:37:29,996 Why would I want to do that? 994 00:37:30,148 --> 00:37:32,192 I don't know. 'Cause it's fun. 995 00:37:37,867 --> 00:37:39,674 When will you have a bed? 996 00:37:39,715 --> 00:37:41,425 I'm not sure she needs a bed. 997 00:37:41,426 --> 00:37:43,135 She's a febrile infant. 998 00:37:43,136 --> 00:37:45,345 Who is clearly over a month old and looks amazing. 999 00:37:45,346 --> 00:37:47,263 Every marker is normal. She has a cold virus. 1000 00:37:47,264 --> 00:37:49,015 Infants with rhinovirus can still have 1001 00:37:49,016 --> 00:37:50,433 a serious bacterial infection. 1002 00:37:50,434 --> 00:37:51,435 Not this one. 1003 00:37:51,436 --> 00:37:53,062 We send kids like this home all the time. 1004 00:37:53,062 --> 00:37:56,424 Except this one doesn't have a home or a parent. 1005 00:37:57,676 --> 00:37:58,852 All right. 1006 00:37:58,877 --> 00:38:01,111 I can't put a kid with a virus in the nursery, 1007 00:38:01,112 --> 00:38:03,363 and I can't waste a private room on a healthy baby. 1008 00:38:03,364 --> 00:38:04,864 Then what do you propose? 1009 00:38:04,865 --> 00:38:08,035 CYF can place her in emergency foster care by tomorrow morning. 1010 00:38:08,036 --> 00:38:10,230 You want to leave her down here overnight? 1011 00:38:10,579 --> 00:38:12,790 Seems to be the standard of care these days. 1012 00:38:12,791 --> 00:38:14,250 Have your attending give me a call. 1013 00:38:14,250 --> 00:38:15,292 Will do. 1014 00:38:15,293 --> 00:38:16,585 I can't believe this. 1015 00:38:16,586 --> 00:38:18,337 Let CYF know it's very urgent. 1016 00:38:18,338 --> 00:38:19,406 Got it. 1017 00:38:19,614 --> 00:38:21,825 This is turning into quite the day. 1018 00:38:22,367 --> 00:38:24,343 You know, I've been thinking 1019 00:38:24,344 --> 00:38:26,011 about applying for a fellowship. 1020 00:38:26,012 --> 00:38:27,929 I thought you had a job lined up in New Jersey. 1021 00:38:27,930 --> 00:38:30,056 I did, to be close to my mom. 1022 00:38:30,057 --> 00:38:33,601 But she sold her house to travel the world 1023 00:38:33,602 --> 00:38:35,296 with her new boyfriend. 1024 00:38:35,547 --> 00:38:37,439 So what's the point of New Jersey? 1025 00:38:37,440 --> 00:38:38,774 Yeah, good question. 1026 00:38:38,775 --> 00:38:40,051 Which fellowship? 1027 00:38:40,301 --> 00:38:44,237 I've narrowed it down to ultrasound, toxicology, 1028 00:38:44,238 --> 00:38:46,433 and sports medicine. 1029 00:38:47,201 --> 00:38:49,010 Those are very disparate fields 1030 00:38:49,035 --> 00:38:50,678 leading to very different careers. 1031 00:38:50,703 --> 00:38:53,247 I know. I'm a little undecided. 1032 00:38:53,248 --> 00:38:55,206 Do you have research experience? 1033 00:38:55,207 --> 00:38:57,792 I was a part of a study on racial disparities 1034 00:38:57,793 --> 00:38:59,854 in health care until the White House 1035 00:38:59,879 --> 00:39:01,339 cut the funding last year. 1036 00:39:01,364 --> 00:39:03,382 Yeah. You are not alone. 1037 00:39:03,383 --> 00:39:06,369 Have you considered a geriatrics fellowship? 1038 00:39:06,594 --> 00:39:08,079 I have not. 1039 00:39:08,371 --> 00:39:10,472 I've seen your skills with the elderly, 1040 00:39:10,473 --> 00:39:12,641 and there are a lot of openings. 1041 00:39:12,642 --> 00:39:14,127 It might be your best shot. 1042 00:39:14,602 --> 00:39:15,920 Think about it. 1043 00:39:17,130 --> 00:39:18,540 Last stitch. 1044 00:39:18,565 --> 00:39:20,759 - You want me to cut? - I got it. 1045 00:39:22,651 --> 00:39:23,985 It looks good. 1046 00:39:23,986 --> 00:39:25,737 OK. Let's pull the traction suture. 1047 00:39:25,738 --> 00:39:27,265 With pleasure. 1048 00:39:29,182 --> 00:39:31,102 OK, Jackie. 1049 00:39:31,394 --> 00:39:32,952 - Jackie. - Stop it. 1050 00:39:33,104 --> 00:39:33,953 Stop. 1051 00:39:33,954 --> 00:39:34,981 All done. 1052 00:39:35,142 --> 00:39:36,791 All done with what? 1053 00:39:36,791 --> 00:39:38,334 Sewing up your tongue. 1054 00:39:38,501 --> 00:39:40,002 What happened to my tongue? 1055 00:39:40,003 --> 00:39:41,296 You bit it. 1056 00:39:41,296 --> 00:39:43,615 Ha. No, I didn't. 1057 00:39:43,907 --> 00:39:45,799 That is called a blackout. 1058 00:39:45,800 --> 00:39:47,410 How much did you drink? 1059 00:39:47,660 --> 00:39:49,761 A couple Bloody Marys. 1060 00:39:49,762 --> 00:39:51,096 Only a couple? 1061 00:39:51,097 --> 00:39:53,182 I don't know. Maybe more. 1062 00:39:53,390 --> 00:39:56,142 It's a holiday, a pub crawl. 1063 00:39:56,143 --> 00:39:58,604 Do you usually have a couple cocktails every day? 1064 00:39:58,605 --> 00:39:59,980 Only on weekends. 1065 00:39:59,981 --> 00:40:01,315 How about during the week? 1066 00:40:01,316 --> 00:40:02,816 Nothing much. 1067 00:40:02,884 --> 00:40:07,096 Just wine with dinner or a few beers. 1068 00:40:07,639 --> 00:40:09,766 Maybe we should recommend rehab? 1069 00:40:10,767 --> 00:40:11,992 Yeah. 1070 00:40:11,993 --> 00:40:13,536 We could try. 1071 00:40:17,950 --> 00:40:19,400 Ready to roll. 1072 00:40:20,296 --> 00:40:21,736 How are you feeling? 1073 00:40:21,986 --> 00:40:23,545 My pain is a two. 1074 00:40:23,546 --> 00:40:24,880 We got meds if you need them. 1075 00:40:24,881 --> 00:40:26,506 Scan will be quicker than the ride to Presby. 1076 00:40:26,507 --> 00:40:27,925 We'll keep trying to reach your sister. 1077 00:40:27,926 --> 00:40:29,593 - You guys are the best. - See you later. 1078 00:40:29,594 --> 00:40:31,303 Can I put a new patient in T1? 1079 00:40:31,304 --> 00:40:33,639 Uh, no, I kind of want to leave one trauma room open. 1080 00:40:33,640 --> 00:40:36,584 Why don't you double up the north if you have to? 1081 00:40:37,252 --> 00:40:38,962 Mr. Digby? 1082 00:40:40,396 --> 00:40:42,313 - It's just Digby. - Right. 1083 00:40:42,314 --> 00:40:44,566 We've been looking all over. Where you been? 1084 00:40:44,567 --> 00:40:46,151 With Louie. 1085 00:40:46,152 --> 00:40:47,861 You've been in there for an hour? 1086 00:40:47,862 --> 00:40:49,364 He was my friend. 1087 00:40:49,639 --> 00:40:51,683 - I had a lot to say. - Hmm. 1088 00:40:51,866 --> 00:40:53,768 Well, let's get you back to your bed. 1089 00:40:56,020 --> 00:40:57,830 Louie got his wings. 1090 00:40:58,430 --> 00:40:59,873 - Dr. Robby. - Dr. Robby. 1091 00:40:59,874 --> 00:41:01,541 We picked up a patient together. 1092 00:41:01,542 --> 00:41:02,626 Teamwork! 1093 00:41:02,627 --> 00:41:04,044 It's a concerning bullous rash. 1094 00:41:04,045 --> 00:41:06,004 We might need a biopsy for pemphigus vulgaris. 1095 00:41:06,005 --> 00:41:07,465 It's phytophotodermatitis. 1096 00:41:07,590 --> 00:41:09,216 - What? - I asked. 1097 00:41:09,217 --> 00:41:11,468 He was making three gallons of margaritas for a party, 1098 00:41:11,469 --> 00:41:13,454 squeezing fresh limes out in the sun. 1099 00:41:13,479 --> 00:41:15,098 Let's go take a peek. 1100 00:41:15,740 --> 00:41:17,375 I don't need to see it again. 1101 00:41:19,560 --> 00:41:20,894 How's it going out there? 1102 00:41:20,895 --> 00:41:22,355 Standing room only. 1103 00:41:22,380 --> 00:41:24,083 If I call the fire department, will they clear 1104 00:41:24,107 --> 00:41:25,625 - that waiting room? - I wish. 1105 00:41:25,650 --> 00:41:28,318 - What's up? - 12 patients need med refills. 1106 00:41:28,319 --> 00:41:29,736 Shouldn't they see their doctors? 1107 00:41:29,737 --> 00:41:31,571 With the Medicaid cuts, we are their doctor. 1108 00:41:31,572 --> 00:41:33,449 No, I can't e-prescribe to their pharmacies. 1109 00:41:33,449 --> 00:41:35,117 So get out your pen. Go old school. 1110 00:41:35,118 --> 00:41:36,853 Dana, on what? 1111 00:41:37,353 --> 00:41:39,830 Nordt, you got the security pads? 1112 00:41:39,831 --> 00:41:40,982 Sure do. 1113 00:41:41,149 --> 00:41:42,916 Just need a patient sticker. 1114 00:41:42,917 --> 00:41:45,336 - Any other questions? - Yeah. 1115 00:41:45,461 --> 00:41:47,614 What would have happened if you weren't here today? 1116 00:41:48,740 --> 00:41:50,799 You'd all be curled up in the fetal position, 1117 00:41:50,800 --> 00:41:52,535 crying like babies. 1118 00:41:53,077 --> 00:41:54,678 Were you wearing flip-flops? 1119 00:41:54,679 --> 00:41:55,971 I was. 1120 00:41:55,972 --> 00:41:58,016 - What is it? - Phytophotodermatitis. 1121 00:41:58,016 --> 00:42:00,464 Otherwise known as margarita burn. 1122 00:42:00,489 --> 00:42:02,161 For some people, limes plus sunshine 1123 00:42:02,186 --> 00:42:03,454 can cause a horrible rash. 1124 00:42:03,479 --> 00:42:05,313 This is all because of limes? 1125 00:42:05,314 --> 00:42:07,967 Have you ever squeezed limes outside in the sun before? 1126 00:42:08,150 --> 00:42:09,609 I don't think so. 1127 00:42:09,610 --> 00:42:12,113 You will feel better after a day of steroid pills. 1128 00:42:12,113 --> 00:42:14,325 But once these heal, you gotta wear sunscreen. 1129 00:42:14,350 --> 00:42:16,509 Because these blisters can turn into dark scars 1130 00:42:16,534 --> 00:42:17,952 and stay a while if you don't. 1131 00:42:19,037 --> 00:42:21,981 I'll be right back with your aftercare instructions. 1132 00:42:22,415 --> 00:42:24,108 - Hey, Robby. - Yep. 1133 00:42:24,400 --> 00:42:26,728 My, uh... my hospice patient Roxie 1134 00:42:26,753 --> 00:42:28,462 is still in a ton of pain. 1135 00:42:28,463 --> 00:42:29,921 Where are we with the morphine? 1136 00:42:29,922 --> 00:42:31,616 10 milligrams an hour. 1137 00:42:31,840 --> 00:42:34,259 OK, you can bolus another 2 and go up to 12. 1138 00:42:34,260 --> 00:42:35,802 I will let Princess know. 1139 00:42:35,803 --> 00:42:36,928 12 an hour is a lot. 1140 00:42:36,929 --> 00:42:38,597 Yeah, on top of the MS Contin, 1141 00:42:38,598 --> 00:42:40,083 she could stop breathing. 1142 00:42:41,292 --> 00:42:44,504 Are you familiar with the doctrine of double effect? 1143 00:42:44,712 --> 00:42:46,631 - Not really. - No. 1144 00:42:46,656 --> 00:42:50,692 It is an ethical principle in palliative care. We treat pain. 1145 00:42:50,693 --> 00:42:52,819 And if, in doing so, there's a negative side effect, 1146 00:42:52,820 --> 00:42:54,093 we accept it. 1147 00:42:54,118 --> 00:42:56,975 Even if the negative side effect is death? 1148 00:42:57,183 --> 00:43:00,286 In some cases, that could be the best outcome. 1149 00:43:05,935 --> 00:43:07,394 Maybe the nurse has it. 1150 00:43:07,426 --> 00:43:10,045 Emma. Emma, where does... 1151 00:43:10,046 --> 00:43:11,922 Maybe the fax ran out of paper? 1152 00:43:11,923 --> 00:43:14,633 No, there is enough paper. I don't know what's wrong. 1153 00:43:14,634 --> 00:43:16,217 - Could be in another room. - We should call IT. 1154 00:43:16,218 --> 00:43:17,929 You want me to check every room? 1155 00:43:17,954 --> 00:43:19,721 How are we gonna get through this mess? 1156 00:43:19,722 --> 00:43:21,374 I was about to ask you. 1157 00:43:22,875 --> 00:43:24,535 Ask the pharmacist. 1158 00:43:24,560 --> 00:43:25,852 She can't leave the PDS. 1159 00:43:25,853 --> 00:43:27,521 Nothing's getting done here. 1160 00:43:27,522 --> 00:43:32,260 Sync and corrections by btsix www.addic7ed.com