1
00:00:15,612 --> 00:00:17,238
Next time, maybe inform
the department chair

2
00:00:17,322 --> 00:00:18,322
before the shit hits the fan.

3
00:00:18,364 --> 00:00:19,949
I was on my way to tell you.

4
00:00:20,033 --> 00:00:21,284
Make sure you get
everything you need.

5
00:00:21,367 --> 00:00:22,368
OK, let's do this.

6
00:00:22,452 --> 00:00:23,953
IT called me up because

7
00:00:24,037 --> 00:00:26,289
I've trained in cyberattack
prevention and response.

8
00:00:26,372 --> 00:00:27,582
Then you can tell everybody
what to do.

9
00:00:27,665 --> 00:00:28,958
No, thank you.

10
00:00:29,042 --> 00:00:30,209
Best if it comes
from the department chair.

11
00:00:30,293 --> 00:00:31,294
Oh, you think?

12
00:00:33,796 --> 00:00:35,965
All right, everybody,
circle up.

13
00:00:36,049 --> 00:00:37,216
What the fuck?

14
00:00:37,300 --> 00:00:39,177
We may have had
a cyberattack.

15
00:00:39,260 --> 00:00:41,512
No, we shut down
to prevent a cyberattack.

16
00:00:43,264 --> 00:00:45,266
OK, everybody, settle down.
Listen up.

17
00:00:45,350 --> 00:00:46,643
As you can see,
we're doing a little

18
00:00:46,726 --> 00:00:49,145
redecorating
in the central work area.

19
00:00:49,228 --> 00:00:52,023
Our hospital computers are
at risk for a cyberattack,

20
00:00:52,106 --> 00:00:54,025
so we are going old school,
analog.

21
00:00:54,108 --> 00:00:55,443
- For how long?
- Great question.

22
00:00:55,526 --> 00:00:57,487
Our IT department
has shut everything down

23
00:00:57,570 --> 00:00:59,822
to give them time to bolster
our cyber defenses.

24
00:00:59,906 --> 00:01:01,741
I believe the question was,
for how long?

25
00:01:01,824 --> 00:01:03,034
Uh, hard to say.

26
00:01:03,117 --> 00:01:04,327
Could be up to 24 hours.

27
00:01:04,410 --> 00:01:05,953
Jesus Christ.

28
00:01:06,037 --> 00:01:07,580
So first order of business,

29
00:01:07,664 --> 00:01:09,540
we need to replicate
the electronic patient boards

30
00:01:09,624 --> 00:01:10,875
on these dry-erase boards.

31
00:01:10,958 --> 00:01:11,959
So please, somebody tell me

32
00:01:12,043 --> 00:01:13,086
they got a photo of the boards.

33
00:01:13,169 --> 00:01:14,155
Uh, yeah, yeah, yeah.

34
00:01:14,170 --> 00:01:15,588
Right here. OK.

35
00:01:15,672 --> 00:01:16,714
Oh, uh…

36
00:01:18,883 --> 00:01:21,010
It's a little blurry.

37
00:01:21,094 --> 00:01:23,638
No, more than
a little blurry.

38
00:01:23,721 --> 00:01:26,432
- Sorry.
- Oh, my God.

39
00:01:26,516 --> 00:01:28,184
- I remember.
- Great.

40
00:01:28,267 --> 00:01:30,144
If everybody else can remember
their patient names

41
00:01:30,228 --> 00:01:31,521
and their room numbers,
that would be awesome.

42
00:01:31,604 --> 00:01:33,523
No, I mean
I can remember all of it.

43
00:01:33,606 --> 00:01:34,649
All of what?

44
00:01:34,732 --> 00:01:36,859
Names, doctors, room numbers.

45
00:01:36,943 --> 00:01:39,278
I kind of have
a photographic memory.

46
00:01:39,362 --> 00:01:41,406
Seriously? The whole board?

47
00:01:41,489 --> 00:01:43,783
Central 12,
Harlow Graham, headache,

48
00:01:43,866 --> 00:01:46,536
- abdominal pain, ASL only.
- Oh, shit.

49
00:01:46,619 --> 00:01:48,454
I have an interpreter
waiting for me.

50
00:01:48,538 --> 00:01:50,581
- Go.
- OK, for patient privacy,

51
00:01:50,665 --> 00:01:52,291
all chief complaints
will be abbreviated.

52
00:01:52,375 --> 00:01:53,626
So HA for headache,

53
00:01:53,710 --> 00:01:55,586
AP for abdominal pain,
and so forth.

54
00:01:55,670 --> 00:01:58,840
Central 10, Jackson Davis,
new-onset psychosis.

55
00:01:58,923 --> 00:02:00,299
Javadi, psych admission.

56
00:02:00,383 --> 00:02:02,301
Greek letter psi for psych.

57
00:02:02,385 --> 00:02:04,554
Pedes is Baby Jane Doe,
fever, Dr. Mohan,

58
00:02:04,637 --> 00:02:06,097
awaiting admission orders.

59
00:02:06,180 --> 00:02:07,807
Nurses need to convert
to a zone defense…

60
00:02:07,890 --> 00:02:08,890
north, central, south, trauma.

61
00:02:08,933 --> 00:02:10,017
Where's Dana?

62
00:02:10,101 --> 00:02:11,686
In with
a sexual assault case.

63
00:02:11,769 --> 00:02:13,271
She can't leave
until the exam is finished.

64
00:02:13,354 --> 00:02:14,564
Yeah, it could be a while.

65
00:02:14,647 --> 00:02:15,982
Princess has
charge nurse experience.

66
00:02:16,065 --> 00:02:17,442
- Not really.
- That's a great idea.

67
00:02:17,525 --> 00:02:18,693
Princess it is.

68
00:02:18,776 --> 00:02:19,762
You can make
the nursing assignments.

69
00:02:19,777 --> 00:02:21,028
- Next.
- Central 9,

70
00:02:21,112 --> 00:02:22,989
Roxie Hamler,
end-stage lung cancer.

71
00:02:23,072 --> 00:02:24,365
Sorry, do we have
to stand here while

72
00:02:24,449 --> 00:02:25,575
- she recites the whole board?
- No.

73
00:02:25,658 --> 00:02:26,826
In fact, go check
on your patients

74
00:02:26,909 --> 00:02:28,327
and then please come back here.

75
00:02:28,411 --> 00:02:29,871
Thank you.

76
00:02:29,954 --> 00:02:31,706
How many hours a day
are you on your laptop?

77
00:02:34,751 --> 00:02:36,002
At least eight hours.

78
00:02:36,085 --> 00:02:37,420
I work from home.

79
00:02:37,503 --> 00:02:39,380
And are you at a desk
all day?

80
00:02:41,257 --> 00:02:42,508
No, no.

81
00:02:42,592 --> 00:02:43,968
I will either sit on the sofa,

82
00:02:44,051 --> 00:02:46,220
or sometimes I'll be in bed,

83
00:02:46,304 --> 00:02:48,389
kind of sitting up
with the computer on my lap,

84
00:02:48,473 --> 00:02:49,932
that kind of thing.

85
00:02:50,016 --> 00:02:52,560
So you're always looking down
at the screen?

86
00:02:52,643 --> 00:02:54,187
- Yeah.
- OK.

87
00:02:54,270 --> 00:02:56,689
I'm going to check
the muscles in your neck.

88
00:03:03,404 --> 00:03:04,405
- Ooh!
- Ooh!

89
00:03:04,489 --> 00:03:06,616
Ow, that hurts.

90
00:03:06,699 --> 00:03:09,327
All right.
Well, I think we can help.

91
00:03:09,410 --> 00:03:11,496
Come on over.

92
00:03:11,579 --> 00:03:13,039
OK, gather up.

93
00:03:13,122 --> 00:03:15,249
Listen up, everybody.
This is our chart rack.

94
00:03:15,333 --> 00:03:17,210
So as you can see,
each slot and clipboard

95
00:03:17,293 --> 00:03:18,336
has a room number on it.

96
00:03:18,419 --> 00:03:19,754
When you pick up a new patient,

97
00:03:19,837 --> 00:03:22,131
you grab a fresh chart
from the T-system.

98
00:03:22,215 --> 00:03:25,134
Pick your chart
by chief complaint.

99
00:03:25,218 --> 00:03:27,345
Use the cartoon to find it.

100
00:03:27,428 --> 00:03:29,096
Why are there two bodies?

101
00:03:29,180 --> 00:03:31,098
Trauma on the left,
medical on the right.

102
00:03:31,182 --> 00:03:32,475
So head injury, you go left.

103
00:03:32,558 --> 00:03:34,018
Headache, go right.

104
00:03:34,101 --> 00:03:35,561
Are those fish
swimming in seaweed?

105
00:03:35,645 --> 00:03:36,646
No.

106
00:03:36,729 --> 00:03:37,980
That is bees and grass.

107
00:03:38,064 --> 00:03:39,232
That's the section
for insect bites,

108
00:03:39,315 --> 00:03:40,775
skin rash, allergies.

109
00:03:40,858 --> 00:03:42,360
OK, let's say, for example,

110
00:03:42,443 --> 00:03:44,487
Dr. Al-Hashimi has
a new patient with belly pain.

111
00:03:44,570 --> 00:03:47,114
For the history,
circle the positives,

112
00:03:47,198 --> 00:03:49,075
like vomiting and diarrhea.

113
00:03:49,158 --> 00:03:51,702
Backslash the negative,
such as recent travel,

114
00:03:51,786 --> 00:03:53,287
sick contacts, fever.

115
00:03:53,371 --> 00:03:57,208
For physical exam,
checkmark normals on the left,

116
00:03:57,291 --> 00:03:59,460
and circle any
abnormal findings on the right.

117
00:03:59,544 --> 00:04:00,545
Questions?

118
00:04:00,628 --> 00:04:01,754
Is your generative AI program

119
00:04:01,838 --> 00:04:02,838
still gonna be working?

120
00:04:04,215 --> 00:04:05,424
Not for a while.

121
00:04:05,508 --> 00:04:07,134
And ditch
your SpectraLink phones.

122
00:04:07,218 --> 00:04:08,761
Those are voice over internet.

123
00:04:11,848 --> 00:04:12,974
PTMC Emergency.

124
00:04:13,057 --> 00:04:14,517
Go ahead, Medic Command.

125
00:04:14,600 --> 00:04:15,685
That is how we will hear
about incoming runs.

126
00:04:15,768 --> 00:04:17,144
Thanks.

127
00:04:17,228 --> 00:04:18,855
Two minutes out with
abdominal pain and fever.

128
00:04:18,938 --> 00:04:20,314
OK, has everybody
got that so far?

129
00:04:20,398 --> 00:04:21,899
How do we write orders?

130
00:04:21,983 --> 00:04:23,526
Physician order form
in triplicate.

131
00:04:23,609 --> 00:04:26,320
Labs, X-rays, IV fluid,
medication.

132
00:04:26,404 --> 00:04:27,738
Will the labs still be able
to run blood tests?

133
00:04:27,822 --> 00:04:29,115
Yes.

134
00:04:29,198 --> 00:04:30,533
Are the CT scanners
still working?

135
00:04:30,616 --> 00:04:31,868
Yes, but the results
will come back

136
00:04:31,951 --> 00:04:34,161
on paper from the radiologist.

137
00:04:34,245 --> 00:04:35,663
This is the dark ages.

138
00:04:35,746 --> 00:04:37,874
So if you have orders
with labs or X-rays,

139
00:04:37,957 --> 00:04:39,417
they go into
the clerk file here.

140
00:04:39,500 --> 00:04:40,710
They will sign them off.

141
00:04:40,793 --> 00:04:42,169
They will add
a downtime slip on them,

142
00:04:42,253 --> 00:04:43,462
make sure they go
to the correct department.

143
00:04:43,546 --> 00:04:45,006
I'm sorry,
who are the clerks?

144
00:04:45,089 --> 00:04:46,299
- You're looking at them.
- At your service.

145
00:04:46,382 --> 00:04:47,592
Larry and Antoine are
filling in

146
00:04:47,675 --> 00:04:49,135
- until more help arrives.
- We got this.

147
00:04:49,218 --> 00:04:51,220
After the clerk orders,
chart gets moved

148
00:04:51,304 --> 00:04:52,972
to the nursing order rack
here for IVs,

149
00:04:53,055 --> 00:04:54,724
medications, procedures.

150
00:04:54,807 --> 00:04:56,934
Medications are locked up
in the PDS.

151
00:04:57,018 --> 00:04:59,729
The PDS is getting unlocked
by a clinical pharmacist,

152
00:04:59,812 --> 00:05:01,314
- Dr. Megan Nordt.
- We've got your back.

153
00:05:01,397 --> 00:05:02,383
This is a lot.

154
00:05:02,398 --> 00:05:04,275
Any questions? Yes.

155
00:05:04,358 --> 00:05:05,568
Uh, no.

156
00:05:05,651 --> 00:05:07,111
What's up
with the third rack?

157
00:05:07,194 --> 00:05:08,654
When your patient is
ready to be discharged,

158
00:05:08,738 --> 00:05:09,906
chart goes here.

159
00:05:09,989 --> 00:05:11,157
This lets everybody know

160
00:05:11,240 --> 00:05:12,408
we're about to have
an open bed.

161
00:05:12,491 --> 00:05:14,201
Or that your tuna melt is up.

162
00:05:14,285 --> 00:05:15,536
Jesse?

163
00:05:16,829 --> 00:05:18,789
- What is that?
- What is that?

164
00:05:18,873 --> 00:05:20,583
That is a fax machine.

165
00:05:20,666 --> 00:05:22,043
They still make those?

166
00:05:22,126 --> 00:05:23,878
This is our lifeline
to labs and X-rays.

167
00:05:23,961 --> 00:05:25,755
When the results come back,
they will fax to us,

168
00:05:25,838 --> 00:05:27,465
and the clerks will
put them on the charts.

169
00:05:27,548 --> 00:05:28,799
- Yes?
- If you say so.

170
00:05:28,883 --> 00:05:30,551
Incoming.

171
00:05:30,635 --> 00:05:33,804
OK, Dr. McKay, Dr. Whitaker,
Ogilvie, you're with me.

172
00:05:33,888 --> 00:05:36,641
The rest of you,
build your clipboards.

173
00:05:39,018 --> 00:05:41,646
Howard Knox, 52,
abdominal pain and fever.

174
00:05:41,729 --> 00:05:44,315
152 over 90, tachy at 120.

175
00:05:44,398 --> 00:05:46,067
- Couldn't get an IV.
- I wonder why.

176
00:05:46,150 --> 00:05:47,652
Hello, sir.
My name is Dr. Robby.

177
00:05:47,735 --> 00:05:50,071
- Howard.
- This is a teaching hospital.

178
00:05:50,154 --> 00:05:52,198
I'll be supervising
Doctors McKay and Dr. Whitaker

179
00:05:52,281 --> 00:05:53,449
- and student Dr. Ogilvie.
- Hey.

180
00:05:53,532 --> 00:05:54,617
- Hello.
- How are you feeling?

181
00:05:54,700 --> 00:05:56,035
- Not so great.
- OK.

182
00:05:56,118 --> 00:05:57,536
- Princess, what's free?
- Trauma 1.

183
00:05:57,620 --> 00:05:58,955
Perlah?

184
00:06:01,415 --> 00:06:04,961
All right, orders for Mylanta
and bupivacaine, Central 12.

185
00:06:05,044 --> 00:06:06,337
Wrong spot, Dr. Santos.

186
00:06:06,420 --> 00:06:08,339
And you need a sticker.

187
00:06:10,091 --> 00:06:11,342
Put it
in the nursing orders rack.

188
00:06:11,425 --> 00:06:12,843
And meet me over at PDS.

189
00:06:12,927 --> 00:06:14,428
How much does this suck?

190
00:06:14,512 --> 00:06:16,138
I didn't think
today could get any worse.

191
00:06:16,222 --> 00:06:18,265
This is how we rolled
when I was a resident.

192
00:06:18,349 --> 00:06:19,850
Was that in the 1900s?

193
00:06:19,934 --> 00:06:22,144
Yeah, when charts were
written by candlelight.

194
00:06:22,228 --> 00:06:23,980
Hey, today will be
an adventure.

195
00:06:24,063 --> 00:06:26,273
Think of it like
"Back to the Future."

196
00:06:28,901 --> 00:06:30,861
Or possibly "Titanic."

197
00:06:30,945 --> 00:06:32,738
Here is your antacid.

198
00:06:32,822 --> 00:06:34,115
Cheers.

199
00:06:34,198 --> 00:06:35,866
And I marked the trigger point

200
00:06:35,950 --> 00:06:37,410
that is bringing out
your headache,

201
00:06:37,493 --> 00:06:39,161
and a shot of local anesthetic
in that area

202
00:06:39,245 --> 00:06:41,205
could really help.

203
00:06:42,456 --> 00:06:43,457
Yeah, let's do it.

204
00:06:43,541 --> 00:06:44,750
All right.

205
00:06:45,960 --> 00:06:48,671
You are going to feel
a little pinprick

206
00:06:48,754 --> 00:06:50,339
and some burning.

207
00:06:56,012 --> 00:06:57,888
OK.

208
00:06:57,972 --> 00:06:59,890
Oh, ow, ow,
that really hurts.

209
00:06:59,974 --> 00:07:04,395
Temp 101.4, tachy at 128,
pulse ox 92 on 2 liters.

210
00:07:04,478 --> 00:07:05,771
When did the pain start?

211
00:07:05,855 --> 00:07:07,314
It's been on and off
for about a week.

212
00:07:07,398 --> 00:07:09,108
- And where do you feel it?
- All over.

213
00:07:09,191 --> 00:07:11,652
It started on the left, and now
there's some on the right.

214
00:07:11,736 --> 00:07:12,862
How about that fever?

215
00:07:12,945 --> 00:07:14,196
Since last night.

216
00:07:14,280 --> 00:07:15,573
I was burning up.

217
00:07:15,656 --> 00:07:17,408
Then I had chills pretty bad.

218
00:07:17,491 --> 00:07:18,477
I can't find a vein here.

219
00:07:18,492 --> 00:07:19,492
We'll try for a midline.

220
00:07:19,535 --> 00:07:21,203
Let us know if this hurts.

221
00:07:21,287 --> 00:07:22,580
- Ah, ah.
- Sorry.

222
00:07:22,663 --> 00:07:24,457
- And on this side?
- Yeah, yeah!

223
00:07:24,540 --> 00:07:25,583
Sorry, sir.

224
00:07:25,666 --> 00:07:26,667
Guarding with no rigidity.

225
00:07:26,751 --> 00:07:28,836
For pain, 100 of fent IM?

226
00:07:28,919 --> 00:07:30,171
Plan, Dr. Whitaker?

227
00:07:30,254 --> 00:07:32,882
Blood cultures,
lactate, Zosyn.

228
00:07:32,965 --> 00:07:35,384
We're gonna need a CT
to figure out what's going on.

229
00:07:35,468 --> 00:07:36,802
Ah-ah.

230
00:07:36,886 --> 00:07:38,846
- Yeah, it's not gonna work.
- Yep.

231
00:07:38,929 --> 00:07:40,181
Write neatly.
Penmanship counts.

232
00:07:40,264 --> 00:07:41,515
Howard, for the scan,
we're gonna have

233
00:07:41,599 --> 00:07:42,600
to lay you flat on your back.

234
00:07:42,683 --> 00:07:43,851
Can you do that?

235
00:07:43,934 --> 00:07:45,102
I could ten years ago,

236
00:07:45,186 --> 00:07:46,687
but now
it's too hard to breathe.

237
00:07:46,771 --> 00:07:48,397
If we can't lay you flat,

238
00:07:48,481 --> 00:07:49,899
then we're gonna have to put
a tube in your windpipe

239
00:07:49,982 --> 00:07:51,400
to help you breathe…
are you OK with that?

240
00:07:51,484 --> 00:07:52,902
Intubation with rapid
sequence induction?

241
00:07:52,985 --> 00:07:54,236
No, we can't lay him down.

242
00:07:54,320 --> 00:07:55,404
The tube will go in your nose

243
00:07:55,488 --> 00:07:56,530
while you're awake, sir.

244
00:07:56,614 --> 00:07:57,614
- Well…
- Right.

245
00:07:57,656 --> 00:07:58,866
Does it hurt?

246
00:07:58,949 --> 00:08:00,034
You'll be numbed up
completely.

247
00:08:00,117 --> 00:08:01,452
You won't feel any discomfort.

248
00:08:01,535 --> 00:08:04,330
Do you happen
to know your weight?

249
00:08:04,413 --> 00:08:05,998
A little over 400.

250
00:08:06,082 --> 00:08:07,333
When was the last time
you checked?

251
00:08:07,416 --> 00:08:08,834
It's been a while.

252
00:08:08,918 --> 00:08:11,295
Is it possible
that you might be over 450?

253
00:08:11,378 --> 00:08:13,255
Possibly.

254
00:08:13,339 --> 00:08:15,549
Perlah,
let's call for the Hoyer.

255
00:08:15,633 --> 00:08:18,552
So we're gonna place the tube
and get you ready for the scan.

256
00:08:18,636 --> 00:08:20,221
Is this something serious?

257
00:08:20,304 --> 00:08:22,014
Well, it's hard to tell
without a CT.

258
00:08:22,098 --> 00:08:23,724
You could just need
antibiotics,

259
00:08:23,808 --> 00:08:25,518
or you could require
an operation.

260
00:08:25,601 --> 00:08:26,811
If surgery is necessary,

261
00:08:26,894 --> 00:08:28,145
then your weight could
make things

262
00:08:28,229 --> 00:08:29,563
- a little bit more complicated.
- I know.

263
00:08:29,647 --> 00:08:31,148
- I'm sorry.
- Not to worry.

264
00:08:31,232 --> 00:08:32,566
We're gonna take
very good care of you.

265
00:08:32,650 --> 00:08:33,859
Team.

266
00:08:33,943 --> 00:08:34,985
OK.

267
00:08:35,069 --> 00:08:36,487
Pain medication for you, OK?

268
00:08:36,570 --> 00:08:38,364
Let's try for a midline,

269
00:08:38,447 --> 00:08:40,241
basilic vein
with ultrasound guidance.

270
00:08:40,324 --> 00:08:41,700
Can ultrasound check
for an appy?

271
00:08:41,784 --> 00:08:43,577
He's a little too large
for an ultrasound.

272
00:08:43,661 --> 00:08:45,996
Plus, our CT can only handle
450 pounds.

273
00:08:46,080 --> 00:08:48,541
And so if he's over that,
we send him to the zoo?

274
00:08:49,583 --> 00:08:50,918
He's right there.

275
00:08:53,254 --> 00:08:56,215
I…I heard that there's
a large animal CT at the zoo.

276
00:08:56,298 --> 00:08:58,217
Presby's CT can handle 650.

277
00:08:58,300 --> 00:09:00,427
Yeah, if Presby's still
up and running.

278
00:09:00,511 --> 00:09:01,929
Wh…

279
00:09:02,012 --> 00:09:03,931
That…that's not a jinx.
It's…

280
00:09:04,014 --> 00:09:06,559
Have any of you ever done
an awake naso-tracheal?

281
00:09:06,642 --> 00:09:07,852
OK.

282
00:09:07,935 --> 00:09:08,936
Perlah, can you also ask

283
00:09:09,019 --> 00:09:10,104
Dr. Al-Hashimi to come in?

284
00:09:10,187 --> 00:09:11,188
I'm gonna need an assist.

285
00:09:11,272 --> 00:09:12,565
Yep. You got it.

286
00:09:12,648 --> 00:09:14,608
Ah, sorry. Signed.

287
00:09:15,776 --> 00:09:18,946
Hall bed F, George Francis,
shortness of breath,

288
00:09:19,029 --> 00:09:21,407
Dr. Mohan, awaiting D-dimer.

289
00:09:21,490 --> 00:09:23,033
Wow. She's still going?

290
00:09:23,117 --> 00:09:25,161
Yeah. Remarkable, really.

291
00:09:25,244 --> 00:09:26,745
Dr. Al,
Robby's asking for you.

292
00:09:26,829 --> 00:09:27,955
Uh, OK.

293
00:09:28,038 --> 00:09:29,707
In Trauma if you need me,
Princess.

294
00:09:29,790 --> 00:09:30,916
Got it.

295
00:09:32,543 --> 00:09:34,044
Who's supposed to run
the downtime slips

296
00:09:34,128 --> 00:09:35,254
to X-ray and lab?

297
00:09:35,337 --> 00:09:37,756
Uh, the charge nurse?

298
00:09:37,840 --> 00:09:39,550
Don't look at me.

299
00:09:39,633 --> 00:09:41,010
My plate's full!

300
00:09:43,053 --> 00:09:45,639
Uh, parents of Roxie Hamler?

301
00:09:45,723 --> 00:09:46,891
Central 9.

302
00:09:46,974 --> 00:09:48,184
Oh, I got it, Donnie.

303
00:09:48,267 --> 00:09:49,476
Hi, I'm Victoria Javadi,

304
00:09:49,560 --> 00:09:50,936
one of the student
doctors here.

305
00:09:51,020 --> 00:09:52,479
I've been assisting
with Roxie's care.

306
00:09:52,563 --> 00:09:53,856
Oh, thank you so much.

307
00:09:53,939 --> 00:09:56,066
- I'm Lloyd.
- Cora.

308
00:09:56,150 --> 00:09:57,193
It's nice to meet you.

309
00:09:57,276 --> 00:09:58,360
She broke her leg?

310
00:09:58,444 --> 00:09:59,695
Um, yeah.

311
00:09:59,778 --> 00:10:01,447
There's a fracture
down by the ankle.

312
00:10:01,530 --> 00:10:03,991
She's in a boot now, so there's
not quite so much pain.

313
00:10:04,074 --> 00:10:06,368
But I'll take you.
She's just in 9.

314
00:10:11,832 --> 00:10:13,167
The hospital Wi-Fi
isn't working.

315
00:10:13,250 --> 00:10:14,543
Oh, it'll be down
for a while.

316
00:10:14,627 --> 00:10:16,378
Sorry.

317
00:10:16,462 --> 00:10:18,881
Mom broke her leg, Grandpa.

318
00:10:18,964 --> 00:10:21,008
We heard.

319
00:10:21,091 --> 00:10:22,718
How are you, honey?

320
00:10:24,970 --> 00:10:27,306
You've got this, kiddo.

321
00:10:27,389 --> 00:10:29,600
Yeah.

322
00:10:29,683 --> 00:10:31,685
How long will she stay
in the ER?

323
00:10:31,769 --> 00:10:35,314
Oh, until a bed
opens up upstairs.

324
00:10:35,397 --> 00:10:36,941
Could be a while.

325
00:10:42,238 --> 00:10:43,906
You know, it's getting
pretty crowded in here.

326
00:10:43,989 --> 00:10:45,658
Maybe we should take Tucker
and Shane out for ice cream.

327
00:10:45,741 --> 00:10:49,119
- Yes, please.
- No, no. I'm OK.

328
00:10:49,203 --> 00:10:52,289
Maybe your mom would like
some time to rest.

329
00:10:52,373 --> 00:10:54,500
Yeah. Go.

330
00:10:56,210 --> 00:10:58,545
Can she have ice cream?

331
00:10:58,629 --> 00:11:01,757
She can have
anything she wants.

332
00:11:01,840 --> 00:11:04,718
Come on, let's go.

333
00:11:04,802 --> 00:11:06,637
Bye, Mom.

334
00:11:08,347 --> 00:11:10,557
Ice cream, ice cream.

335
00:11:13,852 --> 00:11:15,145
Yep.

336
00:11:15,229 --> 00:11:17,147
Listen up.

337
00:11:17,231 --> 00:11:18,649
This is Oxymetazoline.

338
00:11:18,732 --> 00:11:19,732
This will open up the passage.

339
00:11:20,901 --> 00:11:22,278
What medication do you take?

340
00:11:22,361 --> 00:11:25,072
Uh, Lisinopril and Metformin.

341
00:11:25,155 --> 00:11:26,991
Ozempic? Wegovy?

342
00:11:27,074 --> 00:11:28,909
No. Kind of expensive.

343
00:11:28,993 --> 00:11:30,869
I'm going to squirt
some numbing gel in your nose.

344
00:11:30,953 --> 00:11:34,373
If it drips back
in your throat, that's OK.

345
00:11:34,456 --> 00:11:36,667
Here, in case you need it.

346
00:11:36,750 --> 00:11:38,502
Do you smoke?

347
00:11:38,585 --> 00:11:39,795
Alcohol?

348
00:11:39,878 --> 00:11:41,880
- Never.
- Do you exercise?

349
00:11:41,964 --> 00:11:44,341
Moving from the bedroom
to the kitchen.

350
00:11:44,425 --> 00:11:45,843
No, I'd walk more,

351
00:11:45,926 --> 00:11:48,470
but I need a bench
to rest on every block.

352
00:11:48,554 --> 00:11:49,972
What about water aerobics?

353
00:11:50,055 --> 00:11:52,266
Let's focus
on helping Mr. Knox.

354
00:11:52,349 --> 00:11:53,684
Agreed.

355
00:11:53,767 --> 00:11:55,686
It took me 25 years
to get this way.

356
00:11:55,769 --> 00:11:58,314
Car crash, burn unit,

357
00:11:58,397 --> 00:12:01,108
four leg surgeries
over ten years.

358
00:12:01,191 --> 00:12:03,319
Laid me up so much,
I lost my job.

359
00:12:03,402 --> 00:12:04,987
I need to numb
the back of your tongue.

360
00:12:05,070 --> 00:12:06,822
This is gonna taste pretty bad.

361
00:12:06,905 --> 00:12:08,240
Is there anyone
you'd like us to call?

362
00:12:08,324 --> 00:12:09,408
No.

363
00:12:09,491 --> 00:12:10,951
Any family?

364
00:12:11,035 --> 00:12:13,537
Mm. My parents passed.

365
00:12:13,620 --> 00:12:14,747
I'm single.

366
00:12:14,830 --> 00:12:15,816
Go figure.

367
00:12:15,831 --> 00:12:16,957
Siblings?

368
00:12:17,041 --> 00:12:18,959
Sister in Arizona.

369
00:12:19,043 --> 00:12:21,378
We don't talk much.

370
00:12:21,462 --> 00:12:23,255
Now that we've numbed up
the back of your tongue,

371
00:12:23,339 --> 00:12:26,800
we can anesthetize
a bit deeper.

372
00:12:26,884 --> 00:12:27,870
Um, sorry to interrupt.

373
00:12:27,885 --> 00:12:28,871
I have a middle-aged woman

374
00:12:28,886 --> 00:12:30,471
with sudden onset blindness.

375
00:12:30,554 --> 00:12:31,847
- I can go.
- OK.

376
00:12:31,930 --> 00:12:33,098
Will you see if Abbot's
still around?

377
00:12:33,182 --> 00:12:34,168
- Yeah.
- Thank you.

378
00:12:34,183 --> 00:12:35,726
What's your sister's name?

379
00:12:35,809 --> 00:12:37,436
Lauren Milford.

380
00:12:37,519 --> 00:12:38,937
Where in Arizona?

381
00:12:39,021 --> 00:12:40,564
Flagstaff, I think.

382
00:12:40,647 --> 00:12:41,774
Just gonna go
over your tongue

383
00:12:41,857 --> 00:12:42,983
and numb your vocal cords.

384
00:12:43,067 --> 00:12:44,053
Ah.

385
00:12:44,068 --> 00:12:46,362
Ah…

386
00:12:46,445 --> 00:12:47,529
How many fingers?

387
00:12:47,613 --> 00:12:49,740
I don't see any fingers.

388
00:12:49,823 --> 00:12:51,700
And now?

389
00:12:51,784 --> 00:12:54,244
I can see a little bit
of light.

390
00:12:54,328 --> 00:12:55,996
Um, Brooke,
you've met Dr. King.

391
00:12:56,080 --> 00:12:57,498
This is Dr. Al-Hashimi.

392
00:12:57,581 --> 00:12:58,832
- Nice to meet you.
- And her wife, Wendy.

393
00:12:58,916 --> 00:13:00,125
- Hello.
- Hello.

394
00:13:00,209 --> 00:13:01,877
OK if we discuss
your symptoms?

395
00:13:01,960 --> 00:13:04,088
As long as I can correct you
if you get anything wrong.

396
00:13:04,171 --> 00:13:05,881
Trust me, she will.

397
00:13:05,964 --> 00:13:08,967
One hour of sudden, painless
vision loss in the left eye.

398
00:13:09,051 --> 00:13:10,803
No history
of hypercoagulable state

399
00:13:10,886 --> 00:13:12,179
or vascular disease.

400
00:13:12,262 --> 00:13:13,722
Could you look straight ahead,
please?

401
00:13:13,806 --> 00:13:16,183
Could be a central
retinal artery occlusion.

402
00:13:16,266 --> 00:13:17,643
In English, please?

403
00:13:17,726 --> 00:13:19,812
A little blood clot
can block the artery

404
00:13:19,895 --> 00:13:22,398
at the back of the eye
and decrease your vision.

405
00:13:22,481 --> 00:13:24,024
Sometimes it's called
an eye stroke.

406
00:13:24,108 --> 00:13:25,094
Stroke?

407
00:13:25,109 --> 00:13:26,443
Like she could be paralyzed?

408
00:13:26,527 --> 00:13:27,986
No, this would be
limited to the eye.

409
00:13:28,070 --> 00:13:29,405
Is it permanent?

410
00:13:29,488 --> 00:13:31,782
First, we have
to make the diagnosis.

411
00:13:31,865 --> 00:13:32,991
Retinal exam?

412
00:13:33,075 --> 00:13:34,075
Hard to get a good look.

413
00:13:34,118 --> 00:13:35,619
We need the FOP.

414
00:13:35,702 --> 00:13:37,371
The what?

415
00:13:39,748 --> 00:13:41,417
Oh, Princess.

416
00:13:41,500 --> 00:13:43,377
We need patient stickers
on each of these order sheets,

417
00:13:43,460 --> 00:13:45,504
or the pharmacy won't know
who to give meds to.

418
00:13:45,587 --> 00:13:46,922
We're on it.

419
00:13:47,005 --> 00:13:49,091
Princess,
smartphone fundoscope?

420
00:13:49,174 --> 00:13:50,467
Equipment corridor, eye cart.

421
00:13:50,551 --> 00:13:53,595
- Thanks.
- You seem a little confused.

422
00:13:53,679 --> 00:13:55,389
How do I figure out
which new patient to pick up?

423
00:13:55,472 --> 00:13:56,723
Top of the board.

424
00:13:56,807 --> 00:13:57,933
They're listed
in the order they arrive.

425
00:13:58,016 --> 00:13:59,184
You erase the first one,
then put

426
00:13:59,268 --> 00:14:00,644
your initials in the MD box.

427
00:14:00,727 --> 00:14:02,271
OK. Thanks.

428
00:14:02,354 --> 00:14:03,647
- Caleb.
- Michael.

429
00:14:03,730 --> 00:14:05,482
Are you managing this chaos OK?

430
00:14:05,566 --> 00:14:08,110
Well, it's all pretty easy
when you're a short-timer.

431
00:14:08,193 --> 00:14:10,737
Any more comatose patients
for me to have a chat with?

432
00:14:12,531 --> 00:14:13,782
I'm kidding.

433
00:14:13,866 --> 00:14:15,367
OK.

434
00:14:15,451 --> 00:14:17,035
Victoria,
this is Nicole Steadman.

435
00:14:17,119 --> 00:14:18,245
I run
the parent support group

436
00:14:18,328 --> 00:14:19,705
for the psychiatric service.

437
00:14:19,788 --> 00:14:21,498
Yeah.
Nicole's daughter was diagnosed

438
00:14:21,582 --> 00:14:23,250
sophomore year in college.

439
00:14:23,333 --> 00:14:26,378
You think Jackson's parents
might have a chat with her?

440
00:14:26,462 --> 00:14:28,297
We can certainly ask.

441
00:14:28,380 --> 00:14:29,965
Now we can see
the whole retina

442
00:14:30,048 --> 00:14:31,467
without dilating the pupil.

443
00:14:32,676 --> 00:14:34,219
You're looking
in the wrong eye.

444
00:14:34,303 --> 00:14:36,472
Oh, we start with
the good eye for comparison.

445
00:14:36,555 --> 00:14:38,557
Oh.

446
00:14:38,640 --> 00:14:39,641
Retina looks great.

447
00:14:39,725 --> 00:14:40,809
Now for the bad eye?

448
00:14:40,893 --> 00:14:42,144
Eyes wide open.

449
00:14:44,605 --> 00:14:45,898
How's it look?

450
00:14:45,981 --> 00:14:47,483
Extremely pale,
no blood flow.

451
00:14:47,566 --> 00:14:49,610
Digital massage,
10 seconds on, 5 seconds off.

452
00:14:49,693 --> 00:14:53,071
Order non-contrast head CT.

453
00:14:54,698 --> 00:14:56,742
Come in.

454
00:14:56,825 --> 00:14:57,910
Hi.

455
00:14:57,993 --> 00:14:59,328
Heard your patient took off.

456
00:14:59,411 --> 00:15:00,871
She's taking a little break.

457
00:15:00,954 --> 00:15:03,248
How long are you gonna wait?

458
00:15:03,332 --> 00:15:05,125
You know about
the cyber shutdown thing?

459
00:15:05,209 --> 00:15:06,668
Yeah.

460
00:15:06,752 --> 00:15:08,128
Wish I could help,
but I gotta stay here

461
00:15:08,212 --> 00:15:09,546
till all the evidence
is collected, so…

462
00:15:09,630 --> 00:15:11,173
It's a hot mess out there.

463
00:15:11,256 --> 00:15:12,549
This whole day is.

464
00:15:13,717 --> 00:15:16,178
Sorry.
I was just leaving.

465
00:15:16,261 --> 00:15:18,347
You OK?

466
00:15:18,430 --> 00:15:19,806
I'm good.

467
00:15:19,890 --> 00:15:21,558
I'm glad to hear it.

468
00:15:21,642 --> 00:15:22,642
You get something to eat?

469
00:15:22,684 --> 00:15:25,479
No.

470
00:15:25,562 --> 00:15:27,606
Let's keep going.

471
00:15:27,689 --> 00:15:28,941
OK.

472
00:15:29,024 --> 00:15:30,067
Yeah.

473
00:15:40,536 --> 00:15:42,955
Why don't we keep one
in the ER?

474
00:15:43,038 --> 00:15:46,625
Because our intubated
patients are usually sedated.

475
00:15:46,708 --> 00:15:48,126
Right.

476
00:15:48,210 --> 00:15:49,753
Maybe you could ease up

477
00:15:49,836 --> 00:15:51,421
with your comments
about his weight.

478
00:15:52,881 --> 00:15:54,758
I was just wondering
how he got so big

479
00:15:54,841 --> 00:15:56,426
and how we could help.

480
00:15:56,510 --> 00:15:58,136
We can help by finding out
what's wrong with him

481
00:15:58,220 --> 00:15:59,220
and treating him with respect.

482
00:15:59,263 --> 00:16:00,249
How's your belly now?

483
00:16:00,264 --> 00:16:01,515
Second pain shot helped.

484
00:16:01,598 --> 00:16:03,392
OK.
There's more if you need it.

485
00:16:03,475 --> 00:16:04,643
Diminished bowel sounds.

486
00:16:04,726 --> 00:16:05,978
VidaTalk from the ICU.

487
00:16:06,061 --> 00:16:07,563
Great.

488
00:16:07,646 --> 00:16:08,855
Howard, we need to open up
that passageway now

489
00:16:08,939 --> 00:16:10,107
so we can pass the tube.

490
00:16:10,190 --> 00:16:11,692
I'm gonna start
with my pinky.

491
00:16:11,775 --> 00:16:13,110
Slowly, over a few minutes,
I'm gonna go deeper,

492
00:16:13,193 --> 00:16:14,570
all the way to the back
of my knuckle.

493
00:16:14,653 --> 00:16:16,280
Once the tube's
through your vocal cords,

494
00:16:16,363 --> 00:16:17,781
you won't be able to talk.

495
00:16:17,864 --> 00:16:19,533
But this is
a communication device.

496
00:16:19,616 --> 00:16:22,202
Swipe through the screen
for anything you want to say.

497
00:16:22,286 --> 00:16:24,705
Hit the icon,
and it talks to us.

498
00:16:24,788 --> 00:16:26,957
<i>I would like
some pain medicine.</i>

499
00:16:27,040 --> 00:16:28,792
<i>My pain is a nine.</i>

500
00:16:28,875 --> 00:16:30,460
Can I get it
to order a pizza?

501
00:16:32,921 --> 00:16:34,673
There's cell service
in the ambulance bay.

502
00:16:34,756 --> 00:16:37,217
I found his sister's
new number, left a voicemail.

503
00:16:37,301 --> 00:16:38,468
OK, I'm gonna start.

504
00:16:38,552 --> 00:16:39,678
You ready?

505
00:16:39,761 --> 00:16:41,138
Not really.

506
00:16:41,221 --> 00:16:42,207
Go ahead.

507
00:16:42,222 --> 00:16:43,515
Robby, over here.

508
00:16:43,599 --> 00:16:45,809
Here we go. Head back.

509
00:16:47,269 --> 00:16:48,478
You thinking it's surgical?

510
00:16:48,562 --> 00:16:49,938
I'm hoping
for a non-perfed appy.

511
00:16:50,022 --> 00:16:51,523
- Can you do it with a scope?
- Possibly,

512
00:16:51,607 --> 00:16:53,191
but he could be treated
with antibiotics alone.

513
00:16:53,275 --> 00:16:55,193
And if he needs surgery?

514
00:16:55,277 --> 00:16:58,196
With his size,
an emergency open laparotomy,

515
00:16:58,280 --> 00:17:00,324
death rate's close to 50%.

516
00:17:00,407 --> 00:17:01,908
OK, one step at a time.

517
00:17:01,992 --> 00:17:04,494
Let's keep trying his sister
every 15 minutes.

518
00:17:04,578 --> 00:17:05,912
She'll get it.

519
00:17:09,833 --> 00:17:12,919
Half the downtime slips
are blank.

520
00:17:13,003 --> 00:17:15,005
What are you talking about?

521
00:17:15,088 --> 00:17:17,174
Here and here.

522
00:17:17,257 --> 00:17:19,259
Larry, are you using
a felt tip pen?

523
00:17:19,343 --> 00:17:21,553
Maybe.

524
00:17:21,637 --> 00:17:24,848
It's not going through
for the copies.

525
00:17:24,931 --> 00:17:26,642
Ballpoint pen only.

526
00:17:26,725 --> 00:17:28,060
OK.

527
00:17:30,520 --> 00:17:31,813
Digby still MIA?

528
00:17:31,897 --> 00:17:33,023
Is that the homeless guy?

529
00:17:33,106 --> 00:17:34,858
We need the bed if he eloped.

530
00:17:36,276 --> 00:17:38,111
- What do you need?
- An attending.

531
00:17:38,195 --> 00:17:39,946
- Or a senior resident?
- Nope, I'm good.

532
00:17:40,030 --> 00:17:42,157
- Dr. Al-Hashimi, can I present?
- Yes.

533
00:17:42,240 --> 00:17:44,743
32-year-old deaf woman
with myofascial headache.

534
00:17:44,826 --> 00:17:47,037
Ibuprofen caused gastritis
and epigastric pain,

535
00:17:47,120 --> 00:17:49,247
and she vasovagalled,
but now pain-free

536
00:17:49,331 --> 00:17:51,291
after Mylanta
and a trigger point injection.

537
00:17:51,375 --> 00:17:52,501
Excellent.
That can take care of the pain

538
00:17:52,584 --> 00:17:54,169
- for several months.
- Yeah.

539
00:17:54,252 --> 00:17:56,505
It shouldn't recur if she keeps
her screen at eye level.

540
00:17:56,588 --> 00:17:57,881
There was a delay

541
00:17:57,964 --> 00:17:59,466
in getting an ASL interpreter.

542
00:17:59,549 --> 00:18:01,134
And I almost gave up
and ordered

543
00:18:01,218 --> 00:18:03,303
an unnecessary brain
and abdominal CT.

544
00:18:03,387 --> 00:18:04,554
Good thing you didn't.

545
00:18:04,638 --> 00:18:07,224
Dr. Al-Hashimi, for you.

546
00:18:07,307 --> 00:18:08,600
Nice job
on the trigger point.

547
00:18:08,684 --> 00:18:09,810
Yeah, I know.

548
00:18:09,893 --> 00:18:11,561
How's the T-system going?

549
00:18:11,645 --> 00:18:13,647
- Quick and easy.
- Yeah.

550
00:18:13,730 --> 00:18:15,899
On these MDMs, don't just
circle your diagnosis.

551
00:18:15,982 --> 00:18:17,693
Also put a backslash
through all the ones

552
00:18:17,776 --> 00:18:18,776
that you've ruled out.

553
00:18:18,819 --> 00:18:19,819
No problem.

554
00:18:19,861 --> 00:18:21,446
Thank you very much.

555
00:18:21,530 --> 00:18:23,448
Princess, bump Central 13
to the front of the CT line.

556
00:18:23,532 --> 00:18:24,616
What do you got?

557
00:18:24,700 --> 00:18:25,992
Sudden onset
blindness patient

558
00:18:26,076 --> 00:18:27,536
has central retinal
artery occlusion.

559
00:18:27,619 --> 00:18:29,204
I just spoke
to an ophthalmologist

560
00:18:29,287 --> 00:18:30,789
at the VA,
principal investigator

561
00:18:30,872 --> 00:18:32,457
for thrombolytics
in cases like this.

562
00:18:32,541 --> 00:18:33,917
Not exactly standard of care.

563
00:18:34,000 --> 00:18:35,000
Kind of risky.

564
00:18:35,043 --> 00:18:36,586
We'll do informed consent.

565
00:18:36,670 --> 00:18:38,130
It's our best shot at saving
some of her vision.

566
00:18:38,213 --> 00:18:39,923
Your patient, your call.

567
00:18:40,006 --> 00:18:41,925
I'm not gonna be around long
enough for any complications.

568
00:18:44,928 --> 00:18:48,515
I'll be taking
two swabs from the vagina,

569
00:18:48,598 --> 00:18:50,559
two swabs from the cervix.

570
00:18:53,979 --> 00:18:56,773
Let me know if you feel
any discomfort.

571
00:18:56,857 --> 00:18:58,817
OK.

572
00:18:58,900 --> 00:19:02,988
Each swab gets labeled…
first vaginal, second vaginal.

573
00:19:03,071 --> 00:19:05,282
Smear a slide with both,
and let it air dry.

574
00:19:05,365 --> 00:19:06,491
Same for the cervix?

575
00:19:06,575 --> 00:19:07,561
Yeah.

576
00:19:07,576 --> 00:19:08,869
No slide needed.

577
00:19:10,537 --> 00:19:12,664
How you doing, Ilana?

578
00:19:12,748 --> 00:19:14,708
Hanging in there.

579
00:19:14,791 --> 00:19:16,209
OK.

580
00:19:16,293 --> 00:19:17,711
Almost done.

581
00:19:20,505 --> 00:19:23,216
All these samples go in
the vaginal contact envelope.

582
00:19:23,300 --> 00:19:24,634
- I can help with that.
- No.

583
00:19:24,718 --> 00:19:26,344
It's gotta be me.

584
00:19:26,428 --> 00:19:29,723
I'm gonna pull this out.

585
00:19:29,806 --> 00:19:31,516
OK.

586
00:19:31,600 --> 00:19:32,601
All good here.

587
00:19:32,684 --> 00:19:34,060
Legs can come down.

588
00:19:37,898 --> 00:19:39,775
Are we done?

589
00:19:39,858 --> 00:19:41,109
One last thing.

590
00:19:41,193 --> 00:19:43,528
Four more swabs
inside your mouth.

591
00:19:43,612 --> 00:19:45,238
Didn't you do that already?

592
00:19:45,322 --> 00:19:48,241
This one's different…
inside your cheek for your DNA,

593
00:19:48,325 --> 00:19:49,910
not for his.

594
00:19:52,621 --> 00:19:58,001
So it could be bipolar
or schizophrenia?

595
00:19:58,084 --> 00:20:00,295
Those are the two
most likely possibilities.

596
00:20:00,378 --> 00:20:01,838
How do they know which it is?

597
00:20:01,922 --> 00:20:04,007
Based on response
to medicine,

598
00:20:04,090 --> 00:20:06,593
but also with therapy
and observation on the ward.

599
00:20:06,676 --> 00:20:10,055
They'll monitor his mood
and interactions with others.

600
00:20:12,015 --> 00:20:14,768
Is there a blood test
or a brain scan

601
00:20:14,851 --> 00:20:15,851
that will tell us for sure?

602
00:20:15,894 --> 00:20:17,771
Unfortunately not.

603
00:20:17,854 --> 00:20:20,732
When properly medicated,
people with bipolar disorder

604
00:20:20,816 --> 00:20:23,443
can have successful careers.

605
00:20:23,527 --> 00:20:25,362
So we hope for bipolar?

606
00:20:25,445 --> 00:20:27,364
You can hope
for your son's happiness.

607
00:20:27,447 --> 00:20:29,991
With early treatment,
20% of people

608
00:20:30,075 --> 00:20:32,744
with schizophrenia have
a complete recovery.

609
00:20:32,828 --> 00:20:34,663
So 80% don't?

610
00:20:34,746 --> 00:20:36,957
This is a new version
of Jackson.

611
00:20:39,751 --> 00:20:40,836
How old was your daughter?

612
00:20:40,919 --> 00:20:42,754
20.

613
00:20:42,838 --> 00:20:46,174
Studying architecture
at Georgetown.

614
00:20:46,258 --> 00:20:47,884
Schizophrenia.

615
00:20:47,968 --> 00:20:50,095
I'm sorry.

616
00:20:50,178 --> 00:20:51,763
Oh, she's good.

617
00:20:51,847 --> 00:20:56,643
Living at home, working
as a cashier at Giant Eagle.

618
00:20:56,726 --> 00:20:59,104
Employee of the Month.

619
00:20:59,187 --> 00:21:01,314
We still have struggles,

620
00:21:01,398 --> 00:21:04,359
but there's also laughter
and love.

621
00:21:11,616 --> 00:21:13,034
Good to go.

622
00:21:13,118 --> 00:21:14,104
How'd that feel?

623
00:21:14,119 --> 00:21:15,579
Very weird.

624
00:21:15,662 --> 00:21:17,664
There's no pain. Just weird.

625
00:21:17,747 --> 00:21:19,958
OK, the next step is,
we're gonna take this tube

626
00:21:20,041 --> 00:21:21,960
and pass it through your nose,

627
00:21:22,043 --> 00:21:24,462
stopping at the back
of your tongue.

628
00:21:24,546 --> 00:21:26,339
Best not to talk for that.

629
00:21:26,423 --> 00:21:29,968
Tube's soaking in warm water
to make it more flexible.

630
00:21:30,051 --> 00:21:32,679
Do you wanna try it?

631
00:21:32,762 --> 00:21:34,556
<i>What day and time is it?</i>

632
00:21:34,639 --> 00:21:36,933
4th of July, 2:31 p.m.

633
00:21:37,017 --> 00:21:38,852
<i>When is my tube coming out?</i>

634
00:21:38,935 --> 00:21:41,730
We have to put it in first.

635
00:21:41,813 --> 00:21:42,799
<i>I know.</i>

636
00:21:42,814 --> 00:21:44,357
<i>Just practicing.</i>

637
00:21:44,441 --> 00:21:47,736
Sounds like
you're an expert already.

638
00:21:47,819 --> 00:21:50,780
Before I can't talk,

639
00:21:50,864 --> 00:21:53,533
I just wanna say

640
00:21:53,617 --> 00:21:56,995
thank you for everything.

641
00:21:57,078 --> 00:21:59,122
You're very welcome.

642
00:22:04,920 --> 00:22:06,296
Here we go.

643
00:22:10,967 --> 00:22:12,344
STI prevention.

644
00:22:12,427 --> 00:22:13,970
One shot treats gonorrhea,

645
00:22:14,054 --> 00:22:16,348
then pills for chlamydia
and trichomonas.

646
00:22:16,431 --> 00:22:17,891
Thank you.

647
00:22:17,974 --> 00:22:19,684
We also have
morning-after contraception.

648
00:22:19,768 --> 00:22:20,769
She has an IUD.

649
00:22:20,852 --> 00:22:23,313
Over 99% effective, not 100%.

650
00:22:23,396 --> 00:22:24,856
We still offer.

651
00:22:24,940 --> 00:22:26,441
I'll pass.

652
00:22:26,524 --> 00:22:29,903
For HIV, we got PEP,
Post-Exposure Prophylaxis.

653
00:22:29,986 --> 00:22:31,404
28 days.

654
00:22:31,488 --> 00:22:34,658
The sooner you start,
the more effective.

655
00:22:34,741 --> 00:22:36,409
Emma, I'm pretty sure
they could use

656
00:22:36,493 --> 00:22:39,579
an extra set of hands
out there.

657
00:22:39,663 --> 00:22:42,040
It's nice to meet you, Ilana.

658
00:22:42,123 --> 00:22:43,458
You're a very brave woman.

659
00:22:43,541 --> 00:22:44,584
Yeah.

660
00:22:51,716 --> 00:22:53,134
She's a good nurse.

661
00:22:53,218 --> 00:22:57,639
She's still learning,
but she will be.

662
00:22:57,722 --> 00:22:59,599
After this, we're done?

663
00:22:59,683 --> 00:23:01,267
Yeah.

664
00:23:04,521 --> 00:23:06,731
I'm glad you were here today.

665
00:23:11,194 --> 00:23:13,780
Me too.

666
00:23:13,863 --> 00:23:16,866
We have a decision to make.

667
00:23:16,950 --> 00:23:18,868
Studies have shown
that some vision

668
00:23:18,952 --> 00:23:21,663
can be restored
with a clot-busting medication.

669
00:23:21,746 --> 00:23:23,081
So give it.

670
00:23:23,164 --> 00:23:25,250
But there are possible risks.

671
00:23:25,333 --> 00:23:29,838
For eye stroke, only 17% get
better without any treatment.

672
00:23:29,921 --> 00:23:31,840
- Only 17%?
- Yes.

673
00:23:31,923 --> 00:23:36,177
But with the medicine,
another 20% can improve.

674
00:23:36,261 --> 00:23:38,680
But there can be complications.

675
00:23:38,763 --> 00:23:42,308
2% of patients who receive
the medication get worse,

676
00:23:42,392 --> 00:23:47,188
and 1% have
severe disability or death.

677
00:23:52,777 --> 00:23:56,322
Honey, this one
has to be your call.

678
00:23:57,574 --> 00:24:00,785
No, it's our call.

679
00:24:00,869 --> 00:24:02,662
What would you do without me?

680
00:24:02,746 --> 00:24:04,873
I'd figure out how to get by.

681
00:24:06,833 --> 00:24:09,753
And I'd probably cry
for two years solid.

682
00:24:09,836 --> 00:24:12,255
Two years? That's all?

683
00:24:13,506 --> 00:24:14,883
I want the medication.

684
00:24:14,966 --> 00:24:16,843
OK.

685
00:24:20,388 --> 00:24:22,307
<i>OK, we need your full name
to make a chart.</i>

686
00:24:22,390 --> 00:24:24,392
Jackie Liddell.

687
00:24:24,476 --> 00:24:26,061
Jackie Liddell.

688
00:24:26,144 --> 00:24:27,144
And you are?

689
00:24:27,187 --> 00:24:28,521
Her friend Jaquie.

690
00:24:28,605 --> 00:24:30,440
- You have the same name?
- No, no.

691
00:24:30,523 --> 00:24:32,650
She's Jackie with a C-K.
I'm Jaquie with a Q.

692
00:24:32,734 --> 00:24:34,444
You can call me CK.

693
00:24:34,527 --> 00:24:35,528
Oh.

694
00:24:35,612 --> 00:24:36,863
Best not to talk, CK, OK?

695
00:24:36,946 --> 00:24:38,364
- Just chill.
- Chill?

696
00:24:38,448 --> 00:24:41,701
- Q, I bit off half my tongue!
- What?

697
00:24:41,785 --> 00:24:43,536
She said,
I bit off half my tongue.

698
00:24:43,620 --> 00:24:44,913
You can understand that?

699
00:24:44,996 --> 00:24:46,581
Oh, you should hear her
when she's had

700
00:24:46,664 --> 00:24:48,500
two pitchers of margaritas,
fucked up and slurring.

701
00:24:48,583 --> 00:24:51,044
Ooh, you are such an idiot!

702
00:24:51,127 --> 00:24:52,670
Princess, what's open?

703
00:24:52,754 --> 00:24:54,422
South 15's clean.

704
00:24:54,506 --> 00:24:55,965
Deep tongue laceration.

705
00:24:56,049 --> 00:24:58,676
I can jump on this.

706
00:24:58,760 --> 00:25:01,638
Robby and Al-Hashimi are
both with critical patients.

707
00:25:01,721 --> 00:25:02,972
Hello.

708
00:25:03,056 --> 00:25:04,224
I'm Dr. Langdon.

709
00:25:04,307 --> 00:25:06,059
I'll be supervising your care.

710
00:25:08,103 --> 00:25:10,688
Jesus, CK,
your doctor's fucking hot.

711
00:25:13,608 --> 00:25:15,944
Tube's at 14 centimeters,
just above the airway.

712
00:25:16,027 --> 00:25:18,321
OK, Howard,
I'm going to start.

713
00:25:18,404 --> 00:25:22,492
If you want me to stop,
you just put your hand up, OK?

714
00:25:22,575 --> 00:25:25,161
Blue mark tells me
I'm in the tube.

715
00:25:28,581 --> 00:25:30,667
Looks like he cleared it.

716
00:25:30,750 --> 00:25:33,253
If he inhales,
we should see chords.

717
00:25:33,336 --> 00:25:35,630
OK, deep breath for me,
Howard.

718
00:25:38,424 --> 00:25:40,802
- OK.
- Beautiful.

719
00:25:40,885 --> 00:25:42,428
Chords are sensitive,
so we spray lidocaine

720
00:25:42,512 --> 00:25:44,889
- in the scope.
- OK.

721
00:25:44,973 --> 00:25:48,434
1 cc going in now.

722
00:25:48,518 --> 00:25:51,146
And we'll just give that
a second to work.

723
00:25:51,229 --> 00:25:52,647
How you doing, Howard?

724
00:25:54,023 --> 00:25:55,775
Once the tube's in,
you'll have to breathe

725
00:25:55,859 --> 00:25:57,110
through your nose.

726
00:25:57,193 --> 00:25:58,528
OK, Howard, hold still.

727
00:25:58,611 --> 00:26:02,031
I am now going in
past your vocal cords

728
00:26:02,115 --> 00:26:04,617
until we see the carina.

729
00:26:06,244 --> 00:26:07,787
Ogilvie.

730
00:26:07,871 --> 00:26:09,038
Uh, there.

731
00:26:09,122 --> 00:26:10,165
Right and left mainstem.

732
00:26:10,248 --> 00:26:13,001
And the tube slides in.

733
00:26:16,880 --> 00:26:20,133
And then the scope comes out.

734
00:26:21,968 --> 00:26:23,469
Great.

735
00:26:23,553 --> 00:26:24,804
OK, inflate the balloon.

736
00:26:24,888 --> 00:26:26,222
Deep breath through your nose.

737
00:26:26,306 --> 00:26:27,432
Amazing.

738
00:26:27,515 --> 00:26:29,559
You good?

739
00:26:29,642 --> 00:26:31,186
Great end-tidal waveform.

740
00:26:31,269 --> 00:26:32,437
Does he need a vent?

741
00:26:32,520 --> 00:26:33,646
He's breathing on his own,

742
00:26:33,730 --> 00:26:35,064
but a little CPAP
wouldn't hurt.

743
00:26:35,148 --> 00:26:37,275
Starting at 5, titrate to 10.

744
00:26:37,358 --> 00:26:39,277
OK, that went
really well, Howard.

745
00:26:39,360 --> 00:26:41,070
Now we're going
to check your weight.

746
00:26:43,031 --> 00:26:44,574
So the nurse examiner
is supposed

747
00:26:44,657 --> 00:26:46,451
to lock up the rape kit
in this fridge,

748
00:26:46,534 --> 00:26:49,621
where it stays until it gets
turned over to law enforcement.

749
00:26:49,704 --> 00:26:52,332
It's called preserving
the chain of evidence.

750
00:26:52,415 --> 00:26:54,626
Are you fucking kidding me?

751
00:26:54,709 --> 00:26:56,502
Is there a problem?

752
00:26:56,586 --> 00:26:58,796
Jesus Christ.

753
00:26:58,880 --> 00:27:01,883
Police are supposed to pick up
the rape kits within 72 hours.

754
00:27:01,966 --> 00:27:04,886
This one I did two weeks ago.

755
00:27:04,969 --> 00:27:06,387
God damn it.

756
00:27:08,640 --> 00:27:10,808
So how exactly
did this happen?

757
00:27:10,892 --> 00:27:13,686
We were in between pubs
taking a selfie.

758
00:27:13,770 --> 00:27:14,771
Very nice.

759
00:27:14,854 --> 00:27:17,232
Until she jerked her head up.

760
00:27:17,315 --> 00:27:18,691
Ooh.

761
00:27:18,775 --> 00:27:20,026
Ouch.

762
00:27:20,109 --> 00:27:21,694
OK, topical epi
did the trick.

763
00:27:21,778 --> 00:27:23,112
- No more bleeding.
- Sweet.

764
00:27:23,196 --> 00:27:24,489
I can go home now?

765
00:27:24,572 --> 00:27:26,366
I don't think so.

766
00:27:26,449 --> 00:27:27,951
It looks like the Grand Canyon
across the back of your tongue.

767
00:27:28,034 --> 00:27:29,953
We need to put in
some stitches.

768
00:27:30,036 --> 00:27:31,022
I don't want stitches.

769
00:27:31,037 --> 00:27:33,039
Oh. Listen to the doctor.

770
00:27:33,122 --> 00:27:34,791
Don't tell me what to do.

771
00:27:34,874 --> 00:27:36,292
This is all your fault.

772
00:27:36,376 --> 00:27:38,336
- No, it's not.
- Uh, yes, it is.

773
00:27:38,419 --> 00:27:40,004
- Uh, Princess.
- No, it's not.

774
00:27:40,088 --> 00:27:41,589
Princess, hey,
why don't you show Q

775
00:27:41,673 --> 00:27:43,383
where she can wait
while we patch up her friend?

776
00:27:43,466 --> 00:27:44,884
Of course.

777
00:27:44,968 --> 00:27:47,095
OK, this is
a numbing shot for the tip.

778
00:27:47,178 --> 00:27:48,164
The tip?

779
00:27:48,179 --> 00:27:50,014
That's not where I bit it.

780
00:27:50,098 --> 00:27:51,516
One step at a time.

781
00:27:58,731 --> 00:28:01,025
That's 20 migs of TNK.

782
00:28:01,109 --> 00:28:04,070
In at 14:39.

783
00:28:04,153 --> 00:28:06,364
Feeling anything?

784
00:28:06,447 --> 00:28:07,490
Not yet.

785
00:28:07,573 --> 00:28:10,410
Could take an hour or two.

786
00:28:10,493 --> 00:28:11,869
We're going to move you
to another room

787
00:28:11,953 --> 00:28:13,746
for better monitoring.

788
00:28:13,830 --> 00:28:15,373
Dr. King.

789
00:28:18,209 --> 00:28:21,546
I'd like you to stay with her.

790
00:28:21,629 --> 00:28:22,880
Why?

791
00:28:22,964 --> 00:28:24,507
In case
there are complications.

792
00:28:24,590 --> 00:28:26,259
You'll be there
to respond quickly

793
00:28:26,342 --> 00:28:29,178
to a blown pupil, a seizure,
altered mental status.

794
00:28:29,262 --> 00:28:31,222
Or I could catch up
on my charts.

795
00:28:31,306 --> 00:28:33,141
And my deposition's coming up.

796
00:28:33,224 --> 00:28:35,643
Think of this as a great way
to steal some quiet time

797
00:28:35,727 --> 00:28:36,936
and get mentally prepared.

798
00:28:37,020 --> 00:28:39,230
Jesse, Mel's with you.

799
00:28:41,024 --> 00:28:42,942
Oh, excuse me, Dr. Mohan.

800
00:28:43,026 --> 00:28:44,068
Excuse me.

801
00:28:44,152 --> 00:28:45,138
Dr. Mohan.

802
00:28:45,153 --> 00:28:46,487
Uh, in a minute, George.

803
00:28:46,571 --> 00:28:47,572
I've got this.

804
00:28:47,655 --> 00:28:48,781
Thank you.

805
00:28:48,865 --> 00:28:51,117
Oh, uh, I, um…

806
00:28:51,200 --> 00:28:53,286
D-dimer is back normal.

807
00:28:53,369 --> 00:28:54,355
Oh.

808
00:28:54,370 --> 00:28:55,621
I'm ready to go.

809
00:28:55,705 --> 00:28:57,498
Are you feeling better?

810
00:28:57,582 --> 00:29:01,252
I…I really wasn't
short of breath this time.

811
00:29:02,420 --> 00:29:04,047
Then why'd you come in?

812
00:29:05,631 --> 00:29:07,592
When I found out about
the blood clot in my leg,

813
00:29:07,675 --> 00:29:10,511
I just kept thinking it's gonna
go to my lung and kill me.

814
00:29:10,595 --> 00:29:13,681
We've talked before about how
the Eliquis would prevent that.

815
00:29:13,765 --> 00:29:16,392
I know.

816
00:29:16,476 --> 00:29:18,770
Well, I finally took
your advice.

817
00:29:18,853 --> 00:29:21,230
I got out of the house,
and I joined

818
00:29:21,314 --> 00:29:23,149
the Frick Park
Lawn Bowling Club.

819
00:29:23,232 --> 00:29:24,442
Wonderful.

820
00:29:24,525 --> 00:29:25,568
Yeah.

821
00:29:25,651 --> 00:29:27,403
I mean, you're right, you know?

822
00:29:27,487 --> 00:29:29,447
We all need a community.

823
00:29:33,493 --> 00:29:34,869
You're gonna do what?

824
00:29:34,952 --> 00:29:36,537
In order to fix your tongue,

825
00:29:36,621 --> 00:29:39,082
we need to move it forward
to access the laceration.

826
00:29:39,165 --> 00:29:40,708
You're just gonna feel
some pulling, OK?

827
00:29:40,792 --> 00:29:44,087
I guess so.

828
00:29:44,170 --> 00:29:46,798
Go for it.

829
00:29:46,881 --> 00:29:48,174
What size suture is that?

830
00:29:48,257 --> 00:29:51,969
O-silk, the biggest one
we got.

831
00:29:52,053 --> 00:29:54,931
As soon as I cut the needle,
you're on traction, Joy.

832
00:30:03,731 --> 00:30:05,191
Oh.

833
00:30:05,274 --> 00:30:07,402
That is pretty deep.

834
00:30:07,485 --> 00:30:08,986
And now we can
numb up the cut.

835
00:30:09,070 --> 00:30:10,321
It's best to start with…

836
00:30:10,405 --> 00:30:11,739
Proximal side first
so she doesn't

837
00:30:11,823 --> 00:30:14,951
feel the distal injection.

838
00:30:15,034 --> 00:30:16,020
Give it ten minutes.

839
00:30:16,035 --> 00:30:17,537
I'll be back for the repair.

840
00:30:21,749 --> 00:30:23,584
I got a rape kit
sitting here for two weeks

841
00:30:23,668 --> 00:30:26,087
that was supposed to be
picked up within 72 hours.

842
00:30:26,170 --> 00:30:27,170
I don't care!

843
00:30:27,213 --> 00:30:29,173
Get someone over here now! No.

844
00:30:29,257 --> 00:30:30,675
You expect us
to treat your officers

845
00:30:30,758 --> 00:30:32,301
as soon as they come in,

846
00:30:32,385 --> 00:30:34,137
you get a detective
to pick these kits up ASAP.

847
00:30:34,220 --> 00:30:35,206
I gotta go.

848
00:30:35,221 --> 00:30:36,722
- Dana…
- Hey, Dana.

849
00:30:36,806 --> 00:30:37,890
South 19 got their head CT
before we went down.

850
00:30:37,974 --> 00:30:39,225
No results yet.

851
00:30:39,308 --> 00:30:40,393
All right,
I'll send a reminder.

852
00:30:40,476 --> 00:30:41,462
- Hey, Dana.
- Dana.

853
00:30:41,477 --> 00:30:42,854
Hang on.

854
00:30:43,896 --> 00:30:45,565
What's up?

855
00:30:45,648 --> 00:30:47,525
We put in an order
for more pain meds for Roxie.

856
00:30:47,608 --> 00:30:49,610
All right, so put it
in the nursing racks.

857
00:30:49,694 --> 00:30:52,238
Oh, I did, a long time ago.

858
00:30:52,321 --> 00:30:54,115
All right.
I'll bump it to the front.

859
00:30:54,198 --> 00:30:55,658
Thank you.

860
00:30:55,741 --> 00:30:57,368
Uh, what's that noise?

861
00:30:57,452 --> 00:30:58,453
UFO landed.

862
00:30:58,536 --> 00:30:59,522
Aliens are invading.

863
00:30:59,537 --> 00:31:00,955
Hey, Dana.

864
00:31:01,038 --> 00:31:02,832
Chem 7's not back
on Trauma 2 yet.

865
00:31:02,915 --> 00:31:05,126
Let me see the chart.

866
00:31:05,209 --> 00:31:06,669
Oh, Jesus.

867
00:31:06,752 --> 00:31:08,212
I bet your Chem 7 rec
went to Radiology.

868
00:31:08,296 --> 00:31:10,047
Larry, Antoine.

869
00:31:10,131 --> 00:31:12,550
You put labs and chest X-ray
on the same downtime form.

870
00:31:12,633 --> 00:31:14,844
You need two slips…one
for labs, one for radiology.

871
00:31:14,927 --> 00:31:16,512
- Got it.
- Won't happen again.

872
00:31:16,596 --> 00:31:17,638
I'll run it down myself.

873
00:31:17,722 --> 00:31:19,348
Use the iStat at bedside.

874
00:31:19,432 --> 00:31:20,766
They won't take him to CT
without a creatinine.

875
00:31:20,850 --> 00:31:21,976
Oh, perfect.

876
00:31:22,059 --> 00:31:23,102
Nice to have you back.

877
00:31:23,186 --> 00:31:24,395
Thrilled to be here.

878
00:31:24,479 --> 00:31:25,521
You trying to text?

879
00:31:25,605 --> 00:31:27,064
I am just composing.

880
00:31:27,148 --> 00:31:28,608
I'm gonna send it from the bay.

881
00:31:28,691 --> 00:31:30,860
My mechanic friend, Duke,
never showed up.

882
00:31:30,943 --> 00:31:32,403
I thought he was
coming in this morning.

883
00:31:32,487 --> 00:31:33,613
That was the plan.

884
00:31:33,696 --> 00:31:35,907
I guess he got busy.

885
00:31:35,990 --> 00:31:37,116
What if he's a no-show?

886
00:31:37,200 --> 00:31:38,743
Tell me what he needs.

887
00:31:38,826 --> 00:31:39,827
I'll pass it on
to the night shift.

888
00:31:39,911 --> 00:31:40,911
That won't be necessary.

889
00:31:43,664 --> 00:31:45,416
Oh, Princess.

890
00:31:45,500 --> 00:31:46,501
Ask and you shall receive.

891
00:31:46,584 --> 00:31:47,627
Normal head CT.

892
00:31:47,710 --> 00:31:50,004
Thanks.
I'll get him discharged.

893
00:31:50,087 --> 00:31:51,839
How's your day going?

894
00:31:51,923 --> 00:31:54,342
I think I'm getting
writer's cramp.

895
00:31:54,425 --> 00:31:55,676
You with the big guy?

896
00:31:55,760 --> 00:31:57,929
Yeah. It's sad.

897
00:31:58,012 --> 00:32:01,849
Bad car accident, multiple
operations, tons of stress.

898
00:32:03,935 --> 00:32:05,728
Lidocaine shot
to a sensitive area.

899
00:32:05,811 --> 00:32:07,480
I got a binge-drinking
party girl with a tongue lac.

900
00:32:07,563 --> 00:32:08,814
Mm.

901
00:32:08,898 --> 00:32:10,066
Sounds like
she needs some help.

902
00:32:10,149 --> 00:32:12,777
In more ways than one.

903
00:32:12,860 --> 00:32:16,489
How's, uh…how's
your first shift back going?

904
00:32:16,572 --> 00:32:18,699
One day at a time.

905
00:32:18,783 --> 00:32:20,284
First year sober
is the hardest.

906
00:32:20,368 --> 00:32:21,536
That's what
they keep telling me.

907
00:32:21,619 --> 00:32:24,205
I'm nine years and counting.

908
00:32:26,666 --> 00:32:28,167
Oh.

909
00:32:28,251 --> 00:32:31,712
Special delivery for my guy.

910
00:32:31,796 --> 00:32:33,673
If you, um…if you
need anything, call me.

911
00:32:33,756 --> 00:32:35,341
Thanks.

912
00:32:41,347 --> 00:32:42,890
Where are you going?

913
00:32:42,974 --> 00:32:44,267
Blisters in North 3.

914
00:32:44,350 --> 00:32:45,768
That's where I'm going.

915
00:32:45,851 --> 00:32:47,645
Did you sign up
for the patient?

916
00:32:47,728 --> 00:32:49,438
I pulled the chart
from the rack.

917
00:32:49,522 --> 00:32:51,190
You're supposed to sign up
on the dry-erase board.

918
00:32:51,274 --> 00:32:53,067
You're supposed to have
a clipboard for the patient.

919
00:32:53,150 --> 00:32:54,860
I thought
the nurses had that.

920
00:32:54,944 --> 00:32:56,487
Whatever.

921
00:32:56,571 --> 00:32:57,613
Hi.

922
00:32:57,697 --> 00:32:59,031
I'm Student Doctor Ogilvie.

923
00:32:59,115 --> 00:33:01,242
And this is…wow.

924
00:33:01,325 --> 00:33:02,702
That is some rash.

925
00:33:02,785 --> 00:33:05,580
- Yeah. Tell me about it.
- Student Doctor Javadi.

926
00:33:05,663 --> 00:33:07,790
- When did this start?
- Last night.

927
00:33:07,873 --> 00:33:09,333
And have you been
on any hikes recently

928
00:33:09,417 --> 00:33:10,459
around poison ivy?

929
00:33:10,543 --> 00:33:12,378
Nope. Haven't left the house.

930
00:33:12,461 --> 00:33:15,381
What about new medications,
lotions, soaps,

931
00:33:15,464 --> 00:33:16,450
detergents, even?

932
00:33:16,465 --> 00:33:17,675
I don't take medicine.

933
00:33:17,758 --> 00:33:19,343
Nothing new with all
that other stuff.

934
00:33:19,427 --> 00:33:20,428
Uh-huh.
And where did this start?

935
00:33:20,511 --> 00:33:21,846
Everywhere, all at once.

936
00:33:21,929 --> 00:33:25,182
Just a lot of pain,
really itchy.

937
00:33:25,266 --> 00:33:26,892
What is it?

938
00:33:26,976 --> 00:33:28,394
I'm not sure yet.

939
00:33:28,477 --> 00:33:31,147
Um, be back in a second.

940
00:33:31,230 --> 00:33:32,773
Can't…will you…

941
00:33:37,028 --> 00:33:38,988
What are you thinking?

942
00:33:39,071 --> 00:33:40,072
I have no idea.

943
00:33:40,156 --> 00:33:41,324
Agreed.

944
00:33:43,200 --> 00:33:44,702
Bullous pemphigoid?

945
00:33:44,785 --> 00:33:46,412
Autoimmune severe pruritis?

946
00:33:46,495 --> 00:33:48,039
Yeah, but not as deadly
as pemphigus vulgaris.

947
00:33:48,122 --> 00:33:50,041
Untreated, the death rate
is over 90%.

948
00:33:50,124 --> 00:33:51,459
We need to check
for pustules,

949
00:33:51,542 --> 00:33:52,585
mucous membrane involvement…

950
00:33:52,668 --> 00:33:54,045
And the Nikolsky sign.

951
00:33:56,547 --> 00:33:57,923
Here you go.

952
00:33:59,425 --> 00:34:00,426
What?

953
00:34:00,509 --> 00:34:02,053
For your progress note.

954
00:34:03,429 --> 00:34:06,349
Did I hear
we're making progress?

955
00:34:06,432 --> 00:34:08,643
Oh, um,
it's just what we call it

956
00:34:08,726 --> 00:34:11,812
when we write down things
to describe a clinical course.

957
00:34:13,356 --> 00:34:14,356
Any changes?

958
00:34:15,399 --> 00:34:16,609
Not so far.

959
00:34:16,692 --> 00:34:18,986
It's time for the next
neuro check.

960
00:34:19,070 --> 00:34:21,280
Excuse me, Dr. King,
do you have a minute?

961
00:34:21,364 --> 00:34:22,865
Um, no.

962
00:34:22,948 --> 00:34:24,659
I'm observing
a patient right now.

963
00:34:24,742 --> 00:34:27,078
60 seconds tops.

964
00:34:28,496 --> 00:34:29,789
I'll check pupils.

965
00:34:29,872 --> 00:34:31,415
We're good here.

966
00:34:37,046 --> 00:34:38,923
Hey.

967
00:34:39,006 --> 00:34:41,258
I just finished
my deposition.

968
00:34:41,342 --> 00:34:43,719
Oh, should I go up now?

969
00:34:43,803 --> 00:34:45,429
Yeah.
Just wait until you get a call.

970
00:34:45,513 --> 00:34:46,806
OK.

971
00:34:46,889 --> 00:34:48,265
Well, I'd ask how it went,

972
00:34:48,349 --> 00:34:50,309
but we're not supposed
to discuss the case.

973
00:34:50,393 --> 00:34:51,811
This isn't a discussion.

974
00:34:51,894 --> 00:34:55,064
It's a monologue,
so shut up and listen.

975
00:34:55,147 --> 00:34:57,274
The malpractice case
is frivolous.

976
00:34:57,358 --> 00:34:58,818
The mother
of the measles kid claims

977
00:34:58,901 --> 00:35:00,236
we caused intellectual decline

978
00:35:00,319 --> 00:35:02,321
by performing a spinal tap.

979
00:35:02,405 --> 00:35:05,533
But the tap was perfect
with no complications.

980
00:35:05,616 --> 00:35:07,284
Her son presented
with altered mental status

981
00:35:07,368 --> 00:35:10,746
due to low oxygen
from measles pneumonia.

982
00:35:10,830 --> 00:35:13,207
Any change in intellect was
due to hypoxic brain injury.

983
00:35:13,290 --> 00:35:16,877
It had nothing to do
with your spinal tap.

984
00:35:16,961 --> 00:35:18,587
End of monologue.

985
00:35:18,671 --> 00:35:21,340
We never discussed the case.

986
00:35:21,424 --> 00:35:23,676
I gotta get some sleep.

987
00:35:23,759 --> 00:35:27,012
Thanks, I guess.

988
00:35:28,681 --> 00:35:30,891
OK, are you ready
to lay down?

989
00:35:30,975 --> 00:35:31,961
I got your head.

990
00:35:31,976 --> 00:35:33,102
Nice and slow.

991
00:35:33,185 --> 00:35:35,312
One, two, three.

992
00:35:36,731 --> 00:35:37,717
OK.

993
00:35:37,732 --> 00:35:38,816
How's that feel?

994
00:35:41,736 --> 00:35:42,862
Lifting up now.

995
00:35:52,872 --> 00:35:54,498
Keep going.

996
00:35:57,126 --> 00:36:00,379
And…that ought to do it
right about there.

997
00:36:02,131 --> 00:36:03,883
215?

998
00:36:03,966 --> 00:36:05,885
Oh, that's in kilos.

999
00:36:08,220 --> 00:36:09,805
OK, team.

1000
00:36:15,436 --> 00:36:17,104
It's not that much over 450.

1001
00:36:17,188 --> 00:36:19,899
No, we can't risk breaking
our CT on a holiday weekend.

1002
00:36:19,982 --> 00:36:22,026
Would the medics take him
while he's intubated?

1003
00:36:22,109 --> 00:36:24,403
If I go along for the ride,
I could still get a nap in

1004
00:36:24,487 --> 00:36:26,030
before my night shift.

1005
00:36:30,034 --> 00:36:32,912
474.

1006
00:36:32,995 --> 00:36:34,789
Our CT can't handle
your weight,

1007
00:36:34,872 --> 00:36:38,167
but we're gonna take you over
to Presbyterian Hospital.

1008
00:36:38,250 --> 00:36:40,085
<i>Road trip.</i>

1009
00:36:40,169 --> 00:36:42,463
I'll keep you company
the whole time.

1010
00:36:45,007 --> 00:36:47,009
<i>Sorry for all this trouble.</i>

1011
00:36:47,092 --> 00:36:48,219
It's OK.

1012
00:36:48,302 --> 00:36:49,720
This is what we do.

1013
00:36:55,226 --> 00:36:56,727
So sub Q starts deep.

1014
00:36:56,811 --> 00:36:57,853
You want to bury the knot.

1015
00:36:57,937 --> 00:36:59,396
Yeah, I've done these before.

1016
00:36:59,480 --> 00:37:01,690
Joy, how do we cut the ends?

1017
00:37:01,774 --> 00:37:03,234
Short.
Slide to the knot.

1018
00:37:03,317 --> 00:37:04,303
Turn 45 degrees.

1019
00:37:04,318 --> 00:37:06,362
Excellent.

1020
00:37:06,445 --> 00:37:08,197
Um, Dr. Langdon,
we have a case.

1021
00:37:08,280 --> 00:37:09,266
It'll have to wait.

1022
00:37:09,281 --> 00:37:10,324
It could be urgent.

1023
00:37:10,407 --> 00:37:14,161
Find Robby or Al-Hashimi.

1024
00:37:14,245 --> 00:37:16,497
This girl is wasted.

1025
00:37:16,580 --> 00:37:18,541
Drunk as a skunk.

1026
00:37:18,624 --> 00:37:20,292
Should we check
her blood alcohol level?

1027
00:37:20,376 --> 00:37:21,919
No, it won't change
what we do.

1028
00:37:22,002 --> 00:37:23,504
She can go home
when she has a steady gait.

1029
00:37:23,587 --> 00:37:25,673
I already sent one off.

1030
00:37:25,756 --> 00:37:28,342
Joy, do you want to guess
her blood alcohol?

1031
00:37:28,425 --> 00:37:29,844
Why would I want to do that?

1032
00:37:29,927 --> 00:37:31,971
I don't know.
'Cause it's fun.

1033
00:37:37,977 --> 00:37:39,562
When will you have a bed?

1034
00:37:39,645 --> 00:37:41,397
I'm not sure she needs a bed.

1035
00:37:41,480 --> 00:37:43,190
She's a febrile infant.

1036
00:37:43,274 --> 00:37:45,150
Who is clearly over a month
old and looks amazing.

1037
00:37:45,234 --> 00:37:47,111
Every marker is normal.
She has a cold virus.

1038
00:37:47,194 --> 00:37:48,863
Infants with rhinovirus
can still have

1039
00:37:48,946 --> 00:37:50,281
a serious bacterial infection.

1040
00:37:50,364 --> 00:37:51,782
Not this one.

1041
00:37:51,866 --> 00:37:53,409
We send kids like this home
all the time.

1042
00:37:53,492 --> 00:37:56,453
Except this one doesn't have
a home or a parent.

1043
00:37:57,830 --> 00:37:59,290
All right.

1044
00:37:59,373 --> 00:38:01,041
I can't put a kid
with a virus in the nursery,

1045
00:38:01,125 --> 00:38:03,294
and I can't waste a private
room on a healthy baby.

1046
00:38:03,377 --> 00:38:04,712
Then what do you propose?

1047
00:38:04,795 --> 00:38:06,672
CYF can place her
in emergency foster care

1048
00:38:06,755 --> 00:38:08,215
by tomorrow morning.

1049
00:38:08,299 --> 00:38:10,426
You want to leave her
down here overnight?

1050
00:38:10,509 --> 00:38:12,803
Seems to be the standard
of care these days.

1051
00:38:12,887 --> 00:38:14,138
Have your attending
give me a call.

1052
00:38:14,221 --> 00:38:15,221
Will do.

1053
00:38:15,264 --> 00:38:16,515
I can't believe this.

1054
00:38:16,599 --> 00:38:18,309
Let CYF know
it's very urgent.

1055
00:38:18,392 --> 00:38:19,810
Got it.

1056
00:38:19,894 --> 00:38:22,354
This is turning
into quite the day.

1057
00:38:22,438 --> 00:38:24,273
You know, I've been thinking

1058
00:38:24,356 --> 00:38:25,816
about applying
for a fellowship.

1059
00:38:25,900 --> 00:38:27,776
I thought you had a job
lined up in New Jersey.

1060
00:38:27,860 --> 00:38:29,904
I did, to be close to my mom.

1061
00:38:29,987 --> 00:38:33,449
But she sold her house
to travel the world

1062
00:38:33,532 --> 00:38:35,451
with her new boyfriend.

1063
00:38:35,534 --> 00:38:37,286
So what's the point
of New Jersey?

1064
00:38:37,369 --> 00:38:38,704
Yeah, good question.

1065
00:38:38,787 --> 00:38:40,331
Which fellowship?

1066
00:38:40,414 --> 00:38:44,043
I've narrowed it down
to ultrasound, toxicology,

1067
00:38:44,126 --> 00:38:47,296
and sports medicine.

1068
00:38:47,379 --> 00:38:48,672
Those are
very disparate fields

1069
00:38:48,756 --> 00:38:50,174
leading to very
different careers.

1070
00:38:50,257 --> 00:38:51,342
I know.

1071
00:38:51,425 --> 00:38:53,427
I'm a little undecided.

1072
00:38:53,510 --> 00:38:55,054
Do you have
research experience?

1073
00:38:55,137 --> 00:38:57,640
I was a part of a study
on racial disparities

1074
00:38:57,723 --> 00:38:59,516
in health care
until the White House

1075
00:38:59,600 --> 00:39:01,060
cut the funding last year.

1076
00:39:01,143 --> 00:39:03,479
Yeah. You are not alone.

1077
00:39:03,562 --> 00:39:06,398
Have you considered
a geriatrics fellowship?

1078
00:39:06,482 --> 00:39:08,317
I have not.

1079
00:39:08,400 --> 00:39:10,444
I've seen your skills
with the elderly,

1080
00:39:10,527 --> 00:39:12,571
and there are
a lot of openings.

1081
00:39:12,655 --> 00:39:14,406
It might be your best shot.

1082
00:39:14,490 --> 00:39:17,242
Think about it.

1083
00:39:17,326 --> 00:39:18,312
Last stitch.

1084
00:39:18,327 --> 00:39:19,328
You want me to cut?

1085
00:39:19,411 --> 00:39:20,871
I got it.

1086
00:39:22,581 --> 00:39:23,832
It looks good.

1087
00:39:23,916 --> 00:39:25,918
OK.
Let's pull the traction suture.

1088
00:39:26,001 --> 00:39:27,378
With pleasure.

1089
00:39:29,338 --> 00:39:31,382
OK, Jackie.

1090
00:39:31,465 --> 00:39:32,800
- Jackie.
- Stop it.

1091
00:39:32,883 --> 00:39:33,869
Stop.

1092
00:39:33,884 --> 00:39:35,094
All done.

1093
00:39:35,177 --> 00:39:36,679
All done with what?

1094
00:39:36,762 --> 00:39:38,347
Sewing up your tongue.

1095
00:39:38,430 --> 00:39:40,057
What happened to my tongue?

1096
00:39:40,140 --> 00:39:41,266
You bit it.

1097
00:39:41,350 --> 00:39:42,336
Ha.

1098
00:39:42,351 --> 00:39:43,936
No, I didn't.

1099
00:39:44,019 --> 00:39:45,771
That is called a blackout.

1100
00:39:45,854 --> 00:39:47,606
How much did you drink?

1101
00:39:47,690 --> 00:39:49,858
A couple Bloody Marys.

1102
00:39:49,942 --> 00:39:51,068
Only a couple?

1103
00:39:51,151 --> 00:39:53,237
I don't know. Maybe more.

1104
00:39:53,320 --> 00:39:55,948
It's a holiday, a pub crawl.

1105
00:39:56,031 --> 00:39:58,659
Do you usually have
a couple cocktails every day?

1106
00:39:58,742 --> 00:39:59,910
Only on weekends.

1107
00:39:59,994 --> 00:40:01,245
How about during the week?

1108
00:40:01,328 --> 00:40:02,663
Nothing much.

1109
00:40:02,746 --> 00:40:07,668
Just wine with dinner
or a few beers.

1110
00:40:07,751 --> 00:40:10,838
Maybe we should
recommend rehab?

1111
00:40:10,921 --> 00:40:11,922
Yeah.

1112
00:40:12,006 --> 00:40:13,424
We could try.

1113
00:40:18,012 --> 00:40:20,389
Ready to roll.

1114
00:40:20,472 --> 00:40:22,016
How are you feeling?

1115
00:40:22,099 --> 00:40:23,392
<i>My pain is a two.</i>

1116
00:40:23,475 --> 00:40:24,977
We got meds if you need them.

1117
00:40:25,060 --> 00:40:26,520
Scan will be quicker
than the ride to Presby.

1118
00:40:26,603 --> 00:40:27,896
We'll keep trying
to reach your sister.

1119
00:40:27,980 --> 00:40:29,523
<i>- You guys are the best.</i>
- See you later.

1120
00:40:29,606 --> 00:40:31,316
Can I put a new patient
in T1?

1121
00:40:31,400 --> 00:40:33,694
Uh, no, I kind of want
to leave one trauma room open.

1122
00:40:33,777 --> 00:40:37,322
Why don't you double up
the north if you have to?

1123
00:40:37,406 --> 00:40:40,242
Mr. Digby?

1124
00:40:40,325 --> 00:40:42,119
- It's just Digby.
- Right.

1125
00:40:42,202 --> 00:40:44,663
We've been looking all over.
Where you been?

1126
00:40:44,747 --> 00:40:46,206
With Louie.

1127
00:40:46,290 --> 00:40:47,708
You've been in there
for an hour?

1128
00:40:47,791 --> 00:40:49,752
He was my friend.

1129
00:40:49,835 --> 00:40:51,670
- I had a lot to say.
- Hmm.

1130
00:40:51,754 --> 00:40:54,048
Well, let's get you
back to your bed.

1131
00:40:56,133 --> 00:40:57,926
Louie got his wings.

1132
00:40:58,010 --> 00:40:59,845
- Dr. Robby.
- Dr. Robby.

1133
00:40:59,928 --> 00:41:01,430
We picked up
a patient together.

1134
00:41:01,513 --> 00:41:02,848
Teamwork!

1135
00:41:02,931 --> 00:41:04,391
It's a concerning
bullous rash.

1136
00:41:04,475 --> 00:41:05,976
We might need a biopsy
for pemphigus vulgaris.

1137
00:41:06,060 --> 00:41:07,436
It's phytophotodermatitis.

1138
00:41:07,519 --> 00:41:09,188
- What?
- I asked.

1139
00:41:09,271 --> 00:41:11,315
He was making three gallons
of margaritas for a party,

1140
00:41:11,398 --> 00:41:13,567
squeezing fresh limes
out in the sun.

1141
00:41:13,650 --> 00:41:14,985
Let's go take a peek.

1142
00:41:15,069 --> 00:41:16,904
I don't need to see it again.

1143
00:41:19,448 --> 00:41:20,824
How's it going out there?

1144
00:41:20,908 --> 00:41:22,409
Standing room only.

1145
00:41:22,493 --> 00:41:23,827
If I call the fire department,
will they clear

1146
00:41:23,911 --> 00:41:25,120
- that waiting room?
- I wish.

1147
00:41:25,204 --> 00:41:26,246
What's up?

1148
00:41:26,330 --> 00:41:28,290
12 patients need med refills.

1149
00:41:28,373 --> 00:41:29,875
Shouldn't they see
their doctors?

1150
00:41:29,958 --> 00:41:31,627
With the Medicaid cuts,
we are their doctor.

1151
00:41:31,710 --> 00:41:33,337
No, I can't e-prescribe
to their pharmacies.

1152
00:41:33,420 --> 00:41:35,047
So get out your pen.
Go old school.

1153
00:41:35,130 --> 00:41:37,382
Dana, on what?

1154
00:41:37,466 --> 00:41:39,843
Nordt, you got
the security pads?

1155
00:41:39,927 --> 00:41:41,136
Sure do.

1156
00:41:41,220 --> 00:41:42,930
Just need a patient sticker.

1157
00:41:43,013 --> 00:41:45,307
- Any other questions?
- Yeah.

1158
00:41:45,390 --> 00:41:47,768
What would have happened
if you weren't here today?

1159
00:41:48,977 --> 00:41:50,729
You'd all be curled up
in the fetal position,

1160
00:41:50,813 --> 00:41:53,065
crying like babies.

1161
00:41:53,148 --> 00:41:54,691
Were you wearing flip-flops?

1162
00:41:54,775 --> 00:41:56,026
I was.

1163
00:41:56,110 --> 00:41:57,945
- What is it?
- Phytophotodermatitis.

1164
00:41:58,028 --> 00:42:00,155
Otherwise known
as margarita burn.

1165
00:42:00,239 --> 00:42:01,698
For some people,
limes plus sunshine

1166
00:42:01,782 --> 00:42:03,033
can cause a horrible rash.

1167
00:42:03,117 --> 00:42:05,160
This is all because of limes?

1168
00:42:05,244 --> 00:42:07,996
Have you ever squeezed limes
outside in the sun before?

1169
00:42:08,080 --> 00:42:09,665
I don't think so.

1170
00:42:09,748 --> 00:42:12,126
You will feel better
after a day of steroid pills.

1171
00:42:12,209 --> 00:42:14,044
But once these heal,
you gotta wear sunscreen.

1172
00:42:14,128 --> 00:42:16,171
Because these blisters
can turn into dark scars

1173
00:42:16,255 --> 00:42:17,422
and stay a while if you don't.

1174
00:42:19,133 --> 00:42:22,386
I'll be right back with
your aftercare instructions.

1175
00:42:22,469 --> 00:42:24,346
- Hey, Robby.
- Yep.

1176
00:42:24,429 --> 00:42:26,515
My, uh…
my hospice patient Roxie

1177
00:42:26,598 --> 00:42:28,433
is still in a ton of pain.

1178
00:42:28,517 --> 00:42:29,726
Where are we
with the morphine?

1179
00:42:29,810 --> 00:42:31,687
10 milligrams an hour.

1180
00:42:31,770 --> 00:42:34,231
OK, you can bolus another 2
and go up to 12.

1181
00:42:34,314 --> 00:42:35,607
I will let Princess know.

1182
00:42:35,691 --> 00:42:36,984
12 an hour is a lot.

1183
00:42:37,067 --> 00:42:38,443
Yeah, on top
of the MS Contin,

1184
00:42:38,527 --> 00:42:41,405
she could stop breathing.

1185
00:42:41,488 --> 00:42:44,741
Are you familiar with
the doctrine of double effect?

1186
00:42:44,825 --> 00:42:46,827
- Not really.
- No.

1187
00:42:46,910 --> 00:42:49,329
It is an ethical principle
in palliative care.

1188
00:42:49,413 --> 00:42:51,039
We treat pain.

1189
00:42:51,123 --> 00:42:53,000
And if, in doing so,
there's a negative side effect,

1190
00:42:53,083 --> 00:42:54,626
we accept it.

1191
00:42:54,710 --> 00:42:57,462
Even if the negative
side effect is death?

1192
00:42:57,546 --> 00:43:00,174
In some cases,
that could be the best outcome.

1193
00:43:06,013 --> 00:43:07,389
Maybe the nurse has it.

1194
00:43:07,472 --> 00:43:10,100
Emma. Emma, where does…

1195
00:43:10,184 --> 00:43:11,852
Maybe the fax
ran out of paper?

1196
00:43:11,935 --> 00:43:14,563
No, there is enough paper.
I don't know what's wrong.

1197
00:43:14,646 --> 00:43:16,064
- Could be in another room.
- We should call IT.

1198
00:43:16,148 --> 00:43:18,066
You want me to check
every room?

1199
00:43:18,150 --> 00:43:19,651
How are we gonna
get through this mess?

1200
00:43:19,735 --> 00:43:22,613
I was about to ask you.

1201
00:43:22,696 --> 00:43:24,156
Ask the pharmacist.

1202
00:43:24,239 --> 00:43:25,741
She can't leave the PDS.

1203
00:43:25,824 --> 00:43:27,534
Nothing's getting done here.