1 00:00:11,553 --> 00:00:12,971 - You know this guy? - Orlando Diaz. 2 00:00:13,055 --> 00:00:14,723 We were treating him for DKA when he eloped. 3 00:00:14,806 --> 00:00:16,308 - How far did he fall? - 20 feet or so. 4 00:00:16,391 --> 00:00:18,143 - Anyone see him pass out? - No. 5 00:00:18,227 --> 00:00:20,270 They went looking for him after he didn't answer his radio. 6 00:00:20,354 --> 00:00:21,480 Pupils equal but sluggish. 7 00:00:21,563 --> 00:00:22,856 He left against medical advice. 8 00:00:22,940 --> 00:00:25,567 On my count, three, two, one. 9 00:00:26,818 --> 00:00:29,029 Dr. Ellis on the case. Day shift, we got this. 10 00:00:29,112 --> 00:00:31,406 - I'm staying. - Continuity of care. 11 00:00:31,490 --> 00:00:32,783 Dr. Al-Hashimi, why don't you go cover 12 00:00:32,866 --> 00:00:34,076 sign-out rounds with Dr. Abbot? 13 00:00:34,159 --> 00:00:35,410 - Shen, you too. - Got it. 14 00:00:35,494 --> 00:00:37,496 OK, let me know if you need anything. 15 00:00:37,579 --> 00:00:40,082 - Lungs are up bilaterally. - Pelvis is stable. 16 00:00:40,165 --> 00:00:43,961 Right tib-fib hematoma, deformed right forearm. 17 00:00:44,044 --> 00:00:45,963 Ruptured TM on the left with sero-sanguinous fluid. 18 00:00:46,046 --> 00:00:47,756 That means basilar skull fracture. 19 00:00:47,839 --> 00:00:49,550 We've got a diabetic patient, 20-foot fall. 20 00:00:49,633 --> 00:00:51,885 BP 204 over 98, pulse 56. 21 00:00:51,969 --> 00:00:53,554 Dr. Mohan, what do those numbers indicate? 22 00:00:53,637 --> 00:00:55,347 I'm trying to treat the patient. 23 00:00:55,430 --> 00:00:56,640 It's the Cushing's reflex. 24 00:00:56,723 --> 00:00:58,767 From increased intracranial pressure. 25 00:00:58,850 --> 00:01:01,103 Yeah, we need to get him to CT right away. 26 00:01:01,186 --> 00:01:02,771 No free fluid in the belly. 27 00:01:02,854 --> 00:01:06,108 - Any family to notify? - Wife and three kids. 28 00:01:06,191 --> 00:01:08,193 Is there a card to sign for Robby? 29 00:01:08,277 --> 00:01:10,237 No, he said no card, no presents. 30 00:01:10,320 --> 00:01:11,655 Oh. Was there a cake? 31 00:01:11,738 --> 00:01:13,240 Oh, he didn't want that either. 32 00:01:13,323 --> 00:01:15,200 That sucks. I need some cake. 33 00:01:15,284 --> 00:01:17,411 Patient was injured when they raided a restaurant. 34 00:01:17,494 --> 00:01:19,204 And they actually arrested the nurse? 35 00:01:19,288 --> 00:01:21,748 - With a takedown and zip ties. - Damn. 36 00:01:21,832 --> 00:01:23,875 Crus, you, uh, know the computer downtime drill? 37 00:01:23,959 --> 00:01:25,335 Yeah, no biggie. 38 00:01:25,419 --> 00:01:27,004 I prefer to treat 'em without labs and X-rays. 39 00:01:27,087 --> 00:01:28,505 Welcome back. 40 00:01:28,589 --> 00:01:30,382 If you do have orders for labs and X-rays, 41 00:01:30,465 --> 00:01:32,467 clipboards go here. 42 00:01:32,551 --> 00:01:35,220 If it's just nursing orders, here. 43 00:01:35,304 --> 00:01:37,014 Please write neatly, for God's sake. 44 00:01:37,097 --> 00:01:39,558 Oh, Monica, this is Nazely, new intern. 45 00:01:39,641 --> 00:01:42,436 - I don't need to know that. - So nice to meet you. 46 00:01:43,604 --> 00:01:45,230 Looks like you and me, Jack. 47 00:01:45,314 --> 00:01:46,690 Yeah, who's our senior? 48 00:01:46,773 --> 00:01:49,818 - Dr. Henderson. - Excellent. 49 00:01:49,901 --> 00:01:51,695 Night shift's on Crus control. 50 00:01:51,778 --> 00:01:53,822 You hear ICE brought us a patient? 51 00:01:53,905 --> 00:01:55,616 Oh, yeah? How'd that go? 52 00:01:55,699 --> 00:01:56,742 There was some collateral damage. 53 00:01:56,825 --> 00:01:58,243 They arrested Jesse. 54 00:01:58,327 --> 00:02:00,245 - For what? - Assaulting a federal officer. 55 00:02:00,329 --> 00:02:01,788 Are you fucking kidding me? 56 00:02:01,872 --> 00:02:03,165 Oh, Dr. Al-Hashimi, 57 00:02:03,248 --> 00:02:05,459 this is Nazely Toomarian… new intern. 58 00:02:12,257 --> 00:02:14,092 OK, everybody, let's huddle up. 59 00:02:14,176 --> 00:02:15,427 Before we start, 60 00:02:15,510 --> 00:02:17,054 let me address the elephant in the room. 61 00:02:17,137 --> 00:02:18,847 For those of you who don't know, 62 00:02:18,930 --> 00:02:20,307 Jesse tried to intervene 63 00:02:20,390 --> 00:02:22,100 when a federal agent was handling his patient, 64 00:02:22,184 --> 00:02:24,478 and both he and the patient were taken away by ICE. 65 00:02:24,561 --> 00:02:26,146 - Did he punch the guy? - No. 66 00:02:26,229 --> 00:02:28,565 He put out a hand to stop him, made physical contact. 67 00:02:28,649 --> 00:02:30,150 It was a little bit more than that. 68 00:02:30,233 --> 00:02:31,735 The hospital lawyers are on the case, 69 00:02:31,818 --> 00:02:34,071 and we will brief the staff every 12 hours 70 00:02:34,154 --> 00:02:35,822 at sign-out rounds with an official update. 71 00:02:35,906 --> 00:02:38,325 In the meantime, don't feed the rumor mill. 72 00:02:38,408 --> 00:02:40,661 You may have also heard that new grad nurse Emma here 73 00:02:40,744 --> 00:02:43,163 - was assaulted by a patient. - I…I'm fine. 74 00:02:43,246 --> 00:02:44,790 Please don't forget "code hula hoop," 75 00:02:44,873 --> 00:02:46,124 and with risky patients, 76 00:02:46,208 --> 00:02:48,460 always keep a path to the door clear. 77 00:02:48,543 --> 00:02:50,128 Sounds like one hell of a day. 78 00:02:50,212 --> 00:02:51,963 And we're still dealing with downtime, 79 00:02:52,047 --> 00:02:54,132 so day shift should brief night residents 80 00:02:54,216 --> 00:02:55,467 about the protocol… 81 00:02:55,550 --> 00:02:56,495 Hey! 82 00:02:56,510 --> 00:02:58,095 Oh, all right! 83 00:02:58,178 --> 00:03:00,305 Oh, thank God. 84 00:03:00,389 --> 00:03:01,682 Yeah, not so fast. 85 00:03:01,765 --> 00:03:03,558 Every chart from the last five hours 86 00:03:03,642 --> 00:03:05,894 needs to be scanned into the Electronic Health Record 87 00:03:05,977 --> 00:03:07,938 and checked for accuracy… 88 00:03:08,021 --> 00:03:10,107 - Um, whose job is that? - Day shift. 89 00:03:10,190 --> 00:03:12,067 With a completed and signed T-sheet. 90 00:03:12,150 --> 00:03:13,777 - Are you kidding me? - That's gonna take forever. 91 00:03:13,860 --> 00:03:15,529 We will set up stations for scanning. 92 00:03:15,612 --> 00:03:17,322 OK, everybody, let's get moving. 93 00:03:17,406 --> 00:03:19,491 Triage is 20 behind. Gotta help 'em clean up. 94 00:03:19,574 --> 00:03:20,742 I'm skipping rounds. 95 00:03:20,826 --> 00:03:22,577 Consider yourself lucky. 96 00:03:22,661 --> 00:03:23,829 Should we join them? 97 00:03:25,247 --> 00:03:26,873 Might as well witness the magic. 98 00:03:26,957 --> 00:03:29,126 It's like changing of the guard at Buckingham Palace. 99 00:03:29,209 --> 00:03:31,002 Except we're allowed to smile. 100 00:03:31,086 --> 00:03:33,296 "Smile though your heart is aching." 101 00:03:34,464 --> 00:03:35,465 Plain films, right tib-fib 102 00:03:35,549 --> 00:03:37,426 and right forearm after CT. 103 00:03:37,509 --> 00:03:39,428 Got the chem-8. Blood sugar's 284. 104 00:03:39,511 --> 00:03:42,055 That's not too bad. Potassium looks good. 105 00:03:42,139 --> 00:03:44,307 Mm-hmm. Anion gap's up at 14. 106 00:03:44,391 --> 00:03:45,559 It was 24 this morning. 107 00:03:45,642 --> 00:03:47,227 He's definitely improving. 108 00:03:47,310 --> 00:03:48,603 The DKA is resolving. 109 00:03:48,687 --> 00:03:50,230 So what made him pass out? 110 00:03:50,313 --> 00:03:52,065 It's hot as hell out there. 111 00:03:52,149 --> 00:03:54,234 He could have been dehydrated from sweating. 112 00:03:54,317 --> 00:03:57,696 Or he could have had an N-STEMI or a posterior CVA. 113 00:03:57,779 --> 00:03:59,239 Ready to roll. 114 00:04:00,991 --> 00:04:03,618 - I can babysit him at CT. - Thank you. 115 00:04:03,702 --> 00:04:05,912 I'll stay in case he needs the OR. 116 00:04:07,748 --> 00:04:09,624 Hey, we're back up. 117 00:04:09,708 --> 00:04:11,626 It's about time. 118 00:04:11,710 --> 00:04:13,086 - Ooh, Robby. - Yeah. 119 00:04:13,170 --> 00:04:15,297 I got intel on where ICE has taken Jesse. 120 00:04:15,380 --> 00:04:16,548 Intel from who? 121 00:04:16,631 --> 00:04:18,425 Uh, my brother-in-law's a cop. 122 00:04:18,508 --> 00:04:20,761 So he'll be processed at DHS Southside 123 00:04:20,844 --> 00:04:23,263 and then transferred to ICE detention in Clearfield. 124 00:04:23,346 --> 00:04:24,556 Clearfield? That's two hours away. 125 00:04:24,639 --> 00:04:26,057 Mm-hmm. 126 00:04:26,141 --> 00:04:28,185 OK, I'll let the hospital attorneys know. 127 00:04:28,268 --> 00:04:30,103 - How are you doing, Oliver? - Alive and kicking. 128 00:04:30,187 --> 00:04:31,480 Uh, Mr. Haas. 129 00:04:31,563 --> 00:04:33,774 Pulmonary edema after missed dialysis, 130 00:04:33,857 --> 00:04:36,359 now stable with his son Mason at the bedside. 131 00:04:36,443 --> 00:04:37,986 - Hello. - I'm Dr. Shen. 132 00:04:38,069 --> 00:04:39,196 I'll be back. 133 00:04:39,279 --> 00:04:40,279 Dialysis tech says 134 00:04:40,322 --> 00:04:42,032 I'm off the machine at 10:42. 135 00:04:42,115 --> 00:04:44,159 Hit the call light, and I'll come running. 136 00:04:44,242 --> 00:04:46,328 South 21 next… 137 00:04:48,288 --> 00:04:50,040 Mr. Digby. 138 00:04:50,123 --> 00:04:51,625 J-just Digby. 139 00:04:51,708 --> 00:04:53,293 Dr. Mohan's patient. 140 00:04:53,376 --> 00:04:55,504 Forearm cellulitis, admit med-surge. 141 00:04:55,587 --> 00:04:57,088 - Awaiting a bed. - I can take him. 142 00:04:57,172 --> 00:04:58,924 Sold to Dr. Toomarian. 143 00:04:59,007 --> 00:05:01,343 Moving right along. 144 00:05:01,426 --> 00:05:03,136 Get enough to eat? 145 00:05:03,220 --> 00:05:05,472 We'll be back. 146 00:05:05,555 --> 00:05:08,892 Lillian Stegman. Tweaked her knee water-skiing. 147 00:05:08,975 --> 00:05:10,936 Doing a 360 off a 5-foot ramp. 148 00:05:11,019 --> 00:05:12,395 Ooh, respect. 149 00:05:12,479 --> 00:05:13,730 X-rays ordered in triage. 150 00:05:13,814 --> 00:05:15,023 That was hours ago. 151 00:05:15,106 --> 00:05:17,234 Ma'am, I'm Dr. Crus Henderson. 152 00:05:17,317 --> 00:05:19,486 Let's get you home real fast. 153 00:05:19,569 --> 00:05:21,238 - That would be wonderful. - OK, heading to North. 154 00:05:21,321 --> 00:05:22,948 Thank you. 155 00:05:23,031 --> 00:05:25,492 Looks like our first scanning station is almost ready. 156 00:05:25,575 --> 00:05:28,245 Whitaker, Santos, after rounds, this will be your post. 157 00:05:28,328 --> 00:05:30,914 - Seriously? - For…how long? 158 00:05:30,997 --> 00:05:33,041 Till we mop up this mess. 159 00:05:33,124 --> 00:05:34,709 And away we go. 160 00:05:34,793 --> 00:05:36,878 All right, now you know everything 161 00:05:36,962 --> 00:05:38,088 there is to know about rounds. 162 00:05:38,171 --> 00:05:39,256 Fascinating, right? 163 00:05:39,339 --> 00:05:41,424 Uh…yeah. 164 00:05:41,508 --> 00:05:43,718 Here, I got something better for you. 165 00:05:45,512 --> 00:05:48,306 So, Digby, we're gonna find you some new clothes, 166 00:05:48,390 --> 00:05:50,100 but my friend Emma and I wondered if you'd like 167 00:05:50,183 --> 00:05:52,727 to get cleaned up a bit first. 168 00:05:52,811 --> 00:05:54,479 I already had a shower. 169 00:05:54,563 --> 00:05:56,106 I know, and you look good. 170 00:05:56,189 --> 00:05:58,191 But the offer also comes with a shave and a haircut, 171 00:05:58,275 --> 00:05:59,442 if you're interested. 172 00:05:59,526 --> 00:06:00,652 No pressure…like I said, 173 00:06:00,735 --> 00:06:01,903 you already look great. 174 00:06:03,321 --> 00:06:06,241 - Sure, I guess. - Fantastic. 175 00:06:06,324 --> 00:06:08,243 All right, kid, fill that basin with some warm water 176 00:06:08,326 --> 00:06:09,953 and lather him up. 177 00:06:12,873 --> 00:06:15,292 - Hey, stay safe out there. - Back at you in here. 178 00:06:15,375 --> 00:06:17,294 Hey, Cary. 179 00:06:17,377 --> 00:06:19,421 You were on scene with Orlando, right? 180 00:06:19,504 --> 00:06:21,840 Did you notice anything about his fall? 181 00:06:21,923 --> 00:06:23,341 Like what? 182 00:06:23,425 --> 00:06:26,511 Like, um, if there was a break in the railing 183 00:06:26,595 --> 00:06:29,514 or if there were security cameras? 184 00:06:29,598 --> 00:06:31,099 Too busy working on the guy… 185 00:06:31,182 --> 00:06:33,560 IV, intubation, backboard, splint. 186 00:06:33,643 --> 00:06:34,728 Thanks. 187 00:06:34,811 --> 00:06:36,354 Oh, two names is a start. 188 00:06:36,438 --> 00:06:38,106 Pretty soon, we'll retire the clipboards. 189 00:06:38,189 --> 00:06:39,441 Baby Jane Doe in Pedes? 190 00:06:39,524 --> 00:06:41,318 Uh, yeah, abandoned 191 00:06:41,401 --> 00:06:44,070 in the waiting room bathroom at 7:30 a.m. 192 00:06:44,154 --> 00:06:46,531 - Safe haven drop-off? - No, she's too old for that. 193 00:06:46,615 --> 00:06:48,366 - At least two months. - I'll take her. 194 00:06:48,450 --> 00:06:50,535 Awaiting foster placement by CYF. 195 00:06:50,619 --> 00:06:52,871 - What if the mom comes back? - Call the cops. 196 00:06:52,954 --> 00:06:54,331 Day shift, get to work scanning. 197 00:06:54,414 --> 00:06:55,874 Night shift, the room numbers 198 00:06:55,957 --> 00:06:58,043 on top of the dry-erase board need a doctor. 199 00:06:58,126 --> 00:07:00,962 - Who's in BH-1? - Psych hold, danger to self. 200 00:07:01,046 --> 00:07:02,422 What's the story? 201 00:07:02,505 --> 00:07:04,299 Doctors King and Langdon were on the case. 202 00:07:04,382 --> 00:07:06,551 It's a sad story… she says her 5-year-old 203 00:07:06,635 --> 00:07:08,428 snuck into the back seat of the car to take a nap. 204 00:07:08,511 --> 00:07:10,096 Heat stroke. 205 00:07:10,180 --> 00:07:12,474 Mom was extremely distraught. Walked out into traffic. 206 00:07:12,557 --> 00:07:14,017 Grady Barnhill, wheezing 207 00:07:14,100 --> 00:07:15,644 and not responding to albuterol. 208 00:07:15,727 --> 00:07:17,520 Pulse ox 87. His mother, Naomi. 209 00:07:17,604 --> 00:07:19,731 - OK, Trauma Two's open. - On our way. 210 00:07:19,814 --> 00:07:22,233 - Uh, Mom, history of asthma? - His whole life. 211 00:07:22,317 --> 00:07:24,361 - Never this bad. - Barely moving air. 212 00:07:24,444 --> 00:07:26,988 Using all his accessory muscles. 213 00:07:27,072 --> 00:07:28,448 Call RT! 214 00:07:28,531 --> 00:07:31,201 Uh, continuous nebs, 20 milligrams an hour. 215 00:07:31,284 --> 00:07:32,702 We have a home nebulizer. 216 00:07:32,786 --> 00:07:35,580 I've been giving him albuterol every hour. 217 00:07:35,664 --> 00:07:36,706 Ready? 218 00:07:36,790 --> 00:07:39,626 On my count, one, two, three. 219 00:07:39,709 --> 00:07:41,086 Does he take any other medications? 220 00:07:41,169 --> 00:07:42,587 Just the albuterol. 221 00:07:42,671 --> 00:07:44,130 He used to be on montelukast and Symbicort. 222 00:07:44,214 --> 00:07:45,715 Why did you stop that? 223 00:07:45,799 --> 00:07:47,759 Because he lost his Medicaid two months ago. 224 00:07:47,842 --> 00:07:49,594 He's so tight, nothing's getting through. 225 00:07:49,678 --> 00:07:51,179 - Mel, EpiPen. - On it. 226 00:07:51,262 --> 00:07:52,681 0.3 milligrams. 227 00:07:52,764 --> 00:07:55,809 That may open his lungs so the nebs can work. 228 00:07:55,892 --> 00:07:57,894 All right, Grady, shot in the thigh. 229 00:08:02,941 --> 00:08:04,693 Hey. 230 00:08:04,776 --> 00:08:06,152 Something to scan? 231 00:08:06,236 --> 00:08:07,696 Critical labs on North Three. 232 00:08:07,779 --> 00:08:09,280 Oh, it's, uh… it's not my patient. 233 00:08:09,364 --> 00:08:10,615 She's about to be. 234 00:08:12,534 --> 00:08:14,786 I'm, uh… I'm off the clock, so… 235 00:08:14,869 --> 00:08:17,455 These were ordered three hours ago from triage, 236 00:08:17,539 --> 00:08:19,916 so, technically, she is a day-shift patient. 237 00:08:20,000 --> 00:08:21,209 Just get the intern started. 238 00:08:21,292 --> 00:08:22,752 I got a meeting upstairs with admin 239 00:08:22,836 --> 00:08:24,754 to get things back on track. 240 00:08:24,838 --> 00:08:26,506 Sorry. Everyone else is tied up. 241 00:08:26,589 --> 00:08:27,882 That's OK. 242 00:08:27,966 --> 00:08:29,092 How'd you get stuck on night shift 243 00:08:29,175 --> 00:08:30,260 for your first rotation? 244 00:08:30,343 --> 00:08:31,720 Just lucky, I guess. 245 00:08:31,803 --> 00:08:33,263 Yeah, if you like a good horror movie. 246 00:08:34,681 --> 00:08:36,558 - Where was med school? - Uh, UC Irvine. 247 00:08:36,641 --> 00:08:38,351 - California, right? - Yep. 248 00:08:38,435 --> 00:08:39,602 Pittsburgh's a little different. 249 00:08:39,686 --> 00:08:40,812 Yeah, a lot more humidity. 250 00:08:40,895 --> 00:08:41,896 Yeah, that'll go away 251 00:08:41,980 --> 00:08:43,815 with your first foot of snow. 252 00:08:43,898 --> 00:08:46,609 Uh, hi, Mrs. Davis. 253 00:08:46,693 --> 00:08:48,653 I am Dr. McKay. This is Doctor… 254 00:08:48,737 --> 00:08:50,905 - Toomarian. - Hello. 255 00:08:50,989 --> 00:08:54,034 Uh, your labs show a lot of inflammation in your liver. 256 00:08:54,117 --> 00:08:57,412 - Is that why I'm so nauseated? - Definitely, yeah. 257 00:08:57,495 --> 00:09:00,498 Have you, um, noticed a change in your skin coloration? 258 00:09:00,582 --> 00:09:02,542 I've been using this bronzing cream 259 00:09:02,625 --> 00:09:05,211 so I don't look like a ghost in my bathing suit. 260 00:09:05,295 --> 00:09:07,172 Do you remember the name of the bronzer? 261 00:09:07,255 --> 00:09:08,715 It could have a chemical that can cause… 262 00:09:08,798 --> 00:09:10,759 Oh, no, no, it's 100% natural. 263 00:09:10,842 --> 00:09:14,012 - It's DHA from sugar beets. - OK. 264 00:09:14,095 --> 00:09:16,181 Why would my liver be inflamed? 265 00:09:16,264 --> 00:09:18,141 Uh, there's a lot of possibilities. 266 00:09:18,224 --> 00:09:19,976 Are you taking any prescription medications? 267 00:09:20,060 --> 00:09:21,046 Not a single one. 268 00:09:21,061 --> 00:09:22,562 - Tylenol? - God, no. 269 00:09:22,645 --> 00:09:24,773 We have to ask everybody about injection drug use. 270 00:09:24,856 --> 00:09:25,899 Never. 271 00:09:25,982 --> 00:09:27,567 Raw clams or oysters? 272 00:09:27,650 --> 00:09:29,402 I'm a vegan. 273 00:09:29,486 --> 00:09:31,613 One step at a time, OK? 274 00:09:31,696 --> 00:09:32,781 We'll be back. 275 00:09:34,199 --> 00:09:36,034 Digby, Haas, now on the big board. 276 00:09:36,117 --> 00:09:37,103 Progress. 277 00:09:37,118 --> 00:09:38,104 So he's just been waiting 278 00:09:38,119 --> 00:09:39,704 in the hall the whole time? 279 00:09:39,788 --> 00:09:42,665 OK, well, can you maybe get to him next? 280 00:09:43,958 --> 00:09:45,001 Thank you. 281 00:09:46,127 --> 00:09:47,712 Duke goes to CT, and they bump him. 282 00:09:47,796 --> 00:09:50,215 Yeah, he may end up waiting for hours over there. 283 00:09:50,298 --> 00:09:52,717 Oh, look at that. 7:15 already. 284 00:09:52,801 --> 00:09:54,677 Just a few more loose ends to tie up. 285 00:09:54,761 --> 00:09:57,889 You got more loose ends than a macramé wall hanging. 286 00:09:57,972 --> 00:10:00,183 My mom had one. Took up the whole goddamn wall. 287 00:10:00,266 --> 00:10:01,893 Seriously, you should think about signing out 288 00:10:01,976 --> 00:10:03,686 - and hitting the road. - Yeah, maybe you should too. 289 00:10:03,770 --> 00:10:05,438 Oh, that's right, you sent Lena home. 290 00:10:05,522 --> 00:10:07,315 Are you planning on calling in a replacement, 291 00:10:07,398 --> 00:10:09,109 or are you just gonna work till sunrise? 292 00:10:09,192 --> 00:10:10,527 If I have to. 293 00:10:10,610 --> 00:10:12,612 Oh, so you get to go the extra mile, 294 00:10:12,695 --> 00:10:15,115 and the rest of us just get accused of being martyrs. 295 00:10:15,198 --> 00:10:16,491 - Robby. - Excuse me. 296 00:10:18,535 --> 00:10:20,411 - What's the word? - No subdural, no epidural. 297 00:10:20,495 --> 00:10:22,413 Diffuse brain swelling with effacement 298 00:10:22,497 --> 00:10:24,124 and compression of the ventricles. 299 00:10:24,207 --> 00:10:26,334 C-spine? Chest-abdomen-pelvis? 300 00:10:26,417 --> 00:10:28,628 Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 301 00:10:28,711 --> 00:10:29,796 Which means I'm off the hook. 302 00:10:29,879 --> 00:10:31,256 I'll send Neurosurgery down. 303 00:10:31,339 --> 00:10:33,800 If he doesn't need the OR, why Neurosurgery? 304 00:10:33,883 --> 00:10:35,218 - Wait and see. - Let's get busy. 305 00:10:35,301 --> 00:10:36,469 CVP and an art line. 306 00:10:36,553 --> 00:10:39,639 Orlando. Orlando, squeeze my hand. 307 00:10:40,807 --> 00:10:42,016 Open your eyes. 308 00:10:42,100 --> 00:10:44,561 We already know his GCS is going to be three. 309 00:10:44,644 --> 00:10:46,563 Hey, Javadi, anti-seizure prophylaxis? 310 00:10:46,646 --> 00:10:48,565 - Keppra, 20 migs per kilo. - Mixing it now. 311 00:10:48,648 --> 00:10:50,233 Gotta get this brain swelling down, Samira. 312 00:10:50,316 --> 00:10:51,401 How we gonna do that? 313 00:10:52,694 --> 00:10:54,195 - Samira? - What? 314 00:10:54,279 --> 00:10:57,407 We have to lower the intracranial pressure. 315 00:10:57,490 --> 00:10:59,117 - Mannitol. - Not the best. 316 00:10:59,200 --> 00:11:00,451 Can cause diuresis and hypotension. 317 00:11:00,535 --> 00:11:01,828 Then hypertonic saline. 318 00:11:01,911 --> 00:11:04,330 23%. 50 cc's through a central line. 319 00:11:06,249 --> 00:11:07,750 Still tight as a drum. 320 00:11:07,834 --> 00:11:08,877 Five minutes since the epi. 321 00:11:08,960 --> 00:11:10,253 He can have one more EpiPen. 322 00:11:10,336 --> 00:11:12,005 Sats are borderline, 87. 323 00:11:12,088 --> 00:11:13,423 How about BiPap? 10 over 5. 324 00:11:13,506 --> 00:11:15,592 Yes, with in-line nebs. 325 00:11:15,675 --> 00:11:17,427 All right, Grady, shot number two. 326 00:11:17,510 --> 00:11:19,637 Might as well throw in some magnesium, 50 per kilo. 327 00:11:19,721 --> 00:11:20,972 I'm sorry. He's not ventilating. 328 00:11:21,055 --> 00:11:22,348 We should be ready to intubate. 329 00:11:22,432 --> 00:11:23,725 With an asthma patient? 330 00:11:23,808 --> 00:11:25,643 There's a high risk of cardiac arrest. 331 00:11:25,727 --> 00:11:27,896 Naomi, has he ever been put on a breathing machine before? 332 00:11:27,979 --> 00:11:29,564 - Never. - Hospitalized? 333 00:11:29,647 --> 00:11:31,482 No, we could always break him with the Symbicort. 334 00:11:31,566 --> 00:11:32,942 We're gonna give the current treatment 335 00:11:33,026 --> 00:11:35,069 a few more minutes to help him turn the corner. 336 00:11:38,239 --> 00:11:40,074 I could probably do this myself 337 00:11:40,158 --> 00:11:41,492 now that my cast is off. 338 00:11:41,576 --> 00:11:43,411 Oh, that's OK. 339 00:11:43,494 --> 00:11:45,121 I don't mind. 340 00:11:49,042 --> 00:11:50,919 How long have you been a nurse? 341 00:11:52,337 --> 00:11:54,005 This is my first day. 342 00:11:56,716 --> 00:11:58,718 You're doing really good. 343 00:12:00,678 --> 00:12:02,222 Thank you. 344 00:12:06,226 --> 00:12:07,936 - Oh, shit, you OK? - Yeah. 345 00:12:08,019 --> 00:12:09,437 There's water on the floor. 346 00:12:09,520 --> 00:12:10,939 Sorry! I…I might have spilled. 347 00:12:11,022 --> 00:12:12,357 Yeah, no worries. 348 00:12:12,440 --> 00:12:14,400 We're gonna have to sort these all by patient 349 00:12:14,484 --> 00:12:16,194 before we scan them. 350 00:12:16,277 --> 00:12:18,863 Is, uh, Joy still around? 351 00:12:18,947 --> 00:12:21,532 I heard she left at 6:59. 352 00:12:21,616 --> 00:12:23,534 - Smart girl. - Mm-hmm. 353 00:12:23,618 --> 00:12:25,703 You know what? Find Ogilvie. He's such an ass-kisser. 354 00:12:25,787 --> 00:12:27,372 He might stay and scan all the charts himself. 355 00:12:27,455 --> 00:12:29,540 Oh, he, uh, scrubbed in in the OR, 356 00:12:29,624 --> 00:12:31,459 scrubbed in on the ruptured triple-A. 357 00:12:31,542 --> 00:12:33,169 Oh, the kidney stone that wasn't. 358 00:12:33,253 --> 00:12:35,046 That'll be four hours at least. 359 00:12:37,006 --> 00:12:40,343 So are you still going to Amy's after work? 360 00:12:40,426 --> 00:12:42,262 Yeah, maybe just for tonight, 361 00:12:42,345 --> 00:12:44,639 after Robby briefs me on all the house stuff. 362 00:12:45,765 --> 00:12:47,183 Sounds fun. 363 00:12:48,601 --> 00:12:50,520 When he asked, it was hard to say no. 364 00:12:50,603 --> 00:12:51,938 Sure. 365 00:12:54,190 --> 00:12:56,359 It's gonna be very weird without him here. 366 00:12:56,442 --> 00:12:57,777 Yeah. 367 00:12:57,860 --> 00:13:00,321 You think Dr. Al-Hashimi can handle it? 368 00:13:00,405 --> 00:13:01,864 In a word, no. 369 00:13:01,948 --> 00:13:03,283 She's smart. 370 00:13:03,366 --> 00:13:04,575 It takes more than that. 371 00:13:04,659 --> 00:13:06,202 Yeah, well, at least 372 00:13:06,286 --> 00:13:07,578 it's only three months. 373 00:13:07,662 --> 00:13:09,706 Yeah, three long months. 374 00:13:09,789 --> 00:13:11,416 Then you need to find a new home. 375 00:13:12,375 --> 00:13:13,751 Not necessarily. 376 00:13:13,835 --> 00:13:15,837 I mean, if I wanted, I could just check on 377 00:13:15,920 --> 00:13:18,923 Robby's house once or twice a day, you know. 378 00:13:19,007 --> 00:13:20,675 Why would you do that? 379 00:13:22,051 --> 00:13:24,178 I don't know. Why not? 380 00:13:27,265 --> 00:13:28,641 Hypertonic's in. 381 00:13:28,725 --> 00:13:30,768 Maintenance LR in the AC. 382 00:13:30,852 --> 00:13:32,562 Looks like a halo sign. 383 00:13:32,645 --> 00:13:35,148 Cerebrospinal fluid from a basilar skull fracture. 384 00:13:35,231 --> 00:13:39,152 The halo sign is neither sensitive nor specific for CSF. 385 00:13:39,235 --> 00:13:41,446 Saline, tap water, and runny noses 386 00:13:41,529 --> 00:13:42,655 all separate from blood. 387 00:13:42,739 --> 00:13:44,157 - Hello, Linda. - Robby. 388 00:13:44,240 --> 00:13:46,617 Division chief working on a holiday weekend. 389 00:13:46,701 --> 00:13:48,745 Well, somebody's got to. 390 00:13:48,828 --> 00:13:51,539 Saw the scans. This guy needs an EVD. 391 00:13:51,622 --> 00:13:53,833 External ventricular drain to take down the pressure. 392 00:13:53,916 --> 00:13:57,086 Because CPP equals "MAP" minus ICP. 393 00:13:57,170 --> 00:13:59,756 Cerebral perfusion pressure in the brain 394 00:13:59,839 --> 00:14:01,674 equals mean arterial blood pressure 395 00:14:01,758 --> 00:14:03,176 minus the pressure in the skull. 396 00:14:03,259 --> 00:14:04,886 ICP less than 22 397 00:14:04,969 --> 00:14:07,430 predicts survival and favorable outcome. 398 00:14:07,513 --> 00:14:11,809 CPP from 60 to 70 reduces morbidity and mortality. 399 00:14:11,893 --> 00:14:13,227 Can somebody assist? 400 00:14:13,311 --> 00:14:14,395 Dr. Mohan? 401 00:14:14,479 --> 00:14:15,563 I'm good. 402 00:14:16,689 --> 00:14:18,191 Samira, you should lend a hand. 403 00:14:18,274 --> 00:14:19,942 I said I'm good. 404 00:14:20,026 --> 00:14:22,820 - Javadi? - I don't think so. 405 00:14:22,904 --> 00:14:24,364 Javadi? 406 00:14:24,447 --> 00:14:27,784 As in, daughter of Raymond and Eileen? 407 00:14:27,867 --> 00:14:30,244 I was at your mother's baby shower. 408 00:14:30,328 --> 00:14:31,272 She was a resident. 409 00:14:31,287 --> 00:14:32,663 You were in utero. 410 00:14:34,165 --> 00:14:35,208 I don't know how she got through 411 00:14:35,291 --> 00:14:37,001 motherhood and training. 412 00:14:37,085 --> 00:14:38,586 Feel free to join me. 413 00:14:38,669 --> 00:14:40,463 Oh, my…my shift was over a while ago. 414 00:14:40,546 --> 00:14:41,923 OK. 415 00:14:42,006 --> 00:14:43,966 Masks all around. Two sterile gowns. 416 00:14:44,050 --> 00:14:46,594 We brought the surgical towels. Just need some Betadine. 417 00:14:46,677 --> 00:14:48,262 This is kind of an amazing opportunity. 418 00:14:49,430 --> 00:14:50,640 I'm exhausted. 419 00:14:50,723 --> 00:14:52,600 The Chief of Neurosurgery is here. 420 00:14:52,683 --> 00:14:54,060 She's kind of a legend. 421 00:14:54,143 --> 00:14:56,104 Maybe one of the night residents can do it. 422 00:14:56,187 --> 00:14:58,356 Is this about the volvulus case from earlier? 423 00:14:58,439 --> 00:14:59,941 'Cause if it is, you made a mistake. 424 00:15:00,024 --> 00:15:01,859 You need to move on. 425 00:15:01,943 --> 00:15:03,528 I do not want to come back here and find that 426 00:15:03,611 --> 00:15:06,739 you've applied for a residency in derm. 427 00:15:06,823 --> 00:15:09,409 Step up to the plate. Do it. 428 00:15:09,492 --> 00:15:10,618 Javadi will assist. 429 00:15:10,701 --> 00:15:12,286 Excellent. 430 00:15:12,370 --> 00:15:14,038 You know, I think Eileen did her first EVD with me 431 00:15:14,122 --> 00:15:16,582 back when I was a brand-new assistant professor. 432 00:15:18,000 --> 00:15:19,419 Time flies. 433 00:15:22,380 --> 00:15:23,423 How you doing, Grady? 434 00:15:23,506 --> 00:15:24,882 Still retracting. 435 00:15:24,966 --> 00:15:26,592 - Any improvement? - Not really. 436 00:15:26,676 --> 00:15:27,718 You feeling tired? 437 00:15:29,595 --> 00:15:32,098 - Do we have Aerogen in the ED? - Just in the unit. 438 00:15:32,181 --> 00:15:33,724 How fast can you get back? 439 00:15:33,808 --> 00:15:34,892 Two minutes if I take the stairs. 440 00:15:34,976 --> 00:15:35,976 Go. 441 00:15:36,018 --> 00:15:37,270 Uh, Aerogen? 442 00:15:37,353 --> 00:15:39,230 It has a 5-millimeter mesh 443 00:15:39,313 --> 00:15:42,483 that vibrates over 120,000 times per second. 444 00:15:47,655 --> 00:15:48,990 Dr. Al-Hashimi? 445 00:15:53,327 --> 00:15:54,745 You OK? 446 00:15:57,206 --> 00:15:59,208 Uh, you were telling us about Aerogen. 447 00:16:00,376 --> 00:16:01,711 Dr. Shen can explain. 448 00:16:03,129 --> 00:16:06,007 It produces droplets in the 2- to 5-micron range 449 00:16:06,090 --> 00:16:08,009 for medication delivery. 450 00:16:15,308 --> 00:16:17,768 - How's it going? - Just about to start. 451 00:16:17,852 --> 00:16:18,978 Securing the art line here. 452 00:16:19,061 --> 00:16:21,230 Measure twice, cut once. 453 00:16:21,314 --> 00:16:25,026 We enter 11 centimeters back from the nasion, 454 00:16:25,109 --> 00:16:26,652 3 centimeters lateral. 455 00:16:26,736 --> 00:16:28,237 Without any direct imaging? 456 00:16:28,321 --> 00:16:31,282 No, straight shot into the lateral ventricle… 457 00:16:31,365 --> 00:16:34,869 tried and true since 1890. 458 00:16:34,952 --> 00:16:37,246 OK, go ahead with the incision. 459 00:16:38,789 --> 00:16:40,917 Hey, you worked with Dr. Al-Hashimi at the VA. 460 00:16:41,000 --> 00:16:42,043 I did. 461 00:16:42,126 --> 00:16:43,544 For how long? 462 00:16:43,628 --> 00:16:45,505 During my R2 rotation 463 00:16:45,588 --> 00:16:47,715 and then one again last year. 464 00:16:51,135 --> 00:16:54,222 OK. Hand drill's all set. 465 00:16:54,305 --> 00:16:55,640 Maybe you should do this part. 466 00:16:55,723 --> 00:16:57,016 No, no, there's a safety stop here. 467 00:16:57,099 --> 00:16:58,518 You can't go too deep. 468 00:16:58,601 --> 00:17:00,561 It's not brain surgery. 469 00:17:02,813 --> 00:17:04,023 OK. 470 00:17:07,235 --> 00:17:08,986 - Stay perpendicular. - OK. 471 00:17:09,070 --> 00:17:10,947 Good. 472 00:17:11,030 --> 00:17:12,698 All right, now, four turns 473 00:17:12,782 --> 00:17:13,908 to get through the outer table… 474 00:17:13,991 --> 00:17:15,201 - Yep. - Then half turns 475 00:17:15,284 --> 00:17:16,869 till you penetrate the skull. 476 00:17:27,713 --> 00:17:31,300 Three, four. 477 00:17:31,384 --> 00:17:32,635 One… 478 00:17:34,637 --> 00:17:36,222 Holy smoke! 479 00:17:36,305 --> 00:17:39,642 I thought it was Tom Cruise for a second over here. 480 00:17:39,725 --> 00:17:42,687 Nice job. How's that feel, Digby? 481 00:17:42,770 --> 00:17:44,272 - Pretty good. - I bet. 482 00:17:44,355 --> 00:17:45,565 What do you say we trim up 483 00:17:45,648 --> 00:17:47,358 those gorgeous locks of yours now? 484 00:17:49,068 --> 00:17:51,028 I don't like having my hair cut. 485 00:17:51,112 --> 00:17:54,365 I get it, Rapunzel, but you need your ears lowered. 486 00:17:54,448 --> 00:17:56,492 You'll feel better with a fresh summer look 487 00:17:56,576 --> 00:17:58,578 that won't go unnoticed by the ladies. 488 00:18:00,496 --> 00:18:02,790 - Maybe just a trim? - Great. 489 00:18:02,873 --> 00:18:05,001 I'm thinking a pixie cut. 490 00:18:05,084 --> 00:18:06,794 - What? - I'm kidding. 491 00:18:06,877 --> 00:18:08,588 I cut my husband Benji's hair all the time. 492 00:18:08,671 --> 00:18:10,089 Trust me, you're gonna look fabulous. 493 00:18:10,172 --> 00:18:11,757 When's the last time you had a haircut? 494 00:18:13,384 --> 00:18:16,596 Maybe my daughter's wedding a few years ago. 495 00:18:16,679 --> 00:18:17,930 Where? 496 00:18:18,014 --> 00:18:19,140 St. Sebastian, 497 00:18:19,223 --> 00:18:21,142 Our Lady of Mount Carmel Parish. 498 00:18:21,225 --> 00:18:23,769 Does your daughter know where you are? 499 00:18:23,853 --> 00:18:26,939 Of course. We all live in Pittsburgh. 500 00:18:27,023 --> 00:18:29,233 In fact, they live in my old house. 501 00:18:31,861 --> 00:18:34,113 Your daughter lives in your house? 502 00:18:34,196 --> 00:18:35,990 Yep. 503 00:18:36,073 --> 00:18:38,534 Where do you live? 504 00:18:38,618 --> 00:18:40,786 Wherever I want. 505 00:18:42,580 --> 00:18:44,624 You're gonna pass it 5 to 6 centimeters 506 00:18:44,707 --> 00:18:47,209 from the inner table of the skull, OK? 507 00:18:49,170 --> 00:18:51,255 Centered… 508 00:18:51,339 --> 00:18:53,090 perpendicular… 509 00:18:53,174 --> 00:18:54,967 aiming for the medial canthus. 510 00:18:56,135 --> 00:18:57,720 All yours. 511 00:18:57,803 --> 00:18:59,055 A-and just keep going? 512 00:18:59,138 --> 00:19:00,514 You'll feel a pop when you pass 513 00:19:00,598 --> 00:19:03,100 the ependymal lining. 514 00:19:03,184 --> 00:19:04,894 Art line is calibrated. Good to go. 515 00:19:04,977 --> 00:19:08,814 Titrate the nicardipine to a MAP of 85, please. 516 00:19:08,898 --> 00:19:10,232 And if we can get the intracranial pressure 517 00:19:10,316 --> 00:19:12,068 down to 20? 518 00:19:13,527 --> 00:19:14,904 Dr. Mohan? 519 00:19:14,987 --> 00:19:16,364 I'm sorry. 520 00:19:16,447 --> 00:19:18,658 MAP of 85, ICP of 20? 521 00:19:18,741 --> 00:19:21,661 Um, cerebral perfusion pressure 65. 522 00:19:21,744 --> 00:19:24,413 Which gives him the best shot at survival. 523 00:19:24,497 --> 00:19:25,915 A third of patients like this die. 524 00:19:25,998 --> 00:19:28,501 Half have long-term disability. 525 00:19:28,584 --> 00:19:30,461 We'll know in two weeks if there's a possibility 526 00:19:30,544 --> 00:19:32,797 for a good prognosis. 527 00:19:32,880 --> 00:19:34,006 Felt a pop. 528 00:19:34,090 --> 00:19:35,675 Remove the stylet. 529 00:19:38,219 --> 00:19:40,971 OK, let it drain a bit. 530 00:19:42,932 --> 00:19:45,142 And now pinch it shut. 531 00:19:46,644 --> 00:19:47,630 Perfect. 532 00:19:47,645 --> 00:19:49,438 BP is down, 190 over 88. 533 00:19:49,522 --> 00:19:50,856 Heart rate's 67. 534 00:19:54,985 --> 00:19:56,862 How are you guys doing? 535 00:19:56,946 --> 00:19:58,781 Yeah, making some progress. 536 00:19:58,864 --> 00:20:00,116 You seen Abbot? 537 00:20:00,199 --> 00:20:01,909 Not since rounds. 538 00:20:01,992 --> 00:20:04,620 He asked me to see a patient with the night intern. 539 00:20:04,704 --> 00:20:06,247 And you said yes? 540 00:20:06,330 --> 00:20:09,125 48-year-old woman, new onset jaundice, 541 00:20:09,208 --> 00:20:12,211 elevated liver enzymes, no history of alcohol use. 542 00:20:12,294 --> 00:20:13,546 Take your pick… 543 00:20:13,629 --> 00:20:16,257 hepatitis A, B, C, D, or E. 544 00:20:16,340 --> 00:20:19,135 - No risk factors, no fever. - Tylenol? 545 00:20:19,218 --> 00:20:21,011 Never, and no prescription meds. 546 00:20:21,095 --> 00:20:23,305 Does she eat polar bear liver? 547 00:20:24,515 --> 00:20:26,726 It can cause vitamin A toxicity. 548 00:20:27,685 --> 00:20:28,686 - No. - Yeah. 549 00:20:28,769 --> 00:20:29,937 She, uh, doesn't eat meat, 550 00:20:30,020 --> 00:20:31,564 kind of a health nut. 551 00:20:31,647 --> 00:20:32,982 Well, maybe she's gulping down 552 00:20:33,065 --> 00:20:34,608 cod liver oil to prevent measles. 553 00:20:34,692 --> 00:20:36,819 No. Vegan, no fish. 554 00:20:36,902 --> 00:20:38,946 Would you, uh, mind laying eyes on her? 555 00:20:39,739 --> 00:20:40,725 Seriously? 556 00:20:40,740 --> 00:20:42,825 You have a way of figuring out the weird stuff. 557 00:20:42,908 --> 00:20:44,368 Take the compliment. 558 00:20:45,786 --> 00:20:47,121 OK, fine. 559 00:20:47,204 --> 00:20:49,415 Five minutes at the bedside… that's it. 560 00:20:49,498 --> 00:20:51,375 I'm already gonna be here for hours as it is. 561 00:20:51,459 --> 00:20:53,627 Thank you. 562 00:20:53,711 --> 00:20:55,254 What am I doing… 563 00:20:58,466 --> 00:21:00,760 - Definitely improving. - Tidal volume's up. 564 00:21:00,843 --> 00:21:03,262 Wheezes now expiratory only. 565 00:21:03,345 --> 00:21:04,847 Oh, making some progress. 566 00:21:04,930 --> 00:21:06,974 You feeling better, baby? 567 00:21:07,057 --> 00:21:10,227 - You scared the shit out of me. - Language! 568 00:21:10,311 --> 00:21:12,605 Does he have a primary-care doctor? 569 00:21:12,688 --> 00:21:13,981 Not anymore. 570 00:21:14,064 --> 00:21:16,567 How do you get his prescriptions renewed? 571 00:21:16,650 --> 00:21:18,778 Neighborhood clinic. We pay cash. 572 00:21:18,861 --> 00:21:20,571 - Albuterol's cheap. - Symbicort? 573 00:21:20,654 --> 00:21:23,532 Without Medicaid, 400 bucks a month. 574 00:21:23,616 --> 00:21:25,034 Just for a little inhaler? 575 00:21:27,203 --> 00:21:28,704 Trocar is on the tube. 576 00:21:29,789 --> 00:21:33,000 I tunnel underneath the scalp about 5 centimeters 577 00:21:33,083 --> 00:21:34,502 and poke through. 578 00:21:34,585 --> 00:21:36,253 - To prevent infection? - Mm-hmm, exactly. 579 00:21:37,838 --> 00:21:40,382 Now you hold the knuckle steady while I pull it through. 580 00:21:43,761 --> 00:21:45,888 And you can staple the wound shut. 581 00:21:47,389 --> 00:21:49,433 That looks like something from Home Depot. 582 00:21:49,517 --> 00:21:51,268 Yeah, big Fourth of July sale. 583 00:21:51,352 --> 00:21:52,603 The brain pressure is measured by 584 00:21:52,686 --> 00:21:54,480 the height of the fluid column. 585 00:21:54,563 --> 00:21:57,024 We need to calibrate it to zero at the level of the tragus. 586 00:21:57,107 --> 00:21:59,068 Stopcock's on, ready to attach. 587 00:21:59,151 --> 00:22:00,444 First troponin's normal, 588 00:22:00,528 --> 00:22:02,905 but you need a second to rule out MI. 589 00:22:02,988 --> 00:22:04,782 Hey, can you step out for a second? 590 00:22:10,955 --> 00:22:12,331 I really did do everything I could 591 00:22:12,414 --> 00:22:13,916 to try to make Orlando stay. 592 00:22:13,999 --> 00:22:14,985 Yeah, I don't doubt it. 593 00:22:15,000 --> 00:22:15,986 I wanted to ask you about 594 00:22:16,001 --> 00:22:18,128 Dr. Al-Hashimi at the VA. 595 00:22:18,212 --> 00:22:20,840 Did you ever notice anything unusual about her behavior? 596 00:22:20,923 --> 00:22:22,842 Um, like what? 597 00:22:22,925 --> 00:22:25,469 Lapses in focus, attention? 598 00:22:25,553 --> 00:22:28,055 No, she was always on top of her game. 599 00:22:31,058 --> 00:22:34,687 But this morning when she was checking labs on Baby Jane Doe, 600 00:22:34,770 --> 00:22:37,106 it was like she zoned out for a few seconds. 601 00:22:38,607 --> 00:22:40,359 Maybe she was just tired. 602 00:22:47,408 --> 00:22:49,660 No congestion, nodules, 603 00:22:49,743 --> 00:22:51,120 or cirrhosis. 604 00:22:51,203 --> 00:22:52,788 Good-looking liver. 605 00:22:52,872 --> 00:22:54,665 I should not be sick. 606 00:22:54,748 --> 00:22:57,293 I work so hard to stay healthy… 607 00:22:57,376 --> 00:23:00,212 diet, exercise, eight hours of sleep. 608 00:23:00,296 --> 00:23:04,049 I can't remember the last time I got eight hours. 609 00:23:04,133 --> 00:23:06,051 Maybe you should try sleepmaxxing. 610 00:23:06,135 --> 00:23:07,970 Oh, you definitely should. 611 00:23:08,053 --> 00:23:10,890 Yeah, cold room, white noise, eye shades. 612 00:23:10,973 --> 00:23:14,727 Kiwis before bedtime, lettuce water, mouth taping. 613 00:23:14,810 --> 00:23:16,395 Who do you follow for health? 614 00:23:16,478 --> 00:23:18,731 A few naturopaths and some functional healers. 615 00:23:18,814 --> 00:23:20,691 Do you…do you buy vitamins from them? 616 00:23:20,774 --> 00:23:22,526 Oh, no, no, I don't take vitamins. 617 00:23:22,610 --> 00:23:25,321 Food is the best medicine… kale, blueberries, 618 00:23:25,404 --> 00:23:27,907 - kidney beans, turmeric. - Turmeric? 619 00:23:27,990 --> 00:23:29,617 Uh, how long have you been taking that? 620 00:23:29,700 --> 00:23:32,161 For a few months. It's an anti-inflammatory. 621 00:23:32,244 --> 00:23:34,705 It detoxes the body, and it can prevent Alzheimer's. 622 00:23:34,788 --> 00:23:36,165 How much do you take? 623 00:23:36,248 --> 00:23:38,167 500 milligram capsules, 624 00:23:38,250 --> 00:23:39,460 but I take five a day. 625 00:23:41,211 --> 00:23:42,713 What? 626 00:23:42,796 --> 00:23:44,548 With doses that large of turmeric, 627 00:23:44,632 --> 00:23:47,176 there have been cases of liver failure. 628 00:23:47,259 --> 00:23:48,886 From eating a spice? 629 00:23:48,969 --> 00:23:51,555 All right, Digby, I think you're good to go. 630 00:23:51,639 --> 00:23:53,724 Mm-hmm. Would you like to see? 631 00:24:06,362 --> 00:24:08,739 I haven't looked like this in a long time. 632 00:24:08,822 --> 00:24:11,241 Your family won't recognize you. 633 00:24:13,160 --> 00:24:15,245 Then how will they find me? 634 00:24:15,329 --> 00:24:17,247 They…they won't know what I look like. 635 00:24:17,331 --> 00:24:18,332 They won't know this is me. 636 00:24:18,415 --> 00:24:19,458 Of course they will. 637 00:24:19,541 --> 00:24:20,709 They know your voice. 638 00:24:20,793 --> 00:24:22,544 They know where you hang out. 639 00:24:22,628 --> 00:24:26,382 They even remember that you used to look like this. 640 00:24:26,465 --> 00:24:28,467 They remember the wedding. 641 00:24:31,428 --> 00:24:33,597 Did you dance with your daughter 642 00:24:33,681 --> 00:24:35,099 at her wedding? 643 00:24:36,517 --> 00:24:38,644 I did. 644 00:24:38,727 --> 00:24:41,730 Then she will always remember you. 645 00:24:44,483 --> 00:24:46,026 - Yeah. - OK. 646 00:24:47,528 --> 00:24:49,071 Hey, I was just looking for you. 647 00:24:49,154 --> 00:24:50,406 - What's up? - You tell me. 648 00:24:50,489 --> 00:24:52,741 - The, uh, asthma patient. - What about him? 649 00:24:52,825 --> 00:24:54,118 Seemed like you were hesitating 650 00:24:54,201 --> 00:24:55,786 talking about using Aerogen. 651 00:24:55,869 --> 00:24:57,496 I was wondering if you were having second thoughts. 652 00:24:57,579 --> 00:24:59,248 No. Just thinking. 653 00:24:59,331 --> 00:25:00,541 About? 654 00:25:00,624 --> 00:25:02,543 The best treatment plan for the patient. 655 00:25:02,626 --> 00:25:04,628 And I think he's on it. 656 00:25:04,712 --> 00:25:06,130 - Anything else? - I don't know. 657 00:25:06,213 --> 00:25:08,716 You tell me. Anything else I need to know? 658 00:25:08,799 --> 00:25:10,050 I don't think so. 659 00:25:11,719 --> 00:25:13,178 This is Dr. Robby in the ED. 660 00:25:13,262 --> 00:25:14,888 I'm checking on a patient, Ekins. 661 00:25:14,972 --> 00:25:17,433 We can take Larson and Stevens off the dry-erase. 662 00:25:17,516 --> 00:25:18,516 Consider it done. 663 00:25:18,559 --> 00:25:19,685 He's in the scanner now? 664 00:25:19,768 --> 00:25:21,145 Oh, great. 665 00:25:21,228 --> 00:25:22,229 No, I was just calling to confirm. 666 00:25:22,312 --> 00:25:23,522 Thank you. 667 00:25:23,605 --> 00:25:25,315 Any new information from upstairs? 668 00:25:25,399 --> 00:25:26,775 Nothing we don't already know. 669 00:25:26,859 --> 00:25:28,444 Same old story, huh? 670 00:25:28,527 --> 00:25:29,862 You think we should take up a collection 671 00:25:29,945 --> 00:25:31,655 for Jesse for…for bail money? 672 00:25:31,739 --> 00:25:33,240 They don't usually set bail 673 00:25:33,323 --> 00:25:35,034 until after you've appeared in front of a judge. 674 00:25:35,117 --> 00:25:36,910 With the holiday, it's not likely to happen till Monday. 675 00:25:36,994 --> 00:25:39,079 So he's gonna be locked up all weekend? 676 00:25:39,163 --> 00:25:40,789 That sucks. 677 00:25:40,873 --> 00:25:42,791 It does suck. 678 00:25:42,875 --> 00:25:45,836 Dr. Langdon, Grady's worse… much worse. 679 00:25:45,919 --> 00:25:48,630 - Need an attending? - Uh, no, we have Shen. 680 00:25:48,714 --> 00:25:50,049 Sat's down to 83. 681 00:25:50,132 --> 00:25:52,134 - What's happening? - Give us a minute. 682 00:25:52,217 --> 00:25:53,635 He's tiring out. 683 00:25:53,719 --> 00:25:55,679 Ketamine and rock. It's time to intubate. 684 00:25:55,763 --> 00:25:56,889 I'll call Volk. 685 00:25:56,972 --> 00:25:58,640 Ma'am, we have to put a tube 686 00:25:58,724 --> 00:25:59,892 down your son's windpipe 687 00:25:59,975 --> 00:26:01,351 so a machine can breathe for him. 688 00:26:01,435 --> 00:26:02,686 Oh, my God. 689 00:26:02,770 --> 00:26:04,229 Hold on, hold on. 690 00:26:04,313 --> 00:26:05,439 No lung sliding on the right. 691 00:26:05,522 --> 00:26:06,940 Pneumothorax. 692 00:26:07,024 --> 00:26:08,984 No need to intubate. 693 00:26:09,068 --> 00:26:10,277 What's going on? 694 00:26:10,360 --> 00:26:12,237 He has a collapsed lung. 695 00:26:12,321 --> 00:26:14,156 There was no history of trauma 696 00:26:14,239 --> 00:26:15,657 that would have caused pneumothorax. 697 00:26:15,741 --> 00:26:17,701 Glove up, Dr. King. 698 00:26:17,785 --> 00:26:20,037 In asthma, you can get "air trapping." 699 00:26:20,120 --> 00:26:21,789 When the lungs can't fully exhale, 700 00:26:21,872 --> 00:26:23,165 eventually they overinflate, 701 00:26:23,248 --> 00:26:25,084 causing some of the tiny air sacs to burst. 702 00:26:25,167 --> 00:26:26,335 How do you fix it? 703 00:26:32,257 --> 00:26:33,257 Like that. 704 00:26:38,889 --> 00:26:41,433 It's a good thing Dr. Conley was here. 705 00:26:41,517 --> 00:26:42,726 - Yeah. - We should probably try 706 00:26:42,810 --> 00:26:44,269 to find him a Neuro-Critical ICU bed. 707 00:26:44,353 --> 00:26:45,854 We don't want to board a patient like this. 708 00:26:45,938 --> 00:26:47,523 - Mm-hmm. - Hey, Robby. 709 00:26:47,606 --> 00:26:50,109 - Hey, how did the scan go? - Fine. 710 00:26:50,192 --> 00:26:51,568 It is probably gonna take a little while 711 00:26:51,652 --> 00:26:53,028 to get the results from the radiologist. 712 00:26:53,112 --> 00:26:54,488 Well, that's not a problem. 713 00:26:54,571 --> 00:26:56,698 Nurse Vivi and I need a little time 714 00:26:56,782 --> 00:26:59,284 to coordinate our schedules over the next few months. 715 00:26:59,368 --> 00:27:00,354 - Really? - Yeah. 716 00:27:00,369 --> 00:27:01,355 I've always wanted to learn 717 00:27:01,370 --> 00:27:02,370 how to ride a motorcycle, 718 00:27:02,412 --> 00:27:03,831 and Duke offered to teach me. 719 00:27:03,914 --> 00:27:06,125 Well, nobody knows motorcycles like Duke. 720 00:27:06,208 --> 00:27:08,544 He's giving me the health care worker discount. 721 00:27:08,627 --> 00:27:09,878 He's quite the gentleman. 722 00:27:09,962 --> 00:27:11,672 Let's get him back to his room. 723 00:27:11,755 --> 00:27:14,466 How would next Saturday be for you, Vivi? 724 00:27:14,550 --> 00:27:17,803 Uh, maybe we could have some dinner after. 725 00:27:17,886 --> 00:27:19,429 Dr. Mohan, Lorrie Diaz is here. 726 00:27:19,513 --> 00:27:21,181 She wants to see her husband. She's heading back. 727 00:27:21,265 --> 00:27:22,766 OK, I'm on my way. 728 00:27:24,935 --> 00:27:26,854 - Mrs. Diaz? - Hi. 729 00:27:26,937 --> 00:27:29,731 Did Orlando go up to his room yet? 730 00:27:29,815 --> 00:27:31,233 No. Um… 731 00:27:31,316 --> 00:27:33,360 I brought him some dinner from Burgatory. 732 00:27:33,443 --> 00:27:34,736 It's a chicken burger… 733 00:27:34,820 --> 00:27:36,363 no bun, just lettuce. 734 00:27:36,446 --> 00:27:39,074 Figured it would be better than hospital food. 735 00:27:42,411 --> 00:27:46,582 He's being treated by our top brain-injury specialists. 736 00:27:46,665 --> 00:27:48,083 Will he wake up? 737 00:27:48,167 --> 00:27:50,002 We won't know for several weeks. 738 00:27:50,085 --> 00:27:52,588 And then he could be back to normal? 739 00:27:52,671 --> 00:27:55,716 Best-case scenario, it would take about a year 740 00:27:55,799 --> 00:27:58,343 before he could be independent at home. 741 00:27:58,427 --> 00:28:00,012 And the worst case? 742 00:28:00,095 --> 00:28:03,515 Round-the-clock nursing care for severe disability. 743 00:28:07,144 --> 00:28:09,271 You let him leave? 744 00:28:09,354 --> 00:28:13,275 He insisted on leaving to work at his second job. 745 00:28:13,358 --> 00:28:15,485 You couldn't make him stay? 746 00:28:15,569 --> 00:28:18,488 He was competent. He knew the risks. 747 00:28:18,572 --> 00:28:20,490 We honored his decision to leave. 748 00:28:20,574 --> 00:28:22,284 Even if it was a stupid one? 749 00:28:22,367 --> 00:28:23,785 I tried to stop him. 750 00:28:23,869 --> 00:28:25,412 Offered to get him all the supplies he'd need 751 00:28:25,495 --> 00:28:26,914 to take care of himself at home. 752 00:28:26,997 --> 00:28:29,458 But he left before I could give them to him. 753 00:28:29,541 --> 00:28:31,960 He said he couldn't afford to lose a paycheck. 754 00:28:39,509 --> 00:28:41,678 Dr. Langdon. 755 00:28:43,931 --> 00:28:45,599 Are you OK? 756 00:28:45,682 --> 00:28:48,727 Yeah. I'm just kind of, uh… 757 00:28:48,810 --> 00:28:51,188 wondering if I'm really ready to be back here. 758 00:28:51,271 --> 00:28:53,482 Well, of course you are. 759 00:28:53,565 --> 00:28:55,609 Ten months is a long time. 760 00:28:55,692 --> 00:28:58,862 I almost killed that kid with an intubation. 761 00:28:58,946 --> 00:29:02,157 Didn't even occur to me to check for pneumothorax. 762 00:29:02,241 --> 00:29:03,867 There wasn't any trauma to indicate… 763 00:29:03,951 --> 00:29:05,077 - I should have caught it. - OK. 764 00:29:11,833 --> 00:29:13,126 You know, I, um… 765 00:29:15,045 --> 00:29:17,881 I had a deposition today, 766 00:29:17,965 --> 00:29:21,343 and all the lawyer's questions made me feel like 767 00:29:21,426 --> 00:29:23,720 I was a really, really bad doctor. 768 00:29:26,098 --> 00:29:29,559 We don't always get everything right the first time. 769 00:29:30,727 --> 00:29:33,188 You would have caught the collapsed lung. 770 00:29:33,272 --> 00:29:35,899 And it may have taken a minute, but you would have saved him. 771 00:29:37,150 --> 00:29:39,486 I'm not sure Robby would agree with you. 772 00:29:39,569 --> 00:29:42,197 He's been riding me all day. 773 00:29:42,281 --> 00:29:44,074 Well, Robby's leaving for three months. 774 00:29:44,157 --> 00:29:46,910 And, you know, with Robby gone… 775 00:29:46,994 --> 00:29:48,954 I really don't want you to leave either. 776 00:29:52,541 --> 00:29:55,085 That which does not kill me makes me stronger. 777 00:29:55,168 --> 00:29:58,380 Wow, Friedrich Nietzsche. 778 00:29:58,463 --> 00:30:01,591 Yeah, Nietzsche, yeah… 779 00:30:01,675 --> 00:30:03,969 not Kelly Clarkson. 780 00:30:05,971 --> 00:30:07,889 Hey, that's a thick one. 781 00:30:07,973 --> 00:30:10,809 Yeah, Austin Green. Ogilvie's triple-A. 782 00:30:13,854 --> 00:30:16,398 Uh, G-R-E-E-N? 783 00:30:16,481 --> 00:30:17,816 Yeah. Why? What are you doing? 784 00:30:17,899 --> 00:30:19,276 Checking to see when we'll get Ogilvie 785 00:30:19,359 --> 00:30:21,194 back from the OR. 786 00:30:21,278 --> 00:30:23,238 - Oh, shit. - What? 787 00:30:23,322 --> 00:30:24,990 The guy didn't make it. 788 00:30:25,073 --> 00:30:27,284 He died on the table about 40 minutes ago. 789 00:30:27,367 --> 00:30:29,453 Then where's Ogilvie? 790 00:30:29,536 --> 00:30:31,413 Oh, man. 791 00:30:31,496 --> 00:30:34,041 His patient had a CT a year and a half ago 792 00:30:34,124 --> 00:30:36,335 that showed a 4-centimeter triple-A. 793 00:30:36,418 --> 00:30:38,003 That's too small for surgery. 794 00:30:38,086 --> 00:30:39,338 He was supposed to come back 795 00:30:39,421 --> 00:30:41,089 every six months for a repeat ultrasound, 796 00:30:41,173 --> 00:30:42,799 but looks like he didn't. 797 00:30:42,883 --> 00:30:45,469 We would've seen that if the computers were working. 798 00:30:45,552 --> 00:30:47,137 Why wouldn't he tell Ogilvie? 799 00:30:47,220 --> 00:30:49,014 I don't know. Maybe he forgot all about it. 800 00:30:49,097 --> 00:30:51,058 Or Ogilvie didn't ask the right questions. 801 00:30:52,184 --> 00:30:54,144 Dennis, hey, got a minute? 802 00:30:54,227 --> 00:30:56,688 Uh, sure. What do you need? 803 00:30:56,772 --> 00:30:58,357 Teenager with jewelry magnets 804 00:30:58,440 --> 00:31:00,359 stuck to both sides of her nasal septum. 805 00:31:00,442 --> 00:31:02,361 I tried to move them with a plastic curette. 806 00:31:02,444 --> 00:31:04,196 Too much pain, and then there was bleeding. 807 00:31:04,279 --> 00:31:06,490 Those need to come off before they cause permanent damage. 808 00:31:06,573 --> 00:31:08,075 Yeah, you think, uh, you could find, like, 809 00:31:08,158 --> 00:31:09,993 a senior or an attending? 810 00:31:10,077 --> 00:31:11,870 We're really trying to get off the clock here. 811 00:31:11,953 --> 00:31:13,038 They're all busy. 812 00:31:15,791 --> 00:31:17,334 I already took one for the team. 813 00:31:17,417 --> 00:31:19,294 Yeah, fine. 814 00:31:19,378 --> 00:31:22,839 Uh, labs on your yellow lady. 815 00:31:22,923 --> 00:31:25,300 INR is elevated, 2.2. 816 00:31:25,384 --> 00:31:27,260 Liver's in trouble but not dead yet. 817 00:31:27,344 --> 00:31:28,845 Tell her to skip the turmeric. 818 00:31:28,929 --> 00:31:31,014 Admit for monitoring, and follow the LFTs. 819 00:31:31,098 --> 00:31:32,224 - Got it. - Mm-hmm. 820 00:31:32,307 --> 00:31:33,725 - Central 10? - Yeah. 821 00:31:38,105 --> 00:31:40,190 "Sleepmaxxing"? Really? 822 00:31:40,273 --> 00:31:41,775 I track the online trends. 823 00:31:41,858 --> 00:31:44,152 Is that your secret for the tough ones? 824 00:31:44,236 --> 00:31:45,862 I just think, 825 00:31:45,946 --> 00:31:48,240 what's the stupidest thing this person could have done? 826 00:31:48,323 --> 00:31:49,491 Then assume they did it. 827 00:31:50,951 --> 00:31:53,078 Well, I mean, she was trying to be healthy. 828 00:31:53,161 --> 00:31:55,414 Yeah, by taking advice from fools. 829 00:31:55,497 --> 00:31:57,624 Turmeric is recommended by a lot of doctors. 830 00:31:57,707 --> 00:31:59,626 Yeah, then ask your doctor for the dose 831 00:31:59,709 --> 00:32:02,212 or check someplace reputable, like the CDC. 832 00:32:02,295 --> 00:32:05,507 Oh, right, I forgot, it's now a medical toxic waste site. 833 00:32:05,590 --> 00:32:08,552 I mean, she's in pretty bad shape. 834 00:32:08,635 --> 00:32:10,846 If things get worse, she could need a liver transplant. 835 00:32:10,929 --> 00:32:12,973 Yeah, 'cause she's a big fucking idiot. 836 00:32:14,558 --> 00:32:16,309 Wow. 837 00:32:16,393 --> 00:32:18,562 No, I actually appreciate her. 838 00:32:18,645 --> 00:32:21,314 Our job security depends on all these big fucking idiots. 839 00:32:23,775 --> 00:32:24,985 OK. 840 00:32:27,320 --> 00:32:30,699 Uh, good night, Perlah, Monica. 841 00:32:30,782 --> 00:32:33,452 - Good night, Dr. Robby. - Good night. 842 00:32:33,535 --> 00:32:35,036 Bye, Emma. 843 00:32:35,120 --> 00:32:36,496 You could stay to pitch in. 844 00:32:36,580 --> 00:32:38,457 Mm, Dana told me to go and get some rest 845 00:32:38,540 --> 00:32:39,875 before tomorrow's shift. 846 00:32:39,958 --> 00:32:41,543 Yeah, you had quite a day. 847 00:32:41,626 --> 00:32:42,919 Wasn't so bad. 848 00:32:44,963 --> 00:32:46,715 Why can't I find Duke's results? 849 00:32:46,798 --> 00:32:49,468 Oh, new patient, no EHR yet. 850 00:32:49,551 --> 00:32:52,262 I can run over to Radiology, get a printout. 851 00:32:52,345 --> 00:32:53,722 Thank you, Monica. 852 00:32:56,266 --> 00:32:58,185 Ready to pick up a few more. 853 00:32:58,268 --> 00:32:59,603 Orlando's all tucked in for now. 854 00:32:59,686 --> 00:33:01,229 - How's he doing? - Numbers are good. 855 00:33:01,313 --> 00:33:03,064 CPP 22. 856 00:33:03,148 --> 00:33:05,692 OK, so he's got a shot at a decent outcome at least. 857 00:33:05,775 --> 00:33:07,319 You think he has a chance? 858 00:33:07,402 --> 00:33:09,529 Oh, I don't know that survival was 859 00:33:09,613 --> 00:33:11,531 the outcome he was hoping for. 860 00:33:11,615 --> 00:33:13,158 What? 861 00:33:13,241 --> 00:33:15,368 He told Samira he's got $100,000 in medical debt, 862 00:33:15,452 --> 00:33:17,871 - that his life is probably… - Mrs. Diaz! 863 00:33:20,207 --> 00:33:22,626 - How can we help you? - The bathroom? 864 00:33:22,709 --> 00:33:25,337 Uh, yeah. Perlah can show you the way. 865 00:33:27,130 --> 00:33:29,466 Not a great idea to have a private conversation 866 00:33:29,549 --> 00:33:30,717 about a patient in a public area. 867 00:33:30,800 --> 00:33:32,719 I know. I know. 868 00:33:32,802 --> 00:33:34,095 You were about to start yapping… 869 00:33:34,179 --> 00:33:35,680 But I didn't! 870 00:33:38,225 --> 00:33:41,102 OK. 871 00:33:41,186 --> 00:33:43,438 And how long have they been in there? 872 00:33:43,522 --> 00:33:44,898 At least two hours. 873 00:33:44,981 --> 00:33:47,317 - How did it happen? - With my earring. 874 00:33:47,400 --> 00:33:50,237 It was supposed to be, uh, red, white, and blue 875 00:33:50,320 --> 00:33:52,030 to look cool at the fireworks. 876 00:33:52,113 --> 00:33:53,740 I told her for the nose, one side only, 877 00:33:53,823 --> 00:33:54,991 but she never listens. 878 00:33:55,075 --> 00:33:56,243 This can be pretty serious. 879 00:33:56,326 --> 00:33:57,536 If we don't get them out quickly, 880 00:33:57,619 --> 00:33:58,954 it can cut off the blood supply 881 00:33:59,037 --> 00:34:00,872 and cause the septum to collapse. 882 00:34:00,956 --> 00:34:04,459 Like, my nose could be deformed? 883 00:34:06,753 --> 00:34:09,256 - Oh, my God, get them off. - Yeah, that's the plan. 884 00:34:09,339 --> 00:34:10,966 Yeah, she tried already. It hurt like crazy. 885 00:34:11,049 --> 00:34:12,133 Because they're stuck together 886 00:34:12,217 --> 00:34:14,261 by a very strong magnetic force. 887 00:34:14,344 --> 00:34:16,179 - Yeah. - No, no, no. 888 00:34:16,263 --> 00:34:17,931 Oh, uh, I'm not gonna use the tips. 889 00:34:18,014 --> 00:34:20,976 I'm gonna flip it around and use the handle. 890 00:34:21,059 --> 00:34:22,602 It's still gonna hurt. 891 00:34:22,686 --> 00:34:23,812 Probably not. 892 00:34:23,895 --> 00:34:25,230 Just, uh, hold still. 893 00:34:27,774 --> 00:34:29,192 OK. 894 00:34:33,446 --> 00:34:34,656 Voilà. 895 00:34:34,739 --> 00:34:37,367 - Really? - That was amazing. 896 00:34:37,450 --> 00:34:39,202 I think another half hour, 897 00:34:39,286 --> 00:34:40,912 we can send this dry-erase board back to storage. 898 00:34:40,996 --> 00:34:42,122 With pleasure. 899 00:34:42,205 --> 00:34:43,498 - Dr. Robinavitch? - Yep. 900 00:34:43,582 --> 00:34:45,000 Results on your friend. 901 00:34:49,671 --> 00:34:51,798 - Fuck. - Duke? 902 00:34:55,802 --> 00:34:57,429 Are you gonna tell him? 903 00:34:57,512 --> 00:34:59,055 I want to talk to a surgeon first. 904 00:34:59,139 --> 00:35:01,099 Uh, Dr. Robby, I have an update on the patient. 905 00:35:01,182 --> 00:35:02,517 Now is not a great time. 906 00:35:02,601 --> 00:35:03,935 Oh, I thought you were going home. 907 00:35:04,019 --> 00:35:05,145 Uh, I was. 908 00:35:05,228 --> 00:35:06,896 Dr. Ogilvie is just sitting 909 00:35:06,980 --> 00:35:08,648 out in the ambulance bay covered in blood. 910 00:35:08,732 --> 00:35:10,275 Sorry, what… what's he doing out there? 911 00:35:10,358 --> 00:35:12,235 Kind of, uh, staring off into space. 912 00:35:12,319 --> 00:35:13,528 I tried to talk to him, but it was like 913 00:35:13,612 --> 00:35:14,988 - he couldn't hear me. - Monica, 914 00:35:15,071 --> 00:35:16,573 can you stat page CardioThoracic? 915 00:35:16,656 --> 00:35:18,783 - I'll go check on Ogilvie. - Please. 916 00:35:21,119 --> 00:35:22,329 Oh. 917 00:35:33,757 --> 00:35:35,884 Hey, Ogilvie. 918 00:35:38,511 --> 00:35:40,430 Ogilvie… 919 00:35:40,513 --> 00:35:42,349 y-you OK, man? 920 00:35:47,437 --> 00:35:49,481 99 on 2 liters. 921 00:35:49,564 --> 00:35:51,816 Scattered end expiratory wheezes. 922 00:35:51,900 --> 00:35:54,027 He is so much better. 923 00:35:54,110 --> 00:35:56,071 The steroids should kick in soon. 924 00:35:56,154 --> 00:35:58,448 So he'll keep improving. 925 00:35:58,531 --> 00:36:00,784 Um, when can I go home? 926 00:36:00,867 --> 00:36:02,452 In a day or two. 927 00:36:02,535 --> 00:36:05,747 And we will, uh, discharge you with a Symbicort inhaler. 928 00:36:05,830 --> 00:36:07,916 That should last about a month. 929 00:36:07,999 --> 00:36:10,460 Hopefully we'll be back on Medicaid by then. 930 00:36:10,543 --> 00:36:12,504 How'd you lose it? 931 00:36:12,587 --> 00:36:16,007 They sent a redetermination letter to our old apartment. 932 00:36:16,091 --> 00:36:18,551 It didn't get forwarded. 933 00:36:18,635 --> 00:36:20,595 When I went to pick up his prescription, 934 00:36:20,679 --> 00:36:24,432 pharmacist told me we were no longer covered. 935 00:36:24,516 --> 00:36:26,685 And you haven't been able to get it back since? 936 00:36:26,768 --> 00:36:29,020 I've been trying for months. 937 00:36:29,104 --> 00:36:31,481 To get re-enrolled, you need tax returns, 938 00:36:31,564 --> 00:36:32,899 pay stubs. 939 00:36:32,982 --> 00:36:35,819 I cut hair. My income fluctuates. 940 00:36:35,902 --> 00:36:38,279 A lot of my regulars are struggling, 941 00:36:38,363 --> 00:36:41,408 so it's been tough. 942 00:36:41,491 --> 00:36:43,326 Well, if you run out of Symbicort 943 00:36:43,410 --> 00:36:45,704 before your Medicaid kicks in, you can come back, 944 00:36:45,787 --> 00:36:48,623 and we'll, uh, set you up with another one. 945 00:36:48,707 --> 00:36:50,625 Oh, is there a patient in here? 946 00:36:50,709 --> 00:36:53,712 'Cause everyone in this room looks extremely healthy to me. 947 00:36:53,795 --> 00:36:56,172 Dr. Shen and I will be with Grady all night long. 948 00:36:56,256 --> 00:36:58,133 Yeah. Day shift, we got this. 949 00:36:58,216 --> 00:37:00,093 We're leaving you in good hands. 950 00:37:00,176 --> 00:37:01,928 Um… 951 00:37:02,011 --> 00:37:04,347 I was really scared. 952 00:37:04,431 --> 00:37:05,557 Thank you. 953 00:37:07,267 --> 00:37:09,269 You're very welcome. 954 00:37:13,189 --> 00:37:15,775 Due to his injury, things have changed. 955 00:37:17,235 --> 00:37:19,446 I was looking for Dr. Abbot. 956 00:37:19,529 --> 00:37:22,282 I haven't seen him for a while. 957 00:37:22,365 --> 00:37:23,616 Excuse me. 958 00:37:26,661 --> 00:37:28,580 So now, with a long-term disability, 959 00:37:28,663 --> 00:37:31,291 things may be easier. 960 00:37:31,374 --> 00:37:32,459 "Easier"? 961 00:37:32,542 --> 00:37:33,960 His condition will qualify him 962 00:37:34,043 --> 00:37:35,462 for Medicare and Medicaid. 963 00:37:35,545 --> 00:37:37,964 So, moving forward, costs should be covered, 964 00:37:38,047 --> 00:37:39,758 including home health care. 965 00:37:39,841 --> 00:37:41,092 OK. 966 00:37:41,176 --> 00:37:42,552 Perhaps this isn't the best time… 967 00:37:42,635 --> 00:37:43,928 I just wanted to reassure you 968 00:37:44,012 --> 00:37:45,805 about future costs. 969 00:37:54,063 --> 00:37:55,398 Robby. 970 00:37:55,482 --> 00:37:57,567 Noelle. 971 00:37:57,650 --> 00:37:59,194 You're still here. 972 00:37:59,277 --> 00:38:01,529 It's not the best day to try to get out on time. 973 00:38:01,613 --> 00:38:03,198 Mm. 974 00:38:03,281 --> 00:38:04,657 So I guess this is it for a while. 975 00:38:04,741 --> 00:38:06,159 Unless you want to come with me. 976 00:38:06,242 --> 00:38:08,536 No, but thank you, 977 00:38:08,620 --> 00:38:10,580 even if it isn't a legitimate offer. 978 00:38:10,663 --> 00:38:12,081 - What do you mean? - Oh, please. 979 00:38:12,165 --> 00:38:13,958 I know well enough not to get in between 980 00:38:14,042 --> 00:38:16,085 a man and his vision quest. 981 00:38:17,504 --> 00:38:18,755 "Vision quest." 982 00:38:18,838 --> 00:38:21,925 That is my nice way of putting it. 983 00:38:23,176 --> 00:38:24,469 I probably don't want to hear 984 00:38:24,552 --> 00:38:26,346 your not-so-nice way of putting it. 985 00:38:26,429 --> 00:38:27,764 No, probably not. 986 00:38:29,516 --> 00:38:33,061 I-I hope that this is not, um… 987 00:38:33,144 --> 00:38:34,437 about you running away from me. 988 00:38:34,521 --> 00:38:35,688 I'm a big girl. 989 00:38:35,772 --> 00:38:37,357 You can tell me just to get lost. 990 00:38:37,440 --> 00:38:39,192 This has nothing to do with you. 991 00:38:39,275 --> 00:38:40,485 Oh, right. 992 00:38:40,568 --> 00:38:43,279 It's the old, uh, "it's not you, it's me"? 993 00:38:44,781 --> 00:38:46,950 In this case, it's actually true. 994 00:38:53,164 --> 00:38:54,791 Excuse me. 995 00:39:00,880 --> 00:39:02,173 I'll see you next week? 996 00:39:02,257 --> 00:39:03,508 It's a three-month sabbatical. 997 00:39:03,591 --> 00:39:05,552 Like I said, I will see you next week. 998 00:39:12,225 --> 00:39:15,436 My first day here as a med student… 999 00:39:15,520 --> 00:39:17,146 there was a patient. 1000 00:39:18,982 --> 00:39:20,650 He was a real nice guy, 1001 00:39:20,733 --> 00:39:23,486 came in with belly pain. 1002 00:39:23,570 --> 00:39:27,115 I saw a gall stone on the ultrasound, 1003 00:39:27,198 --> 00:39:29,284 normal EKG, troponin. 1004 00:39:29,367 --> 00:39:32,662 The pain resolved, and he was in the hall 1005 00:39:32,745 --> 00:39:34,622 when he had a cardiac arrest. 1006 00:39:37,417 --> 00:39:38,751 I couldn't save him. 1007 00:39:40,378 --> 00:39:41,796 People die. 1008 00:39:43,256 --> 00:39:46,718 And we do the best we can… 1009 00:39:46,801 --> 00:39:49,137 but people die. 1010 00:39:50,388 --> 00:39:52,348 You ever get used to it? 1011 00:39:54,142 --> 00:39:55,226 No. 1012 00:39:56,895 --> 00:39:59,647 No, you… 1013 00:39:59,731 --> 00:40:01,608 you try to accept it. 1014 00:40:03,610 --> 00:40:05,361 You try to find balance. 1015 00:40:10,825 --> 00:40:13,703 I don't know if I can take another day like today. 1016 00:40:15,246 --> 00:40:18,541 Primary care specialty sounds way better. 1017 00:40:18,625 --> 00:40:20,335 Pedes, maybe. 1018 00:40:20,418 --> 00:40:21,961 Yeah, maybe. 1019 00:40:23,504 --> 00:40:26,591 I know I'd be bored out of my fucking mind. 1020 00:40:27,926 --> 00:40:31,930 Seriously, I like the challenge of undiagnosed illness, 1021 00:40:32,013 --> 00:40:36,935 of quick decisions, of life-saving procedures. 1022 00:40:37,018 --> 00:40:39,354 And I like being here for people 1023 00:40:39,437 --> 00:40:41,814 on the worst days of their lives. 1024 00:40:49,989 --> 00:40:51,950 You know what I think? 1025 00:40:52,033 --> 00:40:53,660 What? 1026 00:40:53,743 --> 00:40:55,995 I think you should go home. 1027 00:40:56,079 --> 00:40:57,413 I think you should sleep on it. 1028 00:40:57,497 --> 00:40:58,915 And I think you should at least wait 1029 00:40:58,998 --> 00:41:00,166 till the morning to decide 1030 00:41:00,249 --> 00:41:01,668 if you want to come back. 1031 00:41:04,671 --> 00:41:06,965 I don't really want to… 1032 00:41:07,048 --> 00:41:09,592 go back in there and see anybody. 1033 00:41:09,676 --> 00:41:10,802 Yeah. 1034 00:41:12,345 --> 00:41:14,847 OK, pull off your gown. I'll take it in. 1035 00:41:14,931 --> 00:41:17,308 Shift is over. 1036 00:41:17,392 --> 00:41:18,851 Go home. 1037 00:41:31,739 --> 00:41:32,949 - Oh! - Oh, God. 1038 00:41:33,032 --> 00:41:34,033 - No, I'm…I'm… - Sorry. 1039 00:41:34,117 --> 00:41:35,451 I'm good. I'm good. I'm good. 1040 00:41:35,535 --> 00:41:37,161 There's a dummy in a wheelchair. 1041 00:41:37,245 --> 00:41:39,122 Uh, yeah, he moves around. 1042 00:41:42,208 --> 00:41:44,335 I see I've been replaced. 1043 00:41:44,419 --> 00:41:45,878 Oh, did I take your spot? 1044 00:41:45,962 --> 00:41:47,547 - Not really, no. - Are you sure? 1045 00:41:47,630 --> 00:41:49,007 Where the hell have you been? 1046 00:41:49,090 --> 00:41:50,633 I found Ogilvie. 1047 00:41:50,717 --> 00:41:51,926 And? 1048 00:41:52,010 --> 00:41:54,262 And he's going home. 1049 00:41:54,345 --> 00:41:55,471 That's it? 1050 00:41:55,555 --> 00:41:56,806 It's a long story. 1051 00:41:56,889 --> 00:41:58,266 Well, I got nothing but time. 1052 00:41:58,349 --> 00:42:00,435 I need to respect his privacy. 1053 00:42:00,518 --> 00:42:02,020 Where's the fun in that? 1054 00:42:02,103 --> 00:42:04,063 - Beep. Beep, beep. - Sorry. 1055 00:42:12,655 --> 00:42:13,990 Um, the shredder jammed. 1056 00:42:14,073 --> 00:42:17,035 Yeah, uh, try putting it in reverse. 1057 00:42:19,412 --> 00:42:20,580 Perfect. 1058 00:42:20,663 --> 00:42:22,665 Just give it a little love tap. 1059 00:42:22,749 --> 00:42:24,250 - OK. - Kick it. 1060 00:42:25,418 --> 00:42:26,961 Jesus Christ. 1061 00:42:28,963 --> 00:42:31,049 Guess Mr. Digby got a room upstairs. 1062 00:42:31,132 --> 00:42:32,508 In your dreams. 1063 00:42:32,592 --> 00:42:34,510 He's not in South 21. 1064 00:42:34,594 --> 00:42:35,928 Yeah, he is. 1065 00:42:36,012 --> 00:42:38,264 There's a new guy in the bed. 1066 00:42:38,347 --> 00:42:40,266 Short hair, clean-shaved? 1067 00:42:40,349 --> 00:42:42,685 I'll take care of it. 1068 00:42:42,769 --> 00:42:44,395 Scout film showed obvious pathology, 1069 00:42:44,479 --> 00:42:45,938 so we ordered the CT angiogram. 1070 00:42:46,022 --> 00:42:47,607 Textbook ascending aortic aneurysm. 1071 00:42:47,690 --> 00:42:49,442 Eight centimeters. 1072 00:42:49,525 --> 00:42:51,319 50% one-year mortality. 1073 00:42:51,402 --> 00:42:52,612 So he definitely needs surgery. 1074 00:42:52,695 --> 00:42:53,681 If he wants to live. 1075 00:42:53,696 --> 00:42:54,696 OK, well, he's a friend, 1076 00:42:54,739 --> 00:42:55,948 so I will talk to him. 1077 00:42:56,032 --> 00:42:57,116 I'll get him admitted to your service. 1078 00:42:57,200 --> 00:42:59,243 - Not today. - Why not? 1079 00:42:59,327 --> 00:43:01,079 He needs to see Cardiology and Pulmonary first 1080 00:43:01,162 --> 00:43:02,330 to be cleared for the OR. 1081 00:43:02,413 --> 00:43:04,248 They can do a stress echo, PFTs. 1082 00:43:04,332 --> 00:43:06,501 He needs to be admitted and evaluated as an inpatient. 1083 00:43:06,584 --> 00:43:08,169 Nothing ever gets done over a holiday weekend. 1084 00:43:08,252 --> 00:43:09,253 He can take it easy at home. 1085 00:43:09,337 --> 00:43:10,671 He's a ticking time bomb. 1086 00:43:10,755 --> 00:43:12,006 He's probably been that way for years. 1087 00:43:12,090 --> 00:43:13,299 We can get him in early next week 1088 00:43:13,382 --> 00:43:14,884 with a specialist to get his testing done. 1089 00:43:14,967 --> 00:43:16,844 All goes well, he's on the OR schedule in a week. 1090 00:43:16,928 --> 00:43:18,471 What happens if it ruptures before then? 1091 00:43:18,554 --> 00:43:20,306 Call 911. 1092 00:43:20,389 --> 00:43:21,974 Sorry, Robby. Best we can do. 1093 00:43:22,058 --> 00:43:23,976 Text me his number. I'll have my office coordinate. 1094 00:43:26,187 --> 00:43:27,730 - Fuck! - Hey! 1095 00:43:27,814 --> 00:43:29,482 Take a walk. Come on! 1096 00:43:33,820 --> 00:43:34,806 Two for discharge. 1097 00:43:34,821 --> 00:43:36,239 Yeah, please don't ring the bell. 1098 00:43:36,322 --> 00:43:37,865 The computers are back up and running. 1099 00:43:37,949 --> 00:43:39,408 Not for these two. 1100 00:43:39,492 --> 00:43:40,827 They don't have electronic health records yet. 1101 00:43:40,910 --> 00:43:42,203 Wait, hold up. 1102 00:43:42,286 --> 00:43:44,455 This kid had a wrist X-ray ordered. 1103 00:43:44,539 --> 00:43:45,706 Ugh, it never happened. 1104 00:43:45,790 --> 00:43:47,041 And water-skiing lady's 1105 00:43:47,125 --> 00:43:48,376 still waiting on a knee series. 1106 00:43:48,459 --> 00:43:49,627 I canceled the X-rays. 1107 00:43:49,710 --> 00:43:51,963 Diagnosed them both with ultrasound. 1108 00:43:52,046 --> 00:43:53,214 Really? 1109 00:43:53,297 --> 00:43:54,966 Yeah. 1110 00:43:55,049 --> 00:43:57,426 The, uh, little boy had a simple buckle fracture. 1111 00:43:57,510 --> 00:44:00,054 Distal radius. He got a Velcro splint. 1112 00:44:00,138 --> 00:44:02,765 And Mrs. Stegman had a small medial meniscus tear. 1113 00:44:02,849 --> 00:44:05,184 Knee immobilizer, crutches, and a follow up with ortho. 1114 00:44:05,268 --> 00:44:07,520 Could have used you on the day shift today. 1115 00:44:07,603 --> 00:44:09,939 They don't teach us a lot of musculoskeletal ultrasound. 1116 00:44:10,022 --> 00:44:11,482 I know. 1117 00:44:11,566 --> 00:44:14,110 That's why I did electives at Harvard and Highland. 1118 00:44:14,193 --> 00:44:16,946 Are you applying for an ultrasound fellowship here? 1119 00:44:17,029 --> 00:44:19,740 I am, but it is so competitive. 1120 00:44:19,824 --> 00:44:21,993 - That's what I hear. - Kind of a long shot. 1121 00:44:22,076 --> 00:44:23,411 I only have one publication, 1122 00:44:23,494 --> 00:44:25,329 but it's a series of case reports diagnosing 1123 00:44:25,413 --> 00:44:27,874 shoulder dislocations with ultrasound only. 1124 00:44:27,957 --> 00:44:29,876 If you want to learn some MSK, you can tag along. 1125 00:44:29,959 --> 00:44:31,377 I got three more to scan. 1126 00:44:31,460 --> 00:44:33,379 Maybe some other time. 1127 00:44:33,462 --> 00:44:35,798 Cool. 1128 00:44:38,217 --> 00:44:40,136 Hey, don't jam the shredder. 1129 00:44:40,219 --> 00:44:41,679 What is that, two charts? 1130 00:44:41,762 --> 00:44:44,265 No, it's my ultrasound fellowship application. 1131 00:44:46,100 --> 00:44:47,643 Hey. 1132 00:44:47,727 --> 00:44:50,646 Uh, sorry about your patient. 1133 00:44:50,730 --> 00:44:53,649 Yeah, Orlando's in pretty bad shape. 1134 00:44:53,733 --> 00:44:55,568 Oh, no, I…I was talking about 1135 00:44:55,651 --> 00:44:59,238 the triple-A guy you worked on with Ogilvie. 1136 00:45:01,866 --> 00:45:04,410 He didn't make it through surgery. 1137 00:45:04,493 --> 00:45:05,953 I tried to talk to Robby about it, 1138 00:45:06,037 --> 00:45:07,955 but I think he's busy. 1139 00:45:08,039 --> 00:45:09,665 Excuse me. 1140 00:45:12,043 --> 00:45:13,794 Oh, shit. 1141 00:45:18,049 --> 00:45:19,467 You think I'm on edge? 1142 00:45:19,550 --> 00:45:21,260 First you're shaming Samira, then McKay… 1143 00:45:21,344 --> 00:45:22,595 They both needed to be called out 1144 00:45:22,678 --> 00:45:23,930 - for unacceptable behavior. - Yeah? 1145 00:45:24,013 --> 00:45:25,223 Yeah, well, you do that in private. 1146 00:45:25,306 --> 00:45:26,641 Same place you share your thoughts 1147 00:45:26,724 --> 00:45:27,850 about a patient's possible suicide. 1148 00:45:27,934 --> 00:45:29,310 And slamming stuff? Please. 1149 00:45:29,393 --> 00:45:30,519 Sign out all the shit that's bugging you 1150 00:45:30,603 --> 00:45:31,687 and get out of here. 1151 00:45:31,771 --> 00:45:33,522 - I can't. - Yes, you can. 1152 00:45:33,606 --> 00:45:34,857 When either of my kids was acting like this, 1153 00:45:34,941 --> 00:45:36,317 I gave them a time-out in their room. 1154 00:45:36,400 --> 00:45:37,485 Whoa, whoa, whoa, you're not my mother. 1155 00:45:37,568 --> 00:45:38,694 Yeah? Well, too bad. 1156 00:45:38,778 --> 00:45:39,904 - You need one. - No, I had one. 1157 00:45:39,987 --> 00:45:41,614 She left. I don't need another one. 1158 00:45:41,697 --> 00:45:42,949 What I need is someone who can actually run this place 1159 00:45:43,032 --> 00:45:44,867 - while I'm gone. - OK, I'm sorry. 1160 00:45:44,951 --> 00:45:46,202 - I didn't know. - Nobody knows. 1161 00:45:46,285 --> 00:45:48,496 Who needs to know? Who gives a fuck? 1162 00:45:48,579 --> 00:45:49,830 I think you need a break. 1163 00:45:49,914 --> 00:45:51,415 That is what the sabbatical is for. 1164 00:45:51,499 --> 00:45:52,959 Then start it now. Walk away. 1165 00:45:53,042 --> 00:45:54,210 I have too much to do. 1166 00:45:54,293 --> 00:45:55,920 Let someone else talk to Duke. 1167 00:45:56,003 --> 00:45:57,672 No, that needs to come from me. 1168 00:45:57,755 --> 00:45:59,006 Why? 1169 00:45:59,090 --> 00:46:00,591 Because I owe him that. 1170 00:46:00,675 --> 00:46:02,426 It needs to come from a friend, not a stranger, 1171 00:46:02,510 --> 00:46:04,470 otherwise he's gonna bail and drop dead while I'm gone. 1172 00:46:04,553 --> 00:46:07,348 OK, wrap that up and then leave. 1173 00:46:07,431 --> 00:46:08,975 It's not just Duke. 1174 00:46:09,058 --> 00:46:10,726 I'm not sure that Al-Hashimi is fit to run this place. 1175 00:46:10,810 --> 00:46:11,936 - What's that supposed to mean? - I'm not sure. 1176 00:46:12,019 --> 00:46:13,562 I'm trying to figure that out. 1177 00:46:13,646 --> 00:46:14,814 Did you know that she wants to have two attendings 1178 00:46:14,897 --> 00:46:16,440 - on at all times? - No. 1179 00:46:16,524 --> 00:46:17,942 Is that something she's worked out with Gloria? 1180 00:46:18,025 --> 00:46:19,485 - I don't know. - I also don't know 1181 00:46:19,568 --> 00:46:20,820 if Langdon is going to relapse. 1182 00:46:20,903 --> 00:46:21,889 I don't know if Whitaker's gonna be able 1183 00:46:21,904 --> 00:46:23,197 to take care of my shit. 1184 00:46:23,281 --> 00:46:24,782 I don't know if Javadi's gonna give up on 1185 00:46:24,865 --> 00:46:26,659 what she's good at or if Samira's gonna flame out 1186 00:46:26,742 --> 00:46:28,077 because of some bullshit with her mother. 1187 00:46:28,160 --> 00:46:30,496 - Is there anything else? - Yeah, you. 1188 00:46:30,579 --> 00:46:32,707 I don't know about you running around 1189 00:46:32,790 --> 00:46:34,500 with a full syringe of Versed in your pocket. 1190 00:46:34,583 --> 00:46:36,877 I'm worried about the people that I care about. 1191 00:46:36,961 --> 00:46:39,297 We'll all manage until you come back. 1192 00:46:39,380 --> 00:46:40,464 We always do. 1193 00:46:40,548 --> 00:46:42,300 Yeah? What if I don't come back?