1 00:00:15,703 --> 00:00:17,121 - You know this guy? - Orlando Diaz. 2 00:00:17,205 --> 00:00:18,873 We were treating him for DKA when he eloped. 3 00:00:18,956 --> 00:00:20,458 - How far did he fall? - 20 feet or so. 4 00:00:20,541 --> 00:00:22,293 - Anyone see him pass out? - No. 5 00:00:22,377 --> 00:00:24,420 They went looking for him after he didn't answer his radio. 6 00:00:24,504 --> 00:00:25,630 Pupils equal but sluggish. 7 00:00:25,713 --> 00:00:27,006 He left against medical advice. 8 00:00:27,090 --> 00:00:29,717 On my count, three, two, one. 9 00:00:30,968 --> 00:00:33,179 Dr. Ellis on the case. Day shift, we got this. 10 00:00:33,262 --> 00:00:35,556 - I'm staying. - Continuity of care. 11 00:00:35,640 --> 00:00:36,933 Dr. Al-Hashimi, why don't you go cover 12 00:00:37,016 --> 00:00:38,226 sign-out rounds with Dr. Abbot? 13 00:00:38,309 --> 00:00:39,560 - Shen, you too. - Got it. 14 00:00:39,644 --> 00:00:41,646 OK, let me know if you need anything. 15 00:00:41,729 --> 00:00:44,232 - Lungs are up bilaterally. - Pelvis is stable. 16 00:00:44,315 --> 00:00:48,111 Right tib-fib hematoma, deformed right forearm. 17 00:00:48,194 --> 00:00:50,113 Ruptured TM on the left with sero-sanguinous fluid. 18 00:00:50,196 --> 00:00:51,906 That means basilar skull fracture. 19 00:00:51,989 --> 00:00:53,700 We've got a diabetic patient, 20-foot fall. 20 00:00:53,783 --> 00:00:56,035 BP 204 over 98, pulse 56. 21 00:00:56,119 --> 00:00:57,704 Dr. Mohan, what do those numbers indicate? 22 00:00:57,787 --> 00:00:59,497 I'm trying to treat the patient. 23 00:00:59,580 --> 00:01:00,790 It's the Cushing's reflex. 24 00:01:00,873 --> 00:01:02,917 From increased intracranial pressure. 25 00:01:03,000 --> 00:01:05,253 Yeah, we need to get him to CT right away. 26 00:01:05,336 --> 00:01:06,921 No free fluid in the belly. 27 00:01:07,004 --> 00:01:10,258 - Any family to notify? - Wife and three kids. 28 00:01:10,341 --> 00:01:12,343 Is there a card to sign for Robby? 29 00:01:12,427 --> 00:01:14,387 No, he said no card, no presents. 30 00:01:14,470 --> 00:01:15,805 Oh. Was there a cake? 31 00:01:15,888 --> 00:01:17,390 Oh, he didn't want that either. 32 00:01:17,473 --> 00:01:19,350 That sucks. I need some cake. 33 00:01:19,434 --> 00:01:21,561 Patient was injured when they raided a restaurant. 34 00:01:21,644 --> 00:01:23,354 And they actually arrested the nurse? 35 00:01:23,438 --> 00:01:25,898 - With a takedown and zip ties. - Damn. 36 00:01:25,982 --> 00:01:28,025 Crus, you, uh, know the computer downtime drill? 37 00:01:28,109 --> 00:01:29,485 Yeah, no biggie. 38 00:01:29,569 --> 00:01:31,154 I prefer to treat 'em without labs and X-rays. 39 00:01:31,237 --> 00:01:32,655 Welcome back. 40 00:01:32,739 --> 00:01:34,532 If you do have orders for labs and X-rays, 41 00:01:34,615 --> 00:01:36,617 clipboards go here. 42 00:01:36,701 --> 00:01:39,370 If it's just nursing orders, here. 43 00:01:39,454 --> 00:01:41,164 Please write neatly, for God's sake. 44 00:01:41,247 --> 00:01:43,708 Oh, Monica, this is Nazely, new intern. 45 00:01:43,791 --> 00:01:46,586 - I don't need to know that. - So nice to meet you. 46 00:01:47,754 --> 00:01:49,380 Looks like you and me, Jack. 47 00:01:49,464 --> 00:01:50,840 Yeah, who's our senior? 48 00:01:50,923 --> 00:01:53,968 - Dr. Henderson. - Excellent. 49 00:01:54,051 --> 00:01:55,845 Night shift's on Crus control. 50 00:01:55,928 --> 00:01:57,972 You hear ICE brought us a patient? 51 00:01:58,055 --> 00:01:59,766 Oh, yeah? How'd that go? 52 00:01:59,849 --> 00:02:00,892 There was some collateral damage. 53 00:02:00,975 --> 00:02:02,393 They arrested Jesse. 54 00:02:02,477 --> 00:02:04,395 - For what? - Assaulting a federal officer. 55 00:02:04,479 --> 00:02:05,938 Are you fucking kidding me? 56 00:02:06,022 --> 00:02:07,315 Oh, Dr. Al-Hashimi, 57 00:02:07,398 --> 00:02:09,609 this is Nazely Toomarian… new intern. 58 00:02:16,407 --> 00:02:18,242 OK, everybody, let's huddle up. 59 00:02:18,326 --> 00:02:19,577 Before we start, 60 00:02:19,660 --> 00:02:21,204 let me address the elephant in the room. 61 00:02:21,287 --> 00:02:22,997 For those of you who don't know, 62 00:02:23,080 --> 00:02:24,457 Jesse tried to intervene 63 00:02:24,540 --> 00:02:26,250 when a federal agent was handling his patient, 64 00:02:26,334 --> 00:02:28,628 and both he and the patient were taken away by ICE. 65 00:02:28,711 --> 00:02:30,296 - Did he punch the guy? - No. 66 00:02:30,379 --> 00:02:32,715 He put out a hand to stop him, made physical contact. 67 00:02:32,799 --> 00:02:34,300 It was a little bit more than that. 68 00:02:34,383 --> 00:02:35,885 The hospital lawyers are on the case, 69 00:02:35,968 --> 00:02:38,221 and we will brief the staff every 12 hours 70 00:02:38,304 --> 00:02:39,972 at sign-out rounds with an official update. 71 00:02:40,056 --> 00:02:42,475 In the meantime, don't feed the rumor mill. 72 00:02:42,558 --> 00:02:44,811 You may have also heard that new grad nurse Emma here 73 00:02:44,894 --> 00:02:47,313 - was assaulted by a patient. - I…I'm fine. 74 00:02:47,396 --> 00:02:48,940 Please don't forget "code hula hoop," 75 00:02:49,023 --> 00:02:50,274 and with risky patients, 76 00:02:50,358 --> 00:02:52,610 always keep a path to the door clear. 77 00:02:52,693 --> 00:02:54,278 Sounds like one hell of a day. 78 00:02:54,362 --> 00:02:56,113 And we're still dealing with downtime, 79 00:02:56,197 --> 00:02:58,282 so day shift should brief night residents 80 00:02:58,366 --> 00:02:59,617 about the protocol… 81 00:02:59,700 --> 00:03:00,645 Hey! 82 00:03:00,660 --> 00:03:02,245 Oh, all right! 83 00:03:02,328 --> 00:03:04,455 Oh, thank God. 84 00:03:04,539 --> 00:03:05,832 Yeah, not so fast. 85 00:03:05,915 --> 00:03:07,708 Every chart from the last five hours 86 00:03:07,792 --> 00:03:10,044 needs to be scanned into the Electronic Health Record 87 00:03:10,127 --> 00:03:12,088 and checked for accuracy… 88 00:03:12,171 --> 00:03:14,257 - Um, whose job is that? - Day shift. 89 00:03:14,340 --> 00:03:16,217 With a completed and signed T-sheet. 90 00:03:16,300 --> 00:03:17,927 - Are you kidding me? - That's gonna take forever. 91 00:03:18,010 --> 00:03:19,679 We will set up stations for scanning. 92 00:03:19,762 --> 00:03:21,472 OK, everybody, let's get moving. 93 00:03:21,556 --> 00:03:23,641 Triage is 20 behind. Gotta help 'em clean up. 94 00:03:23,724 --> 00:03:24,892 I'm skipping rounds. 95 00:03:24,976 --> 00:03:26,727 Consider yourself lucky. 96 00:03:26,811 --> 00:03:27,979 Should we join them? 97 00:03:29,397 --> 00:03:31,023 Might as well witness the magic. 98 00:03:31,107 --> 00:03:33,276 It's like changing of the guard at Buckingham Palace. 99 00:03:33,359 --> 00:03:35,152 Except we're allowed to smile. 100 00:03:35,236 --> 00:03:37,446 "Smile though your heart is aching." 101 00:03:38,614 --> 00:03:39,615 Plain films, right tib-fib 102 00:03:39,699 --> 00:03:41,576 and right forearm after CT. 103 00:03:41,659 --> 00:03:43,578 Got the chem-8. Blood sugar's 284. 104 00:03:43,661 --> 00:03:46,205 That's not too bad. Potassium looks good. 105 00:03:46,289 --> 00:03:48,457 Mm-hmm. Anion gap's up at 14. 106 00:03:48,541 --> 00:03:49,709 It was 24 this morning. 107 00:03:49,792 --> 00:03:51,377 He's definitely improving. 108 00:03:51,460 --> 00:03:52,753 The DKA is resolving. 109 00:03:52,837 --> 00:03:54,380 So what made him pass out? 110 00:03:54,463 --> 00:03:56,215 It's hot as hell out there. 111 00:03:56,299 --> 00:03:58,384 He could have been dehydrated from sweating. 112 00:03:58,467 --> 00:04:01,846 Or he could have had an N-STEMI or a posterior CVA. 113 00:04:01,929 --> 00:04:03,389 Ready to roll. 114 00:04:05,141 --> 00:04:07,768 - I can babysit him at CT. - Thank you. 115 00:04:07,852 --> 00:04:10,062 I'll stay in case he needs the OR. 116 00:04:11,898 --> 00:04:13,774 Hey, we're back up. 117 00:04:13,858 --> 00:04:15,776 It's about time. 118 00:04:15,860 --> 00:04:17,236 - Ooh, Robby. - Yeah. 119 00:04:17,320 --> 00:04:19,447 I got intel on where ICE has taken Jesse. 120 00:04:19,530 --> 00:04:20,698 Intel from who? 121 00:04:20,781 --> 00:04:22,575 Uh, my brother-in-law's a cop. 122 00:04:22,658 --> 00:04:24,911 So he'll be processed at DHS Southside 123 00:04:24,994 --> 00:04:27,413 and then transferred to ICE detention in Clearfield. 124 00:04:27,496 --> 00:04:28,706 Clearfield? That's two hours away. 125 00:04:28,789 --> 00:04:30,207 Mm-hmm. 126 00:04:30,291 --> 00:04:32,335 OK, I'll let the hospital attorneys know. 127 00:04:32,418 --> 00:04:34,253 - How are you doing, Oliver? - Alive and kicking. 128 00:04:34,337 --> 00:04:35,630 Uh, Mr. Haas. 129 00:04:35,713 --> 00:04:37,924 Pulmonary edema after missed dialysis, 130 00:04:38,007 --> 00:04:40,509 now stable with his son Mason at the bedside. 131 00:04:40,593 --> 00:04:42,136 - Hello. - I'm Dr. Shen. 132 00:04:42,219 --> 00:04:43,346 I'll be back. 133 00:04:43,429 --> 00:04:44,429 Dialysis tech says 134 00:04:44,472 --> 00:04:46,182 I'm off the machine at 10:42. 135 00:04:46,265 --> 00:04:48,309 Hit the call light, and I'll come running. 136 00:04:48,392 --> 00:04:50,478 South 21 next… 137 00:04:52,438 --> 00:04:54,190 Mr. Digby. 138 00:04:54,273 --> 00:04:55,775 J-just Digby. 139 00:04:55,858 --> 00:04:57,443 Dr. Mohan's patient. 140 00:04:57,526 --> 00:04:59,654 Forearm cellulitis, admit med-surge. 141 00:04:59,737 --> 00:05:01,238 - Awaiting a bed. - I can take him. 142 00:05:01,322 --> 00:05:03,074 Sold to Dr. Toomarian. 143 00:05:03,157 --> 00:05:05,493 Moving right along. 144 00:05:05,576 --> 00:05:07,286 Get enough to eat? 145 00:05:07,370 --> 00:05:09,622 We'll be back. 146 00:05:09,705 --> 00:05:13,042 Lillian Stegman. Tweaked her knee water-skiing. 147 00:05:13,125 --> 00:05:15,086 Doing a 360 off a 5-foot ramp. 148 00:05:15,169 --> 00:05:16,545 Ooh, respect. 149 00:05:16,629 --> 00:05:17,880 X-rays ordered in triage. 150 00:05:17,964 --> 00:05:19,173 That was hours ago. 151 00:05:19,256 --> 00:05:21,384 Ma'am, I'm Dr. Crus Henderson. 152 00:05:21,467 --> 00:05:23,636 Let's get you home real fast. 153 00:05:23,719 --> 00:05:25,388 - That would be wonderful. - OK, heading to North. 154 00:05:25,471 --> 00:05:27,098 Thank you. 155 00:05:27,181 --> 00:05:29,642 Looks like our first scanning station is almost ready. 156 00:05:29,725 --> 00:05:32,395 Whitaker, Santos, after rounds, this will be your post. 157 00:05:32,478 --> 00:05:35,064 - Seriously? - For…how long? 158 00:05:35,147 --> 00:05:37,191 Till we mop up this mess. 159 00:05:37,274 --> 00:05:38,859 And away we go. 160 00:05:38,943 --> 00:05:41,028 All right, now you know everything 161 00:05:41,112 --> 00:05:42,238 there is to know about rounds. 162 00:05:42,321 --> 00:05:43,406 Fascinating, right? 163 00:05:43,489 --> 00:05:45,574 Uh…yeah. 164 00:05:45,658 --> 00:05:47,868 Here, I got something better for you. 165 00:05:49,662 --> 00:05:52,456 So, Digby, we're gonna find you some new clothes, 166 00:05:52,540 --> 00:05:54,250 but my friend Emma and I wondered if you'd like 167 00:05:54,333 --> 00:05:56,877 to get cleaned up a bit first. 168 00:05:56,961 --> 00:05:58,629 I already had a shower. 169 00:05:58,713 --> 00:06:00,256 I know, and you look good. 170 00:06:00,339 --> 00:06:02,341 But the offer also comes with a shave and a haircut, 171 00:06:02,425 --> 00:06:03,592 if you're interested. 172 00:06:03,676 --> 00:06:04,802 No pressure…like I said, 173 00:06:04,885 --> 00:06:06,053 you already look great. 174 00:06:07,471 --> 00:06:10,391 - Sure, I guess. - Fantastic. 175 00:06:10,474 --> 00:06:12,393 All right, kid, fill that basin with some warm water 176 00:06:12,476 --> 00:06:14,103 and lather him up. 177 00:06:17,023 --> 00:06:19,442 - Hey, stay safe out there. - Back at you in here. 178 00:06:19,525 --> 00:06:21,444 Hey, Cary. 179 00:06:21,527 --> 00:06:23,571 You were on scene with Orlando, right? 180 00:06:23,654 --> 00:06:25,990 Did you notice anything about his fall? 181 00:06:26,073 --> 00:06:27,491 Like what? 182 00:06:27,575 --> 00:06:30,661 Like, um, if there was a break in the railing 183 00:06:30,745 --> 00:06:33,664 or if there were security cameras? 184 00:06:33,748 --> 00:06:35,249 Too busy working on the guy… 185 00:06:35,332 --> 00:06:37,710 IV, intubation, backboard, splint. 186 00:06:37,793 --> 00:06:38,878 Thanks. 187 00:06:38,961 --> 00:06:40,504 Oh, two names is a start. 188 00:06:40,588 --> 00:06:42,256 Pretty soon, we'll retire the clipboards. 189 00:06:42,339 --> 00:06:43,591 Baby Jane Doe in Pedes? 190 00:06:43,674 --> 00:06:45,468 Uh, yeah, abandoned 191 00:06:45,551 --> 00:06:48,220 in the waiting room bathroom at 7:30 a.m. 192 00:06:48,304 --> 00:06:50,681 - Safe haven drop-off? - No, she's too old for that. 193 00:06:50,765 --> 00:06:52,516 - At least two months. - I'll take her. 194 00:06:52,600 --> 00:06:54,685 Awaiting foster placement by CYF. 195 00:06:54,769 --> 00:06:57,021 - What if the mom comes back? - Call the cops. 196 00:06:57,104 --> 00:06:58,481 Day shift, get to work scanning. 197 00:06:58,564 --> 00:07:00,024 Night shift, the room numbers 198 00:07:00,107 --> 00:07:02,193 on top of the dry-erase board need a doctor. 199 00:07:02,276 --> 00:07:05,112 - Who's in BH-1? - Psych hold, danger to self. 200 00:07:05,196 --> 00:07:06,572 What's the story? 201 00:07:06,655 --> 00:07:08,449 Doctors King and Langdon were on the case. 202 00:07:08,532 --> 00:07:10,701 It's a sad story… she says her 5-year-old 203 00:07:10,785 --> 00:07:12,578 snuck into the back seat of the car to take a nap. 204 00:07:12,661 --> 00:07:14,246 Heat stroke. 205 00:07:14,330 --> 00:07:16,624 Mom was extremely distraught. Walked out into traffic. 206 00:07:16,707 --> 00:07:18,167 Grady Barnhill, wheezing 207 00:07:18,250 --> 00:07:19,794 and not responding to albuterol. 208 00:07:19,877 --> 00:07:21,670 Pulse ox 87. His mother, Naomi. 209 00:07:21,754 --> 00:07:23,881 - OK, Trauma Two's open. - On our way. 210 00:07:23,964 --> 00:07:26,383 - Uh, Mom, history of asthma? - His whole life. 211 00:07:26,467 --> 00:07:28,511 - Never this bad. - Barely moving air. 212 00:07:28,594 --> 00:07:31,138 Using all his accessory muscles. 213 00:07:31,222 --> 00:07:32,598 Call RT! 214 00:07:32,681 --> 00:07:35,351 Uh, continuous nebs, 20 milligrams an hour. 215 00:07:35,434 --> 00:07:36,852 We have a home nebulizer. 216 00:07:36,936 --> 00:07:39,730 I've been giving him albuterol every hour. 217 00:07:39,814 --> 00:07:40,856 Ready? 218 00:07:40,940 --> 00:07:43,776 On my count, one, two, three. 219 00:07:43,859 --> 00:07:45,236 Does he take any other medications? 220 00:07:45,319 --> 00:07:46,737 Just the albuterol. 221 00:07:46,821 --> 00:07:48,280 He used to be on montelukast and Symbicort. 222 00:07:48,364 --> 00:07:49,865 Why did you stop that? 223 00:07:49,949 --> 00:07:51,909 Because he lost his Medicaid two months ago. 224 00:07:51,992 --> 00:07:53,744 He's so tight, nothing's getting through. 225 00:07:53,828 --> 00:07:55,329 - Mel, EpiPen. - On it. 226 00:07:55,412 --> 00:07:56,831 0.3 milligrams. 227 00:07:56,914 --> 00:07:59,959 That may open his lungs so the nebs can work. 228 00:08:00,042 --> 00:08:02,044 All right, Grady, shot in the thigh. 229 00:08:07,091 --> 00:08:08,843 Hey. 230 00:08:08,926 --> 00:08:10,302 Something to scan? 231 00:08:10,386 --> 00:08:11,846 Critical labs on North Three. 232 00:08:11,929 --> 00:08:13,430 Oh, it's, uh… it's not my patient. 233 00:08:13,514 --> 00:08:14,765 She's about to be. 234 00:08:16,684 --> 00:08:18,936 I'm, uh… I'm off the clock, so… 235 00:08:19,019 --> 00:08:21,605 These were ordered three hours ago from triage, 236 00:08:21,689 --> 00:08:24,066 so, technically, she is a day-shift patient. 237 00:08:24,150 --> 00:08:25,359 Just get the intern started. 238 00:08:25,442 --> 00:08:26,902 I got a meeting upstairs with admin 239 00:08:26,986 --> 00:08:28,904 to get things back on track. 240 00:08:28,988 --> 00:08:30,656 Sorry. Everyone else is tied up. 241 00:08:30,739 --> 00:08:32,032 That's OK. 242 00:08:32,116 --> 00:08:33,242 How'd you get stuck on night shift 243 00:08:33,325 --> 00:08:34,410 for your first rotation? 244 00:08:34,493 --> 00:08:35,870 Just lucky, I guess. 245 00:08:35,953 --> 00:08:37,413 Yeah, if you like a good horror movie. 246 00:08:38,831 --> 00:08:40,708 - Where was med school? - Uh, UC Irvine. 247 00:08:40,791 --> 00:08:42,501 - California, right? - Yep. 248 00:08:42,585 --> 00:08:43,752 Pittsburgh's a little different. 249 00:08:43,836 --> 00:08:44,962 Yeah, a lot more humidity. 250 00:08:45,045 --> 00:08:46,046 Yeah, that'll go away 251 00:08:46,130 --> 00:08:47,965 with your first foot of snow. 252 00:08:48,048 --> 00:08:50,759 Uh, hi, Mrs. Davis. 253 00:08:50,843 --> 00:08:52,803 I am Dr. McKay. This is Doctor… 254 00:08:52,887 --> 00:08:55,055 - Toomarian. - Hello. 255 00:08:55,139 --> 00:08:58,184 Uh, your labs show a lot of inflammation in your liver. 256 00:08:58,267 --> 00:09:01,562 - Is that why I'm so nauseated? - Definitely, yeah. 257 00:09:01,645 --> 00:09:04,648 Have you, um, noticed a change in your skin coloration? 258 00:09:04,732 --> 00:09:06,692 I've been using this bronzing cream 259 00:09:06,775 --> 00:09:09,361 so I don't look like a ghost in my bathing suit. 260 00:09:09,445 --> 00:09:11,322 Do you remember the name of the bronzer? 261 00:09:11,405 --> 00:09:12,865 It could have a chemical that can cause… 262 00:09:12,948 --> 00:09:14,909 Oh, no, no, it's 100% natural. 263 00:09:14,992 --> 00:09:18,162 - It's DHA from sugar beets. - OK. 264 00:09:18,245 --> 00:09:20,331 Why would my liver be inflamed? 265 00:09:20,414 --> 00:09:22,291 Uh, there's a lot of possibilities. 266 00:09:22,374 --> 00:09:24,126 Are you taking any prescription medications? 267 00:09:24,210 --> 00:09:25,196 Not a single one. 268 00:09:25,211 --> 00:09:26,712 - Tylenol? - God, no. 269 00:09:26,795 --> 00:09:28,923 We have to ask everybody about injection drug use. 270 00:09:29,006 --> 00:09:30,049 Never. 271 00:09:30,132 --> 00:09:31,717 Raw clams or oysters? 272 00:09:31,800 --> 00:09:33,552 I'm a vegan. 273 00:09:33,636 --> 00:09:35,763 One step at a time, OK? 274 00:09:35,846 --> 00:09:36,931 We'll be back. 275 00:09:38,349 --> 00:09:40,184 Digby, Haas, now on the big board. 276 00:09:40,267 --> 00:09:41,253 Progress. 277 00:09:41,268 --> 00:09:42,254 So he's just been waiting 278 00:09:42,269 --> 00:09:43,854 in the hall the whole time? 279 00:09:43,938 --> 00:09:46,815 OK, well, can you maybe get to him next? 280 00:09:48,108 --> 00:09:49,151 Thank you. 281 00:09:50,277 --> 00:09:51,862 Duke goes to CT, and they bump him. 282 00:09:51,946 --> 00:09:54,365 Yeah, he may end up waiting for hours over there. 283 00:09:54,448 --> 00:09:56,867 Oh, look at that. 7:15 already. 284 00:09:56,951 --> 00:09:58,827 Just a few more loose ends to tie up. 285 00:09:58,911 --> 00:10:02,039 You got more loose ends than a macramé wall hanging. 286 00:10:02,122 --> 00:10:04,333 My mom had one. Took up the whole goddamn wall. 287 00:10:04,416 --> 00:10:06,043 Seriously, you should think about signing out 288 00:10:06,126 --> 00:10:07,836 - and hitting the road. - Yeah, maybe you should too. 289 00:10:07,920 --> 00:10:09,588 Oh, that's right, you sent Lena home. 290 00:10:09,672 --> 00:10:11,465 Are you planning on calling in a replacement, 291 00:10:11,548 --> 00:10:13,259 or are you just gonna work till sunrise? 292 00:10:13,342 --> 00:10:14,677 If I have to. 293 00:10:14,760 --> 00:10:16,762 Oh, so you get to go the extra mile, 294 00:10:16,845 --> 00:10:19,265 and the rest of us just get accused of being martyrs. 295 00:10:19,348 --> 00:10:20,641 - Robby. - Excuse me. 296 00:10:22,685 --> 00:10:24,561 - What's the word? - No subdural, no epidural. 297 00:10:24,645 --> 00:10:26,563 Diffuse brain swelling with effacement 298 00:10:26,647 --> 00:10:28,274 and compression of the ventricles. 299 00:10:28,357 --> 00:10:30,484 C-spine? Chest-abdomen-pelvis? 300 00:10:30,567 --> 00:10:32,778 Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 301 00:10:32,861 --> 00:10:33,946 Which means I'm off the hook. 302 00:10:34,029 --> 00:10:35,406 I'll send Neurosurgery down. 303 00:10:35,489 --> 00:10:37,950 If he doesn't need the OR, why Neurosurgery? 304 00:10:38,033 --> 00:10:39,368 - Wait and see. - Let's get busy. 305 00:10:39,451 --> 00:10:40,619 CVP and an art line. 306 00:10:40,703 --> 00:10:43,789 Orlando. Orlando, squeeze my hand. 307 00:10:44,957 --> 00:10:46,166 Open your eyes. 308 00:10:46,250 --> 00:10:48,711 We already know his GCS is going to be three. 309 00:10:48,794 --> 00:10:50,713 Hey, Javadi, anti-seizure prophylaxis? 310 00:10:50,796 --> 00:10:52,715 - Keppra, 20 migs per kilo. - Mixing it now. 311 00:10:52,798 --> 00:10:54,383 Gotta get this brain swelling down, Samira. 312 00:10:54,466 --> 00:10:55,551 How we gonna do that? 313 00:10:56,844 --> 00:10:58,345 - Samira? - What? 314 00:10:58,429 --> 00:11:01,557 We have to lower the intracranial pressure. 315 00:11:01,640 --> 00:11:03,267 - Mannitol. - Not the best. 316 00:11:03,350 --> 00:11:04,601 Can cause diuresis and hypotension. 317 00:11:04,685 --> 00:11:05,978 Then hypertonic saline. 318 00:11:06,061 --> 00:11:08,480 23%. 50 cc's through a central line. 319 00:11:10,399 --> 00:11:11,900 Still tight as a drum. 320 00:11:11,984 --> 00:11:13,027 Five minutes since the epi. 321 00:11:13,110 --> 00:11:14,403 He can have one more EpiPen. 322 00:11:14,486 --> 00:11:16,155 Sats are borderline, 87. 323 00:11:16,238 --> 00:11:17,573 How about BiPap? 10 over 5. 324 00:11:17,656 --> 00:11:19,742 Yes, with in-line nebs. 325 00:11:19,825 --> 00:11:21,577 All right, Grady, shot number two. 326 00:11:21,660 --> 00:11:23,787 Might as well throw in some magnesium, 50 per kilo. 327 00:11:23,871 --> 00:11:25,122 I'm sorry. He's not ventilating. 328 00:11:25,205 --> 00:11:26,498 We should be ready to intubate. 329 00:11:26,582 --> 00:11:27,875 With an asthma patient? 330 00:11:27,958 --> 00:11:29,793 There's a high risk of cardiac arrest. 331 00:11:29,877 --> 00:11:32,046 Naomi, has he ever been put on a breathing machine before? 332 00:11:32,129 --> 00:11:33,714 - Never. - Hospitalized? 333 00:11:33,797 --> 00:11:35,632 No, we could always break him with the Symbicort. 334 00:11:35,716 --> 00:11:37,092 We're gonna give the current treatment 335 00:11:37,176 --> 00:11:39,219 a few more minutes to help him turn the corner. 336 00:11:42,389 --> 00:11:44,224 I could probably do this myself 337 00:11:44,308 --> 00:11:45,642 now that my cast is off. 338 00:11:45,726 --> 00:11:47,561 Oh, that's OK. 339 00:11:47,644 --> 00:11:49,271 I don't mind. 340 00:11:53,192 --> 00:11:55,069 How long have you been a nurse? 341 00:11:56,487 --> 00:11:58,155 This is my first day. 342 00:12:00,866 --> 00:12:02,868 You're doing really good. 343 00:12:04,828 --> 00:12:06,372 Thank you. 344 00:12:10,376 --> 00:12:12,086 - Oh, shit, you OK? - Yeah. 345 00:12:12,169 --> 00:12:13,587 There's water on the floor. 346 00:12:13,670 --> 00:12:15,089 Sorry! I…I might have spilled. 347 00:12:15,172 --> 00:12:16,507 Yeah, no worries. 348 00:12:16,590 --> 00:12:18,550 We're gonna have to sort these all by patient 349 00:12:18,634 --> 00:12:20,344 before we scan them. 350 00:12:20,427 --> 00:12:23,013 Is, uh, Joy still around? 351 00:12:23,097 --> 00:12:25,682 I heard she left at 6:59. 352 00:12:25,766 --> 00:12:27,684 - Smart girl. - Mm-hmm. 353 00:12:27,768 --> 00:12:29,853 You know what? Find Ogilvie. He's such an ass-kisser. 354 00:12:29,937 --> 00:12:31,522 He might stay and scan all the charts himself. 355 00:12:31,605 --> 00:12:33,690 Oh, he, uh, scrubbed in in the OR, 356 00:12:33,774 --> 00:12:35,609 scrubbed in on the ruptured triple-A. 357 00:12:35,692 --> 00:12:37,319 Oh, the kidney stone that wasn't. 358 00:12:37,403 --> 00:12:39,196 That'll be four hours at least. 359 00:12:41,156 --> 00:12:44,493 So are you still going to Amy's after work? 360 00:12:44,576 --> 00:12:46,412 Yeah, maybe just for tonight, 361 00:12:46,495 --> 00:12:48,789 after Robby briefs me on all the house stuff. 362 00:12:49,915 --> 00:12:51,333 Sounds fun. 363 00:12:52,751 --> 00:12:54,670 When he asked, it was hard to say no. 364 00:12:54,753 --> 00:12:56,088 Sure. 365 00:12:58,340 --> 00:13:00,509 It's gonna be very weird without him here. 366 00:13:00,592 --> 00:13:01,927 Yeah. 367 00:13:02,010 --> 00:13:04,471 You think Dr. Al-Hashimi can handle it? 368 00:13:04,555 --> 00:13:06,014 In a word, no. 369 00:13:06,098 --> 00:13:07,433 She's smart. 370 00:13:07,516 --> 00:13:08,725 It takes more than that. 371 00:13:08,809 --> 00:13:10,352 Yeah, well, at least 372 00:13:10,436 --> 00:13:11,728 it's only three months. 373 00:13:11,812 --> 00:13:13,856 Yeah, three long months. 374 00:13:13,939 --> 00:13:15,566 Then you need to find a new home. 375 00:13:16,525 --> 00:13:17,901 Not necessarily. 376 00:13:17,985 --> 00:13:19,987 I mean, if I wanted, I could just check on 377 00:13:20,070 --> 00:13:23,073 Robby's house once or twice a day, you know. 378 00:13:23,157 --> 00:13:24,825 Why would you do that? 379 00:13:26,201 --> 00:13:28,328 I don't know. Why not? 380 00:13:31,415 --> 00:13:32,791 Hypertonic's in. 381 00:13:32,875 --> 00:13:34,918 Maintenance LR in the AC. 382 00:13:35,002 --> 00:13:36,712 Looks like a halo sign. 383 00:13:36,795 --> 00:13:39,298 Cerebrospinal fluid from a basilar skull fracture. 384 00:13:39,381 --> 00:13:43,302 The halo sign is neither sensitive nor specific for CSF. 385 00:13:43,385 --> 00:13:45,596 Saline, tap water, and runny noses 386 00:13:45,679 --> 00:13:46,805 all separate from blood. 387 00:13:46,889 --> 00:13:48,307 - Hello, Linda. - Robby. 388 00:13:48,390 --> 00:13:50,767 Division chief working on a holiday weekend. 389 00:13:50,851 --> 00:13:52,895 Well, somebody's got to. 390 00:13:52,978 --> 00:13:55,689 Saw the scans. This guy needs an EVD. 391 00:13:55,772 --> 00:13:57,983 External ventricular drain to take down the pressure. 392 00:13:58,066 --> 00:14:01,236 Because CPP equals "MAP" minus ICP. 393 00:14:01,320 --> 00:14:03,906 Cerebral perfusion pressure in the brain 394 00:14:03,989 --> 00:14:05,824 equals mean arterial blood pressure 395 00:14:05,908 --> 00:14:07,326 minus the pressure in the skull. 396 00:14:07,409 --> 00:14:09,036 ICP less than 22 397 00:14:09,119 --> 00:14:11,580 predicts survival and favorable outcome. 398 00:14:11,663 --> 00:14:15,959 CPP from 60 to 70 reduces morbidity and mortality. 399 00:14:16,043 --> 00:14:17,377 Can somebody assist? 400 00:14:17,461 --> 00:14:18,545 Dr. Mohan? 401 00:14:18,629 --> 00:14:19,713 I'm good. 402 00:14:20,839 --> 00:14:22,341 Samira, you should lend a hand. 403 00:14:22,424 --> 00:14:24,092 I said I'm good. 404 00:14:24,176 --> 00:14:26,970 - Javadi? - I don't think so. 405 00:14:27,054 --> 00:14:28,514 Javadi? 406 00:14:28,597 --> 00:14:31,934 As in, daughter of Raymond and Eileen? 407 00:14:32,017 --> 00:14:34,394 I was at your mother's baby shower. 408 00:14:34,478 --> 00:14:35,422 She was a resident. 409 00:14:35,437 --> 00:14:36,813 You were in utero. 410 00:14:38,315 --> 00:14:39,358 I don't know how she got through 411 00:14:39,441 --> 00:14:41,151 motherhood and training. 412 00:14:41,235 --> 00:14:42,736 Feel free to join me. 413 00:14:42,819 --> 00:14:44,613 Oh, my…my shift was over a while ago. 414 00:14:44,696 --> 00:14:46,073 OK. 415 00:14:46,156 --> 00:14:48,116 Masks all around. Two sterile gowns. 416 00:14:48,200 --> 00:14:50,744 We brought the surgical towels. Just need some Betadine. 417 00:14:50,827 --> 00:14:52,412 This is kind of an amazing opportunity. 418 00:14:53,580 --> 00:14:54,790 I'm exhausted. 419 00:14:54,873 --> 00:14:56,750 The Chief of Neurosurgery is here. 420 00:14:56,833 --> 00:14:58,210 She's kind of a legend. 421 00:14:58,293 --> 00:15:00,254 Maybe one of the night residents can do it. 422 00:15:00,337 --> 00:15:02,506 Is this about the volvulus case from earlier? 423 00:15:02,589 --> 00:15:04,091 'Cause if it is, you made a mistake. 424 00:15:04,174 --> 00:15:06,009 You need to move on. 425 00:15:06,093 --> 00:15:07,678 I do not want to come back here and find that 426 00:15:07,761 --> 00:15:10,889 you've applied for a residency in derm. 427 00:15:10,973 --> 00:15:13,559 Step up to the plate. Do it. 428 00:15:13,642 --> 00:15:14,768 Javadi will assist. 429 00:15:14,851 --> 00:15:16,436 Excellent. 430 00:15:16,520 --> 00:15:18,188 You know, I think Eileen did her first EVD with me 431 00:15:18,272 --> 00:15:20,732 back when I was a brand-new assistant professor. 432 00:15:22,150 --> 00:15:23,569 Time flies. 433 00:15:26,530 --> 00:15:27,573 How you doing, Grady? 434 00:15:27,656 --> 00:15:29,032 Still retracting. 435 00:15:29,116 --> 00:15:30,742 - Any improvement? - Not really. 436 00:15:30,826 --> 00:15:31,868 You feeling tired? 437 00:15:33,745 --> 00:15:36,248 - Do we have Aerogen in the ED? - Just in the unit. 438 00:15:36,331 --> 00:15:37,874 How fast can you get back? 439 00:15:37,958 --> 00:15:39,042 Two minutes if I take the stairs. 440 00:15:39,126 --> 00:15:40,126 Go. 441 00:15:40,168 --> 00:15:41,420 Uh, Aerogen? 442 00:15:41,503 --> 00:15:43,380 It has a 5-millimeter mesh 443 00:15:43,463 --> 00:15:46,633 that vibrates over 120,000 times per second. 444 00:15:51,805 --> 00:15:53,140 Dr. Al-Hashimi? 445 00:15:57,477 --> 00:15:58,895 You OK? 446 00:16:01,356 --> 00:16:03,358 Uh, you were telling us about Aerogen. 447 00:16:04,526 --> 00:16:05,861 Dr. Shen can explain. 448 00:16:07,279 --> 00:16:10,157 It produces droplets in the 2- to 5-micron range 449 00:16:10,240 --> 00:16:12,159 for medication delivery. 450 00:16:19,458 --> 00:16:21,918 - How's it going? - Just about to start. 451 00:16:22,002 --> 00:16:23,128 Securing the art line here. 452 00:16:23,211 --> 00:16:25,380 Measure twice, cut once. 453 00:16:25,464 --> 00:16:29,176 We enter 11 centimeters back from the nasion, 454 00:16:29,259 --> 00:16:30,802 3 centimeters lateral. 455 00:16:30,886 --> 00:16:32,387 Without any direct imaging? 456 00:16:32,471 --> 00:16:35,432 No, straight shot into the lateral ventricle… 457 00:16:35,515 --> 00:16:39,019 tried and true since 1890. 458 00:16:39,102 --> 00:16:41,396 OK, go ahead with the incision. 459 00:16:42,939 --> 00:16:45,067 Hey, you worked with Dr. Al-Hashimi at the VA. 460 00:16:45,150 --> 00:16:46,193 I did. 461 00:16:46,276 --> 00:16:47,694 For how long? 462 00:16:47,778 --> 00:16:49,655 During my R2 rotation 463 00:16:49,738 --> 00:16:51,865 and then one again last year. 464 00:16:55,285 --> 00:16:58,372 OK. Hand drill's all set. 465 00:16:58,455 --> 00:16:59,790 Maybe you should do this part. 466 00:16:59,873 --> 00:17:01,166 No, no, there's a safety stop here. 467 00:17:01,249 --> 00:17:02,668 You can't go too deep. 468 00:17:02,751 --> 00:17:04,711 It's not brain surgery. 469 00:17:06,963 --> 00:17:08,173 OK. 470 00:17:11,385 --> 00:17:13,136 - Stay perpendicular. - OK. 471 00:17:13,220 --> 00:17:15,097 Good. 472 00:17:15,180 --> 00:17:16,848 All right, now, four turns 473 00:17:16,932 --> 00:17:18,058 to get through the outer table… 474 00:17:18,141 --> 00:17:19,351 - Yep. - Then half turns 475 00:17:19,434 --> 00:17:21,019 till you penetrate the skull. 476 00:17:31,863 --> 00:17:35,450 Three, four. 477 00:17:35,534 --> 00:17:36,785 One… 478 00:17:38,787 --> 00:17:40,372 Holy smoke! 479 00:17:40,455 --> 00:17:43,792 I thought it was Tom Cruise for a second over here. 480 00:17:43,875 --> 00:17:46,837 Nice job. How's that feel, Digby? 481 00:17:46,920 --> 00:17:48,422 - Pretty good. - I bet. 482 00:17:48,505 --> 00:17:49,715 What do you say we trim up 483 00:17:49,798 --> 00:17:51,508 those gorgeous locks of yours now? 484 00:17:53,218 --> 00:17:55,178 I don't like having my hair cut. 485 00:17:55,262 --> 00:17:58,515 I get it, Rapunzel, but you need your ears lowered. 486 00:17:58,598 --> 00:18:00,642 You'll feel better with a fresh summer look 487 00:18:00,726 --> 00:18:02,728 that won't go unnoticed by the ladies. 488 00:18:04,646 --> 00:18:06,940 - Maybe just a trim? - Great. 489 00:18:07,023 --> 00:18:09,151 I'm thinking a pixie cut. 490 00:18:09,234 --> 00:18:10,944 - What? - I'm kidding. 491 00:18:11,027 --> 00:18:12,738 I cut my husband Benji's hair all the time. 492 00:18:12,821 --> 00:18:14,239 Trust me, you're gonna look fabulous. 493 00:18:14,322 --> 00:18:15,907 When's the last time you had a haircut? 494 00:18:17,534 --> 00:18:20,746 Maybe my daughter's wedding a few years ago. 495 00:18:20,829 --> 00:18:22,080 Where? 496 00:18:22,164 --> 00:18:23,290 St. Sebastian, 497 00:18:23,373 --> 00:18:25,292 Our Lady of Mount Carmel Parish. 498 00:18:25,375 --> 00:18:27,919 Does your daughter know where you are? 499 00:18:28,003 --> 00:18:31,089 Of course. We all live in Pittsburgh. 500 00:18:31,173 --> 00:18:33,383 In fact, they live in my old house. 501 00:18:36,011 --> 00:18:38,263 Your daughter lives in your house? 502 00:18:38,346 --> 00:18:40,140 Yep. 503 00:18:40,223 --> 00:18:42,684 Where do you live? 504 00:18:42,768 --> 00:18:44,936 Wherever I want. 505 00:18:46,730 --> 00:18:48,774 You're gonna pass it 5 to 6 centimeters 506 00:18:48,857 --> 00:18:51,359 from the inner table of the skull, OK? 507 00:18:53,320 --> 00:18:55,405 Centered… 508 00:18:55,489 --> 00:18:57,240 perpendicular… 509 00:18:57,324 --> 00:18:59,117 aiming for the medial canthus. 510 00:19:00,285 --> 00:19:01,870 All yours. 511 00:19:01,953 --> 00:19:03,205 A-and just keep going? 512 00:19:03,288 --> 00:19:04,664 You'll feel a pop when you pass 513 00:19:04,748 --> 00:19:07,250 the ependymal lining. 514 00:19:07,334 --> 00:19:09,044 Art line is calibrated. Good to go. 515 00:19:09,127 --> 00:19:12,964 Titrate the nicardipine to a MAP of 85, please. 516 00:19:13,048 --> 00:19:14,382 And if we can get the intracranial pressure 517 00:19:14,466 --> 00:19:16,218 down to 20? 518 00:19:17,677 --> 00:19:19,054 Dr. Mohan? 519 00:19:19,137 --> 00:19:20,514 I'm sorry. 520 00:19:20,597 --> 00:19:22,808 MAP of 85, ICP of 20? 521 00:19:22,891 --> 00:19:25,811 Um, cerebral perfusion pressure 65. 522 00:19:25,894 --> 00:19:28,563 Which gives him the best shot at survival. 523 00:19:28,647 --> 00:19:30,065 A third of patients like this die. 524 00:19:30,148 --> 00:19:32,651 Half have long-term disability. 525 00:19:32,734 --> 00:19:34,611 We'll know in two weeks if there's a possibility 526 00:19:34,694 --> 00:19:36,947 for a good prognosis. 527 00:19:37,030 --> 00:19:38,156 Felt a pop. 528 00:19:38,240 --> 00:19:39,825 Remove the stylet. 529 00:19:42,369 --> 00:19:45,121 OK, let it drain a bit. 530 00:19:47,082 --> 00:19:49,292 And now pinch it shut. 531 00:19:50,794 --> 00:19:51,780 Perfect. 532 00:19:51,795 --> 00:19:53,588 BP is down, 190 over 88. 533 00:19:53,672 --> 00:19:55,006 Heart rate's 67. 534 00:19:59,135 --> 00:20:01,012 How are you guys doing? 535 00:20:01,096 --> 00:20:02,931 Yeah, making some progress. 536 00:20:03,014 --> 00:20:04,266 You seen Abbot? 537 00:20:04,349 --> 00:20:06,059 Not since rounds. 538 00:20:06,142 --> 00:20:08,770 He asked me to see a patient with the night intern. 539 00:20:08,854 --> 00:20:10,397 And you said yes? 540 00:20:10,480 --> 00:20:13,275 48-year-old woman, new onset jaundice, 541 00:20:13,358 --> 00:20:16,361 elevated liver enzymes, no history of alcohol use. 542 00:20:16,444 --> 00:20:17,696 Take your pick… 543 00:20:17,779 --> 00:20:20,407 hepatitis A, B, C, D, or E. 544 00:20:20,490 --> 00:20:23,285 - No risk factors, no fever. - Tylenol? 545 00:20:23,368 --> 00:20:25,161 Never, and no prescription meds. 546 00:20:25,245 --> 00:20:27,455 Does she eat polar bear liver? 547 00:20:28,665 --> 00:20:30,876 It can cause vitamin A toxicity. 548 00:20:31,835 --> 00:20:32,836 - No. - Yeah. 549 00:20:32,919 --> 00:20:34,087 She, uh, doesn't eat meat, 550 00:20:34,170 --> 00:20:35,714 kind of a health nut. 551 00:20:35,797 --> 00:20:37,132 Well, maybe she's gulping down 552 00:20:37,215 --> 00:20:38,758 cod liver oil to prevent measles. 553 00:20:38,842 --> 00:20:40,969 No. Vegan, no fish. 554 00:20:41,052 --> 00:20:43,096 Would you, uh, mind laying eyes on her? 555 00:20:43,889 --> 00:20:44,875 Seriously? 556 00:20:44,890 --> 00:20:46,975 You have a way of figuring out the weird stuff. 557 00:20:47,058 --> 00:20:48,518 Take the compliment. 558 00:20:49,936 --> 00:20:51,271 OK, fine. 559 00:20:51,354 --> 00:20:53,565 Five minutes at the bedside… that's it. 560 00:20:53,648 --> 00:20:55,525 I'm already gonna be here for hours as it is. 561 00:20:55,609 --> 00:20:57,777 Thank you. 562 00:20:57,861 --> 00:20:59,404 What am I doing… 563 00:21:02,616 --> 00:21:04,910 - Definitely improving. - Tidal volume's up. 564 00:21:04,993 --> 00:21:07,412 Wheezes now expiratory only. 565 00:21:07,495 --> 00:21:08,997 Oh, making some progress. 566 00:21:09,080 --> 00:21:11,124 You feeling better, baby? 567 00:21:11,207 --> 00:21:14,377 - You scared the shit out of me. - Language! 568 00:21:14,461 --> 00:21:16,755 Does he have a primary-care doctor? 569 00:21:16,838 --> 00:21:18,131 Not anymore. 570 00:21:18,214 --> 00:21:20,717 How do you get his prescriptions renewed? 571 00:21:20,800 --> 00:21:22,928 Neighborhood clinic. We pay cash. 572 00:21:23,011 --> 00:21:24,721 - Albuterol's cheap. - Symbicort? 573 00:21:24,804 --> 00:21:27,682 Without Medicaid, 400 bucks a month. 574 00:21:27,766 --> 00:21:29,184 Just for a little inhaler? 575 00:21:31,353 --> 00:21:32,854 Trocar is on the tube. 576 00:21:33,939 --> 00:21:37,150 I tunnel underneath the scalp about 5 centimeters 577 00:21:37,233 --> 00:21:38,652 and poke through. 578 00:21:38,735 --> 00:21:40,403 - To prevent infection? - Mm-hmm, exactly. 579 00:21:41,988 --> 00:21:44,532 Now you hold the knuckle steady while I pull it through. 580 00:21:47,911 --> 00:21:50,038 And you can staple the wound shut. 581 00:21:51,539 --> 00:21:53,583 That looks like something from Home Depot. 582 00:21:53,667 --> 00:21:55,418 Yeah, big Fourth of July sale. 583 00:21:55,502 --> 00:21:56,753 The brain pressure is measured by 584 00:21:56,836 --> 00:21:58,630 the height of the fluid column. 585 00:21:58,713 --> 00:22:01,174 We need to calibrate it to zero at the level of the tragus. 586 00:22:01,257 --> 00:22:03,218 Stopcock's on, ready to attach. 587 00:22:03,301 --> 00:22:04,594 First troponin's normal, 588 00:22:04,678 --> 00:22:07,055 but you need a second to rule out MI. 589 00:22:07,138 --> 00:22:08,932 Hey, can you step out for a second? 590 00:22:15,105 --> 00:22:16,481 I really did do everything I could 591 00:22:16,564 --> 00:22:18,066 to try to make Orlando stay. 592 00:22:18,149 --> 00:22:19,135 Yeah, I don't doubt it. 593 00:22:19,150 --> 00:22:20,136 I wanted to ask you about 594 00:22:20,151 --> 00:22:22,278 Dr. Al-Hashimi at the VA. 595 00:22:22,362 --> 00:22:24,990 Did you ever notice anything unusual about her behavior? 596 00:22:25,073 --> 00:22:26,992 Um, like what? 597 00:22:27,075 --> 00:22:29,619 Lapses in focus, attention? 598 00:22:29,703 --> 00:22:32,205 No, she was always on top of her game. 599 00:22:35,208 --> 00:22:38,837 But this morning when she was checking labs on Baby Jane Doe, 600 00:22:38,920 --> 00:22:41,256 it was like she zoned out for a few seconds. 601 00:22:42,757 --> 00:22:44,509 Maybe she was just tired. 602 00:22:51,558 --> 00:22:53,810 No congestion, nodules, 603 00:22:53,893 --> 00:22:55,270 or cirrhosis. 604 00:22:55,353 --> 00:22:56,938 Good-looking liver. 605 00:22:57,022 --> 00:22:58,815 I should not be sick. 606 00:22:58,898 --> 00:23:01,443 I work so hard to stay healthy… 607 00:23:01,526 --> 00:23:04,362 diet, exercise, eight hours of sleep. 608 00:23:04,446 --> 00:23:08,199 I can't remember the last time I got eight hours. 609 00:23:08,283 --> 00:23:10,201 Maybe you should try sleepmaxxing. 610 00:23:10,285 --> 00:23:12,120 Oh, you definitely should. 611 00:23:12,203 --> 00:23:15,040 Yeah, cold room, white noise, eye shades. 612 00:23:15,123 --> 00:23:18,877 Kiwis before bedtime, lettuce water, mouth taping. 613 00:23:18,960 --> 00:23:20,545 Who do you follow for health? 614 00:23:20,628 --> 00:23:22,881 A few naturopaths and some functional healers. 615 00:23:22,964 --> 00:23:24,841 Do you…do you buy vitamins from them? 616 00:23:24,924 --> 00:23:26,676 Oh, no, no, I don't take vitamins. 617 00:23:26,760 --> 00:23:29,471 Food is the best medicine… kale, blueberries, 618 00:23:29,554 --> 00:23:32,057 - kidney beans, turmeric. - Turmeric? 619 00:23:32,140 --> 00:23:33,767 Uh, how long have you been taking that? 620 00:23:33,850 --> 00:23:36,311 For a few months. It's an anti-inflammatory. 621 00:23:36,394 --> 00:23:38,855 It detoxes the body, and it can prevent Alzheimer's. 622 00:23:38,938 --> 00:23:40,315 How much do you take? 623 00:23:40,398 --> 00:23:42,317 500 milligram capsules, 624 00:23:42,400 --> 00:23:43,610 but I take five a day. 625 00:23:45,361 --> 00:23:46,863 What? 626 00:23:46,946 --> 00:23:48,698 With doses that large of turmeric, 627 00:23:48,782 --> 00:23:51,326 there have been cases of liver failure. 628 00:23:51,409 --> 00:23:53,036 From eating a spice? 629 00:23:53,119 --> 00:23:55,705 All right, Digby, I think you're good to go. 630 00:23:55,789 --> 00:23:57,874 Mm-hmm. Would you like to see? 631 00:24:10,512 --> 00:24:12,889 I haven't looked like this in a long time. 632 00:24:12,972 --> 00:24:15,391 Your family won't recognize you. 633 00:24:17,310 --> 00:24:19,395 Then how will they find me? 634 00:24:19,479 --> 00:24:21,397 They…they won't know what I look like. 635 00:24:21,481 --> 00:24:22,482 They won't know this is me. 636 00:24:22,565 --> 00:24:23,608 Of course they will. 637 00:24:23,691 --> 00:24:24,859 They know your voice. 638 00:24:24,943 --> 00:24:26,694 They know where you hang out. 639 00:24:26,778 --> 00:24:30,532 They even remember that you used to look like this. 640 00:24:30,615 --> 00:24:32,617 They remember the wedding. 641 00:24:35,578 --> 00:24:37,747 Did you dance with your daughter 642 00:24:37,831 --> 00:24:39,249 at her wedding? 643 00:24:40,667 --> 00:24:42,794 I did. 644 00:24:42,877 --> 00:24:45,880 Then she will always remember you. 645 00:24:48,633 --> 00:24:50,176 - Yeah. - OK. 646 00:24:51,678 --> 00:24:53,221 Hey, I was just looking for you. 647 00:24:53,304 --> 00:24:54,556 - What's up? - You tell me. 648 00:24:54,639 --> 00:24:56,891 - The, uh, asthma patient. - What about him? 649 00:24:56,975 --> 00:24:58,268 Seemed like you were hesitating 650 00:24:58,351 --> 00:24:59,936 talking about using Aerogen. 651 00:25:00,019 --> 00:25:01,646 I was wondering if you were having second thoughts. 652 00:25:01,729 --> 00:25:03,398 No. Just thinking. 653 00:25:03,481 --> 00:25:04,691 About? 654 00:25:04,774 --> 00:25:06,693 The best treatment plan for the patient. 655 00:25:06,776 --> 00:25:08,778 And I think he's on it. 656 00:25:08,862 --> 00:25:10,280 - Anything else? - I don't know. 657 00:25:10,363 --> 00:25:12,866 You tell me. Anything else I need to know? 658 00:25:12,949 --> 00:25:14,200 I don't think so. 659 00:25:15,869 --> 00:25:17,328 This is Dr. Robby in the ED. 660 00:25:17,412 --> 00:25:19,038 I'm checking on a patient, Ekins. 661 00:25:19,122 --> 00:25:21,583 We can take Larson and Stevens off the dry-erase. 662 00:25:21,666 --> 00:25:22,666 Consider it done. 663 00:25:22,709 --> 00:25:23,835 He's in the scanner now? 664 00:25:23,918 --> 00:25:25,295 Oh, great. 665 00:25:25,378 --> 00:25:26,379 No, I was just calling to confirm. 666 00:25:26,462 --> 00:25:27,672 Thank you. 667 00:25:27,755 --> 00:25:29,465 Any new information from upstairs? 668 00:25:29,549 --> 00:25:30,925 Nothing we don't already know. 669 00:25:31,009 --> 00:25:32,594 Same old story, huh? 670 00:25:32,677 --> 00:25:34,012 You think we should take up a collection 671 00:25:34,095 --> 00:25:35,805 for Jesse for…for bail money? 672 00:25:35,889 --> 00:25:37,390 They don't usually set bail 673 00:25:37,473 --> 00:25:39,184 until after you've appeared in front of a judge. 674 00:25:39,267 --> 00:25:41,060 With the holiday, it's not likely to happen till Monday. 675 00:25:41,144 --> 00:25:43,229 So he's gonna be locked up all weekend? 676 00:25:43,313 --> 00:25:44,939 That sucks. 677 00:25:45,023 --> 00:25:46,941 It does suck. 678 00:25:47,025 --> 00:25:49,986 Dr. Langdon, Grady's worse… much worse. 679 00:25:50,069 --> 00:25:52,780 - Need an attending? - Uh, no, we have Shen. 680 00:25:52,864 --> 00:25:54,199 Sat's down to 83. 681 00:25:54,282 --> 00:25:56,284 - What's happening? - Give us a minute. 682 00:25:56,367 --> 00:25:57,785 He's tiring out. 683 00:25:57,869 --> 00:25:59,829 Ketamine and rock. It's time to intubate. 684 00:25:59,913 --> 00:26:01,039 I'll call Volk. 685 00:26:01,122 --> 00:26:02,790 Ma'am, we have to put a tube 686 00:26:02,874 --> 00:26:04,042 down your son's windpipe 687 00:26:04,125 --> 00:26:05,501 so a machine can breathe for him. 688 00:26:05,585 --> 00:26:06,836 Oh, my God. 689 00:26:06,920 --> 00:26:08,379 Hold on, hold on. 690 00:26:08,463 --> 00:26:09,589 No lung sliding on the right. 691 00:26:09,672 --> 00:26:11,090 Pneumothorax. 692 00:26:11,174 --> 00:26:13,134 No need to intubate. 693 00:26:13,218 --> 00:26:14,427 What's going on? 694 00:26:14,510 --> 00:26:16,387 He has a collapsed lung. 695 00:26:16,471 --> 00:26:18,306 There was no history of trauma 696 00:26:18,389 --> 00:26:19,807 that would have caused pneumothorax. 697 00:26:19,891 --> 00:26:21,851 Glove up, Dr. King. 698 00:26:21,935 --> 00:26:24,187 In asthma, you can get "air trapping." 699 00:26:24,270 --> 00:26:25,939 When the lungs can't fully exhale, 700 00:26:26,022 --> 00:26:27,315 eventually they overinflate, 701 00:26:27,398 --> 00:26:29,234 causing some of the tiny air sacs to burst. 702 00:26:29,317 --> 00:26:30,485 How do you fix it? 703 00:26:36,407 --> 00:26:37,407 Like that. 704 00:26:43,039 --> 00:26:45,583 It's a good thing Dr. Conley was here. 705 00:26:45,667 --> 00:26:46,876 - Yeah. - We should probably try 706 00:26:46,960 --> 00:26:48,419 to find him a Neuro-Critical ICU bed. 707 00:26:48,503 --> 00:26:50,004 We don't want to board a patient like this. 708 00:26:50,088 --> 00:26:51,673 - Mm-hmm. - Hey, Robby. 709 00:26:51,756 --> 00:26:54,259 - Hey, how did the scan go? - Fine. 710 00:26:54,342 --> 00:26:55,718 It is probably gonna take a little while 711 00:26:55,802 --> 00:26:57,178 to get the results from the radiologist. 712 00:26:57,262 --> 00:26:58,638 Well, that's not a problem. 713 00:26:58,721 --> 00:27:00,848 Nurse Vivi and I need a little time 714 00:27:00,932 --> 00:27:03,434 to coordinate our schedules over the next few months. 715 00:27:03,518 --> 00:27:04,504 - Really? - Yeah. 716 00:27:04,519 --> 00:27:05,505 I've always wanted to learn 717 00:27:05,520 --> 00:27:06,520 how to ride a motorcycle, 718 00:27:06,562 --> 00:27:07,981 and Duke offered to teach me. 719 00:27:08,064 --> 00:27:10,275 Well, nobody knows motorcycles like Duke. 720 00:27:10,358 --> 00:27:12,694 He's giving me the health care worker discount. 721 00:27:12,777 --> 00:27:14,028 He's quite the gentleman. 722 00:27:14,112 --> 00:27:15,822 Let's get him back to his room. 723 00:27:15,905 --> 00:27:18,616 How would next Saturday be for you, Vivi? 724 00:27:18,700 --> 00:27:21,953 Uh, maybe we could have some dinner after. 725 00:27:22,036 --> 00:27:23,579 Dr. Mohan, Lorrie Diaz is here. 726 00:27:23,663 --> 00:27:25,331 She wants to see her husband. She's heading back. 727 00:27:25,415 --> 00:27:26,916 OK, I'm on my way. 728 00:27:29,085 --> 00:27:31,004 - Mrs. Diaz? - Hi. 729 00:27:31,087 --> 00:27:33,881 Did Orlando go up to his room yet? 730 00:27:33,965 --> 00:27:35,383 No. Um… 731 00:27:35,466 --> 00:27:37,510 I brought him some dinner from Burgatory. 732 00:27:37,593 --> 00:27:38,886 It's a chicken burger… 733 00:27:38,970 --> 00:27:40,513 no bun, just lettuce. 734 00:27:40,596 --> 00:27:43,224 Figured it would be better than hospital food. 735 00:27:46,561 --> 00:27:50,732 He's being treated by our top brain-injury specialists. 736 00:27:50,815 --> 00:27:52,233 Will he wake up? 737 00:27:52,317 --> 00:27:54,152 We won't know for several weeks. 738 00:27:54,235 --> 00:27:56,738 And then he could be back to normal? 739 00:27:56,821 --> 00:27:59,866 Best-case scenario, it would take about a year 740 00:27:59,949 --> 00:28:02,493 before he could be independent at home. 741 00:28:02,577 --> 00:28:04,162 And the worst case? 742 00:28:04,245 --> 00:28:07,665 Round-the-clock nursing care for severe disability. 743 00:28:11,294 --> 00:28:13,421 You let him leave? 744 00:28:13,504 --> 00:28:17,425 He insisted on leaving to work at his second job. 745 00:28:17,508 --> 00:28:19,635 You couldn't make him stay? 746 00:28:19,719 --> 00:28:22,638 He was competent. He knew the risks. 747 00:28:22,722 --> 00:28:24,640 We honored his decision to leave. 748 00:28:24,724 --> 00:28:26,434 Even if it was a stupid one? 749 00:28:26,517 --> 00:28:27,935 I tried to stop him. 750 00:28:28,019 --> 00:28:29,562 Offered to get him all the supplies he'd need 751 00:28:29,645 --> 00:28:31,064 to take care of himself at home. 752 00:28:31,147 --> 00:28:33,608 But he left before I could give them to him. 753 00:28:33,691 --> 00:28:36,110 He said he couldn't afford to lose a paycheck. 754 00:28:43,659 --> 00:28:45,828 Dr. Langdon. 755 00:28:48,081 --> 00:28:49,749 Are you OK? 756 00:28:49,832 --> 00:28:52,877 Yeah. I'm just kind of, uh… 757 00:28:52,960 --> 00:28:55,338 wondering if I'm really ready to be back here. 758 00:28:55,421 --> 00:28:57,632 Well, of course you are. 759 00:28:57,715 --> 00:28:59,759 Ten months is a long time. 760 00:28:59,842 --> 00:29:03,012 I almost killed that kid with an intubation. 761 00:29:03,096 --> 00:29:06,307 Didn't even occur to me to check for pneumothorax. 762 00:29:06,391 --> 00:29:08,017 There wasn't any trauma to indicate… 763 00:29:08,101 --> 00:29:09,227 - I should have caught it. - OK. 764 00:29:15,983 --> 00:29:17,276 You know, I, um… 765 00:29:19,195 --> 00:29:22,031 I had a deposition today, 766 00:29:22,115 --> 00:29:25,493 and all the lawyer's questions made me feel like 767 00:29:25,576 --> 00:29:27,870 I was a really, really bad doctor. 768 00:29:30,248 --> 00:29:33,709 We don't always get everything right the first time. 769 00:29:34,877 --> 00:29:37,338 You would have caught the collapsed lung. 770 00:29:37,422 --> 00:29:40,049 And it may have taken a minute, but you would have saved him. 771 00:29:41,300 --> 00:29:43,636 I'm not sure Robby would agree with you. 772 00:29:43,719 --> 00:29:46,347 He's been riding me all day. 773 00:29:46,431 --> 00:29:48,224 Well, Robby's leaving for three months. 774 00:29:48,307 --> 00:29:51,060 And, you know, with Robby gone… 775 00:29:51,144 --> 00:29:53,104 I really don't want you to leave either. 776 00:29:56,691 --> 00:29:59,235 That which does not kill me makes me stronger. 777 00:29:59,318 --> 00:30:02,530 Wow, Friedrich Nietzsche. 778 00:30:02,613 --> 00:30:05,741 Yeah, Nietzsche, yeah… 779 00:30:05,825 --> 00:30:08,119 not Kelly Clarkson. 780 00:30:10,121 --> 00:30:12,039 Hey, that's a thick one. 781 00:30:12,123 --> 00:30:14,959 Yeah, Austin Green. Ogilvie's triple-A. 782 00:30:18,004 --> 00:30:20,548 Uh, G-R-E-E-N? 783 00:30:20,631 --> 00:30:21,966 Yeah. Why? What are you doing? 784 00:30:22,049 --> 00:30:23,426 Checking to see when we'll get Ogilvie 785 00:30:23,509 --> 00:30:25,344 back from the OR. 786 00:30:25,428 --> 00:30:27,388 - Oh, shit. - What? 787 00:30:27,472 --> 00:30:29,140 The guy didn't make it. 788 00:30:29,223 --> 00:30:31,434 He died on the table about 40 minutes ago. 789 00:30:31,517 --> 00:30:33,603 Then where's Ogilvie? 790 00:30:33,686 --> 00:30:35,563 Oh, man. 791 00:30:35,646 --> 00:30:38,191 His patient had a CT a year and a half ago 792 00:30:38,274 --> 00:30:40,485 that showed a 4-centimeter triple-A. 793 00:30:40,568 --> 00:30:42,153 That's too small for surgery. 794 00:30:42,236 --> 00:30:43,488 He was supposed to come back 795 00:30:43,571 --> 00:30:45,239 every six months for a repeat ultrasound, 796 00:30:45,323 --> 00:30:46,949 but looks like he didn't. 797 00:30:47,033 --> 00:30:49,619 We would've seen that if the computers were working. 798 00:30:49,702 --> 00:30:51,287 Why wouldn't he tell Ogilvie? 799 00:30:51,370 --> 00:30:53,164 I don't know. Maybe he forgot all about it. 800 00:30:53,247 --> 00:30:55,208 Or Ogilvie didn't ask the right questions. 801 00:30:56,334 --> 00:30:58,294 Dennis, hey, got a minute? 802 00:30:58,377 --> 00:31:00,838 Uh, sure. What do you need? 803 00:31:00,922 --> 00:31:02,507 Teenager with jewelry magnets 804 00:31:02,590 --> 00:31:04,509 stuck to both sides of her nasal septum. 805 00:31:04,592 --> 00:31:06,511 I tried to move them with a plastic curette. 806 00:31:06,594 --> 00:31:08,346 Too much pain, and then there was bleeding. 807 00:31:08,429 --> 00:31:10,640 Those need to come off before they cause permanent damage. 808 00:31:10,723 --> 00:31:12,225 Yeah, you think, uh, you could find, like, 809 00:31:12,308 --> 00:31:14,143 a senior or an attending? 810 00:31:14,227 --> 00:31:16,020 We're really trying to get off the clock here. 811 00:31:16,103 --> 00:31:17,188 They're all busy. 812 00:31:19,941 --> 00:31:21,484 I already took one for the team. 813 00:31:21,567 --> 00:31:23,444 Yeah, fine. 814 00:31:23,528 --> 00:31:26,989 Uh, labs on your yellow lady. 815 00:31:27,073 --> 00:31:29,450 INR is elevated, 2.2. 816 00:31:29,534 --> 00:31:31,410 Liver's in trouble but not dead yet. 817 00:31:31,494 --> 00:31:32,995 Tell her to skip the turmeric. 818 00:31:33,079 --> 00:31:35,164 Admit for monitoring, and follow the LFTs. 819 00:31:35,248 --> 00:31:36,374 - Got it. - Mm-hmm. 820 00:31:36,457 --> 00:31:37,875 - Central 10? - Yeah. 821 00:31:42,255 --> 00:31:44,340 "Sleepmaxxing"? Really? 822 00:31:44,423 --> 00:31:45,925 I track the online trends. 823 00:31:46,008 --> 00:31:48,302 Is that your secret for the tough ones? 824 00:31:48,386 --> 00:31:50,012 I just think, 825 00:31:50,096 --> 00:31:52,390 what's the stupidest thing this person could have done? 826 00:31:52,473 --> 00:31:53,641 Then assume they did it. 827 00:31:55,101 --> 00:31:57,228 Well, I mean, she was trying to be healthy. 828 00:31:57,311 --> 00:31:59,564 Yeah, by taking advice from fools. 829 00:31:59,647 --> 00:32:01,774 Turmeric is recommended by a lot of doctors. 830 00:32:01,857 --> 00:32:03,776 Yeah, then ask your doctor for the dose 831 00:32:03,859 --> 00:32:06,362 or check someplace reputable, like the CDC. 832 00:32:06,445 --> 00:32:09,657 Oh, right, I forgot, it's now a medical toxic waste site. 833 00:32:09,740 --> 00:32:12,702 I mean, she's in pretty bad shape. 834 00:32:12,785 --> 00:32:14,996 If things get worse, she could need a liver transplant. 835 00:32:15,079 --> 00:32:17,123 Yeah, 'cause she's a big fucking idiot. 836 00:32:18,708 --> 00:32:20,459 Wow. 837 00:32:20,543 --> 00:32:22,712 No, I actually appreciate her. 838 00:32:22,795 --> 00:32:25,464 Our job security depends on all these big fucking idiots. 839 00:32:27,925 --> 00:32:29,135 OK. 840 00:32:31,470 --> 00:32:34,849 Uh, good night, Perlah, Monica. 841 00:32:34,932 --> 00:32:37,602 - Good night, Dr. Robby. - Good night. 842 00:32:37,685 --> 00:32:39,186 Bye, Emma. 843 00:32:39,270 --> 00:32:40,646 You could stay to pitch in. 844 00:32:40,730 --> 00:32:42,607 Mm, Dana told me to go and get some rest 845 00:32:42,690 --> 00:32:44,025 before tomorrow's shift. 846 00:32:44,108 --> 00:32:45,693 Yeah, you had quite a day. 847 00:32:45,776 --> 00:32:47,069 Wasn't so bad. 848 00:32:49,113 --> 00:32:50,865 Why can't I find Duke's results? 849 00:32:50,948 --> 00:32:53,618 Oh, new patient, no EHR yet. 850 00:32:53,701 --> 00:32:56,412 I can run over to Radiology, get a printout. 851 00:32:56,495 --> 00:32:57,872 Thank you, Monica. 852 00:33:00,416 --> 00:33:02,335 Ready to pick up a few more. 853 00:33:02,418 --> 00:33:03,753 Orlando's all tucked in for now. 854 00:33:03,836 --> 00:33:05,379 - How's he doing? - Numbers are good. 855 00:33:05,463 --> 00:33:07,214 CPP 22. 856 00:33:07,298 --> 00:33:09,842 OK, so he's got a shot at a decent outcome at least. 857 00:33:09,925 --> 00:33:11,469 You think he has a chance? 858 00:33:11,552 --> 00:33:13,679 Oh, I don't know that survival was 859 00:33:13,763 --> 00:33:15,681 the outcome he was hoping for. 860 00:33:15,765 --> 00:33:17,308 What? 861 00:33:17,391 --> 00:33:19,518 He told Samira he's got $100,000 in medical debt, 862 00:33:19,602 --> 00:33:22,021 - that his life is probably… - Mrs. Diaz! 863 00:33:24,357 --> 00:33:26,776 - How can we help you? - The bathroom? 864 00:33:26,859 --> 00:33:29,487 Uh, yeah. Perlah can show you the way. 865 00:33:31,280 --> 00:33:33,616 Not a great idea to have a private conversation 866 00:33:33,699 --> 00:33:34,867 about a patient in a public area. 867 00:33:34,950 --> 00:33:36,869 I know. I know. 868 00:33:36,952 --> 00:33:38,245 You were about to start yapping… 869 00:33:38,329 --> 00:33:39,830 But I didn't! 870 00:33:42,375 --> 00:33:45,252 OK. 871 00:33:45,336 --> 00:33:47,588 And how long have they been in there? 872 00:33:47,672 --> 00:33:49,048 At least two hours. 873 00:33:49,131 --> 00:33:51,467 - How did it happen? - With my earring. 874 00:33:51,550 --> 00:33:54,387 It was supposed to be, uh, red, white, and blue 875 00:33:54,470 --> 00:33:56,180 to look cool at the fireworks. 876 00:33:56,263 --> 00:33:57,890 I told her for the nose, one side only, 877 00:33:57,973 --> 00:33:59,141 but she never listens. 878 00:33:59,225 --> 00:34:00,393 This can be pretty serious. 879 00:34:00,476 --> 00:34:01,686 If we don't get them out quickly, 880 00:34:01,769 --> 00:34:03,104 it can cut off the blood supply 881 00:34:03,187 --> 00:34:05,022 and cause the septum to collapse. 882 00:34:05,106 --> 00:34:08,609 Like, my nose could be deformed? 883 00:34:10,903 --> 00:34:13,406 - Oh, my God, get them off. - Yeah, that's the plan. 884 00:34:13,489 --> 00:34:15,116 Yeah, she tried already. It hurt like crazy. 885 00:34:15,199 --> 00:34:16,283 Because they're stuck together 886 00:34:16,367 --> 00:34:18,411 by a very strong magnetic force. 887 00:34:18,494 --> 00:34:20,329 - Yeah. - No, no, no. 888 00:34:20,413 --> 00:34:22,081 Oh, uh, I'm not gonna use the tips. 889 00:34:22,164 --> 00:34:25,126 I'm gonna flip it around and use the handle. 890 00:34:25,209 --> 00:34:26,752 It's still gonna hurt. 891 00:34:26,836 --> 00:34:27,962 Probably not. 892 00:34:28,045 --> 00:34:29,380 Just, uh, hold still. 893 00:34:31,924 --> 00:34:33,342 OK. 894 00:34:37,596 --> 00:34:38,806 Voilà. 895 00:34:38,889 --> 00:34:41,517 - Really? - That was amazing. 896 00:34:41,600 --> 00:34:43,352 I think another half hour, 897 00:34:43,436 --> 00:34:45,062 we can send this dry-erase board back to storage. 898 00:34:45,146 --> 00:34:46,272 With pleasure. 899 00:34:46,355 --> 00:34:47,648 - Dr. Robinavitch? - Yep. 900 00:34:47,732 --> 00:34:49,150 Results on your friend. 901 00:34:53,821 --> 00:34:55,948 - Fuck. - Duke? 902 00:34:59,952 --> 00:35:01,579 Are you gonna tell him? 903 00:35:01,662 --> 00:35:03,205 I want to talk to a surgeon first. 904 00:35:03,289 --> 00:35:05,249 Uh, Dr. Robby, I have an update on the patient. 905 00:35:05,332 --> 00:35:06,667 Now is not a great time. 906 00:35:06,751 --> 00:35:08,085 Oh, I thought you were going home. 907 00:35:08,169 --> 00:35:09,295 Uh, I was. 908 00:35:09,378 --> 00:35:11,046 Dr. Ogilvie is just sitting 909 00:35:11,130 --> 00:35:12,798 out in the ambulance bay covered in blood. 910 00:35:12,882 --> 00:35:14,425 Sorry, what… what's he doing out there? 911 00:35:14,508 --> 00:35:16,385 Kind of, uh, staring off into space. 912 00:35:16,469 --> 00:35:17,678 I tried to talk to him, but it was like 913 00:35:17,762 --> 00:35:19,138 - he couldn't hear me. - Monica, 914 00:35:19,221 --> 00:35:20,723 can you stat page CardioThoracic? 915 00:35:20,806 --> 00:35:22,933 - I'll go check on Ogilvie. - Please. 916 00:35:25,269 --> 00:35:26,479 Oh. 917 00:35:37,907 --> 00:35:40,034 Hey, Ogilvie. 918 00:35:42,661 --> 00:35:44,580 Ogilvie… 919 00:35:44,663 --> 00:35:46,499 y-you OK, man? 920 00:35:51,587 --> 00:35:53,631 99 on 2 liters. 921 00:35:53,714 --> 00:35:55,966 Scattered end expiratory wheezes. 922 00:35:56,050 --> 00:35:58,177 He is so much better. 923 00:35:58,260 --> 00:36:00,221 The steroids should kick in soon. 924 00:36:00,304 --> 00:36:02,598 So he'll keep improving. 925 00:36:02,681 --> 00:36:04,934 Um, when can I go home? 926 00:36:05,017 --> 00:36:06,602 In a day or two. 927 00:36:06,685 --> 00:36:09,897 And we will, uh, discharge you with a Symbicort inhaler. 928 00:36:09,980 --> 00:36:12,066 That should last about a month. 929 00:36:12,149 --> 00:36:14,610 Hopefully we'll be back on Medicaid by then. 930 00:36:14,693 --> 00:36:16,654 How'd you lose it? 931 00:36:16,737 --> 00:36:20,157 They sent a redetermination letter to our old apartment. 932 00:36:20,241 --> 00:36:22,701 It didn't get forwarded. 933 00:36:22,785 --> 00:36:24,745 When I went to pick up his prescription, 934 00:36:24,829 --> 00:36:28,582 pharmacist told me we were no longer covered. 935 00:36:28,666 --> 00:36:30,835 And you haven't been able to get it back since? 936 00:36:30,918 --> 00:36:33,170 I've been trying for months. 937 00:36:33,254 --> 00:36:35,631 To get re-enrolled, you need tax returns, 938 00:36:35,714 --> 00:36:37,049 pay stubs. 939 00:36:37,132 --> 00:36:39,969 I cut hair. My income fluctuates. 940 00:36:40,052 --> 00:36:42,429 A lot of my regulars are struggling, 941 00:36:42,513 --> 00:36:45,558 so it's been tough. 942 00:36:45,641 --> 00:36:47,476 Well, if you run out of Symbicort 943 00:36:47,560 --> 00:36:49,854 before your Medicaid kicks in, you can come back, 944 00:36:49,937 --> 00:36:52,773 and we'll, uh, set you up with another one. 945 00:36:52,857 --> 00:36:54,775 Oh, is there a patient in here? 946 00:36:54,859 --> 00:36:57,862 'Cause everyone in this room looks extremely healthy to me. 947 00:36:57,945 --> 00:37:00,322 Dr. Shen and I will be with Grady all night long. 948 00:37:00,406 --> 00:37:02,283 Yeah. Day shift, we got this. 949 00:37:02,366 --> 00:37:04,243 We're leaving you in good hands. 950 00:37:04,326 --> 00:37:06,078 Um… 951 00:37:06,161 --> 00:37:08,497 I was really scared. 952 00:37:08,581 --> 00:37:09,707 Thank you. 953 00:37:11,417 --> 00:37:13,419 You're very welcome. 954 00:37:17,339 --> 00:37:19,925 Due to his injury, things have changed. 955 00:37:21,385 --> 00:37:23,596 I was looking for Dr. Abbot. 956 00:37:23,679 --> 00:37:26,432 I haven't seen him for a while. 957 00:37:26,515 --> 00:37:27,766 Excuse me. 958 00:37:30,811 --> 00:37:32,730 So now, with a long-term disability, 959 00:37:32,813 --> 00:37:35,441 things may be easier. 960 00:37:35,524 --> 00:37:36,609 "Easier"? 961 00:37:36,692 --> 00:37:38,110 His condition will qualify him 962 00:37:38,193 --> 00:37:39,612 for Medicare and Medicaid. 963 00:37:39,695 --> 00:37:42,114 So, moving forward, costs should be covered, 964 00:37:42,197 --> 00:37:43,908 including home health care. 965 00:37:43,991 --> 00:37:45,242 OK. 966 00:37:45,326 --> 00:37:46,702 Perhaps this isn't the best time… 967 00:37:46,785 --> 00:37:48,078 I just wanted to reassure you 968 00:37:48,162 --> 00:37:49,955 about future costs. 969 00:37:58,213 --> 00:37:59,548 Robby. 970 00:37:59,632 --> 00:38:01,717 Noelle. 971 00:38:01,800 --> 00:38:03,344 You're still here. 972 00:38:03,427 --> 00:38:05,679 It's not the best day to try to get out on time. 973 00:38:05,763 --> 00:38:07,348 Mm. 974 00:38:07,431 --> 00:38:08,807 So I guess this is it for a while. 975 00:38:08,891 --> 00:38:10,309 Unless you want to come with me. 976 00:38:10,392 --> 00:38:12,686 No, but thank you, 977 00:38:12,770 --> 00:38:14,730 even if it isn't a legitimate offer. 978 00:38:14,813 --> 00:38:16,231 - What do you mean? - Oh, please. 979 00:38:16,315 --> 00:38:18,108 I know well enough not to get in between 980 00:38:18,192 --> 00:38:20,235 a man and his vision quest. 981 00:38:21,654 --> 00:38:22,905 "Vision quest." 982 00:38:22,988 --> 00:38:26,075 That is my nice way of putting it. 983 00:38:27,326 --> 00:38:28,619 I probably don't want to hear 984 00:38:28,702 --> 00:38:30,496 your not-so-nice way of putting it. 985 00:38:30,579 --> 00:38:31,914 No, probably not. 986 00:38:33,666 --> 00:38:37,211 I-I hope that this is not, um… 987 00:38:37,294 --> 00:38:38,587 about you running away from me. 988 00:38:38,671 --> 00:38:39,838 I'm a big girl. 989 00:38:39,922 --> 00:38:41,507 You can tell me just to get lost. 990 00:38:41,590 --> 00:38:43,342 This has nothing to do with you. 991 00:38:43,425 --> 00:38:44,635 Oh, right. 992 00:38:44,718 --> 00:38:47,429 It's the old, uh, "it's not you, it's me"? 993 00:38:48,931 --> 00:38:51,100 In this case, it's actually true. 994 00:38:57,314 --> 00:38:58,941 Excuse me. 995 00:39:05,030 --> 00:39:06,323 I'll see you next week? 996 00:39:06,407 --> 00:39:07,658 It's a three-month sabbatical. 997 00:39:07,741 --> 00:39:09,702 Like I said, I will see you next week. 998 00:39:16,375 --> 00:39:19,586 My first day here as a med student… 999 00:39:19,670 --> 00:39:21,296 there was a patient. 1000 00:39:23,132 --> 00:39:24,800 He was a real nice guy, 1001 00:39:24,883 --> 00:39:27,636 came in with belly pain. 1002 00:39:27,720 --> 00:39:31,265 I saw a gall stone on the ultrasound, 1003 00:39:31,348 --> 00:39:33,434 normal EKG, troponin. 1004 00:39:33,517 --> 00:39:36,812 The pain resolved, and he was in the hall 1005 00:39:36,895 --> 00:39:38,772 when he had a cardiac arrest. 1006 00:39:41,567 --> 00:39:42,901 I couldn't save him. 1007 00:39:44,528 --> 00:39:45,946 People die. 1008 00:39:47,406 --> 00:39:50,868 And we do the best we can… 1009 00:39:50,951 --> 00:39:53,287 but people die. 1010 00:39:54,538 --> 00:39:56,498 You ever get used to it? 1011 00:39:58,292 --> 00:39:59,376 No. 1012 00:40:01,045 --> 00:40:03,797 No, you… 1013 00:40:03,881 --> 00:40:05,758 you try to accept it. 1014 00:40:07,760 --> 00:40:09,511 You try to find balance. 1015 00:40:14,975 --> 00:40:17,853 I don't know if I can take another day like today. 1016 00:40:19,396 --> 00:40:22,691 Primary care specialty sounds way better. 1017 00:40:22,775 --> 00:40:24,485 Pedes, maybe. 1018 00:40:24,568 --> 00:40:26,111 Yeah, maybe. 1019 00:40:27,654 --> 00:40:30,741 I know I'd be bored out of my fucking mind. 1020 00:40:32,076 --> 00:40:36,080 Seriously, I like the challenge of undiagnosed illness, 1021 00:40:36,163 --> 00:40:41,085 of quick decisions, of life-saving procedures. 1022 00:40:41,168 --> 00:40:43,504 And I like being here for people 1023 00:40:43,587 --> 00:40:45,964 on the worst days of their lives. 1024 00:40:54,139 --> 00:40:56,100 You know what I think? 1025 00:40:56,183 --> 00:40:57,810 What? 1026 00:40:57,893 --> 00:41:00,145 I think you should go home. 1027 00:41:00,229 --> 00:41:01,563 I think you should sleep on it. 1028 00:41:01,647 --> 00:41:03,065 And I think you should at least wait 1029 00:41:03,148 --> 00:41:04,316 till the morning to decide 1030 00:41:04,399 --> 00:41:05,818 if you want to come back. 1031 00:41:08,821 --> 00:41:11,115 I don't really want to… 1032 00:41:11,198 --> 00:41:13,742 go back in there and see anybody. 1033 00:41:13,826 --> 00:41:14,952 Yeah. 1034 00:41:16,495 --> 00:41:18,997 OK, pull off your gown. I'll take it in. 1035 00:41:19,081 --> 00:41:21,458 Shift is over. 1036 00:41:21,542 --> 00:41:23,001 Go home. 1037 00:41:35,889 --> 00:41:37,099 - Oh! - Oh, God. 1038 00:41:37,182 --> 00:41:38,183 - No, I'm…I'm… - Sorry. 1039 00:41:38,267 --> 00:41:39,601 I'm good. I'm good. I'm good. 1040 00:41:39,685 --> 00:41:41,311 There's a dummy in a wheelchair. 1041 00:41:41,395 --> 00:41:43,272 Uh, yeah, he moves around. 1042 00:41:46,358 --> 00:41:48,485 I see I've been replaced. 1043 00:41:48,569 --> 00:41:50,028 Oh, did I take your spot? 1044 00:41:50,112 --> 00:41:51,697 - Not really, no. - Are you sure? 1045 00:41:51,780 --> 00:41:53,157 Where the hell have you been? 1046 00:41:53,240 --> 00:41:54,783 I found Ogilvie. 1047 00:41:54,867 --> 00:41:56,076 And? 1048 00:41:56,160 --> 00:41:58,412 And he's going home. 1049 00:41:58,495 --> 00:41:59,621 That's it? 1050 00:41:59,705 --> 00:42:00,956 It's a long story. 1051 00:42:01,039 --> 00:42:02,416 Well, I got nothing but time. 1052 00:42:02,499 --> 00:42:04,585 I need to respect his privacy. 1053 00:42:04,668 --> 00:42:06,170 Where's the fun in that? 1054 00:42:06,253 --> 00:42:08,213 - Beep. Beep, beep. - Sorry. 1055 00:42:16,805 --> 00:42:18,140 Um, the shredder jammed. 1056 00:42:18,223 --> 00:42:21,185 Yeah, uh, try putting it in reverse. 1057 00:42:23,562 --> 00:42:24,730 Perfect. 1058 00:42:24,813 --> 00:42:26,815 Just give it a little love tap. 1059 00:42:26,899 --> 00:42:28,400 - OK. - Kick it. 1060 00:42:29,568 --> 00:42:31,111 Jesus Christ. 1061 00:42:33,113 --> 00:42:35,199 Guess Mr. Digby got a room upstairs. 1062 00:42:35,282 --> 00:42:36,658 In your dreams. 1063 00:42:36,742 --> 00:42:38,660 He's not in South 21. 1064 00:42:38,744 --> 00:42:40,078 Yeah, he is. 1065 00:42:40,162 --> 00:42:42,414 There's a new guy in the bed. 1066 00:42:42,497 --> 00:42:44,416 Short hair, clean-shaved? 1067 00:42:44,499 --> 00:42:46,835 I'll take care of it. 1068 00:42:46,919 --> 00:42:48,545 Scout film showed obvious pathology, 1069 00:42:48,629 --> 00:42:50,088 so we ordered the CT angiogram. 1070 00:42:50,172 --> 00:42:51,757 Textbook ascending aortic aneurysm. 1071 00:42:51,840 --> 00:42:53,592 Eight centimeters. 1072 00:42:53,675 --> 00:42:55,469 50% one-year mortality. 1073 00:42:55,552 --> 00:42:56,762 So he definitely needs surgery. 1074 00:42:56,845 --> 00:42:57,831 If he wants to live. 1075 00:42:57,846 --> 00:42:58,846 OK, well, he's a friend, 1076 00:42:58,889 --> 00:43:00,098 so I will talk to him. 1077 00:43:00,182 --> 00:43:01,266 I'll get him admitted to your service. 1078 00:43:01,350 --> 00:43:03,393 - Not today. - Why not? 1079 00:43:03,477 --> 00:43:05,229 He needs to see Cardiology and Pulmonary first 1080 00:43:05,312 --> 00:43:06,480 to be cleared for the OR. 1081 00:43:06,563 --> 00:43:08,398 They can do a stress echo, PFTs. 1082 00:43:08,482 --> 00:43:10,651 He needs to be admitted and evaluated as an inpatient. 1083 00:43:10,734 --> 00:43:12,319 Nothing ever gets done over a holiday weekend. 1084 00:43:12,402 --> 00:43:13,403 He can take it easy at home. 1085 00:43:13,487 --> 00:43:14,821 He's a ticking time bomb. 1086 00:43:14,905 --> 00:43:16,156 He's probably been that way for years. 1087 00:43:16,240 --> 00:43:17,449 We can get him in early next week 1088 00:43:17,532 --> 00:43:19,034 with a specialist to get his testing done. 1089 00:43:19,117 --> 00:43:20,994 All goes well, he's on the OR schedule in a week. 1090 00:43:21,078 --> 00:43:22,621 What happens if it ruptures before then? 1091 00:43:22,704 --> 00:43:24,456 Call 911. 1092 00:43:24,539 --> 00:43:26,124 Sorry, Robby. Best we can do. 1093 00:43:26,208 --> 00:43:28,126 Text me his number. I'll have my office coordinate. 1094 00:43:30,337 --> 00:43:31,880 - Fuck! - Hey! 1095 00:43:31,964 --> 00:43:33,632 Take a walk. Come on! 1096 00:43:37,970 --> 00:43:38,956 Two for discharge. 1097 00:43:38,971 --> 00:43:40,389 Yeah, please don't ring the bell. 1098 00:43:40,472 --> 00:43:42,015 The computers are back up and running. 1099 00:43:42,099 --> 00:43:43,558 Not for these two. 1100 00:43:43,642 --> 00:43:44,977 They don't have electronic health records yet. 1101 00:43:45,060 --> 00:43:46,353 Wait, hold up. 1102 00:43:46,436 --> 00:43:48,605 This kid had a wrist X-ray ordered. 1103 00:43:48,689 --> 00:43:49,856 Ugh, it never happened. 1104 00:43:49,940 --> 00:43:51,191 And water-skiing lady's 1105 00:43:51,275 --> 00:43:52,526 still waiting on a knee series. 1106 00:43:52,609 --> 00:43:53,777 I canceled the X-rays. 1107 00:43:53,860 --> 00:43:56,113 Diagnosed them both with ultrasound. 1108 00:43:56,196 --> 00:43:57,364 Really? 1109 00:43:57,447 --> 00:43:59,116 Yeah. 1110 00:43:59,199 --> 00:44:01,576 The, uh, little boy had a simple buckle fracture. 1111 00:44:01,660 --> 00:44:04,204 Distal radius. He got a Velcro splint. 1112 00:44:04,288 --> 00:44:06,915 And Mrs. Stegman had a small medial meniscus tear. 1113 00:44:06,999 --> 00:44:09,334 Knee immobilizer, crutches, and a follow up with ortho. 1114 00:44:09,418 --> 00:44:11,670 Could have used you on the day shift today. 1115 00:44:11,753 --> 00:44:14,089 They don't teach us a lot of musculoskeletal ultrasound. 1116 00:44:14,172 --> 00:44:15,632 I know. 1117 00:44:15,716 --> 00:44:18,260 That's why I did electives at Harvard and Highland. 1118 00:44:18,343 --> 00:44:21,096 Are you applying for an ultrasound fellowship here? 1119 00:44:21,179 --> 00:44:23,890 I am, but it is so competitive. 1120 00:44:23,974 --> 00:44:26,143 - That's what I hear. - Kind of a long shot. 1121 00:44:26,226 --> 00:44:27,561 I only have one publication, 1122 00:44:27,644 --> 00:44:29,479 but it's a series of case reports diagnosing 1123 00:44:29,563 --> 00:44:32,024 shoulder dislocations with ultrasound only. 1124 00:44:32,107 --> 00:44:34,026 If you want to learn some MSK, you can tag along. 1125 00:44:34,109 --> 00:44:35,527 I got three more to scan. 1126 00:44:35,610 --> 00:44:37,529 Maybe some other time. 1127 00:44:37,612 --> 00:44:39,948 Cool. 1128 00:44:42,367 --> 00:44:44,286 Hey, don't jam the shredder. 1129 00:44:44,369 --> 00:44:45,829 What is that, two charts? 1130 00:44:45,912 --> 00:44:48,415 No, it's my ultrasound fellowship application. 1131 00:44:50,250 --> 00:44:51,793 Hey. 1132 00:44:51,877 --> 00:44:54,796 Uh, sorry about your patient. 1133 00:44:54,880 --> 00:44:57,799 Yeah, Orlando's in pretty bad shape. 1134 00:44:57,883 --> 00:44:59,718 Oh, no, I…I was talking about 1135 00:44:59,801 --> 00:45:03,388 the triple-A guy you worked on with Ogilvie. 1136 00:45:06,016 --> 00:45:08,560 He didn't make it through surgery. 1137 00:45:08,643 --> 00:45:10,103 I tried to talk to Robby about it, 1138 00:45:10,187 --> 00:45:12,105 but I think he's busy. 1139 00:45:12,189 --> 00:45:13,815 Excuse me. 1140 00:45:16,193 --> 00:45:17,944 Oh, shit. 1141 00:45:22,199 --> 00:45:23,617 You think I'm on edge? 1142 00:45:23,700 --> 00:45:25,410 First you're shaming Samira, then McKay… 1143 00:45:25,494 --> 00:45:26,745 They both needed to be called out 1144 00:45:26,828 --> 00:45:28,080 - for unacceptable behavior. - Yeah? 1145 00:45:28,163 --> 00:45:29,373 Yeah, well, you do that in private. 1146 00:45:29,456 --> 00:45:30,791 Same place you share your thoughts 1147 00:45:30,874 --> 00:45:32,000 about a patient's possible suicide. 1148 00:45:32,084 --> 00:45:33,460 And slamming stuff? Please. 1149 00:45:33,543 --> 00:45:34,669 Sign out all the shit that's bugging you 1150 00:45:34,753 --> 00:45:35,837 and get out of here. 1151 00:45:35,921 --> 00:45:37,672 - I can't. - Yes, you can. 1152 00:45:37,756 --> 00:45:39,007 When either of my kids was acting like this, 1153 00:45:39,091 --> 00:45:40,467 I gave them a time-out in their room. 1154 00:45:40,550 --> 00:45:41,635 Whoa, whoa, whoa, you're not my mother. 1155 00:45:41,718 --> 00:45:42,844 Yeah? Well, too bad. 1156 00:45:42,928 --> 00:45:44,054 - You need one. - No, I had one. 1157 00:45:44,137 --> 00:45:45,764 She left. I don't need another one. 1158 00:45:45,847 --> 00:45:47,099 What I need is someone who can actually run this place 1159 00:45:47,182 --> 00:45:49,017 - while I'm gone. - OK, I'm sorry. 1160 00:45:49,101 --> 00:45:50,352 - I didn't know. - Nobody knows. 1161 00:45:50,435 --> 00:45:52,646 Who needs to know? Who gives a fuck? 1162 00:45:52,729 --> 00:45:53,980 I think you need a break. 1163 00:45:54,064 --> 00:45:55,565 That is what the sabbatical is for. 1164 00:45:55,649 --> 00:45:57,109 Then start it now. Walk away. 1165 00:45:57,192 --> 00:45:58,360 I have too much to do. 1166 00:45:58,443 --> 00:46:00,070 Let someone else talk to Duke. 1167 00:46:00,153 --> 00:46:01,822 No, that needs to come from me. 1168 00:46:01,905 --> 00:46:03,156 Why? 1169 00:46:03,240 --> 00:46:04,741 Because I owe him that. 1170 00:46:04,825 --> 00:46:06,576 It needs to come from a friend, not a stranger, 1171 00:46:06,660 --> 00:46:08,620 otherwise he's gonna bail and drop dead while I'm gone. 1172 00:46:08,703 --> 00:46:11,498 OK, wrap that up and then leave. 1173 00:46:11,581 --> 00:46:13,125 It's not just Duke. 1174 00:46:13,208 --> 00:46:14,876 I'm not sure that Al-Hashimi is fit to run this place. 1175 00:46:14,960 --> 00:46:16,086 - What's that supposed to mean? - I'm not sure. 1176 00:46:16,169 --> 00:46:17,712 I'm trying to figure that out. 1177 00:46:17,796 --> 00:46:18,964 Did you know that she wants to have two attendings 1178 00:46:19,047 --> 00:46:20,590 - on at all times? - No. 1179 00:46:20,674 --> 00:46:22,092 Is that something she's worked out with Gloria? 1180 00:46:22,175 --> 00:46:23,635 - I don't know. - I also don't know 1181 00:46:23,718 --> 00:46:24,970 if Langdon is going to relapse. 1182 00:46:25,053 --> 00:46:26,039 I don't know if Whitaker's gonna be able 1183 00:46:26,054 --> 00:46:27,347 to take care of my shit. 1184 00:46:27,431 --> 00:46:28,932 I don't know if Javadi's gonna give up on 1185 00:46:29,015 --> 00:46:30,809 what she's good at or if Samira's gonna flame out 1186 00:46:30,892 --> 00:46:32,227 because of some bullshit with her mother. 1187 00:46:32,310 --> 00:46:34,646 - Is there anything else? - Yeah, you. 1188 00:46:34,729 --> 00:46:36,857 I don't know about you running around 1189 00:46:36,940 --> 00:46:38,650 with a full syringe of Versed in your pocket. 1190 00:46:38,733 --> 00:46:41,027 I'm worried about the people that I care about. 1191 00:46:41,111 --> 00:46:43,447 We'll all manage until you come back. 1192 00:46:43,530 --> 00:46:44,614 We always do. 1193 00:46:44,698 --> 00:46:46,450 Yeah? What if I don't come back?