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Would you like to inspect the original subtitles? These are the user uploaded subtitles that are being translated: 1 00:00:04,015 --> 00:00:05,443 Move the CR! 2 00:00:05,527 --> 00:00:06,487 Stay with me. 3 00:00:06,571 --> 00:00:07,793 So this is how it's gonna be? 4 00:00:07,877 --> 00:00:09,577 All day long, you've been talking down to me. 5 00:00:09,661 --> 00:00:11,057 I should have given you credit. 6 00:00:11,141 --> 00:00:12,102 I was very impressed with the way 7 00:00:12,186 --> 00:00:13,755 you nearly killed our patient. 8 00:00:15,928 --> 00:00:20,371 We are running low on a number of key supplies. 9 00:00:20,455 --> 00:00:22,634 No, no, no, no, no! Stop! Stop! I need that dye. 10 00:00:22,718 --> 00:00:25,898 We can't have one patient depleting our supplies. 11 00:00:25,982 --> 00:00:26,986 So call into the hospital. 12 00:00:27,070 --> 00:00:28,727 We're all in the same boat. 13 00:00:28,811 --> 00:00:30,685 Dr. Cuevas and I have a strong hunch 14 00:00:30,769 --> 00:00:33,166 that David is developing schizoaffective disorder. 15 00:00:33,250 --> 00:00:34,994 No! My boy isn't crazy. 16 00:00:35,078 --> 00:00:36,474 Stay away from us. 17 00:00:36,558 --> 00:00:39,213 How is that boy supposed to get any help? 18 00:00:40,779 --> 00:00:42,262 It is a real pleasure 19 00:00:42,346 --> 00:00:44,134 to finally meet you, Dr. Hawthorne. 20 00:00:44,218 --> 00:00:47,137 My colleague at Med, David Kwan, 21 00:00:47,221 --> 00:00:49,661 he sings your praises highly. 22 00:00:49,745 --> 00:00:51,489 Oh, I'm not the doctor. 23 00:00:51,573 --> 00:00:53,708 I'm her assistant, Katherine. 24 00:00:53,792 --> 00:00:55,014 Okay. 25 00:00:55,098 --> 00:00:57,753 Sign and date these forms, please. 26 00:01:01,844 --> 00:01:04,238 Just wherever you see a highlight. 27 00:01:07,154 --> 00:01:08,419 While you're finishing up with that, 28 00:01:08,503 --> 00:01:11,245 I'll go over our policies and procedures. 29 00:01:13,856 --> 00:01:15,513 Everything you discuss with Dr. Hawthorne 30 00:01:15,597 --> 00:01:17,689 is confidential, except in the event she feels 31 00:01:17,773 --> 00:01:19,299 - you're a danger to yourself. - You know what, Katherine? 32 00:01:19,383 --> 00:01:21,345 I'm... I'm actually a practicing psychiatrist myself, 33 00:01:21,429 --> 00:01:24,652 so, I mean, if you'd like, you can skip that part. 34 00:01:24,736 --> 00:01:25,958 I totally get it, 35 00:01:26,042 --> 00:01:28,439 but Dr. Hawthorne, who you'll meet next week, 36 00:01:28,523 --> 00:01:31,224 requires we go through the policies together. 37 00:01:31,308 --> 00:01:33,705 If the doctor feels that you're a danger to yourself or others, 38 00:01:33,789 --> 00:01:35,533 - she's required to report... - You know what, Katherine? 39 00:01:35,617 --> 00:01:38,144 I appreciate you're just trying to do your job. 40 00:01:38,228 --> 00:01:42,061 But, um, maybe you could tell Dr. Hawthorne 41 00:01:42,145 --> 00:01:45,456 to give me a call when she has a chance 42 00:01:45,540 --> 00:01:48,108 to meet me herself in person, okay? 43 00:01:49,152 --> 00:01:51,462 Um, you know what? 44 00:01:51,546 --> 00:01:56,116 On second thought, maybe tell her not to bother. 45 00:01:57,943 --> 00:01:58,943 Yeah. 46 00:02:02,339 --> 00:02:03,952 It's been a long time since 47 00:02:04,036 --> 00:02:05,128 you had to hunt for a therapist. 48 00:02:05,212 --> 00:02:06,390 Want me to shoot you some names? 49 00:02:06,474 --> 00:02:08,827 I got a small stockpile of referrals. 50 00:02:08,911 --> 00:02:09,958 I gotta be honest, Sharon, 51 00:02:10,042 --> 00:02:11,395 after these last two experiences, 52 00:02:11,479 --> 00:02:13,745 my interest in the process might be waning. 53 00:02:13,829 --> 00:02:16,574 I mean, this morning in particular 54 00:02:16,658 --> 00:02:18,837 actually had me questioning the state of psychiatry. 55 00:02:18,921 --> 00:02:21,144 Well, that assembly-line mentality 56 00:02:21,228 --> 00:02:23,189 is plaguing much of medicine these days, 57 00:02:23,273 --> 00:02:24,669 not just psychiatry. 58 00:02:24,753 --> 00:02:27,237 But don't worry, you'll find your person. 59 00:02:27,321 --> 00:02:29,326 - See you later. - No coffee? 60 00:02:29,410 --> 00:02:30,936 Ugh, no. I don't have any time. 61 00:02:31,020 --> 00:02:33,634 We're implementing a new drug shortage protocol, 62 00:02:33,718 --> 00:02:36,333 so I'll be in the ED all morning walking the staff 63 00:02:36,417 --> 00:02:37,769 through the new guidelines. 64 00:02:37,853 --> 00:02:39,553 You couldn't get the enforcer, 65 00:02:39,637 --> 00:02:41,381 otherwise known as Maggie Lockwood on that? 66 00:02:41,465 --> 00:02:43,166 She's in Paris. 67 00:02:43,250 --> 00:02:44,863 She and Ben never took their honeymoon, 68 00:02:44,947 --> 00:02:47,257 and she was gonna lose her vacation days. 69 00:02:47,341 --> 00:02:48,954 - Wow. - Yeah. 70 00:02:49,038 --> 00:02:50,129 Well, still, not a great time 71 00:02:50,213 --> 00:02:51,174 to be short-staffed, though, right? 72 00:02:51,258 --> 00:02:52,871 There's never a good time. 73 00:02:52,955 --> 00:02:55,091 - Yep, you got that right. - See you later. 74 00:02:56,524 --> 00:02:58,050 Get these off me! 75 00:02:58,134 --> 00:02:59,312 David Sullivan, 17-year-old male. 76 00:02:59,396 --> 00:03:01,358 Oh, we've met. David, it's me, Dr. Archer. 77 00:03:01,442 --> 00:03:02,663 - Do you remember me? - I can't stay here. 78 00:03:02,747 --> 00:03:04,448 They're gonna find me. I have to keep moving. 79 00:03:04,532 --> 00:03:06,014 - I can't stay in one place! - It's okay, honey. 80 00:03:06,098 --> 00:03:07,451 - You're safe. You're safe. - He ran naked into the street. 81 00:03:07,535 --> 00:03:09,627 Dad managed to grab him before he got hit by a car. 82 00:03:09,711 --> 00:03:11,542 No visible injuries that I can see. 83 00:03:11,626 --> 00:03:13,805 Gave him 0.5 of lorazepam en route. 84 00:03:13,889 --> 00:03:16,199 Hello, again, Mrs. Sullivan. Is your husband all right? 85 00:03:16,283 --> 00:03:19,115 He's fine, yeah. He's just a bit shaken up. 86 00:03:19,199 --> 00:03:20,855 He drove behind us, should be here any minute. 87 00:03:20,939 --> 00:03:22,988 - Doris, would you... - Page psych. I'm on it. 88 00:03:23,072 --> 00:03:24,642 Okay, finish my sentences for me, why don't you? 89 00:03:24,726 --> 00:03:27,123 Okay, David, we're gonna loosen your restraints now 90 00:03:27,207 --> 00:03:28,820 and move you to the bed. 91 00:03:28,904 --> 00:03:30,778 I need you to stay still. 92 00:03:30,862 --> 00:03:33,390 Keep your hands by your side, all right? 93 00:03:33,474 --> 00:03:34,652 Okay, ready, everybody? 94 00:03:34,736 --> 00:03:38,177 On my count, one, two, three. 95 00:03:38,261 --> 00:03:40,832 Good. Okay. 96 00:03:40,916 --> 00:03:42,486 Very good, okay. 97 00:03:42,570 --> 00:03:44,052 - Oh, no, no, no, no, no! - It's all right. 98 00:03:44,136 --> 00:03:45,358 - It's all right. - David, please. 99 00:03:45,442 --> 00:03:47,186 Just let the doctor look at you, okay, honey? 100 00:03:47,270 --> 00:03:48,622 They came inside the light. 101 00:03:48,706 --> 00:03:51,843 They're trying to steal my DNA so they can clone me. 102 00:03:51,927 --> 00:03:53,497 Okay, so what do you think could have triggered this? 103 00:03:53,581 --> 00:03:55,281 We were at a stoplight, 104 00:03:55,365 --> 00:03:57,109 and David became fixated on this billboard. 105 00:03:57,193 --> 00:03:59,329 It was just some random man selling car insurance. 106 00:03:59,413 --> 00:04:01,548 He's not random. He works for them. 107 00:04:01,632 --> 00:04:03,028 - There's a whole network. - I don't know. 108 00:04:03,112 --> 00:04:04,856 He started taking his clothes off and telling us 109 00:04:04,940 --> 00:04:07,946 that they were... they were bugged with recording devices. 110 00:04:08,030 --> 00:04:09,382 And then right when the light turned green, he bolted. 111 00:04:09,466 --> 00:04:11,645 He ran across four lanes of oncoming traffic. 112 00:04:11,729 --> 00:04:12,559 There was... 113 00:04:14,558 --> 00:04:16,520 There was a pickup truck that was coming right at him. 114 00:04:16,604 --> 00:04:18,435 - And he... - Eric. 115 00:04:18,519 --> 00:04:19,697 - Sir, are you all right? - Oh, my God, Eric! 116 00:04:19,781 --> 00:04:21,220 All right, let's get him to the ground. 117 00:04:21,304 --> 00:04:22,656 - Eric! Eric! - Come on. 118 00:04:22,740 --> 00:04:23,962 - What's going on with him? - It was meant for me. 119 00:04:24,046 --> 00:04:25,268 - They're gonna kill us all! - It's okay, honey. 120 00:04:25,352 --> 00:04:26,573 Mom, we gotta get out of here now. 121 00:04:26,657 --> 00:04:27,618 - Let's get a gurney over here! - It's okay. 122 00:04:27,702 --> 00:04:28,575 - Come on! - Oh, my God. 123 00:04:28,659 --> 00:04:30,490 No, no, no! No, no! 124 00:04:32,000 --> 00:04:38,074 -== [ www.OpenSubtitles.com ] ==- 125 00:04:39,928 --> 00:04:43,634 Your husband's CT angiogram showed an aortic dissection. 126 00:04:43,718 --> 00:04:46,680 That's essentially a tear in the wall of his aorta. 127 00:04:46,764 --> 00:04:48,291 So Eric didn't have a heart attack? 128 00:04:48,375 --> 00:04:50,554 Well, a dissection can often mimic 129 00:04:50,638 --> 00:04:52,338 heart attacks in presentation. 130 00:04:52,422 --> 00:04:55,515 This particular tear is very close to his heart, 131 00:04:55,599 --> 00:04:58,649 which is why we need to get him to surgery as soon as possible 132 00:04:58,733 --> 00:05:00,041 in order to repair it. 133 00:05:00,125 --> 00:05:02,348 - Open heart surgery? - Mm-hmm, yes. 134 00:05:02,432 --> 00:05:05,046 Dr. Morris, one of our cardiothoracic surgeons, 135 00:05:05,130 --> 00:05:06,483 will be performing the operation. 136 00:05:06,567 --> 00:05:08,528 He's on his way here now. 137 00:05:08,612 --> 00:05:10,008 Oh. 138 00:05:10,092 --> 00:05:12,837 Okay, can I see Eric before he goes under? 139 00:05:12,921 --> 00:05:14,534 Yes, of course. 140 00:05:14,618 --> 00:05:16,968 Once we get him to pre-op, I'll have a nurse come get you. 141 00:05:19,319 --> 00:05:21,062 How about we go somewhere and chat for a bit? 142 00:05:21,146 --> 00:05:22,673 Thank you. 143 00:05:22,757 --> 00:05:23,978 Okay. 144 00:05:24,062 --> 00:05:25,502 I don't understand. 145 00:05:25,586 --> 00:05:28,679 Why would David think that this man on a billboard 146 00:05:28,763 --> 00:05:30,376 was after him? 147 00:05:30,460 --> 00:05:32,422 It's what we call a delusion of persecution. 148 00:05:32,506 --> 00:05:36,252 Yeah, one becomes convinced that some individual, 149 00:05:36,336 --> 00:05:38,906 you know, or group is conspiring to harm them 150 00:05:38,990 --> 00:05:40,299 or the people that they love. 151 00:05:40,383 --> 00:05:43,911 And these delusions, that's something that 152 00:05:43,995 --> 00:05:45,348 you see with schizophrenia? 153 00:05:45,432 --> 00:05:46,520 It is, yeah. 154 00:05:49,174 --> 00:05:53,530 I know Eric and I weren't exactly receptive 155 00:05:53,614 --> 00:05:54,792 the last time we all spoke. 156 00:05:54,876 --> 00:05:55,923 We completely understand. 157 00:05:56,007 --> 00:05:57,838 It's... it's a lot to take in. 158 00:05:57,922 --> 00:05:59,405 I Just thought that David was going 159 00:05:59,489 --> 00:06:05,019 through some kind of phase, growing pains, you know? 160 00:06:05,103 --> 00:06:10,242 But in these last couple of days, it's like he's... 161 00:06:10,326 --> 00:06:14,115 He's lost all touch with reality. 162 00:06:14,199 --> 00:06:18,163 It's just like, I feel him slipping away. 163 00:06:18,247 --> 00:06:21,384 Mrs. Sullivan, I promise you, David is still there. 164 00:06:21,468 --> 00:06:24,082 Yeah, and with treatment, these episodes will become 165 00:06:24,166 --> 00:06:26,127 less severe and less frequent. 166 00:06:26,211 --> 00:06:28,869 And with proper management, they can even go away. 167 00:06:28,953 --> 00:06:30,306 What do you mean, medication? 168 00:06:30,390 --> 00:06:33,396 That's a crucial component, yeah. 169 00:06:33,480 --> 00:06:36,399 David thinks people are trying to poison him. 170 00:06:36,483 --> 00:06:39,315 How am I going to convince him to take pills? 171 00:06:39,399 --> 00:06:41,621 There are actually inject able versions 172 00:06:41,705 --> 00:06:44,145 of many antipsychotics. 173 00:06:44,229 --> 00:06:45,799 Though we don't generally start there. 174 00:06:45,883 --> 00:06:47,192 Those are usually held in reserve 175 00:06:47,276 --> 00:06:48,976 for non-compliant patients. 176 00:06:49,060 --> 00:06:50,587 Of course. 177 00:06:50,671 --> 00:06:54,025 I'm just saying, if he refuses or becomes non-cooperative, 178 00:06:54,109 --> 00:06:56,201 - they're an option. - Right. 179 00:06:56,285 --> 00:06:58,986 But we'll cross that bridge if and when we get there. 180 00:06:59,070 --> 00:07:00,466 In the long run, it's just much better 181 00:07:00,550 --> 00:07:03,295 if we can get David on board with taking medication. 182 00:07:03,379 --> 00:07:05,468 Okay. 183 00:07:08,340 --> 00:07:10,563 Ms. Martin, I'm Doctor... 184 00:07:10,647 --> 00:07:14,654 Liza. 185 00:07:14,738 --> 00:07:17,440 Sorry, you were saying? 186 00:07:17,524 --> 00:07:18,963 Uh, I'm Dr. Choi. 187 00:07:19,047 --> 00:07:20,834 I understand you haven't been feeling well. 188 00:07:20,918 --> 00:07:22,836 Yeah I can't keep anything down. 189 00:07:22,920 --> 00:07:25,230 And you're 12 weeks along. 190 00:07:25,314 --> 00:07:29,277 Uh, that's just an estimate. 191 00:07:29,361 --> 00:07:33,281 I only just recently found out I was pregnant. 192 00:07:33,365 --> 00:07:36,284 I haven't gotten around to see a doctor just yet. 193 00:07:36,368 --> 00:07:39,244 Well, in that case, we'll go ahead and run an ultrasound. 194 00:07:39,328 --> 00:07:40,985 Doris, will you mind grabbing Dr. Asher? 195 00:07:41,069 --> 00:07:43,466 - Sure thing. - Thanks. 196 00:07:43,550 --> 00:07:45,859 So when did the vomiting and diarrhea start? 197 00:07:45,943 --> 00:07:47,078 Just last night. 198 00:07:47,162 --> 00:07:48,688 And you haven't taken any medication? 199 00:07:48,772 --> 00:07:51,430 No, nothing. 200 00:07:51,514 --> 00:07:53,693 I don't want to take anything while I'm pregnant. 201 00:07:53,777 --> 00:07:56,043 Well, you know there are some nausea medications 202 00:07:56,127 --> 00:07:57,436 that are safe for pregnancy. 203 00:07:57,520 --> 00:07:59,612 Still, I just... 204 00:07:59,696 --> 00:08:01,350 I would rather not. 205 00:08:03,047 --> 00:08:04,530 I'll be fine. 206 00:08:04,614 --> 00:08:07,490 I just really came in here to make sure the baby's okay. 207 00:08:07,574 --> 00:08:10,014 Understood. Mind if I press on your belly? 208 00:08:10,098 --> 00:08:11,711 I just want to see if anything feels tender. 209 00:08:11,795 --> 00:08:13,583 Mm-hmm. 210 00:08:15,973 --> 00:08:17,717 No, no, no. No, no, no. 211 00:08:17,801 --> 00:08:19,545 I don't want her. 212 00:08:19,629 --> 00:08:21,547 You'll have to get me another doctor. 213 00:08:21,631 --> 00:08:23,114 Dr. Asher? 214 00:08:23,198 --> 00:08:25,421 Hannah Asher, right? 215 00:08:25,505 --> 00:08:27,074 Yeah. She's an excellent physician. 216 00:08:27,158 --> 00:08:29,686 She's an addict. 217 00:08:29,770 --> 00:08:31,383 You get me another doctor, or I'm leaving. 218 00:08:31,467 --> 00:08:32,906 Whoa, whoa, whoa. Okay, okay, okay. 219 00:08:32,990 --> 00:08:33,907 Just hold on a moment. 220 00:08:38,605 --> 00:08:42,133 Hey, Hannah, sorry, I jumped the gun, actually. 221 00:08:42,217 --> 00:08:43,830 We're all good. 222 00:08:43,914 --> 00:08:45,528 Oh, okay. 223 00:08:45,612 --> 00:08:46,964 Well, in that case, I'm grabbing breakfast 224 00:08:47,048 --> 00:08:50,225 if anybody's looking for me. 225 00:08:57,145 --> 00:08:59,237 Dr. Tanaka-Reed, hold up a minute. 226 00:08:59,321 --> 00:09:01,108 Can you have them update that for me? 227 00:09:01,192 --> 00:09:02,545 Thank you. 228 00:09:02,629 --> 00:09:05,373 Look, I... I wanted to clear the air. 229 00:09:05,457 --> 00:09:09,160 The other day, I may have come off a little condescending. 230 00:09:09,244 --> 00:09:11,467 I appreciate the acknowledgment, Dr. Marcel. 231 00:09:11,551 --> 00:09:15,601 Of course, and if there's anything you'd like to say... 232 00:09:15,685 --> 00:09:17,951 No, don't think so. 233 00:09:18,035 --> 00:09:20,563 We're all good. 234 00:09:20,647 --> 00:09:21,999 What, you didn't have time to grab him 235 00:09:22,083 --> 00:09:24,392 flowers from the gift shop? 236 00:09:24,476 --> 00:09:26,177 Huh? 237 00:09:26,261 --> 00:09:27,439 I mean, I expect the other docs 238 00:09:27,523 --> 00:09:30,311 to go soft on the residents. 239 00:09:30,395 --> 00:09:32,139 I thought you had grit. 240 00:09:32,223 --> 00:09:33,750 Well, no man's an island, right? 241 00:09:33,834 --> 00:09:35,142 Aha. 242 00:09:35,226 --> 00:09:36,492 You know, island life's really not so bad. 243 00:09:36,576 --> 00:09:38,319 Maybe you just don't have the stomach for it. 244 00:09:38,403 --> 00:09:40,713 Dr. Marcel, you've got a trauma incoming. 245 00:09:40,797 --> 00:09:42,976 Well, thanks for that pep talk, coach. 246 00:09:43,060 --> 00:09:44,543 Any time. 247 00:09:46,890 --> 00:09:48,286 What do we got? 248 00:09:48,370 --> 00:09:50,723 Marcus Walker, 50-year-old male, fall from standing. 249 00:09:50,807 --> 00:09:53,247 Gave him a 500 liter bolus en route. 250 00:09:53,331 --> 00:09:54,945 Pressure's hanging around 100, systolic. 251 00:09:55,029 --> 00:09:56,381 Heart rate's 120. 252 00:09:56,465 --> 00:09:58,383 Yeah, I've never seen him in this much pain. 253 00:09:58,467 --> 00:10:00,777 It hasn't let up since he hit the pavement. 254 00:10:00,861 --> 00:10:01,821 This is his sister, Janet. 255 00:10:01,905 --> 00:10:03,388 Did you witness the fall, Janet? 256 00:10:03,472 --> 00:10:04,824 He lost his balance stepping off the sidewalk. 257 00:10:04,908 --> 00:10:06,783 It didn't look that bad, but then he couldn't get up. 258 00:10:06,867 --> 00:10:08,262 Okay, we'll give him something for the pain. 259 00:10:08,346 --> 00:10:09,437 We just got to find the source of it first. 260 00:10:09,521 --> 00:10:10,482 Any medications we should know about? 261 00:10:10,566 --> 00:10:11,875 Dialysis. 262 00:10:11,959 --> 00:10:13,311 Oh, and he takes ramipril for his blood pressure. 263 00:10:13,395 --> 00:10:14,486 Okay, here we go, guys. 264 00:10:14,570 --> 00:10:15,835 Nice and easy on my count, okay? 265 00:10:15,919 --> 00:10:17,576 One, two, three. 266 00:10:17,660 --> 00:10:20,144 I'm sorry, Marcus. 267 00:10:20,228 --> 00:10:22,581 I'm right here, Marcus. I'm right here. 268 00:10:22,665 --> 00:10:24,627 Janet, let's give the doctor some room to work, okay? 269 00:10:24,711 --> 00:10:26,542 We're gonna take care of him, Janet, we got this. 270 00:10:26,626 --> 00:10:27,934 Let's hang a unit of whole blood. 271 00:10:28,018 --> 00:10:29,370 Pressure it in, Ron. 272 00:10:29,454 --> 00:10:32,373 Hey, Marcus, put your arms by your side for me. 273 00:10:32,457 --> 00:10:34,245 There you go, bud. Deep breaths. 274 00:10:34,329 --> 00:10:35,638 Okay, lungs are clear. 275 00:10:35,722 --> 00:10:37,378 - He's still shocking. - Yeah. 276 00:10:37,462 --> 00:10:38,945 He's bleeding from somewhere. 277 00:10:39,029 --> 00:10:40,730 Let's fast him, Dr. Taylor. 278 00:10:48,082 --> 00:10:49,434 Belly's negative. 279 00:10:49,518 --> 00:10:51,001 Really? 280 00:10:51,085 --> 00:10:52,742 Yeah. 281 00:10:52,826 --> 00:10:54,787 All right, let's get him on his side. 282 00:10:54,871 --> 00:10:57,616 Herbert, come over, please. 283 00:10:57,700 --> 00:10:59,662 All right, here we go. Nice and easy, all right? 284 00:10:59,746 --> 00:11:01,141 One, two, three. 285 00:11:02,879 --> 00:11:04,101 There you go. You're doing great. 286 00:11:04,185 --> 00:11:05,885 You're doing great, Marcus. 287 00:11:09,973 --> 00:11:11,848 What is it? 288 00:11:11,932 --> 00:11:12,892 Oh. 289 00:11:12,976 --> 00:11:14,067 An abscess. 290 00:11:14,151 --> 00:11:15,068 Looks like it. 291 00:11:15,152 --> 00:11:16,417 Pus under pressure. 292 00:11:16,501 --> 00:11:17,984 It's gotta be the source of the pain. 293 00:11:18,068 --> 00:11:20,596 All right, let's drain it. 294 00:11:20,680 --> 00:11:21,727 Scalpel. 295 00:11:27,774 --> 00:11:29,558 Hematoma. 296 00:11:36,086 --> 00:11:37,177 Yep. 297 00:11:37,261 --> 00:11:39,876 Hold pressure and pack it in. 298 00:11:39,960 --> 00:11:41,094 - You got it? - Yeah. 299 00:11:41,178 --> 00:11:42,487 - Okay. - Got it. 300 00:11:42,571 --> 00:11:44,445 All right, give me another unit of whole blood. 301 00:11:44,529 --> 00:11:48,798 Start DDAVP and a unit of platelets, stat. 302 00:11:48,882 --> 00:11:50,448 Come on, let's move, folks. 303 00:11:58,108 --> 00:11:59,547 Ms. Arya, hello again. 304 00:11:59,631 --> 00:12:01,201 Indrani, please. 305 00:12:01,285 --> 00:12:03,943 Indrani, I got the results back on your culture. 306 00:12:04,027 --> 00:12:05,510 Unfortunately, you tested positive 307 00:12:05,594 --> 00:12:07,294 for an infection called MRSA. 308 00:12:07,378 --> 00:12:10,776 From an ingrown toenail? 309 00:12:10,860 --> 00:12:13,866 MRSA is really hard to treat, isn't it? 310 00:12:13,950 --> 00:12:15,999 While it is resistant to many antibiotics, 311 00:12:16,083 --> 00:12:17,870 luckily, there are a couple that still work for it. 312 00:12:17,954 --> 00:12:20,003 How long do I have to be on antibiotics? 313 00:12:20,087 --> 00:12:21,787 - About seven to ten days. - Oh. 314 00:12:21,871 --> 00:12:25,008 See, I told you you wouldn't have to cancel your trip. 315 00:12:25,092 --> 00:12:26,749 Oh, yeah? Where are you headed? 316 00:12:26,833 --> 00:12:28,751 Well, I'm going to Scotland in a few weeks 317 00:12:28,835 --> 00:12:30,361 to hike the West Highland Way. 318 00:12:30,445 --> 00:12:33,756 It's a 96-mile trail through the Scottish Highlands. 319 00:12:33,840 --> 00:12:35,061 96 miles? 320 00:12:35,145 --> 00:12:37,281 I've been training for the last year. 321 00:12:37,365 --> 00:12:40,066 I may be pushing 60, but I don't feel it. 322 00:12:40,150 --> 00:12:42,068 Let's start with vancomycin. 323 00:12:42,152 --> 00:12:44,723 No, I can't take vancomycin. I'm allergic. 324 00:12:44,807 --> 00:12:46,290 Aha, I see that. 325 00:12:46,374 --> 00:12:48,596 I had a terrible reaction when I was a kid. 326 00:12:48,680 --> 00:12:49,859 My throat closed up. 327 00:12:49,943 --> 00:12:51,687 Then we will steer clear. Nancy? 328 00:12:51,771 --> 00:12:54,080 - Linezolid? On it. - Mm-hmm. 329 00:12:54,164 --> 00:12:55,865 We'll get you in tip top shape for Scotland, Indrani. 330 00:12:55,949 --> 00:12:57,910 I've been wanting to do this a long time. 331 00:12:57,994 --> 00:13:00,913 Um, Dr. Halstead, the pharmacy 332 00:13:00,997 --> 00:13:03,437 won't release the medication. 333 00:13:03,521 --> 00:13:05,265 What? 334 00:13:05,349 --> 00:13:06,310 Is there a problem? 335 00:13:09,179 --> 00:13:11,968 No, just probably a system glitch. 336 00:13:12,052 --> 00:13:14,100 Sit tight, and I'll be right back. 337 00:13:14,184 --> 00:13:16,450 Look, per the new protocol, 338 00:13:16,534 --> 00:13:18,931 you're gonna have to go through Infectious Disease first. 339 00:13:19,015 --> 00:13:21,629 And they're going to want to try incising 340 00:13:21,713 --> 00:13:23,283 and draining the infected tissue 341 00:13:23,367 --> 00:13:25,721 before they approve giving linezolid. 342 00:13:25,805 --> 00:13:26,809 Incising and draining? 343 00:13:26,893 --> 00:13:28,288 So source control. 344 00:13:28,372 --> 00:13:29,855 That is not gonna cut it, Ms. Goodwin. 345 00:13:29,939 --> 00:13:31,767 She needs linezolid. 346 00:13:34,161 --> 00:13:36,122 I mean, can't we just say that, um, 347 00:13:36,206 --> 00:13:38,951 you know, Infectious Disease already signed off? 348 00:13:39,035 --> 00:13:40,953 No, we cannot, Dr. Halstead. 349 00:13:41,037 --> 00:13:43,042 Linezolid is on the restricted list 350 00:13:43,126 --> 00:13:45,523 due to extremely low inventory. 351 00:13:45,607 --> 00:13:48,221 There's a region-wide shortage. 352 00:13:48,305 --> 00:13:50,789 And we are dealing with a systemic MRSA infection. 353 00:13:50,873 --> 00:13:53,618 You're looking at the patient in front of you. 354 00:13:53,702 --> 00:13:56,839 But the Oversight Committee designed the guidelines 355 00:13:56,923 --> 00:14:00,843 to ration these drugs to the most severe cases. 356 00:14:00,927 --> 00:14:05,804 I have seen early source control work wonders. 357 00:14:05,888 --> 00:14:07,498 Give it a shot. 358 00:14:12,764 --> 00:14:14,334 Dr. Marcel. 359 00:14:14,418 --> 00:14:16,510 - Yeah? - I got Marcus' CAT scans. 360 00:14:16,594 --> 00:14:17,860 Uh-huh. 361 00:14:17,944 --> 00:14:19,731 Two very severe lumbar burst fractures. 362 00:14:19,815 --> 00:14:21,167 All from a spill on the sidewalk? 363 00:14:21,251 --> 00:14:22,252 Take a look. 364 00:14:23,775 --> 00:14:24,997 Oof. 365 00:14:25,081 --> 00:14:27,086 Renal disease definitely sped up his bone loss. 366 00:14:27,170 --> 00:14:29,349 He's gonna need spinal stabilization surgery. 367 00:14:29,433 --> 00:14:33,179 Yeah, agreed, only option to get him walking again. 368 00:14:33,263 --> 00:14:34,877 Given his co-morbidities, without it, 369 00:14:34,961 --> 00:14:37,053 he's just gonna circle the drain. 370 00:14:37,137 --> 00:14:41,054 All right, let's... Let's go talk to neurosurgery. 371 00:14:42,446 --> 00:14:45,322 And David, this voice that you're hearing, 372 00:14:45,406 --> 00:14:47,803 is it male or female? 373 00:14:47,887 --> 00:14:49,326 I don't know. 374 00:14:49,410 --> 00:14:52,198 It's more like it has its own language, 375 00:14:52,282 --> 00:14:54,157 its own way of communicating. 376 00:14:54,241 --> 00:14:57,029 And then my brain translates messages 377 00:14:57,113 --> 00:14:59,031 - so I can understand them. - Mm. 378 00:14:59,115 --> 00:15:01,251 Are you getting any messages right now? 379 00:15:01,335 --> 00:15:03,383 That you're writing down everything 380 00:15:03,467 --> 00:15:05,513 I say because you work for them. 381 00:15:10,431 --> 00:15:13,741 You're one of their spies, aren't you? 382 00:15:13,825 --> 00:15:15,178 No, I'm not a spy. 383 00:15:15,262 --> 00:15:17,354 Then give me your notebook. 384 00:15:17,438 --> 00:15:18,834 I'm not gonna give you my notebook, David. 385 00:15:18,918 --> 00:15:19,965 Give it to me. 386 00:15:20,049 --> 00:15:20,923 David, I need you to listen to me. 387 00:15:21,007 --> 00:15:22,185 I'm a doctor. 388 00:15:22,269 --> 00:15:23,316 I'm writing things down so I can 389 00:15:23,400 --> 00:15:24,578 better understand what's going... 390 00:15:24,662 --> 00:15:26,406 Get out of here! 391 00:15:26,490 --> 00:15:27,843 Out, now! 392 00:15:27,927 --> 00:15:29,583 David, David, how about Dr. Cuevas 393 00:15:29,667 --> 00:15:30,846 puts her notebook away for now. 394 00:15:30,930 --> 00:15:33,065 Would that make you feel better? 395 00:15:33,149 --> 00:15:37,156 And I notice you've been checking out this vent. 396 00:15:37,240 --> 00:15:38,459 There's a camera in there. 397 00:15:40,200 --> 00:15:42,074 Huh. 398 00:15:42,158 --> 00:15:43,423 They're always watching me. 399 00:15:43,507 --> 00:15:45,338 There isn't a camera in there, David. 400 00:15:45,422 --> 00:15:47,427 Yeah, I'm pretty sure that there isn't. 401 00:15:47,511 --> 00:15:48,820 But, you know, we're... 402 00:15:48,904 --> 00:15:49,908 We're happy to cover it up if it'll 403 00:15:49,992 --> 00:15:52,606 make you more comfortable. 404 00:15:52,690 --> 00:15:54,086 Okay, good. 405 00:15:54,170 --> 00:15:56,784 So why don't I go see what I can scrounge up. 406 00:15:56,868 --> 00:15:58,961 And I have another couple of patients 407 00:15:59,045 --> 00:16:00,440 I need to check in on, but in the meantime, 408 00:16:00,524 --> 00:16:01,964 is there anything else I can get you? 409 00:16:02,048 --> 00:16:03,443 Can I have a Coke? 410 00:16:03,527 --> 00:16:04,528 Absolutely. 411 00:16:06,661 --> 00:16:08,144 Okay, so back in a bit. 412 00:16:08,228 --> 00:16:11,451 And Dr. Cuevas, can I just get a quick word, please? 413 00:16:18,455 --> 00:16:20,939 So with patients experiencing paranoia, 414 00:16:21,023 --> 00:16:24,247 I've found that it's probably not the best idea to push back 415 00:16:24,331 --> 00:16:25,857 too hard on their version of events, 416 00:16:25,941 --> 00:16:27,946 you know, especially at the outset. 417 00:16:28,030 --> 00:16:29,817 There's actually evidence-based research 418 00:16:29,901 --> 00:16:31,732 suggesting the opposite, 419 00:16:31,816 --> 00:16:34,300 that you shouldn't reinforce a patient's delusion. 420 00:16:34,384 --> 00:16:35,954 Instead, you should try to explain to them 421 00:16:36,038 --> 00:16:38,130 why they're experiencing things differently. 422 00:16:38,214 --> 00:16:39,958 I hear you, except that that's 423 00:16:40,042 --> 00:16:42,004 pretty much impossible if you haven't 424 00:16:42,088 --> 00:16:43,875 first established trust. 425 00:16:43,959 --> 00:16:45,964 But very glad to hear that you are 426 00:16:46,048 --> 00:16:47,357 keeping up on the literature. 427 00:16:47,441 --> 00:16:48,967 Way to go. 428 00:16:54,796 --> 00:16:57,019 Ooh, got Choi as your advisor. 429 00:16:57,103 --> 00:16:59,325 Luck really isn't on your side. 430 00:16:59,409 --> 00:17:00,239 Why? 431 00:17:00,323 --> 00:17:01,980 He's been really cool with me. 432 00:17:02,064 --> 00:17:03,808 Yeah, well, I wouldn't get too comfortable. 433 00:17:03,892 --> 00:17:06,028 Word is, he's a real hard-ass. 434 00:17:06,112 --> 00:17:08,157 Got his last resident fired. 435 00:17:13,119 --> 00:17:14,950 Olga, what are you doing down here? 436 00:17:15,034 --> 00:17:16,342 I was gonna ask you the same thing. 437 00:17:16,426 --> 00:17:18,692 - I assumed you were out today. - Why's that? 438 00:17:18,776 --> 00:17:20,781 Oh, well, Dr. Choi asked me to ultrasound 439 00:17:20,865 --> 00:17:21,953 his pregnant patient. 440 00:17:24,826 --> 00:17:27,005 I don't understand. Why would he ask you? 441 00:17:27,089 --> 00:17:28,702 I cover the ED. 442 00:17:33,139 --> 00:17:35,100 So do you have a question about my qualifications 443 00:17:35,184 --> 00:17:37,059 - or something? - Of course not, Hannah. 444 00:17:37,143 --> 00:17:39,104 Then why would you ask another obstetrician 445 00:17:39,188 --> 00:17:41,802 to do an ultrasound in the ED when I'm here? 446 00:17:41,886 --> 00:17:43,543 Obviously, you don't trust me. 447 00:17:43,627 --> 00:17:44,675 It's not that. 448 00:17:44,759 --> 00:17:46,851 I... 449 00:17:46,935 --> 00:17:49,071 The patient requested another doctor. 450 00:17:49,155 --> 00:17:52,726 She... she knew about your past. 451 00:17:52,810 --> 00:17:54,073 What? How? 452 00:17:55,813 --> 00:17:57,209 Does she know me personally? 453 00:17:57,293 --> 00:17:58,515 She didn't volunteer that information, 454 00:17:58,599 --> 00:18:00,256 - so I didn't press it. - Fine. 455 00:18:00,340 --> 00:18:02,040 - Forget it. - Hannah. 456 00:18:02,124 --> 00:18:05,957 I'm just so sick of this following me everywhere I go. 457 00:18:06,041 --> 00:18:07,567 No matter how much progress I make, 458 00:18:07,651 --> 00:18:10,135 everyone's still judging me for who I used to be. 459 00:18:15,833 --> 00:18:16,924 Nope. 460 00:18:17,008 --> 00:18:18,578 Medically, it's just too risky. 461 00:18:18,662 --> 00:18:21,059 Chronic hypertension, end-stage renal disease... 462 00:18:21,143 --> 00:18:22,713 The list goes on and on with this patient. 463 00:18:22,797 --> 00:18:24,367 The real kicker is that platelet count. 464 00:18:24,451 --> 00:18:27,196 I'm not touching anyone whose platelet count's below 100k. 465 00:18:27,280 --> 00:18:29,807 Listen, we know that he's not an ideal candidate. 466 00:18:29,891 --> 00:18:31,113 Oh, wait, I almost forgot. 467 00:18:31,197 --> 00:18:33,071 You guys also hacked his back open in the ED, 468 00:18:33,155 --> 00:18:35,160 making a posterior approach impossible. 469 00:18:35,244 --> 00:18:36,596 Should I go on? 470 00:18:36,680 --> 00:18:38,729 Look, I can give you great anterior exposure. 471 00:18:38,813 --> 00:18:40,600 All you have to do is stabilize his spine. 472 00:18:40,684 --> 00:18:42,124 I'll take care of everything else. 473 00:18:42,208 --> 00:18:44,735 Oh, you'd be assisting me on this one? 474 00:18:44,819 --> 00:18:47,607 Wow, way to save your strongest argument for last. 475 00:18:47,691 --> 00:18:49,740 Maybe you're just worried about your stats, Sam. 476 00:18:51,826 --> 00:18:53,439 Send him up to interventional radiology. 477 00:18:53,523 --> 00:18:55,485 Have them inject cement into his fractures. 478 00:18:55,569 --> 00:18:57,443 That'll at least get him sitting up. 479 00:18:57,527 --> 00:18:59,141 But that won't get him walking. 480 00:18:59,225 --> 00:19:00,751 And lack of movement is dangerous 481 00:19:00,835 --> 00:19:02,274 in Marcus's condition. 482 00:19:02,358 --> 00:19:04,581 He can develop pressure sores, blood clots, pneumonia. 483 00:19:04,665 --> 00:19:07,058 All preferable to him bleeding out on my table. 484 00:19:13,717 --> 00:19:16,114 We just need to get his platelet count up. 485 00:19:16,198 --> 00:19:17,637 Yeah, it's the only way to get Marcus 486 00:19:17,721 --> 00:19:19,944 healthy enough for surgery and Abrams on board. 487 00:19:20,028 --> 00:19:21,598 All right, I'll... 488 00:19:21,682 --> 00:19:24,206 I'll order a couple of units of platelets, all right? 489 00:19:30,386 --> 00:19:33,479 Patty, any updates on your husband? 490 00:19:33,563 --> 00:19:35,177 Oh, he just went into surgery. 491 00:19:35,261 --> 00:19:36,787 Dr. Archer said it will be a while 492 00:19:36,871 --> 00:19:38,005 before there's any updates. 493 00:19:38,089 --> 00:19:40,007 Okay, well, he's in very good hands. 494 00:19:40,091 --> 00:19:41,705 You can trust me on that. 495 00:19:41,789 --> 00:19:44,316 David, got that Coke you asked for 496 00:19:44,400 --> 00:19:46,318 and some stuff for the vent. 497 00:19:46,402 --> 00:19:49,231 Do you think you might be up for chatting a bit? 498 00:19:52,147 --> 00:19:53,238 You all right, pal? 499 00:19:55,933 --> 00:19:59,114 Trini gave him something just to calm him down. 500 00:19:59,198 --> 00:20:00,286 Huh. 501 00:20:03,114 --> 00:20:05,769 Okay, back in a second. 502 00:20:07,945 --> 00:20:08,862 What did you give him? 503 00:20:08,946 --> 00:20:10,473 6 of risperidone. 504 00:20:10,557 --> 00:20:11,430 What? 505 00:20:11,514 --> 00:20:13,432 Who the hell ordered that? 506 00:20:13,516 --> 00:20:14,259 I did. 507 00:20:23,499 --> 00:20:26,315 He became extremely agitated and was resisting restraints. 508 00:20:26,399 --> 00:20:27,794 Lorazepam worked this morning. 509 00:20:27,878 --> 00:20:29,361 You didn't see how upset he was. 510 00:20:29,445 --> 00:20:30,710 Haldol then. 511 00:20:30,794 --> 00:20:32,625 He was going to tear out his IV. 512 00:20:32,709 --> 00:20:34,018 His mom was freaking out, begging me to do... 513 00:20:34,102 --> 00:20:35,628 Well, you cannot let a family member 514 00:20:35,712 --> 00:20:37,761 pressure you into making a rushed treatment call. 515 00:20:37,845 --> 00:20:40,720 It wasn't rushed. It was necessary. 516 00:20:40,804 --> 00:20:42,853 And besides, the meds will clear his system 517 00:20:42,937 --> 00:20:44,246 by tomorrow morning at the latest. 518 00:20:44,330 --> 00:20:45,595 At which point, we'll be back at square one 519 00:20:45,679 --> 00:20:47,466 with David, if we're lucky, all right? 520 00:20:47,550 --> 00:20:50,077 Any trust established, down the drain. 521 00:20:50,161 --> 00:20:52,254 How about this, in the future, maybe at least page me 522 00:20:52,338 --> 00:20:55,518 before administering a very high dose of antipsychotics 523 00:20:55,602 --> 00:20:57,911 to a patient we're still evaluating? 524 00:20:57,995 --> 00:21:01,088 With all due respect, Dr. Charles, 525 00:21:01,172 --> 00:21:03,395 I am not a trainee. 526 00:21:03,479 --> 00:21:06,485 And 6 milligrams is well within the standard of care, I... 527 00:21:06,569 --> 00:21:08,052 Standard of care, whatever that is, 528 00:21:08,136 --> 00:21:10,315 is not some blanket template you follow 529 00:21:10,399 --> 00:21:13,275 without any regard for the person in front of you 530 00:21:13,359 --> 00:21:14,624 you're supposed to be helping! 531 00:21:27,677 --> 00:21:29,116 Hey, Janet. 532 00:21:29,200 --> 00:21:31,206 I just want to let you know, the nurse will be by soon 533 00:21:31,290 --> 00:21:33,425 to start Marcus' platelet transfusion, okay? 534 00:21:40,299 --> 00:21:42,695 I know it's been a rough day. 535 00:21:42,779 --> 00:21:45,742 More like a rough year. 536 00:21:45,826 --> 00:21:48,440 Lost my husband in January. 537 00:21:48,524 --> 00:21:51,269 I'm so sorry. 538 00:21:51,353 --> 00:21:54,098 Marcus came out from California for the funeral 539 00:21:54,182 --> 00:21:58,320 and just never went home, 540 00:21:58,404 --> 00:21:59,843 moved in with me. 541 00:21:59,927 --> 00:22:01,711 You must really get on. 542 00:22:03,409 --> 00:22:08,286 Never had a choice in the matter. 543 00:22:08,370 --> 00:22:11,115 We're twins, actually. 544 00:22:11,199 --> 00:22:15,337 Marcus was born 45 seconds before me, 545 00:22:15,421 --> 00:22:19,210 but you'd think he was years older, the way he acts. 546 00:22:19,294 --> 00:22:24,560 Seeing him here like this, so fragile... 547 00:22:27,258 --> 00:22:29,438 It's really hard. 548 00:22:38,618 --> 00:22:41,928 I want you to know that, uh, 549 00:22:42,012 --> 00:22:47,586 we're gonna do everything we can for Marcus, I promise. 550 00:22:47,670 --> 00:22:48,889 Okay. 551 00:22:53,415 --> 00:22:55,638 What is it? 552 00:22:55,722 --> 00:22:57,857 I was just looking back in Marcus's history. 553 00:22:57,941 --> 00:23:00,033 His platelets have always been low. 554 00:23:00,117 --> 00:23:01,383 Huh. 555 00:23:01,467 --> 00:23:02,862 Do you think this is chronic? 556 00:23:02,946 --> 00:23:05,474 Some kind of undiagnosed blood disorder, or...? 557 00:23:05,558 --> 00:23:07,563 - ITP would be my guess. - Oh, man. 558 00:23:07,647 --> 00:23:08,781 And if that's the case, 559 00:23:08,865 --> 00:23:10,087 a transfusion is not gonna do much. 560 00:23:10,171 --> 00:23:11,523 I mean, his body would just keep chewing up 561 00:23:11,607 --> 00:23:13,046 any new platelets we give him. 562 00:23:13,130 --> 00:23:15,397 Well, unless... 563 00:23:15,481 --> 00:23:17,134 Unless what? 564 00:23:18,919 --> 00:23:22,404 Um, forget it, actually. 565 00:23:22,488 --> 00:23:23,796 I thought I had something. 566 00:23:23,880 --> 00:23:25,189 But let's just hope the transfusion 567 00:23:25,273 --> 00:23:28,279 moves the needle a little, okay? 568 00:23:36,284 --> 00:23:39,072 Podiatry incised and drained the toe. 569 00:23:39,156 --> 00:23:41,988 They had to cut the nail out. 570 00:23:42,072 --> 00:23:43,773 I'm not a doctor, but it looks like 571 00:23:43,857 --> 00:23:44,861 it's getting worse to me. 572 00:23:44,945 --> 00:23:46,863 Don't worry. I'm on it. 573 00:23:46,947 --> 00:23:48,212 We're gonna get you the medicine you need. 574 00:23:48,296 --> 00:23:51,737 Dr. Halstead, can I speak with you outside? 575 00:23:51,821 --> 00:23:54,436 What's wrong? 576 00:23:54,520 --> 00:23:56,826 Just give us a moment. 577 00:24:02,441 --> 00:24:05,011 We're now completely out of linezolid. 578 00:24:05,095 --> 00:24:07,579 You've gotta be kidding me. 579 00:24:07,663 --> 00:24:09,102 I knew it. 580 00:24:09,186 --> 00:24:11,844 I knew source control wasn't gonna cut it. 581 00:24:11,928 --> 00:24:13,498 How soon are we expecting to get it back in stock? 582 00:24:13,582 --> 00:24:15,671 Tomorrow morning, at the earliest. 583 00:24:19,414 --> 00:24:21,245 Order vancomycin. 584 00:24:21,329 --> 00:24:22,507 She's allergic. 585 00:24:22,591 --> 00:24:25,376 I know, all right, but I've got an idea. 586 00:24:29,032 --> 00:24:31,470 Hey, Liza. 587 00:24:33,341 --> 00:24:35,346 So got your labs back, and they look good. 588 00:24:35,430 --> 00:24:37,957 Your white blood count is slightly elevated, 589 00:24:38,041 --> 00:24:40,264 but that's pretty common in pregnancy. 590 00:24:40,348 --> 00:24:43,180 I think we're just looking at a stomach bug. 591 00:24:43,264 --> 00:24:44,529 Makes sense. 592 00:24:44,613 --> 00:24:45,878 I can go home then? 593 00:24:45,962 --> 00:24:47,967 Yeah, Dr. Patchefsky sent down a list 594 00:24:48,051 --> 00:24:49,969 of OB-GYN referrals, 595 00:24:50,053 --> 00:24:52,363 as well as some genetic testing counselors. 596 00:24:52,447 --> 00:24:54,713 We'll just add those to your discharge. 597 00:24:54,797 --> 00:24:56,628 Genetic testing? 598 00:24:56,712 --> 00:24:58,413 I thought she said the... 599 00:24:58,497 --> 00:25:00,980 The baby looked healthy on the ultrasound. 600 00:25:01,064 --> 00:25:03,330 Genetic testing for hereditary conditions 601 00:25:03,414 --> 00:25:04,414 is completely optional. 602 00:25:05,895 --> 00:25:09,511 But the baby's healthy, right? 603 00:25:09,595 --> 00:25:10,726 Yeah. 604 00:25:12,989 --> 00:25:14,777 Hey, listen, if... 605 00:25:14,861 --> 00:25:16,515 Liza, my dear. 606 00:25:18,342 --> 00:25:20,736 I have your discharge paperwork. 607 00:25:25,393 --> 00:25:28,573 I'm not sure I'm following you. 608 00:25:28,657 --> 00:25:32,011 You want to give me a drug I told you almost killed me? 609 00:25:32,095 --> 00:25:34,318 And we'll do everything we can to mitigate the chances 610 00:25:34,402 --> 00:25:36,538 - of another adverse reaction. - How, exactly? 611 00:25:36,622 --> 00:25:39,062 Through a process called desensitizing. 612 00:25:39,146 --> 00:25:41,325 We'll pre-medicate you with steroids and antihistamines 613 00:25:41,409 --> 00:25:44,415 and then administer the vancomycin via a slow IV drip. 614 00:25:44,499 --> 00:25:47,374 And can you promise me that my throat 615 00:25:47,458 --> 00:25:48,593 won't close up again? 616 00:25:48,677 --> 00:25:50,334 I can't promise that, no. 617 00:25:50,418 --> 00:25:51,944 But if you do go into anaphylaxis, 618 00:25:52,028 --> 00:25:53,293 we'll have epinephrine at the ready. 619 00:25:53,377 --> 00:25:54,904 Worst case scenario, we might need to intubate, 620 00:25:54,988 --> 00:25:56,558 but that would only be temporary. 621 00:25:56,642 --> 00:25:57,950 Intubate me? No, no. 622 00:25:58,034 --> 00:25:59,343 I'll go to another hospital. 623 00:25:59,427 --> 00:26:01,171 Well, we've called everywhere. 624 00:26:01,255 --> 00:26:02,694 The earliest anyone has linezolid is tomorrow. 625 00:26:02,778 --> 00:26:04,653 So I'll wait. 626 00:26:04,737 --> 00:26:07,046 As you're seeing, MRSA moves fast. 627 00:26:07,130 --> 00:26:08,395 I am afraid if we wait until tomorrow, 628 00:26:08,479 --> 00:26:10,267 it will have already spread to the bone. 629 00:26:10,351 --> 00:26:11,660 You could lose your leg, Indrani. 630 00:26:19,447 --> 00:26:21,408 Give me the vancomycin. 631 00:26:21,492 --> 00:26:22,492 Okay. 632 00:26:26,585 --> 00:26:29,721 Marcus' platelet count rose from 50,000 to 105,000. 633 00:26:29,805 --> 00:26:30,722 Can you believe it? 634 00:26:30,806 --> 00:26:32,507 That's great. 635 00:26:32,591 --> 00:26:34,247 It's fantastic. 636 00:26:34,331 --> 00:26:36,293 He must not have ITP after all. 637 00:26:36,377 --> 00:26:37,555 Do me a favor. 638 00:26:37,639 --> 00:26:39,557 Show Abrams these updated labs. 639 00:26:39,641 --> 00:26:43,430 I think he'll be more receptive if you deliver them solo. 640 00:26:43,514 --> 00:26:45,607 How could he possibly refuse to operate now? 641 00:26:45,691 --> 00:26:47,391 It's Abrams. 642 00:26:47,475 --> 00:26:49,132 I'll get him on board. 643 00:26:49,216 --> 00:26:53,310 Dr. Choi? We've got a problem. 644 00:26:53,394 --> 00:26:55,617 Liza? 645 00:26:55,701 --> 00:26:56,705 I thought she had left. 646 00:26:56,789 --> 00:26:57,793 I came in to turn over the room, 647 00:26:57,877 --> 00:26:59,055 and I found her passed out. 648 00:26:59,139 --> 00:27:00,099 Let's get her back in the bed 649 00:27:00,183 --> 00:27:01,231 and up on the monitors. Ready? 650 00:27:01,315 --> 00:27:03,625 One, two, three. 651 00:27:03,709 --> 00:27:05,757 All right. All right. 652 00:27:05,841 --> 00:27:07,629 Liza? Liza, can you hear me? 653 00:27:07,713 --> 00:27:09,761 All right, let's re-start her IV and get a Foley in her. 654 00:27:09,845 --> 00:27:10,936 - Grab OB. - Patchefsky, right? 655 00:27:11,020 --> 00:27:11,937 No, no, no. No time. 656 00:27:12,021 --> 00:27:13,330 - Grab Asher. - Okay. 657 00:27:13,414 --> 00:27:15,767 She's hypotensive. BP 85/43. 658 00:27:15,851 --> 00:27:17,290 Maybe she vasovagaled? 659 00:27:17,374 --> 00:27:19,379 Her white count was more significant than I thought. 660 00:27:21,770 --> 00:27:23,296 Liza. 661 00:27:23,380 --> 00:27:25,603 - You know her? - Yeah, Doris filled me in. 662 00:27:25,687 --> 00:27:26,865 How long had she been experiencing symptoms 663 00:27:26,949 --> 00:27:27,953 when she came in? 664 00:27:28,037 --> 00:27:29,215 Less than 24 hours. 665 00:27:29,299 --> 00:27:31,261 And that's self-reported from the patient? 666 00:27:31,345 --> 00:27:32,567 Yeah, why? 667 00:27:36,045 --> 00:27:37,310 Bolus a liter of normal saline. 668 00:27:37,394 --> 00:27:38,790 Hannah, we've been giving her fluids. 669 00:27:38,874 --> 00:27:40,313 Could this be sepsis? 670 00:27:40,397 --> 00:27:41,793 We could start a broad spectrum antibiotic. 671 00:27:41,877 --> 00:27:43,142 Let's just see what this does first. 672 00:27:43,226 --> 00:27:44,666 I don't think we're looking at sepsis. 673 00:27:44,750 --> 00:27:48,670 I think she's hypovolemic from massive volume depletion. 674 00:27:48,754 --> 00:27:52,804 I suspect she's been sick a lot longer than she reported. 675 00:27:52,888 --> 00:27:54,763 BP's starting to come up. 676 00:28:16,738 --> 00:28:19,570 Appreciate you stepping up to the plate on this one, Sam. 677 00:28:19,654 --> 00:28:21,616 His platelets sure turned around fast, didn't they? 678 00:28:21,700 --> 00:28:22,918 Marcus is a fighter. 679 00:28:25,442 --> 00:28:26,925 All right, this is my show. 680 00:28:27,009 --> 00:28:28,927 Once we get to the spine, you follow my lead, understood? 681 00:28:29,011 --> 00:28:30,450 Fair enough. 682 00:28:30,534 --> 00:28:33,192 Mia, start my play list. 683 00:28:34,756 --> 00:28:36,979 All right, after you. 684 00:28:37,063 --> 00:28:38,154 Scalpel. 685 00:28:51,599 --> 00:28:52,777 Where are we at? 686 00:28:52,861 --> 00:28:55,084 I gave 125 of the methylprednisolone 687 00:28:55,168 --> 00:28:57,042 and 50 of diphenhydramine. 688 00:28:57,126 --> 00:28:59,784 All right, we're ready to start the vancomycin. 689 00:28:59,868 --> 00:29:01,525 Now, we're gonna take it slowly, 690 00:29:01,609 --> 00:29:03,527 gradually increase the dose over time. 691 00:29:03,611 --> 00:29:05,311 Are you ready? 692 00:29:05,395 --> 00:29:07,052 As I'll ever be. 693 00:29:19,670 --> 00:29:21,850 Something doesn't feel right. 694 00:29:21,934 --> 00:29:23,547 - Okay. - Oh, my God. 695 00:29:23,631 --> 00:29:25,462 Oh, my God. My throat... I can't swallow. 696 00:29:25,546 --> 00:29:27,725 Okay, we got you. Nancy, 0.3 of Epi. 697 00:29:27,809 --> 00:29:31,163 I can't... 698 00:29:31,247 --> 00:29:32,338 It takes time to work. 699 00:29:32,422 --> 00:29:33,946 Just stay calm. Keep your eyes on me. 700 00:29:36,905 --> 00:29:39,952 Another 0.3 of Epi and another 50 of diphenhydramine. 701 00:29:43,520 --> 00:29:45,395 Mask. 702 00:29:45,479 --> 00:29:46,785 There you go. 703 00:29:52,138 --> 00:29:54,970 Get ready to intubate. 704 00:29:55,054 --> 00:29:56,406 Just a precaution. 705 00:30:10,765 --> 00:30:12,248 I think it's working. 706 00:30:12,332 --> 00:30:13,553 Slow, deep breaths. 707 00:30:13,637 --> 00:30:15,683 In through the nose, out through the mouth. 708 00:30:21,384 --> 00:30:22,516 That's it. 709 00:30:29,915 --> 00:30:33,182 So how long have you actually been sick? 710 00:30:33,266 --> 00:30:35,619 This is day six. 711 00:30:35,703 --> 00:30:40,664 Ever since I stopped using. 712 00:30:41,883 --> 00:30:43,453 Did you know that these symptoms 713 00:30:43,537 --> 00:30:46,586 are a result of withdrawal? 714 00:30:46,670 --> 00:30:48,716 I figured. 715 00:30:51,240 --> 00:30:54,420 Dr. Asher, if I outed you to your colleagues... 716 00:30:54,504 --> 00:30:56,292 No. 717 00:30:56,376 --> 00:30:57,772 No, you didn't. 718 00:30:57,856 --> 00:31:01,601 Everyone here knows that I'm in recovery. 719 00:31:01,685 --> 00:31:05,211 And you don't have to call me Dr. Asher. 720 00:31:06,255 --> 00:31:10,303 It does feel kind of weird calling you by your last name. 721 00:31:11,739 --> 00:31:14,005 I won't tell anyone in group. 722 00:31:14,089 --> 00:31:15,833 Thank you. 723 00:31:15,917 --> 00:31:17,661 I don't even know if the drugs 724 00:31:17,745 --> 00:31:20,142 have cleared my system yet. 725 00:31:20,226 --> 00:31:22,971 I couldn't risk you running a drug test on me, 726 00:31:23,055 --> 00:31:25,364 given everything you know about me. 727 00:31:25,448 --> 00:31:30,062 I just... I don't want anyone taking my baby away. 728 00:31:32,151 --> 00:31:36,114 Well, I commend you for quitting, Liza. 729 00:31:36,198 --> 00:31:38,508 Going cold turkey is really hard. 730 00:31:40,637 --> 00:31:43,861 There are some medications like Suboxone and methadone 731 00:31:43,945 --> 00:31:46,429 that can help curb the cravings. 732 00:31:46,513 --> 00:31:48,474 Those are opiates, right? 733 00:31:48,558 --> 00:31:50,172 Yes. 734 00:31:50,256 --> 00:31:52,478 But when you're medically supervised, 735 00:31:52,562 --> 00:31:55,612 you are allowed to be on them while you're pregnant. 736 00:31:55,696 --> 00:31:57,353 The risk to the fetus is minimal... 737 00:31:57,437 --> 00:31:58,920 No. 738 00:31:59,004 --> 00:32:02,050 If there are any risks, then no. 739 00:32:03,922 --> 00:32:07,929 I probably shot up, 740 00:32:08,013 --> 00:32:11,364 like, a half dozen times during my first trimester. 741 00:32:13,583 --> 00:32:19,633 And still, by some miracle, the baby seems to be okay. 742 00:32:22,244 --> 00:32:26,208 I can't do anything to jeopardize that. 743 00:32:26,292 --> 00:32:27,292 I won't. 744 00:32:31,645 --> 00:32:32,820 Come in. 745 00:32:38,782 --> 00:32:40,613 I was going to check with Mrs. Sullivan 746 00:32:40,697 --> 00:32:42,920 to see if she would agree to David spending 747 00:32:43,004 --> 00:32:45,662 a couple of nights in the psych ward. 748 00:32:45,746 --> 00:32:47,969 I figure we can talk to him more, 749 00:32:48,053 --> 00:32:52,669 begin to find the correct medication and dosage. 750 00:32:52,753 --> 00:32:54,323 Well, that sounds good, Dr. Cuevas. 751 00:32:54,407 --> 00:32:55,933 Thank you. 752 00:32:56,017 --> 00:32:58,544 Oh, and his father is out of surgery. 753 00:32:58,628 --> 00:32:59,981 No complications. 754 00:33:00,065 --> 00:33:04,069 Well, good stuff. I'm glad to... glad to hear too. 755 00:33:08,769 --> 00:33:12,863 I should have spoken to you first before medicating David. 756 00:33:12,947 --> 00:33:15,518 Look, you know it was a chaotic situation, 757 00:33:15,602 --> 00:33:18,695 and I understand that you felt the need to act swiftly. 758 00:33:18,779 --> 00:33:20,131 I do. 759 00:33:20,215 --> 00:33:23,308 I probably did jump to medication too quickly, 760 00:33:23,392 --> 00:33:24,614 if I'm being honest. 761 00:33:27,701 --> 00:33:31,447 I know I rely heavily on the literature 762 00:33:31,531 --> 00:33:33,753 and the standard of care, 763 00:33:33,837 --> 00:33:38,541 but I just don't always feel 764 00:33:38,625 --> 00:33:41,802 like I can trust my own instincts. 765 00:33:44,805 --> 00:33:49,552 I mean, it took me years, years. 766 00:33:49,636 --> 00:33:50,770 And still, I have... 767 00:33:50,854 --> 00:33:54,992 I have my days when... you know? 768 00:33:55,076 --> 00:33:58,082 But this, I can promise you, you will get there. 769 00:33:58,166 --> 00:33:59,344 You will. 770 00:33:59,428 --> 00:34:01,169 There's not a shred of doubt in my mind. 771 00:34:02,692 --> 00:34:03,914 Trust me on that. 772 00:34:20,275 --> 00:34:22,324 Hey, Janet. 773 00:34:22,408 --> 00:34:23,974 Marcus did great. 774 00:34:27,717 --> 00:34:29,331 I can't thank you both enough. 775 00:34:29,415 --> 00:34:30,593 No need. 776 00:34:30,677 --> 00:34:31,811 He's got a long road ahead, 777 00:34:31,895 --> 00:34:33,552 but with physical therapy, I'm confident 778 00:34:33,636 --> 00:34:35,946 he'll be back on his feet. 779 00:34:36,030 --> 00:34:37,295 Can... can I see him? 780 00:34:37,379 --> 00:34:39,341 Of course. I'll take you to recovery. 781 00:34:39,425 --> 00:34:42,083 Now, he's just waking up, so he might be a bit groggy, okay? 782 00:34:42,167 --> 00:34:43,385 This way. 783 00:34:47,824 --> 00:34:49,829 Dr. Abrams, I heard the good news. 784 00:34:49,913 --> 00:34:51,179 I really appreciate... 785 00:34:51,263 --> 00:34:53,703 Yeah, you two ever pull a stunt like that again, 786 00:34:53,787 --> 00:34:54,747 I won't keep it to myself. 787 00:34:54,831 --> 00:34:56,184 I'll go straight to Goodwin. 788 00:34:56,268 --> 00:34:57,489 Excuse me? 789 00:34:57,573 --> 00:34:59,317 I don't appreciate being conned into surgery 790 00:34:59,401 --> 00:35:01,363 - under false pretenses. - Wait. 791 00:35:01,447 --> 00:35:03,582 I'm sorry, Dr. Abrams. What are you talking about? 792 00:35:07,409 --> 00:35:09,501 My antenna went up when Marcus's platelets 793 00:35:09,585 --> 00:35:10,937 corrected so quickly. 794 00:35:11,021 --> 00:35:13,027 So I had the lab run an anti-platelet antibody test 795 00:35:13,111 --> 00:35:14,289 while we were in surgery. 796 00:35:14,373 --> 00:35:16,984 You might be interested in the results. 797 00:35:21,728 --> 00:35:23,211 - Marcus has ITP. - Mm-hmm. 798 00:35:23,295 --> 00:35:24,690 But this doesn't make any sense. 799 00:35:24,774 --> 00:35:26,214 If Marcus has ITP, the transfusion 800 00:35:26,298 --> 00:35:28,564 - shouldn't have worked. - Correct. 801 00:35:28,648 --> 00:35:31,436 Unless someone gave him a little assistance. 802 00:35:41,280 --> 00:35:43,970 You gave Marcus steroids, didn't you? 803 00:35:44,054 --> 00:35:45,320 And that's why his platelet count went up. 804 00:35:45,404 --> 00:35:47,148 I know steroids can be controversial 805 00:35:47,232 --> 00:35:49,150 - in the surgical settings... - To put it lightly. 806 00:35:49,234 --> 00:35:52,283 You put him at greater risk of post-op infection. 807 00:35:52,367 --> 00:35:53,763 Vanessa, believe me when I tell you, 808 00:35:53,847 --> 00:35:56,331 this was our only play. 809 00:35:56,415 --> 00:35:57,680 Our only play? 810 00:35:57,764 --> 00:36:00,291 I was left in the dark. 811 00:36:00,375 --> 00:36:01,988 Look, I didn't want you catching any heat 812 00:36:02,072 --> 00:36:03,512 if things went south, okay? 813 00:36:03,596 --> 00:36:05,818 I have more cover as an attending. 814 00:36:05,902 --> 00:36:07,168 I was trying to protect you. 815 00:36:09,167 --> 00:36:10,780 I do not need your protection. 816 00:36:10,864 --> 00:36:11,998 I need your respect. 817 00:36:12,082 --> 00:36:14,000 Vanessa, of course I respect you. 818 00:36:14,084 --> 00:36:16,177 It does not feel that way right now. 819 00:36:25,008 --> 00:36:27,101 Looking much better, Indrani. 820 00:36:27,185 --> 00:36:29,059 Some techs will be back soon to move you upstairs. 821 00:36:29,143 --> 00:36:31,409 We're gonna keep you on IV vancomycin for a few days 822 00:36:31,493 --> 00:36:34,282 and then switch you over to the oral version. 823 00:36:34,366 --> 00:36:37,285 Dr. Halstead, I can't thank you enough. 824 00:36:37,369 --> 00:36:39,678 I'm just sorry we had to put you through all that. 825 00:36:39,762 --> 00:36:41,416 Oh, it was worth it, believe me. 826 00:36:44,463 --> 00:36:46,334 That's where I'm going to be next month. 827 00:36:48,336 --> 00:36:50,120 I'm adding it to my bucket list. 828 00:36:54,734 --> 00:36:55,825 Would you excuse me for a moment? 829 00:36:55,909 --> 00:36:57,127 Of course. 830 00:36:59,608 --> 00:37:01,439 Ms. Goodwin. 831 00:37:01,523 --> 00:37:03,746 Stop by my office before you leave tonight. 832 00:37:03,830 --> 00:37:05,135 I'd like a word. 833 00:37:07,225 --> 00:37:09,096 Will do. 834 00:37:12,969 --> 00:37:15,584 Dr. Choi, 835 00:37:15,668 --> 00:37:19,153 uh, this is for you. 836 00:37:19,237 --> 00:37:20,545 I saw you were staying on for the night shift, 837 00:37:20,629 --> 00:37:23,722 so I figured you might need a caffeine boost. 838 00:37:23,806 --> 00:37:25,333 Oh, and these are also for you. 839 00:37:25,417 --> 00:37:27,726 It's my CV, in-progress research papers, 840 00:37:27,810 --> 00:37:29,203 and all my case logs to date. 841 00:37:30,987 --> 00:37:33,254 For our first advisor meeting tomorrow. 842 00:37:33,338 --> 00:37:38,346 Ah, well, you are really prepared, Zach. 843 00:37:38,430 --> 00:37:39,477 Will you excuse me? 844 00:37:39,561 --> 00:37:41,436 Yeah, of course. 845 00:37:41,520 --> 00:37:43,438 See you tomorrow. 846 00:37:43,522 --> 00:37:45,744 See you tomorrow. 847 00:37:45,828 --> 00:37:48,094 - Hey. - Hey. 848 00:37:48,178 --> 00:37:50,706 Liza agreed to be admitted overnight for observation. 849 00:37:50,790 --> 00:37:52,621 Good. 850 00:37:52,705 --> 00:37:55,014 She's in withdrawal, I take it. 851 00:37:55,098 --> 00:37:56,929 Don't worry, I won't say anything. 852 00:37:57,013 --> 00:37:59,018 I appreciate that, Ethan. 853 00:37:59,102 --> 00:38:00,803 And while I suspect that the drugs 854 00:38:00,887 --> 00:38:02,108 have already cleared her system, 855 00:38:02,192 --> 00:38:03,849 she's terrified someone might report her. 856 00:38:03,933 --> 00:38:05,547 The last thing she needs is to be 857 00:38:05,631 --> 00:38:09,028 penalized for seeking care. 858 00:38:09,112 --> 00:38:11,117 Look, you were absolutely right, by the way, 859 00:38:11,201 --> 00:38:13,163 to bring in Dr. Patchefsky. 860 00:38:13,247 --> 00:38:15,034 I never should have given you flack for that. 861 00:38:15,118 --> 00:38:18,037 Look, I know how frustrating it is 862 00:38:18,121 --> 00:38:20,779 to always feel like you're being held 863 00:38:20,863 --> 00:38:23,434 to some former version of yourself. 864 00:38:23,518 --> 00:38:26,132 But on the flip side, because of who you were 865 00:38:26,216 --> 00:38:27,873 and what you went through, 866 00:38:27,957 --> 00:38:29,484 you were able to connect to Liza 867 00:38:29,568 --> 00:38:31,399 in a way no one else could. 868 00:38:32,962 --> 00:38:35,054 Yeah. 869 00:38:35,138 --> 00:38:36,357 I guess that's true. 870 00:38:38,141 --> 00:38:40,321 Maybe it's not always such a bad thing, 871 00:38:40,405 --> 00:38:42,497 having your reputation precede you. 872 00:38:50,502 --> 00:38:52,550 Great work today, Sam. 873 00:38:58,814 --> 00:38:59,989 Goodnight, Dr. Taylor. 874 00:39:05,604 --> 00:39:07,348 Ooh, ouch. 875 00:39:07,432 --> 00:39:12,091 Why, I see you've got yourself quite the fan club. 876 00:39:12,175 --> 00:39:14,093 You know, maybe I was wrong about you. 877 00:39:14,177 --> 00:39:16,661 You might be cut out for island life after all. 878 00:39:21,097 --> 00:39:24,365 So let me get this straight. 879 00:39:24,449 --> 00:39:27,237 You gave the patient an antibiotic 880 00:39:27,321 --> 00:39:29,239 you knew she was allergic to... 881 00:39:29,323 --> 00:39:31,850 Only after I advised her of the potential risks 882 00:39:31,934 --> 00:39:33,591 and with her full consent. 883 00:39:33,675 --> 00:39:35,898 Which, trust me, wouldn't hold up in court 884 00:39:35,982 --> 00:39:38,509 if this thing had gone sideways. 885 00:39:38,593 --> 00:39:40,555 Well, Ms. Goodwin, it wasn't my first choice. 886 00:39:40,639 --> 00:39:42,948 I understand the new protocols got off 887 00:39:43,032 --> 00:39:44,776 to a bit of a rocky start today, but... 888 00:39:44,860 --> 00:39:47,039 They're not working. 889 00:39:47,123 --> 00:39:48,606 I have no doubt they were designed 890 00:39:48,690 --> 00:39:49,912 with the best of intentions, 891 00:39:49,996 --> 00:39:51,043 but as your boots on the ground, 892 00:39:51,127 --> 00:39:52,262 I have to give it to you straight. 893 00:39:52,346 --> 00:39:54,569 Let me give it to you straight. 894 00:39:54,653 --> 00:39:59,008 These supply chain issues are not gonna resolve anytime soon, 895 00:39:59,092 --> 00:40:02,011 and not for lack of trying on my part. 896 00:40:02,095 --> 00:40:06,407 So as imperfect as these new protocols may be, 897 00:40:06,491 --> 00:40:12,543 we need some sort of semblance of order in the ED. 898 00:40:12,627 --> 00:40:16,501 I can't have it turning into the Wild West! 899 00:40:18,328 --> 00:40:21,465 Honestly, Ms. Goodwin, I think we're already there. 899 00:40:22,305 --> 00:41:22,802 Please rate this subtitle at www.osdb.link/aqmws Help other users to choose the best subtitles 65655

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