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1
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- Robby.
2
00:00:28,695 --> 00:00:30,279
Robby.
3
00:00:30,280 --> 00:00:31,905
College kid in
respiratory distress is here.
4
00:00:31,906 --> 00:00:33,282
- All right.
- You OK?
5
00:00:33,283 --> 00:00:35,075
Yep.
6
00:00:35,076 --> 00:00:37,119
I wanted to talk to the patient
in Central 12's son,
7
00:00:37,120 --> 00:00:38,287
but he took off.
8
00:00:38,288 --> 00:00:39,413
- Is there a problem?
9
00:00:39,414 --> 00:00:40,748
According to Mom,
10
00:00:40,749 --> 00:00:41,790
she found a list
of high school girls
11
00:00:41,791 --> 00:00:44,835
that he'd like to eliminate.
12
00:00:44,836 --> 00:00:46,962
- What's wrong
with kids these days?
13
00:00:46,963 --> 00:00:48,922
You mean besides social media
14
00:00:48,923 --> 00:00:51,633
and the worldwide pandemic
and the environmental crisis?
15
00:00:51,634 --> 00:00:53,469
- Yeah, yeah, yeah.
- And gun violence?
16
00:00:53,470 --> 00:00:55,137
- You're a fucking fountain
of hope today, aren't you?
17
00:00:55,138 --> 00:00:57,931
- Nick Bradley, 19,
found unresponsive by parents.
18
00:00:57,932 --> 00:00:59,308
No meds, no allergies.
19
00:00:59,309 --> 00:01:00,934
On arrival,
he was barely breathing
20
00:01:00,935 --> 00:01:03,270
with pinpoint pupils,
bradycardic at 38.
21
00:01:03,271 --> 00:01:04,980
Pupils responded to Narcan,
22
00:01:04,981 --> 00:01:07,566
but we tubed him when his
respirations didn't pick up.
23
00:01:07,567 --> 00:01:09,568
- Any drugs or alcohol
on the scene?
24
00:01:09,569 --> 00:01:11,111
- No.
- Signs of trauma?
25
00:01:11,112 --> 00:01:12,321
- Nothing.
26
00:01:12,322 --> 00:01:13,989
- OK.
Open your eyes, Nick.
27
00:01:13,990 --> 00:01:16,493
On three.
One, two, three.
28
00:01:18,370 --> 00:01:21,663
- Where was he found?
- In bed by his mom.
29
00:01:21,664 --> 00:01:26,168
- Pupils are 6 millimeters,
non-reactive.
30
00:01:26,169 --> 00:01:28,671
- Heart rate's 64.
BP is cycling.
31
00:01:28,672 --> 00:01:31,465
- No response to pain.
GCS 3.
32
00:01:31,466 --> 00:01:34,009
- Does that fit any toxidrome?
- No.
33
00:01:34,010 --> 00:01:36,470
If it was just opiates
with Narcan,
34
00:01:36,471 --> 00:01:38,806
he'd be breathing on his own.
35
00:01:38,807 --> 00:01:41,016
Beta blockers
shouldn't get pinpoint pupils.
36
00:01:41,017 --> 00:01:42,518
- Maybe parents had some
37
00:01:42,519 --> 00:01:43,602
prescription meds
in their bathroom.
38
00:01:43,603 --> 00:01:45,270
- They're on their way.
39
00:01:45,271 --> 00:01:47,356
- Code trauma, tier 1,
ETA five minutes.
40
00:01:47,357 --> 00:01:49,692
- That's a stand-up scooter
rider versus car door.
41
00:01:49,693 --> 00:01:51,985
No helmet.
- No blood in the belly.
42
00:01:51,986 --> 00:01:57,074
No pericardial effusion,
and lungs are up.
43
00:01:57,075 --> 00:01:58,992
- Hemocue's good, 15.
44
00:01:58,993 --> 00:02:01,829
BP 84 over 58.
- OK.
45
00:02:01,830 --> 00:02:03,789
What's your plan, Dr. Collins?
46
00:02:03,790 --> 00:02:07,710
- Um, push dose epi,
0.1 milligram.
47
00:02:07,711 --> 00:02:10,170
Foley for urine,
stabilize for CT,
48
00:02:10,171 --> 00:02:13,382
and throw a wide net.
49
00:02:17,512 --> 00:02:18,846
- Where...
where are we going now?
50
00:02:18,847 --> 00:02:20,681
- We need the room
for someone else,
51
00:02:20,682 --> 00:02:23,685
but you can rest in the hall
till we get your labs back.
52
00:02:25,311 --> 00:02:27,855
- Your parents must be proud.
53
00:02:27,856 --> 00:02:30,065
Having a son for a doctor.
54
00:02:30,066 --> 00:02:32,735
- Yeah, I guess.
55
00:02:32,736 --> 00:02:34,403
Um, you know,
56
00:02:34,404 --> 00:02:38,532
I was the first one
in my family to go to college.
57
00:02:38,533 --> 00:02:42,369
You know, they sacrificed a lot
to get me here.
58
00:02:42,370 --> 00:02:43,912
How's your pain, Mr. Milton?
59
00:02:43,913 --> 00:02:45,414
I'm fine.
60
00:02:45,415 --> 00:02:46,999
Could use a latte, though.
61
00:02:47,000 --> 00:02:49,251
- That could bring back
the gallstone pain.
62
00:02:49,252 --> 00:02:50,753
- How about a bourbon?
63
00:02:50,754 --> 00:02:52,421
It's barely 8:00.
64
00:02:52,422 --> 00:02:54,757
How about some ice chips?
65
00:02:54,758 --> 00:02:56,759
No, thanks.
66
00:02:56,760 --> 00:02:58,594
I prefer my whiskey neat.
67
00:02:58,595 --> 00:02:59,970
Yeah, that's not happening.
68
00:03:04,684 --> 00:03:07,436
- Systolic back down to 90.
69
00:03:07,437 --> 00:03:09,438
- Another 0.1 of epi.
70
00:03:09,439 --> 00:03:13,233
- Flaccid paralysis
of all four extremities.
71
00:03:13,234 --> 00:03:16,111
No eye movement with ice water.
72
00:03:16,112 --> 00:03:17,696
- So no brainstem function.
73
00:03:17,697 --> 00:03:19,073
- Due to?
74
00:03:19,074 --> 00:03:21,492
- Hypoxic injury,
massive hemorrhage.
75
00:03:21,493 --> 00:03:23,744
Samira, escort him to CT.
76
00:03:23,745 --> 00:03:25,788
Take the drug box with you.
77
00:03:25,789 --> 00:03:27,289
- Call me if you need me.
78
00:03:27,290 --> 00:03:29,833
Hey, are you OK?
79
00:03:29,834 --> 00:03:31,627
- Yep.
- Are you sure?
80
00:03:31,628 --> 00:03:33,921
- Have you ever had
to worry about me?
81
00:03:33,922 --> 00:03:36,256
- No, but it never hurts
to check in.
82
00:03:36,257 --> 00:03:38,092
It's part of my job.
83
00:03:38,093 --> 00:03:40,427
- Consider yourself checked in.
84
00:03:40,428 --> 00:03:41,930
- OK.
85
00:03:45,308 --> 00:03:46,600
Got something?
86
00:03:46,601 --> 00:03:48,227
I had a case
for Dr. Collins.
87
00:03:48,228 --> 00:03:50,604
- May I see?
- Yeah.
88
00:03:50,605 --> 00:03:53,857
A 68-year-old male,
history of hypertension,
89
00:03:53,858 --> 00:03:55,609
one hour of right
upper quadrant pain
90
00:03:55,610 --> 00:03:57,820
after eating a fatty meal,
now resolved.
91
00:03:57,821 --> 00:03:59,279
Afebrile, non-tender.
92
00:03:59,280 --> 00:04:01,156
There was a gallstone present
on POCUS.
93
00:04:01,157 --> 00:04:03,659
EKG shows no acute
ischemic changes,
94
00:04:03,660 --> 00:04:05,994
but I'm still waiting
on LFTs and lipase.
95
00:04:05,995 --> 00:04:08,497
- Why did you order the EKG?
96
00:04:08,498 --> 00:04:11,750
- The nurse suggested it
to rule out any cardiac issues.
97
00:04:11,751 --> 00:04:14,294
- Well, good call
on both your parts.
98
00:04:14,295 --> 00:04:15,629
Nurses know what they're doing.
99
00:04:15,630 --> 00:04:17,089
Never hesitate
to listen to them.
100
00:04:17,090 --> 00:04:18,674
Come find me when
those labs are back.
101
00:04:18,675 --> 00:04:20,134
- Hey, how's that finger?
- It's nothing.
102
00:04:20,135 --> 00:04:21,552
- Dr. Robby?
- Yep?
103
00:04:21,553 --> 00:04:23,012
- The son and daughter
of Mr. Spencer
104
00:04:23,013 --> 00:04:24,555
from assisted living,
they're here.
105
00:04:24,556 --> 00:04:26,849
- OK. I'll be right there.
106
00:04:33,648 --> 00:04:36,859
Your father has pneumonia
and a condition called sepsis.
107
00:04:36,860 --> 00:04:38,777
- What is...
what is that exactly?
108
00:04:38,778 --> 00:04:41,113
- It means that the bacteria
has spread from his lung
109
00:04:41,114 --> 00:04:42,698
to his bloodstream.
110
00:04:42,699 --> 00:04:45,200
So far, he's been
responding well to treatment.
111
00:04:45,201 --> 00:04:47,661
- Hey, Pop.
112
00:04:47,662 --> 00:04:49,955
It's Helen and Jereme.
113
00:04:51,708 --> 00:04:54,168
- Jereme...
114
00:04:54,169 --> 00:04:56,003
Hillary...
115
00:04:56,004 --> 00:04:57,212
Boob...
116
00:04:57,213 --> 00:04:58,881
Fud.
117
00:05:00,842 --> 00:05:03,761
It's the "Nowhere Man"
from "Yellow Submarine."
118
00:05:03,762 --> 00:05:06,096
It's what he used to call me
when I didn't do my homework.
119
00:05:06,097 --> 00:05:07,890
- Is this his baseline?
120
00:05:07,891 --> 00:05:10,143
- He has good days and bad days.
121
00:05:11,644 --> 00:05:13,855
- Why don't we step out
for one more second?
122
00:05:18,443 --> 00:05:20,652
So your father came in
with low blood pressure,
123
00:05:20,653 --> 00:05:21,987
which is improving.
124
00:05:21,988 --> 00:05:23,572
- Can he go back
to assisted living?
125
00:05:23,573 --> 00:05:25,407
- Eventually, we hope so.
126
00:05:25,408 --> 00:05:27,242
Your dad has
an advanced directive
127
00:05:27,243 --> 00:05:28,911
expressing his wishes,
which says that
128
00:05:28,912 --> 00:05:31,246
IV fluids and medications
are OK,
129
00:05:31,247 --> 00:05:33,749
but no artificial life support,
no CPR.
130
00:05:33,750 --> 00:05:36,543
- He doesn't want a bunch
of machines keeping him alive.
131
00:05:36,544 --> 00:05:38,212
- OK.
132
00:05:38,213 --> 00:05:40,005
Then we will continue
with oxygen
133
00:05:40,006 --> 00:05:42,508
and IV fluids and antibiotics,
134
00:05:42,509 --> 00:05:44,176
but if his lungs stop working,
135
00:05:44,177 --> 00:05:45,594
we're not going
to place a tube in his windpipe
136
00:05:45,595 --> 00:05:46,762
for a breathing machine.
137
00:05:46,763 --> 00:05:49,223
- But pneumonia is treatable?
138
00:05:49,224 --> 00:05:51,934
- Most of the time, it is.
139
00:05:51,935 --> 00:05:53,018
- But if he can get better
in a week,
140
00:05:53,019 --> 00:05:54,269
then put him on a machine.
141
00:05:54,270 --> 00:05:56,105
- That's not what he wanted.
142
00:05:56,106 --> 00:05:58,107
- Do either of you have
durable power of attorney
143
00:05:58,108 --> 00:05:59,650
for health care?
144
00:05:59,651 --> 00:06:00,943
- Yes.
- We both do.
145
00:06:00,944 --> 00:06:02,111
- OK.
146
00:06:02,112 --> 00:06:03,612
Well, this is a decision
147
00:06:03,613 --> 00:06:04,947
that does not need
to be made right now.
148
00:06:04,948 --> 00:06:06,490
Why don't you think about it?
149
00:06:06,491 --> 00:06:08,075
Talk about it.
150
00:06:08,076 --> 00:06:11,954
If things get worse,
sometimes allowing
151
00:06:11,955 --> 00:06:15,000
for a comfortable natural death
can be the most humane path.
152
00:06:18,378 --> 00:06:21,255
- No routine cases until
we assess the tier 1.
153
00:06:21,256 --> 00:06:22,256
Thanks.
154
00:06:22,257 --> 00:06:24,800
- Dr. Langdon?
155
00:06:24,801 --> 00:06:27,970
So, how was the VA?
156
00:06:27,971 --> 00:06:30,681
Yeah, it was, good,
you know, challenging.
157
00:06:30,682 --> 00:06:33,308
I learned a ton.
I just think it...
158
00:06:33,309 --> 00:06:34,643
maybe it should be mandatory
159
00:06:34,644 --> 00:06:35,686
that all doctors
spend time there,
160
00:06:35,687 --> 00:06:37,187
like, on a regular basis
161
00:06:37,188 --> 00:06:39,189
because of all
they've sacrificed for us.
162
00:06:39,190 --> 00:06:41,984
- That's a nice thought.
Why'd you choose the Pitt?
163
00:06:41,985 --> 00:06:43,444
I have a sister
with special needs
164
00:06:43,445 --> 00:06:45,070
and she got into
this really great facility
165
00:06:45,071 --> 00:06:46,447
here in Pittsburgh.
166
00:06:46,448 --> 00:06:48,157
And PTMC has such
a great reputation,
167
00:06:48,158 --> 00:06:49,992
I thought, you know,
it'd be a good fit.
168
00:06:49,993 --> 00:06:51,076
- Can I present my headache
to you?
169
00:06:51,077 --> 00:06:52,619
Yeah, what do you got?
170
00:06:52,620 --> 00:06:54,496
- A 36-year-old woman
with severe headache
171
00:06:54,497 --> 00:06:56,331
due to paracervical
trigger point.
172
00:06:56,332 --> 00:06:59,001
Her pain went from 11 to zero
after 2 ccs of IM Marcaine
173
00:06:59,002 --> 00:07:00,336
to the...
- Wait, wait, wait.
174
00:07:00,337 --> 00:07:01,837
You did
a trigger point injection
175
00:07:01,838 --> 00:07:03,505
before presenting the case?
- Yeah. I...
176
00:07:03,506 --> 00:07:05,799
- Interns always present first.
177
00:07:05,800 --> 00:07:07,051
- I spent a month at
the pain clinic at Hopkins.
178
00:07:07,052 --> 00:07:08,844
- No, it's not OK.
- Incoming!
179
00:07:08,845 --> 00:07:10,804
- I'm very comfortable with...
- It's definitely not OK.
180
00:07:10,805 --> 00:07:12,556
- 23-year-old Ben Kemper,
no helmet,
181
00:07:12,557 --> 00:07:14,433
got doored riding an e-scooter.
182
00:07:14,434 --> 00:07:16,435
Neck versus handlebar then
face-planted to the pavement.
183
00:07:16,436 --> 00:07:18,020
Obvious facial fractures,
184
00:07:18,021 --> 00:07:19,981
but alert and oriented
with good vitals.
185
00:07:22,359 --> 00:07:23,735
- Here we go.
186
00:07:25,278 --> 00:07:27,572
One, two, three.
187
00:07:29,866 --> 00:07:31,200
- How are we doing, Ben?
188
00:07:31,201 --> 00:07:33,577
Blood, back in my throat.
189
00:07:33,578 --> 00:07:35,371
- That's probably
from the nosebleed.
190
00:07:35,372 --> 00:07:37,247
Short Rapid Rhino, please.
191
00:07:37,248 --> 00:07:40,501
- Tachy at 120,
pulse ox borderline at 90.
192
00:07:40,502 --> 00:07:41,877
- Blow by at 15 liters for now.
193
00:07:41,878 --> 00:07:43,420
- Neck contusion.
- BP 138 over 84.
194
00:07:43,421 --> 00:07:45,130
- Larynx shifted to the right,
no crepitance.
195
00:07:45,131 --> 00:07:47,132
- 4 of morphine.
196
00:07:47,133 --> 00:07:51,637
I'm going to stick something in
your nose to stop the bleeding.
197
00:07:51,638 --> 00:07:53,347
- No hemotympanum.
198
00:07:53,348 --> 00:07:56,225
- Inflate the balloon.
199
00:07:56,226 --> 00:07:58,686
- How about now, Ben?
200
00:07:58,687 --> 00:08:01,188
- Better.
- What's up?
201
00:08:01,189 --> 00:08:04,401
- Good vitals,
A and O, let's have a look.
202
00:08:08,196 --> 00:08:09,571
- Ouch.
203
00:08:09,572 --> 00:08:12,324
- Floating face.
- Le Fort III fracture.
204
00:08:12,325 --> 00:08:14,743
- You don't see that every day.
OK, let's prep for airway.
205
00:08:14,744 --> 00:08:17,037
Double setup just in case.
206
00:08:30,844 --> 00:08:34,096
- Nice work.
- Thanks.
207
00:08:34,097 --> 00:08:36,140
- All right, Mr. Tagari,
you are good to go.
208
00:08:36,141 --> 00:08:37,808
Thank you.
209
00:08:37,809 --> 00:08:42,146
Remember, 10% off
for doctors and nurses.
210
00:08:42,147 --> 00:08:43,605
- I'm a student doctor.
211
00:08:43,606 --> 00:08:45,607
Right. Sorry.
212
00:08:45,608 --> 00:08:47,985
I hit my head, remember?
- Well, my son loves pizza,
213
00:08:47,986 --> 00:08:49,611
so I will take you up on it
for sure, OK?
214
00:08:49,612 --> 00:08:50,821
- Thank you. Thank you.
- Thank you.
215
00:08:50,822 --> 00:08:52,614
Wait for a nurse.
- OK, thanks.
216
00:08:52,615 --> 00:08:54,575
Hi.
217
00:08:54,576 --> 00:08:57,119
I just realized it sounds like
I always feed my kid junk food.
218
00:08:57,120 --> 00:08:58,328
You know?
219
00:08:58,329 --> 00:08:59,913
Pizza, s'mores.
220
00:08:59,914 --> 00:09:02,791
- No, no, please.
I... I like pizza and s'mores.
221
00:09:02,792 --> 00:09:05,627
Who doesn't?
222
00:09:05,628 --> 00:09:09,131
How many kids do you have?
- Just one, Harrison.
223
00:09:09,132 --> 00:09:11,592
He's 11 now.
224
00:09:11,593 --> 00:09:12,968
- What does your husband do?
225
00:09:12,969 --> 00:09:14,928
- No husband,
just me and my son.
226
00:09:14,929 --> 00:09:16,388
I take it you don't have kids?
227
00:09:16,389 --> 00:09:18,766
I... I don't mean on account
of your age.
228
00:09:18,767 --> 00:09:20,392
Or maybe I do.
229
00:09:20,393 --> 00:09:22,311
I mean, most medical students
don't have kids.
230
00:09:22,312 --> 00:09:25,939
- Yeah, no, no.
- Um, no kids.
231
00:09:25,940 --> 00:09:29,234
Just not even a boyfriend.
It's just school for now.
232
00:09:29,235 --> 00:09:31,236
- Yeah.
That'll keep you pretty busy.
233
00:09:31,237 --> 00:09:33,530
I do not miss it.
234
00:09:33,531 --> 00:09:35,824
- Must have been difficult
as a young mother.
235
00:09:35,825 --> 00:09:37,326
- It had its moments,
236
00:09:37,327 --> 00:09:39,036
but my life has been
full of challenges,
237
00:09:39,037 --> 00:09:42,331
and med school was not one
of the hardest, by far.
238
00:09:42,332 --> 00:09:44,667
It was one of the most
rewarding, though.
239
00:09:44,668 --> 00:09:48,462
Other than having my son.
- Hey.
240
00:09:48,463 --> 00:09:50,881
Facial lash with possible
foreign object in the eye,
241
00:09:50,882 --> 00:09:54,343
which is always a solid 7
on the WMMV Scale.
242
00:09:54,344 --> 00:09:56,011
What Makes Mateo Vomit.
243
00:09:59,265 --> 00:10:01,975
- You OK?
- Yeah.
244
00:10:01,976 --> 00:10:05,521
Yeah.
Um, he's funny, the...
245
00:10:05,522 --> 00:10:06,980
- the nurse.
- Mateo.
246
00:10:06,981 --> 00:10:08,733
You can say his name.
247
00:10:09,943 --> 00:10:12,319
Um, yeah...
248
00:10:12,320 --> 00:10:15,490
a foreign object in the eye
could be really serious.
249
00:10:22,288 --> 00:10:25,457
- Hey, Fruitcake.
250
00:10:25,458 --> 00:10:26,875
Hey, I'm talking to you,
Fruitcake.
251
00:10:26,876 --> 00:10:28,627
- Myrna, I told you
a hundred times
252
00:10:28,628 --> 00:10:31,046
my name is Dr. Robby.
253
00:10:31,047 --> 00:10:33,173
- You want to see my vagina?
254
00:10:33,174 --> 00:10:35,217
- I have already seen it.
255
00:10:35,218 --> 00:10:38,095
And once was enough, thank you.
256
00:10:38,096 --> 00:10:40,180
- Robby,
parents of Nick Bradley,
257
00:10:40,181 --> 00:10:42,933
the OD teen, are here.
- OK, park them in Trauma 1.
258
00:10:42,934 --> 00:10:44,727
He's not back from CT yet.
259
00:10:44,728 --> 00:10:46,020
I'll be right there in a minute.
260
00:10:46,021 --> 00:10:47,354
- Got it.
Behaving yourself, Myrna?
261
00:10:47,355 --> 00:10:49,274
Yes, ma'am.
262
00:10:52,944 --> 00:10:53,944
- How we doing?
263
00:10:53,945 --> 00:10:55,070
- Ketamine and sux on board.
264
00:10:55,071 --> 00:10:56,739
- Pulse ox holding at 94.
265
00:10:56,740 --> 00:10:58,115
- Prepping the neck
just in case.
266
00:10:58,116 --> 00:10:59,199
- Let's have a look.
267
00:11:01,411 --> 00:11:03,412
A little deeper.
268
00:11:03,413 --> 00:11:05,039
- Lots of swelling.
I can't see the cords.
269
00:11:05,040 --> 00:11:07,583
- To the right.
The left.
270
00:11:07,584 --> 00:11:09,084
Yeah, it really distorted
from the trauma,
271
00:11:09,085 --> 00:11:10,252
and the edema's
only going to get worse.
272
00:11:10,253 --> 00:11:11,712
- Which is why we should crike.
273
00:11:11,713 --> 00:11:13,505
- You don't crike
a laryngeal fracture.
274
00:11:13,506 --> 00:11:14,757
Don't listen to
Edwina Scissorhands here.
275
00:11:14,758 --> 00:11:16,175
If they can't cut it,
276
00:11:16,176 --> 00:11:17,760
surgery doesn't know
how to fix it.
277
00:11:17,761 --> 00:11:19,428
- The contusion is high
at the thyroid cartilage,
278
00:11:19,429 --> 00:11:21,096
so you just stand there
looking pretty, ER Ken,
279
00:11:21,097 --> 00:11:23,557
and let me fix this.
280
00:11:23,558 --> 00:11:24,933
- We're down to 85.
- All right, pull out.
281
00:11:24,934 --> 00:11:27,227
I-gel, bag and crike.
- I-gel, please.
282
00:11:27,228 --> 00:11:28,520
Turn off the alarm.
283
00:11:28,521 --> 00:11:29,605
- I've never done
a crike before.
284
00:11:29,606 --> 00:11:30,939
- No. Mel will do the crike.
285
00:11:30,940 --> 00:11:32,107
You've already had
a busy morning.
286
00:11:32,108 --> 00:11:33,442
Glove up, Mel.
287
00:11:33,443 --> 00:11:34,943
- No, I'm doing the crike, doctor.
288
00:11:34,944 --> 00:11:35,944
- You would be doing it, doctor,
289
00:11:35,945 --> 00:11:37,446
if it wasn't an odd day.
290
00:11:37,447 --> 00:11:38,655
Surgery gets even days,
ED gets odd days.
291
00:11:38,656 --> 00:11:40,407
You know this.
For crikes' sake.
292
00:11:40,408 --> 00:11:42,076
- That's because you're
all fucking odd down here.
293
00:11:42,077 --> 00:11:43,827
- OK, team work, please.
Let's focus on the patient.
294
00:11:43,828 --> 00:11:45,829
- I so appreciate
your gracious understanding.
295
00:11:45,830 --> 00:11:47,581
- I'll assist in case
she screws up.
296
00:11:47,582 --> 00:11:49,625
- Yolanda, play nice.
297
00:11:49,626 --> 00:11:51,168
- Sats are up with the I-gel.
298
00:11:51,169 --> 00:11:53,629
- You ready?
Hello?
299
00:11:53,630 --> 00:11:55,422
Hello.
300
00:11:55,423 --> 00:11:56,924
- You've done this?
301
00:11:56,925 --> 00:12:00,469
- Yes, in the cadaver lab.
302
00:12:00,470 --> 00:12:03,472
- Let's hope that's not where
this poor soul ends up.
303
00:12:03,473 --> 00:12:05,349
We'll do an open technique
since we have a minute.
304
00:12:05,350 --> 00:12:07,518
- OK.
305
00:12:07,519 --> 00:12:09,603
OK, you're going to be
making a vertical incision
306
00:12:09,604 --> 00:12:12,147
to avoid the jugulars
in the carotids.
307
00:12:13,608 --> 00:12:15,401
Good.
308
00:12:15,402 --> 00:12:17,069
If this was a crike that needed
to happen in seconds,
309
00:12:17,070 --> 00:12:20,072
you could use a 10 blade,
your finger, and a bougie.
310
00:12:23,410 --> 00:12:24,993
- This is called a Weitlaner.
311
00:12:24,994 --> 00:12:27,454
And this is your trake hook.
312
00:12:27,455 --> 00:12:31,333
- C-spine, head CT, OMF.
Start a propofol drip.
313
00:12:31,334 --> 00:12:33,002
OK, now we're going to make
a horizontal incision
314
00:12:33,003 --> 00:12:35,130
across
the cricothyroid membrane.
315
00:12:37,549 --> 00:12:39,675
Yeah.
316
00:12:39,676 --> 00:12:41,677
- 4.0 Shiley next.
317
00:12:41,678 --> 00:12:42,929
Get ready to bag the crike.
318
00:12:44,723 --> 00:12:46,850
Yeah, yeah, yeah, good.
319
00:12:54,107 --> 00:12:55,024
Excuse me.
320
00:12:55,025 --> 00:12:57,192
- No worries.
321
00:12:57,193 --> 00:12:58,527
- End tidal CO2 is yellow.
322
00:12:58,528 --> 00:13:00,070
- Yellow is yes.
Nicely done.
323
00:13:00,071 --> 00:13:03,157
Sew it in.
OK, I will be next-door.
324
00:13:04,826 --> 00:13:06,160
- Does your resident
know how to suture,
325
00:13:06,161 --> 00:13:07,536
or do I need to teach?
326
00:13:07,537 --> 00:13:10,581
- You're all class, Yoyo.
- I know, thanks.
327
00:13:10,582 --> 00:13:13,042
That means a lot of nothing
coming from you.
328
00:13:13,043 --> 00:13:15,544
- Mel, you OK?
- If you're done fighting.
329
00:13:15,545 --> 00:13:17,046
- We're not fighting.
This is playing.
330
00:13:17,047 --> 00:13:18,881
Langdon's too soft to fight.
331
00:13:18,882 --> 00:13:20,883
Yeah, I have nothing
but respect for Dr. Garcia.
332
00:13:20,884 --> 00:13:22,343
In fact, I think she would
333
00:13:22,344 --> 00:13:24,219
make a wonderful hostess
at Applebee's.
334
00:13:24,220 --> 00:13:25,764
- Later, Odds.
335
00:13:28,058 --> 00:13:29,850
- Let's go.
336
00:13:29,851 --> 00:13:31,518
- OK, thanks.
337
00:13:31,519 --> 00:13:33,979
Just received word
your son's head CT is normal,
338
00:13:33,980 --> 00:13:35,814
and he's maintaining
a good heart rate.
339
00:13:35,815 --> 00:13:38,025
- You got him back.
- Thank you. Thank God.
340
00:13:38,026 --> 00:13:39,485
- Right now, he's unconscious
341
00:13:39,486 --> 00:13:42,738
with a tube in his throat
for oxygen.
342
00:13:42,739 --> 00:13:44,239
Why don't we step out
for a minute while they
343
00:13:44,240 --> 00:13:45,783
get him settled,
and then you can come back?
344
00:13:45,784 --> 00:13:48,243
You can sit with him
as long as you want.
345
00:13:48,244 --> 00:13:50,746
- Nicky, it's Mama.
I'm here, baby.
346
00:13:50,747 --> 00:13:53,207
- You're doing great, son.
347
00:13:53,208 --> 00:13:56,085
- Blown.
348
00:13:56,086 --> 00:13:59,463
- OK, let's step outside.
- OK.
349
00:14:05,595 --> 00:14:07,554
So we don't know
350
00:14:07,555 --> 00:14:09,598
how long he was at home
without breathing.
351
00:14:09,599 --> 00:14:12,768
- He's breathing now.
- Not on his own.
352
00:14:12,769 --> 00:14:14,103
- But he's going to wake up.
353
00:14:14,104 --> 00:14:15,854
- We certainly hope so.
354
00:14:15,855 --> 00:14:17,106
We're going to know better after
355
00:14:17,107 --> 00:14:18,607
we get some more
test results back.
356
00:14:18,608 --> 00:14:21,360
Are you sure that
he didn't take anything
357
00:14:21,361 --> 00:14:22,444
that could have caused this?
358
00:14:22,445 --> 00:14:24,196
- No, no, he's a good kid.
359
00:14:24,197 --> 00:14:26,448
He's in college,
he has a part-time job.
360
00:14:26,449 --> 00:14:29,743
He even chose to live at home
so he could focus on school.
361
00:14:29,744 --> 00:14:31,620
- Dr. Robby.
From the urine.
362
00:14:31,621 --> 00:14:34,123
- What's that?
363
00:14:34,124 --> 00:14:35,457
- It's a drug test.
364
00:14:35,458 --> 00:14:38,085
And it is positive for fentanyl.
365
00:14:38,086 --> 00:14:40,796
- No, that is impossible.
Nick doesn't do drugs.
366
00:14:40,797 --> 00:14:43,132
- There are a lot of pills
that are sold illegally
367
00:14:43,133 --> 00:14:45,342
that have fentanyl,
not just painkillers.
368
00:14:45,343 --> 00:14:47,094
Xanax, Ativan.
369
00:14:47,095 --> 00:14:49,596
No, not our son.
370
00:14:49,597 --> 00:14:51,181
- Well, maybe he didn't know
that he took something
371
00:14:51,182 --> 00:14:52,766
with fentanyl, I don't know.
372
00:14:52,767 --> 00:14:54,977
The hows and the whys
don't really matter.
373
00:14:54,978 --> 00:14:56,979
What matters is
spending time with Nick.
374
00:14:56,980 --> 00:14:58,313
We've got some
more tests to run.
375
00:14:58,314 --> 00:14:59,440
We'll know our options
after that,
376
00:14:59,441 --> 00:15:00,816
but in the meantime,
377
00:15:00,817 --> 00:15:02,736
why don't you take a seat
and talk to him?
378
00:15:05,238 --> 00:15:06,488
- Can he hear us?
379
00:15:06,489 --> 00:15:07,823
- You know,
we're never really sure,
380
00:15:07,824 --> 00:15:09,825
so we should assume that he can.
381
00:15:09,826 --> 00:15:12,161
And we'll come find you
as soon as we know more, OK?
382
00:15:12,162 --> 00:15:13,162
- OK.
383
00:15:19,753 --> 00:15:21,920
- Can we move Nick Bradley
to a private room?
384
00:15:21,921 --> 00:15:23,465
- The kid going to make it?
385
00:15:24,924 --> 00:15:26,759
Didn't he respond to Narcan?
386
00:15:26,760 --> 00:15:28,802
- I think his pinpoint pupils
just grew into blown pupils
387
00:15:28,803 --> 00:15:29,928
from brainstem death.
388
00:15:29,929 --> 00:15:33,265
- Shit.
- Yeah.
389
00:15:33,266 --> 00:15:35,809
Not much older than Jake.
390
00:15:35,810 --> 00:15:37,145
- Don't go there.
391
00:15:38,188 --> 00:15:41,190
Hard not to sometimes.
392
00:15:41,191 --> 00:15:43,359
- Mr. Spencer's room.
393
00:15:43,360 --> 00:15:45,194
Hey, Robby,
394
00:15:45,195 --> 00:15:47,363
Theresa, the mother of the
young man David who bolted,
395
00:15:47,364 --> 00:15:48,697
she's asking for her son.
396
00:15:48,698 --> 00:15:50,199
- OK.
I'll be there in a minute.
397
00:15:50,200 --> 00:15:51,700
- What is happening?
398
00:15:51,701 --> 00:15:54,536
His oxygen levels are dropping.
399
00:15:54,537 --> 00:15:56,830
Mr. Spencer,
how are you feeling?
400
00:15:56,831 --> 00:15:59,375
- I don't remember
where I parked.
401
00:15:59,376 --> 00:16:01,335
- Mr. Spencer,
do you know where you are?
402
00:16:01,336 --> 00:16:03,712
- It's so loud in here.
403
00:16:03,713 --> 00:16:06,215
- Dad?
Do you know where you are?
404
00:16:06,216 --> 00:16:08,676
- Dad, look at me.
What's my name?
405
00:16:08,677 --> 00:16:12,763
I don't know where my car is.
406
00:16:12,764 --> 00:16:14,515
- BiPAP, 15 over 5.
407
00:16:14,516 --> 00:16:15,850
Let's step out.
408
00:16:20,146 --> 00:16:21,980
- What's a BiPAP?
409
00:16:21,981 --> 00:16:25,317
- It is a pressurized air mask
that can improve his oxygen.
410
00:16:25,318 --> 00:16:26,735
Either his pneumonia
is getting worse
411
00:16:26,736 --> 00:16:28,737
or his heart couldn't
handle the fluids
412
00:16:28,738 --> 00:16:30,572
that we gave him
to treat the sepsis.
413
00:16:30,573 --> 00:16:32,074
His lungs are filling up
with fluid.
414
00:16:32,075 --> 00:16:33,534
- Can't you take the fluid away?
415
00:16:33,535 --> 00:16:35,369
- Not without his
blood pressure crashing
416
00:16:35,370 --> 00:16:36,662
with very bad consequences,
417
00:16:36,663 --> 00:16:38,747
so let's just hope
the BiPAP works.
418
00:16:38,748 --> 00:16:40,749
- And if it doesn't?
419
00:16:40,750 --> 00:16:43,210
- Then I would need
to know your decision
420
00:16:43,211 --> 00:16:44,586
about using a breathing machine.
421
00:16:44,587 --> 00:16:46,588
- We're still talking about it.
422
00:16:46,589 --> 00:16:48,924
- Well, we know
he expressed his wishes.
423
00:16:48,925 --> 00:16:50,968
In writing.
"Do not intubate."
424
00:16:50,969 --> 00:16:54,096
- We're thinking
try it for a week.
425
00:16:54,097 --> 00:16:57,391
- That would be
a very painful week.
426
00:16:57,392 --> 00:17:00,102
He wouldn't get a lot of rest
with all the monitors
427
00:17:00,103 --> 00:17:02,312
and all the blood tests.
He might need to be sedated.
428
00:17:02,313 --> 00:17:03,814
He might need to be restrained
429
00:17:03,815 --> 00:17:05,941
because he'd be
in an unfamiliar place
430
00:17:05,942 --> 00:17:08,569
with a very uncomfortable tube
down his throat.
431
00:17:08,570 --> 00:17:10,904
And he wouldn't really know
what was happening.
432
00:17:10,905 --> 00:17:14,408
Elderly patients
can often develop psychosis.
433
00:17:14,409 --> 00:17:17,661
- But he might get better.
- Or he might get worse.
434
00:17:17,662 --> 00:17:19,955
What would you do?
435
00:17:19,956 --> 00:17:21,707
- I really
can't answer that for you.
436
00:17:21,708 --> 00:17:23,250
This is your father.
It's your decision to make.
437
00:17:23,251 --> 00:17:24,918
I can guarantee you
438
00:17:24,919 --> 00:17:26,754
that we will keep him
as comfortable as possible
439
00:17:26,755 --> 00:17:28,589
if a natural death
is what you choose.
440
00:17:28,590 --> 00:17:30,299
- But he's not your father.
441
00:17:30,300 --> 00:17:32,092
And he can recover from this.
442
00:17:32,093 --> 00:17:33,802
- What my sister means
443
00:17:33,803 --> 00:17:35,847
is that we're still deciding
the best thing to do.
444
00:17:38,850 --> 00:17:40,976
- Well, the sooner you decide,
the better.
445
00:17:40,977 --> 00:17:42,311
I'm really sorry.
446
00:17:42,312 --> 00:17:44,313
I wish there was more
that I could do.
447
00:17:44,314 --> 00:17:46,648
I'm not sure that
he has that much time left.
448
00:17:53,031 --> 00:17:55,241
- Dr. Robby.
449
00:18:01,581 --> 00:18:03,165
- You were right.
450
00:18:03,166 --> 00:18:04,833
She can't say whether
she was bumped by accident
451
00:18:04,834 --> 00:18:06,669
or shoved on purpose.
- No other witnesses?
452
00:18:06,670 --> 00:18:09,213
- No, not really.
453
00:18:09,214 --> 00:18:11,173
We pulled security footage.
Maybe we'll find something.
454
00:18:11,174 --> 00:18:13,467
Hopefully she tripped.
455
00:18:13,468 --> 00:18:14,885
I don't mean I hope she tripped.
456
00:18:14,886 --> 00:18:17,388
I mean I hope she wasn't
pushed on purpose.
457
00:18:17,389 --> 00:18:19,348
- That would this a hate crime.
458
00:18:19,349 --> 00:18:21,850
- Yes, ma'am.
459
00:18:21,851 --> 00:18:24,019
- Ma'am?
- Doctor.
460
00:18:24,020 --> 00:18:26,188
Sorry.
I'm... I'm sorry.
461
00:18:26,189 --> 00:18:28,482
No harm, no foul.
462
00:18:28,483 --> 00:18:32,904
- Will you let me know
if she says anything else?
463
00:18:34,239 --> 00:18:35,907
- Will do.
464
00:18:38,576 --> 00:18:39,868
- At the risk of seeming...
465
00:18:39,869 --> 00:18:41,036
- Then you probably shouldn't.
466
00:18:41,037 --> 00:18:43,372
- I just...
- No, trust me.
467
00:18:43,373 --> 00:18:45,165
- How do you know...
- I just know.
468
00:18:45,166 --> 00:18:48,127
- I just wanted...
- I know.
469
00:18:48,128 --> 00:18:51,046
Look, I'll let you know
if she says anything else
470
00:18:51,047 --> 00:18:53,800
that could be important
to your investigation.
471
00:18:57,429 --> 00:18:59,263
- Thank you.
472
00:18:59,264 --> 00:19:02,224
You know, for the record...
- Nope.
473
00:19:12,277 --> 00:19:15,237
- Any luck getting our
psych boarders upstairs?
474
00:19:15,238 --> 00:19:18,575
- Yeah, right, at least
the Kraken's still sleeping.
475
00:19:20,035 --> 00:19:21,201
- Is it me or was
that officer...
476
00:19:21,202 --> 00:19:23,245
- No.
- What?
477
00:19:23,246 --> 00:19:26,540
You don't even know what I...
- What you were going to say?
478
00:19:26,541 --> 00:19:29,585
- Maybe you do.
479
00:19:29,586 --> 00:19:31,545
He seemed nice.
- Absolutely not.
480
00:19:33,423 --> 00:19:34,923
There is no possible scenario
481
00:19:34,924 --> 00:19:37,384
in which you and I
have this conversation.
482
00:19:37,385 --> 00:19:39,261
You of all people
should know better.
483
00:19:39,262 --> 00:19:42,014
- I was...
- No.
484
00:19:42,015 --> 00:19:43,599
Just walk away.
485
00:19:43,600 --> 00:19:46,769
Best possible scenario.
Just keep on walking.
486
00:19:48,605 --> 00:19:51,565
- You got to lay off mixing
Adderall and energy drinks.
487
00:19:51,566 --> 00:19:52,900
- Trust me, I will.
488
00:19:52,901 --> 00:19:55,028
All right. Thanks.
489
00:19:56,321 --> 00:19:57,780
That's the thing about
emergency medicine.
490
00:19:57,781 --> 00:19:59,281
You never know what
you're going to get.
491
00:19:59,282 --> 00:20:01,158
And we get everything.
492
00:20:01,159 --> 00:20:02,451
- Is that why you chose it?
493
00:20:02,452 --> 00:20:04,119
Maybe a little.
494
00:20:04,120 --> 00:20:05,621
I also get to pick my shifts,
495
00:20:05,622 --> 00:20:08,290
which, for a single mother,
is amazing.
496
00:20:08,291 --> 00:20:11,001
But mostly, I just like
the people, you know?
497
00:20:11,002 --> 00:20:12,670
They're always there
when you need them.
498
00:20:12,671 --> 00:20:14,591
Who wouldn't want to
be a part of that, you know?
499
00:20:16,966 --> 00:20:18,967
Fuck off.
500
00:20:25,225 --> 00:20:27,101
- This is the monitoring center.
501
00:20:27,102 --> 00:20:28,977
We see that you are not
in your inclusion zone.
502
00:20:28,978 --> 00:20:31,063
Do you have permission
to be outside this area?
503
00:20:31,064 --> 00:20:33,607
- Yes, I am at work.
504
00:20:33,608 --> 00:20:37,444
Just like last time
and the time before that.
505
00:20:38,947 --> 00:20:40,155
I'll be right back.
506
00:20:42,158 --> 00:20:44,660
What is the point
of this fucking thing
507
00:20:44,661 --> 00:20:46,286
if it doesn't even work?
508
00:20:54,045 --> 00:20:55,421
- Sorry.
509
00:20:55,422 --> 00:20:57,423
- You're doing great.
Take your time.
510
00:20:57,424 --> 00:20:58,465
You OK?
511
00:20:58,466 --> 00:20:59,967
- I am... yeah.
512
00:20:59,968 --> 00:21:01,343
I get frustrated
when I can't do things,
513
00:21:01,344 --> 00:21:02,845
or at least it looks like it.
514
00:21:02,846 --> 00:21:05,055
- Yeah, you and me both.
515
00:21:05,056 --> 00:21:08,392
- Thanks, but my frustration
manifests itself emotionally,
516
00:21:08,393 --> 00:21:10,310
and then, I get upset,
517
00:21:10,311 --> 00:21:12,146
and then it looks like
I can't handle things,
518
00:21:12,147 --> 00:21:14,314
and, you know, then I can't cry
in front of the patient
519
00:21:14,315 --> 00:21:15,524
because no one wants
to see their doctor cry.
520
00:21:15,525 --> 00:21:17,234
That's just a big red flag.
521
00:21:17,235 --> 00:21:20,530
- You just did a perfect crike.
You're doing great.
522
00:21:23,658 --> 00:21:25,659
- Hey, you!
Pasty white!
523
00:21:25,660 --> 00:21:27,077
How about a sandwich?
524
00:21:27,078 --> 00:21:30,372
What brings you here today, sir?
525
00:21:30,373 --> 00:21:33,292
- I'm here
for a fucking sandwich.
526
00:21:33,293 --> 00:21:35,044
- OK.
527
00:21:35,045 --> 00:21:37,963
OK, excuse me...
528
00:21:37,964 --> 00:21:39,381
- Perlah.
- Perlah.
529
00:21:39,382 --> 00:21:41,216
Can this patient get a sandwich?
530
00:21:41,217 --> 00:21:42,718
- I already gave you
a sandwich, Earl.
531
00:21:42,719 --> 00:21:45,637
- I ain't ate this whole week.
532
00:21:45,638 --> 00:21:47,306
Sure.
533
00:21:47,307 --> 00:21:49,141
Give him another sandwich.
They're on the food cart.
534
00:21:49,142 --> 00:21:50,351
Just make sure
it's not egg salad,
535
00:21:50,352 --> 00:21:51,894
or he'll throw it on the floor.
536
00:21:51,895 --> 00:21:53,772
- OK. Good to know.
Thanks.
537
00:22:08,286 --> 00:22:09,912
- Any quick ones up here?
538
00:22:09,913 --> 00:22:11,747
It's only 8:30,
and Robby's already on my case
539
00:22:11,748 --> 00:22:13,707
for being too slow.
540
00:22:13,708 --> 00:22:14,792
I can usually at least
make it to lunch
541
00:22:14,793 --> 00:22:16,418
before he starts hounding me.
542
00:22:16,419 --> 00:22:18,295
- Cut him a little slack
today, OK?
543
00:22:18,296 --> 00:22:20,923
It's the anniversary
of Dr. Adamson's death.
544
00:22:20,924 --> 00:22:23,550
- That's sad.
545
00:22:23,551 --> 00:22:26,220
But it's still no reason
to take it out on me.
546
00:22:26,221 --> 00:22:27,930
I'm just saying.
547
00:22:27,931 --> 00:22:30,432
- Dr. Mohan?
- Samira, please.
548
00:22:30,433 --> 00:22:32,434
- I just wanted to apologize.
549
00:22:32,435 --> 00:22:35,521
When my phone went off earlier,
that was really unprofessional.
550
00:22:35,522 --> 00:22:36,897
- Don't sweat it.
Trust me.
551
00:22:36,898 --> 00:22:38,273
We need to laugh.
552
00:22:38,274 --> 00:22:39,775
Otherwise,
we'd never stop crying.
553
00:22:39,776 --> 00:22:41,110
- Thank you.
554
00:22:41,111 --> 00:22:42,569
- Besides,
with all the craziness
555
00:22:42,570 --> 00:22:43,904
that comes through here
every hour,
556
00:22:43,905 --> 00:22:45,698
nobody cares or notices.
557
00:22:45,699 --> 00:22:48,075
- Got an unresponsive
unhoused man coming in.
558
00:22:48,076 --> 00:22:52,163
Might be a good teaching case,
Funky Music.
559
00:22:54,290 --> 00:22:55,624
Let's go.
560
00:22:55,625 --> 00:22:56,959
- Caucasian male,
561
00:22:56,960 --> 00:22:58,627
approximately
60 to 70 years old,
562
00:22:58,628 --> 00:23:02,007
found unresponsive.
No signs of trauma, no ID.
563
00:23:03,383 --> 00:23:05,092
- On three.
564
00:23:05,093 --> 00:23:07,387
One, two, three.
565
00:23:09,681 --> 00:23:12,099
Oof.
Did you take anything?
566
00:23:12,100 --> 00:23:13,600
- I smell the alcohol from here.
567
00:23:13,601 --> 00:23:14,810
- This guy's wearing
the spring, summer,
568
00:23:14,811 --> 00:23:15,978
and fall collection.
569
00:23:17,105 --> 00:23:18,313
Whoa!
570
00:23:18,314 --> 00:23:20,107
Jesus...
571
00:23:20,108 --> 00:23:21,150
What the...
572
00:23:22,485 --> 00:23:25,154
- What's wrong?
- What's going on?
573
00:23:25,155 --> 00:23:28,157
- Patient tested positive
for rats.
574
00:23:28,158 --> 00:23:29,533
- No.
575
00:23:29,534 --> 00:23:33,120
- If it matters,
I only counted three.
576
00:23:33,121 --> 00:23:34,621
There goes one.
577
00:23:39,085 --> 00:23:41,253
- Because your son
tested positive for THC,
578
00:23:41,254 --> 00:23:43,422
the psychoactive ingredient
in cannabis,
579
00:23:43,423 --> 00:23:45,090
we're going to have to
admit him for overnight
580
00:23:45,091 --> 00:23:47,092
observation and monitoring.
581
00:23:47,093 --> 00:23:49,178
- And what about his brain?
582
00:23:49,179 --> 00:23:51,597
Is there a chance that much pot
is going to do some damage?
583
00:23:51,598 --> 00:23:53,015
He's only four.
584
00:23:53,016 --> 00:23:54,683
- The honest answer
is we don't know.
585
00:23:54,684 --> 00:23:56,268
There haven't been
any long-term studies,
586
00:23:56,269 --> 00:23:58,020
but the fact that this is
a one-time occurrence
587
00:23:58,021 --> 00:24:00,189
suggests that there should be
no long-term effects.
588
00:24:00,190 --> 00:24:01,940
- But you don't know.
589
00:24:01,941 --> 00:24:04,109
So my son could end up
with learning disabilities,
590
00:24:04,110 --> 00:24:06,570
psychiatric problems,
or even autism because of this.
591
00:24:06,571 --> 00:24:08,364
- There's no evidence
to suggest any of that.
592
00:24:08,365 --> 00:24:11,158
- Hello.
I'm Kiara Alfaro.
593
00:24:11,159 --> 00:24:13,035
I'm the department
social worker.
594
00:24:13,036 --> 00:24:15,996
- Kiara will help you
navigate the next steps.
595
00:24:15,997 --> 00:24:17,247
- What steps?
596
00:24:17,248 --> 00:24:18,832
- Well, a case like this
597
00:24:18,833 --> 00:24:21,877
requires mandatory reporting
to child services
598
00:24:21,878 --> 00:24:23,921
and sometimes law enforcement.
- No.
599
00:24:23,922 --> 00:24:25,089
- Why... why do you have
to involve the police?
600
00:24:25,090 --> 00:24:26,423
- It's a controlled substance.
601
00:24:26,424 --> 00:24:28,092
- They're not taking
my kid away.
602
00:24:28,093 --> 00:24:30,010
- They were pot gummies.
- No one's suggesting that.
603
00:24:30,011 --> 00:24:32,096
- Well, fuck your suggestions!
No one is touching my child!
604
00:24:32,097 --> 00:24:33,597
In fact, we're leaving.
605
00:24:33,598 --> 00:24:35,099
- Well you...
no, you can't take your son.
606
00:24:35,100 --> 00:24:36,725
He could stop breathing.
He could have a seizure.
607
00:24:36,726 --> 00:24:38,310
- I will observe him at home.
- Amanda, please.
608
00:24:38,311 --> 00:24:39,978
- Fuck off, Drew.
- Get security.
609
00:24:39,979 --> 00:24:41,355
If you can't cooperate,
610
00:24:41,356 --> 00:24:42,731
I'm going to have to ask you
to leave.
611
00:24:42,732 --> 00:24:44,233
- Amanda, please.
He needs to stay here.
612
00:24:44,234 --> 00:24:45,984
- And you need
to get a fucking hotel.
613
00:24:45,985 --> 00:24:47,236
- Your son can't leave
the hospital,
614
00:24:47,237 --> 00:24:48,570
but I can have you removed.
615
00:24:48,571 --> 00:24:49,905
- Don't you dare touch me.
616
00:24:49,906 --> 00:24:51,573
Get out! All of you!
617
00:24:51,574 --> 00:24:53,742
- Mrs. Jones, I know this
is scary and stressful.
618
00:24:53,743 --> 00:24:55,911
- Fuck you! Fuck you!
- This is my son.
619
00:24:55,912 --> 00:24:57,246
My son!
And nobody is touching him!
620
00:24:57,247 --> 00:24:58,914
- Whoa, whoa, whoa.
What's going on?
621
00:24:58,915 --> 00:25:00,332
- How can I help you?
- By backing the fuck off!
622
00:25:00,333 --> 00:25:01,917
- Mom's worried
a CYF investigation.
623
00:25:01,918 --> 00:25:03,919
- Amanda, just calm down!
- OK, OK, OK, enough!
624
00:25:03,920 --> 00:25:05,337
This is a hospital.
625
00:25:05,338 --> 00:25:06,922
This isn't
"The Jerry Springer Show."
626
00:25:06,923 --> 00:25:09,425
Ma'am, nobody's trying
to take your child,
627
00:25:09,426 --> 00:25:11,093
so why don't you
stay here with him
628
00:25:11,094 --> 00:25:12,886
while your husband talks
to our social worker outside
629
00:25:12,887 --> 00:25:14,555
and straightens all this out?
630
00:25:14,556 --> 00:25:16,932
- Well, I don't want him
speaking for me and my son.
631
00:25:16,933 --> 00:25:18,892
- Well, it is either you or him.
632
00:25:18,893 --> 00:25:21,895
Your son is not leaving,
but you can be escorted out
633
00:25:21,896 --> 00:25:23,939
and even arrested
if you refuse to cooperate.
634
00:25:23,940 --> 00:25:25,441
Nobody wants that.
635
00:25:25,442 --> 00:25:27,485
So you tell us.
What do you want to do?
636
00:25:30,447 --> 00:25:33,240
- I'm staying with my son.
- OK, great.
637
00:25:33,241 --> 00:25:35,075
You do that.
638
00:25:35,076 --> 00:25:37,453
We all on the same page here?
639
00:25:37,454 --> 00:25:38,829
Thank you, Olsen.
640
00:25:38,830 --> 00:25:39,872
- You know where to find me.
- You OK?
641
00:25:39,873 --> 00:25:41,623
- Yeah, we got this.
642
00:25:41,624 --> 00:25:43,459
- All good.
- It's all yours.
643
00:25:43,460 --> 00:25:45,210
- Mrs. Jones, we just
have a couple things.
644
00:25:48,465 --> 00:25:49,798
- Everything all right
out there?
645
00:25:49,799 --> 00:25:52,134
- Yeah, just another day
in paradise.
646
00:25:52,135 --> 00:25:54,094
How are you feeling?
- Better.
647
00:25:54,095 --> 00:25:56,638
Where's David?
- He left.
648
00:25:56,639 --> 00:25:59,475
He said he had to
get back to school.
649
00:26:01,102 --> 00:26:02,895
- Um, maybe you
could try calling him,
650
00:26:02,896 --> 00:26:04,105
get him to come back.
651
00:26:06,858 --> 00:26:09,735
- What's going to happen
to him if I do?
652
00:26:09,736 --> 00:26:11,987
- Hopefully he'll be willing
to talk to somebody.
653
00:26:11,988 --> 00:26:14,615
- Will you talk to him?
- I can try.
654
00:26:14,616 --> 00:26:17,326
I don't think
he wanted to talk to me.
655
00:26:17,327 --> 00:26:19,661
Have you shared with anyone
656
00:26:19,662 --> 00:26:21,789
about the writings
of his you found?
657
00:26:21,790 --> 00:26:23,540
- No.
658
00:26:23,541 --> 00:26:25,292
I didn't know who to tell.
659
00:26:25,293 --> 00:26:27,503
I just don't want
to see him get hurt.
660
00:26:27,504 --> 00:26:29,381
- Neither do we.
661
00:26:38,682 --> 00:26:40,057
It's just going straight
to voicemail.
662
00:26:40,058 --> 00:26:42,227
- Maybe if you can text him.
663
00:26:54,531 --> 00:26:56,615
- He's not texting back.
664
00:26:56,616 --> 00:26:58,200
I'm sorry about all this.
665
00:26:58,201 --> 00:26:59,702
- It's OK, it's OK.
666
00:26:59,703 --> 00:27:02,955
What are you doing for David
is very brave.
667
00:27:02,956 --> 00:27:04,206
- I'm his mother.
668
00:27:04,207 --> 00:27:06,334
I'll do anything to protect him.
669
00:27:08,294 --> 00:27:09,545
- Do you think
he would hurt anyone?
670
00:27:09,546 --> 00:27:11,256
- No.
671
00:27:12,924 --> 00:27:16,927
But...
672
00:27:16,928 --> 00:27:20,723
I'm sure
a lot of parents felt that way
673
00:27:20,724 --> 00:27:23,685
before their children
did unspeakable things.
674
00:27:26,312 --> 00:27:27,730
- Does he have any history
of violence?
675
00:27:27,731 --> 00:27:29,189
Has he ever been in any trouble?
676
00:27:29,190 --> 00:27:30,607
- No, never.
677
00:27:30,608 --> 00:27:33,068
He's very quiet.
678
00:27:33,069 --> 00:27:35,446
And he takes great care of me.
679
00:27:35,447 --> 00:27:40,951
He... he's struggled
with his father's death.
680
00:27:40,952 --> 00:27:42,911
We both have.
681
00:27:42,912 --> 00:27:45,247
- Flight is ten minutes out
with an electrocution.
682
00:27:45,248 --> 00:27:48,334
- OK, grab Collins.
I'll be right there.
683
00:27:48,335 --> 00:27:49,752
Keep trying to reach him.
684
00:27:49,753 --> 00:27:51,378
If you do,
have someone come find me.
685
00:27:51,379 --> 00:27:53,756
OK?
- OK.
686
00:27:53,757 --> 00:27:55,883
Thank you.
- Of course.
687
00:27:55,884 --> 00:27:58,052
You got some good news for me?
- I sure do.
688
00:27:58,053 --> 00:27:59,678
There are two rooms
in ICU being cleaned.
689
00:27:59,679 --> 00:28:01,430
They'll be ready by now.
- Great.
690
00:28:01,431 --> 00:28:02,556
- And I got bagels
in the lounge.
691
00:28:02,557 --> 00:28:04,099
- Nice job.
Thank you.
692
00:28:06,519 --> 00:28:09,063
- Is it true?
- You have to be more specific.
693
00:28:09,064 --> 00:28:10,689
- Are there rats in the ED?
694
00:28:10,690 --> 00:28:13,025
Apparently,
if somebody already snitched.
695
00:28:13,026 --> 00:28:15,444
- Do you know how bad
this looks?
696
00:28:15,445 --> 00:28:17,446
One more reason
to shutter this place.
697
00:28:17,447 --> 00:28:19,656
Only the emergency department
admits rats.
698
00:28:19,657 --> 00:28:21,283
- Emergency department
would never admit rats,
699
00:28:21,284 --> 00:28:22,826
unless they had
the right insurance.
700
00:28:22,827 --> 00:28:24,244
- Did you catch any of them?
701
00:28:24,245 --> 00:28:25,996
- One, and I charged him
for a full visit.
702
00:28:25,997 --> 00:28:27,581
- I'm glad
you think this is funny.
703
00:28:27,582 --> 00:28:28,749
- I'm sorry that you don't.
704
00:28:28,750 --> 00:28:30,501
- Did you call an exterminator?
705
00:28:30,502 --> 00:28:32,294
- He's waiting
on a second opinion.
706
00:28:32,295 --> 00:28:35,506
You're pushing your luck today.
707
00:28:35,507 --> 00:28:36,799
- Don't worry.
Last I heard,
708
00:28:36,800 --> 00:28:38,175
they were headed
for the cafeteria,
709
00:28:38,176 --> 00:28:39,343
so they should be dead
within the hour.
710
00:28:39,344 --> 00:28:40,803
OK.
711
00:28:40,804 --> 00:28:43,681
I'll be here all week.
- Or maybe not.
712
00:28:47,310 --> 00:28:49,603
- Drug-seeking woman
kicked off the city bus
713
00:28:49,604 --> 00:28:50,979
for disrupting
and disturbing passengers.
714
00:28:50,980 --> 00:28:52,564
- I called 911!
715
00:28:52,565 --> 00:28:54,316
- She's been screaming
for narcotics nonstop.
716
00:28:54,317 --> 00:28:55,943
We found an empty Percocet
bottle filled five days ago.
717
00:28:55,944 --> 00:28:57,111
- What are you doing?
What are you doing?
718
00:28:57,112 --> 00:28:58,570
- She's been uncooperative
719
00:28:58,571 --> 00:28:59,780
and combative
since we picked her up.
720
00:28:59,781 --> 00:29:01,156
- Get off her.
Let her go.
721
00:29:01,157 --> 00:29:02,741
Stop fighting.
722
00:29:02,742 --> 00:29:04,576
- Calm the fuck down,
or I'm calling the cops.
723
00:29:04,577 --> 00:29:06,286
- My meds at home
aren't working!
724
00:29:06,287 --> 00:29:08,497
Please, I have sickle cell!
725
00:29:08,498 --> 00:29:10,290
- OK, stop.
Everybody stop.
726
00:29:10,291 --> 00:29:11,960
Stop!
727
00:29:12,669 --> 00:29:14,294
What's your name?
728
00:29:14,295 --> 00:29:16,505
- It's Joyce.
It's Joyce St. Claire.
729
00:29:16,506 --> 00:29:18,716
- Joyce, is this
your sickle cell pain?
730
00:29:18,717 --> 00:29:21,010
- Yes!
- 10 milligrams of IV morphine.
731
00:29:21,011 --> 00:29:22,344
- You really want 10?
- Yes.
732
00:29:22,345 --> 00:29:23,512
Repeat it in five minutes
if needed.
733
00:29:23,513 --> 00:29:24,847
And she needs a Dilaudid drip.
734
00:29:24,848 --> 00:29:25,973
This is a vaso-occlusive crisis!
735
00:29:25,974 --> 00:29:27,141
I'm so sorry this happened.
736
00:29:27,142 --> 00:29:28,726
You're going to be OK now.
737
00:29:28,727 --> 00:29:29,852
You're safe here, I promise.
738
00:29:29,853 --> 00:29:31,353
Come on.
739
00:29:31,354 --> 00:29:33,022
You're going to be safe here.
I promise.
740
00:29:33,023 --> 00:29:34,857
Just breathe. OK?
741
00:30:00,216 --> 00:30:01,800
- Live wire hit
his left forearm,
742
00:30:01,801 --> 00:30:03,510
shocked him once for v-fib.
743
00:30:03,511 --> 00:30:05,554
- Was there a power pole down?
- No, abandoned factory.
744
00:30:05,555 --> 00:30:06,638
We found bolt cutters
at his side.
745
00:30:06,639 --> 00:30:07,890
- Got electrocuted.
746
00:30:07,891 --> 00:30:08,891
- Was he trying to steal copper?
747
00:30:08,892 --> 00:30:09,892
- Most likely.
748
00:30:09,893 --> 00:30:11,810
Powerline fried his arm,
749
00:30:11,811 --> 00:30:14,688
and the current through his
whole body stopped his heart.
750
00:30:14,689 --> 00:30:17,358
- Ready?
751
00:30:17,359 --> 00:30:19,527
Steady, lift.
752
00:30:21,279 --> 00:30:24,073
Add a myoglobin and a CK
to the labs.
753
00:30:24,074 --> 00:30:26,075
Two liters normal saline
wide open.
754
00:30:26,076 --> 00:30:27,868
- Dr. Santos,
what are we worried about?
755
00:30:27,869 --> 00:30:30,788
- Um, rhabdomyolysis
from tissue damage
756
00:30:30,789 --> 00:30:33,749
can kill the kidneys, ongoing
risk of cardiac irritability.
757
00:30:33,750 --> 00:30:35,376
- Excellent.
- AP pads in place.
758
00:30:35,377 --> 00:30:37,086
- Guy fell off a telephone pole?
759
00:30:37,087 --> 00:30:39,421
- No, he was on a platform.
- Boring.
760
00:30:39,422 --> 00:30:41,965
- Cut into a live wire.
761
00:30:41,966 --> 00:30:43,634
- Tense ventral compartment.
762
00:30:43,635 --> 00:30:45,094
- Set up the STIC
pressure monitor.
763
00:30:45,095 --> 00:30:46,595
V-fib.
764
00:30:46,596 --> 00:30:48,055
- All right, charge to 300.
- Charge to 300.
765
00:30:48,056 --> 00:30:49,264
Am I running this or are you?
766
00:30:49,265 --> 00:30:51,392
- Sorry, reflex response.
- Clear.
767
00:30:52,769 --> 00:30:54,103
Fuck!
768
00:30:54,104 --> 00:30:55,604
- Sorry.
769
00:30:55,605 --> 00:30:57,106
Sorry.
770
00:30:57,107 --> 00:30:59,692
- So what... what happened?
771
00:30:59,693 --> 00:31:02,236
I bought it
for my girlfriend's dog.
772
00:31:02,237 --> 00:31:06,281
I work nights,
and he yaps all day long.
773
00:31:06,282 --> 00:31:08,951
And when I woke up,
I was wearing it.
774
00:31:08,952 --> 00:31:10,536
Stupid bitch!
775
00:31:11,913 --> 00:31:14,915
- Sorry, sorry.
776
00:31:14,916 --> 00:31:17,418
- I think she must have
used Krazy Glue.
777
00:31:17,419 --> 00:31:20,754
- Yeah, it, um,
it looks that way.
778
00:31:20,755 --> 00:31:22,464
Have you tried
removing the batteries?
779
00:31:22,465 --> 00:31:26,468
- Of course.
She glued the case shut.
780
00:31:26,469 --> 00:31:29,346
- All right, I think we have
a couple options, Gary.
781
00:31:29,347 --> 00:31:32,433
Um, we can try to find
a solvent that will dissolve
782
00:31:32,434 --> 00:31:34,852
or at least soften the glue
enough for you to peel it off
783
00:31:34,853 --> 00:31:36,979
without taking your skin
with it.
784
00:31:36,980 --> 00:31:39,189
Or, um...
785
00:31:39,190 --> 00:31:41,775
Dr. Javadi?
- Um...
786
00:31:41,776 --> 00:31:44,820
I... I guess your skin cells
on your neck will naturally
787
00:31:44,821 --> 00:31:48,323
slough off and you should just
be able to remove it in time.
788
00:31:48,324 --> 00:31:51,368
- How much time?
- Um, couple of weeks, maybe.
789
00:31:51,369 --> 00:31:52,703
Couple weeks?
790
00:31:52,704 --> 00:31:54,329
- I think this guy's got scurvy.
791
00:31:54,330 --> 00:31:55,497
- What is he, a pirate?
792
00:31:55,498 --> 00:31:57,166
- No, he's an unhoused man
793
00:31:57,167 --> 00:31:59,752
who lives almost exclusively
on dollar store ramen.
794
00:31:59,753 --> 00:32:02,338
There's perifollicular
hemorrhage, gingivitis,
795
00:32:02,339 --> 00:32:04,673
bleeding gums, and, um, yeah,
796
00:32:04,674 --> 00:32:06,133
no fruit or vegetables
in his diet.
797
00:32:06,134 --> 00:32:07,426
- I suppose that could do it
798
00:32:07,427 --> 00:32:09,261
as long as
you've ruled out piracy.
799
00:32:09,262 --> 00:32:12,348
No parrot, no peg leg,
doesn't reek of sweat and rum?
800
00:32:12,349 --> 00:32:14,308
- Well, now that you
mention it, there was a smell.
801
00:32:14,309 --> 00:32:17,311
- Probably a pirate.
802
00:32:17,312 --> 00:32:18,687
Tell him to pick up
some vitamin C
803
00:32:18,688 --> 00:32:20,231
next time he docks
at a dollar store.
804
00:32:22,525 --> 00:32:24,193
- I can't tell if you're joking.
805
00:32:24,194 --> 00:32:26,528
- No, Captain Scurvy's
got a vitamin C deficiency.
806
00:32:26,529 --> 00:32:29,031
Cheapest way to fix it
is with a daily supplement.
807
00:32:29,032 --> 00:32:30,866
- Captain Scurvy
is another joke.
808
00:32:30,867 --> 00:32:32,868
- I'd like to think so.
- It's a good one.
809
00:32:32,869 --> 00:32:34,912
- Dr. Langdon, Dr. King,
this is Arthur Carlson
810
00:32:34,913 --> 00:32:36,663
from Children,
Youth, and Families.
811
00:32:36,664 --> 00:32:38,540
He'd like to speak to
the parents of Tyler Jones.
812
00:32:38,541 --> 00:32:40,417
- Right, right.
813
00:32:40,418 --> 00:32:42,920
Mel, would you mind showing
him to Kiara and the family?
814
00:32:42,921 --> 00:32:44,422
Yeah, right this way.
815
00:32:49,302 --> 00:32:51,053
- Beto?
- Hello, Doctor.
816
00:32:51,054 --> 00:32:54,431
- What are you doing here?
- I'm working day shifts now.
817
00:32:54,432 --> 00:32:56,392
- Didn't you retire
a couple of years ago?
818
00:32:56,393 --> 00:32:57,893
- No.
819
00:32:57,894 --> 00:33:01,063
I have to work today.
- Right.
820
00:33:01,064 --> 00:33:02,648
Right.
Just stay right here, OK?
821
00:33:02,649 --> 00:33:04,566
- I... I have a lot
of cleaning to do.
822
00:33:04,567 --> 00:33:06,527
- Yeah, no,
I'll be just one second.
823
00:33:06,528 --> 00:33:08,862
- Hey, Doc, Doc!
How about a sandwich?
824
00:33:08,863 --> 00:33:10,656
- Sure, Earl.
Turkey, no egg salad.
825
00:33:10,657 --> 00:33:12,908
I got you.
Just give me one minute.
826
00:33:14,994 --> 00:33:16,829
So Beto said he's working here?
827
00:33:16,830 --> 00:33:18,372
- Yeah,
he just started wandering.
828
00:33:18,373 --> 00:33:20,541
Fortunately,
he always winds up back here.
829
00:33:20,542 --> 00:33:22,251
He thinks he still works
in the ED.
830
00:33:22,252 --> 00:33:23,752
I called his family.
831
00:33:23,753 --> 00:33:25,045
They usually pick him up
after a few hours.
832
00:33:25,046 --> 00:33:26,171
- Really?
833
00:33:26,172 --> 00:33:27,589
- Yeah. It gives them a break.
834
00:33:27,590 --> 00:33:29,091
And look at him.
He's talking to people,
835
00:33:29,092 --> 00:33:31,468
feeling useful,
getting some exercise.
836
00:33:31,469 --> 00:33:33,095
Hell, I wish I was that happy.
837
00:33:33,096 --> 00:33:34,763
- You think he's any good
at catching rats?
838
00:33:34,764 --> 00:33:37,433
- Stop.
- Earl wants a sandwich.
839
00:33:37,434 --> 00:33:39,393
- He always wants a sandwich.
840
00:33:39,394 --> 00:33:40,811
- Hey, check it out.
841
00:33:40,812 --> 00:33:42,396
I got my kids a puppy.
842
00:33:42,397 --> 00:33:44,565
- Cute.
Hope that wasn't your idea.
843
00:33:44,566 --> 00:33:46,316
- Why?
- Seriously?
844
00:33:46,317 --> 00:33:47,651
You really think your wife
845
00:33:47,652 --> 00:33:49,111
needs anything else
to take care of?
846
00:33:49,112 --> 00:33:51,238
- Abby loves dogs.
- I love penguins.
847
00:33:51,239 --> 00:33:52,781
It doesn't mean
I want to take care of one.
848
00:33:52,782 --> 00:33:54,324
- I'm pretty sure it's illegal
to own a penguin.
849
00:33:54,325 --> 00:33:55,826
- Pretty sure
you're missing the point.
850
00:33:55,827 --> 00:33:57,286
- The point is Tanner promised
851
00:33:57,287 --> 00:33:58,579
he would take care of it.
852
00:33:58,580 --> 00:34:01,623
- A four-year-old?
Yeah, OK.
853
00:34:06,796 --> 00:34:08,547
- How's she doing?
854
00:34:08,548 --> 00:34:11,593
- Still breathing
after 20 of morphine.
855
00:34:13,803 --> 00:34:15,137
- How's the pain, Joyce?
856
00:34:15,138 --> 00:34:17,806
A little better.
857
00:34:17,807 --> 00:34:19,892
- We've ordered
an exchange transfusion.
858
00:34:19,893 --> 00:34:22,394
Figured I needed that.
859
00:34:22,395 --> 00:34:24,938
- What's your normal regimen
at home?
860
00:34:24,939 --> 00:34:28,817
- 90 of extended-release
morphine every 12 hours
861
00:34:28,818 --> 00:34:31,153
and oxycodone
for breakthrough pain,
862
00:34:31,154 --> 00:34:33,655
but it wasn't working.
863
00:34:33,656 --> 00:34:36,825
- Starting IV Dilaudid
of four an hour.
864
00:34:36,826 --> 00:34:39,161
You can press this button
if you need a little extra.
865
00:34:39,162 --> 00:34:42,831
- That only works once an hour,
though, so don't go crazy.
866
00:34:42,832 --> 00:34:45,752
- Could I confer with you?
- Yeah.
867
00:34:54,469 --> 00:34:57,012
- You seem surprised
by the opioid dosage.
868
00:34:57,013 --> 00:34:59,556
- It seemed a little high.
- So was her pain.
869
00:34:59,557 --> 00:35:01,183
- How do you know
she's not drug-seeking?
870
00:35:01,184 --> 00:35:03,018
- You can't fake
a hemoglobin of 6.
871
00:35:03,019 --> 00:35:05,104
Do you know what sickle cell
crisis does to the body?
872
00:35:05,105 --> 00:35:06,647
Blood cells get caught
and plug up your capillaries
873
00:35:06,648 --> 00:35:08,357
and deprive
all your cells of oxygen.
874
00:35:08,358 --> 00:35:11,193
It's been described
as an electrical stabbing pain
875
00:35:11,194 --> 00:35:12,695
that feels like
it's breaking your bones
876
00:35:12,696 --> 00:35:15,447
and flushing glass
through your body.
877
00:35:15,448 --> 00:35:17,282
- I never thought of it
like that.
878
00:35:17,283 --> 00:35:18,659
- Little empathy goes a long way
879
00:35:18,660 --> 00:35:20,412
with those suffering
in real pain.
880
00:35:22,539 --> 00:35:23,956
- Yeah.
- Don't worry.
881
00:35:23,957 --> 00:35:25,457
You'll get good
at spotting the fakers,
882
00:35:25,458 --> 00:35:27,334
and half the time,
all those people need
883
00:35:27,335 --> 00:35:29,921
is someone to really listen
to them and hear their story.
884
00:35:33,008 --> 00:35:36,885
- Interior compartment
pressure is 49.
885
00:35:36,886 --> 00:35:38,595
- Burn caused massive swelling.
886
00:35:38,596 --> 00:35:40,514
- What does he need,
Dr. Santos?
887
00:35:40,515 --> 00:35:43,434
- Fasciotomy, but he
still has a radial pulse.
888
00:35:43,435 --> 00:35:45,519
- Pressure would have to be
over 100 to lose the pulse,
889
00:35:45,520 --> 00:35:47,187
and at that point,
he'd lose the arm.
890
00:35:47,188 --> 00:35:49,231
- 49 is enough to destroy
all the nerves and muscles
891
00:35:49,232 --> 00:35:51,066
in a matter of hours.
892
00:35:51,067 --> 00:35:52,776
- Compartment pressure's 49?
- Yeah.
893
00:35:52,777 --> 00:35:54,737
I'm going to make the
initial incision down here.
894
00:35:54,738 --> 00:35:56,447
Ortho can finish it up
in the OR.
895
00:35:56,448 --> 00:35:58,282
- Good plan.
I'll let them know.
896
00:35:58,283 --> 00:36:00,075
Hey, Robby.
- Always good to see you, Fred.
897
00:36:00,076 --> 00:36:01,368
- How do you like my rock star?
- She's pretty good.
898
00:36:01,369 --> 00:36:03,912
She has a great teacher.
899
00:36:03,913 --> 00:36:05,914
- Sterile gloves
for Dr. Santos.
900
00:36:05,915 --> 00:36:09,209
We don't teach forearm
fasciotomies to our residents.
901
00:36:09,210 --> 00:36:11,170
- What if she's all alone
somewhere someday
902
00:36:11,171 --> 00:36:13,381
with no backup?
903
00:36:15,425 --> 00:36:18,594
This is the path
to avoid the median nerve
904
00:36:18,595 --> 00:36:20,763
and all major vessels.
905
00:36:20,764 --> 00:36:23,098
- Maybe just watch
the first time.
906
00:36:23,099 --> 00:36:25,517
- She'll hold the blade,
I'll cut.
907
00:36:25,518 --> 00:36:27,062
10 blade to Dr. Santos.
908
00:36:30,648 --> 00:36:33,067
We'll start proximal.
909
00:36:33,068 --> 00:36:34,485
- How much pressure?
910
00:36:34,486 --> 00:36:37,655
- Just about this much.
911
00:36:45,997 --> 00:36:48,541
Through the skin and sub-Q.
912
00:36:53,004 --> 00:36:54,421
- Good.
913
00:36:58,677 --> 00:37:00,511
- How they making out?
914
00:37:00,512 --> 00:37:02,263
- They're still talking.
915
00:37:03,723 --> 00:37:05,766
- You OK?
- Yeah, for sure.
916
00:37:05,767 --> 00:37:07,935
I just... I hate seeing families
torn apart.
917
00:37:07,936 --> 00:37:09,478
They'll be fine.
918
00:37:09,479 --> 00:37:11,980
- How can you be sure?
- They're white.
919
00:37:11,981 --> 00:37:14,274
Probably get off
with a slap on the wrist.
920
00:37:14,275 --> 00:37:16,777
If they weren't,
she'd probably lose her child
921
00:37:16,778 --> 00:37:20,406
and he'd end up going
to jail, but...
922
00:37:20,407 --> 00:37:23,325
Sorry, I did a fellowship
in cynicism.
923
00:37:23,326 --> 00:37:24,827
You sure you're OK?
924
00:37:24,828 --> 00:37:26,955
- 100%.
I'm just going to get some air.
925
00:37:32,836 --> 00:37:35,671
I am a savage, classy, bougie,
926
00:37:35,672 --> 00:37:38,507
ratchet, sassy, moody, nasty.
927
00:37:38,508 --> 00:37:40,509
I am a savage...
928
00:37:40,510 --> 00:37:42,845
I need help!
929
00:37:42,846 --> 00:37:44,013
I got shot.
930
00:37:44,014 --> 00:37:45,222
- Can you guys help?
931
00:37:45,223 --> 00:37:47,474
What's your name?
932
00:37:47,475 --> 00:37:48,642
- Alex.
933
00:37:48,643 --> 00:37:50,853
- OK, Alex, let me take a look.
934
00:37:50,854 --> 00:37:52,187
- It fucking hurts.
935
00:37:52,188 --> 00:37:54,189
- I know.
- All right.
936
00:37:54,190 --> 00:37:55,357
We're going to take
good care of you.
937
00:37:55,358 --> 00:37:57,026
- Yeah.
- You guys got it?
938
00:37:57,027 --> 00:37:59,236
Let me get you up here, Alex.
939
00:37:59,237 --> 00:38:00,988
- I got you.
940
00:38:00,989 --> 00:38:02,364
- I have an abdominal GSW
941
00:38:02,365 --> 00:38:05,159
in the ambulance bay,
code trauma now.
942
00:38:05,160 --> 00:38:07,786
- GSW just got dumped
by a homeboy ambulance.
943
00:38:07,787 --> 00:38:10,831
- You got this?
- Yeah, go.
944
00:38:10,832 --> 00:38:14,169
- 2 grams of Ancef.
Ortho's on their way.
945
00:38:17,922 --> 00:38:20,549
- Systolic's only 80.
14 gauge left AC.
946
00:38:20,550 --> 00:38:21,717
- We got two units
of whole blood
947
00:38:21,718 --> 00:38:23,052
going on the rapid infuser.
948
00:38:23,053 --> 00:38:24,386
- Call the OR.
We'll be right up.
949
00:38:24,387 --> 00:38:25,721
Lungs up.
950
00:38:25,722 --> 00:38:26,889
- Do you take medications
every day?
951
00:38:26,890 --> 00:38:28,849
Any allergies?
- No.
952
00:38:28,850 --> 00:38:30,309
- Morrison's is full of blood.
You see that?
953
00:38:30,310 --> 00:38:32,186
- Yeah.
- Tore up his liver.
954
00:38:32,187 --> 00:38:33,562
- What's his name?
- Alex.
955
00:38:33,563 --> 00:38:34,980
- Alex, you've lost
a lot of blood.
956
00:38:34,981 --> 00:38:36,315
You need to go to surgery
right away.
957
00:38:36,316 --> 00:38:37,316
- Am I going to die?
958
00:38:37,317 --> 00:38:38,776
- Not now that I'm here.
959
00:38:38,777 --> 00:38:40,069
- Spoken with the humility
of a surgeon.
960
00:38:40,070 --> 00:38:41,403
- OR's ready.
How's he doing?
961
00:38:41,404 --> 00:38:43,113
- BP is coming up a bit.
- Let's go.
962
00:38:43,114 --> 00:38:44,907
- Can you call my mom?
- Yep.
963
00:38:44,908 --> 00:38:47,576
- She's the "ICE" on my cell.
- Of course, of course.
964
00:38:47,577 --> 00:38:50,120
- So he didn't have
to wait for an OR?
965
00:38:50,121 --> 00:38:51,955
- No, we're a trauma center.
966
00:38:51,956 --> 00:38:54,416
We always keep one OR
stocked and ready to go.
967
00:38:54,417 --> 00:38:58,087
Well, that's awesome!
968
00:38:58,088 --> 00:39:01,090
What... what happens if there are
multiple traumas needing OR?
969
00:39:01,091 --> 00:39:02,717
- We get a lot busier.
970
00:39:04,636 --> 00:39:06,095
- Mr. Milton, I'm sorry.
971
00:39:06,096 --> 00:39:07,805
We had to move you
into the hall.
972
00:39:07,806 --> 00:39:09,765
I know it gets pretty chaotic
and noisy out here.
973
00:39:09,766 --> 00:39:12,267
Mr. Milton?
974
00:39:12,268 --> 00:39:14,813
Hey, hey, Bennet,
wake up for me.
975
00:39:17,148 --> 00:39:19,984
Shit, shit, shit.
Um, I need a little help here!
976
00:39:21,152 --> 00:39:22,444
Help!
977
00:39:22,445 --> 00:39:24,029
- When did you
check on him last?
978
00:39:24,030 --> 00:39:25,614
- I don't know, around
half an hour ago at most.
979
00:39:25,615 --> 00:39:27,116
I was waiting on labs.
- What's going on?
980
00:39:27,117 --> 00:39:28,784
- It's my gallstone guy.
You saw his EKGs.
981
00:39:28,785 --> 00:39:31,453
- Unknown downtime.
He was sleeping in the hall.
982
00:39:31,454 --> 00:39:33,455
Crash cart, let's go!
983
00:39:36,459 --> 00:39:38,419
- I got it.
984
00:39:40,839 --> 00:39:42,464
- Hold compressions.
985
00:39:44,592 --> 00:39:46,176
Asystole.
986
00:39:46,177 --> 00:39:49,972
- Resume compressions,
amp of epi.
987
00:39:49,973 --> 00:39:51,432
- Slower, slower tempo,
slower tempo.
988
00:39:51,433 --> 00:39:53,350
- Should I intubate?
- No. Drop an LMA.
989
00:39:53,351 --> 00:39:56,020
We don't want
to hold compressions.
990
00:39:56,021 --> 00:39:58,147
- Pupils are fixed and dilated.
991
00:39:58,148 --> 00:39:59,607
- He's been down a long time.
992
00:40:11,619 --> 00:40:12,995
- How we doing in here?
993
00:40:12,996 --> 00:40:14,496
- So much better.
994
00:40:14,497 --> 00:40:17,124
Dr. Mohan, this is my wife,
Ondine.
995
00:40:17,125 --> 00:40:19,752
- Dr. Samira Mohan.
Nice to meet you, Ondine.
996
00:40:19,753 --> 00:40:21,920
- Thank you for helping her.
- Of course.
997
00:40:21,921 --> 00:40:24,673
And, again, I'm so sorry
about how you were treated
998
00:40:24,674 --> 00:40:26,342
when you first arrived.
999
00:40:26,343 --> 00:40:27,760
Not everyone who works here
1000
00:40:27,761 --> 00:40:29,678
is accustomed to dealing
with sickle cell.
1001
00:40:29,679 --> 00:40:31,138
We will be doing
everything possible
1002
00:40:31,139 --> 00:40:33,807
from here on in
to manage Joyce's crisis.
1003
00:40:33,808 --> 00:40:35,684
In the meantime,
can I get you anything?
1004
00:40:35,685 --> 00:40:36,685
- I'm fine.
1005
00:40:36,686 --> 00:40:38,187
- Ondine?
- No, thank you.
1006
00:40:38,188 --> 00:40:39,646
- OK. Well, have the nurses
come find me
1007
00:40:39,647 --> 00:40:40,815
if you need anything.
1008
00:40:43,526 --> 00:40:45,903
- Take slow, deep breaths
for me, Ian.
1009
00:40:45,904 --> 00:40:48,906
- They ordered a neb,
5 albuterol, 125 solumedrol.
1010
00:40:48,907 --> 00:40:50,532
- All right.
1011
00:40:50,533 --> 00:40:52,201
Keep an eye on him
and present to Dr. Langdon.
1012
00:40:52,202 --> 00:40:54,328
- OK.
- OK, great.
1013
00:40:54,329 --> 00:40:56,538
I'll see you back in triage
once he settles down.
1014
00:40:56,539 --> 00:40:58,415
- Yeah.
1015
00:40:58,416 --> 00:40:59,541
OK, let's take this off.
1016
00:40:59,542 --> 00:41:01,001
All right, hang in there, Ian.
1017
00:41:01,002 --> 00:41:02,837
This should really help
your asthma.
1018
00:41:12,764 --> 00:41:13,889
- How can I help you, hon?
1019
00:41:13,890 --> 00:41:15,307
- Um, I'm looking
for Dr. Langdon.
1020
00:41:15,308 --> 00:41:17,143
- Yeah, let me see where he is.
1021
00:41:20,647 --> 00:41:22,481
Dr. Langdon,
we have a med student
1022
00:41:22,482 --> 00:41:24,109
at Central looking for you.
1023
00:41:25,652 --> 00:41:27,403
Copy that.
He's headed this way.
1024
00:41:27,404 --> 00:41:28,613
- Thanks.
1025
00:41:29,823 --> 00:41:31,073
- Hey, Crash.
1026
00:41:31,074 --> 00:41:33,575
You missed
a pretty cool fasciotomy.
1027
00:41:33,576 --> 00:41:34,910
- I'm not sure I'd be describing
1028
00:41:34,911 --> 00:41:36,495
a fasciotomy as cool.
1029
00:41:36,496 --> 00:41:39,206
- You would if you were
the one who did it.
1030
00:41:39,207 --> 00:41:42,335
How's it going out
in the arrivals lounge?
1031
00:41:44,295 --> 00:41:47,256
- Do you know anything
about Dr. McKay?
1032
00:41:47,257 --> 00:41:49,591
- I've been here
for less than two hours.
1033
00:41:49,592 --> 00:41:52,761
I don't know anybody,
including you.
1034
00:41:52,762 --> 00:41:55,639
I thought you were some kind
of kid genius.
1035
00:41:55,640 --> 00:41:58,100
- I'm like any other
third-year med student.
1036
00:41:58,101 --> 00:42:00,978
Clearly.
1037
00:42:00,979 --> 00:42:02,438
Hey, I'm just trying
to break the ice.
1038
00:42:02,439 --> 00:42:04,481
I'm not trying to annoy you.
1039
00:42:04,482 --> 00:42:06,442
- And yet, you're still
calling me Crash
1040
00:42:06,443 --> 00:42:07,818
when I asked you not to.
1041
00:42:07,819 --> 00:42:09,611
- Really?
You're still on that?
1042
00:42:09,612 --> 00:42:11,031
- Still on that.
1043
00:42:12,323 --> 00:42:15,242
Yep. OK, sorry.
1044
00:42:15,243 --> 00:42:20,205
I had no idea genius
was so sensitive.
1045
00:42:20,206 --> 00:42:23,292
But I get it.
Big brain, big feelings.
1046
00:42:23,293 --> 00:42:24,752
Makes total sense.
1047
00:42:24,753 --> 00:42:26,671
I'll try to be softer.
1048
00:42:50,612 --> 00:42:51,945
- We switch out
every few minutes.
1049
00:42:51,946 --> 00:42:53,614
You can take a break.
- I'm fine.
1050
00:42:53,615 --> 00:42:54,865
- Hold compressions.
1051
00:42:56,826 --> 00:42:58,494
- Still in asystole.
1052
00:42:58,495 --> 00:43:00,996
- Resume compressions.
1053
00:43:00,997 --> 00:43:02,331
- Should we shock him?
1054
00:43:02,332 --> 00:43:03,791
- You don't shock asystole.
1055
00:43:03,792 --> 00:43:05,042
- It could be fine v-fib.
1056
00:43:05,043 --> 00:43:07,711
- Not a chance.
- OK.
1057
00:43:07,712 --> 00:43:08,962
When was his last epi?
1058
00:43:08,963 --> 00:43:10,673
- Three minutes ago.
- OK.
1059
00:43:10,674 --> 00:43:12,049
Well, ACLS says every
three to five minute, right?
1060
00:43:12,050 --> 00:43:14,635
So let's push another round.
- Fine.
1061
00:43:14,636 --> 00:43:17,513
- Robby, Mr. Spencer's adult
children are asking for you.
1062
00:43:17,514 --> 00:43:19,431
And the parents of Nick Bradley,
1063
00:43:19,432 --> 00:43:21,350
the fentanyl overdose,
also want to speak with you.
1064
00:43:21,351 --> 00:43:22,768
- OK.
1065
00:43:22,769 --> 00:43:25,979
Three rounds of epi
and then call it.
1066
00:43:25,980 --> 00:43:28,524
- Mr. Spencer's maxed out
on BiPAP, 25 on 10.
1067
00:43:28,525 --> 00:43:31,527
- Sats?
- Not great, High 80s.
1068
00:43:34,364 --> 00:43:36,115
- Hi. I heard you wanted
to talk to me.
1069
00:43:36,116 --> 00:43:37,950
- Yeah.
That alarm kept going off.
1070
00:43:37,951 --> 00:43:40,953
- Yeah.
Why don't we step outside?
1071
00:43:40,954 --> 00:43:43,288
The alarm is for low oxygen.
1072
00:43:43,289 --> 00:43:45,541
- Does he need more
of that, um, BiPAP?
1073
00:43:45,542 --> 00:43:47,626
- I'm afraid
that's as high as we go.
1074
00:43:47,627 --> 00:43:49,378
So the decision
at this point is...
1075
00:43:49,379 --> 00:43:52,382
- We want you to put our father
on the breathing machine.
1076
00:43:54,175 --> 00:43:55,884
- Even though that goes
against his desires
1077
00:43:55,885 --> 00:43:58,220
to not be intubated?
1078
00:43:58,221 --> 00:44:00,723
- We're not ready to let go yet.
1079
00:44:00,724 --> 00:44:03,810
- And if your father is?
1080
00:44:05,311 --> 00:44:06,770
- He was a stubborn
son of a bitch
1081
00:44:06,771 --> 00:44:09,356
who would never have given up
on either of us.
1082
00:44:09,357 --> 00:44:12,109
We're not giving up on him.
1083
00:44:12,110 --> 00:44:14,111
- You're absolutely certain
you want
1084
00:44:14,112 --> 00:44:16,592
to put your father through this
after everything I've told you?
1085
00:44:20,744 --> 00:44:24,913
I may have to honor
his advanced directive.
1086
00:44:24,914 --> 00:44:29,043
- No, you have to honor our
durable power for health care.
1087
00:44:29,044 --> 00:44:32,505
If not, we can talk
to your hospital attorney.
1088
00:44:35,008 --> 00:44:37,259
- Jereme,
you're on board with this?
1089
00:44:37,260 --> 00:44:39,512
- Yeah, I guess so.
1090
00:44:41,181 --> 00:44:43,891
- OK. You can sit with him
until we're ready.
1091
00:44:43,892 --> 00:44:46,060
- And when will that be?
- Momentarily.
1092
00:44:57,655 --> 00:44:58,989
- Please don't tell me
1093
00:44:58,990 --> 00:45:00,324
you're going to intubate
that poor man.
1094
00:45:00,325 --> 00:45:02,076
- It's what the family wants.
1095
00:45:02,077 --> 00:45:03,786
- So what?
They want to torture him?
1096
00:45:03,787 --> 00:45:06,288
- I explained all that.
1097
00:45:06,289 --> 00:45:10,292
- If I co-sign, you can
override their durable power.
1098
00:45:10,293 --> 00:45:12,127
- They're threatening
to go to the hospital attorney.
1099
00:45:12,128 --> 00:45:13,587
- Let them.
Call the Ethics Committee.
1100
00:45:13,588 --> 00:45:14,797
They'll agree with us.
1101
00:45:14,798 --> 00:45:16,131
- No, no, you're probably right.
1102
00:45:16,132 --> 00:45:17,633
But we don't have
that kind of time.
1103
00:45:17,634 --> 00:45:19,426
We are stuck.
1104
00:45:19,427 --> 00:45:22,555
- What are you talking about?
- Shit.
1105
00:45:24,724 --> 00:45:26,141
- What?
1106
00:45:26,142 --> 00:45:27,559
- I got to go tell those parents
1107
00:45:27,560 --> 00:45:30,062
their 18-year-old son
is brain-dead.
1108
00:45:30,063 --> 00:45:32,648
- Want me to come with you?
- No, It's OK.
1109
00:45:32,649 --> 00:45:33,982
- What are you going to say?
1110
00:45:33,983 --> 00:45:35,442
- I'm going to say
that it's likely,
1111
00:45:35,443 --> 00:45:36,985
but we still need
to do an apnea test
1112
00:45:36,986 --> 00:45:40,072
and a cerebral perfusion study.
1113
00:45:40,073 --> 00:45:41,782
- There's no
cranial nerve activity.
1114
00:45:41,783 --> 00:45:45,619
- Those people need some hope.
- False hope.
1115
00:45:45,620 --> 00:45:47,746
- Hope is hope.
- Is it?
1116
00:45:47,747 --> 00:45:51,333
What, are we praying
for miracles today?
1117
00:45:51,334 --> 00:45:52,835
- They need time to process
1118
00:45:52,836 --> 00:45:55,838
before they can accept
what's happening.
1119
00:45:55,839 --> 00:45:59,299
- You ever consider
taking that advice?
1120
00:45:59,300 --> 00:46:02,386
Physician, heal thyself.
1121
00:46:02,387 --> 00:46:04,014
- Don't you have patients?
1122
00:46:26,578 --> 00:46:29,288
- No, no, no, no, no, no.
People wake up from comas.
1123
00:46:29,289 --> 00:46:31,373
You can wake him up.
1124
00:46:31,374 --> 00:46:33,667
You can do that.
You can... you can shock...
1125
00:46:33,668 --> 00:46:36,211
you can...
you can shock him back.
1126
00:46:41,718 --> 00:46:44,678
Nick.
1127
00:46:52,270 --> 00:46:53,812
- Hey, hey, hey.
1128
00:46:53,813 --> 00:46:55,564
Hey, hey, hey, hey, hey.
1129
00:46:55,565 --> 00:46:57,566
Nick.
1130
00:46:59,736 --> 00:47:03,530
Please, no!
1131
00:48:07,929 --> 00:48:10,973
No change.
1132
00:48:10,974 --> 00:48:12,474
- No pericardial effusion,
1133
00:48:12,475 --> 00:48:16,437
no tension pneumothorax,
no cardiac activity.
1134
00:48:16,438 --> 00:48:18,647
- Try calcium.
Could be hyperkalemia.
1135
00:48:18,648 --> 00:48:20,691
- No, his potassium was normal.
1136
00:48:20,692 --> 00:48:23,277
- Ready to call this?
- Not yet.
1137
00:48:23,278 --> 00:48:25,279
Dr. Robby said
three rounds of epi.
1138
00:48:25,280 --> 00:48:26,822
It's time.
Let's push another amp.
1139
00:48:26,823 --> 00:48:28,450
This one could do it.
1140
00:48:31,036 --> 00:48:32,161
- OK.
1141
00:48:35,165 --> 00:48:38,167
[tense music[
82891
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