1 00:00:13,972 --> 00:00:16,015 - Robby. - Yep. 2 00:00:16,099 --> 00:00:18,143 Cellulitis on the dorsum of the foot, 3 00:00:18,226 --> 00:00:20,145 now spreading up the leg. 4 00:00:20,228 --> 00:00:21,354 Hello, I'm Dr. Robby. 5 00:00:21,438 --> 00:00:23,064 Mind if I take a look? 6 00:00:23,148 --> 00:00:25,150 How long do you think this is gonna take? 7 00:00:25,233 --> 00:00:26,735 I took an early lunch break. 8 00:00:27,944 --> 00:00:29,070 I don't know that you're gonna 9 00:00:29,154 --> 00:00:30,947 make it back to work today. 10 00:00:31,031 --> 00:00:32,615 Erythema and warmth halfway up her knee. 11 00:00:32,698 --> 00:00:33,742 When did you see her, Donnie? 12 00:00:33,825 --> 00:00:36,202 He didn't. I did. 13 00:00:36,286 --> 00:00:37,704 - When? - About four hours ago. 14 00:00:37,787 --> 00:00:39,122 Gave her a dose of Keflex, 15 00:00:39,205 --> 00:00:40,665 told her to come back if things got worse. 16 00:00:40,749 --> 00:00:42,625 Things have definitely gotten worse. 17 00:00:42,709 --> 00:00:43,626 Dana, what's open? 18 00:00:43,710 --> 00:00:45,086 Trauma Two. 19 00:00:45,170 --> 00:00:46,588 Jesse, can you get her started in Trauma Two 20 00:00:46,671 --> 00:00:47,881 with some vanco and blood cultures, please? 21 00:00:47,964 --> 00:00:49,340 - Got it, boss. - I'm coming with. 22 00:00:49,424 --> 00:00:51,426 Suit yourself. 23 00:00:51,509 --> 00:00:54,721 Santos, you want in on Trauma Two? 24 00:00:54,804 --> 00:00:57,682 Too much charting, too little time. 25 00:00:57,766 --> 00:01:01,436 62-year-old male presents with chief complaint 26 00:01:01,519 --> 00:01:02,604 of left lower back pain. 27 00:01:02,687 --> 00:01:04,063 - Considered the diagnosis-- - Hey. 28 00:01:04,147 --> 00:01:05,272 Oh, Jesus Christ. 29 00:01:05,355 --> 00:01:06,733 I'm charting. 30 00:01:06,816 --> 00:01:08,234 Sorry. 31 00:01:09,319 --> 00:01:10,820 Did I do something wrong? 32 00:01:10,904 --> 00:01:12,572 Besides interrupting me? Probably. 33 00:01:12,655 --> 00:01:14,199 Then I apologize. 34 00:01:14,282 --> 00:01:17,827 I know that second year of residency can be stressful, 35 00:01:17,911 --> 00:01:21,039 so if there's anything I can do to help you... 36 00:01:21,122 --> 00:01:22,289 like stop talking. 37 00:01:22,373 --> 00:01:24,626 - That's a great idea. - Yeah. 38 00:01:24,709 --> 00:01:28,797 Considered the diagnosis of aortic aneurysm or dissection. 39 00:01:28,880 --> 00:01:30,507 Got a new one for you in 13. 40 00:01:30,590 --> 00:01:33,134 I'm 20 charts behind, and the new attending 41 00:01:33,218 --> 00:01:34,301 is threatening to make me repeat 42 00:01:34,384 --> 00:01:35,428 a year if I can't catch up. 43 00:01:35,512 --> 00:01:36,679 Cry me a river. 44 00:01:36,763 --> 00:01:37,806 Old lady with bad abdominal pain. 45 00:01:37,889 --> 00:01:38,973 Somebody's gotta see her. 46 00:01:39,057 --> 00:01:40,475 Dana, please do me a solid. 47 00:01:40,558 --> 00:01:42,143 Holiday weekend. 48 00:01:42,227 --> 00:01:43,770 Westbridge is down, and our waiting room's on overdrive. 49 00:01:43,853 --> 00:01:45,146 I'm sorry, but your charting's gonna have to wait 50 00:01:45,229 --> 00:01:47,607 until after your shift. 51 00:01:47,690 --> 00:01:49,067 Ogilvie. 52 00:01:49,150 --> 00:01:52,946 Dr. Santos needs you to pick up a new patient in 13. 53 00:01:53,029 --> 00:01:56,825 Y-yes, ma'am. I'm on it. 54 00:01:56,908 --> 00:01:58,118 Chart while you supervise. 55 00:01:58,201 --> 00:01:59,911 Best I can do. 56 00:02:03,039 --> 00:02:05,917 Setting up a GoFundMe, that's what her generation does. 57 00:02:06,000 --> 00:02:07,794 That's how they support each other. 58 00:02:07,877 --> 00:02:08,877 Doctor, tell him. 59 00:02:08,961 --> 00:02:10,463 Your wife's right. 60 00:02:10,547 --> 00:02:12,799 Staying here's gonna cost more than we can afford. 61 00:02:12,882 --> 00:02:14,676 Look, I'm feeling better. 62 00:02:14,759 --> 00:02:16,219 I'll just leave. 63 00:02:16,302 --> 00:02:19,180 Mr. Diaz, even if your blood sugar is back to normal, 64 00:02:19,264 --> 00:02:21,141 we have to continue with the insulin drip 65 00:02:21,224 --> 00:02:23,059 until we clear the ketones from your bloodstream. 66 00:02:23,143 --> 00:02:25,603 Otherwise, you could experience electrolyte disorders, 67 00:02:25,687 --> 00:02:26,938 heart and kidney problems-- 68 00:02:27,021 --> 00:02:30,483 Mi amor, your health is what matters. 69 00:02:30,567 --> 00:02:31,943 I'll make you a deal. 70 00:02:32,026 --> 00:02:33,778 You agree to stay on the insulin drip, 71 00:02:33,862 --> 00:02:35,280 and I'll go find our case manager 72 00:02:35,363 --> 00:02:37,198 to discuss cost-cutting options for your stay. 73 00:02:37,281 --> 00:02:38,575 Deal. 74 00:02:38,658 --> 00:02:40,827 And I'm sitting here making sure he doesn't move. 75 00:02:40,910 --> 00:02:42,954 - You should go look for Ana. - Mm-hmm. 76 00:02:43,037 --> 00:02:44,038 I can find her. 77 00:02:44,122 --> 00:02:45,707 BRB. 78 00:02:47,876 --> 00:02:49,002 Hanging vanco. 79 00:02:49,085 --> 00:02:50,545 What's vanco? 80 00:02:50,628 --> 00:02:53,047 A really strong antibiotic to kill skin germs. 81 00:02:53,131 --> 00:02:55,591 - Need a hand? - No. We got this. 82 00:02:55,675 --> 00:02:57,427 I'll just observe. 83 00:02:57,510 --> 00:02:58,887 Pretend I'm not even here. 84 00:02:58,970 --> 00:03:02,348 Let's send off a CBC, blood cultures, and CMP. 85 00:03:02,432 --> 00:03:05,393 And also a lactic acid, CRP, and calcitonin. 86 00:03:05,476 --> 00:03:07,478 Wait, she's not febrile, not tachycardic. 87 00:03:07,562 --> 00:03:09,105 No evidence of SIRS. 88 00:03:09,189 --> 00:03:11,065 - Yet. - What's SIRS? 89 00:03:11,149 --> 00:03:14,819 Systemic inflammatory response syndrome. 90 00:03:14,903 --> 00:03:15,862 Sorry. 91 00:03:15,945 --> 00:03:17,530 An exaggerated defense response. 92 00:03:17,614 --> 00:03:18,865 A what? 93 00:03:18,948 --> 00:03:20,950 Sometimes the human body can have an overreaction 94 00:03:21,034 --> 00:03:22,869 to an infection, so we're gonna monitor you 95 00:03:22,952 --> 00:03:24,495 to make sure that this does not progress. 96 00:03:27,332 --> 00:03:28,708 It's my boss. 97 00:03:28,791 --> 00:03:30,710 Sorry, I have to take this, or he's gonna fire me. 98 00:03:30,793 --> 00:03:32,795 OK. 99 00:03:32,879 --> 00:03:34,339 Hello. 100 00:03:34,422 --> 00:03:37,966 No, I'm still at the hospital. 101 00:03:38,051 --> 00:03:39,469 Being seen right now. 102 00:03:39,552 --> 00:03:40,762 Ow. 103 00:03:40,845 --> 00:03:43,932 No, they just stuck me with a needle. 104 00:03:44,015 --> 00:03:45,642 I don't know. 105 00:03:45,725 --> 00:03:48,061 You wanna talk to them? 106 00:03:48,144 --> 00:03:51,105 They're kind of busy right now. 107 00:03:51,189 --> 00:03:52,565 I know you are. 108 00:03:52,649 --> 00:03:54,025 Second IV's in. 109 00:03:54,108 --> 00:03:55,735 No, I'm not overreacting. 110 00:03:55,817 --> 00:03:58,071 My body's overreacting. 111 00:03:58,154 --> 00:04:00,073 Please--please don't fire me. 112 00:04:00,156 --> 00:04:01,366 I-- 113 00:04:01,449 --> 00:04:02,825 This is Dr. Michael Robinavitch. 114 00:04:02,909 --> 00:04:04,869 I am the chief of emergency medicine at PTMC. 115 00:04:04,953 --> 00:04:06,829 If you fire her, she will sue you, 116 00:04:06,913 --> 00:04:09,832 and I will testify on her behalf. 117 00:04:09,916 --> 00:04:12,126 OK. 118 00:04:12,210 --> 00:04:14,087 Don't worry about it. We got you. 119 00:04:18,966 --> 00:04:20,843 Do you know how long Jackson's gonna be asleep? 120 00:04:20,927 --> 00:04:24,097 So there's no exact timeline with the sedatives we gave him, 121 00:04:24,180 --> 00:04:25,807 but he should be awake soon. 122 00:04:25,890 --> 00:04:27,475 Have you spoken to your parents yet? 123 00:04:27,558 --> 00:04:29,102 Yeah, they're on their way back from Columbus. 124 00:04:29,185 --> 00:04:31,562 Maybe you should take some time for yourself 125 00:04:31,646 --> 00:04:32,981 before they arrive. 126 00:04:33,064 --> 00:04:34,649 Yeah, cafeteria's right down the hall. 127 00:04:34,732 --> 00:04:35,692 Decent grilled cheese. 128 00:04:35,775 --> 00:04:36,818 Stay away from the tuna. 129 00:04:36,901 --> 00:04:38,861 Thanks, but I'm not hungry. 130 00:04:38,945 --> 00:04:41,572 You know, I just can't believe that a campus security guard 131 00:04:41,656 --> 00:04:43,032 tased my brother. 132 00:04:43,116 --> 00:04:44,534 Aren't they supposed to be helping students 133 00:04:44,617 --> 00:04:46,619 and protect them, not shoot at them? 134 00:04:46,703 --> 00:04:48,329 You have every right to be upset, 135 00:04:48,413 --> 00:04:50,999 and you should absolutely pursue accountability. 136 00:04:51,082 --> 00:04:53,293 But right now, we are taking care of your brother. 137 00:04:53,376 --> 00:04:56,129 And you should really take care of yourself. 138 00:04:56,212 --> 00:04:57,714 I--I have your number. 139 00:04:57,797 --> 00:05:00,091 I'll text you as soon as Jackson's LP results get back 140 00:05:00,174 --> 00:05:02,302 or if he wakes up. 141 00:05:02,385 --> 00:05:04,012 OK. 142 00:05:04,095 --> 00:05:05,346 OK, thank you. 143 00:05:05,430 --> 00:05:06,514 Of course. 144 00:05:06,597 --> 00:05:09,684 - Oh. - OK. 145 00:05:09,767 --> 00:05:11,311 Hypoactive bowel sounds. 146 00:05:11,394 --> 00:05:14,188 Soft, with moderate tenderness in the left lower quadrant. 147 00:05:14,272 --> 00:05:17,442 Mrs. Randolph, do you take Percocet every day? 148 00:05:17,525 --> 00:05:19,360 - No. - Huh. 149 00:05:19,444 --> 00:05:20,820 And what about your water intake, 'cause-- 150 00:05:20,903 --> 00:05:22,363 Pause. 151 00:05:22,447 --> 00:05:24,532 Mrs. Randolph, you said you don't take Percocet every day, 152 00:05:24,615 --> 00:05:26,534 but when was the last time you took some? 153 00:05:26,617 --> 00:05:29,829 Maybe three or four times last week. 154 00:05:29,912 --> 00:05:33,457 Assisted living had a ballroom dance competition, 155 00:05:33,541 --> 00:05:35,668 - and I tweaked my back. - Mm. 156 00:05:35,752 --> 00:05:39,756 Any further questions, Ogilvie? 157 00:05:39,839 --> 00:05:43,468 When was your last bowel movement? 158 00:05:43,551 --> 00:05:45,970 I don't know. Sometime last week. 159 00:05:46,054 --> 00:05:48,973 I've been stopped up for at least five or six days. 160 00:05:49,057 --> 00:05:52,435 Mm-hmm, painkillers can cause constipation. 161 00:05:52,518 --> 00:05:53,728 I know. 162 00:05:53,811 --> 00:05:56,272 That's why they put me on a stool softener, 163 00:05:56,356 --> 00:05:57,607 and then they tried an enema. 164 00:05:57,690 --> 00:05:59,650 - And--and no movements? - Yep. 165 00:05:59,734 --> 00:06:02,945 And then they gave me this horrible drink. 166 00:06:03,029 --> 00:06:04,572 Mag citrate. 167 00:06:04,655 --> 00:06:05,615 Yeah. 168 00:06:05,698 --> 00:06:07,950 Mag citrate. 169 00:06:08,034 --> 00:06:09,243 Made me puke. 170 00:06:09,327 --> 00:06:11,454 All right, what's next, Ogilvie? 171 00:06:11,537 --> 00:06:13,498 Let's get you an X-ray and see how we can help you, 172 00:06:13,581 --> 00:06:14,499 Mrs. Randolph. 173 00:06:14,582 --> 00:06:16,376 - Thank you. - Yeah. 174 00:06:16,459 --> 00:06:18,544 Differential? 175 00:06:18,628 --> 00:06:20,213 Probable stool impaction. 176 00:06:20,296 --> 00:06:21,798 But with her history of cholecystectomy, 177 00:06:21,881 --> 00:06:23,549 it could be small bowel obstruction. 178 00:06:23,633 --> 00:06:24,675 Or worse. 179 00:06:24,759 --> 00:06:26,928 Sigmoid volvulus? 180 00:06:27,011 --> 00:06:29,305 But that's a surgical emergency. 181 00:06:29,389 --> 00:06:30,848 Wouldn't she have tons of pain? 182 00:06:30,932 --> 00:06:34,394 Not always, especially when you're in your 80s. 183 00:06:40,024 --> 00:06:41,567 I am getting concerned. 184 00:06:41,651 --> 00:06:44,153 This is a millimeter past the line. 185 00:06:44,237 --> 00:06:45,530 Or my line was sloppy. 186 00:06:45,613 --> 00:06:47,073 - Any increase in pain? - Oh. 187 00:06:47,156 --> 00:06:49,659 OK, sorry. Let's try four morphine. 188 00:06:49,742 --> 00:06:50,993 White count's only 10,000. 189 00:06:51,077 --> 00:06:53,037 It'd be over 12,000 for SIRS. 190 00:06:53,121 --> 00:06:54,831 There are other criteria. 191 00:06:54,914 --> 00:06:56,290 Still afebrile. 192 00:06:56,374 --> 00:06:57,875 Did you ask about past history of MRSA? 193 00:06:57,959 --> 00:06:59,669 Not specifically, but she's never been hospitalized. 194 00:06:59,752 --> 00:07:01,170 Any evidence of an immunocompromised state? 195 00:07:01,254 --> 00:07:02,422 - No, she's healthy. - Steroid use? 196 00:07:02,505 --> 00:07:03,423 Never. 197 00:07:03,506 --> 00:07:04,966 Maximum heart rate's only 89. 198 00:07:05,049 --> 00:07:06,134 Is that OK? 199 00:07:06,217 --> 00:07:08,219 That's good, very good. 200 00:07:08,302 --> 00:07:09,220 Stay with her. 201 00:07:09,303 --> 00:07:10,805 Monitor her closely. 202 00:07:10,888 --> 00:07:12,640 If there's any change in her condition, come find me. 203 00:07:12,723 --> 00:07:13,850 I mean any change. 204 00:07:16,978 --> 00:07:19,564 Roxie Hamler, 42, home hospice patient 205 00:07:19,647 --> 00:07:21,149 with a history of lung cancer. 206 00:07:21,232 --> 00:07:24,360 New-onset tonic-clonic seizure with right lower leg pain. 207 00:07:24,444 --> 00:07:26,487 She hit it on the coffee table. 208 00:07:28,197 --> 00:07:29,949 Initially nonverbal, now coming around. 209 00:07:30,032 --> 00:07:31,451 That's normal after a seizure. 210 00:07:31,534 --> 00:07:33,034 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 211 00:07:33,119 --> 00:07:34,829 - Nope, we got it. - She hit her head? 212 00:07:34,912 --> 00:07:35,997 No. I was there. 213 00:07:36,080 --> 00:07:37,623 - I caught her. - No IV? 214 00:07:37,707 --> 00:07:38,916 Couldn't get one in. 215 00:07:39,000 --> 00:07:40,418 Gave her four of IM versed for the seizure, 216 00:07:40,501 --> 00:07:41,961 - 25 of fent for the pain. - OK. 217 00:07:42,044 --> 00:07:43,838 - Dana, where to? - Trauma One. 218 00:07:43,921 --> 00:07:45,089 This way. 219 00:07:45,173 --> 00:07:47,425 Haven't seen you guys in a hot minute. 220 00:07:47,508 --> 00:07:50,011 Pickup from SCI Jones Forge. 221 00:07:50,094 --> 00:07:51,512 Was supposed to go to Westbridge but got 222 00:07:51,596 --> 00:07:52,513 diverted to you. 223 00:07:52,597 --> 00:07:53,931 Yeah, you and everybody else. 224 00:07:54,015 --> 00:07:55,475 Princess, I need you pivot to Central 9. 225 00:07:55,558 --> 00:07:56,808 Got it. 226 00:07:56,893 --> 00:07:58,519 Gus Varney, 54, victim of assault 227 00:07:58,603 --> 00:07:59,896 with diffuse blunt trauma. 228 00:07:59,979 --> 00:08:01,898 He's got bruising to the face, the right chest, 229 00:08:01,981 --> 00:08:03,566 10-centimeter laceration to the left arm. 230 00:08:03,649 --> 00:08:05,151 BP's 136 over 84, pulse 102, 231 00:08:05,234 --> 00:08:07,904 good sats, 95 on room air. 232 00:08:07,987 --> 00:08:09,614 How you feeling there, Mr. Varney? 233 00:08:09,697 --> 00:08:11,115 - Fucking hurts. - Where? 234 00:08:11,199 --> 00:08:13,451 - Everywhere. - I am Dr. Robby. 235 00:08:13,534 --> 00:08:14,744 This is Dr. Al-Hashimi. 236 00:08:14,827 --> 00:08:16,204 We'll get you something for the pain. 237 00:08:16,287 --> 00:08:17,747 I've got a progressing cellulitis in Trauma Two. 238 00:08:17,830 --> 00:08:19,373 - Go. I'm good. - Thank you. 239 00:08:19,457 --> 00:08:21,417 Gus, do you know who hurt you? 240 00:08:21,501 --> 00:08:24,086 One of the fine, upstanding citizens of cell block 6. 241 00:08:24,170 --> 00:08:27,006 It's a deep lac through the muscle fascia. 242 00:08:27,089 --> 00:08:28,549 Can we get the cuffs off once he settles? 243 00:08:28,633 --> 00:08:29,717 Not a chance. 244 00:08:29,800 --> 00:08:31,677 Orange jumpsuit. He's cuffed for a reason. 245 00:08:31,761 --> 00:08:33,804 Let's go. 246 00:08:44,190 --> 00:08:47,652 OK, everyone, on my count. 247 00:08:47,735 --> 00:08:49,278 1, 2-- 248 00:08:49,362 --> 00:08:50,821 Hold on. 249 00:08:54,450 --> 00:08:57,954 - Go. - 1, 2, 3. 250 00:08:58,037 --> 00:08:59,455 Mel, E-FAST. 251 00:08:59,539 --> 00:09:01,040 Whitaker, primary assessment. 252 00:09:01,123 --> 00:09:02,333 On it. 253 00:09:07,463 --> 00:09:08,589 Oh, weird bruise. 254 00:09:08,673 --> 00:09:09,882 Did he fall on something? 255 00:09:09,966 --> 00:09:11,384 Footprint, got stomped. 256 00:09:11,467 --> 00:09:13,386 Jesus. 257 00:09:14,679 --> 00:09:16,305 Is it--is that necessary? 258 00:09:16,389 --> 00:09:18,474 Afraid so. 259 00:09:18,558 --> 00:09:21,102 Airway's patent. 260 00:09:21,185 --> 00:09:23,854 Good lung sliding on the left. 261 00:09:23,938 --> 00:09:25,064 Sorry. 262 00:09:25,147 --> 00:09:26,357 Good on the right, too. 263 00:09:26,440 --> 00:09:27,733 How are the lungs? 264 00:09:27,817 --> 00:09:28,859 Good breath sounds. 265 00:09:28,943 --> 00:09:31,612 - No crepitus. - No effusion. 266 00:09:31,696 --> 00:09:34,907 Pulse ox 97, BP 118 over 78, heart rate 112. 267 00:09:34,991 --> 00:09:36,284 Tachycardic from the pain. 268 00:09:36,367 --> 00:09:37,827 Start with four of morphine. Repeat prn. 269 00:09:37,910 --> 00:09:38,828 On it. 270 00:09:38,911 --> 00:09:40,955 OK. Swollen mandible. 271 00:09:41,038 --> 00:09:42,373 Open your mouth for me, Gus. 272 00:09:42,456 --> 00:09:44,208 Little wider. 273 00:09:44,292 --> 00:09:45,459 Can't. 274 00:09:45,543 --> 00:09:46,836 Whitaker, you know the tongue blade exam? 275 00:09:46,919 --> 00:09:48,296 Yeah. 276 00:09:48,379 --> 00:09:49,755 It's a great test for mandible fracture. 277 00:09:49,839 --> 00:09:52,967 Gus, bite down hard on this for me. 278 00:09:55,261 --> 00:09:56,554 Sorry, Gus. 279 00:09:56,637 --> 00:09:58,681 Positive test. 280 00:09:58,764 --> 00:10:00,224 No free fluid in the belly. 281 00:10:00,308 --> 00:10:01,225 Any idea how long this will take? 282 00:10:01,309 --> 00:10:02,602 Too soon to tell. 283 00:10:02,685 --> 00:10:03,686 Whitaker, your assessment? 284 00:10:03,769 --> 00:10:05,104 Fractured left mandible, 285 00:10:05,187 --> 00:10:07,273 multiple rib fractures. 286 00:10:07,356 --> 00:10:08,774 Complex forearm lac. 287 00:10:08,858 --> 00:10:10,776 OK, log roll to the left, then pan scan. 288 00:10:10,860 --> 00:10:12,737 Where were you when Mr. Varney got assaulted? 289 00:10:12,820 --> 00:10:14,322 I just move 'em. I don't get to know 'em. 290 00:10:14,405 --> 00:10:16,073 CT's ready for us. 291 00:10:16,157 --> 00:10:17,908 Cycling the BP. 292 00:10:17,992 --> 00:10:20,578 OK, this redness is now a centimeter over that line, 293 00:10:20,661 --> 00:10:22,079 and this might be a bulla forming. 294 00:10:22,163 --> 00:10:23,372 The vanco takes a little time to work. 295 00:10:23,456 --> 00:10:26,917 Vital signs are still stable, 122 over 78. 296 00:10:27,001 --> 00:10:28,002 I got it. 297 00:10:28,085 --> 00:10:31,005 How are you feeling, Debbie? 298 00:10:31,088 --> 00:10:32,673 I'm feeling a little warm. 299 00:10:32,757 --> 00:10:34,091 That can happen with vanco. 300 00:10:34,175 --> 00:10:36,052 Thanks, man. 301 00:10:36,135 --> 00:10:39,096 Lactic acid 4.2. 302 00:10:39,180 --> 00:10:40,890 - OK. - What's wrong? 303 00:10:40,973 --> 00:10:43,601 That can be a sign of a more serious infection, 304 00:10:43,684 --> 00:10:45,227 but the good news is, we know what to do. 305 00:10:45,311 --> 00:10:48,939 Jesse, 2 liters of LR wide open. 306 00:10:49,023 --> 00:10:50,399 This is severe sepsis. 307 00:10:50,483 --> 00:10:52,026 I know, but at 7:00 AM, it was a simple cellulitis. 308 00:10:52,109 --> 00:10:53,653 Anyone would have given her Keflex. 309 00:10:53,736 --> 00:10:55,655 We could add carbapenem or Zosyn to broaden 310 00:10:55,738 --> 00:10:56,697 our antibiotic coverage. 311 00:10:56,781 --> 00:10:57,865 OK, I got it. 312 00:10:57,948 --> 00:10:59,283 Thanks. 313 00:10:59,367 --> 00:11:02,286 Jesse, 1 gram meropenem, 900 milligrams clinda, 314 00:11:02,370 --> 00:11:04,330 and page Dr. Garcia, please. 315 00:11:04,413 --> 00:11:05,748 What's going on? 316 00:11:05,831 --> 00:11:07,208 We're adding new antibiotics. 317 00:11:07,291 --> 00:11:08,626 It's serious? 318 00:11:08,709 --> 00:11:09,835 We wanna get ahead of it and make sure 319 00:11:09,919 --> 00:11:11,712 it doesn't become serious. 320 00:11:13,381 --> 00:11:14,382 What else can I do? 321 00:11:14,465 --> 00:11:15,549 I think you've done enough. 322 00:11:15,633 --> 00:11:16,759 You can go. 323 00:11:20,513 --> 00:11:21,430 All good in there? 324 00:11:21,514 --> 00:11:22,556 Code sepsis. 325 00:11:22,640 --> 00:11:23,891 Stable for the moment. 326 00:11:23,974 --> 00:11:25,184 How about you? 327 00:11:25,267 --> 00:11:27,561 Perfect vitals, E-FAST negative, off to CT. 328 00:11:27,645 --> 00:11:28,771 Good. 329 00:11:28,854 --> 00:11:30,356 Keep me posted. 330 00:11:30,439 --> 00:11:31,732 Ditto. 331 00:11:35,361 --> 00:11:36,696 How's it going? 332 00:11:36,779 --> 00:11:38,698 Great, if you ignore the hot mess in chairs. 333 00:11:38,781 --> 00:11:40,616 Any update on our little baby Jane Doe? 334 00:11:40,700 --> 00:11:42,618 Security's reviewing the CCTV from last night 335 00:11:42,702 --> 00:11:43,911 and this morning. 336 00:11:46,288 --> 00:11:47,665 You two kiss and make up yet? 337 00:11:47,748 --> 00:11:49,250 I think someone needs to smoke a cigarette. 338 00:11:49,333 --> 00:11:50,668 I'm trying to quit. 339 00:11:50,751 --> 00:11:52,211 Why don't you quit when I'm on my trip? 340 00:11:52,294 --> 00:11:53,462 Everyone's glad to have you back. 341 00:11:53,546 --> 00:11:56,006 - Asshole. - Well, not everyone. 342 00:11:57,508 --> 00:11:59,885 Hey, you want in on this betting board? 343 00:11:59,969 --> 00:12:02,847 Look, all you gotta do is pick why Westbridge went down, 344 00:12:02,930 --> 00:12:04,473 how many of their patients we're gonna get, 345 00:12:04,557 --> 00:12:06,100 and when they'll be back in action. 346 00:12:06,183 --> 00:12:08,853 Hey, already up to $500. 347 00:12:08,936 --> 00:12:11,188 Oh, ah, gotta pass. 348 00:12:11,272 --> 00:12:13,357 Still catching up on rehab bills. 349 00:12:13,441 --> 00:12:15,901 Respect. 350 00:12:17,486 --> 00:12:18,571 All right. 351 00:12:18,654 --> 00:12:20,281 What's the rules on me changing my bet? 352 00:12:20,364 --> 00:12:22,491 Only if you double down. 353 00:12:24,618 --> 00:12:25,995 Sinkhole. 354 00:12:28,664 --> 00:12:32,084 You watch too many movies, man. 355 00:12:32,168 --> 00:12:35,171 Considered the diagnosis of aortic aneurysm 356 00:12:35,254 --> 00:12:37,423 or dissection, but the point-of-care ultrasound was-- 357 00:12:37,506 --> 00:12:40,009 You done want that gridlocked granny? 358 00:12:40,092 --> 00:12:41,927 Ordered an acute abdominal series 359 00:12:42,011 --> 00:12:43,179 to rule out obstruction. 360 00:12:43,262 --> 00:12:44,430 - Still waiting on the X-rays. - Great. 361 00:12:44,513 --> 00:12:45,556 Then you're free to treat our latest 362 00:12:45,639 --> 00:12:46,766 and greatest in South 16. 363 00:12:46,849 --> 00:12:49,560 Oh, come on, D, it's like, every time 364 00:12:49,643 --> 00:12:51,145 I get a moment to chart, I barely get 365 00:12:51,228 --> 00:12:53,856 - a sentence out before I get-- - Interrupted? 366 00:12:53,939 --> 00:12:55,900 Sucks to be you, but trust me, it sucks worse 367 00:12:55,983 --> 00:12:57,818 for the poor gal in 16. 368 00:12:57,902 --> 00:13:00,571 I'm beginning to think you enjoy torturing me. 369 00:13:00,654 --> 00:13:02,698 Perks of the job. 370 00:13:02,782 --> 00:13:04,074 Ogilvie, let's go. 371 00:13:07,703 --> 00:13:10,414 Hold out your hand, Louie. 372 00:13:11,373 --> 00:13:13,000 A little shaky. 373 00:13:13,083 --> 00:13:14,001 No surprise. 374 00:13:14,084 --> 00:13:16,170 I've been here since 4:00 AM. 375 00:13:16,253 --> 00:13:17,546 We can get you something for that. 376 00:13:17,630 --> 00:13:18,881 Or I can take care of it myself 377 00:13:18,964 --> 00:13:21,008 if you cut me loose right now. 378 00:13:21,091 --> 00:13:23,177 Let's get Louie 50 milligrams of Librium. 379 00:13:23,260 --> 00:13:24,804 I'll put in the order. 380 00:13:26,931 --> 00:13:29,683 I will get it from the PDS. 381 00:13:33,229 --> 00:13:35,731 I'm already assigned as Louie's treating physician. 382 00:13:35,815 --> 00:13:38,150 Just makes sense that I put it in. 383 00:13:38,234 --> 00:13:40,319 Yeah. Yeah, yeah. Of course. 384 00:13:45,449 --> 00:13:47,868 Any changes with our septic waitress? 385 00:13:47,952 --> 00:13:48,994 Not yet. 386 00:13:49,078 --> 00:13:50,079 Wait, if you have a second, I-- 387 00:13:50,162 --> 00:13:51,247 I don't. 388 00:13:51,330 --> 00:13:52,665 But the point-of-care ultrasound 389 00:13:52,748 --> 00:13:54,083 was negative for both. 390 00:13:54,165 --> 00:13:56,502 I considered the diagnosis of cauda equina syndrome. 391 00:13:56,585 --> 00:13:59,630 You writing the great American novel? 392 00:13:59,713 --> 00:14:01,590 Charting and supervising. 393 00:14:01,674 --> 00:14:02,633 It's Dana's idea. 394 00:14:02,716 --> 00:14:04,176 Who's the lucky patient? 395 00:14:04,260 --> 00:14:06,053 Unhoused woman with a bad cough. 396 00:14:06,136 --> 00:14:07,847 Ogilvie's all over it. 397 00:14:07,930 --> 00:14:09,223 OK. 398 00:14:09,306 --> 00:14:10,766 Say "eee." 399 00:14:10,850 --> 00:14:12,518 Eee. 400 00:14:12,601 --> 00:14:14,270 OK, deep breath in. 401 00:14:14,353 --> 00:14:16,188 Blow it out real hard. 402 00:14:16,272 --> 00:14:17,940 You haven't heard enough already? 403 00:14:18,023 --> 00:14:21,986 I need to check for wheezing with forced exhalation. 404 00:14:25,239 --> 00:14:27,116 Fucking cough is killing me. 405 00:14:27,199 --> 00:14:28,701 You smoke, Mrs. Yardley? 406 00:14:28,784 --> 00:14:30,911 Yeah, but I haven't been able to 407 00:14:30,995 --> 00:14:32,329 for a couple days 'cause of this cough. 408 00:14:32,413 --> 00:14:34,582 Mm. You ever consider quitting? 409 00:14:34,665 --> 00:14:38,085 You ever considered minding your own business? 410 00:14:42,006 --> 00:14:44,174 Well, the good news is that your test from earlier 411 00:14:44,258 --> 00:14:46,385 came back negative for both COVID and influenza, 412 00:14:46,468 --> 00:14:48,053 but I'm gonna order a chest X-ray 413 00:14:48,137 --> 00:14:49,597 so that we can see what's really going on in those lungs. 414 00:14:49,680 --> 00:14:51,599 You got time to let us do that? 415 00:14:52,892 --> 00:14:55,769 Where the fuck else you think I gotta be? 416 00:14:55,853 --> 00:14:57,563 And we're in. 417 00:14:57,646 --> 00:14:59,231 3 grams Keppra over 10 minutes. 418 00:14:59,315 --> 00:15:00,941 That'll prevent another seizure. 419 00:15:01,025 --> 00:15:02,026 Thank you. 420 00:15:02,109 --> 00:15:03,944 Nobody can ever get an IV in her. 421 00:15:04,028 --> 00:15:05,905 Yeah, midline cath is the way to go 422 00:15:05,988 --> 00:15:07,531 when your veins are shot. 423 00:15:07,615 --> 00:15:12,119 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 424 00:15:12,202 --> 00:15:14,830 - OK. - Cold. 425 00:15:14,914 --> 00:15:18,292 Is it possible to get her a blanket and some socks? 426 00:15:18,375 --> 00:15:20,044 Can do. 427 00:15:20,127 --> 00:15:22,588 When was she diagnosed? 428 00:15:22,671 --> 00:15:24,548 Seven years ago. 429 00:15:24,632 --> 00:15:27,134 Resected a lobe. 430 00:15:27,217 --> 00:15:29,678 Four cycles of platinum chemo gave us a couple good years, 431 00:15:29,762 --> 00:15:32,139 but then it spread to the bones. 432 00:15:32,222 --> 00:15:34,350 Has she had radiation therapy? 433 00:15:34,433 --> 00:15:36,810 Shrunk down the mets, but they're still there. 434 00:15:36,894 --> 00:15:38,771 That's why you're at hospice at home. 435 00:15:38,854 --> 00:15:39,772 Yep. 436 00:15:39,855 --> 00:15:41,815 I'm sorry. 437 00:15:41,899 --> 00:15:43,108 Me too. 438 00:15:43,192 --> 00:15:45,694 Ah. 439 00:15:45,778 --> 00:15:46,820 Sorry. 440 00:15:46,904 --> 00:15:48,364 You have kids? 441 00:15:48,447 --> 00:15:50,824 Yeah, two boys. 442 00:15:50,908 --> 00:15:52,910 15 and 9. 443 00:15:52,993 --> 00:15:54,495 My son's 12. 444 00:15:54,578 --> 00:15:56,705 Goes fast. 445 00:15:56,789 --> 00:15:58,540 Too fast. 446 00:15:58,624 --> 00:16:03,170 Swelling and bruising over the distal tibia. 447 00:16:03,253 --> 00:16:05,798 50 of fentanyl once her systolic's over 100. 448 00:16:05,881 --> 00:16:08,425 What do you usually take for pain? 449 00:16:11,428 --> 00:16:14,556 MS Contin, 30 milligrams twice a day, 450 00:16:14,640 --> 00:16:16,976 oxycodone for breakthrough, and sublingual Actiq 451 00:16:17,059 --> 00:16:20,771 for when it gets really bad. 452 00:16:20,854 --> 00:16:21,939 That's a lot. 453 00:16:22,022 --> 00:16:23,732 You handle her pain meds? 454 00:16:23,816 --> 00:16:24,817 Sometimes. 455 00:16:24,900 --> 00:16:26,694 All the time. 456 00:16:26,777 --> 00:16:29,571 A hospice nurse comes by a few times a week, 457 00:16:29,655 --> 00:16:31,949 but I was alone when she had the seizure. 458 00:16:32,032 --> 00:16:33,909 They told us that it could happen, 459 00:16:33,993 --> 00:16:35,494 but she couldn't breathe. 460 00:16:35,577 --> 00:16:39,957 And I freaked out, and I called 911. 461 00:16:40,040 --> 00:16:42,251 I'm so sorry. 462 00:16:42,334 --> 00:16:44,169 I'm sorry. 463 00:16:44,253 --> 00:16:46,088 I'm sorry. 464 00:16:55,764 --> 00:16:58,851 Due to your family income, you make too much 465 00:16:58,934 --> 00:17:00,728 to be eligible for either PENNIE 466 00:17:00,811 --> 00:17:03,147 or the hospital's "charity care." 467 00:17:03,230 --> 00:17:05,273 But we can't afford health-care premiums. 468 00:17:05,357 --> 00:17:08,068 It's unfortunately very common for people 469 00:17:08,152 --> 00:17:09,361 to fall between the cracks. 470 00:17:09,444 --> 00:17:11,488 It's an imperfect system. 471 00:17:11,571 --> 00:17:13,656 Can PTMC help with the costs in any way? 472 00:17:13,741 --> 00:17:16,117 We can offer financial assistance. 473 00:17:16,201 --> 00:17:17,953 You'd pay the same that Medicare 474 00:17:18,037 --> 00:17:19,579 and Medicaid would pay. 475 00:17:19,663 --> 00:17:20,705 How much is that? 476 00:17:20,789 --> 00:17:24,626 You pay 60%, we cover 40%. 477 00:17:24,710 --> 00:17:26,002 Thank you. 478 00:17:26,086 --> 00:17:27,921 Uh-huh. 479 00:17:29,131 --> 00:17:31,133 Where have you been? 480 00:17:31,216 --> 00:17:33,635 - How are you doing? - I'm sorry, mijita. 481 00:17:33,719 --> 00:17:36,722 You were being thoughtful, and I just blew up. 482 00:17:36,805 --> 00:17:39,641 Well, Ms. Noelle was just telling us that the hospital 483 00:17:39,725 --> 00:17:41,351 is gonna give us a big discount. 484 00:17:41,435 --> 00:17:44,021 We can knock 40% off your final bill. 485 00:17:44,104 --> 00:17:45,981 - That's great. - Mm-hmm. 486 00:17:46,065 --> 00:17:47,858 I stay here for a few days, 487 00:17:47,941 --> 00:17:50,152 my bill could be over $100,000, right? 488 00:17:51,862 --> 00:17:53,530 Yes, unfortunately. 489 00:17:53,614 --> 00:17:55,616 It could end up being lower, 490 00:17:55,699 --> 00:17:58,035 depending on your level of needed care. 491 00:17:58,118 --> 00:18:00,037 Or higher? 492 00:18:00,120 --> 00:18:03,999 So we would still have to pay $60,000? 493 00:18:04,083 --> 00:18:05,542 Which we don't have. 494 00:18:05,626 --> 00:18:07,753 He has to stay here to get better, right? 495 00:18:07,836 --> 00:18:10,130 - Yes. - No. 496 00:18:10,214 --> 00:18:11,381 Excuse me? 497 00:18:11,465 --> 00:18:13,592 I mean, not necessarily. 498 00:18:13,675 --> 00:18:16,261 Couldn't we just admit him to med-surg instead of ICU? 499 00:18:16,345 --> 00:18:18,097 Wouldn't that be a lot cheaper? 500 00:18:18,180 --> 00:18:20,224 Med-surg won't accept him with an insulin drip. 501 00:18:20,307 --> 00:18:22,017 Usually true. 502 00:18:22,101 --> 00:18:25,687 But let me talk to the charge nurse upstairs, and I'll-- 503 00:18:25,771 --> 00:18:26,855 I'll see what she says. 504 00:18:26,939 --> 00:18:28,398 Thank you. 505 00:18:30,400 --> 00:18:32,361 Food poisoning in the hall's asking to leave, 506 00:18:32,444 --> 00:18:34,404 wants to take her kids to the water park. 507 00:18:34,488 --> 00:18:36,949 Those places are cesspools. 508 00:18:37,032 --> 00:18:38,450 Preaching to the choir. 509 00:18:38,534 --> 00:18:40,077 If she's feeling fine on Zofran, she's good to go. 510 00:18:40,160 --> 00:18:41,537 All right. 511 00:18:41,620 --> 00:18:43,455 Louie's in South 15. Meds are coming down. 512 00:18:43,539 --> 00:18:45,457 Another couple hours of monitoring, and he can broom. 513 00:18:45,541 --> 00:18:46,750 Straight to the liquor store. 514 00:18:46,834 --> 00:18:47,876 Don't pass "go." 515 00:18:47,960 --> 00:18:48,877 What about that clamshell case 516 00:18:48,961 --> 00:18:50,337 that went up--anything? 517 00:18:50,420 --> 00:18:52,297 Out of surgery, in recovery, still sedated. 518 00:18:52,381 --> 00:18:54,216 Good. Keep me posted on that. 519 00:18:54,299 --> 00:18:55,634 Will do. 520 00:18:57,845 --> 00:18:59,096 Three times in one day. 521 00:18:59,179 --> 00:19:00,681 To what do we owe the pleasure? 522 00:19:00,764 --> 00:19:02,391 I came down for a consult 523 00:19:02,474 --> 00:19:04,810 and to persuade Ahmad to start a new betting board. 524 00:19:04,893 --> 00:19:06,395 Why, is the Westbridge board full already? 525 00:19:06,478 --> 00:19:08,438 Mm-hmm, was gonna ask him to start one about you 526 00:19:08,522 --> 00:19:10,732 and your midlife crisis trip. 527 00:19:10,816 --> 00:19:12,734 I give it four weeks. 528 00:19:12,818 --> 00:19:15,279 Seven, tops. 529 00:19:15,362 --> 00:19:16,530 Ye of little faith. 530 00:19:16,613 --> 00:19:19,283 Not about faith, just facts. 531 00:19:19,366 --> 00:19:20,576 Facts? 532 00:19:20,659 --> 00:19:22,494 Based on my experience, you're a seven-week-itch 533 00:19:22,578 --> 00:19:23,954 kind of guy. 534 00:19:24,037 --> 00:19:26,165 Hey, Robby, med student's got a pickleball player 535 00:19:26,248 --> 00:19:28,125 in the North Hall with possible Achilles rupture, 536 00:19:28,208 --> 00:19:29,126 asking for your opinion. 537 00:19:29,209 --> 00:19:30,711 Thank you, Perlah. 538 00:19:30,794 --> 00:19:32,880 At least somebody down here has a little faith in me. 539 00:19:35,549 --> 00:19:38,177 You know what Motorcycle Mike's sabbatical is really about? 540 00:19:38,260 --> 00:19:41,054 I never try to guess what's going on in that head of his. 541 00:19:41,138 --> 00:19:44,266 Three months being on the open road by himself. 542 00:19:44,349 --> 00:19:46,435 Man can't stand to be alone for more than a few hours. 543 00:19:46,518 --> 00:19:49,479 He sleeps with the TV on in his bedroom. 544 00:19:49,563 --> 00:19:52,357 I really don't think I needed to know that. 545 00:19:53,817 --> 00:19:56,904 Look, maybe he's looking for something new 546 00:19:56,987 --> 00:19:59,823 or trying to outrun some old ghosts. 547 00:19:59,907 --> 00:20:03,118 Well, I hope he finds what he's looking for. 548 00:20:03,202 --> 00:20:05,287 Man deserves some peace. 549 00:20:05,370 --> 00:20:06,663 Amen. 550 00:20:06,747 --> 00:20:09,333 I considered the diagnosis of cauda equina syndrome, 551 00:20:09,416 --> 00:20:11,168 but the motor and sensory exam 552 00:20:11,251 --> 00:20:13,545 were both intact in the sacral nerve root-- 553 00:20:13,629 --> 00:20:14,880 Our unhoused cougher has pneumonia. 554 00:20:14,963 --> 00:20:17,758 I'm cursed, fucking cursed. 555 00:20:17,841 --> 00:20:19,259 Fuck. 556 00:20:19,343 --> 00:20:21,011 What? 557 00:20:21,094 --> 00:20:23,430 That is a cavitary lesion in the right upper lobe. 558 00:20:23,513 --> 00:20:25,224 Active TB. 559 00:20:25,307 --> 00:20:27,559 What's next? 560 00:20:27,643 --> 00:20:29,144 AFB stain to confirm, 561 00:20:29,228 --> 00:20:31,688 move her to a negative airflow room, start her on meds. 562 00:20:31,772 --> 00:20:33,815 Call infection control and public health. 563 00:20:33,899 --> 00:20:36,109 And now you get to sign in as a patient 564 00:20:36,193 --> 00:20:38,570 and get your blood drawn for a QuantiFERON Gold. 565 00:20:38,654 --> 00:20:40,572 It's too soon to be positive. 566 00:20:40,656 --> 00:20:41,740 Yeah, but you were exposed. 567 00:20:41,823 --> 00:20:43,367 You need a baseline test 568 00:20:43,450 --> 00:20:46,578 and then again in eight weeks to see if you convert. 569 00:20:46,662 --> 00:20:47,913 And if I do? 570 00:20:47,996 --> 00:20:50,040 Then meds every day for three or four months 571 00:20:50,123 --> 00:20:52,918 with regular blood tests to check for toxicity. 572 00:20:53,001 --> 00:20:54,253 - Jesus. - All right. 573 00:20:54,336 --> 00:20:55,754 Let Dana know what's up. 574 00:20:55,837 --> 00:20:58,840 And for the love of God, mask up when you move her. 575 00:21:07,391 --> 00:21:09,518 - Dr. Langdon. - Hey, man. Alex. 576 00:21:09,601 --> 00:21:10,727 Let's take a look. 577 00:21:13,355 --> 00:21:16,233 Ah. 578 00:21:16,316 --> 00:21:17,234 Is it bad? 579 00:21:17,317 --> 00:21:18,777 It's not good. 580 00:21:18,860 --> 00:21:21,405 Sorry, your chart says you were burned with dry ice? 581 00:21:21,488 --> 00:21:23,448 - What happened? - My jack-off brother. 582 00:21:23,532 --> 00:21:25,033 Does he not like you? 583 00:21:25,117 --> 00:21:28,662 I asked him to do it, just not like this exactly. 584 00:21:28,745 --> 00:21:30,247 What? Why? 585 00:21:30,330 --> 00:21:31,915 He was gonna brand me like I branded him. 586 00:21:31,999 --> 00:21:33,750 Branded? Like cattle? 587 00:21:33,834 --> 00:21:36,878 Instead of hot branding, you stick the iron in dry ice, 588 00:21:36,962 --> 00:21:39,840 let it get super cold, and then you put it on your skin. 589 00:21:39,923 --> 00:21:41,675 Cool, huh? 590 00:21:41,758 --> 00:21:42,718 You're stupid. 591 00:21:42,801 --> 00:21:43,969 Let's get some LET on this. 592 00:21:44,052 --> 00:21:45,762 I'll get some snips to debride. 593 00:21:48,265 --> 00:21:49,850 You good? 594 00:21:49,933 --> 00:21:52,185 Yeah. Yeah, good. 595 00:21:52,269 --> 00:21:53,603 You sure? 596 00:21:53,687 --> 00:21:56,690 Doesn't seem like Robby's all that happy I'm back. 597 00:21:56,773 --> 00:21:59,318 Well, he's not going to be here, 598 00:21:59,401 --> 00:22:01,111 and I'm happy you're back. 599 00:22:01,194 --> 00:22:03,071 Thanks. 600 00:22:07,451 --> 00:22:11,580 Head and neck CT is negative, except for mandible fracture. 601 00:22:12,539 --> 00:22:13,832 OK, let's get him off the board. 602 00:22:13,915 --> 00:22:15,125 Roll him, right side up. 603 00:22:15,208 --> 00:22:16,918 Hey, we're gonna need the cuffs off. 604 00:22:19,963 --> 00:22:22,716 Ready. And 1, 2, 3. 605 00:22:22,799 --> 00:22:25,093 Ah, gentle. 606 00:22:25,177 --> 00:22:26,762 Dr. King, how are the chest and belly? 607 00:22:26,845 --> 00:22:30,015 We have three anterior rib fractures 608 00:22:30,098 --> 00:22:31,933 and a small pulmonary contusion. 609 00:22:32,017 --> 00:22:33,185 - Not too bad. - Mm-mm. 610 00:22:33,268 --> 00:22:34,895 When do pulmonary contusions peak? 611 00:22:34,978 --> 00:22:36,313 After a few hours. 612 00:22:36,396 --> 00:22:37,856 And do we always admit for three-rib fractures? 613 00:22:37,939 --> 00:22:39,191 In the elderly, yes, 614 00:22:39,274 --> 00:22:40,984 but not if a patient can manage the pain 615 00:22:41,068 --> 00:22:42,986 and doesn't need supplemental oxygen. 616 00:22:44,279 --> 00:22:45,739 OK, he's really hurting here. 617 00:22:45,822 --> 00:22:47,407 You think you could set us up with a serratus anterior 618 00:22:47,491 --> 00:22:48,617 - field block? - No problem. 619 00:22:48,700 --> 00:22:50,744 Oh, as long as that's OK 620 00:22:50,827 --> 00:22:51,912 with Dr. Al-Hashimi. 621 00:22:51,995 --> 00:22:54,039 If the patient consents. 622 00:22:54,122 --> 00:22:57,918 Mr. Varney, we wanna give you a shot to numb your broken ribs 623 00:22:58,001 --> 00:22:59,086 so you can breathe easier. 624 00:22:59,169 --> 00:23:00,337 Uh-huh. 625 00:23:00,420 --> 00:23:02,005 OK, get Mr. Varney prepped and draped. 626 00:23:02,089 --> 00:23:03,590 Dr. Mohan, you're in charge. 627 00:23:03,673 --> 00:23:05,425 Let's identify the landmarks. 628 00:23:05,509 --> 00:23:06,593 Cuffs. 629 00:23:07,969 --> 00:23:09,554 Yeah, you can just leave them off, man. 630 00:23:09,638 --> 00:23:12,474 He's clearly not moving on his own. 631 00:23:12,557 --> 00:23:14,059 We follow protocol, 632 00:23:14,142 --> 00:23:17,437 for his safety and yours. 633 00:23:19,231 --> 00:23:20,816 Do you need to get that? 634 00:23:20,899 --> 00:23:23,652 Nope. It's my mom. 635 00:23:23,735 --> 00:23:25,904 Ignore it. Just ignore it. 636 00:23:25,987 --> 00:23:27,739 - Amen, sister. - Forearm is numb. 637 00:23:27,823 --> 00:23:29,032 We can irrigate. 638 00:23:29,116 --> 00:23:30,617 If I ignore a problem for long enough, 639 00:23:30,700 --> 00:23:32,244 it just goes away, right? 640 00:23:32,327 --> 00:23:34,496 I wish I could ignore my deposition. 641 00:23:34,579 --> 00:23:36,748 That, you can't ignore. 642 00:23:36,832 --> 00:23:37,999 But you'll be fine. 643 00:23:38,083 --> 00:23:39,543 What's up with you, Whitaker? 644 00:23:39,626 --> 00:23:41,044 Trouble in roomie land? 645 00:23:41,128 --> 00:23:42,587 No, not really. 646 00:23:42,671 --> 00:23:45,882 I think I overstepped with Dr. Langdon earlier. 647 00:23:45,966 --> 00:23:47,134 Oh. 648 00:23:47,217 --> 00:23:49,761 He was trying to prescribe a patient benzos, 649 00:23:49,845 --> 00:23:52,681 and I told Langdon that it'd be better if I did it. 650 00:23:52,764 --> 00:23:54,141 Oof. 651 00:23:54,224 --> 00:23:56,518 Only because I was already the assigned physician. 652 00:23:56,601 --> 00:23:58,353 But yeah, now I feel like an asshole. 653 00:23:58,437 --> 00:23:59,604 Langdon's fine. 654 00:23:59,688 --> 00:24:01,982 He went to rehab, he's working the steps, 655 00:24:02,065 --> 00:24:06,528 and hopefully it's all behind him. 656 00:24:06,611 --> 00:24:08,238 Place the needle in-plane, 657 00:24:08,321 --> 00:24:10,115 superficial to the serratus anterior, 658 00:24:10,198 --> 00:24:12,367 between it and the latissimus dorsi. 659 00:24:12,451 --> 00:24:13,702 Mm-hmm. 660 00:24:13,785 --> 00:24:15,871 You can see the fluid dissect and diffuse-- 661 00:24:15,954 --> 00:24:17,205 Dr. Mohan, we need you. 662 00:24:17,289 --> 00:24:18,832 We've got two more rigs from Westbridge 663 00:24:18,915 --> 00:24:21,042 pulling up right now. 664 00:24:21,126 --> 00:24:22,544 Go. We got this. 665 00:24:22,627 --> 00:24:23,545 Thanks. 666 00:24:23,628 --> 00:24:26,047 How we doing in here? 667 00:24:26,131 --> 00:24:29,676 Spiked a temp to 102, gave Tylenol. 668 00:24:29,759 --> 00:24:31,428 Check out her leg. 669 00:24:31,511 --> 00:24:33,346 That is a definite bulla. 670 00:24:33,430 --> 00:24:34,806 Did surgery come down yet? 671 00:24:34,890 --> 00:24:36,558 - Not yet. - I need surgery? 672 00:24:36,641 --> 00:24:37,642 Page them again. 673 00:24:37,726 --> 00:24:39,436 Surgery would be a last resort. 674 00:24:39,519 --> 00:24:41,771 We would like them to come down and check out your leg 675 00:24:41,855 --> 00:24:44,357 in case we need to remove this infected skin. 676 00:24:44,441 --> 00:24:45,859 I thought it was just a little swelling 677 00:24:45,942 --> 00:24:46,902 'cause I'm on my feet all day. 678 00:24:48,862 --> 00:24:50,697 BP's down to 85 over 40. 679 00:24:50,780 --> 00:24:52,365 - How much LR is in? - Full bolus. 680 00:24:52,449 --> 00:24:53,992 Do another liter and then start Levophed. 681 00:24:54,075 --> 00:24:55,494 Titrate to a MAP of 65. 682 00:24:56,870 --> 00:24:58,330 Can someone please tell me what's going on? 683 00:24:58,413 --> 00:24:59,414 Pulse ox down to 89. 684 00:24:59,498 --> 00:25:00,916 100% non-rebreather. 685 00:25:00,999 --> 00:25:03,960 Sometimes an infection can cause your blood pressure 686 00:25:04,044 --> 00:25:06,880 to drop and lower the amount of oxygen in your blood. 687 00:25:06,963 --> 00:25:08,048 Am I gonna be OK? 688 00:25:08,131 --> 00:25:09,257 We're doing everything that we can 689 00:25:09,341 --> 00:25:10,550 to make sure that you are. 690 00:25:10,634 --> 00:25:11,843 Jesse. 691 00:25:14,262 --> 00:25:15,555 What's up? 692 00:25:15,639 --> 00:25:16,890 Be ready to intubate if you need to. 693 00:25:16,973 --> 00:25:18,391 - You want me to call Langdon? - No. 694 00:25:18,475 --> 00:25:19,976 I will be right back, and you can call surgery 695 00:25:20,060 --> 00:25:21,686 and tell them to get their heads out of their asses 696 00:25:21,770 --> 00:25:23,355 and get down here. 697 00:25:31,905 --> 00:25:33,240 Did you bring Langdon back here? 698 00:25:33,323 --> 00:25:34,991 No, Al-Hashimi did. 699 00:25:35,075 --> 00:25:36,368 You banished him to scut purgatory. 700 00:25:36,451 --> 00:25:37,536 He did everything you would've done 701 00:25:37,619 --> 00:25:39,162 with that cellulitis patient. 702 00:25:39,246 --> 00:25:40,664 If you think he missed something, tell him. 703 00:25:40,747 --> 00:25:42,249 Well, we're probably gonna need to intubate. 704 00:25:42,332 --> 00:25:43,833 We're definitely gonna need an ICU bed. 705 00:25:43,917 --> 00:25:45,085 What happened? 706 00:25:45,168 --> 00:25:47,254 She is in septic shock, on pressors. 707 00:25:47,337 --> 00:25:49,089 Open shoulder dislocation is back. 708 00:25:49,172 --> 00:25:50,882 Westbridge shut down all their ORs, so they told us 709 00:25:50,966 --> 00:25:52,717 - to bring them back here. - You joking? 710 00:25:52,801 --> 00:25:53,718 This ain't the Radisson. 711 00:25:53,802 --> 00:25:54,928 Not my problem. 712 00:25:55,011 --> 00:25:56,471 - Where should we park him? - Grab a wall. 713 00:25:56,555 --> 00:25:57,889 Call Noelle. Call ortho. 714 00:25:57,973 --> 00:25:59,182 Call the OR and tell them we got a patient back 715 00:25:59,266 --> 00:26:00,725 that needs surgery and admission. 716 00:26:00,809 --> 00:26:02,727 Hey, so sorry about this ambulance tour 717 00:26:02,811 --> 00:26:04,729 of Allegheny County, Mr. Billings, 718 00:26:04,813 --> 00:26:06,356 but we got you from here, I promise. 719 00:26:06,439 --> 00:26:07,732 Yeah, I'm starving. 720 00:26:07,816 --> 00:26:09,234 Is there any way I can get something to eat? 721 00:26:09,317 --> 00:26:11,069 Sorry, not before surgery. 722 00:26:11,152 --> 00:26:12,320 Can I have a visitor? 723 00:26:12,404 --> 00:26:13,822 Sure. 724 00:26:13,905 --> 00:26:15,615 Any word from Gloria about what's going on at Westbridge? 725 00:26:15,699 --> 00:26:17,242 Radio silence from the ivory tower. 726 00:26:17,325 --> 00:26:18,910 And the charge nurse over there isn't responding. 727 00:26:18,994 --> 00:26:20,537 Must be bad. 728 00:26:20,620 --> 00:26:21,913 I wonder if it's something that security needs to know about. 729 00:26:21,997 --> 00:26:23,415 I'll keep you posted. 730 00:26:23,498 --> 00:26:25,208 Hey, you're kind of buds with Gloria. 731 00:26:25,292 --> 00:26:26,501 Did she say anything to you about what's 732 00:26:26,585 --> 00:26:28,253 - happening at Westbridge? - No. You? 733 00:26:28,336 --> 00:26:30,797 Nope. How are your patients? 734 00:26:30,880 --> 00:26:33,216 Our prisoner, Gus, has stable injuries, 735 00:26:33,300 --> 00:26:35,427 and our law student in Central 10 is awake, 736 00:26:35,510 --> 00:26:37,637 normal LP, and awaiting a psych consult. 737 00:26:37,721 --> 00:26:38,972 Good. 738 00:26:39,055 --> 00:26:40,640 Quicker we can treat 'em, street 'em, move 'em 739 00:26:40,724 --> 00:26:42,100 up the food chain, the better. 740 00:26:42,183 --> 00:26:44,185 Question. 741 00:26:44,269 --> 00:26:48,440 Why are you treating me like one of your residents? 742 00:26:48,523 --> 00:26:49,649 I'm not. 743 00:26:49,733 --> 00:26:51,443 As the attending, I like to know the status 744 00:26:51,526 --> 00:26:53,194 of all the patients and doctors in the ED 745 00:26:53,278 --> 00:26:55,488 in case I need to jump in quickly. 746 00:26:55,572 --> 00:26:56,489 Makes sense. 747 00:26:56,573 --> 00:26:58,908 Now your turn. 748 00:26:58,992 --> 00:27:00,243 What? 749 00:27:00,327 --> 00:27:02,370 As your fellow attending in our ED, 750 00:27:02,454 --> 00:27:04,164 it only makes sense for me to know the status 751 00:27:04,247 --> 00:27:06,249 of all the patients and all the doctors 752 00:27:06,333 --> 00:27:09,794 in case I need to jump in on a moment's notice. 753 00:27:09,878 --> 00:27:11,338 Touché. 754 00:27:14,049 --> 00:27:16,593 You have a non-displaced fracture, distal tibia. 755 00:27:16,676 --> 00:27:18,762 So if you look at the bone here, it's pretty well aligned. 756 00:27:18,845 --> 00:27:20,138 Sorry. Hi. 757 00:27:20,221 --> 00:27:22,515 Hi, I was in the shower, and I came as soon 758 00:27:22,599 --> 00:27:23,642 as I got Paul's message. 759 00:27:23,725 --> 00:27:25,268 - Lena? - Hi. 760 00:27:25,352 --> 00:27:27,145 What happened? 761 00:27:27,228 --> 00:27:28,605 I had a seizure. 762 00:27:28,688 --> 00:27:30,231 You load her with Keppra? 763 00:27:30,315 --> 00:27:31,608 Yeah. 764 00:27:31,691 --> 00:27:33,610 Yeah, she's back to baseline mental status. 765 00:27:33,693 --> 00:27:35,862 I'm sorry, I'm confused. Aren't you off duty? 766 00:27:35,945 --> 00:27:39,032 - I'm Roxie's death doula. - Oh. 767 00:27:39,115 --> 00:27:40,742 Her--her what? 768 00:27:40,825 --> 00:27:42,744 I help advocate for people like Roxie 769 00:27:42,827 --> 00:27:45,747 to make their transition to death a more peaceful process. 770 00:27:45,830 --> 00:27:48,750 It's like a birth doula but for the end of life. 771 00:27:48,833 --> 00:27:52,379 She's been a real lifesaver for our family. 772 00:27:52,462 --> 00:27:55,215 My husband cracking jokes while I'm dying. 773 00:27:55,298 --> 00:27:56,966 See why I married him? 774 00:27:57,050 --> 00:27:58,802 Whatever you have to say about my condition, 775 00:27:58,885 --> 00:28:00,720 you can share with Lena too. 776 00:28:00,804 --> 00:28:02,681 We were just explaining that Roxie 777 00:28:02,764 --> 00:28:05,850 has a pathological fracture through a metastatic lesion. 778 00:28:05,934 --> 00:28:07,394 Can you fix that? 779 00:28:07,477 --> 00:28:10,230 The bones are well aligned, so she won't need surgery. 780 00:28:10,313 --> 00:28:11,690 The treatment is immobilization 781 00:28:11,773 --> 00:28:12,857 and a long leg boot. 782 00:28:12,941 --> 00:28:14,609 Oh! 783 00:28:14,693 --> 00:28:16,152 Maybe we up her pain meds. 784 00:28:16,236 --> 00:28:17,696 Yeah, sure. 785 00:28:17,779 --> 00:28:19,072 We can do that. 786 00:28:19,155 --> 00:28:21,366 The bones should heal in about six weeks. 787 00:28:21,449 --> 00:28:23,993 If I live that long. 788 00:28:25,912 --> 00:28:26,871 Still numb here? 789 00:28:26,955 --> 00:28:28,456 Yeah, bro. 790 00:28:28,540 --> 00:28:30,792 Great. 791 00:28:30,875 --> 00:28:32,669 You think it's gonna leave a scar? 792 00:28:32,752 --> 00:28:36,715 I don't think it. I know it. 793 00:28:36,798 --> 00:28:38,508 Holy shit. 794 00:28:38,591 --> 00:28:40,051 Fuck are you doing here? 795 00:28:40,135 --> 00:28:41,052 I'm sorry, who are you? 796 00:28:41,136 --> 00:28:42,178 Concerned brother. 797 00:28:42,262 --> 00:28:44,681 That looks not too bad. 798 00:28:44,764 --> 00:28:46,057 You gooning me? 799 00:28:46,141 --> 00:28:47,684 Yeah, it's nasty. 800 00:28:47,767 --> 00:28:49,102 Thanks to you. 801 00:28:49,185 --> 00:28:50,228 You did this? 802 00:28:50,311 --> 00:28:51,688 Oh, yeah. You wanna see the video? 803 00:28:53,898 --> 00:28:55,775 - Yes. - Definitely. 804 00:28:55,859 --> 00:28:57,235 Got you. 805 00:28:58,528 --> 00:29:00,905 All right. All right, get in close. 806 00:29:00,989 --> 00:29:02,574 Brothers unite! 807 00:29:02,657 --> 00:29:04,284 - Ooh! - Ooh! 808 00:29:04,367 --> 00:29:06,119 Dude, why in the world 809 00:29:06,202 --> 00:29:07,746 would you ask to have that done to you? 810 00:29:07,829 --> 00:29:11,416 He was trying to brand me with our family crest. 811 00:29:13,793 --> 00:29:15,920 Your family crest is the Penguins logo? 812 00:29:16,004 --> 00:29:17,714 We were gonna be bonded for life. 813 00:29:17,797 --> 00:29:19,549 You already are, with DNA. 814 00:29:19,632 --> 00:29:20,717 Yeah. 815 00:29:20,800 --> 00:29:22,260 I love you, man. 816 00:29:22,343 --> 00:29:24,095 - I'm real sorry. - It's OK. 817 00:29:24,179 --> 00:29:27,766 Doc said it's gonna take some time, but it'll heal OK. 818 00:29:27,849 --> 00:29:29,309 Awesome. 819 00:29:29,392 --> 00:29:31,102 So maybe we can try again in a couple of months or-- 820 00:29:31,186 --> 00:29:32,604 No. 821 00:29:34,063 --> 00:29:35,732 OK, bag her. 822 00:29:37,776 --> 00:29:39,152 Yellow on the end-tidal. 823 00:29:39,235 --> 00:29:40,904 - Sorry, got backed up. - Sounds a little wet. 824 00:29:40,987 --> 00:29:42,030 Someone asked for a surgical consult? 825 00:29:42,113 --> 00:29:43,281 That's because all the fluid. 826 00:29:43,364 --> 00:29:44,699 TKO the lines for now. 827 00:29:44,783 --> 00:29:47,035 Vent settings 50%, tidal volume 500, AC 12? 828 00:29:47,118 --> 00:29:48,411 Yep, that's perfect. 829 00:29:48,495 --> 00:29:49,746 Surgery here. Hello. 830 00:29:49,829 --> 00:29:51,331 Hey, it's about time. Where's Garcia? 831 00:29:51,414 --> 00:29:53,166 Stuck in the ER. She sent me down. What you got? 832 00:29:53,249 --> 00:29:54,626 Septic shock, respiratory failure, 833 00:29:54,709 --> 00:29:56,294 and possible necrotizing fasciitis. 834 00:29:56,377 --> 00:29:58,046 She needs to go to the OR ASAP. 835 00:29:58,129 --> 00:30:00,298 The infection was isolated to the dorsum of the foot 836 00:30:00,381 --> 00:30:01,925 five hours ago, but now we're almost to the knee 837 00:30:02,008 --> 00:30:03,593 with bullae, crepitus, and edema. 838 00:30:03,676 --> 00:30:05,261 - Yeah. - You seen nec fasc before? 839 00:30:05,345 --> 00:30:06,471 In a textbook. 840 00:30:06,554 --> 00:30:08,681 I was a med student two weeks ago. 841 00:30:10,558 --> 00:30:13,061 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 842 00:30:13,144 --> 00:30:14,729 Go get anybody else from your service down here-- 843 00:30:14,813 --> 00:30:16,022 Shamsi, Miller, Walsh-- 844 00:30:16,105 --> 00:30:17,148 I don't know any of this people, but-- 845 00:30:17,232 --> 00:30:18,525 Don't take this personally. 846 00:30:18,608 --> 00:30:21,569 I just need a fucking grown-up down here. 847 00:30:21,653 --> 00:30:23,530 Nice job on the sub-Qs. 848 00:30:23,613 --> 00:30:25,281 Really took the tension off the wound. 849 00:30:25,365 --> 00:30:26,366 Thanks. 850 00:30:26,449 --> 00:30:28,034 I can help with the skin layer. 851 00:30:28,117 --> 00:30:30,078 Four hands are faster than two. 852 00:30:32,539 --> 00:30:33,873 - Whoa. - Whoa. 853 00:30:33,957 --> 00:30:36,209 That just tore right through the skin. 854 00:30:36,292 --> 00:30:37,544 You may need to take bigger bites 855 00:30:37,627 --> 00:30:39,254 farther away from the wound edges. 856 00:30:39,337 --> 00:30:41,589 Yep. 857 00:30:41,673 --> 00:30:44,968 Skin seems pretty fragile. 858 00:30:49,097 --> 00:30:50,473 Oh. 859 00:30:50,557 --> 00:30:52,141 Yeah, this is not working. 860 00:30:52,225 --> 00:30:54,102 He has the skin strength of an 80-year-old. 861 00:30:54,185 --> 00:30:56,271 Put down Steri-Strips with benzoin, 862 00:30:56,354 --> 00:30:59,566 not across the wound but along each wound edge, both sides. 863 00:30:59,649 --> 00:31:01,109 It'll hold the sutures. 864 00:31:01,192 --> 00:31:04,571 - Yup. - What say you, Dr. Robby? 865 00:31:04,654 --> 00:31:06,531 Great. MacGyver move. 866 00:31:06,614 --> 00:31:09,450 Go for it. 867 00:31:09,534 --> 00:31:13,204 Does a Dr. MacGyver work here? 868 00:31:13,288 --> 00:31:15,707 I don't know. 869 00:31:15,790 --> 00:31:17,667 The patient symptoms are consistent with lumbar 870 00:31:17,750 --> 00:31:21,629 radiculopathy at L4, L5, most likely due to disc herniation. 871 00:31:21,713 --> 00:31:23,131 Coughing patient admitted to isolation 872 00:31:23,214 --> 00:31:25,091 for verified medication administration 873 00:31:25,174 --> 00:31:26,467 and started on RIPE therapy. 874 00:31:26,551 --> 00:31:28,011 Yeah, why do I even bother? 875 00:31:28,094 --> 00:31:29,053 Just fail me now. 876 00:31:29,137 --> 00:31:30,221 OK. 877 00:31:30,305 --> 00:31:31,723 Get in touch with a social worker. 878 00:31:31,806 --> 00:31:33,224 They're gonna wanna do contact tracing 879 00:31:33,308 --> 00:31:35,059 and help her figure out transitional housing 880 00:31:35,143 --> 00:31:36,436 for when she's discharged. 881 00:31:36,519 --> 00:31:37,770 Got it. 882 00:31:37,854 --> 00:31:39,731 And make sure infection control responded. 883 00:31:39,814 --> 00:31:41,190 The people in the waiting room could have been exposed. 884 00:31:41,274 --> 00:31:44,527 They need to be notified and tested. 885 00:31:44,611 --> 00:31:45,778 OK. 886 00:31:45,862 --> 00:31:48,698 Relax. 887 00:31:48,781 --> 00:31:50,950 You can take the mask off. You don't have TB. 888 00:31:51,034 --> 00:31:54,078 At least not yet. 889 00:31:54,162 --> 00:31:56,664 Oh, great. 890 00:31:56,748 --> 00:31:59,584 This is fucked up. 891 00:31:59,667 --> 00:32:01,878 How are you so calm? 892 00:32:01,961 --> 00:32:03,546 Expected job hazard. 893 00:32:03,630 --> 00:32:04,797 You get used to it. 894 00:32:04,881 --> 00:32:06,382 Yeah, no, thanks. 895 00:32:06,466 --> 00:32:08,968 70% of doctors in training at urban hospitals 896 00:32:09,052 --> 00:32:11,304 get exposed to TB and wind up on meds. 897 00:32:11,387 --> 00:32:13,640 - Jesus. - Mm-hmm. 898 00:32:13,723 --> 00:32:16,017 They don't teach you that in med school. 899 00:32:16,100 --> 00:32:18,186 Mrs. Randolph's back. 900 00:32:18,269 --> 00:32:20,063 Pulled up her X-ray. 901 00:32:20,146 --> 00:32:21,230 OK. 902 00:32:21,314 --> 00:32:23,358 No volvulus, no air fluid levels. 903 00:32:23,441 --> 00:32:25,944 What do you think of this? 904 00:32:26,027 --> 00:32:28,029 Fecal material? 905 00:32:28,112 --> 00:32:29,739 A shit ton. 906 00:32:29,822 --> 00:32:31,366 Sorry, had to be said. 907 00:32:31,449 --> 00:32:32,951 So, what, she needs an enema? 908 00:32:33,034 --> 00:32:34,535 No. Tried and failed, remember? 909 00:32:34,619 --> 00:32:35,536 Yeah. 910 00:32:35,620 --> 00:32:37,205 Time to dig in. 911 00:32:37,288 --> 00:32:38,831 How are we gonna do that? 912 00:32:38,915 --> 00:32:42,835 Oh, there is no "we" in disimpaction. 913 00:32:47,799 --> 00:32:49,968 I haven't done one before. 914 00:32:50,051 --> 00:32:52,929 Shouldn't I observe first? 915 00:32:53,012 --> 00:32:55,556 I know just the guy to teach you. 916 00:33:04,816 --> 00:33:07,568 I spoke to the charge nurse in med-surg. 917 00:33:07,652 --> 00:33:08,861 They can take Orlando today. 918 00:33:08,945 --> 00:33:10,655 - Yes! - That's wonderful. 919 00:33:10,738 --> 00:33:12,240 They know he's on an insulin drip? 920 00:33:12,323 --> 00:33:14,784 They know, and they can change to a SQUID protocol. 921 00:33:14,867 --> 00:33:15,785 SQUID? 922 00:33:15,868 --> 00:33:17,537 Sub-Q insulin in DKA. 923 00:33:17,620 --> 00:33:19,247 So no IV drip? 924 00:33:19,330 --> 00:33:22,041 Just shots of short-acting insulin every four hours prn. 925 00:33:22,125 --> 00:33:25,461 The med-surg nurses have time to check a glucose every hour? 926 00:33:25,545 --> 00:33:26,462 They say so. 927 00:33:26,546 --> 00:33:28,506 And five days on med-surge 928 00:33:28,589 --> 00:33:32,260 is gonna cut your hospital bill down by 2/3. 929 00:33:32,343 --> 00:33:34,137 OK. 930 00:33:34,220 --> 00:33:36,014 So what's that gonna cost? 931 00:33:36,097 --> 00:33:37,432 Well, I can't give you an exact amount, 932 00:33:37,515 --> 00:33:39,517 but roughly $35,000. 933 00:33:39,600 --> 00:33:42,645 So after about 40%, I'll still have to pay, 934 00:33:42,729 --> 00:33:44,480 what, like, 20 grand? 935 00:33:44,564 --> 00:33:46,733 The hospital can work out a payment plan. 936 00:33:46,816 --> 00:33:48,443 Orlando, we'll be OK. 937 00:33:48,526 --> 00:33:49,986 We'll figure it out. 938 00:33:50,069 --> 00:33:52,447 I'll take on extra shifts at the coffee shop. 939 00:33:52,530 --> 00:33:55,450 We got you, Dad. 940 00:33:55,533 --> 00:33:58,661 Let's give you some private time with your family. 941 00:33:58,745 --> 00:34:01,164 Thanks. 942 00:34:01,247 --> 00:34:02,790 Sorry. Thank you. 943 00:34:02,874 --> 00:34:04,375 I was worried he might bail. 944 00:34:04,459 --> 00:34:05,626 My pleasure. 945 00:34:05,710 --> 00:34:07,336 The real thanks goes to the newbie here 946 00:34:07,420 --> 00:34:09,088 for thinking outside the box. 947 00:34:11,841 --> 00:34:13,676 Sorry I doubted your med-surg pitch. 948 00:34:13,760 --> 00:34:15,261 Oh, no sweat. 949 00:34:15,344 --> 00:34:17,472 How'd you think of that? 950 00:34:17,554 --> 00:34:20,141 My family had to think of a lot of creative ways 951 00:34:20,224 --> 00:34:23,186 to help my uninsured grandma. 952 00:34:23,268 --> 00:34:24,728 Leukemia. 953 00:34:24,812 --> 00:34:28,065 System doesn't work for you, you gotta work the system. 954 00:34:28,149 --> 00:34:30,318 She survive? 955 00:34:30,400 --> 00:34:32,527 For a while, till she didn't. 956 00:34:32,612 --> 00:34:34,989 She died before my freshman year in college. 957 00:34:35,072 --> 00:34:37,324 Sorry. 958 00:34:37,408 --> 00:34:39,494 Her death taught me a lot. 959 00:34:39,577 --> 00:34:42,455 Mainly that I don't wanna be around people dying. 960 00:34:44,331 --> 00:34:46,918 So they got her, and we can get out of here soon? 961 00:34:47,001 --> 00:34:48,377 Yeah. Oh, I think so. 962 00:34:48,460 --> 00:34:49,795 - I think so, yeah. - OK. 963 00:34:49,879 --> 00:34:53,049 Hi. 964 00:34:53,132 --> 00:34:55,635 Morphine PCA looks ready to go. 965 00:34:55,717 --> 00:34:57,637 This should do the trick. 966 00:34:57,720 --> 00:34:59,055 Do you notice a difference? 967 00:34:59,138 --> 00:35:00,056 Better. 968 00:35:00,139 --> 00:35:02,558 Oh, great. Great. 969 00:35:02,642 --> 00:35:04,310 How does this thing work? 970 00:35:04,393 --> 00:35:06,729 There's a baseline rate of morphine. 971 00:35:06,813 --> 00:35:08,773 And if you're having pain, you can push this button. 972 00:35:08,856 --> 00:35:09,774 You'll get some extra. 973 00:35:09,857 --> 00:35:11,109 And you can push for another dose 974 00:35:11,192 --> 00:35:12,568 every 10 minutes if needed. 975 00:35:12,652 --> 00:35:14,821 Your very own morphine butler. 976 00:35:17,406 --> 00:35:18,491 Amazing. 977 00:35:18,574 --> 00:35:20,034 She can go home with this? 978 00:35:20,118 --> 00:35:21,577 Yeah. 979 00:35:21,661 --> 00:35:23,704 Though you'll need more equipment for the house 980 00:35:23,788 --> 00:35:25,915 now that she can't bear weight on her leg. 981 00:35:25,998 --> 00:35:27,834 OK. Like what? 982 00:35:27,917 --> 00:35:32,004 A wheelchair to go to the bathroom, a shower chair, 983 00:35:32,088 --> 00:35:34,215 wall bars, if you don't already have them. 984 00:35:34,298 --> 00:35:37,343 And a hospital bed could be helpful too. 985 00:35:37,426 --> 00:35:38,678 How do we get all that? 986 00:35:38,761 --> 00:35:40,555 You don't. I do. 987 00:35:40,638 --> 00:35:42,431 I will get everything so that the two of you 988 00:35:42,515 --> 00:35:44,642 can get out of here and back to the kids. 989 00:35:44,725 --> 00:35:46,811 - At home. - Thank you. 990 00:35:53,901 --> 00:35:55,778 Nice of you to join us, Huckleberry. 991 00:35:55,862 --> 00:35:57,071 What do you need? 992 00:35:57,155 --> 00:35:58,906 Some help with a disimpaction. 993 00:36:00,783 --> 00:36:02,743 That is a med student procedure. 994 00:36:02,827 --> 00:36:04,162 Oh, you know the old adage-- 995 00:36:04,245 --> 00:36:06,414 see one, do one, teach one. 996 00:36:06,497 --> 00:36:08,666 Say hello to teaching young Ogilvie here. 997 00:36:08,749 --> 00:36:11,335 -OK. 998 00:36:11,419 --> 00:36:13,462 - Double glove, Ogilvie. - All right. 999 00:36:13,546 --> 00:36:14,964 Mrs. Randolph, we're going to need 1000 00:36:15,047 --> 00:36:17,592 to manually unblock your rectum so that we can 1001 00:36:17,675 --> 00:36:19,093 get your bowels moving again. 1002 00:36:19,177 --> 00:36:20,094 I know. 1003 00:36:20,178 --> 00:36:22,847 Here we go. 1004 00:36:22,930 --> 00:36:25,975 Mrs. Randolph, I would like you to relax 1005 00:36:26,058 --> 00:36:28,895 like you're having a bowel movement. 1006 00:36:28,978 --> 00:36:31,480 Nice and deep. 1007 00:36:31,564 --> 00:36:33,774 OK. 1008 00:36:33,858 --> 00:36:37,987 Curve the finger like an ice cream scoop. 1009 00:36:38,070 --> 00:36:42,617 And bring it out. 1010 00:36:42,700 --> 00:36:44,452 You're up, Ogilvie. 1011 00:36:48,748 --> 00:36:50,875 Some more pressure, Mrs. Randolph. 1012 00:36:50,958 --> 00:36:52,418 I'm ready. 1013 00:36:59,175 --> 00:37:03,221 And here I thought you weren't a quick study. 1014 00:37:03,304 --> 00:37:05,139 Keep going. 1015 00:37:05,223 --> 00:37:07,350 Mrs. Randolph, in order to prevent this 1016 00:37:07,433 --> 00:37:08,768 from happening again, I think you 1017 00:37:08,851 --> 00:37:10,353 need a better stool softener. 1018 00:37:10,436 --> 00:37:11,896 You can try MiraLAX. 1019 00:37:11,979 --> 00:37:14,440 Just a tablespoon with a big glass of water every morning 1020 00:37:14,523 --> 00:37:15,441 should do the trick. 1021 00:37:15,524 --> 00:37:16,651 OK. 1022 00:37:18,945 --> 00:37:19,862 Oh. 1023 00:37:19,946 --> 00:37:21,447 Sorry. 1024 00:37:21,530 --> 00:37:22,615 Passing gas is good. 1025 00:37:22,698 --> 00:37:24,325 Means we're making progress. 1026 00:37:24,408 --> 00:37:26,035 Does that mean that I can-- I can stop? 1027 00:37:26,118 --> 00:37:27,870 No. Nope. Keep going. 1028 00:37:32,917 --> 00:37:36,087 OK, Ogilvie, you-- you might wanna-- 1029 00:37:36,170 --> 00:37:37,880 Oh! 1030 00:37:41,759 --> 00:37:43,261 Much better. 1031 00:37:44,303 --> 00:37:46,222 MAP's holding on Levophed. 1032 00:37:46,305 --> 00:37:48,182 1 mike per kg per minute. 1033 00:37:48,266 --> 00:37:49,392 Do me a favor. 1034 00:37:49,475 --> 00:37:50,601 Give me some 4x4s on some Betadine. 1035 00:37:50,685 --> 00:37:51,894 Sorry, we're getting killed 1036 00:37:51,978 --> 00:37:53,312 with transfers from Westbridge. 1037 00:37:53,396 --> 00:37:55,481 Mesenteric ischemia, perforated bowel. 1038 00:37:55,564 --> 00:37:56,482 Got a hot one here. 1039 00:37:56,565 --> 00:37:57,483 Yeah. 1040 00:37:57,566 --> 00:37:58,609 Possible nec fasc. 1041 00:37:58,693 --> 00:37:59,986 Possible? 1042 00:38:00,069 --> 00:38:01,362 Need CT with contrast to confirm. 1043 00:38:01,445 --> 00:38:03,072 This is spreading like wildfire. 1044 00:38:03,155 --> 00:38:04,448 By the time you get your CT, it's gonna be up to her waist. 1045 00:38:04,532 --> 00:38:05,533 She's gonna need a hemicorporectomy. 1046 00:38:05,616 --> 00:38:06,867 She needs a CT scan. 1047 00:38:06,951 --> 00:38:09,537 How about a stainless steel scan? 1048 00:38:09,620 --> 00:38:11,747 For Christ's sake. Robinavitch! 1049 00:38:11,831 --> 00:38:15,209 Robby, what the fuck are you doing? 1050 00:38:15,293 --> 00:38:16,919 Oh, God, I think I might puke. 1051 00:38:17,003 --> 00:38:19,380 That's called dirty dishwater exudate without purulence. 1052 00:38:19,463 --> 00:38:21,590 There's a gray appearance to the fascia, and in the OR, 1053 00:38:21,674 --> 00:38:23,801 you'll see easy separation in the tissue planes. 1054 00:38:23,884 --> 00:38:25,136 When do you start your sabbatical? 1055 00:38:25,219 --> 00:38:26,887 - Tomorrow. - Not a moment too soon. 1056 00:38:26,971 --> 00:38:28,889 Thanks for coming down. 1057 00:38:32,101 --> 00:38:35,604 I'm catching up on my charting as fast as I can. 1058 00:38:35,688 --> 00:38:38,482 Why don't you give my generative AI app a try? 1059 00:38:38,566 --> 00:38:40,985 It's 30% more efficient, and providers report 1060 00:38:41,068 --> 00:38:42,862 increased job satisfaction. 1061 00:38:42,945 --> 00:38:45,865 And you'll rarely have to stay overtime to complete charts. 1062 00:38:45,948 --> 00:38:47,616 Yeah? 1063 00:38:47,700 --> 00:38:48,909 OK. 1064 00:38:48,993 --> 00:38:50,494 Yeah, I'm usually here at least a couple hours 1065 00:38:50,578 --> 00:38:52,371 after every shift trying to catch up, so... 1066 00:38:52,455 --> 00:38:54,790 Sure, AI will make doctors more efficient, 1067 00:38:54,874 --> 00:38:57,084 but hospitals will expect us to treat more patients 1068 00:38:57,168 --> 00:38:59,086 without any extra pay, of course, 1069 00:38:59,170 --> 00:39:00,880 all the while eliminating staff positions 1070 00:39:00,963 --> 00:39:02,590 for attending and residents. 1071 00:39:02,673 --> 00:39:04,175 Oh, Dr. Robby, I am not an advocate 1072 00:39:04,258 --> 00:39:06,302 for erasing my own profession. 1073 00:39:06,385 --> 00:39:09,805 But I am advocating for getting to spend more time with my son. 1074 00:39:09,889 --> 00:39:12,767 Nothing can replace family. 1075 00:39:12,850 --> 00:39:14,769 What's the status of your septic patient? 1076 00:39:14,852 --> 00:39:17,563 Nec fasc. Surgery's taking her up. 1077 00:39:17,646 --> 00:39:20,107 Think they'll be able to save her leg? 1078 00:39:20,191 --> 00:39:22,068 Right now, I'm just hoping they can save her life. 1079 00:39:22,151 --> 00:39:24,653 Hey, how's Ogilvie doing? 1080 00:39:24,737 --> 00:39:28,491 A little TB exposure, a touch of ass-plosion. 1081 00:39:28,574 --> 00:39:30,618 All in all, pretty good day so far. 1082 00:39:30,701 --> 00:39:31,911 Kaison, you came. 1083 00:39:31,994 --> 00:39:33,454 Hey, ain't no way I was gonna let you 1084 00:39:33,537 --> 00:39:35,373 miss Peter and Aubrey's epic Fourth of July party. 1085 00:39:35,456 --> 00:39:37,583 Come on, now. Hey. 1086 00:39:37,666 --> 00:39:39,251 Brought some brew. 1087 00:39:39,335 --> 00:39:40,628 Oh, you are the man. 1088 00:39:40,711 --> 00:39:42,088 Appreciate the bromance over here, 1089 00:39:42,171 --> 00:39:44,423 but no food 'cause you might go into surgery. 1090 00:39:44,507 --> 00:39:47,093 And no beer 'cause we're a goddamn hospital. 1091 00:39:50,721 --> 00:39:52,848 Starting your sabbatical early? 1092 00:39:52,932 --> 00:39:54,683 I know someone who could really use a drink right now. 1093 00:39:54,767 --> 00:39:55,976 In the hospital? 1094 00:39:56,060 --> 00:39:58,479 As a parting gift. 1095 00:40:02,525 --> 00:40:04,068 How's it looking? 1096 00:40:04,151 --> 00:40:05,319 Good. 1097 00:40:05,403 --> 00:40:07,279 The Steri-Strips did the trick. 1098 00:40:07,363 --> 00:40:08,406 CT's ready. 1099 00:40:08,489 --> 00:40:10,032 We already scanned him. 1100 00:40:10,116 --> 00:40:12,410 Head and neck want thin cuts and a 3D reconstruction 1101 00:40:12,493 --> 00:40:14,412 of the mandible before they decide 1102 00:40:14,495 --> 00:40:15,871 if Mr. Varney needs surgery. 1103 00:40:15,955 --> 00:40:17,790 Have they even come down to examine him in person? 1104 00:40:17,873 --> 00:40:19,375 No, they must be backed up. 1105 00:40:19,458 --> 00:40:23,170 Or there's a July Fourth sale at the BMW dealership. 1106 00:40:23,254 --> 00:40:24,463 Labs are back. 1107 00:40:24,547 --> 00:40:26,298 Albumin's low. Total protein's low. 1108 00:40:26,382 --> 00:40:27,883 He also has megaloblastic anemia. 1109 00:40:27,967 --> 00:40:29,135 - Malnutrition. - Probably. 1110 00:40:29,218 --> 00:40:30,302 Jail cuisine. 1111 00:40:30,386 --> 00:40:31,679 Whitaker, what labs should we add? 1112 00:40:31,762 --> 00:40:33,806 B12, folate, iron levels. 1113 00:40:33,889 --> 00:40:35,307 Good. 1114 00:40:35,391 --> 00:40:36,934 We're gonna run some more tests, Mr. Varney. 1115 00:40:37,017 --> 00:40:38,352 Hang in there. 1116 00:40:42,982 --> 00:40:45,401 I have to pee. 1117 00:40:45,484 --> 00:40:46,861 There's no PureWick here. 1118 00:40:46,944 --> 00:40:48,112 But here you go, hon. 1119 00:40:48,195 --> 00:40:50,072 - I'll help you get on. - No. No. 1120 00:40:50,156 --> 00:40:52,491 No bedpan. I can walk to the bathroom. 1121 00:40:52,575 --> 00:40:54,160 - I just need a little help. - Are you sure? 1122 00:40:54,243 --> 00:40:55,244 I'm here, babe. 1123 00:40:55,327 --> 00:40:56,745 Oh, we got this Mr. Hamler. 1124 00:40:56,829 --> 00:40:59,999 You'll have to bring your IV and portable oxygen. 1125 00:41:00,082 --> 00:41:02,001 Please? 1126 00:41:02,084 --> 00:41:04,420 I'll grab a wheelchair. 1127 00:41:04,503 --> 00:41:06,380 Let's try to sit you up and dangle your legs. 1128 00:41:06,464 --> 00:41:07,923 OK. 1129 00:41:10,634 --> 00:41:13,971 1, 2, 3. 1130 00:41:19,685 --> 00:41:21,312 This is not a good idea. 1131 00:41:21,395 --> 00:41:23,439 I don't think we're gonna need this. 1132 00:41:23,522 --> 00:41:25,065 Hey, Paul, Paul, 1133 00:41:25,149 --> 00:41:27,234 why don't you come grab a cup of coffee with me? 1134 00:41:27,318 --> 00:41:29,195 I'm still zonked from my all-nighter, 1135 00:41:29,278 --> 00:41:32,865 and I wanna go over some delivery instructions with you. 1136 00:41:32,948 --> 00:41:35,534 Sure. 1137 00:41:35,618 --> 00:41:37,411 Rox, you OK? 1138 00:41:37,495 --> 00:41:40,331 - Mm-hmm. - Yeah. It's OK. 1139 00:41:47,046 --> 00:41:49,006 Bedpan it is. 1140 00:41:57,014 --> 00:41:58,807 You lose your pulse ox again, bud? 1141 00:42:04,438 --> 00:42:05,773 Louie. 1142 00:42:05,856 --> 00:42:07,650 Louie! 1143 00:42:07,733 --> 00:42:10,236 He kept pulling off his pulse ox. 1144 00:42:10,319 --> 00:42:11,654 It's on. It's at 71. 1145 00:42:11,737 --> 00:42:13,155 Louie, wake up. 1146 00:42:14,782 --> 00:42:16,492 - I'm not getting a carotid. - I got the airway. 1147 00:42:16,575 --> 00:42:19,662 Hey, Perlah, crash cart, intubation tray, please.