Original subtitles

I'm in.

Bag him.

B -fib pads.

We're in place.

Okay. Holding compressions. Good square line on the inside with the O2.

B -fib. Charge at 200.

Charged.

Clear.

Stand by with that B.

Touching that tube.

I'm not in the esophagus, are you? Definitely not. I pass right through the

cords. Good breath sounds.

Entitled CO2 confirmed.

Too long for filling up with water. I know.

Okay, rhythm check.

Hey, Cicely, push the epi.

Patients with lunch trays have been admitted. They're boarded. They're

for a bed to open upstairs.

What about the other? Non -admitted patients. They can have sandwiches or

boxes. Just make sure they're not NPO.

It's nil per os. It's Latin for nothing by mouth. NPO's are waiting for surgery.

They'll beg, spit, and curse for food, but you gotta stay strong.

Hey, I've been waiting for an hour. When am I gonna see a fucking doctor? Excuse

me!

Perhaps you didn't see this, which is strange, because they're all over the

place. Aggressive behavior toward healthcare workers is a felony.

$2 ,000 fine, possible jail time. Got it?

Okay.

I was just asking.

We're busy today.

It's a holiday weekend. We see the sickest patient first. They'll be happy

still waiting.

Jack off.

PTMC charge nurse.

Go ahead, medic command.

Okay.

Got it.

Incoming trauma.

Come on.

Three minutes.

Hold compressions.

Eight, seven, three.

Uh, resumes TPR. Another amp of epi. He's no victim.

Pulmonary hemorrhage from liver failure.

Is he going to make it?

Should we give you a PC?

Too late for that.

And he's not an ECMO candidate.

Nothing else we can do.

I think we're done.

Lily.

1207.

Should we do a debrief?

We've got another motorcycle injury coming in, ETA 10 minutes. We'll get it

cleaned up.

Into the VR app.

Yeah, anybody that wants to pay their respects can join us in there.

Thank you, everyone.

I'll clean them up.

Why don't you take five first?

What's that?

This is Dr. Jefferson from psychiatry.

Why do I need to see a psychiatrist?

Jada, why do I need to see a psychiatrist?

Oh, it's going to be okay, Jackson.

Dr. Jefferson says he can help.

Do you know how you got here?

The medics brought me.

I don't really remember.

I was in the library.

What were you doing there?

I was studying.

I was trying to study.

But then they wouldn't stop talking.

Who wouldn't stop talking?

They don't want me to pass the bar.

Who doesn't want you to pass the bar? That's what they told me.

Hey, hey, hey, look at me. Look at me. Who doesn't want you to pass the bar?

Let's give them some privacy. Dr. Jefferson will let us know when he's

I'm going to pass.

I'll be right outside.

Okay, I'll be right outside, Jackson.

Why don't they want you to pass the bar, Jackson?

You're afraid of me becoming a lawyer?

Are they afraid of you becoming a lawyer?

He must have been studying with his law school friends.

They should know what's happened. I'm going to call them.

If you need anything, let me know.

Okay. Thank you.

Louie.

What?

Pulmonary hemorrhage.

That's quick.

I'm going to go clean him up.

I'll help.

Go, go. Okay, now.

Everything okay, Roxy?

I can't get off the bedpan.

That's what I'm here for.

Your husband seems like a saint.

How long have you been married?

Too long.

Almost 20 years.

You put your arm around me. Now put the bedpan on three.

One, two, three.

One more.

Great.

20. Wow.

Yeah.

Been by my side through all of this.

What does the light go out of them?

So have the kids.

That's what happened to my auntie when my uncle Gerald got sick.

But your husband does it because he loves you.

I don't know how you two care for people day after day.

I'll tell you my secret.

I go home at the end of every shift.

Leave this all behind and escape to Love Island.

How's it going in here?

The high -demand dose of morphine helped a little, but she's still in pain.

Okay. I got your order.

0 .1 per kilo. Thanks.

This is a very low sub -dissociative dose of ketamine.

You might feel a little weird, but I think it's going to help with the pain.

Is my husband still in the cafeteria?

I think so.

Want me to get him?

No, no.

It's good for us to have a little time apart.

I'll get you another blanket.

Here. I'm headed that way. Thank you.

Back in for good?

Officially out of triage. They need extra hands with all the Westbridge

hullabaloo.

How many cups have you had today? Don't judge me. Just ask. You're judging.

Did you hear about Louie?

No.

Pulmonary hemorrhage. Didn't make it.

Shit.

He's been here a hundred times. I know.

Debrief in the viewing room later.

On a happier note, Pearlie and I are planning a birthday party for Javadi.

She's turning 21.

You two are as big as thieves.

I don't have much of a social life these days.

But I'll be sure to keep an eye out for part of it. Let's discuss our

incarcerated patient gut.

Prison infirmaries tend to be short -stabbed, so we need to be thorough.

What's in a differential diagnosis for malnutrition?

Inadequate intake, methamphetamine use, severe alcoholism, ADHD medication.

What else? Cancer of the oropharynx, esophageal strictures, prior strokes,

malabsorption, inflammatory bowel disease, none of which were in its

record.

What about psychosocial causes?

Could be an intentional hunger strike.

Or refusing food to get to the infirmary. Could also be abuse or

Let's start with the nutrition history once he's back from CT.

Do you have a second to talk about Westbridge? Mm -hmm. Hey, we need to

moving some patients out of here. These walls are starting to fill up with

gurneys. Santas, Ogilvy, and King all have patients on the launching pad. I'll

check in with them. How many patients have we had re -reader from Westbridge?

Ten. God knows how many more in the waiting room.

Ambulance will be here in a few minutes with the accident victim unless they

came in trauma, too.

What is the story with your incarcerated patient?

Gus Varney, three rib fractures with normal O2 subs currently, waiting on CT

results. Okay, if he's stable at the two -hour mark, I'd say he's good to go.

Let's get the ball rolling on discharge. Let's wait on the CT results.

We can move him out of trauma one at least.

Yes, we can. What's open?

13 and 14 will be discharged soon. 15, once we can move Lou to the viewing room

and get it cleaned up. Our paracentesis patient, Mr.

Cloverfield? He's a barist. We'll do a debrief when we know how many patients

we're getting from Westbridge.

So Gus goes to 13, 14, or 15.

I kind of want to keep him in plain sight. What about BH2?

So, why not give him some privacy?

Everyone can see him in BH2, like he's a monkey at the zoo.

Because he came in with an orange jumpsuit, we need to think about patient

staff safety.

Safety first. BH2 beats a prison cell. Not by much.

Did you guys hear about Louie?

Yeah. A chronic alcoholic?

Go figure.

Hey, uh, Fentody and South 20 is ready for discharge, but could you get Lupe to

call him a ride? I need to check on Louie.

Uh, actually, Whitaker... He croaked.

What? Five minutes ago, Robbie called it.

I'm sorry,

man. We didn't have time to find you.

What happened?

He was apneic, impulseless.

We started CPR and intubated him.

He had a massive pulmonary hemorrhage, Robbie called it.

Found this with his stuff.

Guess he was married at some point.

Never knew that.

Didn't miss this part of the job.

Yeah.

Perla, did Louie ever mention anything about a wife and kids?

As far as I know, he only had eyes for Rita Moreno.

This is not Rita Moreno.

No, it's not.

Can we check to see if there's an emergency contact?

Yeah, there's a number listed.

You were his primary. Do you want to...

P .T .M .C. charge nurse.

Langdon? Where are you?

Makes sense that we'd be his emergency contact. Sorry to get your hopes up.

My social worker's gonna do their thing. If Louie had any family left, they'll

find them.

You okay?

Guess it's good it happened here, not out on the street.

You're off the hook with Louie. I'm gonna teach Emma here how to clean a

body.

I'm sorry, but then you mean LMD. You might want to call for another

interpreter. Busy day.

Shit, that's our girl in 12? She's been waiting for five hours. Didn't hear her

name called the first time.

You check on her?

You need to brush up on my ASL.

You know sign language, too?

Princess June has six languages.

I know French. It's not a contest.

No,

she's talking in front of me. I get enough of that from her and Perla.

Guess I'll call for backup.

Yo, Donnie, did you discharge your butt abscess? Not yet.

What the hell? Your good friends upstairs sent donuts.

Special thank you for working the holiday.

You've got to be kidding me.

What were you expecting, tacos and tequila?

Every single one of them can forget about extra shifts. Won't hire more

Won't pay us a decent wage. Won't hire security that can actually protect us

from patients. But absolutely, send donuts.

Sure you want to go into this line of work? Want me to get you one? Of course

do, but I'm not taking admins' blood pastries.

Hey, too, Donnie?

Okay, move it or lose it. Meet me in South 15 with gowns and gloves.

Looks like it's a happy hour in here.

Don't ask. What's up with Eva Knievel?

Brandon Lee, 52, fell off a motorcycle pyramid at 25 miles per hour.

Motorcycle pyramid? You recruiting?

Got a fellow rider in your midst. No kidding. How high up were you? On top of

3 -2 -1.

But the bottom guys are sitting down, driving the choppers.

I'm fine. I don't need all this. Were you wearing a helmet? Of course.

Oh, what do you know? They're still in style.

Good vitals, tender right wrist, and big left knee lack.

Hey, Joy, Perla, trauma two.

Who else can I have?

Sansa and Whitaker in with Louie. Yeah, give me Whitaker. He could use a

distraction. Sansa's been ducking traumas all day.

She's behind you in her chart. Who isn't?

Even when it's not your fault, sometimes it's worse knowing that there was

nothing you could do.

Are you?

Well, we need you both in trauma, too, and I need you to discharge Sweet Patty

and 13 as soon as you're done.

Can't catch a break.

I'll push you because I know you can take it.

You ever clean up that body?

I never seen one either.

No one tells you what it looks.

It feels, it smells like them.

I get used to it over time.

We pull off the gown, wipe him down with towels, and we'll roll him on his side,

clean his back, stuff the sheet under him, wipe down the bed, roll him the

way, pull out the sheet, and repeat. Just follow my lead.

Usually, I leave the ET tube in for the coroner, but...

He was a chronic alcoholic with end -stage liver disease, not a coroner's

Did he have family? Everyone has family.

The social worker always tries to find them.

Sometimes the family loved them, tried to get them to come home. Other times

family wants nothing to do with them.

That's sad. That's life.

What happens if no one claims his body? He'll be cremated.

Where would his ashes go?

Keep him for a few months, then he gets buried in the mass grave with all the

other unclaimed bodies.

Okay. Now we roll him.

Oh, my God. Is he still alive?

No, that happens.

These frequent flyers.

It can be a real pain in the ass, but you miss them when they're gone.

We've been at every Melville 4th of July parade since 08.

World record is 40 men on seven motorcycles.

Plan to beat that someday.

Good lung sliding bilaterally. Pupils equal and reactive.

What do you ride?

A bullet.

Oh, Royal Enfield, ankle breaker, thumper. BP 138 over 80, pulse 94, pulse

98. All your vitals sound really good, Brandon.

They call it an ankle breaker because you've got to kick over a big fat single

cylinder to get it started. Sometimes five or six kicks.

Especially on a cold day.

Um, does anyone have any trauma scissors? I'll check the knee.

Uh, not yet. Why not?

Dr. Santos?

Primary survey means rule out the life threats. Don't get distracted by

lacerations or fractures. No free fluid in the belly.

Airway, breathing, circulation are fine.

Okay, that's ABC.

That just leaves two letters. Tell her about D, Dr. Santos.

Disability. Wiggle your toes, sir.

Any pain in your arms or leg?

Not really.

Hurt when I put here?

No. Okay, no midline tenderness.

Next is negative.

No obvious brain injury or spinal cord injury.

That just leaves E. Joy.

Can I buy another vowel?

Dr. Whitaker.

Exposure.

A .K .A. strip and flip. Cut off his clothes and we'll log roll him. What do

have?

Helmeted motorcycle acrobat.

Eight foot falls. Standing on top of five riders. Primary survey normal. E

negative. Another motorcycle accident.

Hello, sir. I'm Dr. Garcia from surgery.

Hello.

Okay, we will roll him in three, two, one.

Well, I grew up a block from Carrick. My mom was a teacher at Brashear, so I had

to go there.

The Bullets?

That's right.

They were the Bullets when I was there. They changed to the Bulls when I left.

Oh.

Hey, you think I could get something to eat?

Gus here is wondering if he's clear to eat.

As long as it's a liquid diet.

We have the results of your CT scan.

Your jaw should heal without surgery, which is good news, but it will be a few

weeks. Before I can eat?

Solid foods, yes.

Or you can have food -prurated liquid in a blender.

I don't have a blender.

Right. Sorry.

We have a calorie -rich supplement drink called Ensure. It comes in chocolate,

vanilla, or strawberry.

Chocolate, please.

Good choice.

How many can I have?

Two a day is recommended.

I'll get it for you.

You have an appetite.

Good.

Mr. Varney, your blood tests indicate low levels of protein and vitamins.

Can we ask you a few questions about your diet?

How many meals or snacks do you have in a 24 -hour period?

I don't know.

Don't count.

Pretty sure it's three trays a day.

Okay. How often do you eat cereals, fruits, or vegetables?

Not many fruits and vegetables in prison.

Slow and steady.

What year is your Bonneville?

69.

Rescued it from a motor graveyard and brought it back to life with a bunny of

mine who's supposed to be coming in today.

How often do you ride?

I ride it into work every day.

Good for you.

Don't encourage him.

CT's ready for Brandon.

I say we take a look at this knee.

Whoa. Through the deep fascia. How's it look?

Definitely going to need stitches.

How many?

A lot.

It could be an open joint.

We'll do a saline load after CP.

Leave her sign negative, ACL intact.

Okay, ready to roll.

Are you still coming over tonight?

I think Whitaker is going to be playing farm boy again this weekend, so he's not

going to be around. I may need a rain check. Hey, do you have an update on

neck patch patient?

Last I heard, Miller was doing an above -the -knee amputation with ortho.

Langdon's waitress with the cellulitis? Yeah.

Man, that took a turn. Sure did.

Hey, did you hear about Louie?

Yeah. You okay?

Um, one of my uncles drank himself to death.

Barely recognized him at the end.

At least Louie always seemed happy.

Let me know if you want to talk.

There's a nun I'm finding in here.

She only wants lunch. It's a $20 fine.

Made a lot of changes while you were gone.

I can see that.

Look, I'll let you hide out a little bit longer, but then I need you to pick up

more patients. You're not as fast as you used to be. Damn donuts.

Ouch.

First day back, I get kicked in the nuts.

One dead, one septic bounce back.

Look at those, not your fault.

You expecting a party?

No, not really.

Didn't hear from anyone while I was gone.

Sorry.

They ever, uh, arrest that guy who punched you?

Yeah.

Wasn't enough. I want to press charges, but I don't want to go through all that.

Thought I was done, but I'm bored now.

Only lasted a few weeks. You?

Ten months is a long time to be alone with your thoughts.

I almost lost everything.

I know a lot of women who would have taken the kids and left, but Abby

Because she's a good woman. Because you deserve a second chance.

I'm not sure everyone agrees with you.

Give it time.

Look, I...

I, um... I've been working the 12 steps, trying to make amends.

I was really selfish.

I lied to myself, and I lied to you. I'm really sorry. You can check me off your

list, kid.

My bad.

Okay?

Yeah. Got a lovely patient for you, too. Let's get you back on the horse.

I really need to talk with Robbie.

I don't know if today's the best day for that. He lives on vacation tomorrow.

Let him get to the day in peace.

He's supposed to be gone for three months? That's what he says. I give him

Go get him, kid.

Dr. Langdon, this is Rocky.

Great name.

What brings you in, Rocky?

Very thick.

When did it start?

An hour ago.

After he won a hot dog eating contest.

A hot dog eating contest? How many he eat?

351 hot dogs?

36.

Still a lot.

I pulled data, Zofran. Go for it. All right, this should help.

Stick it under your tongue, let it dissolve.

Okay. Are you taking any...

Sanchez, what's up with your earliest patient?

Admitted to medicine, and before you ask, 13 has been discharged.

Great. 12 needs a doctor.

No, don't make me go back there. That disinfectant left a smell and stunk up

whole hallway.

So grab some coffee grounds from the lounge.

We need to admit our incarcerated patient, Gus.

What did the CT show?

Moderate pulmonary contusion, three rib fractures, no intra -abdominal bleeding,

and oblique fracture in the body of the mandible anterior to the ankle.

All favorable for healing?

A pain medication,

antibiotics,

liquid diet, pulse ox a few times a day, and then also dressing changes for the

last ratio.

Which he can get at his correctional facility.

Or he stays here for a few days and we get him on the right track to healing.

Why don't you two go check on your patients?

Sure thing.

What am I missing?

He's not getting enough to eat at his correctional facility.

The portions are tiny, too many carbs, not enough fruits or vegetables.

He's lucky he hasn't developed a chronic illness.

We don't have any inpatient beds. He would board down here for three days.

still getting runs from Westbridge, and we cannot tie up behavioral for that

long. Dr. Al -Hashemi, Dr. Jefferson wants to talk to you about our tasered

Why don't I call the prison doctor and find out what they're working with over

there? Thank you. My pleasure.

Dr. Jefferson seems to have a good rapport with Jackson.

Excellent. How's the sister doing?

Still pretty upset.

She's never seen him like this.

A lot to process.

How's he doing?

He's scared.

Dr. Peredal had a positive effect, but he doesn't understand what's going on.

He's been experiencing auditory hallucinations and paranoid delusions,

or telling him he isn't safe.

This has been going on for months.

Months? Yeah, it turns out his sister hasn't seen him in a while.

Family history of mental illness?

Not that we know of.

I'm going to give him a break and then continue the conversation.

Parents are on their way. We'll let you know when they get here.

Yes, dear.

Okay, hospital bed, wheelchair, and shower chair have all been ordered.

Please stay, kid.

Ready to go home.

How's your payment, Mrs. Hamler?

It's the same.

We're going to write you a script for Keppra.

You'll take that to prevent... Seizure is once a day starting tomorrow.

Between your broken leg and the bruises from your seizure, the pain will

probably get a little worse.

Yeah, the most important thing is to let others help you. You'll need assistance

showering and getting to the bathroom.

Yeah, no problem. I won't leave her side.

Paul, you need a break.

If you're taking care of me, the kids, the house, it's too much for one person.

I'm not the one battling cancer.

Paul? Hey, you're in pain.

Every day.

Find a free life.

I'm happy to do this for you.

You're my wife.

Now let's go home and forget this day ever happened.

I'll call the transfer ambulance.

Thanks, Princess.

Hey.

Hmm?

Why don't you go ahead?

What? Yeah, you can get the house ready.

I'll be right behind you.

No.

No, I'm riding in the back with you.

Yeah, I'll stay with her.

You sure?

Yeah.

Okay.

Call me if you need me to come back.

Mr. Francis, short of breath?

Yeah, I was worried the clot in my leg could have gone up to my lungs.

You're on Eliquis. That shouldn't happen.

Yeah, I know. Don, I got this.

Don't worry, Mr. Francis.

I'll order the D -dimer. I'll be back to see you.

Thank you, Dr. Mohan.

You know, I'm an MP now. I can pick up a patient with dyspnea. I'm sorry.

I've seen him before, and he's asked for me.

Why even order the test? He's on Eliquis.

Mr. Francis comes in every month and always asks for a D -dimer.

Just, he's worried, and it puts his mind at ease.

Why not?

Yeah, okay.

Donnie's the best. You learn a lot from him.

That's right.

All right, film in.

This is Harlow Graham.

She was seen in triage.

CBC and CMP came back normal.

IT was supposed to bring the VRI down, but they're slammed.

I know a bit of sign language.

Harlow, this is Dr.

Santos.

Hi, Harlow. How are you feeling?

She has a headache.

Okay, what else?

What does she think?

I think she had a stomach ache and she might have passed out.

I'm not 100 % sure.

Okay.

We're just going to need to wait for an interpreter because I need to ask a

million questions and I can't do it this way. So just call me when I do come

down.

CT head, neck, chest, abdomen, pelvis, all negative.

It means you can get this cholera.

Thank you.

Roll to your side.

We'll get you off this board.

How long's your trip?

2 ,000 miles, all the way from here to Alberta.

A couple stops along the way.

Got the whole thing mapped out.

Sounds like heaven.

Let's sit you up.

Sorry I got stuck with a patient.

You know the old saying, four wheels move the body, two wheels move the soul.

You're gonna be living the dream.

Thank you, Brandon. Not everybody down here feels that way. Okay, Whitaker,

what's next? Ortho -assessment.

Palpate all long bones, starting with the clavicle.

Got it. We'll take the lower extremities.

Distal radius tender. No deformities. Need an x -ray. No bony tenderness down

here. No laxity of the knee. Any concern about that knee leg?

If it's an open joint, he'll need a washout in the OR. We could try a

fluorescein injection.

Okay, we'll need a wood lamp. Wood lamp, 1 % lighter with epi, sterile ceiling,

sterile basin, sterile floor strip, 18 and 27 gauge needles, 5 and 60cc

syringes.

How does she know all that?

She just does.

How we feeling, Rocky?

Oh, much better.

She said eight weeks of ondansetron. Any pain in the belly?

No, but my mouth is really dry.

No doubt from consuming mass quantities of salty hot dogs.

Can I have another sip of water?

Sure, a little sip.

Take it slow.

Here you go.

Thank you.

Just enough to wet your whistle.

So, how'd you get your start as a competitive eater?

Any pain here, Mr. Lee?

Can't feel a thing. Great.

Where's Santos?

Probably catching up on our charting.

Right. Lights out. What's the lamp on?

some of that on Halloween?

That is 250 cc's of sterile saline with one small touch of a sterile floor

strip.

We are going to inject this fluid into your knee, Brandon, and if there's

anything glowing in your wound, we know we have a leak.

Feeling some pressure?

Yeah, it's normal. As soon as I finish the test, I'll pull off the fluid.

That looks good.

Laceration did not enter into the joint space.

Surgery not needed.

Excellent. I can get back to the parade. No, we'll still need to stitch you up

and splint your wrist.

Hey, Grandma Vance. Wait, he has a penicillin allergy.

No, PenFast was negative. We're okay.

My mom said I got a rash with amoxicillin when I was two.

Yeah, probably not a true allergy.

Go ahead and give it, Kim.

But have Epi and Benadryl standing by, right? Yes, to be on the safe side.

Most people who think they have a penicillin allergy actually don't.

Always listen to the nurses.

They run the ER. We just try and stay out of their way.

Now we can really clean him up.

Didn't we already do that?

Dry blood on the face, neck, hands. If anyone comes, they shouldn't have to see

that.

Sometimes the local unhoused folks are paid a visit, but we always make them

presentable in case anyone comes.

It's the last thing we can do for them.

They get to do that during COVID.

Once he's spotless, we'll tuck him in nice and tight, but we always leave one

arm outside the sheet.

Because?

So the ones can hold their hands.

We're ready to discharge our cancer mom, Roxy.

Ambulance is on the way. We just need to reconcile with her.

Hey, I thought I saw another charge nurse around here.

Yeah, we travel in packs. Aren't you sick of this place yet?

Ah, someone is ready for his sabbatical. Guilty as charged.

Hey, I just got word that the at -home morphine pump is going to be delayed.

Hospital pharmacy has to mix it and then deliver it later today. Well, should we

keep her here until it's ready?

No, you can give her a 200 milligram tablet of MS -Contin.

200 milligrams?

Biggest pill they make. Releases over 12 hours for patients with opiate

tolerance.

And you want to stick around a little bit? Westbridge is close to internal

disaster. We're getting all their runs. Yeah, I heard. I put 20 bucks on a

plumbing issue. I just watched that Poop Cruise documentary.

I cannot stop thinking about it. That sounds like something I'll absolutely

never watch. Dr. Robbie, you gave us a clozapine ileus about an hour ago.

Your resident reported no surgical history, but the chart says they've had

appendectomy. We're not admitting the patient without a surgery consult.

Who called it in? Dr.

Trinity Santos.

Dr. Santos.

You had an Ilias patient. You neglected to mention a history of appendectomy.

There was no history of appendectomy. It was in your note.

I may have forgotten to proof check it. I was using the app that Dr. Al Hashimi

suggested to catch up on my charting. Wonderful.

Ah, Dr. Al Hashimi. Yes. Dr. Santos was just using your AI tool for her

charting, and it hallucinated a history of appendicitis.

As I mentioned to Dr. Santos, generative AI is not perfect. We still need to

proofread every chart it creates.

The patient also has a history of headache, followed by Dr. Park from

That should probably be neurology.

Unless urologists are now treating migraines. Another example that should

been caught by proofreading.

AI's 2 % error rate is still better than dictation. Yeah, I don't really give a

shit whether or not you want to use robots down here.

I need accurate information in the medical record. Dr.

Santos.

Dr. Santos.

Yep, won't happen again.

Thanks,

Prilla. Six hours to go. You got this.

When a wound is gaping like this, you want to use sub -Q to bring the edges

together. A lot of meat to close.

What would happen if we just did a simple wound closure?

You take the stitches out in 10 days, the wound opens, dehisses.

Exactly. So what suture do we use under the skin?

A Vicryl provides support for a month. It takes two months to dissolve.

So 5 -0 nylon on the skin for a Vicryl under the skin. I go with a 3 -0 Vicryl.

You think?

Most definitely.

Donnie is the master of wound closure. I do at least 10 lakhs a day out at tree

yards. Can we see your sub -Q?

You my guest?

If you insist.

The secret is to be sure your entry point and exit point on both sides of

wound matches the depth on the other side.

Start deep.

Come up at the dermis.

Big bites help the tissue close.

Samara image on the other side.

Superficial. To deep.

So you bury the knot.

Bingo. Boyd's bumps on the scarlet.

Three ties.

Not four.

Yeah, that's beautiful.

And then you cut it short, not too short.

I like to slide my scissors down on the knot.

And rotate up 45 degrees before I cut.

Can use two more sub cues.

One above, one below.

Have at it.

Interesting ink.

Do they mean anything?

This, this is death and chaos.

And this is miracles and blessings.

Got this one after the pit fest shooting.

I got this after my daughter was born.

Put the head of the gurney up so people can see him, but not so high that his

head flops to the side.

What do you think?

You look beautiful.

What's the hardest part of this job?

It's pretty dankless, and I can be tough. You've seen the burnout rates.

sure I teach you that at school.

All my closest friends left after COVID.

Some during.

I don't blame them.

They had to do what was best for their mental health.

A lot of people broke.

Why do you keep coming back?

Why don't you, um, just finish up here and then.

Go help Carla for a bit.

Great. Thank you. No, that is exactly what I needed to know.

Okay.

I just got off the phone with the physician assistant at the prison.

a 16 -hour day infirmary with NP and PA coverage, giving everything that we

need, and they've got an RN for overnight.

Even so, he's here because they're ignoring his basic needs.

He's here because somebody kicked the shit out of him. I think you're missing

the point.

We have more to offer.

Robbie, there's a formal coming our way. Okay, got it.

What you're trying to do is very noble.

We don't have the resources to check. Okay, then why admit the unhoused man,

Digby? Why not send him back to the street with antibiotics and a roll of

Because Digby lives on the street, and your incarcerated patient has a mid

-level provider and a nurse looking after him. We both know the quality of

is not the same.

Sorry, are you waiting for me? No, Dr.

Al -Shimi, for the patient's assignment.

A few days here could make a world of difference for Gus's health.

We are a safety net. The nets have holes. We are not admitting him because

is not about social justice.

Everything I've done in my career is an effort to improve the system.

Just because you know it's broken doesn't mean you stop trying.

Excuse me.

I talked to Jackson's girlfriend.

She told me a lot of stuff.

She wants to come see him, but I just don't think that's a good idea.

And my parents are asking a lot of questions. Can I just take him home?

I'm so sorry. Your brother's on an involuntary psych hold.

He can't leave.

It could take us weeks to figure out what's wrong with him. What's wrong with

him?

I'm so sorry. I did not mean it like that. Why don't we go somewhere quiet?

What's wrong with him?

Let's go over here.

How's she doing?

She took three ounces of formula without vomiting or distress.

Excellent.

Dr. Wolk from Pete's should be done shortly.

I think I saw her smile.

A true social smile where the baby is awake, alert, and responding to facial

expressions usually doesn't happen until six weeks or older. It was likely a

reflex smile that happens while they're sleeping.

But some parents have reported...

Their baby smiled socially for the last four weeks.

Jesse,

North Florida needs a blood draw when you have a shot. Got it.

How are we doing in here?

Almost ready to head out.

Looking good.

Heart rate 91, BP is 115 over 82, oxygen stats 95%. Great. I'm sending him home

with some nonstick dressing in case they don't stock him.

Grab some Burnette, too.

He's a good guy.

He's local.

Yeah? You from Pittsburgh?

Yes, ma 'am. Born and raised.

Whereabouts? Bloomfield.

Liberty Ave.

Bloomfield.

You know Sonny's Tavern?

Worked there through high school.

No kidding.

You know Sonny's?

Had my first kiss there.

Hey, Sonny. My buddy Duke hasn't checked in yet? No, I told Lupe to keep an eye

out. Thank you. Yep.

Right, left, right, left. Yeah.

You back to check our work? Nope. I need a silastic loop drain.

That looks great.

Thanks for your fine instruction.

He's going to need Curlex and Xeroform.

You should throw a neoprene sleeve on him. Limits the range of motion at the

knee so the sutures don't pull out. Good idea.

Must be fun to work here.

Oh, sure is. First week for these two.

How are you guys liking the pit?

I feel like I was born to do this.

Hard pass.

I'm shooting for pathology.

I like medical mysteries, but I don't really deal well with people.

You have an interest in energy.

What's that for?

Splint starts at the knuckles, comes up and around the elbow, and back down

to the palm.

It needs to be smaller. I can't ride with a splint.

Well, you shouldn't be riding at all. Right now, that's a non -displaced

fracture. If you fall on it again, you're going to need to go to the OR.

No worries, Doc.

I won't fall again.

Uh -huh.

Robbie, pulse oxygen's dropped.

What happened?

I don't know. I stepped out for a minute. It's down to 85%. You having

trouble breathing?

A little.

Start him on two liters of oxygen, nasal cannulas, titrate to five, get the

pulse oxygen to 92 or higher, and have a rebreather standard by just in case.

He's going to have to stay.

For how long?

I'm not sure.

Sorry, boss. I only stepped out for a second. Let me know if anything changes.

You were in the room when his pulse tox dropped?

I was.

What were you doing? He still can't get a hold of Ortho. Leave him to me.

Feeling better?

So much better.

Well, I wrote you a script for Zofran just in case.

Thanks. I think I cleared it all out.

So no more hot dogs, right?

Oh, not today.

But I'll be back next year.

Gotta defend my title. Okay, well, best of luck to you. They got a Wiener World

truck outside.

You want one? I think I'm getting hot dogs for the rest of my life. Wait.

Did I just see you eating a donut? Don't judge.

Stay here for a sec.

Transport ambulance is here. This is a 200 milligram MS cotton. This will give

you 12 hours of relief.

Whenever you're ready, Rox.

Hey, guys, this is Roxy Hamler.

Hello, ma 'am.

You'd be on the transfer. Yeah.

On my count.

No, no, no.

This isn't going to work out.

I'm sorry.

I can't, I can't, I can't, I can't do this.

Can I assume that you've already called upstairs to get Gus Varney in bed?

Do you want to tell me what you did?

I don't know what you're talking about.

His pulse ox was steady. We were about to discharge him.

Did Dr. Al Hashimi put you up to that?

Al Hashimi? No.

You know he's going to go back to prison after they discharge him upstairs.

I thought you didn't go the extra distance for your patients anymore.

It's Emma, right?

Yeah.

How's your first day going?

Good, I think.

Haven't killed anyone yet.

I'm sorry, I... It's okay.

I guess time will tell if I'm cut out for this.

Well, when in doubt, stick with her, kid.

She scares me.

No, that's just a tough exterior. She's warm and gooey on the inside.

Looks like they're doing the debrief for Louie.

You coming?

I pay my respects.

I'm just going to hold down the floor.

Remember the day he found him passed out in the park?

Sure do. I had to drag his ass over here. He even soaked to the bone. He

his life.

How about last summer when we didn't see him for months?

He said he finally quit drinking, so he didn't need to come in.

How many times did he say he was going to quit drinking?

He always asked about Harrison.

Always said thank you.

Found this with his stuff.

Who knew he was married?

That's Rhonda, Louie's wife.

High school sweetheart.

About five years ago, I was covering a night shift.

He came in feeling talkative.

Born and raised in Pittsburgh, lifelong Steelers fan,

groundskeeper at Three Rivers Stadium until 1998.

He never really wanted kids.

But Rhonda wore him down, and when she finally got pregnant, he changed his

tune, he got excited.

And then about a month before the baby was due, Rhonda and the baby were killed

in the car crash.

Louis never really came back from that.

May his memory be a blessing.

May his memory be a blessing.

Yep.

See him tired and shivering, stumbling through the day.

Can you see his lips are quivering like he's gotten how to pray?

Can you see the way it's perilous? She's absorbing all the blows.

And who will now take care of us in the hills and valleys, the highs and lows?

All I know is you're new.

Bye. Bye. Bye. Bye. Bye.

I'm gonna cry.