1 00:00:13,972 --> 00:00:16,098 - Robby. - Yep. 2 00:00:16,099 --> 00:00:18,225 Cellulitis on the dorsum of the foot, 3 00:00:18,226 --> 00:00:20,227 now spreading up the leg. 4 00:00:20,228 --> 00:00:21,437 Hello, I'm Dr. Robby. 5 00:00:21,438 --> 00:00:23,147 Mind if I take a look? 6 00:00:23,148 --> 00:00:25,232 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 --> 00:00:29,153 I don't know that you're gonna 9 00:00:29,154 --> 00:00:31,030 make it back to work today. 10 00:00:31,031 --> 00:00:32,698 Erythema and warmth halfway up her knee. 11 00:00:32,699 --> 00:00:33,824 When did you see her, Donnie? 12 00:00:33,825 --> 00:00:36,285 He didn't. I did. 13 00:00:36,286 --> 00:00:37,786 - When? - About four hours ago. 14 00:00:37,787 --> 00:00:39,204 Gave her a dose of Keflex, 15 00:00:39,205 --> 00:00:40,748 told her to come back if things got worse. 16 00:00:40,749 --> 00:00:42,708 Things have definitely gotten worse. 17 00:00:42,709 --> 00:00:43,709 Dana, what's open? 18 00:00:43,710 --> 00:00:45,169 Trauma Two. 19 00:00:45,170 --> 00:00:46,670 Jesse, can you get her started in Trauma Two 20 00:00:46,671 --> 00:00:47,963 with some vanco and blood cultures, please? 21 00:00:47,964 --> 00:00:49,423 - Got it, boss. - I'm coming with. 22 00:00:49,424 --> 00:00:51,508 Suit yourself. 23 00:00:51,509 --> 00:00:54,803 Santos, you want in on Trauma Two? 24 00:00:54,804 --> 00:00:57,765 Too much charting, too little time. 25 00:00:57,766 --> 00:01:01,518 62-year-old male presents with chief complaint 26 00:01:01,519 --> 00:01:02,686 of left lower back pain. 27 00:01:02,687 --> 00:01:04,146 - Considered the diagnosis... - Hey. 28 00:01:04,147 --> 00:01:05,355 Oh, Jesus Christ. 29 00:01:05,356 --> 00:01:06,815 I'm charting. 30 00:01:06,816 --> 00:01:08,234 Sorry. 31 00:01:09,319 --> 00:01:10,903 Did I do something wrong? 32 00:01:10,904 --> 00:01:12,654 Besides interrupting me? Probably. 33 00:01:12,655 --> 00:01:14,281 Then I apologize. 34 00:01:14,282 --> 00:01:17,910 I know that second year of residency can be stressful, 35 00:01:17,911 --> 00:01:21,121 so if there's anything I can do to help you... 36 00:01:21,122 --> 00:01:22,372 like stop talking. 37 00:01:22,373 --> 00:01:24,708 - That's a great idea. - Yeah. 38 00:01:24,709 --> 00:01:28,879 Considered the diagnosis of aortic aneurysm or dissection. 39 00:01:28,880 --> 00:01:30,589 Got a new one for you in 13. 40 00:01:30,590 --> 00:01:33,217 I'm 20 charts behind, and the new attending 41 00:01:33,218 --> 00:01:34,384 is threatening to make me repeat 42 00:01:34,385 --> 00:01:35,511 a year if I can't catch up. 43 00:01:35,512 --> 00:01:36,762 Cry me a river. 44 00:01:36,763 --> 00:01:37,888 Old lady with bad abdominal pain. 45 00:01:37,889 --> 00:01:39,056 Somebody's gotta see her. 46 00:01:39,057 --> 00:01:40,557 Dana, please do me a solid. 47 00:01:40,558 --> 00:01:42,226 Holiday weekend. 48 00:01:42,227 --> 00:01:43,852 Westbridge is down, and our waiting room's on overdrive. 49 00:01:43,853 --> 00:01:45,229 I'm sorry, but your charting's gonna have to wait 50 00:01:45,230 --> 00:01:47,689 until after your shift. 51 00:01:47,690 --> 00:01:49,149 Ogilvie. 52 00:01:49,150 --> 00:01:53,028 Dr. Santos needs you to pick up a new patient in 13. 53 00:01:53,029 --> 00:01:56,907 Y-yes, ma'am. I'm on it. 54 00:01:56,908 --> 00:01:58,200 Chart while you supervise. 55 00:01:58,201 --> 00:01:59,911 Best I can do. 56 00:02:03,039 --> 00:02:05,999 Setting up a GoFundMe, that's what her generation does. 57 00:02:06,000 --> 00:02:07,876 That's how they support each other. 58 00:02:07,877 --> 00:02:08,961 Doctor, tell him. 59 00:02:08,962 --> 00:02:10,546 Your wife's right. 60 00:02:10,547 --> 00:02:12,881 Staying here's gonna cost more than we can afford. 61 00:02:12,882 --> 00:02:14,758 Look, I'm feeling better. 62 00:02:14,759 --> 00:02:16,301 I'll just leave. 63 00:02:16,302 --> 00:02:19,263 Mr. Diaz, even if your blood sugar is back to normal, 64 00:02:19,264 --> 00:02:21,223 we have to continue with the insulin drip 65 00:02:21,224 --> 00:02:23,142 until we clear the ketones from your bloodstream. 66 00:02:23,143 --> 00:02:25,686 Otherwise, you could experience electrolyte disorders, 67 00:02:25,687 --> 00:02:27,020 heart and kidney problems... 68 00:02:27,021 --> 00:02:30,566 Mi amor, your health is what matters. 69 00:02:30,567 --> 00:02:32,025 I'll make you a deal. 70 00:02:32,026 --> 00:02:33,861 You agree to stay on the insulin drip, 71 00:02:33,862 --> 00:02:35,362 and I'll go find our case manager 72 00:02:35,363 --> 00:02:37,281 to discuss cost-cutting options for your stay. 73 00:02:37,282 --> 00:02:38,657 Deal. 74 00:02:38,658 --> 00:02:40,909 And I'm sitting here making sure he doesn't move. 75 00:02:40,910 --> 00:02:43,036 - You should go look for Ana. - Mm-hmm. 76 00:02:43,037 --> 00:02:44,121 I can find her. 77 00:02:44,122 --> 00:02:45,707 BRB. 78 00:02:47,876 --> 00:02:49,084 Hanging vanco. 79 00:02:49,085 --> 00:02:50,627 What's vanco? 80 00:02:50,628 --> 00:02:53,130 A really strong antibiotic to kill skin germs. 81 00:02:53,131 --> 00:02:55,674 - Need a hand? - No. We got this. 82 00:02:55,675 --> 00:02:57,509 I'll just observe. 83 00:02:57,510 --> 00:02:58,969 Pretend I'm not even here. 84 00:02:58,970 --> 00:03:02,431 Let's send off a CBC, blood cultures, and CMP. 85 00:03:02,432 --> 00:03:05,475 And also a lactic acid, CRP, and calcitonin. 86 00:03:05,476 --> 00:03:07,561 Wait, she's not febrile, not tachycardic. 87 00:03:07,562 --> 00:03:09,188 No evidence of SIRS. 88 00:03:09,189 --> 00:03:11,148 - Yet. - What's SIRS? 89 00:03:11,149 --> 00:03:14,902 Systemic inflammatory response syndrome. 90 00:03:14,903 --> 00:03:15,944 Sorry. 91 00:03:15,945 --> 00:03:17,613 An exaggerated defense response. 92 00:03:17,614 --> 00:03:18,947 A what? 93 00:03:18,948 --> 00:03:21,033 Sometimes the human body can have an overreaction 94 00:03:21,034 --> 00:03:22,951 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 --> 00:03:28,790 It's my boss. 97 00:03:28,791 --> 00:03:30,792 Sorry, I have to take this, or he's gonna fire me. 98 00:03:30,793 --> 00:03:32,878 OK. 99 00:03:32,879 --> 00:03:34,421 Hello. 100 00:03:34,422 --> 00:03:38,050 No, I'm still at the hospital. 101 00:03:38,051 --> 00:03:39,551 Being seen right now. 102 00:03:39,552 --> 00:03:40,844 Ow. 103 00:03:40,845 --> 00:03:44,014 No, they just stuck me with a needle. 104 00:03:44,015 --> 00:03:45,724 I don't know. 105 00:03:45,725 --> 00:03:48,143 You wanna talk to them? 106 00:03:48,144 --> 00:03:51,188 They're kind of busy right now. 107 00:03:51,189 --> 00:03:52,648 I know you are. 108 00:03:52,649 --> 00:03:54,107 Second IV's in. 109 00:03:54,108 --> 00:03:55,817 No, I'm not overreacting. 110 00:03:55,818 --> 00:03:58,153 My body's overreacting. 111 00:03:58,154 --> 00:04:00,155 Please... please don't fire me. 112 00:04:00,156 --> 00:04:01,448 I... 113 00:04:01,449 --> 00:04:02,908 This is Dr. Michael Robinavitch. 114 00:04:02,909 --> 00:04:04,952 I am the chief of emergency medicine at PTMC. 115 00:04:04,953 --> 00:04:06,912 If you fire her, she will sue you, 116 00:04:06,913 --> 00:04:09,915 and I will testify on her behalf. 117 00:04:09,916 --> 00:04:12,209 OK. 118 00:04:12,210 --> 00:04:14,087 Don't worry about it. We got you. 119 00:04:18,967 --> 00:04:20,926 Do you know how long Jackson's gonna be asleep? 120 00:04:20,927 --> 00:04:24,179 So there's no exact timeline with the sedatives we gave him, 121 00:04:24,180 --> 00:04:25,889 but he should be awake soon. 122 00:04:25,890 --> 00:04:27,557 Have you spoken to your parents yet? 123 00:04:27,558 --> 00:04:29,184 Yeah, they're on their way back from Columbus. 124 00:04:29,185 --> 00:04:31,645 Maybe you should take some time for yourself 125 00:04:31,646 --> 00:04:33,063 before they arrive. 126 00:04:33,064 --> 00:04:34,731 Yeah, cafeteria's right down the hall. 127 00:04:34,732 --> 00:04:35,774 Decent grilled cheese. 128 00:04:35,775 --> 00:04:36,900 Stay away from the tuna. 129 00:04:36,901 --> 00:04:38,944 Thanks, but I'm not hungry. 130 00:04:38,945 --> 00:04:41,655 You know, I just can't believe that a campus security guard 131 00:04:41,656 --> 00:04:43,115 tased my brother. 132 00:04:43,116 --> 00:04:44,616 Aren't they supposed to be helping students 133 00:04:44,617 --> 00:04:46,702 and protect them, not shoot at them? 134 00:04:46,703 --> 00:04:48,412 You have every right to be upset, 135 00:04:48,413 --> 00:04:51,081 and you should absolutely pursue accountability. 136 00:04:51,082 --> 00:04:53,375 But right now, we are taking care of your brother. 137 00:04:53,376 --> 00:04:56,211 And you should really take care of yourself. 138 00:04:56,212 --> 00:04:57,796 I... I have your number. 139 00:04:57,797 --> 00:05:00,173 I'll text you as soon as Jackson's LP results get back 140 00:05:00,174 --> 00:05:02,384 or if he wakes up. 141 00:05:02,385 --> 00:05:04,094 OK. 142 00:05:04,095 --> 00:05:05,429 OK, thank you. 143 00:05:05,430 --> 00:05:06,596 Of course. 144 00:05:06,597 --> 00:05:09,766 - Oh. - OK. 145 00:05:09,767 --> 00:05:11,393 Hypoactive bowel sounds. 146 00:05:11,394 --> 00:05:14,271 Soft, with moderate tenderness in the left lower quadrant. 147 00:05:14,272 --> 00:05:17,524 Mrs. Randolph, do you take Percocet every day? 148 00:05:17,525 --> 00:05:19,443 - No. - Huh. 149 00:05:19,444 --> 00:05:20,902 And what about your water intake, 'cause... 150 00:05:20,903 --> 00:05:22,446 Pause. 151 00:05:22,447 --> 00:05:24,614 Mrs. Randolph, you said you don't take Percocet every day, 152 00:05:24,615 --> 00:05:26,616 but when was the last time you took some? 153 00:05:26,617 --> 00:05:29,911 Maybe three or four times last week. 154 00:05:29,912 --> 00:05:33,540 Assisted living had a ballroom dance competition, 155 00:05:33,541 --> 00:05:35,751 - and I tweaked my back. - Mm. 156 00:05:35,752 --> 00:05:39,838 Any further questions, Ogilvie? 157 00:05:39,839 --> 00:05:43,550 When was your last bowel movement? 158 00:05:43,551 --> 00:05:46,053 I don't know. Sometime last week. 159 00:05:46,054 --> 00:05:49,056 I've been stopped up for at least five or six days. 160 00:05:49,057 --> 00:05:52,517 Mm-hmm, painkillers can cause constipation. 161 00:05:52,518 --> 00:05:53,810 I know. 162 00:05:53,811 --> 00:05:56,355 That's why they put me on a stool softener, 163 00:05:56,356 --> 00:05:57,689 and then they tried an enema. 164 00:05:57,690 --> 00:05:59,733 - And... and no movements? - Yep. 165 00:05:59,734 --> 00:06:03,028 And then they gave me this horrible drink. 166 00:06:03,029 --> 00:06:04,654 Mag citrate. 167 00:06:04,655 --> 00:06:05,697 Yeah. 168 00:06:05,698 --> 00:06:08,033 Mag citrate. 169 00:06:08,034 --> 00:06:09,326 Made me puke. 170 00:06:09,327 --> 00:06:11,536 All right, what's next, Ogilvie? 171 00:06:11,537 --> 00:06:13,580 Let's get you an X-ray and see how we can help you, 172 00:06:13,581 --> 00:06:14,581 Mrs. Randolph. 173 00:06:14,582 --> 00:06:16,458 - Thank you. - Yeah. 174 00:06:16,459 --> 00:06:18,627 Differential? 175 00:06:18,628 --> 00:06:20,295 Probable stool impaction. 176 00:06:20,296 --> 00:06:21,880 But with her history of cholecystectomy, 177 00:06:21,881 --> 00:06:23,632 it could be small bowel obstruction. 178 00:06:23,633 --> 00:06:24,758 Or worse. 179 00:06:24,759 --> 00:06:27,010 Sigmoid volvulus? 180 00:06:27,011 --> 00:06:29,388 But that's a surgical emergency. 181 00:06:29,389 --> 00:06:30,931 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 --> 00:06:41,650 I am getting concerned. 184 00:06:41,651 --> 00:06:44,236 This is a millimeter past the line. 185 00:06:44,237 --> 00:06:45,612 Or my line was sloppy. 186 00:06:45,613 --> 00:06:47,155 - Any increase in pain? - Oh. 187 00:06:47,156 --> 00:06:49,741 OK, sorry. Let's try four morphine. 188 00:06:49,742 --> 00:06:51,076 White count's only 10,000. 189 00:06:51,077 --> 00:06:53,120 It'd be over 12,000 for SIRS. 190 00:06:53,121 --> 00:06:54,913 There are other criteria. 191 00:06:54,914 --> 00:06:56,373 Still afebrile. 192 00:06:56,374 --> 00:06:57,958 Did you ask about past history of MRSA? 193 00:06:57,959 --> 00:06:59,751 Not specifically, but she's never been hospitalized. 194 00:06:59,752 --> 00:07:01,253 Any evidence of an immunocompromised state? 195 00:07:01,254 --> 00:07:02,504 - No, she's healthy. - Steroid use? 196 00:07:02,505 --> 00:07:03,505 Never. 197 00:07:03,506 --> 00:07:05,048 Maximum heart rate's only 89. 198 00:07:05,049 --> 00:07:06,216 Is that OK? 199 00:07:06,217 --> 00:07:08,301 That's good, very good. 200 00:07:08,302 --> 00:07:09,302 Stay with her. 201 00:07:09,303 --> 00:07:10,887 Monitor her closely. 202 00:07:10,888 --> 00:07:12,722 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 --> 00:07:19,646 Roxie Hamler, 42, home hospice patient 205 00:07:19,647 --> 00:07:21,231 with a history of lung cancer. 206 00:07:21,232 --> 00:07:24,443 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 --> 00:07:30,031 Initially nonverbal, now coming around. 209 00:07:30,032 --> 00:07:31,533 That's normal after a seizure. 210 00:07:31,534 --> 00:07:33,118 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 211 00:07:33,119 --> 00:07:34,911 - Nope, we got it. - She hit her head? 212 00:07:34,912 --> 00:07:36,079 No. I was there. 213 00:07:36,080 --> 00:07:37,706 - I caught her. - No IV? 214 00:07:37,707 --> 00:07:38,999 Couldn't get one in. 215 00:07:39,000 --> 00:07:40,500 Gave her four of IM versed for the seizure, 216 00:07:40,501 --> 00:07:42,043 - 25 of fent for the pain. - OK. 217 00:07:42,044 --> 00:07:43,920 - Dana, where to? - Trauma One. 218 00:07:43,921 --> 00:07:45,172 This way. 219 00:07:45,173 --> 00:07:47,507 Haven't seen you guys in a hot minute. 220 00:07:47,508 --> 00:07:50,093 Pickup from SCI Jones Forge. 221 00:07:50,094 --> 00:07:51,595 Was supposed to go to Westbridge but got 222 00:07:51,596 --> 00:07:52,596 diverted to you. 223 00:07:52,597 --> 00:07:54,014 Yeah, you and everybody else. 224 00:07:54,015 --> 00:07:55,557 Princess, I need you pivot to Central 9. 225 00:07:55,558 --> 00:07:56,892 Got it. 226 00:07:56,893 --> 00:07:58,602 Gus Varney, 54, victim of assault 227 00:07:58,603 --> 00:07:59,978 with diffuse blunt trauma. 228 00:07:59,979 --> 00:08:01,980 He's got bruising to the face, the right chest, 229 00:08:01,981 --> 00:08:03,648 10-centimeter laceration to the left arm. 230 00:08:03,649 --> 00:08:05,233 BP's 136 over 84, pulse 102, 231 00:08:05,234 --> 00:08:07,986 good sats, 95 on room air. 232 00:08:07,987 --> 00:08:09,696 How you feeling there, Mr. Varney? 233 00:08:09,697 --> 00:08:11,198 - Fucking hurts. - Where? 234 00:08:11,199 --> 00:08:13,533 - Everywhere. - I am Dr. Robby. 235 00:08:13,534 --> 00:08:14,826 This is Dr. Al-Hashimi. 236 00:08:14,827 --> 00:08:16,286 We'll get you something for the pain. 237 00:08:16,287 --> 00:08:17,829 I've got a progressing cellulitis in Trauma Two. 238 00:08:17,830 --> 00:08:19,456 - Go. I'm good. - Thank you. 239 00:08:19,457 --> 00:08:21,500 Gus, do you know who hurt you? 240 00:08:21,501 --> 00:08:24,169 One of the fine, upstanding citizens of cell block 6. 241 00:08:24,170 --> 00:08:27,088 It's a deep lac through the muscle fascia. 242 00:08:27,089 --> 00:08:28,632 Can we get the cuffs off once he settles? 243 00:08:28,633 --> 00:08:29,799 Not a chance. 244 00:08:29,800 --> 00:08:31,760 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 --> 00:08:47,734 OK, everyone, on my count. 247 00:08:47,735 --> 00:08:49,361 1, 2... 248 00:08:49,362 --> 00:08:50,821 Hold on. 249 00:08:54,450 --> 00:08:58,036 - Go. - 1, 2, 3. 250 00:08:58,037 --> 00:08:59,538 Mel, E-FAST. 251 00:08:59,539 --> 00:09:01,122 Whitaker, primary assessment. 252 00:09:01,123 --> 00:09:02,333 On it. 253 00:09:07,463 --> 00:09:08,672 Oh, weird bruise. 254 00:09:08,673 --> 00:09:09,965 Did he fall on something? 255 00:09:09,966 --> 00:09:11,466 Footprint, got stomped. 256 00:09:11,467 --> 00:09:13,386 Jesus. 257 00:09:14,679 --> 00:09:16,388 Is it... is that necessary? 258 00:09:16,389 --> 00:09:18,557 Afraid so. 259 00:09:18,558 --> 00:09:21,184 Airway's patent. 260 00:09:21,185 --> 00:09:23,937 Good lung sliding on the left. 261 00:09:23,938 --> 00:09:25,146 Sorry. 262 00:09:25,147 --> 00:09:26,439 Good on the right, too. 263 00:09:26,440 --> 00:09:27,816 How are the lungs? 264 00:09:27,817 --> 00:09:28,942 Good breath sounds. 265 00:09:28,943 --> 00:09:31,695 - No crepitus. - No effusion. 266 00:09:31,696 --> 00:09:34,990 Pulse ox 97, BP 118 over 78, heart rate 112. 267 00:09:34,991 --> 00:09:36,366 Tachycardic from the pain. 268 00:09:36,367 --> 00:09:37,909 Start with four of morphine. Repeat prn. 269 00:09:37,910 --> 00:09:38,910 On it. 270 00:09:38,911 --> 00:09:41,037 OK. Swollen mandible. 271 00:09:41,038 --> 00:09:42,455 Open your mouth for me, Gus. 272 00:09:42,456 --> 00:09:44,291 Little wider. 273 00:09:44,292 --> 00:09:45,542 Can't. 274 00:09:45,543 --> 00:09:46,918 Whitaker, you know the tongue blade exam? 275 00:09:46,919 --> 00:09:48,378 Yeah. 276 00:09:48,379 --> 00:09:49,838 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 --> 00:09:56,636 Sorry, Gus. 279 00:09:56,637 --> 00:09:58,763 Positive test. 280 00:09:58,764 --> 00:10:00,307 No free fluid in the belly. 281 00:10:00,308 --> 00:10:01,308 Any idea how long this will take? 282 00:10:01,309 --> 00:10:02,684 Too soon to tell. 283 00:10:02,685 --> 00:10:03,768 Whitaker, your assessment? 284 00:10:03,769 --> 00:10:05,186 Fractured left mandible, 285 00:10:05,187 --> 00:10:07,355 multiple rib fractures. 286 00:10:07,356 --> 00:10:08,857 Complex forearm lac. 287 00:10:08,858 --> 00:10:10,859 OK, log roll to the left, then pan scan. 288 00:10:10,860 --> 00:10:12,819 Where were you when Mr. Varney got assaulted? 289 00:10:12,820 --> 00:10:14,404 I just move 'em. I don't get to know 'em. 290 00:10:14,405 --> 00:10:16,156 CT's ready for us. 291 00:10:16,157 --> 00:10:17,991 Cycling the BP. 292 00:10:17,992 --> 00:10:20,660 OK, this redness is now a centimeter over that line, 293 00:10:20,661 --> 00:10:22,162 and this might be a bulla forming. 294 00:10:22,163 --> 00:10:23,455 The vanco takes a little time to work. 295 00:10:23,456 --> 00:10:27,000 Vital signs are still stable, 122 over 78. 296 00:10:27,001 --> 00:10:28,084 I got it. 297 00:10:28,085 --> 00:10:31,087 How are you feeling, Debbie? 298 00:10:31,088 --> 00:10:32,756 I'm feeling a little warm. 299 00:10:32,757 --> 00:10:34,174 That can happen with vanco. 300 00:10:34,175 --> 00:10:36,134 Thanks, man. 301 00:10:36,135 --> 00:10:39,179 Lactic acid 4.2. 302 00:10:39,180 --> 00:10:40,972 - OK. - What's wrong? 303 00:10:40,973 --> 00:10:43,683 That can be a sign of a more serious infection, 304 00:10:43,684 --> 00:10:45,310 but the good news is, we know what to do. 305 00:10:45,311 --> 00:10:49,022 Jesse, 2 liters of LR wide open. 306 00:10:49,023 --> 00:10:50,482 This is severe sepsis. 307 00:10:50,483 --> 00:10:52,108 I know, but at 7:00 AM, it was a simple cellulitis. 308 00:10:52,109 --> 00:10:53,735 Anyone would have given her Keflex. 309 00:10:53,736 --> 00:10:55,737 We could add carbapenem or Zosyn to broaden 310 00:10:55,738 --> 00:10:56,780 our antibiotic coverage. 311 00:10:56,781 --> 00:10:57,947 OK, I got it. 312 00:10:57,948 --> 00:10:59,366 Thanks. 313 00:10:59,367 --> 00:11:02,369 Jesse, 1 gram meropenem, 900 milligrams clinda, 314 00:11:02,370 --> 00:11:04,412 and page Dr. Garcia, please. 315 00:11:04,413 --> 00:11:05,830 What's going on? 316 00:11:05,831 --> 00:11:07,290 We're adding new antibiotics. 317 00:11:07,291 --> 00:11:08,708 It's serious? 318 00:11:08,709 --> 00:11:09,918 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 --> 00:11:14,464 What else can I do? 321 00:11:14,465 --> 00:11:15,632 I think you've done enough. 322 00:11:15,633 --> 00:11:16,759 You can go. 323 00:11:20,513 --> 00:11:21,513 All good in there? 324 00:11:21,514 --> 00:11:22,639 Code sepsis. 325 00:11:22,640 --> 00:11:23,973 Stable for the moment. 326 00:11:23,974 --> 00:11:25,266 How about you? 327 00:11:25,267 --> 00:11:27,644 Perfect vitals, E-FAST negative, off to CT. 328 00:11:27,645 --> 00:11:28,853 Good. 329 00:11:28,854 --> 00:11:30,438 Keep me posted. 330 00:11:30,439 --> 00:11:31,732 Ditto. 331 00:11:35,361 --> 00:11:36,778 How's it going? 332 00:11:36,779 --> 00:11:38,780 Great, if you ignore the hot mess in chairs. 333 00:11:38,781 --> 00:11:40,699 Any update on our little baby Jane Doe? 334 00:11:40,700 --> 00:11:42,701 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 --> 00:11:47,747 You two kiss and make up yet? 337 00:11:47,748 --> 00:11:49,332 I think someone needs to smoke a cigarette. 338 00:11:49,333 --> 00:11:50,750 I'm trying to quit. 339 00:11:50,751 --> 00:11:52,293 Why don't you quit when I'm on my trip? 340 00:11:52,294 --> 00:11:53,545 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 --> 00:11:59,968 Hey, you want in on this betting board? 343 00:11:59,969 --> 00:12:02,929 Look, all you gotta do is pick why Westbridge went down, 344 00:12:02,930 --> 00:12:04,556 how many of their patients we're gonna get, 345 00:12:04,557 --> 00:12:06,182 and when they'll be back in action. 346 00:12:06,183 --> 00:12:08,935 Hey, already up to $500. 347 00:12:08,936 --> 00:12:11,271 Oh, ah, gotta pass. 348 00:12:11,272 --> 00:12:13,440 Still catching up on rehab bills. 349 00:12:13,441 --> 00:12:15,901 Respect. 350 00:12:17,486 --> 00:12:18,653 All right. 351 00:12:18,654 --> 00:12:20,363 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 --> 00:12:32,167 You watch too many movies, man. 355 00:12:32,168 --> 00:12:35,253 Considered the diagnosis of aortic aneurysm 356 00:12:35,254 --> 00:12:37,505 or dissection, but the point-of-care ultrasound was... 357 00:12:37,506 --> 00:12:40,091 You done want that gridlocked granny? 358 00:12:40,092 --> 00:12:42,010 Ordered an acute abdominal series 359 00:12:42,011 --> 00:12:43,261 to rule out obstruction. 360 00:12:43,262 --> 00:12:44,512 - Still waiting on the X-rays. - Great. 361 00:12:44,513 --> 00:12:45,638 Then you're free to treat our latest 362 00:12:45,639 --> 00:12:46,848 and greatest in South 16. 363 00:12:46,849 --> 00:12:49,642 Oh, come on, D, it's like, every time 364 00:12:49,643 --> 00:12:51,227 I get a moment to chart, I barely get 365 00:12:51,228 --> 00:12:53,938 - a sentence out before I get... - Interrupted? 366 00:12:53,939 --> 00:12:55,982 Sucks to be you, but trust me, it sucks worse 367 00:12:55,983 --> 00:12:57,901 for the poor gal in 16. 368 00:12:57,902 --> 00:13:00,653 I'm beginning to think you enjoy torturing me. 369 00:13:00,654 --> 00:13:02,781 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 --> 00:13:13,082 A little shaky. 373 00:13:13,083 --> 00:13:14,083 No surprise. 374 00:13:14,084 --> 00:13:16,252 I've been here since 4:00 AM. 375 00:13:16,253 --> 00:13:17,629 We can get you something for that. 376 00:13:17,630 --> 00:13:18,963 Or I can take care of it myself 377 00:13:18,964 --> 00:13:21,090 if you cut me loose right now. 378 00:13:21,091 --> 00:13:23,259 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 --> 00:13:35,814 I'm already assigned as Louie's treating physician. 382 00:13:35,815 --> 00:13:38,233 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 --> 00:13:47,951 Any changes with our septic waitress? 385 00:13:47,952 --> 00:13:49,077 Not yet. 386 00:13:49,078 --> 00:13:50,161 Wait, if you have a second, I... 387 00:13:50,162 --> 00:13:51,329 I don't. 388 00:13:51,330 --> 00:13:52,747 But the point-of-care ultrasound 389 00:13:52,748 --> 00:13:54,165 was negative for both. 390 00:13:54,166 --> 00:13:56,584 I considered the diagnosis of cauda equina syndrome. 391 00:13:56,585 --> 00:13:59,712 You writing the great American novel? 392 00:13:59,713 --> 00:14:01,673 Charting and supervising. 393 00:14:01,674 --> 00:14:02,715 It's Dana's idea. 394 00:14:02,716 --> 00:14:04,259 Who's the lucky patient? 395 00:14:04,260 --> 00:14:06,135 Unhoused woman with a bad cough. 396 00:14:06,136 --> 00:14:07,929 Ogilvie's all over it. 397 00:14:07,930 --> 00:14:09,305 OK. 398 00:14:09,306 --> 00:14:10,849 Say "eee." 399 00:14:10,850 --> 00:14:12,600 Eee. 400 00:14:12,601 --> 00:14:14,352 OK, deep breath in. 401 00:14:14,353 --> 00:14:16,271 Blow it out real hard. 402 00:14:16,272 --> 00:14:18,022 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 --> 00:14:27,198 Fucking cough is killing me. 405 00:14:27,199 --> 00:14:28,783 You smoke, Mrs. Yardley? 406 00:14:28,784 --> 00:14:30,994 Yeah, but I haven't been able to 407 00:14:30,995 --> 00:14:32,412 for a couple days 'cause of this cough. 408 00:14:32,413 --> 00:14:34,664 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 --> 00:14:44,257 Well, the good news is that your test from earlier 411 00:14:44,258 --> 00:14:46,467 came back negative for both COVID and influenza, 412 00:14:46,468 --> 00:14:48,136 but I'm gonna order a chest X-ray 413 00:14:48,137 --> 00:14:49,679 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 --> 00:14:55,852 Where the fuck else you think I gotta be? 416 00:14:55,853 --> 00:14:57,645 And we're in. 417 00:14:57,646 --> 00:14:59,314 3 grams Keppra over 10 minutes. 418 00:14:59,315 --> 00:15:01,024 That'll prevent another seizure. 419 00:15:01,025 --> 00:15:02,108 Thank you. 420 00:15:02,109 --> 00:15:04,027 Nobody can ever get an IV in her. 421 00:15:04,028 --> 00:15:05,987 Yeah, midline cath is the way to go 422 00:15:05,988 --> 00:15:07,614 when your veins are shot. 423 00:15:07,615 --> 00:15:12,201 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 424 00:15:12,202 --> 00:15:14,913 - OK. - Cold. 425 00:15:14,914 --> 00:15:18,374 Is it possible to get her a blanket and some socks? 426 00:15:18,375 --> 00:15:20,126 Can do. 427 00:15:20,127 --> 00:15:22,670 When was she diagnosed? 428 00:15:22,671 --> 00:15:24,631 Seven years ago. 429 00:15:24,632 --> 00:15:27,216 Resected a lobe. 430 00:15:27,217 --> 00:15:29,761 Four cycles of platinum chemo gave us a couple good years, 431 00:15:29,762 --> 00:15:32,221 but then it spread to the bones. 432 00:15:32,222 --> 00:15:34,432 Has she had radiation therapy? 433 00:15:34,433 --> 00:15:36,893 Shrunk down the mets, but they're still there. 434 00:15:36,894 --> 00:15:38,853 That's why you're at hospice at home. 435 00:15:38,854 --> 00:15:39,854 Yep. 436 00:15:39,855 --> 00:15:41,898 I'm sorry. 437 00:15:41,899 --> 00:15:43,191 Me too. 438 00:15:43,192 --> 00:15:45,777 Ah. 439 00:15:45,778 --> 00:15:46,903 Sorry. 440 00:15:46,904 --> 00:15:48,446 You have kids? 441 00:15:48,447 --> 00:15:50,907 Yeah, two boys. 442 00:15:50,908 --> 00:15:52,992 15 and 9. 443 00:15:52,993 --> 00:15:54,577 My son's 12. 444 00:15:54,578 --> 00:15:56,788 Goes fast. 445 00:15:56,789 --> 00:15:58,623 Too fast. 446 00:15:58,624 --> 00:16:03,252 Swelling and bruising over the distal tibia. 447 00:16:03,253 --> 00:16:05,880 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 --> 00:16:14,639 MS Contin, 30 milligrams twice a day, 450 00:16:14,640 --> 00:16:17,058 oxycodone for breakthrough, and sublingual Actiq 451 00:16:17,059 --> 00:16:20,853 for when it gets really bad. 452 00:16:20,854 --> 00:16:22,021 That's a lot. 453 00:16:22,022 --> 00:16:23,815 You handle her pain meds? 454 00:16:23,816 --> 00:16:24,899 Sometimes. 455 00:16:24,900 --> 00:16:26,776 All the time. 456 00:16:26,777 --> 00:16:29,654 A hospice nurse comes by a few times a week, 457 00:16:29,655 --> 00:16:32,031 but I was alone when she had the seizure. 458 00:16:32,032 --> 00:16:33,992 They told us that it could happen, 459 00:16:33,993 --> 00:16:35,576 but she couldn't breathe. 460 00:16:35,577 --> 00:16:40,039 And I freaked out, and I called 911. 461 00:16:40,040 --> 00:16:42,333 I'm so sorry. 462 00:16:42,334 --> 00:16:46,088 I'm sorry. 463 00:16:55,764 --> 00:16:58,933 Due to your family income, you make too much 464 00:16:58,934 --> 00:17:00,810 to be eligible for either PENNIE 465 00:17:00,811 --> 00:17:03,229 or the hospital's "charity care." 466 00:17:03,230 --> 00:17:05,356 But we can't afford health-care premiums. 467 00:17:05,357 --> 00:17:08,151 It's unfortunately very common for people 468 00:17:08,152 --> 00:17:09,444 to fall between the cracks. 469 00:17:09,445 --> 00:17:11,571 It's an imperfect system. 470 00:17:11,572 --> 00:17:13,740 Can PTMC help with the costs in any way? 471 00:17:13,741 --> 00:17:16,200 We can offer financial assistance. 472 00:17:16,201 --> 00:17:18,036 You'd pay the same that Medicare 473 00:17:18,037 --> 00:17:19,662 and Medicaid would pay. 474 00:17:19,663 --> 00:17:20,788 How much is that? 475 00:17:20,789 --> 00:17:24,709 You pay 60%, we cover 40%. 476 00:17:24,710 --> 00:17:26,085 Thank you. 477 00:17:26,086 --> 00:17:27,921 Uh-huh. 478 00:17:29,131 --> 00:17:31,215 Where have you been? 479 00:17:31,216 --> 00:17:33,718 - How are you doing? - I'm sorry, mijita. 480 00:17:33,719 --> 00:17:36,804 You were being thoughtful, and I just blew up. 481 00:17:36,805 --> 00:17:39,724 Well, Ms. Noelle was just telling us that the hospital 482 00:17:39,725 --> 00:17:41,434 is gonna give us a big discount. 483 00:17:41,435 --> 00:17:44,103 We can knock 40% off your final bill. 484 00:17:44,104 --> 00:17:46,064 - That's great. - Mm-hmm. 485 00:17:46,065 --> 00:17:47,940 I stay here for a few days, 486 00:17:47,941 --> 00:17:50,152 my bill could be over $100,000, right? 487 00:17:51,862 --> 00:17:53,613 Yes, unfortunately. 488 00:17:53,614 --> 00:17:55,698 It could end up being lower, 489 00:17:55,699 --> 00:17:58,117 depending on your level of needed care. 490 00:17:58,118 --> 00:18:00,119 Or higher? 491 00:18:00,120 --> 00:18:04,082 So we would still have to pay $60,000? 492 00:18:04,083 --> 00:18:05,625 Which we don't have. 493 00:18:05,626 --> 00:18:07,835 He has to stay here to get better, right? 494 00:18:07,836 --> 00:18:10,213 - Yes. - No. 495 00:18:10,214 --> 00:18:11,464 Excuse me? 496 00:18:11,465 --> 00:18:13,674 I mean, not necessarily. 497 00:18:13,675 --> 00:18:16,344 Couldn't we just admit him to med-surg instead of ICU? 498 00:18:16,345 --> 00:18:18,179 Wouldn't that be a lot cheaper? 499 00:18:18,180 --> 00:18:20,306 Med-surg won't accept him with an insulin drip. 500 00:18:20,307 --> 00:18:22,100 Usually true. 501 00:18:22,101 --> 00:18:25,770 But let me talk to the charge nurse upstairs, and I'll... 502 00:18:25,771 --> 00:18:26,938 I'll see what she says. 503 00:18:26,939 --> 00:18:28,398 Thank you. 504 00:18:30,400 --> 00:18:32,443 Food poisoning in the hall's asking to leave, 505 00:18:32,444 --> 00:18:34,487 wants to take her kids to the water park. 506 00:18:34,488 --> 00:18:37,031 Those places are cesspools. 507 00:18:37,032 --> 00:18:38,533 Preaching to the choir. 508 00:18:38,534 --> 00:18:40,159 If she's feeling fine on Zofran, she's good to go. 509 00:18:40,160 --> 00:18:41,619 All right. 510 00:18:41,620 --> 00:18:43,538 Louie's in South 15. Meds are coming down. 511 00:18:43,539 --> 00:18:45,540 Another couple hours of monitoring, and he can broom. 512 00:18:45,541 --> 00:18:46,833 Straight to the liquor store. 513 00:18:46,834 --> 00:18:47,959 Don't pass "go." 514 00:18:47,960 --> 00:18:48,960 What about that clamshell case 515 00:18:48,961 --> 00:18:50,419 that went up... anything? 516 00:18:50,420 --> 00:18:52,380 Out of surgery, in recovery, still sedated. 517 00:18:52,381 --> 00:18:54,298 Good. Keep me posted on that. 518 00:18:54,299 --> 00:18:55,634 Will do. 519 00:18:57,845 --> 00:18:59,178 Three times in one day. 520 00:18:59,179 --> 00:19:00,763 To what do we owe the pleasure? 521 00:19:00,764 --> 00:19:02,473 I came down for a consult 522 00:19:02,474 --> 00:19:04,892 and to persuade Ahmad to start a new betting board. 523 00:19:04,893 --> 00:19:06,477 Why, is the Westbridge board full already? 524 00:19:06,478 --> 00:19:08,521 Mm-hmm, was gonna ask him to start one about you 525 00:19:08,522 --> 00:19:10,815 and your midlife crisis trip. 526 00:19:10,816 --> 00:19:12,817 I give it four weeks. 527 00:19:12,818 --> 00:19:15,361 Seven, tops. 528 00:19:15,362 --> 00:19:16,612 Ye of little faith. 529 00:19:16,613 --> 00:19:19,365 Not about faith, just facts. 530 00:19:19,366 --> 00:19:20,658 Facts? 531 00:19:20,659 --> 00:19:22,577 Based on my experience, you're a seven-week-itch 532 00:19:22,578 --> 00:19:24,036 kind of guy. 533 00:19:24,037 --> 00:19:26,247 Hey, Robby, med student's got a pickleball player 534 00:19:26,248 --> 00:19:28,207 in the North Hall with possible Achilles rupture, 535 00:19:28,208 --> 00:19:29,208 asking for your opinion. 536 00:19:29,209 --> 00:19:30,793 Thank you, Perlah. 537 00:19:30,794 --> 00:19:32,880 At least somebody down here has a little faith in me. 538 00:19:35,549 --> 00:19:38,259 You know what Motorcycle Mike's sabbatical is really about? 539 00:19:38,260 --> 00:19:41,137 I never try to guess what's going on in that head of his. 540 00:19:41,138 --> 00:19:44,348 Three months being on the open road by himself. 541 00:19:44,349 --> 00:19:46,517 Man can't stand to be alone for more than a few hours. 542 00:19:46,518 --> 00:19:49,562 He sleeps with the TV on in his bedroom. 543 00:19:49,563 --> 00:19:52,357 I really don't think I needed to know that. 544 00:19:53,817 --> 00:19:56,986 Look, maybe he's looking for something new 545 00:19:56,987 --> 00:19:59,906 or trying to outrun some old ghosts. 546 00:19:59,907 --> 00:20:03,201 Well, I hope he finds what he's looking for. 547 00:20:03,202 --> 00:20:05,369 Man deserves some peace. 548 00:20:05,370 --> 00:20:06,746 Amen. 549 00:20:06,747 --> 00:20:09,415 I considered the diagnosis of cauda equina syndrome, 550 00:20:09,416 --> 00:20:11,250 but the motor and sensory exam 551 00:20:11,251 --> 00:20:13,628 were both intact in the sacral nerve root... 552 00:20:13,629 --> 00:20:14,962 Our unhoused cougher has pneumonia. 553 00:20:14,963 --> 00:20:17,840 I'm cursed, fucking cursed. 554 00:20:17,841 --> 00:20:19,342 Fuck. 555 00:20:19,343 --> 00:20:21,093 What? 556 00:20:21,094 --> 00:20:23,512 That is a cavitary lesion in the right upper lobe. 557 00:20:23,513 --> 00:20:25,306 Active TB. 558 00:20:25,307 --> 00:20:27,642 What's next? 559 00:20:27,643 --> 00:20:29,227 AFB stain to confirm, 560 00:20:29,228 --> 00:20:31,771 move her to a negative airflow room, start her on meds. 561 00:20:31,772 --> 00:20:33,898 Call infection control and public health. 562 00:20:33,899 --> 00:20:36,192 And now you get to sign in as a patient 563 00:20:36,193 --> 00:20:38,653 and get your blood drawn for a QuantiFERON Gold. 564 00:20:38,654 --> 00:20:40,655 It's too soon to be positive. 565 00:20:40,656 --> 00:20:41,822 Yeah, but you were exposed. 566 00:20:41,823 --> 00:20:43,449 You need a baseline test 567 00:20:43,450 --> 00:20:46,661 and then again in eight weeks to see if you convert. 568 00:20:46,662 --> 00:20:47,995 And if I do? 569 00:20:47,996 --> 00:20:50,122 Then meds every day for three or four months 570 00:20:50,123 --> 00:20:53,000 with regular blood tests to check for toxicity. 571 00:20:53,001 --> 00:20:54,335 - Jesus. - All right. 572 00:20:54,336 --> 00:20:55,836 Let Dana know what's up. 573 00:20:55,837 --> 00:20:58,840 And for the love of God, mask up when you move her. 574 00:21:07,391 --> 00:21:09,600 - Dr. Langdon. - Hey, man. Alex. 575 00:21:09,601 --> 00:21:10,727 Let's take a look. 576 00:21:13,355 --> 00:21:16,315 Ah. 577 00:21:16,316 --> 00:21:17,316 Is it bad? 578 00:21:17,317 --> 00:21:18,859 It's not good. 579 00:21:18,860 --> 00:21:21,487 Sorry, your chart says you were burned with dry ice? 580 00:21:21,488 --> 00:21:23,531 - What happened? - My jack-off brother. 581 00:21:23,532 --> 00:21:25,116 Does he not like you? 582 00:21:25,117 --> 00:21:28,744 I asked him to do it, just not like this exactly. 583 00:21:28,745 --> 00:21:30,329 What? Why? 584 00:21:30,330 --> 00:21:31,998 He was gonna brand me like I branded him. 585 00:21:31,999 --> 00:21:33,833 Branded? Like cattle? 586 00:21:33,834 --> 00:21:36,961 Instead of hot branding, you stick the iron in dry ice, 587 00:21:36,962 --> 00:21:39,922 let it get super cold, and then you put it on your skin. 588 00:21:39,923 --> 00:21:41,757 Cool, huh? 589 00:21:41,758 --> 00:21:42,800 You're stupid. 590 00:21:42,801 --> 00:21:44,051 Let's get some LET on this. 591 00:21:44,052 --> 00:21:45,762 I'll get some snips to debride. 592 00:21:48,265 --> 00:21:49,932 You good? 593 00:21:49,933 --> 00:21:52,268 Yeah. Yeah, good. 594 00:21:52,269 --> 00:21:53,686 You sure? 595 00:21:53,687 --> 00:21:56,772 Doesn't seem like Robby's all that happy I'm back. 596 00:21:56,773 --> 00:21:59,400 Well, he's not going to be here, 597 00:21:59,401 --> 00:22:01,193 and I'm happy you're back. 598 00:22:01,194 --> 00:22:03,071 Thanks. 599 00:22:07,451 --> 00:22:11,580 Head and neck CT is negative, except for mandible fracture. 600 00:22:12,539 --> 00:22:13,914 OK, let's get him off the board. 601 00:22:13,915 --> 00:22:15,207 Roll him, right side up. 602 00:22:15,208 --> 00:22:16,918 Hey, we're gonna need the cuffs off. 603 00:22:19,963 --> 00:22:22,798 Ready. And 1, 2, 3. 604 00:22:22,799 --> 00:22:25,176 Ah, gentle. 605 00:22:25,177 --> 00:22:26,844 Dr. King, how are the chest and belly? 606 00:22:26,845 --> 00:22:30,097 We have three anterior rib fractures 607 00:22:30,098 --> 00:22:32,016 and a small pulmonary contusion. 608 00:22:32,017 --> 00:22:33,267 - Not too bad. - Mm-mm. 609 00:22:33,268 --> 00:22:34,977 When do pulmonary contusions peak? 610 00:22:34,978 --> 00:22:36,395 After a few hours. 611 00:22:36,396 --> 00:22:37,938 And do we always admit for three-rib fractures? 612 00:22:37,939 --> 00:22:39,273 In the elderly, yes, 613 00:22:39,274 --> 00:22:41,067 but not if a patient can manage the pain 614 00:22:41,068 --> 00:22:42,986 and doesn't need supplemental oxygen. 615 00:22:44,279 --> 00:22:45,821 OK, he's really hurting here. 616 00:22:45,822 --> 00:22:47,490 You think you could set us up with a serratus anterior 617 00:22:47,491 --> 00:22:48,699 - field block? - No problem. 618 00:22:48,700 --> 00:22:50,826 Oh, as long as that's OK 619 00:22:50,827 --> 00:22:51,994 with Dr. Al-Hashimi. 620 00:22:51,995 --> 00:22:54,121 If the patient consents. 621 00:22:54,122 --> 00:22:58,000 Mr. Varney, we wanna give you a shot to numb your broken ribs 622 00:22:58,001 --> 00:22:59,168 so you can breathe easier. 623 00:22:59,169 --> 00:23:00,419 Uh-huh. 624 00:23:00,420 --> 00:23:02,088 OK, get Mr. Varney prepped and draped. 625 00:23:02,089 --> 00:23:03,672 Dr. Mohan, you're in charge. 626 00:23:03,673 --> 00:23:05,508 Let's identify the landmarks. 627 00:23:05,509 --> 00:23:06,593 Cuffs. 628 00:23:07,969 --> 00:23:09,637 Yeah, you can just leave them off, man. 629 00:23:09,638 --> 00:23:12,556 He's clearly not moving on his own. 630 00:23:12,557 --> 00:23:14,141 We follow protocol, 631 00:23:14,142 --> 00:23:17,437 for his safety and yours. 632 00:23:19,231 --> 00:23:20,898 Do you need to get that? 633 00:23:20,899 --> 00:23:23,734 Nope. It's my mom. 634 00:23:23,735 --> 00:23:25,986 Ignore it. Just ignore it. 635 00:23:25,987 --> 00:23:27,822 - Amen, sister. - Forearm is numb. 636 00:23:27,823 --> 00:23:29,115 We can irrigate. 637 00:23:29,116 --> 00:23:30,699 If I ignore a problem for long enough, 638 00:23:30,700 --> 00:23:32,326 it just goes away, right? 639 00:23:32,327 --> 00:23:34,578 I wish I could ignore my deposition. 640 00:23:34,579 --> 00:23:36,831 That, you can't ignore. 641 00:23:36,832 --> 00:23:38,082 But you'll be fine. 642 00:23:38,083 --> 00:23:39,625 What's up with you, Whitaker? 643 00:23:39,626 --> 00:23:41,127 Trouble in roomie land? 644 00:23:41,128 --> 00:23:42,670 No, not really. 645 00:23:42,671 --> 00:23:45,965 I think I overstepped with Dr. Langdon earlier. 646 00:23:45,966 --> 00:23:47,216 Oh. 647 00:23:47,217 --> 00:23:49,844 He was trying to prescribe a patient benzos, 648 00:23:49,845 --> 00:23:52,763 and I told Langdon that it'd be better if I did it. 649 00:23:52,764 --> 00:23:54,223 Oof. 650 00:23:54,224 --> 00:23:56,600 Only because I was already the assigned physician. 651 00:23:56,601 --> 00:23:58,436 But yeah, now I feel like an asshole. 652 00:23:58,437 --> 00:23:59,687 Langdon's fine. 653 00:23:59,688 --> 00:24:02,064 He went to rehab, he's working the steps, 654 00:24:02,065 --> 00:24:06,610 and hopefully it's all behind him. 655 00:24:06,611 --> 00:24:08,320 Place the needle in-plane, 656 00:24:08,321 --> 00:24:10,197 superficial to the serratus anterior, 657 00:24:10,198 --> 00:24:12,450 between it and the latissimus dorsi. 658 00:24:12,451 --> 00:24:13,784 Mm-hmm. 659 00:24:13,785 --> 00:24:15,953 You can see the fluid dissect and diffuse... 660 00:24:15,954 --> 00:24:17,288 Dr. Mohan, we need you. 661 00:24:17,289 --> 00:24:18,914 We've got two more rigs from Westbridge 662 00:24:18,915 --> 00:24:21,125 pulling up right now. 663 00:24:21,126 --> 00:24:22,626 Go. We got this. 664 00:24:22,627 --> 00:24:23,627 Thanks. 665 00:24:23,628 --> 00:24:26,130 How we doing in here? 666 00:24:26,131 --> 00:24:29,758 Spiked a temp to 102, gave Tylenol. 667 00:24:29,759 --> 00:24:31,510 Check out her leg. 668 00:24:31,511 --> 00:24:33,429 That is a definite bulla. 669 00:24:33,430 --> 00:24:34,889 Did surgery come down yet? 670 00:24:34,890 --> 00:24:36,640 - Not yet. - I need surgery? 671 00:24:36,641 --> 00:24:37,725 Page them again. 672 00:24:37,726 --> 00:24:39,518 Surgery would be a last resort. 673 00:24:39,519 --> 00:24:41,854 We would like them to come down and check out your leg 674 00:24:41,855 --> 00:24:44,440 in case we need to remove this infected skin. 675 00:24:44,441 --> 00:24:45,941 I thought it was just a little swelling 676 00:24:45,942 --> 00:24:46,902 'cause I'm on my feet all day. 677 00:24:48,862 --> 00:24:50,779 BP's down to 85 over 40. 678 00:24:50,780 --> 00:24:52,448 - How much LR is in? - Full bolus. 679 00:24:52,449 --> 00:24:54,074 Do another liter and then start Levophed. 680 00:24:54,075 --> 00:24:55,494 Titrate to a MAP of 65. 681 00:24:56,870 --> 00:24:58,412 Can someone please tell me what's going on? 682 00:24:58,413 --> 00:24:59,497 Pulse ox down to 89. 683 00:24:59,498 --> 00:25:00,998 100% non-rebreather. 684 00:25:00,999 --> 00:25:04,043 Sometimes an infection can cause your blood pressure 685 00:25:04,044 --> 00:25:06,962 to drop and lower the amount of oxygen in your blood. 686 00:25:06,963 --> 00:25:08,130 Am I gonna be OK? 687 00:25:08,131 --> 00:25:09,340 We're doing everything that we can 688 00:25:09,341 --> 00:25:10,633 to make sure that you are. 689 00:25:10,634 --> 00:25:11,843 Jesse. 690 00:25:14,262 --> 00:25:15,638 What's up? 691 00:25:15,639 --> 00:25:16,972 Be ready to intubate if you need to. 692 00:25:16,973 --> 00:25:18,474 - You want me to call Langdon? - No. 693 00:25:18,475 --> 00:25:20,059 I will be right back, and you can call surgery 694 00:25:20,060 --> 00:25:21,769 and tell them to get their heads out of their asses 695 00:25:21,770 --> 00:25:23,355 and get down here. 696 00:25:31,905 --> 00:25:33,322 Did you bring Langdon back here? 697 00:25:33,323 --> 00:25:35,074 No, Al-Hashimi did. 698 00:25:35,075 --> 00:25:36,450 You banished him to scut purgatory. 699 00:25:36,451 --> 00:25:37,618 He did everything you would've done 700 00:25:37,619 --> 00:25:39,245 with that cellulitis patient. 701 00:25:39,246 --> 00:25:40,746 If you think he missed something, tell him. 702 00:25:40,747 --> 00:25:42,331 Well, we're probably gonna need to intubate. 703 00:25:42,332 --> 00:25:43,916 We're definitely gonna need an ICU bed. 704 00:25:43,917 --> 00:25:45,167 What happened? 705 00:25:45,168 --> 00:25:47,336 She is in septic shock, on pressors. 706 00:25:47,337 --> 00:25:49,171 Open shoulder dislocation is back. 707 00:25:49,172 --> 00:25:50,965 Westbridge shut down all their ORs, so they told us 708 00:25:50,966 --> 00:25:52,800 - to bring them back here. - You joking? 709 00:25:52,801 --> 00:25:53,801 This ain't the Radisson. 710 00:25:53,802 --> 00:25:55,010 Not my problem. 711 00:25:55,011 --> 00:25:56,554 - Where should we park him? - Grab a wall. 712 00:25:56,555 --> 00:25:57,972 Call Noelle. Call ortho. 713 00:25:57,973 --> 00:25:59,265 Call the OR and tell them we got a patient back 714 00:25:59,266 --> 00:26:00,808 that needs surgery and admission. 715 00:26:00,809 --> 00:26:02,810 Hey, so sorry about this ambulance tour 716 00:26:02,811 --> 00:26:04,812 of Allegheny County, Mr. Billings, 717 00:26:04,813 --> 00:26:06,438 but we got you from here, I promise. 718 00:26:06,439 --> 00:26:07,815 Yeah, I'm starving. 719 00:26:07,816 --> 00:26:09,316 Is there any way I can get something to eat? 720 00:26:09,317 --> 00:26:11,151 Sorry, not before surgery. 721 00:26:11,152 --> 00:26:12,403 Can I have a visitor? 722 00:26:12,404 --> 00:26:13,904 Sure. 723 00:26:13,905 --> 00:26:15,698 Any word from Gloria about what's going on at Westbridge? 724 00:26:15,699 --> 00:26:17,324 Radio silence from the ivory tower. 725 00:26:17,325 --> 00:26:18,993 And the charge nurse over there isn't responding. 726 00:26:18,994 --> 00:26:20,619 Must be bad. 727 00:26:20,620 --> 00:26:21,996 I wonder if it's something that security needs to know about. 728 00:26:21,997 --> 00:26:23,497 I'll keep you posted. 729 00:26:23,498 --> 00:26:25,291 Hey, you're kind of buds with Gloria. 730 00:26:25,292 --> 00:26:26,584 Did she say anything to you about what's 731 00:26:26,585 --> 00:26:28,335 - happening at Westbridge? - No. You? 732 00:26:28,336 --> 00:26:30,879 Nope. How are your patients? 733 00:26:30,880 --> 00:26:33,299 Our prisoner, Gus, has stable injuries, 734 00:26:33,300 --> 00:26:35,509 and our law student in Central 10 is awake, 735 00:26:35,510 --> 00:26:37,720 normal LP, and awaiting a psych consult. 736 00:26:37,721 --> 00:26:39,054 Good. 737 00:26:39,055 --> 00:26:40,723 Quicker we can treat 'em, street 'em, move 'em 738 00:26:40,724 --> 00:26:42,182 up the food chain, the better. 739 00:26:42,183 --> 00:26:44,268 Question. 740 00:26:44,269 --> 00:26:48,522 Why are you treating me like one of your residents? 741 00:26:48,523 --> 00:26:49,732 I'm not. 742 00:26:49,733 --> 00:26:51,525 As the attending, I like to know the status 743 00:26:51,526 --> 00:26:53,277 of all the patients and doctors in the ED 744 00:26:53,278 --> 00:26:55,571 in case I need to jump in quickly. 745 00:26:55,572 --> 00:26:56,572 Makes sense. 746 00:26:56,573 --> 00:26:58,991 Now your turn. 747 00:26:58,992 --> 00:27:00,326 What? 748 00:27:00,327 --> 00:27:02,453 As your fellow attending in our ED, 749 00:27:02,454 --> 00:27:04,246 it only makes sense for me to know the status 750 00:27:04,247 --> 00:27:06,332 of all the patients and all the doctors 751 00:27:06,333 --> 00:27:09,877 in case I need to jump in on a moment's notice. 752 00:27:09,878 --> 00:27:11,338 Touché. 753 00:27:14,049 --> 00:27:16,675 You have a non-displaced fracture, distal tibia. 754 00:27:16,676 --> 00:27:18,844 So if you look at the bone here, it's pretty well aligned. 755 00:27:18,845 --> 00:27:20,220 Sorry. Hi. 756 00:27:20,221 --> 00:27:22,598 Hi, I was in the shower, and I came as soon 757 00:27:22,599 --> 00:27:23,724 as I got Paul's message. 758 00:27:23,725 --> 00:27:25,351 - Lena? - Hi. 759 00:27:25,352 --> 00:27:27,227 What happened? 760 00:27:27,228 --> 00:27:28,687 I had a seizure. 761 00:27:28,688 --> 00:27:30,314 You load her with Keppra? 762 00:27:30,315 --> 00:27:31,690 Yeah. 763 00:27:31,691 --> 00:27:33,692 Yeah, she's back to baseline mental status. 764 00:27:33,693 --> 00:27:35,944 I'm sorry, I'm confused. Aren't you off duty? 765 00:27:35,945 --> 00:27:39,114 - I'm Roxie's death doula. - Oh. 766 00:27:39,115 --> 00:27:40,824 Her... her what? 767 00:27:40,825 --> 00:27:42,826 I help advocate for people like Roxie 768 00:27:42,827 --> 00:27:45,829 to make their transition to death a more peaceful process. 769 00:27:45,830 --> 00:27:48,832 It's like a birth doula but for the end of life. 770 00:27:48,833 --> 00:27:52,461 She's been a real lifesaver for our family. 771 00:27:52,462 --> 00:27:55,297 My husband cracking jokes while I'm dying. 772 00:27:55,298 --> 00:27:57,049 See why I married him? 773 00:27:57,050 --> 00:27:58,884 Whatever you have to say about my condition, 774 00:27:58,885 --> 00:28:00,803 you can share with Lena too. 775 00:28:00,804 --> 00:28:02,763 We were just explaining that Roxie 776 00:28:02,764 --> 00:28:05,933 has a pathological fracture through a metastatic lesion. 777 00:28:05,934 --> 00:28:07,476 Can you fix that? 778 00:28:07,477 --> 00:28:10,312 The bones are well aligned, so she won't need surgery. 779 00:28:10,313 --> 00:28:11,772 The treatment is immobilization 780 00:28:11,773 --> 00:28:12,940 and a long leg boot. 781 00:28:12,941 --> 00:28:14,692 Oh! 782 00:28:14,693 --> 00:28:16,235 Maybe we up her pain meds. 783 00:28:16,236 --> 00:28:17,778 Yeah, sure. 784 00:28:17,779 --> 00:28:19,154 We can do that. 785 00:28:19,155 --> 00:28:21,448 The bones should heal in about six weeks. 786 00:28:21,449 --> 00:28:23,993 If I live that long. 787 00:28:25,912 --> 00:28:26,954 Still numb here? 788 00:28:26,955 --> 00:28:28,539 Yeah, bro. 789 00:28:28,540 --> 00:28:30,874 Great. 790 00:28:30,875 --> 00:28:32,751 You think it's gonna leave a scar? 791 00:28:32,752 --> 00:28:36,797 I don't think it. I know it. 792 00:28:36,798 --> 00:28:38,590 Holy shit. 793 00:28:38,591 --> 00:28:40,134 Fuck are you doing here? 794 00:28:40,135 --> 00:28:41,135 I'm sorry, who are you? 795 00:28:41,136 --> 00:28:42,261 Concerned brother. 796 00:28:42,262 --> 00:28:44,763 That looks not too bad. 797 00:28:44,764 --> 00:28:46,140 You gooning me? 798 00:28:46,141 --> 00:28:47,766 Yeah, it's nasty. 799 00:28:47,767 --> 00:28:49,184 Thanks to you. 800 00:28:49,185 --> 00:28:50,310 You did this? 801 00:28:50,311 --> 00:28:51,688 Oh, yeah. You wanna see the video? 802 00:28:53,898 --> 00:28:55,858 - Yes. - Definitely. 803 00:28:55,859 --> 00:28:57,235 Got you. 804 00:28:58,528 --> 00:29:00,988 All right. All right, get in close. 805 00:29:00,989 --> 00:29:02,656 Brothers unite! 806 00:29:02,657 --> 00:29:04,366 - Ooh! - Ooh! 807 00:29:04,367 --> 00:29:06,201 Dude, why in the world 808 00:29:06,202 --> 00:29:07,828 would you ask to have that done to you? 809 00:29:07,829 --> 00:29:11,416 He was trying to brand me with our family crest. 810 00:29:13,793 --> 00:29:16,003 Your family crest is the Penguins logo? 811 00:29:16,004 --> 00:29:17,796 We were gonna be bonded for life. 812 00:29:17,797 --> 00:29:19,631 You already are, with DNA. 813 00:29:19,632 --> 00:29:20,799 Yeah. 814 00:29:20,800 --> 00:29:22,342 I love you, man. 815 00:29:22,343 --> 00:29:24,178 - I'm real sorry. - It's OK. 816 00:29:24,179 --> 00:29:27,848 Doc said it's gonna take some time, but it'll heal OK. 817 00:29:27,849 --> 00:29:29,391 Awesome. 818 00:29:29,392 --> 00:29:31,185 So maybe we can try again in a couple of months or... 819 00:29:31,186 --> 00:29:32,604 No. 820 00:29:34,063 --> 00:29:35,732 OK, bag her. 821 00:29:37,776 --> 00:29:39,234 Yellow on the end-tidal. 822 00:29:39,235 --> 00:29:40,986 - Sorry, got backed up. - Sounds a little wet. 823 00:29:40,987 --> 00:29:42,112 Someone asked for a surgical consult? 824 00:29:42,113 --> 00:29:43,363 That's because all the fluid. 825 00:29:43,364 --> 00:29:44,782 TKO the lines for now. 826 00:29:44,783 --> 00:29:47,117 Vent settings 50%, tidal volume 500, AC 12? 827 00:29:47,118 --> 00:29:48,494 Yep, that's perfect. 828 00:29:48,495 --> 00:29:49,828 Surgery here. Hello. 829 00:29:49,829 --> 00:29:51,413 Hey, it's about time. Where's Garcia? 830 00:29:51,414 --> 00:29:53,248 Stuck in the ER. She sent me down. What you got? 831 00:29:53,249 --> 00:29:54,708 Septic shock, respiratory failure, 832 00:29:54,709 --> 00:29:56,376 and possible necrotizing fasciitis. 833 00:29:56,377 --> 00:29:58,128 She needs to go to the OR ASAP. 834 00:29:58,129 --> 00:30:00,380 The infection was isolated to the dorsum of the foot 835 00:30:00,381 --> 00:30:02,007 five hours ago, but now we're almost to the knee 836 00:30:02,008 --> 00:30:03,675 with bullae, crepitus, and edema. 837 00:30:03,676 --> 00:30:05,344 - Yeah. - You seen nec fasc before? 838 00:30:05,345 --> 00:30:06,553 In a textbook. 839 00:30:06,554 --> 00:30:08,681 I was a med student two weeks ago. 840 00:30:10,558 --> 00:30:13,143 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 841 00:30:13,144 --> 00:30:14,812 Go get anybody else from your service down here... 842 00:30:14,813 --> 00:30:16,104 Shamsi, Miller, Walsh... 843 00:30:16,105 --> 00:30:17,231 I don't know any of this people, but... 844 00:30:17,232 --> 00:30:18,607 Don't take this personally. 845 00:30:18,608 --> 00:30:21,652 I just need a fucking grown-up down here. 846 00:30:21,653 --> 00:30:23,612 Nice job on the sub-Qs. 847 00:30:23,613 --> 00:30:25,364 Really took the tension off the wound. 848 00:30:25,365 --> 00:30:26,448 Thanks. 849 00:30:26,449 --> 00:30:28,116 I can help with the skin layer. 850 00:30:28,117 --> 00:30:30,078 Four hands are faster than two. 851 00:30:32,539 --> 00:30:33,956 - Whoa. - Whoa. 852 00:30:33,957 --> 00:30:36,291 That just tore right through the skin. 853 00:30:36,292 --> 00:30:37,626 You may need to take bigger bites 854 00:30:37,627 --> 00:30:39,336 farther away from the wound edges. 855 00:30:39,337 --> 00:30:41,672 Yep. 856 00:30:41,673 --> 00:30:44,968 Skin seems pretty fragile. 857 00:30:49,097 --> 00:30:50,556 Oh. 858 00:30:50,557 --> 00:30:52,224 Yeah, this is not working. 859 00:30:52,225 --> 00:30:54,184 He has the skin strength of an 80-year-old. 860 00:30:54,185 --> 00:30:56,353 Put down Steri-Strips with benzoin, 861 00:30:56,354 --> 00:30:59,648 not across the wound but along each wound edge, both sides. 862 00:30:59,649 --> 00:31:01,191 It'll hold the sutures. 863 00:31:01,192 --> 00:31:04,653 - Yup. - What say you, Dr. Robby? 864 00:31:04,654 --> 00:31:06,613 Great. MacGyver move. 865 00:31:06,614 --> 00:31:09,533 Go for it. 866 00:31:09,534 --> 00:31:13,287 Does a Dr. MacGyver work here? 867 00:31:13,288 --> 00:31:15,789 I don't know. 868 00:31:15,790 --> 00:31:17,749 The patient symptoms are consistent with lumbar 869 00:31:17,750 --> 00:31:21,712 radiculopathy at L4, L5, most likely due to disc herniation. 870 00:31:21,713 --> 00:31:23,213 Coughing patient admitted to isolation 871 00:31:23,214 --> 00:31:25,173 for verified medication administration 872 00:31:25,174 --> 00:31:26,550 and started on RIPE therapy. 873 00:31:26,551 --> 00:31:28,093 Yeah, why do I even bother? 874 00:31:28,094 --> 00:31:29,136 Just fail me now. 875 00:31:29,137 --> 00:31:30,304 OK. 876 00:31:30,305 --> 00:31:31,805 Get in touch with a social worker. 877 00:31:31,806 --> 00:31:33,307 They're gonna wanna do contact tracing 878 00:31:33,308 --> 00:31:35,142 and help her figure out transitional housing 879 00:31:35,143 --> 00:31:36,518 for when she's discharged. 880 00:31:36,519 --> 00:31:37,853 Got it. 881 00:31:37,854 --> 00:31:39,813 And make sure infection control responded. 882 00:31:39,814 --> 00:31:41,273 The people in the waiting room could have been exposed. 883 00:31:41,274 --> 00:31:44,610 They need to be notified and tested. 884 00:31:44,611 --> 00:31:45,861 OK. 885 00:31:45,862 --> 00:31:48,780 Relax. 886 00:31:48,781 --> 00:31:51,033 You can take the mask off. You don't have TB. 887 00:31:51,034 --> 00:31:54,161 At least not yet. 888 00:31:54,162 --> 00:31:56,747 Oh, great. 889 00:31:56,748 --> 00:31:59,666 This is fucked up. 890 00:31:59,667 --> 00:32:01,960 How are you so calm? 891 00:32:01,961 --> 00:32:03,629 Expected job hazard. 892 00:32:03,630 --> 00:32:04,880 You get used to it. 893 00:32:04,881 --> 00:32:06,465 Yeah, no, thanks. 894 00:32:06,466 --> 00:32:09,051 70% of doctors in training at urban hospitals 895 00:32:09,052 --> 00:32:11,386 get exposed to TB and wind up on meds. 896 00:32:11,387 --> 00:32:13,722 - Jesus. - Mm-hmm. 897 00:32:13,723 --> 00:32:16,099 They don't teach you that in med school. 898 00:32:16,100 --> 00:32:18,268 Mrs. Randolph's back. 899 00:32:18,269 --> 00:32:20,145 Pulled up her X-ray. 900 00:32:20,146 --> 00:32:21,313 OK. 901 00:32:21,314 --> 00:32:23,440 No volvulus, no air fluid levels. 902 00:32:23,441 --> 00:32:26,026 What do you think of this? 903 00:32:26,027 --> 00:32:28,111 Fecal material? 904 00:32:28,112 --> 00:32:29,821 A shit ton. 905 00:32:29,822 --> 00:32:31,448 Sorry, had to be said. 906 00:32:31,449 --> 00:32:33,033 So, what, she needs an enema? 907 00:32:33,034 --> 00:32:34,618 No. Tried and failed, remember? 908 00:32:34,619 --> 00:32:35,619 Yeah. 909 00:32:35,620 --> 00:32:37,287 Time to dig in. 910 00:32:37,288 --> 00:32:38,914 How are we gonna do that? 911 00:32:38,915 --> 00:32:42,835 Oh, there is no "we" in disimpaction. 912 00:32:47,799 --> 00:32:50,050 I haven't done one before. 913 00:32:50,051 --> 00:32:53,011 Shouldn't I observe first? 914 00:32:53,012 --> 00:32:55,556 I know just the guy to teach you. 915 00:33:04,816 --> 00:33:07,651 I spoke to the charge nurse in med-surg. 916 00:33:07,652 --> 00:33:08,944 They can take Orlando today. 917 00:33:08,945 --> 00:33:10,737 - Yes! - That's wonderful. 918 00:33:10,738 --> 00:33:12,322 They know he's on an insulin drip? 919 00:33:12,323 --> 00:33:14,866 They know, and they can change to a SQUID protocol. 920 00:33:14,867 --> 00:33:15,867 SQUID? 921 00:33:15,868 --> 00:33:17,619 Sub-Q insulin in DKA. 922 00:33:17,620 --> 00:33:19,329 So no IV drip? 923 00:33:19,330 --> 00:33:22,124 Just shots of short-acting insulin every four hours prn. 924 00:33:22,125 --> 00:33:25,544 The med-surg nurses have time to check a glucose every hour? 925 00:33:25,545 --> 00:33:26,545 They say so. 926 00:33:26,546 --> 00:33:28,588 And five days on med-surge 927 00:33:28,589 --> 00:33:32,342 is gonna cut your hospital bill down by 2/3. 928 00:33:32,343 --> 00:33:34,219 OK. 929 00:33:34,220 --> 00:33:36,096 So what's that gonna cost? 930 00:33:36,097 --> 00:33:37,514 Well, I can't give you an exact amount, 931 00:33:37,515 --> 00:33:39,599 but roughly $35,000. 932 00:33:39,600 --> 00:33:42,728 So after about 40%, I'll still have to pay, 933 00:33:42,729 --> 00:33:44,563 what, like, 20 grand? 934 00:33:44,564 --> 00:33:46,815 The hospital can work out a payment plan. 935 00:33:46,816 --> 00:33:48,525 Orlando, we'll be OK. 936 00:33:48,526 --> 00:33:50,068 We'll figure it out. 937 00:33:50,069 --> 00:33:52,529 I'll take on extra shifts at the coffee shop. 938 00:33:52,530 --> 00:33:55,532 We got you, Dad. 939 00:33:55,533 --> 00:33:58,744 Let's give you some private time with your family. 940 00:33:58,745 --> 00:34:01,246 Thanks. 941 00:34:01,247 --> 00:34:02,873 Sorry. Thank you. 942 00:34:02,874 --> 00:34:04,458 I was worried he might bail. 943 00:34:04,459 --> 00:34:05,709 My pleasure. 944 00:34:05,710 --> 00:34:07,419 The real thanks goes to the newbie here 945 00:34:07,420 --> 00:34:09,088 for thinking outside the box. 946 00:34:11,841 --> 00:34:13,759 Sorry I doubted your med-surg pitch. 947 00:34:13,760 --> 00:34:15,343 Oh, no sweat. 948 00:34:15,344 --> 00:34:17,554 How'd you think of that? 949 00:34:17,555 --> 00:34:20,223 My family had to think of a lot of creative ways 950 00:34:20,224 --> 00:34:23,268 to help my uninsured grandma. 951 00:34:23,269 --> 00:34:24,811 Leukemia. 952 00:34:24,812 --> 00:34:28,148 System doesn't work for you, you gotta work the system. 953 00:34:28,149 --> 00:34:30,400 She survive? 954 00:34:30,401 --> 00:34:32,611 For a while, till she didn't. 955 00:34:32,612 --> 00:34:35,072 She died before my freshman year in college. 956 00:34:35,073 --> 00:34:37,407 Sorry. 957 00:34:37,408 --> 00:34:39,576 Her death taught me a lot. 958 00:34:39,577 --> 00:34:42,455 Mainly that I don't wanna be around people dying. 959 00:34:44,332 --> 00:34:47,000 So they got her, and we can get out of here soon? 960 00:34:47,001 --> 00:34:48,460 Yeah. Oh, I think so. 961 00:34:48,461 --> 00:34:49,878 - I think so, yeah. - OK. 962 00:34:49,879 --> 00:34:53,131 Hi. 963 00:34:53,132 --> 00:34:55,717 Morphine PCA looks ready to go. 964 00:34:55,718 --> 00:34:57,719 This should do the trick. 965 00:34:57,720 --> 00:34:59,137 Do you notice a difference? 966 00:34:59,138 --> 00:35:00,138 Better. 967 00:35:00,139 --> 00:35:02,641 Oh, great. Great. 968 00:35:02,642 --> 00:35:04,392 How does this thing work? 969 00:35:04,393 --> 00:35:06,812 There's a baseline rate of morphine. 970 00:35:06,813 --> 00:35:08,855 And if you're having pain, you can push this button. 971 00:35:08,856 --> 00:35:09,856 You'll get some extra. 972 00:35:09,857 --> 00:35:11,191 And you can push for another dose 973 00:35:11,192 --> 00:35:12,651 every 10 minutes if needed. 974 00:35:12,652 --> 00:35:14,821 Your very own morphine butler. 975 00:35:17,406 --> 00:35:18,573 Amazing. 976 00:35:18,574 --> 00:35:20,117 She can go home with this? 977 00:35:20,118 --> 00:35:21,660 Yeah. 978 00:35:21,661 --> 00:35:23,787 Though you'll need more equipment for the house 979 00:35:23,788 --> 00:35:25,997 now that she can't bear weight on her leg. 980 00:35:25,998 --> 00:35:27,916 OK. Like what? 981 00:35:27,917 --> 00:35:32,087 A wheelchair to go to the bathroom, a shower chair, 982 00:35:32,088 --> 00:35:34,297 wall bars, if you don't already have them. 983 00:35:34,298 --> 00:35:37,425 And a hospital bed could be helpful too. 984 00:35:37,426 --> 00:35:38,760 How do we get all that? 985 00:35:38,761 --> 00:35:40,637 You don't. I do. 986 00:35:40,638 --> 00:35:42,514 I will get everything so that the two of you 987 00:35:42,515 --> 00:35:44,724 can get out of here and back to the kids. 988 00:35:44,725 --> 00:35:46,811 - At home. - Thank you. 989 00:35:53,901 --> 00:35:55,861 Nice of you to join us, Huckleberry. 990 00:35:55,862 --> 00:35:57,154 What do you need? 991 00:35:57,155 --> 00:35:58,906 Some help with a disimpaction. 992 00:36:00,783 --> 00:36:02,826 That is a med student procedure. 993 00:36:02,827 --> 00:36:04,244 Oh, you know the old adage... 994 00:36:04,245 --> 00:36:06,496 see one, do one, teach one. 995 00:36:06,497 --> 00:36:08,748 Say hello to teaching young Ogilvie here. 996 00:36:08,749 --> 00:36:11,418 OK. 997 00:36:11,419 --> 00:36:13,545 - Double glove, Ogilvie. - All right. 998 00:36:13,546 --> 00:36:15,046 Mrs. Randolph, we're going to need 999 00:36:15,047 --> 00:36:17,674 to manually unblock your rectum so that we can 1000 00:36:17,675 --> 00:36:19,176 get your bowels moving again. 1001 00:36:19,177 --> 00:36:20,177 I know. 1002 00:36:20,178 --> 00:36:22,929 Here we go. 1003 00:36:22,930 --> 00:36:26,057 Mrs. Randolph, I would like you to relax 1004 00:36:26,058 --> 00:36:28,977 like you're having a bowel movement. 1005 00:36:28,978 --> 00:36:31,563 Nice and deep. 1006 00:36:31,564 --> 00:36:33,857 OK. 1007 00:36:33,858 --> 00:36:38,069 Curve the finger like an ice cream scoop. 1008 00:36:38,070 --> 00:36:42,699 And bring it out. 1009 00:36:42,700 --> 00:36:44,452 You're up, Ogilvie. 1010 00:36:48,748 --> 00:36:50,957 Some more pressure, Mrs. Randolph. 1011 00:36:50,958 --> 00:36:52,418 I'm ready. 1012 00:36:59,175 --> 00:37:03,303 And here I thought you weren't a quick study. 1013 00:37:03,304 --> 00:37:05,222 Keep going. 1014 00:37:05,223 --> 00:37:07,432 Mrs. Randolph, in order to prevent this 1015 00:37:07,433 --> 00:37:08,850 from happening again, I think you 1016 00:37:08,851 --> 00:37:10,435 need a better stool softener. 1017 00:37:10,436 --> 00:37:11,978 You can try MiraLAX. 1018 00:37:11,979 --> 00:37:14,522 Just a tablespoon with a big glass of water every morning 1019 00:37:14,523 --> 00:37:15,523 should do the trick. 1020 00:37:15,524 --> 00:37:16,651 OK. 1021 00:37:18,945 --> 00:37:19,945 Oh. 1022 00:37:19,946 --> 00:37:21,529 Sorry. 1023 00:37:21,530 --> 00:37:22,697 Passing gas is good. 1024 00:37:22,698 --> 00:37:24,407 Means we're making progress. 1025 00:37:24,408 --> 00:37:26,117 Does that mean that I can... I can stop? 1026 00:37:26,118 --> 00:37:27,870 No. Nope. Keep going. 1027 00:37:32,917 --> 00:37:36,169 OK, Ogilvie, you... you might wanna... 1028 00:37:36,170 --> 00:37:37,880 Oh! 1029 00:37:41,759 --> 00:37:43,261 Much better. 1030 00:37:44,303 --> 00:37:46,304 MAP's holding on Levophed. 1031 00:37:46,305 --> 00:37:48,265 1 mike per kg per minute. 1032 00:37:48,266 --> 00:37:49,474 Do me a favor. 1033 00:37:49,475 --> 00:37:50,684 Give me some 4x4s on some Betadine. 1034 00:37:50,685 --> 00:37:51,977 Sorry, we're getting killed 1035 00:37:51,978 --> 00:37:53,395 with transfers from Westbridge. 1036 00:37:53,396 --> 00:37:55,563 Mesenteric ischemia, perforated bowel. 1037 00:37:55,564 --> 00:37:56,564 Got a hot one here. 1038 00:37:56,565 --> 00:37:57,565 Yeah. 1039 00:37:57,566 --> 00:37:58,692 Possible nec fasc. 1040 00:37:58,693 --> 00:38:00,068 Possible? 1041 00:38:00,069 --> 00:38:01,444 Need CT with contrast to confirm. 1042 00:38:01,445 --> 00:38:03,154 This is spreading like wildfire. 1043 00:38:03,155 --> 00:38:04,531 By the time you get your CT, it's gonna be up to her waist. 1044 00:38:04,532 --> 00:38:05,615 She's gonna need a hemicorporectomy. 1045 00:38:05,616 --> 00:38:06,950 She needs a CT scan. 1046 00:38:06,951 --> 00:38:09,619 How about a stainless steel scan? 1047 00:38:09,620 --> 00:38:11,830 For Christ's sake. Robinavitch! 1048 00:38:11,831 --> 00:38:15,292 Robby, what the fuck are you doing? 1049 00:38:15,293 --> 00:38:17,002 Oh, God, I think I might puke. 1050 00:38:17,003 --> 00:38:19,462 That's called dirty dishwater exudate without purulence. 1051 00:38:19,463 --> 00:38:21,673 There's a gray appearance to the fascia, and in the OR, 1052 00:38:21,674 --> 00:38:23,883 you'll see easy separation in the tissue planes. 1053 00:38:23,884 --> 00:38:25,218 When do you start your sabbatical? 1054 00:38:25,219 --> 00:38:26,970 - Tomorrow. - Not a moment too soon. 1055 00:38:26,971 --> 00:38:28,889 Thanks for coming down. 1056 00:38:32,101 --> 00:38:35,687 I'm catching up on my charting as fast as I can. 1057 00:38:35,688 --> 00:38:38,565 Why don't you give my generative AI app a try? 1058 00:38:38,566 --> 00:38:41,067 It's 30% more efficient, and providers report 1059 00:38:41,068 --> 00:38:42,944 increased job satisfaction. 1060 00:38:42,945 --> 00:38:45,947 And you'll rarely have to stay overtime to complete charts. 1061 00:38:45,948 --> 00:38:47,699 Yeah? 1062 00:38:47,700 --> 00:38:48,992 OK. 1063 00:38:48,993 --> 00:38:50,577 Yeah, I'm usually here at least a couple hours 1064 00:38:50,578 --> 00:38:52,454 after every shift trying to catch up, so... 1065 00:38:52,455 --> 00:38:54,873 Sure, AI will make doctors more efficient, 1066 00:38:54,874 --> 00:38:57,167 but hospitals will expect us to treat more patients 1067 00:38:57,168 --> 00:38:59,169 without any extra pay, of course, 1068 00:38:59,170 --> 00:39:00,962 all the while eliminating staff positions 1069 00:39:00,963 --> 00:39:02,672 for attending and residents. 1070 00:39:02,673 --> 00:39:04,257 Oh, Dr. Robby, I am not an advocate 1071 00:39:04,258 --> 00:39:06,384 for erasing my own profession. 1072 00:39:06,385 --> 00:39:09,888 But I am advocating for getting to spend more time with my son. 1073 00:39:09,889 --> 00:39:12,849 Nothing can replace family. 1074 00:39:12,850 --> 00:39:14,851 What's the status of your septic patient? 1075 00:39:14,852 --> 00:39:17,645 Nec fasc. Surgery's taking her up. 1076 00:39:17,646 --> 00:39:20,190 Think they'll be able to save her leg? 1077 00:39:20,191 --> 00:39:22,150 Right now, I'm just hoping they can save her life. 1078 00:39:22,151 --> 00:39:24,736 Hey, how's Ogilvie doing? 1079 00:39:24,737 --> 00:39:28,573 A little TB exposure, a touch of ass-plosion. 1080 00:39:28,574 --> 00:39:30,700 All in all, pretty good day so far. 1081 00:39:30,701 --> 00:39:31,993 Kaison, you came. 1082 00:39:31,994 --> 00:39:33,536 Hey, ain't no way I was gonna let you 1083 00:39:33,537 --> 00:39:35,455 miss Peter and Aubrey's epic Fourth of July party. 1084 00:39:35,456 --> 00:39:37,665 Come on, now. Hey. 1085 00:39:37,666 --> 00:39:39,334 Brought some brew. 1086 00:39:39,335 --> 00:39:40,710 Oh, you are the man. 1087 00:39:40,711 --> 00:39:42,170 Appreciate the bromance over here, 1088 00:39:42,171 --> 00:39:44,506 but no food 'cause you might go into surgery. 1089 00:39:44,507 --> 00:39:47,093 And no beer 'cause we're a goddamn hospital. 1090 00:39:50,721 --> 00:39:52,931 Starting your sabbatical early? 1091 00:39:52,932 --> 00:39:54,766 I know someone who could really use a drink right now. 1092 00:39:54,767 --> 00:39:56,059 In the hospital? 1093 00:39:56,060 --> 00:39:58,479 As a parting gift. 1094 00:40:02,525 --> 00:40:04,150 How's it looking? 1095 00:40:04,151 --> 00:40:05,402 Good. 1096 00:40:05,403 --> 00:40:07,362 The Steri-Strips did the trick. 1097 00:40:07,363 --> 00:40:08,488 CT's ready. 1098 00:40:08,489 --> 00:40:10,115 We already scanned him. 1099 00:40:10,116 --> 00:40:12,492 Head and neck want thin cuts and a 3D reconstruction 1100 00:40:12,493 --> 00:40:14,494 of the mandible before they decide 1101 00:40:14,495 --> 00:40:15,954 if Mr. Varney needs surgery. 1102 00:40:15,955 --> 00:40:17,872 Have they even come down to examine him in person? 1103 00:40:17,873 --> 00:40:19,457 No, they must be backed up. 1104 00:40:19,458 --> 00:40:23,253 Or there's a July Fourth sale at the BMW dealership. 1105 00:40:23,254 --> 00:40:24,546 Labs are back. 1106 00:40:24,547 --> 00:40:26,381 Albumin's low. Total protein's low. 1107 00:40:26,382 --> 00:40:27,966 He also has megaloblastic anemia. 1108 00:40:27,967 --> 00:40:29,217 - Malnutrition. - Probably. 1109 00:40:29,218 --> 00:40:30,385 Jail cuisine. 1110 00:40:30,386 --> 00:40:31,761 Whitaker, what labs should we add? 1111 00:40:31,762 --> 00:40:33,888 B12, folate, iron levels. 1112 00:40:33,889 --> 00:40:35,390 Good. 1113 00:40:35,391 --> 00:40:37,016 We're gonna run some more tests, Mr. Varney. 1114 00:40:37,017 --> 00:40:38,352 Hang in there. 1115 00:40:42,982 --> 00:40:45,483 I have to pee. 1116 00:40:45,484 --> 00:40:46,943 There's no PureWick here. 1117 00:40:46,944 --> 00:40:48,194 But here you go, hon. 1118 00:40:48,195 --> 00:40:50,155 - I'll help you get on. - No. No. 1119 00:40:50,156 --> 00:40:52,574 No bedpan. I can walk to the bathroom. 1120 00:40:52,575 --> 00:40:54,242 - I just need a little help. - Are you sure? 1121 00:40:54,243 --> 00:40:55,326 I'm here, babe. 1122 00:40:55,327 --> 00:40:56,828 Oh, we got this Mr. Hamler. 1123 00:40:56,829 --> 00:41:00,081 You'll have to bring your IV and portable oxygen. 1124 00:41:00,082 --> 00:41:02,083 Please? 1125 00:41:02,084 --> 00:41:04,502 I'll grab a wheelchair. 1126 00:41:04,503 --> 00:41:06,463 Let's try to sit you up and dangle your legs. 1127 00:41:06,464 --> 00:41:07,923 OK. 1128 00:41:10,634 --> 00:41:13,971 1, 2, 3. 1129 00:41:19,685 --> 00:41:21,394 This is not a good idea. 1130 00:41:21,395 --> 00:41:23,521 I don't think we're gonna need this. 1131 00:41:23,522 --> 00:41:25,148 Hey, Paul, Paul, 1132 00:41:25,149 --> 00:41:27,317 why don't you come grab a cup of coffee with me? 1133 00:41:27,318 --> 00:41:29,277 I'm still zonked from my all-nighter, 1134 00:41:29,278 --> 00:41:32,947 and I wanna go over some delivery instructions with you. 1135 00:41:32,948 --> 00:41:35,617 Sure. 1136 00:41:35,618 --> 00:41:37,494 Rox, you OK? 1137 00:41:37,495 --> 00:41:40,331 - Mm-hmm. - Yeah. It's OK. 1138 00:41:47,046 --> 00:41:49,006 Bedpan it is. 1139 00:41:57,014 --> 00:41:58,807 You lose your pulse ox again, bud? 1140 00:42:04,438 --> 00:42:05,855 Louie. 1141 00:42:05,856 --> 00:42:07,732 Louie! 1142 00:42:07,733 --> 00:42:10,318 He kept pulling off his pulse ox. 1143 00:42:10,319 --> 00:42:11,736 It's on. It's at 71. 1144 00:42:11,737 --> 00:42:13,155 Louie, wake up. 1145 00:42:14,782 --> 00:42:16,574 - I'm not getting a carotid. - I got the airway. 1146 00:42:16,575 --> 00:42:19,662 Hey, Perlah, crash cart, intubation tray, please.