All language subtitles for The Pitt - 1x08

Next time, maybe inform the department
chair before the shit hits the fan. I

on my way to tell you.

Make sure you get everything you need.
Okay, let's do this.

IT called me up because I've trained in
cyber attack prevention and response.

You can tell everybody what to do.

No, thank you. That's if it comes from
the department chair. Oh, you think?

All right, everybody, circle up.

What the fuck? We may have had a cyber
attack.

No, we shut down to prevent a cyber
attack.

Okay, everybody settle down. Listen up.
As you can see, we're doing a little

redecorating in the central work area.

Our hospital computers are at risk for a
cyber attack, so we are going old

school analog.

For how long? Great question. Our IT
department has shut everything down to

them time to bolster our cyber defenses.

I believe the question was for how long?

Hard to say. Could be up to 24 hours.

Jesus. So, first order of business, we
need to replicate the electronic patient

boards on these dry erase boards, so
please, somebody tell me they got a

of the boards. Uh, yeah, yeah, yeah,
right here.

Fuck. Oh, uh... It's a little blurry.

More than a little blurry.

Sorry. Oh, my God.

I remember.

Great. If everybody else can remember
their patient names and their room

numbers, that would be awesome. No, I
mean I can remember all of it.

All of what?

Names, doctors, room numbers.

I kind of have a photographic memory.

Seriously, the whole board?

Central 12, hologram, headache,
abdominal pain, ASL only. Oh, shit, I

interpreter waiting for me. Okay, for
patient privacy, all chief complaints

be abbreviated, so HA for headache, AP
for abdominal pain, and so forth.

Central 10, Jackson Davis, nuance at
psychosis, Javadi, psych admission.

Greek letter Psi for psych?

He eats his baby Jane. Doe fever. Dr.
Mohan awaiting admission orders.

Nurses need to convert to a zone
defense.

North, Central, South, trauma.

Where's Dana?

In with a sexual assault case.

She can't leave until the exam is
finished. Yeah, it can be a while.

has charge nurse experience.

Not really. Great idea.

Princess it is. You can make the nursing
assignment.

Next. Central 9, Roxy Hamler, and stage
1 cancer.

Sir, do we have to stand here while she
recites on board? No. In fact, go check

on your patients and then please come
back here.

Thank you.

How many hours a day are you on your
laptop?

At least eight hours. I work from home.

And are you at a desk all day?

No, no. I will either sit on the sofa or
sometimes I'll be in bed, kind of

sitting up with the computer on my lap,
that kind of thing. So you're always

looking down at the screen?

Yeah. Okay.

I'm going to check the muscles in your
neck.

Ow, that hurts.

All right, well, I think we can help.

Come on over.

Okay, gather up.

Listen up, everybody. This is our chart
rack. So as you can see, each slot and

clipboard has a room number on it. When
you pick up a new patient, you grab a

fresh chart from the T -system.

Pick your chart by chief complaint.

Use the cartoon to find it. Why are
there two bodies?

Trauma on the left, medical on the
right. So head injury, you go left.

go right.

Is this fish swimming in seaweed?

No, that is bees and grass. It's a
section for insect bites, skin rash,

allergies. Okay, let's say, for example,
Dr. Alishimi has a new patient with

belly pain.

For the history, circle the positive,
like vomiting and diarrhea.

Backslash the negative, such as recent
travel, sick contact, fever.

For physical exam, checkmark normals on
the left and circle any abnormal

findings on the right. Questions? Is
your regenerative AI program still going

be working?

Not for a while.

And ditch your Spectralink phones.
There's your voice over internet.

PGMC emergency.

Go ahead, medic command.

That is how we will hear about incoming
runs.

Thanks. Two minutes out with abdominal
pain and fever. Okay, has everybody got

that so far? How do we write orders?

Physician order form and triplicate
labs, x -rays, IV, fluid, medication.

Will the lab still be able to run blood
tests? Yes.

Are the CT scanners still working? Yes,
but the results will come back on paper

from the radiologist. This is the dark
ages. So if you have orders with labs or

x -rays, they go into the clerk file
here. They will sign them off. They will

add a downtime slip on them, make sure
they go to the correct department.

I'm sorry, who are the clerks? You're
looking at... Larry and Antoine are

filling in until more help arrives.

Gotcha. After the clerk orders, chart
gets moved to the nursing order rack

for IVs, medications, procedures.

Our medications are locked up in the
PDS. The PDS is getting unlocked by a

clinical pharmacist, Dr. Megan Nord.
We've got your back. This is the lock.

questions? Yes.

No. What's up with the third rack? When
your patient is ready to be discharged,

chart goes here.

Just like everybody know, we're about to
have an open bed. Oh, your tuna melted

up. Jesse?

What is that?

That is a fax machine.

They still make those? This is our
lifeline to labs and x -rays. When the

results come back, they will fax to us,
and the clerks will put them on the

charts. Yes?

If you say so.

Incoming!

Okay, Dr.

McKay, Dr.

Whitaker, overview with me. The rest of
you, build your clipboards.

Howard Knox, 52, abdominal pain and
fever, 152 over 90, tachy at 120,

get an IV.

I wonder why.

Hello, sir, my name is Dr. Robbie.

Howard. This is a teaching hospital.

I'll be supervising Drs. McKay and Dr.
Whitaker through to Dr. Ogilvie. Hello.

How are you feeling? Not so great. Okay.
Princess, what's free? Trouble one.

Herla.

My orders for Mylanta and Bupivacan
Central 12.

We're on the spot, Dr. Santos.

And you need a sticker.

Put it in the nursing orders rack and
meet me over at PDS.

How much does this suck?

You didn't think today could get any
worse?

This is how we roll when I was a
resident.

Was that in the 1900s? Yeah, when cards
were written by candlelight.

Hey, today we'll be an inventor. Think
of it like back to the... Or

possibly Titanic.

Here is your antacid. Cheers.

And I marked the trigger point that is
bringing out your headache, and a shot

local anesthetic in that area could
really help.

Yeah, let's do it. Great.

You... You are going to feel a little
pinprick and some burning.

Ow, ow, that really hurts.

Temp 101 .4, tacky at 128, pulse flux 92
on 2 liters. When did the pain start?

It's been on and off for about a week.
And where do you feel it? All over.

Stern on the left, and then there's some
on the right. How about that fever?

Since last night, I was burning up.

Then I had chills pretty bad. Can't find
a vein here. We'll try for midline. Let

us know if this hurts.

Sorry. On this side?

Yeah, yeah. Sorry, sorry.

Guarding with no rigidity for pain, 100
of fentam.

Plan, Dr. Whitaker.

Blood cultures, lactate, zosyn. We're
going to need a CT to figure out what's

going on.

Uh -uh.

Yeah, it's not going to work. Yep, right
neatly. Tenmanship count. Howard, for

the scan, we're going to have to lay you
flat on your back. Can you do that?

I could 10 years ago, but now it's too
hard to breathe. If we can't lay you

flat, then we're going to have to put a
tube in your windpipe to help you

breathe. Are you okay with that?
Intubation with rapid sequence

we can't lay him down. The tube will go
in your nose while you're awake, sir.

Right. Does it hurt?

You'll be numbed up completely. You
won't feel any discomfort. Do you happen

know your weight?

A little over 400.

When was the last time you checked?

It's been a while. Is it possible that
you might be over 450?

Possibly.

Carla, let's call for the Hoyer.

So we're going to place the tube and get
you ready for the scan.

Is this something serious?

It's hard to tell without a CT. You
could just need antibiotics or you could

require an operation.

If surgery is necessary, then your
weight could make things a little bit

complicated. I know. Sorry.

Not to worry. We're going to take very
good care of you.

Team.

Let's try for a midline. So, then, with
ultrasound, good. Can ultrasound check

for a nappy? A little too large for
ultrasound. But our CT can only handle

pounds. And so if he's over that, we
send him to the zoo?

He's right there.

I heard that there's a large animal CT
in the zoo. Presby CT can handle 350

pounds. Yeah, if Presby's still up and
running.

Well... That's not a jinx.

Have any of you ever done an awake nasal
tracheal?

Okay. Perla, can you also ask Dr.
Alishimini to come in? I'm going to need

assist. Yep, you got it.

Uh, sorry.

Fine.

Thank you. How about, uh, George
Francis, shortness of breath, Dr. Mohan

awaiting D -dimer.

Wow, she's still going? Yeah,
remarkable, really.

Dr. Al, Robbie's asking for you.

Uh, okay. In trauma if you need me,
princess. Got it.

Who supposed to warn the downtime slits
to X -ray and lab? Uh, the charge nurse.

Oh, look at me.

My plate's full.

Uh, parents of Roxy Hamlin.

Central 9. Oh, I got it, Donnie. Hi, I'm
Victoria Javadi, one of the student

doctors here.

I've been assisting with Roxy's care.

Oh, thank you so much. I'm Lloyd.

Cora. It's nice to meet you.

She broke her leg?

Yeah, there's a fracture down by the
ankle. She's in a boot now, so there's

quite so much pain.

But I'll take you. She's just in nine.

The hospital Wi -Fi isn't working.

Oh, it'll be down for a while. Sorry.

Mom broke her leg, Grandpa.

We heard.

How are you, honey?

You've got this, kiddo.

How long will she stay in the ER?

Oh, until the bed opens up upstairs.

Could be a while.

You know, it's getting pretty crowded in
here. Maybe we should take Tucker and

Shane out for ice cream. Yes, please.

No, no, I'm okay.

Maybe your mom would like some time to
rest.

Yeah, go.

Can't she have ice cream?

She can have anything she wants.

Come on. Let's go.

Bye, Mom.

Yep.

Listen up.

This is oxymetazoline to open up the
pathogen.

What medication do you take?

Lucinopril and metformin.

Ozempic, Vigobi.

No. Kind of expensive.

I'm going to squirt some numbing gel in
your nose. If it drips back in your

throat, that's okay.

Here, in case you need it.

Do you smoke?

Alcohol? Never.

Do you exercise?

Moving from the bedroom to the kitchen.

No, I'd walk more, but I'd need a bench
to rest on every block.

What about water aerobics? Let's focus
on helping, Mr. Knox.

Agreed.

Took me 25 years to get this way. Car
crash.

Burn unit.

Four leg surgeries over ten years.

Laid me up so much I lost my job.

I need to numb the back of your tongue.
This is going to taste pretty bad.

Is there anyone you'd like us to call?

Any family?

My parents passed.

I'm single. Go figure.

Siblings? Sister in Arizona.

We don't talk much.

Now that we've numbed up the back of
your tongue, we can anesthetize a bit

deeper.

I'm sorry to interrupt. I have a middle
-aged woman with sudden onset blindness.

I can go.

Do you see if Abba's still around? Yeah.
Thank you.

What's your sister's name?

Lauren Milford.

Where in Arizona?

Flagstaff, I think. It's going to go
over your tongue and numb your vocal

How many fingers?

I don't see any fingers.

And now I can see a little bit of light.

Brooke, you've met Dr. King. This is Dr.
Al Hashimi. Nice to meet you. And her

wife, Wendy. Hello. Hello.

Okay, if we discuss your symptoms.

As long as I can correct you if you get
anything wrong.

Trust me, she will.

One hour of sudden painless vision loss
in the left eye. No history of

hypochondriacal state or vascular
disease.

Could you look straight ahead, please?
Could be a central retinal artery

occlusion. In English, please.

A little blood clot can block the artery
at the back of the eye and decrease

your vision.

Sometimes it's called an eye stroke.

Stroke? Like she could be paralyzed?

No, this would be limited to the eye. Is
it permanent?

First, we have to make the diagnosis.

Retinal exam?

Hard to get a good look. We need the
FLP.

The what?

Oh, Princess, we need patient stickers
on each of these order sheets or the

pharmacy won't know who to give meds to.

We're on it.

Princess, smartphone fundoscope.

Equipment corridor, I -Cart. Thanks.

You seem a little confused.

How do I figure out which new patient to
pick up?

Top of the board, they're listed in the
order they arrive.

You erase the first one, then put your
initials in the empty box.

Okay, thanks.

Caleb, Michael, you managing this chaos
okay? Oh, it's all pretty easy when

you're a short -timer.

Any more comatose patients for me to
have a chat with?

I'm kidding.

Okay. Victoria.

This is Nicole Stedman.

I run the parent support group for the
psychiatric service.

Yeah. Nicole's daughter was diagnosed
sophomore year in college.

You think Jackson's parents might have a
chat with her?

We can certainly ask.

Now we can see the whole retina without
dilating the pupil.

You're looking in the wrong eye.

We start with the good eye for
comparison.

Retina looks great. Now for the bad eye.

Eyes wide open.

How's it look?

Extremely pale, no blood flow. Digital
massage, 10 seconds on, 5 seconds off.

Order non -contract head CT.

Come in.

Hi. Heard your patient took off.

She's taking a little break.

How long are you going to wait?

You know about the cyber shutdown thing?

Yeah. I wish I could help, but I think
it's all the evidence I've collected,

so... It's a hot mess out there.

It's all day, yes.

Sorry, I was just leaving.

You okay?

I'm good.

I'm glad to hear it.

Did you get something to eat? No.

Let's keep going.

Okay.

Yeah.

All right.

How do we keep one in the ER?

Because our intubated patients are
usually sedated.

Right.

Maybe you could ease up with your
comments about his weights.

I was just wondering how he got so big
and how we could help. We can help by

finding out what's wrong with him and
treating him with respect.

There's more if you need it.

Bye to talk from the ICU.

Great. Howard, we need to open up that
passageway now so we can pass the tube.

I'm going to start with my pinky slowly
over a few minutes. I'm going to go

deeper, all the way to the back of my
knuckle.

Once the tube's through your vocal
cords, you won't be able to talk. This

communication device.

Swipe through the screen for anything
you want to say.

Hit the icon, and it talks to us.

I would like some pain medicine.

My pain is a nine.

Can I get it to order a pizza?

There is self -service in the ambulance
bay. I found his sister's new number,

left a voicemail.

Okay, I'm going to start.

You ready?

Not really.

Go ahead.

Robbie, over here. Here we go, head
back.

Do they need a surgical?

Looking for a non -perfect happy. Can
you do it with a scope?

Possibly, but he could be treated with
antibiotics alone.

If he needs surgery?

With his size and emergency, open
laparotomy, death rates close to 50%.

one step at a time.

Let's keep trying his sister every 15
minutes.

She'll get it.

Half the downtime puts a blank.

What are you talking about?

Here and here.

Larry, are you using a felt -tip pen?

Maybe.

It's not going through for the copies.

Ballpoint pen only.

Okay.

He's still MIA.

Is that the homeless guy?

We need to bet if he eloped.

What do you need? I'm attending.

You're a senior resident?

No, I'm good. Dr. Alashimi, can I
present?

Yes. 32 -year -old deaf woman with
myofascial headache, ibuprofen -caused

gastritis, and epigastric pain, and she
vasovagal. But now pain -free after

Mylanta and a trigger point injection.

Excellent. That can take care of the
pain for several months.

Yeah, it shouldn't recur. She keeps her
screen at eye level.

There was a delay in getting an ASL
interpreter, and I almost gave up and

ordered an unnecessary brain and
abdominal CT.

Good thing you didn't.

Dr. Al -Hashemi, for you.

Nice job on the trigger point.

Yeah, I know. How's the T system going?

Quick and easy.

Yeah, and these MDMs, don't just circle
your diagnosis. Also put a backslash

through all the ones that you ruled out.
No problem.

Thank you very much.

Princess, bump central 13 to the front
of the CT line. What do you got?

Sudden -offset blindness patient has
central retinal artery occlusion. I just

spoke to an ophthalmologist at the VA,
principal investigator for thrombolytics

in cases like this.

Not exactly standard of care. Kind of
risky.

Well, do informed consent.

It's our best shot at saving some of her
vision. Your patient, your call.

Not going to be around long enough for
any complications.

I'll be taking two swabs from the
vagina, two swabs from the cervix.

Let me know if you're feeling
discomfort.

Okay.

These swab gets labeled.

First vaginal, second vaginal.

Smear a slide with both and let it air
dry.

Same for the cervix?

Yeah, but no slide needed.

Are you doing a lot of... Hanging in
there.

Almost done.

All these samples go in the vaginal
contact envelope.

I can help with that. No. It's got to be
me.

I'm going to pull this out.

Okay.

All good here. Legs can come down.

Are we done?

One last thing. Four more swabs inside
your mouth.

Didn't you do that already?

Next one's different.

Inside your cheek for your DNA.

Not for his.

It could be bipolar or schizophrenia.

Those are the two most likely
possibilities.

How do they know which it is? Based on
response to medicine, but also with

therapy and observation on the ward.
They'll monitor his mood and

with others.

Is there a blood test or a brain scan
that'll tell us for sure? Unfortunately

not. When properly medicated, people
with bipolar disorder can have

careers.

So we hope for bipolar.

You can hope for your son's happiness.

With early treatment, 20 % of people
with schizophrenia have a complete

recovery. So 80 % don't.

This is a new version of Jackson.

How old was your daughter? 20.

Studying architecture at Georgetown.

Schizophrenia. I'm sorry.

She's good.

Living at home, working as a cashier at
Giant Eagle.

Employee of the month.

We still have struggles.

But there's also laughter and love.

Good to go.

How'd that feel?

Very weird.

No pain, just weird.

Okay, the next step is we're going to
take... this tube and pass it through

nose, stopping at the back of your
tongue.

Not the tongue for that. Tube soaking in
warm water to make it more flexible.

Do you want to try it?

What day and time is it? Fourth of July,
2 .31 p .m.

When is my tube coming out?

We have to put it in first.

I know, just practicing.

Sounds like you're an expert already.

Before I can't talk, I just want to say
thank you

for everything.

You're very welcome.

Here we go.

STI prevention.

One shot treats gonorrhea, then pills
for chlamydia and trichomonas.

Thank you.

We also have morning after
contraception. She has an IUD.

Over 99 % effective, not 100.

We still offer.

I'll pass.

For HIV, we got PEP, post -exposure
prophylaxis.

28 days, and then you start the more
effective.

I'm pretty sure they could use an extra
set of hands out there.

It's nice to meet you, Alana.

You're a very brave woman.

She's a good nurse.

She's still learning, but she will be.

After this, we're done?

Yeah.

I'm glad you were here today.

Me too.

We have a decision to make.

Studies have shown that some vision can
be restored with a clot -busting

medication. So get it.

But there are possible risks.

For eye stroke, only 17 % get better
without any treatment.

Only 17 %?

Yes, but with the medicine, another 20 %
can improve.

But there can be complications.

2 % of patients who receive the
medication get worse, and 1 % have

disability or death.

This one has to be your call.

No, it's our call.

What would you do without me?

Figure out how to get by.

And I'd probably cry for two years
solid.

Two years, that's all?

I want the medication.

Hey, we need your full name to make a
chart.

Jackie Liddell.

Jackie Liddell.

And you are?

Her friend Jackie.

You have the same name? No, no, she's
Jackie with a C -K, I'm Jackie with a Q.

You can call me C -K.

Best not to talk C -K, okay? Just chill.

No, I don't have my tongue.

What? She said I bit off half my tongue.

You can understand that?

Oh, you should hear her when she's had
two pictures of margaritas fucked up and

slurring. Princess,

what's open?

South 15th clean.

Deep tongue laceration.

I can jump on this.

Robbie and Alice Shimmer are both
critical patients.

Hello.

I'm Dr. Langdon. I'll be supervising
your care.

Jesus, she killed your doctor's fucking
heart.

Tubes at 14 centimeters just above the
airway.

Okay, Howard, I'm going to start. If you
want me to stop, you just put your hand

up, okay?

Blue mark tells me I'm in the tube.

Looks like you cleared it.

If he inhales, we should see cords.

Okay, deep breath for me, Howard.

Beautiful.

Chords are sensitive, so we spray
lidocaine and scope.

Okay.

One CC going in now.

And we'll just give that a second to
work.

Hey, how you doing, Howard?

Once the tube's in, you'll have to
breathe through your nose.

Okay, Howard, hold still. I am now going
in past your vocal cords until we see

the carina.

Ogilvy? There.

Right and left mainstream.

And the tube slides in.

And the scope comes out.

Great.

Okay, inflate the balloon. Deep breath
through your nose.

Amazing. You good?

Great, entitled waveform.

Does he need a pen? He's breathing on
his own. A little CPAP wouldn't hurt.

Starting at 5, titrate to 10.

Okay, that went really well, Howard. Now
we're going to check your weight.

So the nurse examiner is supposed to
lock up the rape kit in this fridge

it stays until it gets turned over to
law enforcement.

It's called preserving the chain of
evidence.

Are you fucking kidding me?

Is there a problem?

Jesus Christ.

Police are supposed to pick up the rape
kits within 72 hours.

This is what I did two weeks ago.

God damn it.

So, how exactly did this happen?

We were in between pubs taking a selfie.

Very nice. Until she jerks her head off.

Ouch.

Okay, topical epi did the trick. No more
bleeding.

Sweet. I can go home now?

I don't think so. It looks like the
Grand Canyon across the back of your

We need to put in some stitches.

I don't want stitches.

Listen to the doctor.

Don't tell me... what to do. This is all
your fault.

No, it's not.

Yes, it is.

Princess, hey, why don't you show Q
where she can wait while we patch up her

friend? Of course.

Okay, this is a numbing shot for the
tip. The tip?

That's not where I bit it. One step at a
time.

That's 20 mixed TNK.

And 1439.

Failing anything?

Not yet.

Could take an hour or two.

We're going to move you to another room
for better monitoring.

Dr. King?

I'd like you to stay with her.

Why? In case there are complications.

You'll be there to respond quickly to a
blown pupil, a seizure, altered mental

status. Or I could catch up on my
charts.

And my deposition's coming up.

Think of this as a great way to steal
some quiet time and get mentally

Jesse, Mel's with you.

Excuse me, Dr. Mohan.

Excuse me, Dr. Mohan.

In a minute, George.

I've got this.

Thank you.

D -dimer's back.

Normal.

I'm ready to go.

Are you feeling better?

I really wasn't short of breath this
time.

Then why'd you come in?

I found out about the blood clot in my
leg. I kept thinking it's going to go to

my lung and kill me.

We've talked before about how the
Eliquis would prevent that. I know.

Well, I finally took your advice.

I got out of the house.

I joined the Frick Park Lawn Bowling
Club.

Wonderful. I mean, you're right, you
know.

We all need a community.

You're going to do what?

In order to fix your tongue, we need to
move it forward to access the

laceration. You're just going to feel
some pulling, okay?

I guess so.

Go for it.

What size suture is that?

Oh, silk. The biggest one we got.

As soon as I cut the needle, you're on
traction, Joy.

Pretty deep.

And now we can numb up the cut.

It's best to start with... Proximal side
first so she doesn't feel the distal

injection.

Give it ten minutes. I'll be back for
the repair.

I got a rape kit sitting here for two
weeks so it's supposed to be picked up

within 72 hours.

I don't care.

Get someone out of here now.

No. You expect us to treat your
officers? As soon as they come in, you

detective to pick these kits up ASAP.

I gotta go.

Dana, South 19 got their head CT before
it went down. No results yet. All right,

I'll send a reminder.

Hey, Dana. Hang on.

What's up?

We put in an order for more pain meds
for Roxy. All right, so put it in the

nursing rack.

Oh, I did, a long time ago.

All right, I'll bump it to the front.
Thank you.

What's that noise?

UFO landed. Aliens are invading. Hey,
Dana, Chem 7's not back on Proma 2 yet.

Let me see the chart.

Oh, Jesus, bet you Chem 7 rec went to
radiology. Larry, Antoine, you put labs

and chest X -ray on the same downtime
form. You need two slips, one for labs,

one for radiology.

What happened again? I'll run it down
myself.

Use the ice at a bedside. They won't
take them at C2, they'll cram them. Oh,

perfect. Nice to have you back.

Thrilled to be here.

You trying to tech?

I am composing. I'm going to send it
from the bay.

My mechanic friend, Duke, never showed
up.

I thought he was coming in this morning.
That was the plan. I guess he got busy.

What if he's a no -show?

Tell me what he needs. I'll pass it on
in a night shift. That won't be

necessary.

Oh, princess.

Asking you shall receive no more hot tea
tea.

Thanks. I'll get him discharged.

How's your day going?

I think I'm getting writer's cramp.

You with the big guy?

Yeah.

It's sad.

Bad car accident, multiple operations,
tons of stress.

Well, I can't shout to a sensitive area.
I'm going to binge drinking party gold.

The tongue lack.

She needs some help. More ways than one.

How's your first shift back going?

One day at a time.

First year's so bizarre.

That's what they keep telling me.

I'm nine years and counting.

Oh, special delivery for my guy.

If you need anything, call me.

Thanks.

Where are you going?

Lister's in North 3.

That's where I'm going.

Did you sign up for the patient?

I pulled the chart from the rack.

You're supposed to sign up on the dry
erase board. You're supposed to have a

clipboard for the patient.

I thought the nurses had that.

Whatever.

Hi, I'm student Dr.

Ogilvie, and this is Wow.

That is some rash.

Tell me about it. Student Dr. Javadi,
when did this start?

Last night.

And have you been on any hikes recently
around Poison Ivy?

Nope, haven't left the house.

What about new medications?

Motions, soaps, detergents even? I don't
take medicine, nothing new with all

that other stuff.

And where did this start?

Everywhere, all at once. Just a lot of
pain.

Really itchy.

What is it?

Not sure yet.

Be back in a second.

What are you thinking?

I have no idea.

Agreed.

Bellas pemphigoid?

Autoimmune severe pruritus?

Yeah, but not as deadly as pemphigus
vulgaris. Untreated, the death rate is

90%. We need to check for pustules,
mucous membrane involvement.

And the Nikolsky sign.

Here you go.

What? For your progress note.

Did I hear we're making progress?

Oh, um, it's just what we call it when
we write down things to describe a

clinical course.

Any changes?

Not so far.

It's time for the next neurocheck.

Excuse me, Dr. King, do you have a
minute?

Um, no, I'm observing a patient right
now. 60 seconds tops.

I'll check pupils.

We're good here.

Hey.

I just finished my deposition.

Oh, um, should I go up now?

Yeah, just wait until you get a call.

Okay.

Well, I'd ask how it went, but we're not
supposed to discuss the case.

This isn't a discussion.

It's a monologue, so shut up and listen.

The malpractice case is frivolous.

The mother of the measles kid claims we
caused intellectual decline by

performing a spinal tap, but the tap was
perfect with no complications.

Her son presented with altered mental
status due to low oxygen from measles

pneumonia.

Any change in intellect was due to
hypoxic brain injury. It had nothing to

with your spinal tap.

End of monologue.

We never discussed the case.

I'm going to get some sleep.

Thanks.

Bye, guys.

Okay, are you ready to lay down?

I got your head. Nice and slow.

One, two, three.

Okay, how's that feel?

Lifting up now.

I'll do it right about there.

2 .15?

That's in kilos.

Okay. Team.

It's not that much over 4 .15. No, we
can't miss breaking our CT on a holiday

weekend. Can the medics take him while
he's intubated?

If I go along for the ride, I could
still get a nap in before my night

474. Our CT can't handle your weight,
but we're going to take you over to

Presbyterian Hospital.

Road trip.

I'll keep you company the whole time.

Sorry for all this trouble.

It's okay.

This is what we do.

So sub -Q starts deep. You want to bury
the knot?

Yeah, I've done these before.

Joy, how do we cut the ends?

Short, slide to the knot, turn 45
degrees.

Dr.

Langdon, we have a case.

It'll have to wait. It could be urgent.

Find Robbie or Alice Shimmie.

This girl is wasted.

Drunk as a skunk.

Should we check her blood alcohol level?

No, it won't change what we do. She can
go home when she has a steady gig.

I already set one off.

Joy, do you want to guess her blood
alcohol?

Why would I want to do that?

I don't know, because it's fun.

When will you have a bed?

I'm not sure she needs a bed.

She's a febrile infant.

Oh, it's clearly over a month old and
looks amazing. Every marker is normal.

has a cold virus.

Infants with rhinovirus can still have a
serious bacterial infection.

Not this one. We send kids like this
home all the time. Except this one

have a home.

Or a parent.

I can't put a kid with the virus in the
nursery and I can't waste the private

room on a healthy baby.

Then what do you propose?

CYF can place her in an emergency foster
care by tomorrow morning.

You want to leave her down here
overnight?

Seems to be the standard of care these
days.

Have your attending give me a call. Will
do.

I can't believe this. Let CYF know it's
very urgent. Got it.

It's turning into quite the day.

You know, I've been thinking about
applying for a fellowship.

I thought you had a job lined up in New
Jersey. I did, to be close to my mom,

but she sold our house to travel the
world with her new boyfriend.

So what's the point of New Jersey?

Yeah, good question. Which fellowship?

I've narrowed it down to ultrasound,
toxicology, and sports medicine.

Those are very disparate fields leading
to very different careers.

I know.

I'm a little undecided.

Do you have research experience?

I was.

a part of a study on racial disparities
in health care until the White House cut

the funding last year.

Yeah, you are not alone.

Have you considered a geriatrics
fellowship?

I have not.

I've seen your skills with the elderly,
and there are a lot of openings. It

might be your best shot.

Think about it.

Black stitch.

You want me to cut?

You got it.

It looks good.

Okay, let's pull the traction suture.

With pleasure.

Okay, Jackie.

Jackie. What's up?

What's up?

All done.

All done with what?

Sewing up your tongue.

What happened to my tongue?

You bit it.

No, I didn't.

That is called a blackout. How much did
you drink?

A couple Bloody Marys.

Only a couple?

I don't know, maybe more.

A holiday, a pub crawl.

Do you usually have a couple cocktails
every day? Only on weekends.

How about during the week?

Nothing much.

Just wine with dinner or a few beers.

Maybe we should recommend rehab?

Yeah, we could try.

Ready to roll.

How are you feeling?

We got meds if you need them. Scan will
be quicker than the ride to Presby.

We'll keep trying to reach your system.
You guys are the best. See you later.

Can I put a new patient in T1?

Uh, no, I kind of want to leave one
trauma room open. Why don't you double

the north if you have to?

Mr. Digby?

It's just Digby. Right.

You've been looking all over. Where you
been?

With Louie.

Been there for an hour?

He was my friend.

I had a lot to say.

I'll get you back to your bed.

Louie got his wings.

Dr. Robbie, we picked up a patient
together.

Teamwork. It's the concerning bolus
rash.

We might need a biopsy for pemphigus
vulcae. It's phytophotodermatitis.

What? I asked.

He was making three gallons of
margaritas for a party, squeezing fresh

in the sun.

Let's go take a peek.

I don't need to see it again.

How's it going out there? Standing room
only. If I call the fire department,

will they clear that waiting room? Wish.
What's up?

Twelve patients need med refills.

Shouldn't they see their doctors?

The Medicaid cuts, we are their doctors.

No, I can't be prescribed to their
pharmacies.

Look at your pen. Go old school.

Dana, on what?

Lord, you got the security pads?

Sure do.

Just need a patient sticker.

Any other questions?

Yeah. What would have happened if you
weren't here today?

It'll be curled up in the fetal
position, crying like babies.

Were you wearing flip -flops?

I was.

What is it?

Phytophotodermatitis. Otherwise known as
Margaritaburn. For some people, limes

plus sunshine can cause a horrible rash.

This is all because of limes?

Have you ever squeezed limes outside in
the sun before?

I don't think so.

You will feel better after a day of
steroid pills, but once these heal, you

gotta wear sunscreen, because these
blisters can turn into dark scars and

while if you don't.

I'll be right back with your aftercare
instructions.

Hey, Robbie?

Yep.

My, uh, my hospice patient, Roxy, is
still in a ton of pain.

Where are we with the morphine?

10 milligrams an hour.

Okay, you can both, uh, another two and
go up to 12. I will let Princess know.

12 an hour is a lot.

Yeah, on top of the MS cotton, she could
stop breathing.

Are you familiar with the doctrine of
double effect?

Not really.

It is an ethical principle in palliative
care. We treat pain. And if in doing so

there's a negative side effect, we
accept it.

Even if the negative side effect is
death?

In some cases, that could be the best
outcome.

How are we going to get through this,
man?

I was about to ask you.