Original subtitles

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.