1
00:00:09,507 --> 00:00:13,976
<b>Sync and corrections by btsix
www.addic7ed.com</b>

2
00:00:15,470 --> 00:00:17,221
Next time, maybe inform
the department chair

3
00:00:17,222 --> 00:00:18,222
before the shit hits the fan.

4
00:00:18,223 --> 00:00:19,890
I was on my way to tell you.

5
00:00:19,891 --> 00:00:21,225
Make sure you get everything you need.

6
00:00:21,226 --> 00:00:22,309
OK, let's do this.

7
00:00:22,310 --> 00:00:23,894
IT called me up because

8
00:00:23,895 --> 00:00:26,230
I've trained in cyberattack
prevention and response.

9
00:00:26,231 --> 00:00:27,564
Then you can tell everybody what to do.

10
00:00:27,565 --> 00:00:28,673
No, thank you.

11
00:00:28,674 --> 00:00:30,192
Best if it comes
from the department chair.

12
00:00:30,193 --> 00:00:31,236
Oh, you think?

13
00:00:33,696 --> 00:00:35,906
All right, everybody, circle up.

14
00:00:35,907 --> 00:00:37,199
What the fuck?

15
00:00:37,200 --> 00:00:39,117
We may have had a cyberattack.

16
00:00:39,118 --> 00:00:41,412
No, we shut down
to prevent a cyberattack.

17
00:00:43,122 --> 00:00:45,249
OK, everybody, settle down. Listen up.

18
00:00:45,250 --> 00:00:46,583
As you can see, we're doing a little

19
00:00:46,584 --> 00:00:49,086
redecorating in the central work area.

20
00:00:49,087 --> 00:00:51,964
Our hospital computers are
at risk for a cyberattack,

21
00:00:51,965 --> 00:00:53,966
so we are going old school, analog.

22
00:00:53,967 --> 00:00:55,425
- For how long?
- Great question.

23
00:00:55,426 --> 00:00:57,427
Our IT department
has shut everything down

24
00:00:57,428 --> 00:00:59,763
to give them time to bolster
our cyber defenses.

25
00:00:59,764 --> 00:01:01,723
I believe the question was,
for how long?

26
00:01:01,724 --> 00:01:02,975
Uh, hard to say.

27
00:01:02,976 --> 00:01:04,268
Could be up to 24 hours.

28
00:01:04,269 --> 00:01:05,936
Jesus Christ.

29
00:01:05,937 --> 00:01:07,563
So first order of business,

30
00:01:07,564 --> 00:01:09,481
we need to replicate
the electronic patient boards

31
00:01:09,482 --> 00:01:10,816
on these dry-erase boards.

32
00:01:10,817 --> 00:01:11,942
So please, somebody tell me

33
00:01:11,943 --> 00:01:13,068
they got a photo of the boards.

34
00:01:13,069 --> 00:01:14,069
Uh, yeah, yeah, yeah.

35
00:01:14,070 --> 00:01:15,529
Right here. OK.

36
00:01:15,530 --> 00:01:16,614
Oh, uh...

37
00:01:18,783 --> 00:01:20,951
It's a little blurry.

38
00:01:20,952 --> 00:01:23,620
No, more than a little blurry.

39
00:01:23,621 --> 00:01:26,373
- Sorry.
- Oh, my God.

40
00:01:26,374 --> 00:01:28,125
- I remember.
- Great.

41
00:01:28,126 --> 00:01:30,127
If everybody else can remember
their patient names

42
00:01:30,128 --> 00:01:31,461
and their room numbers,
that would be awesome.

43
00:01:31,462 --> 00:01:33,463
No, I mean I can remember all of it.

44
00:01:33,464 --> 00:01:34,631
All of what?

45
00:01:34,632 --> 00:01:36,800
Names, doctors, room numbers.

46
00:01:36,801 --> 00:01:39,261
I kind of have a photographic memory.

47
00:01:39,262 --> 00:01:41,346
Seriously? The whole board?

48
00:01:41,347 --> 00:01:43,765
Central 12, Harlow Graham, headache,

49
00:01:43,766 --> 00:01:46,476
- abdominal pain, ASL only.
- Oh, shit.

50
00:01:46,477 --> 00:01:48,395
I have an interpreter waiting for me.

51
00:01:48,396 --> 00:01:50,522
- Go.
- OK, for patient privacy,

52
00:01:50,523 --> 00:01:52,232
all chief complaints
will be abbreviated.

53
00:01:52,233 --> 00:01:53,567
So HA for headache,

54
00:01:53,568 --> 00:01:55,527
AP for abdominal pain, and so forth.

55
00:01:55,528 --> 00:01:58,822
Central 10, Jackson Davis,
new-onset psychosis.

56
00:01:58,823 --> 00:02:00,240
Javadi, psych admission.

57
00:02:00,241 --> 00:02:02,284
Greek letter psi for psych.

58
00:02:02,285 --> 00:02:04,494
Pedes is Baby Jane Doe,
fever, Dr. Mohan,

59
00:02:04,495 --> 00:02:06,038
awaiting admission orders.

60
00:02:06,039 --> 00:02:07,789
Nurses need to convert
to a zone defense...

61
00:02:07,790 --> 00:02:08,832
north, central, south, trauma.

62
00:02:08,833 --> 00:02:10,000
Where's Dana?

63
00:02:10,001 --> 00:02:11,668
In with a sexual assault case.

64
00:02:11,669 --> 00:02:13,211
She can't leave
until the exam is finished.

65
00:02:13,212 --> 00:02:14,504
Yeah, it could be a while.

66
00:02:14,505 --> 00:02:15,964
Princess has charge nurse experience.

67
00:02:15,965 --> 00:02:17,382
- Not really.
- That's a great idea.

68
00:02:17,383 --> 00:02:18,675
Princess it is.

69
00:02:18,676 --> 00:02:19,676
You can make the nursing assignments.

70
00:02:19,677 --> 00:02:21,011
- Next.
- Central 9,

71
00:02:21,012 --> 00:02:22,929
Roxie Hamler, end-stage lung cancer.

72
00:02:22,930 --> 00:02:24,348
Sorry, do we have to stand here while

73
00:02:24,349 --> 00:02:25,515
- she recites the whole board?
- No.

74
00:02:25,516 --> 00:02:26,767
In fact, go check on your patients

75
00:02:26,768 --> 00:02:28,268
and then please come back here.

76
00:02:28,269 --> 00:02:29,811
Thank you.

77
00:02:29,812 --> 00:02:31,612
How many hours a day
are you on your laptop?

78
00:02:34,651 --> 00:02:35,984
At least eight hours.

79
00:02:35,985 --> 00:02:37,361
I work from home.

80
00:02:37,362 --> 00:02:39,280
And are you at a desk all day?

81
00:02:41,157 --> 00:02:42,491
No, no.

82
00:02:42,492 --> 00:02:43,909
I will either sit on the sofa,

83
00:02:43,910 --> 00:02:46,203
or sometimes I'll be in bed,

84
00:02:46,204 --> 00:02:48,372
kind of sitting up
with the computer on my lap,

85
00:02:48,373 --> 00:02:49,873
that kind of thing.

86
00:02:49,874 --> 00:02:52,501
So you're always looking down
at the screen?

87
00:02:52,502 --> 00:02:54,127
- Yeah.
- OK.

88
00:02:54,128 --> 00:02:56,589
I'm going to check
the muscles in your neck.

89
00:03:03,262 --> 00:03:04,388
- Ooh!
- Ooh!

90
00:03:04,389 --> 00:03:06,556
Ow, that hurts.

91
00:03:06,557 --> 00:03:09,267
All right. Well, I think we can help.

92
00:03:09,268 --> 00:03:11,436
Come on over.

93
00:03:11,437 --> 00:03:13,021
OK, gather up.

94
00:03:13,022 --> 00:03:15,190
Listen up, everybody.
This is our chart rack.

95
00:03:15,191 --> 00:03:17,192
So as you can see,
each slot and clipboard

96
00:03:17,193 --> 00:03:18,276
has a room number on it.

97
00:03:18,277 --> 00:03:19,736
When you pick up a new patient,

98
00:03:19,737 --> 00:03:22,072
you grab a fresh chart
from the T-system.

99
00:03:22,073 --> 00:03:25,075
Pick your chart by chief complaint.

100
00:03:25,076 --> 00:03:27,285
Use the cartoon to find it.

101
00:03:27,286 --> 00:03:29,037
Why are there two bodies?

102
00:03:29,038 --> 00:03:31,081
Trauma on the left,
medical on the right.

103
00:03:31,082 --> 00:03:32,416
So head injury, you go left.

104
00:03:32,417 --> 00:03:33,959
Headache, go right.

105
00:03:33,960 --> 00:03:35,544
Are those fish swimming in seaweed?

106
00:03:35,545 --> 00:03:36,586
No.

107
00:03:36,587 --> 00:03:37,921
That is bees and grass.

108
00:03:37,922 --> 00:03:39,214
That's the section for insect bites,

109
00:03:39,215 --> 00:03:40,757
skin rash, allergies.

110
00:03:40,758 --> 00:03:42,300
OK, let's say, for example,

111
00:03:42,301 --> 00:03:44,428
Dr. Al-Hashimi has
a new patient with belly pain.

112
00:03:44,429 --> 00:03:47,097
For the history, circle the positives,

113
00:03:47,098 --> 00:03:49,057
like vomiting and diarrhea.

114
00:03:49,058 --> 00:03:51,643
Backslash the negative,
such as recent travel,

115
00:03:51,644 --> 00:03:53,228
sick contacts, fever.

116
00:03:53,229 --> 00:03:57,149
For physical exam,
checkmark normals on the left,

117
00:03:57,150 --> 00:03:59,443
and circle any
abnormal findings on the right.

118
00:03:59,444 --> 00:04:00,485
Questions?

119
00:04:00,486 --> 00:04:01,695
Is your generative AI program

120
00:04:01,696 --> 00:04:02,696
still gonna be working?

121
00:04:04,115 --> 00:04:05,365
Not for a while.

122
00:04:05,366 --> 00:04:07,117
And ditch your SpectraLink phones.

123
00:04:07,118 --> 00:04:08,744
Those are voice over internet.

124
00:04:11,748 --> 00:04:12,956
PTMC Emergency.

125
00:04:12,957 --> 00:04:14,458
Go ahead, Medic Command.

126
00:04:14,459 --> 00:04:15,625
That is how we will hear
about incoming runs.

127
00:04:15,626 --> 00:04:17,085
Thanks.

128
00:04:17,086 --> 00:04:18,795
Two minutes out with
abdominal pain and fever.

129
00:04:18,796 --> 00:04:20,297
OK, has everybody got that so far?

130
00:04:20,298 --> 00:04:21,840
How do we write orders?

131
00:04:21,841 --> 00:04:23,467
Physician order form in triplicate.

132
00:04:23,468 --> 00:04:26,303
Labs, X-rays, IV fluid, medication.

133
00:04:26,304 --> 00:04:27,679
Will the labs still be able
to run blood tests?

134
00:04:27,680 --> 00:04:29,055
Yes.

135
00:04:29,056 --> 00:04:30,474
Are the CT scanners still working?

136
00:04:30,475 --> 00:04:31,808
Yes, but the results will come back

137
00:04:31,809 --> 00:04:34,144
on paper from the radiologist.

138
00:04:34,145 --> 00:04:35,604
This is the dark ages.

139
00:04:35,605 --> 00:04:37,814
So if you have orders
with labs or X-rays,

140
00:04:37,815 --> 00:04:39,357
they go into the clerk file here.

141
00:04:39,358 --> 00:04:40,650
They will sign them off.

142
00:04:40,651 --> 00:04:42,152
They will add a downtime slip on them,

143
00:04:42,153 --> 00:04:43,445
make sure they go
to the correct department.

144
00:04:43,446 --> 00:04:44,988
I'm sorry, who are the clerks?

145
00:04:44,989 --> 00:04:46,281
- You're looking at them.
- At your service.

146
00:04:46,282 --> 00:04:47,532
Larry and Antoine are filling in

147
00:04:47,533 --> 00:04:49,117
- until more help arrives.
- We got this.

148
00:04:49,118 --> 00:04:51,161
After the clerk orders, chart gets moved

149
00:04:51,162 --> 00:04:52,913
to the nursing order rack here for IVs,

150
00:04:52,914 --> 00:04:54,664
medications, procedures.

151
00:04:54,665 --> 00:04:56,875
Medications are locked up in the PDS.

152
00:04:56,876 --> 00:04:59,669
The PDS is getting unlocked
by a clinical pharmacist,

153
00:04:59,670 --> 00:05:01,254
- Dr. Megan Nordt.
- We've got your back.

154
00:05:01,255 --> 00:05:02,255
This is a lot.

155
00:05:02,256 --> 00:05:04,216
Any questions? Yes.

156
00:05:04,217 --> 00:05:05,509
Uh, no.

157
00:05:05,510 --> 00:05:07,052
What's up with the third rack?

158
00:05:07,053 --> 00:05:08,637
When your patient is
ready to be discharged,

159
00:05:08,638 --> 00:05:09,846
chart goes here.

160
00:05:09,847 --> 00:05:11,139
This lets everybody know

161
00:05:11,140 --> 00:05:12,349
we're about to have an open bed.

162
00:05:12,350 --> 00:05:14,184
Or that your tuna melt is up.

163
00:05:14,185 --> 00:05:15,436
Jesse?

164
00:05:16,687 --> 00:05:18,730
- What is that?
- What is that?

165
00:05:18,731 --> 00:05:20,524
That is a fax machine.

166
00:05:20,525 --> 00:05:22,025
They still make those?

167
00:05:22,026 --> 00:05:23,819
This is our lifeline to labs and X-rays.

168
00:05:23,820 --> 00:05:25,695
When the results come back,
they will fax to us,

169
00:05:25,696 --> 00:05:27,405
and the clerks will
put them on the charts.

170
00:05:27,406 --> 00:05:28,740
- Yes?
- If you say so.

171
00:05:28,741 --> 00:05:30,492
Incoming.

172
00:05:30,493 --> 00:05:33,745
OK, Dr. McKay, Dr. Whitaker,
Ogilvie, you're with me.

173
00:05:33,746 --> 00:05:36,581
The rest of you, build your clipboards.

174
00:05:38,876 --> 00:05:41,586
Howard Knox, 52,
abdominal pain and fever.

175
00:05:41,587 --> 00:05:44,256
152 over 90, tachy at 120.

176
00:05:44,257 --> 00:05:46,049
- Couldn't get an IV.
- I wonder why.

177
00:05:46,050 --> 00:05:47,592
Hello, sir. My name is Dr. Robby.

178
00:05:47,593 --> 00:05:50,053
- Howard.
- This is a teaching hospital.

179
00:05:50,054 --> 00:05:52,180
I'll be supervising
Doctors McKay and Dr. Whitaker

180
00:05:52,181 --> 00:05:53,390
- and student Dr. Ogilvie.
- Hey.

181
00:05:53,391 --> 00:05:54,558
- Hello.
- How are you feeling?

182
00:05:54,559 --> 00:05:55,976
- Not so great.
- OK.

183
00:05:55,977 --> 00:05:57,477
- Princess, what's free?
- Trauma 1.

184
00:05:57,478 --> 00:05:58,855
Perlah?

185
00:06:01,274 --> 00:06:04,901
All right, orders for Mylanta
and bupivacaine, Central 12.

186
00:06:04,902 --> 00:06:06,278
Wrong spot, Dr. Santos.

187
00:06:06,279 --> 00:06:08,239
And you need a sticker.

188
00:06:09,949 --> 00:06:11,283
Put it in the nursing orders rack.

189
00:06:11,284 --> 00:06:12,784
And meet me over at PDS.

190
00:06:12,785 --> 00:06:14,411
How much does this suck?

191
00:06:14,412 --> 00:06:16,079
I didn't think
today could get any worse.

192
00:06:16,080 --> 00:06:18,248
This is how we rolled
when I was a resident.

193
00:06:18,249 --> 00:06:19,791
Was that in the 1900s?

194
00:06:19,792 --> 00:06:22,085
Yeah, when charts were
written by candlelight.

195
00:06:22,086 --> 00:06:23,920
Hey, today will be an adventure.

196
00:06:23,921 --> 00:06:26,173
Think of it like "Back to the Future."

197
00:06:28,759 --> 00:06:30,802
Or possibly "Titanic."

198
00:06:30,803 --> 00:06:32,679
Here is your antacid.

199
00:06:32,680 --> 00:06:34,097
Cheers.

200
00:06:34,098 --> 00:06:35,807
And I marked the trigger point

201
00:06:35,808 --> 00:06:37,350
that is bringing out your headache,

202
00:06:37,351 --> 00:06:39,102
and a shot of local anesthetic
in that area

203
00:06:39,103 --> 00:06:41,105
could really help.

204
00:06:42,315 --> 00:06:43,440
Yeah, let's do it.

205
00:06:43,441 --> 00:06:44,650
All right.

206
00:06:45,818 --> 00:06:48,612
You are going to feel a little pinprick

207
00:06:48,613 --> 00:06:50,281
and some burning.

208
00:06:55,912 --> 00:06:57,829
OK.

209
00:06:57,830 --> 00:06:59,831
Oh, ow, ow, that really hurts.

210
00:06:59,832 --> 00:07:04,336
Temp 101.4, tachy at 128,
pulse ox 92 on 2 liters.

211
00:07:04,337 --> 00:07:05,712
When did the pain start?

212
00:07:05,713 --> 00:07:07,297
It's been on and off for about a week.

213
00:07:07,298 --> 00:07:09,049
- And where do you feel it?
- All over.

214
00:07:09,050 --> 00:07:11,635
It started on the left, and now
there's some on the right.

215
00:07:11,636 --> 00:07:12,802
How about that fever?

216
00:07:12,803 --> 00:07:14,137
Since last night.

217
00:07:14,138 --> 00:07:15,513
I was burning up.

218
00:07:15,514 --> 00:07:17,349
Then I had chills pretty bad.

219
00:07:17,350 --> 00:07:18,350
I can't find a vein here.

220
00:07:18,351 --> 00:07:19,434
We'll try for a midline.

221
00:07:19,435 --> 00:07:21,144
Let us know if this hurts.

222
00:07:21,145 --> 00:07:22,520
- Ah, ah.
- Sorry.

223
00:07:22,521 --> 00:07:24,439
- And on this side?
- Yeah, yeah!

224
00:07:24,440 --> 00:07:25,523
Sorry, sir.

225
00:07:25,524 --> 00:07:26,650
Guarding with no rigidity.

226
00:07:26,651 --> 00:07:28,818
For pain, 100 of fent IM?

227
00:07:28,819 --> 00:07:30,153
Plan, Dr. Whitaker?

228
00:07:30,154 --> 00:07:32,822
Blood cultures, lactate, Zosyn.

229
00:07:32,823 --> 00:07:35,325
We're gonna need a CT
to figure out what's going on.

230
00:07:35,326 --> 00:07:36,743
Ah-ah.

231
00:07:36,744 --> 00:07:38,828
- Yeah, it's not gonna work.
- Yep.

232
00:07:38,829 --> 00:07:40,163
Write neatly. Penmanship counts.

233
00:07:40,164 --> 00:07:41,498
Howard, for the scan, we're gonna have

234
00:07:41,499 --> 00:07:42,540
to lay you flat on your back.

235
00:07:42,541 --> 00:07:43,833
Can you do that?

236
00:07:43,834 --> 00:07:45,043
I could ten years ago,

237
00:07:45,044 --> 00:07:46,670
but now it's too hard to breathe.

238
00:07:46,671 --> 00:07:48,338
If we can't lay you flat,

239
00:07:48,339 --> 00:07:49,839
then we're gonna have to put
a tube in your windpipe

240
00:07:49,840 --> 00:07:51,341
to help you breathe...
are you OK with that?

241
00:07:51,342 --> 00:07:52,842
Intubation with rapid
sequence induction?

242
00:07:52,843 --> 00:07:54,177
No, we can't lay him down.

243
00:07:54,178 --> 00:07:55,345
The tube will go in your nose

244
00:07:55,346 --> 00:07:56,513
while you're awake, sir.

245
00:07:56,514 --> 00:07:57,514
- Well...
- Right.

246
00:07:57,515 --> 00:07:58,848
Does it hurt?

247
00:07:58,849 --> 00:08:00,016
You'll be numbed up completely.

248
00:08:00,017 --> 00:08:01,393
You won't feel any discomfort.

249
00:08:01,394 --> 00:08:04,270
Do you happen to know your weight?

250
00:08:04,271 --> 00:08:05,939
A little over 400.

251
00:08:05,940 --> 00:08:07,273
When was the last time you checked?

252
00:08:07,274 --> 00:08:08,775
It's been a while.

253
00:08:08,776 --> 00:08:11,236
Is it possible
that you might be over 450?

254
00:08:11,237 --> 00:08:13,196
Possibly.

255
00:08:13,197 --> 00:08:15,490
Perlah, let's call for the Hoyer.

256
00:08:15,491 --> 00:08:18,535
So we're gonna place the tube
and get you ready for the scan.

257
00:08:18,536 --> 00:08:20,203
Is this something serious?

258
00:08:20,204 --> 00:08:21,997
Well, it's hard to tell without a CT.

259
00:08:21,998 --> 00:08:23,707
You could just need antibiotics,

260
00:08:23,708 --> 00:08:25,500
or you could require an operation.

261
00:08:25,501 --> 00:08:26,751
If surgery is necessary,

262
00:08:26,752 --> 00:08:28,086
then your weight could make things

263
00:08:28,087 --> 00:08:29,546
- a little bit more complicated.
- I know.

264
00:08:29,547 --> 00:08:31,089
- I'm sorry.
- Not to worry.

265
00:08:31,090 --> 00:08:32,549
We're gonna take very good care of you.

266
00:08:32,550 --> 00:08:33,800
Team.

267
00:08:33,801 --> 00:08:34,926
OK.

268
00:08:34,927 --> 00:08:36,428
Pain medication for you, OK?

269
00:08:36,429 --> 00:08:38,304
Let's try for a midline,

270
00:08:38,305 --> 00:08:40,181
basilic vein with ultrasound guidance.

271
00:08:40,182 --> 00:08:41,641
Can ultrasound check for an appy?

272
00:08:41,642 --> 00:08:43,560
He's a little too large
for an ultrasound.

273
00:08:43,561 --> 00:08:45,937
Plus, our CT can only handle 450 pounds.

274
00:08:45,938 --> 00:08:48,441
And so if he's over that,
we send him to the zoo?

275
00:08:49,442 --> 00:08:50,818
He's right there.

276
00:08:53,112 --> 00:08:56,156
I... I heard that there's
a large animal CT at the zoo.

277
00:08:56,157 --> 00:08:58,158
Presby's CT can handle 650.

278
00:08:58,159 --> 00:09:00,410
Yeah, if Presby's still up and running.

279
00:09:00,411 --> 00:09:01,911
Wh...

280
00:09:01,912 --> 00:09:03,913
That... that's not a jinx. It's...

281
00:09:03,914 --> 00:09:06,541
Have any of you ever done
an awake naso-tracheal?

282
00:09:06,542 --> 00:09:07,792
OK.

283
00:09:07,793 --> 00:09:08,918
Perlah, can you also ask

284
00:09:08,919 --> 00:09:10,086
Dr. Al-Hashimi to come in?

285
00:09:10,087 --> 00:09:11,129
I'm gonna need an assist.

286
00:09:11,130 --> 00:09:12,547
Yep. You got it.

287
00:09:12,548 --> 00:09:14,508
Ah, sorry. Signed.

288
00:09:15,634 --> 00:09:18,928
Hall bed F, George Francis,
shortness of breath,

289
00:09:18,929 --> 00:09:21,389
Dr. Mohan, awaiting D-dimer.

290
00:09:21,390 --> 00:09:22,974
Wow. She's still going?

291
00:09:22,975 --> 00:09:25,101
Yeah. Remarkable, really.

292
00:09:25,102 --> 00:09:26,728
Dr. Al, Robby's asking for you.

293
00:09:26,729 --> 00:09:27,937
Uh, OK.

294
00:09:27,938 --> 00:09:29,647
In Trauma if you need me, Princess.

295
00:09:29,648 --> 00:09:30,899
Got it.

296
00:09:32,443 --> 00:09:33,985
Who's supposed to run the downtime slips

297
00:09:33,986 --> 00:09:35,195
to X-ray and lab?

298
00:09:35,196 --> 00:09:37,697
Uh, the charge nurse?

299
00:09:37,698 --> 00:09:39,491
Don't look at me.

300
00:09:39,492 --> 00:09:40,910
My plate's full!

301
00:09:42,953 --> 00:09:45,622
Uh, parents of Roxie Hamler?

302
00:09:45,623 --> 00:09:46,831
Central 9.

303
00:09:46,832 --> 00:09:48,124
Oh, I got it, Donnie.

304
00:09:48,125 --> 00:09:49,459
Hi, I'm Victoria Javadi,

305
00:09:49,460 --> 00:09:50,877
one of the student doctors here.

306
00:09:50,878 --> 00:09:52,462
I've been assisting with Roxie's care.

307
00:09:52,463 --> 00:09:53,797
Oh, thank you so much.

308
00:09:53,798 --> 00:09:56,007
- I'm Lloyd.
- Cora.

309
00:09:56,008 --> 00:09:57,133
It's nice to meet you.

310
00:09:57,134 --> 00:09:58,301
She broke her leg?

311
00:09:58,302 --> 00:09:59,636
Um, yeah.

312
00:09:59,637 --> 00:10:01,387
There's a fracture down by the ankle.

313
00:10:01,388 --> 00:10:03,973
She's in a boot now, so there's
not quite so much pain.

314
00:10:03,974 --> 00:10:06,310
But I'll take you. She's just in 9.

315
00:10:11,690 --> 00:10:13,149
The hospital Wi-Fi isn't working.

316
00:10:13,150 --> 00:10:14,484
Oh, it'll be down for a while.

317
00:10:14,485 --> 00:10:16,319
Sorry.

318
00:10:16,320 --> 00:10:18,822
Mom broke her leg, Grandpa.

319
00:10:18,823 --> 00:10:20,990
We heard.

320
00:10:20,991 --> 00:10:22,660
How are you, honey?

321
00:10:24,829 --> 00:10:27,288
You've got this, kiddo.

322
00:10:27,289 --> 00:10:29,541
Yeah.

323
00:10:29,542 --> 00:10:31,668
How long will she stay in the ER?

324
00:10:31,669 --> 00:10:35,255
Oh, until a bed opens up upstairs.

325
00:10:35,256 --> 00:10:36,841
Could be a while.

326
00:10:42,096 --> 00:10:43,847
You know, it's getting
pretty crowded in here.

327
00:10:43,848 --> 00:10:45,598
Maybe we should take Tucker
and Shane out for ice cream.

328
00:10:45,599 --> 00:10:49,060
- Yes, please.
- No, no. I'm OK.

329
00:10:49,061 --> 00:10:52,230
Maybe your mom would like
some time to rest.

330
00:10:52,231 --> 00:10:54,400
Yeah. Go.

331
00:10:56,068 --> 00:10:58,528
Can she have ice cream?

332
00:10:58,529 --> 00:11:01,698
She can have anything she wants.

333
00:11:01,699 --> 00:11:04,701
Come on, let's go.

334
00:11:04,702 --> 00:11:06,537
Bye, Mom.

335
00:11:08,205 --> 00:11:10,457
Ice cream, ice cream.

336
00:11:13,711 --> 00:11:15,086
Yep.

337
00:11:15,087 --> 00:11:17,088
Listen up.

338
00:11:17,089 --> 00:11:18,590
This is Oxymetazoline.

339
00:11:18,591 --> 00:11:19,791
This will open up the passage.

340
00:11:20,759 --> 00:11:22,218
What medication do you take?

341
00:11:22,219 --> 00:11:25,013
Uh, Lisinopril and Metformin.

342
00:11:25,014 --> 00:11:26,931
Ozempic? Wegovy?

343
00:11:26,932 --> 00:11:28,850
No. Kind of expensive.

344
00:11:28,851 --> 00:11:30,852
I'm going to squirt
some numbing gel in your nose.

345
00:11:30,853 --> 00:11:34,355
If it drips back
in your throat, that's OK.

346
00:11:34,356 --> 00:11:36,608
Here, in case you need it.

347
00:11:36,609 --> 00:11:38,443
Do you smoke?

348
00:11:38,444 --> 00:11:39,736
Alcohol?

349
00:11:39,737 --> 00:11:41,821
- Never.
- Do you exercise?

350
00:11:41,822 --> 00:11:44,282
Moving from the bedroom to the kitchen.

351
00:11:44,283 --> 00:11:45,783
No, I'd walk more,

352
00:11:45,784 --> 00:11:48,411
but I need a bench
to rest on every block.

353
00:11:48,412 --> 00:11:49,913
What about water aerobics?

354
00:11:49,914 --> 00:11:52,248
Let's focus on helping Mr. Knox.

355
00:11:52,249 --> 00:11:53,625
Agreed.

356
00:11:53,626 --> 00:11:55,627
It took me 25 years to get this way.

357
00:11:55,628 --> 00:11:58,254
Car crash, burn unit,

358
00:11:58,255 --> 00:12:01,090
four leg surgeries over ten years.

359
00:12:01,091 --> 00:12:03,259
Laid me up so much, I lost my job.

360
00:12:03,260 --> 00:12:04,928
I need to numb the back of your tongue.

361
00:12:04,929 --> 00:12:06,763
This is gonna taste pretty bad.

362
00:12:06,764 --> 00:12:08,181
Is there anyone you'd like us to call?

363
00:12:08,182 --> 00:12:09,390
No.

364
00:12:09,391 --> 00:12:10,934
Any family?

365
00:12:10,935 --> 00:12:13,478
Mm. My parents passed.

366
00:12:13,479 --> 00:12:14,729
I'm single.

367
00:12:14,730 --> 00:12:15,730
Go figure.

368
00:12:15,731 --> 00:12:16,940
Siblings?

369
00:12:16,941 --> 00:12:18,942
Sister in Arizona.

370
00:12:18,943 --> 00:12:21,319
We don't talk much.

371
00:12:21,320 --> 00:12:23,238
Now that we've numbed up
the back of your tongue,

372
00:12:23,239 --> 00:12:26,783
we can anesthetize a bit deeper.

373
00:12:26,784 --> 00:12:27,784
Um, sorry to interrupt.

374
00:12:27,785 --> 00:12:28,785
I have a middle-aged woman

375
00:12:28,786 --> 00:12:30,453
with sudden onset blindness.

376
00:12:30,454 --> 00:12:31,788
- I can go.
- OK.

377
00:12:31,789 --> 00:12:33,081
Will you see if Abbot's still around?

378
00:12:33,082 --> 00:12:34,082
- Yeah.
- Thank you.

379
00:12:34,083 --> 00:12:35,667
What's your sister's name?

380
00:12:35,668 --> 00:12:37,418
Lauren Milford.

381
00:12:37,419 --> 00:12:38,920
Where in Arizona?

382
00:12:38,921 --> 00:12:40,505
Flagstaff, I think.

383
00:12:40,506 --> 00:12:41,714
Just gonna go over your tongue

384
00:12:41,715 --> 00:12:42,966
and numb your vocal cords.

385
00:12:42,967 --> 00:12:43,967
Ah.

386
00:12:43,968 --> 00:12:46,302
Ah...

387
00:12:46,303 --> 00:12:47,470
How many fingers?

388
00:12:47,471 --> 00:12:49,681
I don't see any fingers.

389
00:12:49,682 --> 00:12:51,641
And now?

390
00:12:51,642 --> 00:12:54,185
I can see a little bit of light.

391
00:12:54,186 --> 00:12:55,979
Um, Brooke, you've met Dr. King.

392
00:12:55,980 --> 00:12:57,480
This is Dr. Al-Hashimi.

393
00:12:57,481 --> 00:12:58,815
- Nice to meet you.
- And her wife, Wendy.

394
00:12:58,816 --> 00:13:00,066
- Hello.
- Hello.

395
00:13:00,067 --> 00:13:01,818
OK if we discuss your symptoms?

396
00:13:01,819 --> 00:13:04,028
As long as I can correct you
if you get anything wrong.

397
00:13:04,029 --> 00:13:05,822
Trust me, she will.

398
00:13:05,823 --> 00:13:08,908
One hour of sudden, painless
vision loss in the left eye.

399
00:13:08,909 --> 00:13:10,743
No history of hypercoagulable state

400
00:13:10,744 --> 00:13:12,161
or vascular disease.

401
00:13:12,162 --> 00:13:13,663
Could you look straight ahead, please?

402
00:13:13,664 --> 00:13:16,165
Could be a central
retinal artery occlusion.

403
00:13:16,166 --> 00:13:17,625
In English, please?

404
00:13:17,626 --> 00:13:19,794
A little blood clot can block the artery

405
00:13:19,795 --> 00:13:22,338
at the back of the eye
and decrease your vision.

406
00:13:22,339 --> 00:13:23,965
Sometimes it's called an eye stroke.

407
00:13:23,966 --> 00:13:25,008
Stroke?

408
00:13:25,009 --> 00:13:26,384
Like she could be paralyzed?

409
00:13:26,385 --> 00:13:27,969
No, this would be limited to the eye.

410
00:13:27,970 --> 00:13:29,345
Is it permanent?

411
00:13:29,346 --> 00:13:31,723
First, we have to make the diagnosis.

412
00:13:31,724 --> 00:13:32,974
Retinal exam?

413
00:13:32,975 --> 00:13:34,017
Hard to get a good look.

414
00:13:34,018 --> 00:13:35,560
We need the FOP.

415
00:13:35,561 --> 00:13:37,353
The what?

416
00:13:39,648 --> 00:13:41,357
Oh, Princess.

417
00:13:41,358 --> 00:13:43,359
We need patient stickers
on each of these order sheets,

418
00:13:43,360 --> 00:13:45,445
or the pharmacy won't know
who to give meds to.

419
00:13:45,446 --> 00:13:46,863
We're on it.

420
00:13:46,864 --> 00:13:49,032
Princess, smartphone fundoscope?

421
00:13:49,033 --> 00:13:50,408
Equipment corridor, eye cart.

422
00:13:50,409 --> 00:13:53,536
- Thanks.
- You seem a little confused.

423
00:13:53,537 --> 00:13:55,371
How do I figure out
which new patient to pick up?

424
00:13:55,372 --> 00:13:56,706
Top of the board.

425
00:13:56,707 --> 00:13:57,874
They're listed in the order they arrive.

426
00:13:57,875 --> 00:13:59,125
You erase the first one, then put

427
00:13:59,126 --> 00:14:00,585
your initials in the MD box.

428
00:14:00,586 --> 00:14:02,211
OK. Thanks.

429
00:14:02,212 --> 00:14:03,588
- Caleb.
- Michael.

430
00:14:03,589 --> 00:14:05,423
Are you managing this chaos OK?

431
00:14:05,424 --> 00:14:08,051
Well, it's all pretty easy
when you're a short-timer.

432
00:14:08,052 --> 00:14:10,637
Any more comatose patients
for me to have a chat with?

433
00:14:12,389 --> 00:14:13,723
I'm kidding.

434
00:14:13,724 --> 00:14:15,350
OK.

435
00:14:15,351 --> 00:14:17,018
Victoria, this is Nicole Steadman.

436
00:14:17,019 --> 00:14:18,227
I run the parent support group

437
00:14:18,228 --> 00:14:19,687
for the psychiatric service.

438
00:14:19,688 --> 00:14:21,439
Yeah. Nicole's daughter was diagnosed

439
00:14:21,440 --> 00:14:23,191
sophomore year in college.

440
00:14:23,192 --> 00:14:26,361
You think Jackson's parents
might have a chat with her?

441
00:14:26,362 --> 00:14:28,237
We can certainly ask.

442
00:14:28,238 --> 00:14:29,906
Now we can see the whole retina

443
00:14:29,907 --> 00:14:31,407
without dilating the pupil.

444
00:14:32,576 --> 00:14:34,202
You're looking in the wrong eye.

445
00:14:34,203 --> 00:14:36,412
Oh, we start with
the good eye for comparison.

446
00:14:36,413 --> 00:14:38,539
Oh.

447
00:14:38,540 --> 00:14:39,582
Retina looks great.

448
00:14:39,583 --> 00:14:40,750
Now for the bad eye?

449
00:14:40,751 --> 00:14:42,086
Eyes wide open.

450
00:14:44,463 --> 00:14:45,838
How's it look?

451
00:14:45,839 --> 00:14:47,423
Extremely pale, no blood flow.

452
00:14:47,424 --> 00:14:49,592
Digital massage,
10 seconds on, 5 seconds off.

453
00:14:49,593 --> 00:14:53,012
Order non-contrast head CT.

454
00:14:54,598 --> 00:14:56,682
Come in.

455
00:14:56,683 --> 00:14:57,850
Hi.

456
00:14:57,851 --> 00:14:59,268
Heard your patient took off.

457
00:14:59,269 --> 00:15:00,812
She's taking a little break.

458
00:15:00,813 --> 00:15:03,189
How long are you gonna wait?

459
00:15:03,190 --> 00:15:05,066
You know about the cyber shutdown thing?

460
00:15:05,067 --> 00:15:06,609
Yeah.

461
00:15:06,610 --> 00:15:08,111
Wish I could help, but I gotta stay here

462
00:15:08,112 --> 00:15:09,487
till all the evidence
is collected, so...

463
00:15:09,488 --> 00:15:11,114
It's a hot mess out there.

464
00:15:11,115 --> 00:15:12,490
This whole day is.

465
00:15:13,617 --> 00:15:16,119
Sorry. I was just leaving.

466
00:15:16,120 --> 00:15:18,287
You OK?

467
00:15:18,288 --> 00:15:19,789
I'm good.

468
00:15:19,790 --> 00:15:21,499
I'm glad to hear it.

469
00:15:21,500 --> 00:15:22,583
You get something to eat?

470
00:15:22,584 --> 00:15:25,461
No.

471
00:15:25,462 --> 00:15:27,588
Let's keep going.

472
00:15:27,589 --> 00:15:28,923
OK.

473
00:15:28,924 --> 00:15:29,967
Yeah.

474
00:15:40,436 --> 00:15:42,937
Why don't we keep one in the ER?

475
00:15:42,938 --> 00:15:46,607
Because our intubated
patients are usually sedated.

476
00:15:46,608 --> 00:15:48,067
Right.

477
00:15:48,068 --> 00:15:49,694
Maybe you could ease up

478
00:15:49,695 --> 00:15:51,362
with your comments about his weight.

479
00:15:52,739 --> 00:15:54,699
I was just wondering how he got so big

480
00:15:54,700 --> 00:15:56,367
and how we could help.

481
00:15:56,368 --> 00:15:58,077
We can help by finding out
what's wrong with him

482
00:15:58,078 --> 00:15:59,162
and treating him with respect.

483
00:15:59,163 --> 00:16:00,163
How's your belly now?

484
00:16:00,164 --> 00:16:01,497
Second pain shot helped.

485
00:16:01,498 --> 00:16:03,332
OK. There's more if you need it.

486
00:16:03,333 --> 00:16:04,584
Diminished bowel sounds.

487
00:16:04,585 --> 00:16:05,918
VidaTalk from the ICU.

488
00:16:05,919 --> 00:16:07,503
Great.

489
00:16:07,504 --> 00:16:08,838
Howard, we need to open up
that passageway now

490
00:16:08,839 --> 00:16:10,047
so we can pass the tube.

491
00:16:10,048 --> 00:16:11,674
I'm gonna start with my pinky.

492
00:16:11,675 --> 00:16:13,050
Slowly, over a few minutes,
I'm gonna go deeper,

493
00:16:13,051 --> 00:16:14,510
all the way to the back of my knuckle.

494
00:16:14,511 --> 00:16:16,220
Once the tube's
through your vocal cords,

495
00:16:16,221 --> 00:16:17,722
you won't be able to talk.

496
00:16:17,723 --> 00:16:19,515
But this is a communication device.

497
00:16:19,516 --> 00:16:22,185
Swipe through the screen
for anything you want to say.

498
00:16:22,186 --> 00:16:24,687
Hit the icon, and it talks to us.

499
00:16:24,688 --> 00:16:26,898
<i>I would like some pain medicine.</i>

500
00:16:26,899 --> 00:16:28,733
<i>My pain is a nine.</i>

501
00:16:28,734 --> 00:16:30,401
Can I get it to order a pizza?

502
00:16:32,821 --> 00:16:34,655
There's cell service
in the ambulance bay.

503
00:16:34,656 --> 00:16:37,200
I found his sister's
new number, left a voicemail.

504
00:16:37,201 --> 00:16:38,409
OK, I'm gonna start.

505
00:16:38,410 --> 00:16:39,660
You ready?

506
00:16:39,661 --> 00:16:41,078
Not really.

507
00:16:41,079 --> 00:16:42,079
Go ahead.

508
00:16:42,080 --> 00:16:43,498
Robby, over here.

509
00:16:43,499 --> 00:16:45,709
Here we go. Head back.

510
00:16:47,169 --> 00:16:48,419
You thinking it's surgical?

511
00:16:48,420 --> 00:16:49,879
I'm hoping for a non-perfed appy.

512
00:16:49,880 --> 00:16:51,464
- Can you do it with a scope?
- Possibly,

513
00:16:51,465 --> 00:16:53,132
but he could be treated
with antibiotics alone.

514
00:16:53,133 --> 00:16:55,134
And if he needs surgery?

515
00:16:55,135 --> 00:16:58,137
With his size,
an emergency open laparotomy,

516
00:16:58,138 --> 00:17:00,264
death rate's close to 50%.

517
00:17:00,265 --> 00:17:01,849
OK, one step at a time.

518
00:17:01,850 --> 00:17:04,435
Let's keep trying his sister
every 15 minutes.

519
00:17:04,436 --> 00:17:05,812
She'll get it.

520
00:17:09,691 --> 00:17:12,902
Half the downtime slips are blank.

521
00:17:12,903 --> 00:17:14,946
What are you talking about?

522
00:17:14,947 --> 00:17:17,114
Here and here.

523
00:17:17,115 --> 00:17:19,242
Larry, are you using a felt tip pen?

524
00:17:19,243 --> 00:17:21,536
Maybe.

525
00:17:21,537 --> 00:17:24,789
It's not going through for the copies.

526
00:17:24,790 --> 00:17:26,582
Ballpoint pen only.

527
00:17:26,583 --> 00:17:27,960
OK.

528
00:17:30,379 --> 00:17:31,754
Digby still MIA?

529
00:17:31,755 --> 00:17:32,964
Is that the homeless guy?

530
00:17:32,965 --> 00:17:34,758
We need the bed if he eloped.

531
00:17:36,134 --> 00:17:38,094
- What do you need?
- An attending.

532
00:17:38,095 --> 00:17:39,929
- Or a senior resident?
- Nope, I'm good.

533
00:17:39,930 --> 00:17:42,098
- Dr. Al-Hashimi, can I present?
- Yes.

534
00:17:42,099 --> 00:17:44,725
32-year-old deaf woman
with myofascial headache.

535
00:17:44,726 --> 00:17:46,978
Ibuprofen caused gastritis
and epigastric pain,

536
00:17:46,979 --> 00:17:49,230
and she vasovagalled, but now pain-free

537
00:17:49,231 --> 00:17:51,274
after Mylanta
and a trigger point injection.

538
00:17:51,275 --> 00:17:52,441
Excellent.
That can take care of the pain

539
00:17:52,442 --> 00:17:54,110
- for several months.
- Yeah.

540
00:17:54,111 --> 00:17:56,445
It shouldn't recur if she keeps
her screen at eye level.

541
00:17:56,446 --> 00:17:57,822
There was a delay

542
00:17:57,823 --> 00:17:59,448
in getting an ASL interpreter.

543
00:17:59,449 --> 00:18:01,117
And I almost gave up and ordered

544
00:18:01,118 --> 00:18:03,286
an unnecessary brain and abdominal CT.

545
00:18:03,287 --> 00:18:04,495
Good thing you didn't.

546
00:18:04,496 --> 00:18:07,164
Dr. Al-Hashimi, for you.

547
00:18:07,165 --> 00:18:08,541
Nice job on the trigger point.

548
00:18:08,542 --> 00:18:09,792
Yeah, I know.

549
00:18:09,793 --> 00:18:11,502
How's the T-system going?

550
00:18:11,503 --> 00:18:13,629
- Quick and easy.
- Yeah.

551
00:18:13,630 --> 00:18:15,840
On these MDMs, don't just
circle your diagnosis.

552
00:18:15,841 --> 00:18:17,633
Also put a backslash
through all the ones

553
00:18:17,634 --> 00:18:18,676
that you've ruled out.

554
00:18:18,677 --> 00:18:19,719
No problem.

555
00:18:19,720 --> 00:18:21,387
Thank you very much.

556
00:18:21,388 --> 00:18:23,431
Princess, bump Central 13
to the front of the CT line.

557
00:18:23,432 --> 00:18:24,599
What do you got?

558
00:18:24,600 --> 00:18:25,975
Sudden onset blindness patient

559
00:18:25,976 --> 00:18:27,476
has central retinal artery occlusion.

560
00:18:27,477 --> 00:18:29,145
I just spoke to an ophthalmologist

561
00:18:29,146 --> 00:18:30,771
at the VA, principal investigator

562
00:18:30,772 --> 00:18:32,440
for thrombolytics in cases like this.

563
00:18:32,441 --> 00:18:33,858
Not exactly standard of care.

564
00:18:33,859 --> 00:18:34,942
Kind of risky.

565
00:18:34,943 --> 00:18:36,527
We'll do informed consent.

566
00:18:36,528 --> 00:18:38,426
It's our best shot at saving
some of her vision.

567
00:18:38,427 --> 00:18:39,694
Your patient, your call.

568
00:18:39,695 --> 00:18:42,145
I'm not gonna be around long
enough for any complications.

569
00:18:44,786 --> 00:18:48,497
I'll be taking
two swabs from the vagina,

570
00:18:48,498 --> 00:18:50,500
two swabs from the cervix.

571
00:18:53,837 --> 00:18:56,714
Let me know if you feel any discomfort.

572
00:18:56,715 --> 00:18:58,758
OK.

573
00:18:58,759 --> 00:19:02,928
Each swab gets labeled...
first vaginal, second vaginal.

574
00:19:02,929 --> 00:19:05,222
Smear a slide with both,
and let it air dry.

575
00:19:05,223 --> 00:19:06,432
Same for the cervix?

576
00:19:06,433 --> 00:19:07,433
Yeah.

577
00:19:07,434 --> 00:19:08,769
No slide needed.

578
00:19:10,395 --> 00:19:12,605
How you doing, Ilana?

579
00:19:12,606 --> 00:19:14,690
Hanging in there.

580
00:19:14,691 --> 00:19:16,192
OK.

581
00:19:16,193 --> 00:19:17,611
Almost done.

582
00:19:20,364 --> 00:19:23,199
All these samples go in
the vaginal contact envelope.

583
00:19:23,200 --> 00:19:24,575
- I can help with that.
- No.

584
00:19:24,576 --> 00:19:26,327
It's gotta be me.

585
00:19:26,328 --> 00:19:29,705
I'm gonna pull this out.

586
00:19:29,706 --> 00:19:31,499
OK.

587
00:19:31,500 --> 00:19:32,541
All good here.

588
00:19:32,542 --> 00:19:33,960
Legs can come down.

589
00:19:37,756 --> 00:19:39,715
Are we done?

590
00:19:39,716 --> 00:19:41,050
One last thing.

591
00:19:41,051 --> 00:19:43,511
Four more swabs inside your mouth.

592
00:19:43,512 --> 00:19:45,179
Didn't you do that already?

593
00:19:45,180 --> 00:19:48,224
This one's different...
inside your cheek for your DNA,

594
00:19:48,225 --> 00:19:49,810
not for his.

595
00:19:52,521 --> 00:19:57,942
So it could be bipolar or schizophrenia?

596
00:19:57,943 --> 00:20:00,236
Those are the two
most likely possibilities.

597
00:20:00,237 --> 00:20:01,779
How do they know which it is?

598
00:20:01,780 --> 00:20:03,948
Based on response to medicine,

599
00:20:03,949 --> 00:20:06,575
but also with therapy
and observation on the ward.

600
00:20:06,576 --> 00:20:09,995
They'll monitor his mood
and interactions with others.

601
00:20:11,915 --> 00:20:14,709
Is there a blood test or a brain scan

602
00:20:14,710 --> 00:20:15,751
that will tell us for sure?

603
00:20:15,752 --> 00:20:17,712
Unfortunately not.

604
00:20:17,713 --> 00:20:20,673
When properly medicated,
people with bipolar disorder

605
00:20:20,674 --> 00:20:23,426
can have successful careers.

606
00:20:23,427 --> 00:20:25,302
So we hope for bipolar?

607
00:20:25,303 --> 00:20:27,304
You can hope for your son's happiness.

608
00:20:27,305 --> 00:20:29,932
With early treatment, 20% of people

609
00:20:29,933 --> 00:20:32,727
with schizophrenia have
a complete recovery.

610
00:20:32,728 --> 00:20:34,603
So 80% don't?

611
00:20:34,604 --> 00:20:36,857
This is a new version of Jackson.

612
00:20:39,609 --> 00:20:40,776
How old was your daughter?

613
00:20:40,777 --> 00:20:42,737
20.

614
00:20:42,738 --> 00:20:46,115
Studying architecture at Georgetown.

615
00:20:46,116 --> 00:20:47,825
Schizophrenia.

616
00:20:47,826 --> 00:20:50,077
I'm sorry.

617
00:20:50,078 --> 00:20:51,746
Oh, she's good.

618
00:20:51,747 --> 00:20:56,625
Living at home, working
as a cashier at Giant Eagle.

619
00:20:56,626 --> 00:20:59,044
Employee of the Month.

620
00:20:59,045 --> 00:21:01,297
We still have struggles,

621
00:21:01,298 --> 00:21:04,259
but there's also laughter and love.

622
00:21:11,475 --> 00:21:12,975
Good to go.

623
00:21:12,976 --> 00:21:13,976
How'd that feel?

624
00:21:13,977 --> 00:21:15,519
Very weird.

625
00:21:15,520 --> 00:21:17,605
There's no pain. Just weird.

626
00:21:17,606 --> 00:21:19,899
OK, the next step is,
we're gonna take this tube

627
00:21:19,900 --> 00:21:21,901
and pass it through your nose,

628
00:21:21,902 --> 00:21:24,403
stopping at the back of your tongue.

629
00:21:24,404 --> 00:21:26,280
Best not to talk for that.

630
00:21:26,281 --> 00:21:29,950
Tube's soaking in warm water
to make it more flexible.

631
00:21:29,951 --> 00:21:32,661
Do you wanna try it?

632
00:21:32,662 --> 00:21:34,497
<i>What day and time is it?</i>

633
00:21:34,498 --> 00:21:36,874
4th of July, 2:31 p.m.

634
00:21:36,875 --> 00:21:38,834
<i>When is my tube coming out?</i>

635
00:21:38,835 --> 00:21:41,670
We have to put it in first.

636
00:21:41,671 --> 00:21:42,671
<i>I know.</i>

637
00:21:42,672 --> 00:21:44,340
<i>Just practicing.</i>

638
00:21:44,341 --> 00:21:47,676
Sounds like you're an expert already.

639
00:21:47,677 --> 00:21:50,721
Before I can't talk,

640
00:21:50,722 --> 00:21:53,516
I just wanna say

641
00:21:53,517 --> 00:21:56,977
thank you for everything.

642
00:21:56,978 --> 00:21:59,022
You're very welcome.

643
00:22:04,778 --> 00:22:06,196
Here we go.

644
00:22:10,867 --> 00:22:12,284
STI prevention.

645
00:22:12,285 --> 00:22:13,911
One shot treats gonorrhea,

646
00:22:13,912 --> 00:22:16,288
then pills for chlamydia
and trichomonas.

647
00:22:16,289 --> 00:22:17,832
Thank you.

648
00:22:17,833 --> 00:22:19,625
We also have
morning-after contraception.

649
00:22:19,626 --> 00:22:20,709
She has an IUD.

650
00:22:20,710 --> 00:22:23,254
Over 99% effective, not 100%.

651
00:22:23,255 --> 00:22:24,797
We still offer.

652
00:22:24,798 --> 00:22:26,382
I'll pass.

653
00:22:26,383 --> 00:22:29,885
For HIV, we got PEP,
Post-Exposure Prophylaxis.

654
00:22:29,886 --> 00:22:31,345
28 days.

655
00:22:31,346 --> 00:22:34,598
The sooner you start,
the more effective.

656
00:22:34,599 --> 00:22:36,392
Emma, I'm pretty sure they could use

657
00:22:36,393 --> 00:22:39,562
an extra set of hands out there.

658
00:22:39,563 --> 00:22:42,022
It's nice to meet you, Ilana.

659
00:22:42,023 --> 00:22:43,399
You're a very brave woman.

660
00:22:43,400 --> 00:22:44,484
Yeah.

661
00:22:51,575 --> 00:22:53,075
She's a good nurse.

662
00:22:53,076 --> 00:22:57,580
She's still learning, but she will be.

663
00:22:57,581 --> 00:22:59,540
After this, we're done?

664
00:22:59,541 --> 00:23:01,250
Yeah.

665
00:23:04,421 --> 00:23:06,631
I'm glad you were here today.

666
00:23:11,094 --> 00:23:13,762
Me too.

667
00:23:13,763 --> 00:23:16,807
We have a decision to make.

668
00:23:16,808 --> 00:23:18,809
Studies have shown that some vision

669
00:23:18,810 --> 00:23:21,604
can be restored
with a clot-busting medication.

670
00:23:21,605 --> 00:23:23,022
So give it.

671
00:23:23,023 --> 00:23:25,190
But there are possible risks.

672
00:23:25,191 --> 00:23:29,778
For eye stroke, only 17% get
better without any treatment.

673
00:23:29,779 --> 00:23:31,780
- Only 17%?
- Yes.

674
00:23:31,781 --> 00:23:36,118
But with the medicine,
another 20% can improve.

675
00:23:36,119 --> 00:23:38,621
But there can be complications.

676
00:23:38,622 --> 00:23:42,291
2% of patients who receive
the medication get worse,

677
00:23:42,292 --> 00:23:47,130
and 1% have severe disability or death.

678
00:23:52,636 --> 00:23:56,222
Honey, this one has to be your call.

679
00:23:57,474 --> 00:24:00,768
No, it's our call.

680
00:24:00,769 --> 00:24:02,645
What would you do without me?

681
00:24:02,646 --> 00:24:04,814
I'd figure out how to get by.

682
00:24:06,691 --> 00:24:09,693
And I'd probably cry
for two years solid.

683
00:24:09,694 --> 00:24:12,155
Two years? That's all?

684
00:24:13,365 --> 00:24:14,823
I want the medication.

685
00:24:14,824 --> 00:24:16,743
OK.

686
00:24:20,246 --> 00:24:22,247
<i>OK, we need your full name
to make a chart.</i>

687
00:24:22,248 --> 00:24:24,333
Jackie Liddell.

688
00:24:24,334 --> 00:24:26,001
Jackie Liddell.

689
00:24:26,002 --> 00:24:27,044
And you are?

690
00:24:27,045 --> 00:24:28,504
Her friend Jaquie.

691
00:24:28,505 --> 00:24:30,381
- You have the same name?
- No, no.

692
00:24:30,382 --> 00:24:32,591
She's Jackie with a C-K.
I'm Jaquie with a Q.

693
00:24:32,592 --> 00:24:34,385
You can call me CK.

694
00:24:34,386 --> 00:24:35,511
Oh.

695
00:24:35,512 --> 00:24:36,845
Best not to talk, CK, OK?

696
00:24:36,846 --> 00:24:38,347
- Just chill.
- Chill?

697
00:24:38,348 --> 00:24:41,684
- Q, I bit off half my tongue!
- What?

698
00:24:41,685 --> 00:24:43,519
She said, I bit off half my tongue.

699
00:24:43,520 --> 00:24:44,853
You can understand that?

700
00:24:44,854 --> 00:24:46,522
Oh, you should hear her when she's had

701
00:24:46,523 --> 00:24:48,482
two pitchers of margaritas,
fucked up and slurring.

702
00:24:48,483 --> 00:24:51,026
Ooh, you are such an idiot!

703
00:24:51,027 --> 00:24:52,653
Princess, what's open?

704
00:24:52,654 --> 00:24:54,363
South 15's clean.

705
00:24:54,364 --> 00:24:55,906
Deep tongue laceration.

706
00:24:55,907 --> 00:24:58,659
I can jump on this.

707
00:24:58,660 --> 00:25:01,578
Robby and Al-Hashimi are
both with critical patients.

708
00:25:01,579 --> 00:25:02,913
Hello.

709
00:25:02,914 --> 00:25:04,206
I'm Dr. Langdon.

710
00:25:04,207 --> 00:25:05,959
I'll be supervising your care.

711
00:25:07,961 --> 00:25:10,629
Jesus, CK, your doctor's fucking hot.

712
00:25:13,466 --> 00:25:15,884
Tube's at 14 centimeters,
just above the airway.

713
00:25:15,885 --> 00:25:18,262
OK, Howard, I'm going to start.

714
00:25:18,263 --> 00:25:22,433
If you want me to stop,
you just put your hand up, OK?

715
00:25:22,434 --> 00:25:25,061
Blue mark tells me I'm in the tube.

716
00:25:28,440 --> 00:25:30,607
Looks like he cleared it.

717
00:25:30,608 --> 00:25:33,235
If he inhales, we should see chords.

718
00:25:33,236 --> 00:25:35,571
OK, deep breath for me, Howard.

719
00:25:38,283 --> 00:25:40,743
- OK.
- Beautiful.

720
00:25:40,744 --> 00:25:42,411
Chords are sensitive,
so we spray lidocaine

721
00:25:42,412 --> 00:25:44,872
- in the scope.
- OK.

722
00:25:44,873 --> 00:25:48,417
1 cc going in now.

723
00:25:48,418 --> 00:25:51,086
And we'll just give that
a second to work.

724
00:25:51,087 --> 00:25:52,589
How you doing, Howard?

725
00:25:53,882 --> 00:25:55,758
Once the tube's in,
you'll have to breathe

726
00:25:55,759 --> 00:25:57,092
through your nose.

727
00:25:57,093 --> 00:25:58,469
OK, Howard, hold still.

728
00:25:58,470 --> 00:26:01,972
I am now going in past your vocal cords

729
00:26:01,973 --> 00:26:04,517
until we see the carina.

730
00:26:06,102 --> 00:26:07,770
Ogilvie.

731
00:26:07,771 --> 00:26:08,979
Uh, there.

732
00:26:08,980 --> 00:26:10,105
Right and left mainstem.

733
00:26:10,106 --> 00:26:12,901
And the tube slides in.

734
00:26:16,780 --> 00:26:20,033
And then the scope comes out.

735
00:26:21,826 --> 00:26:23,452
Great.

736
00:26:23,453 --> 00:26:24,787
OK, inflate the balloon.

737
00:26:24,788 --> 00:26:26,163
Deep breath through your nose.

738
00:26:26,164 --> 00:26:27,372
Amazing.

739
00:26:27,373 --> 00:26:29,500
You good?

740
00:26:29,501 --> 00:26:31,126
Great end-tidal waveform.

741
00:26:31,127 --> 00:26:32,377
Does he need a vent?

742
00:26:32,378 --> 00:26:33,629
He's breathing on his own,

743
00:26:33,630 --> 00:26:35,005
but a little CPAP wouldn't hurt.

744
00:26:35,006 --> 00:26:37,216
Starting at 5, titrate to 10.

745
00:26:37,217 --> 00:26:39,218
OK, that went really well, Howard.

746
00:26:39,219 --> 00:26:40,970
Now we're going to check your weight.

747
00:26:42,931 --> 00:26:44,515
So the nurse examiner is supposed

748
00:26:44,516 --> 00:26:46,433
to lock up the rape kit in this fridge,

749
00:26:46,434 --> 00:26:49,603
where it stays until it gets
turned over to law enforcement.

750
00:26:49,604 --> 00:26:52,314
It's called preserving
the chain of evidence.

751
00:26:52,315 --> 00:26:54,608
Are you fucking kidding me?

752
00:26:54,609 --> 00:26:56,485
Is there a problem?

753
00:26:56,486 --> 00:26:58,779
Jesus Christ.

754
00:26:58,780 --> 00:27:01,824
Police are supposed to pick up
the rape kits within 72 hours.

755
00:27:01,825 --> 00:27:04,827
This one I did two weeks ago.

756
00:27:04,828 --> 00:27:06,329
God damn it.

757
00:27:08,498 --> 00:27:10,791
So how exactly did this happen?

758
00:27:10,792 --> 00:27:13,669
We were in between pubs taking a selfie.

759
00:27:13,670 --> 00:27:14,711
Very nice.

760
00:27:14,712 --> 00:27:17,172
Until she jerked her head up.

761
00:27:17,173 --> 00:27:18,674
Ooh.

762
00:27:18,675 --> 00:27:20,008
Ouch.

763
00:27:20,009 --> 00:27:21,677
OK, topical epi did the trick.

764
00:27:21,678 --> 00:27:23,053
- No more bleeding.
- Sweet.

765
00:27:23,054 --> 00:27:24,429
I can go home now?

766
00:27:24,430 --> 00:27:26,348
I don't think so.

767
00:27:26,349 --> 00:27:27,891
It looks like the Grand Canyon
across the back of your tongue.

768
00:27:27,892 --> 00:27:29,893
We need to put in some stitches.

769
00:27:29,894 --> 00:27:30,894
I don't want stitches.

770
00:27:30,895 --> 00:27:33,021
Oh. Listen to the doctor.

771
00:27:33,022 --> 00:27:34,731
Don't tell me what to do.

772
00:27:34,732 --> 00:27:36,233
This is all your fault.

773
00:27:36,234 --> 00:27:38,277
- No, it's not.
- Uh, yes, it is.

774
00:27:38,278 --> 00:27:39,945
- Uh, Princess.
- No, it's not.

775
00:27:39,946 --> 00:27:41,530
Princess, hey, why don't you show Q

776
00:27:41,531 --> 00:27:43,365
where she can wait
while we patch up her friend?

777
00:27:43,366 --> 00:27:44,867
Of course.

778
00:27:44,868 --> 00:27:47,035
OK, this is a numbing shot for the tip.

779
00:27:47,036 --> 00:27:48,036
The tip?

780
00:27:48,037 --> 00:27:49,997
That's not where I bit it.

781
00:27:49,998 --> 00:27:51,416
One step at a time.

782
00:27:58,590 --> 00:28:01,008
That's 20 migs of TNK.

783
00:28:01,009 --> 00:28:04,052
In at 14:39.

784
00:28:04,053 --> 00:28:06,346
Feeling anything?

785
00:28:06,347 --> 00:28:07,431
Not yet.

786
00:28:07,432 --> 00:28:10,350
Could take an hour or two.

787
00:28:10,351 --> 00:28:11,852
We're going to move you to another room

788
00:28:11,853 --> 00:28:13,729
for better monitoring.

789
00:28:13,730 --> 00:28:15,273
Dr. King.

790
00:28:18,067 --> 00:28:21,486
I'd like you to stay with her.

791
00:28:21,487 --> 00:28:22,821
Why?

792
00:28:22,822 --> 00:28:24,448
In case there are complications.

793
00:28:24,449 --> 00:28:26,241
You'll be there to respond quickly

794
00:28:26,242 --> 00:28:29,119
to a blown pupil, a seizure,
altered mental status.

795
00:28:29,120 --> 00:28:31,163
Or I could catch up on my charts.

796
00:28:31,164 --> 00:28:33,081
And my deposition's coming up.

797
00:28:33,082 --> 00:28:35,584
Think of this as a great way
to steal some quiet time

798
00:28:35,585 --> 00:28:36,919
and get mentally prepared.

799
00:28:36,920 --> 00:28:39,130
Jesse, Mel's with you.

800
00:28:40,924 --> 00:28:42,925
Oh, excuse me, Dr. Mohan.

801
00:28:42,926 --> 00:28:44,009
Excuse me.

802
00:28:44,010 --> 00:28:45,010
Dr. Mohan.

803
00:28:45,011 --> 00:28:46,428
Uh, in a minute, George.

804
00:28:46,429 --> 00:28:47,554
I've got this.

805
00:28:47,555 --> 00:28:48,764
Thank you.

806
00:28:48,765 --> 00:28:51,099
Oh, uh, I, um...

807
00:28:51,100 --> 00:28:53,268
D-dimer is back normal.

808
00:28:53,269 --> 00:28:54,269
Oh.

809
00:28:54,270 --> 00:28:55,604
I'm ready to go.

810
00:28:55,605 --> 00:28:57,439
Are you feeling better?

811
00:28:57,440 --> 00:29:01,152
I... I really wasn't
short of breath this time.

812
00:29:02,278 --> 00:29:03,987
Then why'd you come in?

813
00:29:05,490 --> 00:29:07,574
When I found out about
the blood clot in my leg,

814
00:29:07,575 --> 00:29:10,452
I just kept thinking it's gonna
go to my lung and kill me.

815
00:29:10,453 --> 00:29:13,622
We've talked before about how
the Eliquis would prevent that.

816
00:29:13,623 --> 00:29:16,333
I know.

817
00:29:16,334 --> 00:29:18,710
Well, I finally took your advice.

818
00:29:18,711 --> 00:29:21,171
I got out of the house, and I joined

819
00:29:21,172 --> 00:29:23,131
the Frick Park Lawn Bowling Club.

820
00:29:23,132 --> 00:29:24,383
Wonderful.

821
00:29:24,384 --> 00:29:25,509
Yeah.

822
00:29:25,510 --> 00:29:27,344
I mean, you're right, you know?

823
00:29:27,345 --> 00:29:29,347
We all need a community.

824
00:29:33,351 --> 00:29:34,810
You're gonna do what?

825
00:29:34,811 --> 00:29:36,478
In order to fix your tongue,

826
00:29:36,479 --> 00:29:39,022
we need to move it forward
to access the laceration.

827
00:29:39,023 --> 00:29:40,649
You're just gonna feel some pulling, OK?

828
00:29:40,650 --> 00:29:44,027
I guess so.

829
00:29:44,028 --> 00:29:46,738
Go for it.

830
00:29:46,739 --> 00:29:48,156
What size suture is that?

831
00:29:48,157 --> 00:29:51,952
O-silk, the biggest one we got.

832
00:29:51,953 --> 00:29:54,831
As soon as I cut the needle,
you're on traction, Joy.

833
00:30:03,631 --> 00:30:05,173
Oh.

834
00:30:05,174 --> 00:30:07,342
That is pretty deep.

835
00:30:07,343 --> 00:30:08,969
And now we can numb up the cut.

836
00:30:08,970 --> 00:30:10,304
It's best to start with...

837
00:30:10,305 --> 00:30:11,680
Proximal side first so she doesn't

838
00:30:11,681 --> 00:30:14,891
feel the distal injection.

839
00:30:14,892 --> 00:30:15,892
Give it ten minutes.

840
00:30:15,893 --> 00:30:17,437
I'll be back for the repair.

841
00:30:21,607 --> 00:30:23,525
I got a rape kit
sitting here for two weeks

842
00:30:23,526 --> 00:30:26,028
that was supposed to be
picked up within 72 hours.

843
00:30:26,029 --> 00:30:27,070
I don't care!

844
00:30:27,071 --> 00:30:29,114
Get someone over here now! No.

845
00:30:29,115 --> 00:30:30,615
You expect us to treat your officers

846
00:30:30,616 --> 00:30:32,242
as soon as they come in,

847
00:30:32,243 --> 00:30:34,077
you get a detective
to pick these kits up ASAP.

848
00:30:34,078 --> 00:30:35,078
I gotta go.

849
00:30:35,079 --> 00:30:36,705
- Dana...
- Hey, Dana.

850
00:30:36,706 --> 00:30:37,873
South 19 got their head CT
before we went down.

851
00:30:37,874 --> 00:30:39,207
No results yet.

852
00:30:39,208 --> 00:30:40,375
All right, I'll send a reminder.

853
00:30:40,376 --> 00:30:41,376
- Hey, Dana.
- Dana.

854
00:30:41,377 --> 00:30:42,754
Hang on.

855
00:30:43,755 --> 00:30:45,547
What's up?

856
00:30:45,548 --> 00:30:47,466
We put in an order
for more pain meds for Roxie.

857
00:30:47,467 --> 00:30:49,551
All right, so put it
in the nursing racks.

858
00:30:49,552 --> 00:30:52,220
Oh, I did, a long time ago.

859
00:30:52,221 --> 00:30:54,056
All right. I'll bump it to the front.

860
00:30:54,057 --> 00:30:55,599
Thank you.

861
00:30:55,600 --> 00:30:57,351
Uh, what's that noise?

862
00:30:57,352 --> 00:30:58,393
UFO landed.

863
00:30:58,394 --> 00:30:59,394
Aliens are invading.

864
00:30:59,395 --> 00:31:00,896
Hey, Dana.

865
00:31:00,897 --> 00:31:02,773
Chem 7's not back on Trauma 2 yet.

866
00:31:02,774 --> 00:31:05,067
Let me see the chart.

867
00:31:05,068 --> 00:31:06,610
Oh, Jesus.

868
00:31:06,611 --> 00:31:08,195
I bet your Chem 7 rec went to Radiology.

869
00:31:08,196 --> 00:31:10,030
Larry, Antoine.

870
00:31:10,031 --> 00:31:12,532
You put labs and chest X-ray
on the same downtime form.

871
00:31:12,533 --> 00:31:14,785
You need two slips... one
for labs, one for radiology.

872
00:31:14,786 --> 00:31:16,453
- Got it.
- Won't happen again.

873
00:31:16,454 --> 00:31:17,579
I'll run it down myself.

874
00:31:17,580 --> 00:31:19,289
Use the iStat at bedside.

875
00:31:19,290 --> 00:31:20,749
They won't take him to CT
without a creatinine.

876
00:31:20,750 --> 00:31:21,917
Oh, perfect.

877
00:31:21,918 --> 00:31:23,085
Nice to have you back.

878
00:31:23,086 --> 00:31:24,336
Thrilled to be here.

879
00:31:24,337 --> 00:31:25,462
You trying to text?

880
00:31:25,463 --> 00:31:27,005
I am just composing.

881
00:31:27,006 --> 00:31:28,590
I'm gonna send it from the bay.

882
00:31:28,591 --> 00:31:30,801
My mechanic friend, Duke,
never showed up.

883
00:31:30,802 --> 00:31:32,344
I thought he was coming in this morning.

884
00:31:32,345 --> 00:31:33,595
That was the plan.

885
00:31:33,596 --> 00:31:35,847
I guess he got busy.

886
00:31:35,848 --> 00:31:37,099
What if he's a no-show?

887
00:31:37,100 --> 00:31:38,683
Tell me what he needs.

888
00:31:38,684 --> 00:31:39,768
I'll pass it on to the night shift.

889
00:31:39,769 --> 00:31:40,769
That won't be necessary.

890
00:31:43,523 --> 00:31:45,357
Oh, Princess.

891
00:31:45,358 --> 00:31:46,441
Ask and you shall receive.

892
00:31:46,442 --> 00:31:47,609
Normal head CT.

893
00:31:47,610 --> 00:31:49,945
Thanks. I'll get him discharged.

894
00:31:49,946 --> 00:31:51,780
How's your day going?

895
00:31:51,781 --> 00:31:54,282
I think I'm getting writer's cramp.

896
00:31:54,283 --> 00:31:55,617
You with the big guy?

897
00:31:55,618 --> 00:31:57,911
Yeah. It's sad.

898
00:31:57,912 --> 00:32:01,790
Bad car accident, multiple
operations, tons of stress.

899
00:32:03,793 --> 00:32:05,669
Lidocaine shot to a sensitive area.

900
00:32:05,670 --> 00:32:07,462
I got a binge-drinking
party girl with a tongue lac.

901
00:32:07,463 --> 00:32:08,797
Mm.

902
00:32:08,798 --> 00:32:10,006
Sounds like she needs some help.

903
00:32:10,007 --> 00:32:12,759
In more ways than one.

904
00:32:12,760 --> 00:32:16,471
How's, uh... how's
your first shift back going?

905
00:32:16,472 --> 00:32:18,640
One day at a time.

906
00:32:18,641 --> 00:32:20,267
First year sober is the hardest.

907
00:32:20,268 --> 00:32:21,476
That's what they keep telling me.

908
00:32:21,477 --> 00:32:24,147
I'm nine years and counting.

909
00:32:26,524 --> 00:32:28,150
Oh.

910
00:32:28,151 --> 00:32:31,653
Special delivery for my guy.

911
00:32:31,654 --> 00:32:33,655
If you, um... if you
need anything, call me.

912
00:32:33,656 --> 00:32:35,241
Thanks.

913
00:32:41,205 --> 00:32:42,831
Where are you going?

914
00:32:42,832 --> 00:32:44,207
Blisters in North 3.

915
00:32:44,208 --> 00:32:45,709
That's where I'm going.

916
00:32:45,710 --> 00:32:47,586
Did you sign up for the patient?

917
00:32:47,587 --> 00:32:49,379
I pulled the chart from the rack.

918
00:32:49,380 --> 00:32:51,131
You're supposed to sign up
on the dry-erase board.

919
00:32:51,132 --> 00:32:53,008
You're supposed to have
a clipboard for the patient.

920
00:32:53,009 --> 00:32:54,843
I thought the nurses had that.

921
00:32:54,844 --> 00:32:56,470
Whatever.

922
00:32:56,471 --> 00:32:57,554
Hi.

923
00:32:57,555 --> 00:32:59,014
I'm Student Doctor Ogilvie.

924
00:32:59,015 --> 00:33:01,183
And this is... wow.

925
00:33:01,184 --> 00:33:02,642
That is some rash.

926
00:33:02,643 --> 00:33:05,520
- Yeah. Tell me about it.
- Student Doctor Javadi.

927
00:33:05,521 --> 00:33:07,731
- When did this start?
- Last night.

928
00:33:07,732 --> 00:33:09,316
And have you been on any hikes recently

929
00:33:09,317 --> 00:33:10,400
around poison ivy?

930
00:33:10,401 --> 00:33:12,360
Nope. Haven't left the house.

931
00:33:12,361 --> 00:33:15,363
What about new medications,
lotions, soaps,

932
00:33:15,364 --> 00:33:16,364
detergents, even?

933
00:33:16,365 --> 00:33:17,657
I don't take medicine.

934
00:33:17,658 --> 00:33:19,326
Nothing new with all that other stuff.

935
00:33:19,327 --> 00:33:20,368
Uh-huh. And where did this start?

936
00:33:20,369 --> 00:33:21,828
Everywhere, all at once.

937
00:33:21,829 --> 00:33:25,165
Just a lot of pain, really itchy.

938
00:33:25,166 --> 00:33:26,875
What is it?

939
00:33:26,876 --> 00:33:28,376
I'm not sure yet.

940
00:33:28,377 --> 00:33:31,087
Um, be back in a second.

941
00:33:31,088 --> 00:33:32,714
Can't... will you...

942
00:33:36,886 --> 00:33:38,929
What are you thinking?

943
00:33:38,930 --> 00:33:40,055
I have no idea.

944
00:33:40,056 --> 00:33:41,224
Agreed.

945
00:33:43,059 --> 00:33:44,643
Bullous pemphigoid?

946
00:33:44,644 --> 00:33:46,394
Autoimmune severe pruritis?

947
00:33:46,395 --> 00:33:47,979
Yeah, but not as deadly
as pemphigus vulgaris.

948
00:33:47,980 --> 00:33:49,981
Untreated, the death rate is over 90%.

949
00:33:49,982 --> 00:33:51,399
We need to check for pustules,

950
00:33:51,400 --> 00:33:52,567
mucous membrane involvement...

951
00:33:52,568 --> 00:33:53,945
And the Nikolsky sign.

952
00:33:56,405 --> 00:33:57,823
Here you go.

953
00:33:59,283 --> 00:34:00,408
What?

954
00:34:00,409 --> 00:34:01,953
For your progress note.

955
00:34:03,287 --> 00:34:06,289
Did I hear we're making progress?

956
00:34:06,290 --> 00:34:08,583
Oh, um, it's just what we call it

957
00:34:08,584 --> 00:34:11,754
when we write down things
to describe a clinical course.

958
00:34:13,256 --> 00:34:14,256
Any changes?

959
00:34:15,258 --> 00:34:16,591
Not so far.

960
00:34:16,592 --> 00:34:18,927
It's time for the next neuro check.

961
00:34:18,928 --> 00:34:21,221
Excuse me, Dr. King,
do you have a minute?

962
00:34:21,222 --> 00:34:22,806
Um, no.

963
00:34:22,807 --> 00:34:24,599
I'm observing a patient right now.

964
00:34:24,600 --> 00:34:26,978
60 seconds tops.

965
00:34:28,396 --> 00:34:29,771
I'll check pupils.

966
00:34:29,772 --> 00:34:31,315
We're good here.

967
00:34:36,946 --> 00:34:38,863
Hey.

968
00:34:38,864 --> 00:34:41,199
I just finished my deposition.

969
00:34:41,200 --> 00:34:43,660
Oh, should I go up now?

970
00:34:43,661 --> 00:34:45,370
Yeah. Just wait until you get a call.

971
00:34:45,371 --> 00:34:46,788
OK.

972
00:34:46,789 --> 00:34:48,206
Well, I'd ask how it went,

973
00:34:48,207 --> 00:34:50,292
but we're not supposed
to discuss the case.

974
00:34:50,293 --> 00:34:51,793
This isn't a discussion.

975
00:34:51,794 --> 00:34:55,005
It's a monologue, so shut up and listen.

976
00:34:55,006 --> 00:34:57,215
The malpractice case is frivolous.

977
00:34:57,216 --> 00:34:58,800
The mother of the measles kid claims

978
00:34:58,801 --> 00:35:00,176
we caused intellectual decline

979
00:35:00,177 --> 00:35:02,262
by performing a spinal tap.

980
00:35:02,263 --> 00:35:05,473
But the tap was perfect
with no complications.

981
00:35:05,474 --> 00:35:07,267
Her son presented
with altered mental status

982
00:35:07,268 --> 00:35:10,687
due to low oxygen
from measles pneumonia.

983
00:35:10,688 --> 00:35:13,148
Any change in intellect was
due to hypoxic brain injury.

984
00:35:13,149 --> 00:35:16,818
It had nothing to do
with your spinal tap.

985
00:35:16,819 --> 00:35:18,528
End of monologue.

986
00:35:18,529 --> 00:35:21,323
We never discussed the case.

987
00:35:21,324 --> 00:35:23,658
I gotta get some sleep.

988
00:35:23,659 --> 00:35:26,912
Thanks, I guess.

989
00:35:28,539 --> 00:35:30,832
OK, are you ready to lay down?

990
00:35:30,833 --> 00:35:31,833
I got your head.

991
00:35:31,834 --> 00:35:33,043
Nice and slow.

992
00:35:33,044 --> 00:35:35,212
One, two, three.

993
00:35:36,589 --> 00:35:37,589
OK.

994
00:35:37,590 --> 00:35:38,716
How's that feel?

995
00:35:41,594 --> 00:35:42,844
Lifting up now.

996
00:35:52,730 --> 00:35:54,398
Keep going.

997
00:35:57,026 --> 00:36:00,279
And... that ought to do it
right about there.

998
00:36:02,031 --> 00:36:03,865
215?

999
00:36:03,866 --> 00:36:05,785
Oh, that's in kilos.

1000
00:36:08,079 --> 00:36:09,705
OK, team.

1001
00:36:15,336 --> 00:36:17,045
It's not that much over 450.

1002
00:36:17,046 --> 00:36:19,881
No, we can't risk breaking
our CT on a holiday weekend.

1003
00:36:19,882 --> 00:36:22,008
Would the medics take him
while he's intubated?

1004
00:36:22,009 --> 00:36:24,386
If I go along for the ride,
I could still get a nap in

1005
00:36:24,387 --> 00:36:25,930
before my night shift.

1006
00:36:29,892 --> 00:36:32,852
474.

1007
00:36:32,853 --> 00:36:34,729
Our CT can't handle your weight,

1008
00:36:34,730 --> 00:36:38,108
but we're gonna take you over
to Presbyterian Hospital.

1009
00:36:38,109 --> 00:36:40,068
<i>Road trip.</i>

1010
00:36:40,069 --> 00:36:42,363
I'll keep you company the whole time.

1011
00:36:44,907 --> 00:36:46,950
<i>Sorry for all this trouble.</i>

1012
00:36:46,951 --> 00:36:48,159
It's OK.

1013
00:36:48,160 --> 00:36:49,620
This is what we do.

1014
00:36:55,084 --> 00:36:56,668
So sub Q starts deep.

1015
00:36:56,669 --> 00:36:57,794
You want to bury the knot.

1016
00:36:57,795 --> 00:36:59,337
Yeah, I've done these before.

1017
00:36:59,338 --> 00:37:01,631
Joy, how do we cut the ends?

1018
00:37:01,632 --> 00:37:03,174
Short. Slide to the knot.

1019
00:37:03,175 --> 00:37:04,175
Turn 45 degrees.

1020
00:37:04,176 --> 00:37:06,302
Excellent.

1021
00:37:06,303 --> 00:37:08,138
Um, Dr. Langdon, we have a case.

1022
00:37:08,139 --> 00:37:09,139
It'll have to wait.

1023
00:37:09,140 --> 00:37:10,265
It could be urgent.

1024
00:37:10,266 --> 00:37:14,102
Find Robby or Al-Hashimi.

1025
00:37:14,103 --> 00:37:16,438
This girl is wasted.

1026
00:37:16,439 --> 00:37:18,481
Drunk as a skunk.

1027
00:37:18,482 --> 00:37:20,275
Should we check her blood alcohol level?

1028
00:37:20,276 --> 00:37:21,901
No, it won't change what we do.

1029
00:37:21,902 --> 00:37:23,445
She can go home
when she has a steady gait.

1030
00:37:23,446 --> 00:37:25,613
I already sent one off.

1031
00:37:25,614 --> 00:37:28,283
Joy, do you want to guess
her blood alcohol?

1032
00:37:28,284 --> 00:37:29,784
Why would I want to do that?

1033
00:37:29,785 --> 00:37:31,871
I don't know. 'Cause it's fun.

1034
00:37:37,835 --> 00:37:39,502
When will you have a bed?

1035
00:37:39,503 --> 00:37:41,337
I'm not sure she needs a bed.

1036
00:37:41,338 --> 00:37:43,131
She's a febrile infant.

1037
00:37:43,132 --> 00:37:45,133
Who is clearly over a month
old and looks amazing.

1038
00:37:45,134 --> 00:37:47,051
Every marker is normal.
She has a cold virus.

1039
00:37:47,052 --> 00:37:48,803
Infants with rhinovirus can still have

1040
00:37:48,804 --> 00:37:50,221
a serious bacterial infection.

1041
00:37:50,222 --> 00:37:51,723
Not this one.

1042
00:37:51,724 --> 00:37:53,349
We send kids like this home
all the time.

1043
00:37:53,350 --> 00:37:56,353
Except this one doesn't have
a home or a parent.

1044
00:37:57,688 --> 00:37:59,230
All right.

1045
00:37:59,231 --> 00:38:00,982
I can't put a kid
with a virus in the nursery,

1046
00:38:00,983 --> 00:38:03,234
and I can't waste a private
room on a healthy baby.

1047
00:38:03,235 --> 00:38:04,652
Then what do you propose?

1048
00:38:04,653 --> 00:38:06,654
CYF can place her
in emergency foster care

1049
00:38:06,655 --> 00:38:08,156
by tomorrow morning.

1050
00:38:08,157 --> 00:38:10,366
You want to leave her
down here overnight?

1051
00:38:10,367 --> 00:38:12,786
Seems to be the standard
of care these days.

1052
00:38:12,787 --> 00:38:14,120
Have your attending give me a call.

1053
00:38:14,121 --> 00:38:15,163
Will do.

1054
00:38:15,164 --> 00:38:16,498
I can't believe this.

1055
00:38:16,499 --> 00:38:18,291
Let CYF know it's very urgent.

1056
00:38:18,292 --> 00:38:19,793
Got it.

1057
00:38:19,794 --> 00:38:22,337
This is turning into quite the day.

1058
00:38:22,338 --> 00:38:24,214
You know, I've been thinking

1059
00:38:24,215 --> 00:38:25,799
about applying for a fellowship.

1060
00:38:25,800 --> 00:38:27,717
I thought you had a job
lined up in New Jersey.

1061
00:38:27,718 --> 00:38:29,844
I did, to be close to my mom.

1062
00:38:29,845 --> 00:38:33,389
But she sold her house
to travel the world

1063
00:38:33,390 --> 00:38:35,391
with her new boyfriend.

1064
00:38:35,392 --> 00:38:37,227
So what's the point of New Jersey?

1065
00:38:37,228 --> 00:38:38,686
Yeah, good question.

1066
00:38:38,687 --> 00:38:40,271
Which fellowship?

1067
00:38:40,272 --> 00:38:44,025
I've narrowed it down
to ultrasound, toxicology,

1068
00:38:44,026 --> 00:38:47,237
and sports medicine.

1069
00:38:47,238 --> 00:38:48,613
Those are very disparate fields

1070
00:38:48,614 --> 00:38:50,114
leading to very different careers.

1071
00:38:50,115 --> 00:38:51,282
I know.

1072
00:38:51,283 --> 00:38:53,368
I'm a little undecided.

1073
00:38:53,369 --> 00:38:54,994
Do you have research experience?

1074
00:38:54,995 --> 00:38:57,580
I was a part of a study
on racial disparities

1075
00:38:57,581 --> 00:38:59,457
in health care until the White House

1076
00:38:59,458 --> 00:39:01,042
cut the funding last year.

1077
00:39:01,043 --> 00:39:03,419
Yeah. You are not alone.

1078
00:39:03,420 --> 00:39:06,381
Have you considered
a geriatrics fellowship?

1079
00:39:06,382 --> 00:39:08,258
I have not.

1080
00:39:08,259 --> 00:39:10,385
I've seen your skills with the elderly,

1081
00:39:10,386 --> 00:39:12,554
and there are a lot of openings.

1082
00:39:12,555 --> 00:39:14,389
It might be your best shot.

1083
00:39:14,390 --> 00:39:17,225
Think about it.

1084
00:39:17,226 --> 00:39:18,226
Last stitch.

1085
00:39:18,227 --> 00:39:19,269
You want me to cut?

1086
00:39:19,270 --> 00:39:20,771
I got it.

1087
00:39:22,439 --> 00:39:23,773
It looks good.

1088
00:39:23,774 --> 00:39:25,900
OK. Let's pull the traction suture.

1089
00:39:25,901 --> 00:39:27,278
With pleasure.

1090
00:39:29,238 --> 00:39:31,364
OK, Jackie.

1091
00:39:31,365 --> 00:39:32,740
- Jackie.
- Stop it.

1092
00:39:32,741 --> 00:39:33,741
Stop.

1093
00:39:33,742 --> 00:39:35,076
All done.

1094
00:39:35,077 --> 00:39:36,619
All done with what?

1095
00:39:36,620 --> 00:39:38,288
Sewing up your tongue.

1096
00:39:38,289 --> 00:39:40,039
What happened to my tongue?

1097
00:39:40,040 --> 00:39:41,249
You bit it.

1098
00:39:41,250 --> 00:39:42,250
Ha.

1099
00:39:42,251 --> 00:39:43,877
No, I didn't.

1100
00:39:43,878 --> 00:39:45,753
That is called a blackout.

1101
00:39:45,754 --> 00:39:47,589
How much did you drink?

1102
00:39:47,590 --> 00:39:49,799
A couple Bloody Marys.

1103
00:39:49,800 --> 00:39:51,009
Only a couple?

1104
00:39:51,010 --> 00:39:53,177
I don't know. Maybe more.

1105
00:39:53,178 --> 00:39:55,930
It's a holiday, a pub crawl.

1106
00:39:55,931 --> 00:39:58,600
Do you usually have
a couple cocktails every day?

1107
00:39:58,601 --> 00:39:59,851
Only on weekends.

1108
00:39:59,852 --> 00:40:01,185
How about during the week?

1109
00:40:01,186 --> 00:40:02,604
Nothing much.

1110
00:40:02,605 --> 00:40:07,609
Just wine with dinner or a few beers.

1111
00:40:07,610 --> 00:40:10,778
Maybe we should recommend rehab?

1112
00:40:10,779 --> 00:40:11,905
Yeah.

1113
00:40:11,906 --> 00:40:13,324
We could try.

1114
00:40:17,912 --> 00:40:20,330
Ready to roll.

1115
00:40:20,331 --> 00:40:21,956
How are you feeling?

1116
00:40:21,957 --> 00:40:23,333
<i>My pain is a two.</i>

1117
00:40:23,334 --> 00:40:24,959
We got meds if you need them.

1118
00:40:24,960 --> 00:40:26,461
Scan will be quicker
than the ride to Presby.

1119
00:40:26,462 --> 00:40:27,837
We'll keep trying to reach your sister.

1120
00:40:27,838 --> 00:40:29,464
<i>- You guys are the best.</i>
- See you later.

1121
00:40:29,465 --> 00:40:31,299
Can I put a new patient in T1?

1122
00:40:31,300 --> 00:40:33,635
Uh, no, I kind of want
to leave one trauma room open.

1123
00:40:33,636 --> 00:40:37,305
Why don't you double up
the north if you have to?

1124
00:40:37,306 --> 00:40:40,183
Mr. Digby?

1125
00:40:40,184 --> 00:40:42,101
- It's just Digby.
- Right.

1126
00:40:42,102 --> 00:40:44,646
We've been looking all over.
Where you been?

1127
00:40:44,647 --> 00:40:46,147
With Louie.

1128
00:40:46,148 --> 00:40:47,649
You've been in there for an hour?

1129
00:40:47,650 --> 00:40:49,692
He was my friend.

1130
00:40:49,693 --> 00:40:51,653
- I had a lot to say.
- Hmm.

1131
00:40:51,654 --> 00:40:53,988
Well, let's get you back to your bed.

1132
00:40:55,991 --> 00:40:57,867
Louie got his wings.

1133
00:40:57,868 --> 00:40:59,827
- Dr. Robby.
- Dr. Robby.

1134
00:40:59,828 --> 00:41:01,371
We picked up a patient together.

1135
00:41:01,372 --> 00:41:02,830
Teamwork!

1136
00:41:02,831 --> 00:41:04,332
It's a concerning bullous rash.

1137
00:41:04,333 --> 00:41:05,917
We might need a biopsy
for pemphigus vulgaris.

1138
00:41:05,918 --> 00:41:07,377
It's phytophotodermatitis.

1139
00:41:07,378 --> 00:41:09,170
- What?
- I asked.

1140
00:41:09,171 --> 00:41:11,255
He was making three gallons
of margaritas for a party,

1141
00:41:11,256 --> 00:41:13,508
squeezing fresh limes out in the sun.

1142
00:41:13,509 --> 00:41:14,968
Let's go take a peek.

1143
00:41:14,969 --> 00:41:16,845
I don't need to see it again.

1144
00:41:19,348 --> 00:41:20,807
How's it going out there?

1145
00:41:20,808 --> 00:41:22,350
Standing room only.

1146
00:41:22,351 --> 00:41:23,810
If I call the fire department,
will they clear

1147
00:41:23,811 --> 00:41:25,061
- that waiting room?
- I wish.

1148
00:41:25,062 --> 00:41:26,187
What's up?

1149
00:41:26,188 --> 00:41:28,231
12 patients need med refills.

1150
00:41:28,232 --> 00:41:29,816
Shouldn't they see their doctors?

1151
00:41:29,817 --> 00:41:31,567
With the Medicaid cuts,
we are their doctor.

1152
00:41:31,568 --> 00:41:33,319
No, I can't e-prescribe
to their pharmacies.

1153
00:41:33,320 --> 00:41:35,029
So get out your pen. Go old school.

1154
00:41:35,030 --> 00:41:37,365
Dana, on what?

1155
00:41:37,366 --> 00:41:39,826
Nordt, you got the security pads?

1156
00:41:39,827 --> 00:41:41,077
Sure do.

1157
00:41:41,078 --> 00:41:42,870
Just need a patient sticker.

1158
00:41:42,871 --> 00:41:45,248
- Any other questions?
- Yeah.

1159
00:41:45,249 --> 00:41:47,668
What would have happened
if you weren't here today?

1160
00:41:48,836 --> 00:41:50,712
You'd all be curled up
in the fetal position,

1161
00:41:50,713 --> 00:41:53,047
crying like babies.

1162
00:41:53,048 --> 00:41:54,632
Were you wearing flip-flops?

1163
00:41:54,633 --> 00:41:55,967
I was.

1164
00:41:55,968 --> 00:41:57,885
- What is it?
- Phytophotodermatitis.

1165
00:41:57,886 --> 00:42:00,096
Otherwise known as margarita burn.

1166
00:42:00,097 --> 00:42:01,639
For some people, limes plus sunshine

1167
00:42:01,640 --> 00:42:02,974
can cause a horrible rash.

1168
00:42:02,975 --> 00:42:05,101
This is all because of limes?

1169
00:42:05,102 --> 00:42:07,937
Have you ever squeezed limes
outside in the sun before?

1170
00:42:07,938 --> 00:42:09,605
I don't think so.

1171
00:42:09,606 --> 00:42:12,066
You will feel better
after a day of steroid pills.

1172
00:42:12,067 --> 00:42:13,985
But once these heal,
you gotta wear sunscreen.

1173
00:42:13,986 --> 00:42:16,112
Because these blisters
can turn into dark scars

1174
00:42:16,113 --> 00:42:17,405
and stay a while if you don't.

1175
00:42:19,033 --> 00:42:22,368
I'll be right back with
your aftercare instructions.

1176
00:42:22,369 --> 00:42:24,287
- Hey, Robby.
- Yep.

1177
00:42:24,288 --> 00:42:26,456
My, uh... my hospice patient Roxie

1178
00:42:26,457 --> 00:42:28,416
is still in a ton of pain.

1179
00:42:28,417 --> 00:42:29,709
Where are we with the morphine?

1180
00:42:29,710 --> 00:42:31,627
10 milligrams an hour.

1181
00:42:31,628 --> 00:42:34,213
OK, you can bolus another 2
and go up to 12.

1182
00:42:34,214 --> 00:42:35,590
I will let Princess know.

1183
00:42:35,591 --> 00:42:36,924
12 an hour is a lot.

1184
00:42:36,925 --> 00:42:38,426
Yeah, on top of the MS Contin,

1185
00:42:38,427 --> 00:42:41,387
she could stop breathing.

1186
00:42:41,388 --> 00:42:44,724
Are you familiar with
the doctrine of double effect?

1187
00:42:44,725 --> 00:42:46,768
- Not really.
- No.

1188
00:42:46,769 --> 00:42:49,270
It is an ethical principle
in palliative care.

1189
00:42:49,271 --> 00:42:50,980
We treat pain.

1190
00:42:50,981 --> 00:42:52,940
And if, in doing so,
there's a negative side effect,

1191
00:42:52,941 --> 00:42:54,609
we accept it.

1192
00:42:54,610 --> 00:42:57,445
Even if the negative
side effect is death?

1193
00:42:57,446 --> 00:43:00,074
In some cases,
that could be the best outcome.

1194
00:43:05,871 --> 00:43:07,330
Maybe the nurse has it.

1195
00:43:07,331 --> 00:43:10,041
Emma. Emma, where does...

1196
00:43:10,042 --> 00:43:11,793
Maybe the fax ran out of paper?

1197
00:43:11,794 --> 00:43:14,504
No, there is enough paper.
I don't know what's wrong.

1198
00:43:14,505 --> 00:43:16,005
- Could be in another room.
- We should call IT.

1199
00:43:16,006 --> 00:43:18,007
You want me to check every room?

1200
00:43:18,008 --> 00:43:19,634
How are we gonna get through this mess?

1201
00:43:19,635 --> 00:43:22,595
I was about to ask you.

1202
00:43:22,596 --> 00:43:24,138
Ask the pharmacist.

1203
00:43:24,139 --> 00:43:25,681
She can't leave the PDS.

1204
00:43:25,682 --> 00:43:27,475
Nothing's getting done here.

1205
00:43:27,476 --> 00:43:32,048
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