All language subtitles for The Pitt - 02x13 - 7_00 P.M..1080pic7ed.com

Sync and corrections by btsix
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- You know this guy?
- Orlando Diaz.

We were treating him
for DKA when he eloped.

- How far did he fall?
- 20 feet or so.

- Anyone see him pass out?
- No.

They went looking for him after
he didn't answer his radio.

Pupils equal but sluggish.

He left against medical advice.

On my count, three, two, one.

Dr. Ellis on the case.
Day shift, we got this.

- I'm staying.
- Continuity of care.

Dr. Al-Hashimi, why don't you go cover

sign-out rounds with Dr. Abbot?

- Shen, you too.
- Got it.

OK, let me know if you need anything.

- Lungs are up bilaterally.
- Pelvis is stable.

Right tib-fib hematoma,
deformed right forearm.

Ruptured TM on the left
with sero-sanguinous fluid.

That means basilar skull fracture.

We've got a diabetic patient,
20-foot fall.

BP 204 over 98, pulse 56.

Dr. Mohan, what do those
numbers indicate?

I'm trying to treat the patient.

It's the Cushing's reflex.

From increased intracranial pressure.

Yeah, we need to get him
to CT right away.

No free fluid in the belly.

- Any family to notify?
- Wife and three kids.

Is there a card to sign for Robby?

No, he said no card, no presents.

Oh. Was there a cake?

Oh, he didn't want that either.

That sucks. I need some cake.

Patient was injured
when they raided a restaurant.

And they actually arrested the nurse?

- With a takedown and zip ties.
- Damn.

Crus, you, uh, know
the computer downtime drill?

Yeah, no biggie.

I prefer to treat 'em
without labs and X-rays.

Welcome back.

If you do have orders
for labs and X-rays,

clipboards go here.

If it's just nursing orders, here.

Please write neatly, for God's sake.

Oh, Monica, this is Nazely, new intern.

- I don't need to know that.
- So nice to meet you.

Looks like you and me, Jack.

Yeah, who's our senior?

- Dr. Henderson.
- Excellent.

Night shift's on Crus control.

You hear ICE brought us a patient?

Oh, yeah? How'd that go?

There was some collateral damage.

They arrested Jesse.

- For what?
- Assaulting a federal officer.

Are you fucking kidding me?

Oh, Dr. Al-Hashimi,

this is Nazely Toomarian... new intern.

OK, everybody, let's huddle up.

Before we start,

let me address the elephant in the room.

For those of you who don't know,

Jesse tried to intervene

when a federal agent
was handling his patient,

and both he and the patient
were taken away by ICE.

- Did he punch the guy?
- No.

He put out a hand to stop him,
made physical contact.

It was a little bit more than that.

The hospital lawyers are on the case,

and we will brief the staff
every 12 hours

at sign-out rounds
with an official update.

In the meantime,
don't feed the rumor mill.

You may have also heard
that new grad nurse Emma here

- was assaulted by a patient.
- I... I'm fine.

Please don't forget "code hula hoop,"

and with risky patients,

always keep a path to the door clear.

Sounds like one hell of a day.

And we're still dealing with downtime,

so day shift should brief
night residents

about the protocol...

Hey!

Oh, all right!

Oh, thank God.

Yeah, not so fast.

Every chart from the last five hours

needs to be scanned into
the Electronic Health Record

and checked for accuracy...

- Um, whose job is that?
- Day shift.

With a completed and signed T-sheet.

- Are you kidding me?
- That's gonna take forever.

We will set up stations for scanning.

OK, everybody, let's get moving.

Triage is 20 behind.
Gotta help 'em clean up.

I'm skipping rounds.

Consider yourself lucky.

Should we join them?

Might as well witness the magic.

It's like changing of the guard
at Buckingham Palace.

Except we're allowed to smile.

"Smile though your heart is aching."

Plain films, right tib-fib

and right forearm after CT.

Got the chem-8. Blood sugar's 284.

That's not too bad.
Potassium looks good.

Mm-hmm. Anion gap's up at 14.

It was 24 this morning.

He's definitely improving.

The DKA is resolving.

So what made him pass out?

It's hot as hell out there.

He could have been dehydrated
from sweating.

Or he could have had
an N-STEMI or a posterior CVA.

Ready to roll.

- I can babysit him at CT.
- Thank you.

I'll stay in case he needs the OR.

Hey, we're back up.

It's about time.

- Ooh, Robby.
- Yeah.

I got intel on where
ICE has taken Jesse.

Intel from who?

Uh, my brother-in-law's a cop.

So he'll be processed at DHS Southside

and then transferred
to ICE detention in Clearfield.

Clearfield? That's two hours away.

Mm-hmm.

OK, I'll let
the hospital attorneys know.

- How are you doing, Oliver?
- Alive and kicking.

Uh, Mr. Haas.

Pulmonary edema after missed dialysis,

now stable with his son Mason
at the bedside.

- Hello.
- I'm Dr. Shen.

I'll be back.

Dialysis tech says

I'm off the machine at 10:42.

Hit the call light,
and I'll come running.

South 21 next...

Mr. Digby.

J-just Digby.

Dr. Mohan's patient.

Forearm cellulitis, admit med-surge.

- Awaiting a bed.
- I can take him.

Sold to Dr. Toomarian.

Moving right along.

Get enough to eat?

We'll be back.

Lillian Stegman.
Tweaked her knee water-skiing.

Doing a 360 off a 5-foot ramp.

Ooh, respect.

X-rays ordered in triage.

That was hours ago.

Ma'am, I'm Dr. Crus Henderson.

Let's get you home real fast.

- That would be wonderful.
- OK, heading to North.

Thank you.

Looks like our first scanning
station is almost ready.

Whitaker, Santos, after rounds,
this will be your post.

- Seriously?
- For... how long?

Till we mop up this mess.

And away we go.

All right, now you know everything

there is to know about rounds.

Fascinating, right?

Uh... yeah.

Here, I got something better for you.

So, Digby, we're gonna find you
some new clothes,

but my friend Emma and I
wondered if you'd like

to get cleaned up a bit first.

I already had a shower.

I know, and you look good.

But the offer also comes
with a shave and a haircut,

if you're interested.

No pressure... like I said,

you already look great.

- Sure, I guess.
- Fantastic.

All right, kid, fill that basin
with some warm water

and lather him up.

- Hey, stay safe out there.
- Back at you in here.

Hey, Cary.

You were on scene with Orlando, right?

Did you notice anything about his fall?

Like what?

Like, um, if there was
a break in the railing

or if there were security cameras?

Too busy working on the guy...

IV, intubation, backboard, splint.

Thanks.

Oh, two names is a start.

Pretty soon, we'll retire
the clipboards.

Baby Jane Doe in Pedes?

Uh, yeah, abandoned

in the waiting room bathroom
at 7:30 a.m.

- Safe haven drop-off?
- No, she's too old for that.

- At least two months.
- I'll take her.

Awaiting foster placement by CYF.

- What if the mom comes back?
- Call the cops.

Day shift, get to work scanning.

Night shift, the room numbers

on top of the dry-erase board
need a doctor.

- Who's in BH-1?
- Psych hold, danger to self.

What's the story?

Doctors King and Langdon
were on the case.

It's a sad story...
she says her 5-year-old

snuck into the back seat
of the car to take a nap.

Heat stroke.

Mom was extremely distraught.
Walked out into traffic.

Grady Barnhill, wheezing

and not responding to albuterol.

Pulse ox 87. His mother, Naomi.

- OK, Trauma Two's open.
- On our way.

- Uh, Mom, history of asthma?
- His whole life.

- Never this bad.
- Barely moving air.

Using all his accessory muscles.

Call RT!

Uh, continuous nebs,
20 milligrams an hour.

We have a home nebulizer.

I've been giving him
albuterol every hour.

Ready?

On my count, one, two, three.

Does he take any other medications?

Just the albuterol.

He used to be on montelukast
and Symbicort.

Why did you stop that?

Because he lost his Medicaid
two months ago.

He's so tight,
nothing's getting through.

- Mel, EpiPen.
- On it.

0.3 milligrams.

That may open his lungs
so the nebs can work.

All right, Grady, shot in the thigh.

Hey.

Something to scan?

Critical labs on North Three.

Oh, it's, uh... it's not my patient.

She's about to be.

I'm, uh... I'm off the clock, so...

These were ordered
three hours ago from triage,

so, technically,
she is a day-shift patient.

Just get the intern started.

I got a meeting upstairs with admin

to get things back on track.

Sorry. Everyone else is tied up.

That's OK.

How'd you get stuck on night shift

for your first rotation?

Just lucky, I guess.

Yeah, if you like a good horror movie.

- Where was med school?
- Uh, UC Irvine.

- California, right?
- Yep.

Pittsburgh's a little different.

Yeah, a lot more humidity.

Yeah, that'll go away

with your first foot of snow.

Uh, hi, Mrs. Davis.

I am Dr. McKay. This is Doctor...

- Toomarian.
- Hello.

Uh, your labs show a lot
of inflammation in your liver.

- Is that why I'm so nauseated?
- Definitely, yeah.

Have you, um, noticed a change
in your skin coloration?

I've been using this bronzing cream

so I don't look like a ghost
in my bathing suit.

Do you remember the name of the bronzer?

It could have a chemical
that can cause...

Oh, no, no, it's 100% natural.

- It's DHA from sugar beets.
- OK.

Why would my liver be inflamed?

Uh, there's a lot of possibilities.

Are you taking any
prescription medications?

Not a single one.

- Tylenol?
- God, no.

We have to ask everybody
about injection drug use.

Never.

Raw clams or oysters?

I'm a vegan.

One step at a time, OK?

We'll be back.

Digby, Haas, now on the big board.

Progress.

So he's just been waiting
in the hall the whole time?

OK, well, can you maybe get to him next?

Thank you.

Duke goes to CT, and they bump him.

Yeah, he may end up
waiting for hours over there.

Oh, look at that. 7:15 already.

Just a few more loose ends to tie up.

You got more loose ends
than a macramé wall hanging.

My mom had one.
Took up the whole goddamn wall.

Seriously, you should
think about signing out

- and hitting the road.
- Yeah, maybe you should too.

Oh, that's right, you sent Lena home.

Are you planning on
calling in a replacement,

or are you just gonna work till sunrise?

If I have to.

Oh, so you get to go the extra mile,

and the rest of us just get
accused of being martyrs.

- Robby.
- Excuse me.

- What's the word?
- No subdural, no epidural.

Diffuse brain swelling with effacement

and compression of the ventricles.

C-spine? Chest-abdomen-pelvis?

Uh, left pulmonary contusion,
no intra-abdominal hemorrhage.

Which means I'm off the hook.

I'll send Neurosurgery down.

If he doesn't need the OR,
why Neurosurgery?

- Wait and see.
- Let's get busy.

CVP and an art line.

Orlando. Orlando, squeeze my hand.

Open your eyes.

We already know his GCS
is going to be three.

Hey, Javadi, anti-seizure prophylaxis?

- Keppra, 20 migs per kilo.
- Mixing it now.

Gotta get this brain swelling
down, Samira.

How we gonna do that?

- Samira?
- What?

We have to lower
the intracranial pressure.

- Mannitol.
- Not the best.

Can cause diuresis and hypotension.

Then hypertonic saline.

23%. 50 cc's through a central line.

Still tight as a drum.

Five minutes since the epi.

He can have one more EpiPen.

Sats are borderline, 87.

How about BiPap? 10 over 5.

Yes, with in-line nebs.

All right, Grady, shot number two.

Might as well throw in
some magnesium, 50 per kilo.

I'm sorry. He's not ventilating.

We should be ready to intubate.

With an asthma patient?

There's a high risk of cardiac arrest.

Naomi, has he ever been put
on a breathing machine before?

- Never.
- Hospitalized?

No, we could always break him
with the Symbicort.

We're gonna give the current treatment

a few more minutes to help him
turn the corner.

I could probably do this myself

now that my cast is off.

Oh, that's OK.

I don't mind.

How long have you been a nurse?

This is my first day.

You're doing really good.

Thank you.

- Oh, shit, you OK?
- Yeah.

There's water on the floor.

Sorry! I... I might have spilled.

Yeah, no worries.

We're gonna have to sort
these all by patient

before we scan them.

Is, uh, Joy still around?

I heard she left at 6:59.

- Smart girl.
- Mm-hmm.

You know what? Find Ogilvie.
He's such an ass-kisser.

He might stay and scan
all the charts himself.

Oh, he, uh, scrubbed in in the OR,

scrubbed in on the ruptured triple-A.

Oh, the kidney stone that wasn't.

That'll be four hours at least.

So are you still going
to Amy's after work?

Yeah, maybe just for tonight,

after Robby briefs me
on all the house stuff.

Sounds fun.

When he asked, it was hard to say no.

Sure.

It's gonna be very weird
without him here.

Yeah.

You think Dr. Al-Hashimi can handle it?

In a word, no.

She's smart.

It takes more than that.

Yeah, well, at least

it's only three months.

Yeah, three long months.

Then you need to find a new home.

Not necessarily.

I mean, if I wanted,
I could just check on

Robby's house once
or twice a day, you know.

Why would you do that?

I don't know. Why not?

Hypertonic's in.

Maintenance LR in the AC.

Looks like a halo sign.

Cerebrospinal fluid
from a basilar skull fracture.

The halo sign is neither
sensitive nor specific for CSF.

Saline, tap water, and runny noses

all separate from blood.

- Hello, Linda.
- Robby.

Division chief working
on a holiday weekend.

Well, somebody's got to.

Saw the scans. This guy needs an EVD.

External ventricular drain
to take down the pressure.

Because CPP equals "MAP" minus ICP.

Cerebral perfusion pressure in the brain

equals mean arterial blood pressure

minus the pressure in the skull.

ICP less than 22

predicts survival and favorable outcome.

CPP from 60 to 70 reduces
morbidity and mortality.

Can somebody assist?

Dr. Mohan?

I'm good.

Samira, you should lend a hand.

I said I'm good.

- Javadi?
- I don't think so.

Javadi?

As in, daughter of Raymond and Eileen?

I was at your mother's baby shower.

She was a resident.

You were in utero.

I don't know how she got through

motherhood and training.

Feel free to join me.

Oh, my... my shift was over a while ago.

OK.

Masks all around. Two sterile gowns.

We brought the surgical towels.
Just need some Betadine.

This is kind of an amazing opportunity.

I'm exhausted.

The Chief of Neurosurgery is here.

She's kind of a legend.

Maybe one of the night
residents can do it.

Is this about
the volvulus case from earlier?

'Cause if it is, you made a mistake.

You need to move on.

I do not want to come back here
and find that

you've applied for a residency in derm.

Step up to the plate. Do it.

Javadi will assist.

Excellent.

You know, I think Eileen did
her first EVD with me

back when I was a brand-new
assistant professor.

Time flies.

How you doing, Grady?

Still retracting.

- Any improvement?
- Not really.

You feeling tired?

- Do we have Aerogen in the ED?
- Just in the unit.

How fast can you get back?

Two minutes if I take the stairs.

Go.

Uh, Aerogen?

It has a 5-millimeter mesh

that vibrates
over 120,000 times per second.

Dr. Al-Hashimi?

You OK?

Uh, you were telling us about Aerogen.

Dr. Shen can explain.

It produces droplets
in the 2-to 5-micron range

for medication delivery.

- How's it going?
- Just about to start.

Securing the art line here.

Measure twice, cut once.

We enter 11 centimeters
back from the nasion,

3 centimeters lateral.

Without any direct imaging?

No, straight shot
into the lateral ventricle...

tried and true since 1890.

OK, go ahead with the incision.

Hey, you worked
with Dr. Al-Hashimi at the VA.

I did.

For how long?

During my R2 rotation

and then one again last year.

OK. Hand drill's all set.

Maybe you should do this part.

No, no, there's a safety stop here.

You can't go too deep.

It's not brain surgery.

OK.

- Stay perpendicular.
- OK.

Good.

All right, now, four turns

to get through the outer table...

- Yep.
- Then half turns

till you penetrate the skull.

Three, four.

One...

Holy smoke!

I thought it was Tom Cruise
for a second over here.

Nice job. How's that feel, Digby?

- Pretty good.
- I bet.

What do you say we trim up

those gorgeous locks of yours now?

I don't like having my hair cut.

I get it, Rapunzel,
but you need your ears lowered.

You'll feel better
with a fresh summer look

that won't go unnoticed by the ladies.

- Maybe just a trim?
- Great.

I'm thinking a pixie cut.

- What?
- I'm kidding.

I cut my husband Benji's hair
all the time.

Trust me, you're gonna look fabulous.

When's the last time you had a haircut?

Maybe my daughter's wedding
a few years ago.

Where?

St. Sebastian,

Our Lady of Mount Carmel Parish.

Does your daughter know where you are?

Of course. We all live in Pittsburgh.

In fact, they live in my old house.

Your daughter lives in your house?

Yep.

Where do you live?

Wherever I want.

You're gonna pass it 5 to 6 centimeters

from the inner table of the skull, OK?

Centered...

perpendicular...

aiming for the medial canthus.

All yours.

A-and just keep going?

You'll feel a pop when you pass

the ependymal lining.

Art line is calibrated. Good to go.

Titrate the nicardipine
to a MAP of 85, please.

And if we can get
the intracranial pressure

down to 20?

Dr. Mohan?

I'm sorry.

MAP of 85, ICP of 20?

Um, cerebral perfusion pressure 65.

Which gives him
the best shot at survival.

A third of patients like this die.

Half have long-term disability.

We'll know in two weeks
if there's a possibility

for a good prognosis.

Felt a pop.

Remove the stylet.

OK, let it drain a bit.

And now pinch it shut.

Perfect.

BP is down, 190 over 88.

Heart rate's 67.

How are you guys doing?

Yeah, making some progress.

You seen Abbot?

Not since rounds.

He asked me to see a patient
with the night intern.

And you said yes?

48-year-old woman, new onset jaundice,

elevated liver enzymes,
no history of alcohol use.

Take your pick...

hepatitis A, B, C, D, or E.

- No risk factors, no fever.
- Tylenol?

Never, and no prescription meds.

Does she eat polar bear liver?

It can cause vitamin A toxicity.

- No.
- Yeah.

She, uh, doesn't eat meat,

kind of a health nut.

Well, maybe she's gulping down

cod liver oil to prevent measles.

No. Vegan, no fish.

Would you, uh, mind laying eyes on her?

Seriously?

You have a way of
figuring out the weird stuff.

Take the compliment.

OK, fine.

Five minutes at the bedside...
that's it.

I'm already gonna be here
for hours as it is.

Thank you.

What am I doing...

- Definitely improving.
- Tidal volume's up.

Wheezes now expiratory only.

Oh, making some progress.

You feeling better, baby?

- You scared the shit out of me.
- Language!

Does he have a primary-care doctor?

Not anymore.

How do you get
his prescriptions renewed?

Neighborhood clinic. We pay cash.

- Albuterol's cheap.
- Symbicort?

Without Medicaid, 400 bucks a month.

Just for a little inhaler?

Trocar is on the tube.

I tunnel underneath the scalp
about 5 centimeters

and poke through.

- To prevent infection?
- Mm-hmm, exactly.

Now you hold the knuckle steady
while I pull it through.

And you can staple the wound shut.

That looks like something
from Home Depot.

Yeah, big Fourth of July sale.

The brain pressure is measured by

the height of the fluid column.

We need to calibrate it to zero
at the level of the tragus.

Stopcock's on, ready to attach.

First troponin's normal,

but you need a second to rule out MI.

Hey, can you step out for a second?

I really did do everything I could

to try to make Orlando stay.

Yeah, I don't doubt it.

I wanted to ask you about

Dr. Al-Hashimi at the VA.

Did you ever notice anything
unusual about her behavior?

Um, like what?

Lapses in focus, attention?

No, she was always on top of her game.

But this morning when she was
checking labs on Baby Jane Doe,

it was like she zoned out
for a few seconds.

Maybe she was just tired.

No congestion, nodules,

or cirrhosis.

Good-looking liver.

I should not be sick.

I work so hard to stay healthy...

diet, exercise, eight hours of sleep.

I can't remember the last
time I got eight hours.

Maybe you should try sleepmaxxing.

Oh, you definitely should.

Yeah, cold room,
white noise, eye shades.

Kiwis before bedtime,
lettuce water, mouth taping.

Who do you follow for health?

A few naturopaths
and some functional healers.

Do you... do you buy vitamins from them?

Oh, no, no, I don't take vitamins.

Food is the best medicine...
kale, blueberries,

- kidney beans, turmeric.
- Turmeric?

Uh, how long have you been taking that?

For a few months.
It's an anti-inflammatory.

It detoxes the body,
and it can prevent Alzheimer's.

How much do you take?

500 milligram capsules,

but I take five a day.

What?

With doses that large of turmeric,

there have been cases of liver failure.

From eating a spice?

All right, Digby,
I think you're good to go.

Mm-hmm. Would you like to see?

I haven't looked like this
in a long time.

Your family won't recognize you.

Then how will they find me?

They... they won't know
what I look like.

They won't know this is me.

Of course they will.

They know your voice.

They know where you hang out.

They even remember that
you used to look like this.

They remember the wedding.

Did you dance with your daughter

at her wedding?

I did.

Then she will always remember you.

- Yeah.
- OK.

Hey, I was just looking for you.

- What's up?
- You tell me.

- The, uh, asthma patient.
- What about him?

Seemed like you were hesitating

talking about using Aerogen.

I was wondering if you were
having second thoughts.

No. Just thinking.

About?

The best treatment plan for the patient.

And I think he's on it.

- Anything else?
- I don't know.

You tell me.
Anything else I need to know?

I don't think so.

This is Dr. Robby in the ED.

I'm checking on a patient, Ekins.

We can take Larson
and Stevens off the dry-erase.

Consider it done.

He's in the scanner now?

Oh, great.

No, I was just calling to confirm.

Thank you.

Any new information from upstairs?

Nothing we don't already know.

Same old story, huh?

You think we should take up a collection

for Jesse for... for bail money?

They don't usually set bail

until after you've appeared
in front of a judge.

With the holiday, it's not
likely to happen till Monday.

So he's gonna be locked up all weekend?

That sucks.

It does suck.

Dr. Langdon, Grady's worse...
much worse.

- Need an attending?
- Uh, no, we have Shen.

Sat's down to 83.

- What's happening?
- Give us a minute.

He's tiring out.

Ketamine and rock.
It's time to intubate.

I'll call Volk.

Ma'am, we have to put a tube

down your son's windpipe

so a machine can breathe for him.

Oh, my God.

Hold on, hold on.

No lung sliding on the right.

Pneumothorax.

No need to intubate.

What's going on?

He has a collapsed lung.

There was no history of trauma

that would have caused pneumothorax.

Glove up, Dr. King.

In asthma, you can get "air trapping."

When the lungs can't fully exhale,

eventually they overinflate,

causing some of the tiny
air sacs to burst.

How do you fix it?

Like that.

It's a good thing Dr. Conley was here.

- Yeah.
- We should probably try

to find him a Neuro-Critical ICU bed.

We don't want to board
a patient like this.

- Mm-hmm.
- Hey, Robby.

- Hey, how did the scan go?
- Fine.

It is probably gonna take a little while

to get the results from the radiologist.

Well, that's not a problem.

Nurse Vivi and I need a little time

to coordinate our schedules
over the next few months.

- Really?
- Yeah.

I've always wanted to learn

how to ride a motorcycle,

and Duke offered to teach me.

Well, nobody knows
motorcycles like Duke.

He's giving me the health
care worker discount.

He's quite the gentleman.

Let's get him back to his room.

How would next Saturday be
for you, Vivi?

Uh, maybe we could have
some dinner after.

Dr. Mohan, Lorrie Diaz is here.

She wants to see her husband.
She's heading back.

OK, I'm on my way.

- Mrs. Diaz?
- Hi.

Did Orlando go up to his room yet?

No. Um...

I brought him some dinner
from Burgatory.

It's a chicken burger...

no bun, just lettuce.

Figured it would be better
than hospital food.

He's being treated by our top
brain-injury specialists.

Will he wake up?

We won't know for several weeks.

And then he could be back to normal?

Best-case scenario,
it would take about a year

before he could be independent at home.

And the worst case?

Round-the-clock nursing care
for severe disability.

You let him leave?

He insisted on leaving
to work at his second job.

You couldn't make him stay?

He was competent. He knew the risks.

We honored his decision to leave.

Even if it was a stupid one?

I tried to stop him.

Offered to get him
all the supplies he'd need

to take care of himself at home.

But he left before
I could give them to him.

He said he couldn't afford
to lose a paycheck.

Dr. Langdon.

Are you OK?

Yeah. I'm just kind of, uh...

wondering if I'm really
ready to be back here.

Well, of course you are.

Ten months is a long time.

I almost killed that kid
with an intubation.

Didn't even occur to me
to check for pneumothorax.

There wasn't any trauma to indicate...

- I should have caught it.
- OK.

You know, I, um...

I had a deposition today,

and all the lawyer's questions
made me feel like

I was a really, really bad doctor.

We don't always get everything
right the first time.

You would have caught
the collapsed lung.

And it may have taken a minute,
but you would have saved him.

I'm not sure Robby would agree with you.

He's been riding me all day.

Well, Robby's leaving for three months.

And, you know, with Robby gone...

I really don't want you to leave either.

That which does not kill me
makes me stronger.

Wow, Friedrich Nietzsche.

Yeah, Nietzsche, yeah...

not Kelly Clarkson.

Hey, that's a thick one.

Yeah, Austin Green. Ogilvie's triple-A.

Uh, G-R-E-E-N?

Yeah. Why? What are you doing?

Checking to see when we'll get Ogilvie

back from the OR.

- Oh, shit.
- What?

The guy didn't make it.

He died on the table
about 40 minutes ago.

Then where's Ogilvie?

Oh, man.

His patient had a CT
a year and a half ago

that showed a 4-centimeter triple-A.

That's too small for surgery.

He was supposed to come back

every six months
for a repeat ultrasound,

but looks like he didn't.

We would've seen that
if the computers were working.

Why wouldn't he tell Ogilvie?

I don't know.
Maybe he forgot all about it.

Or Ogilvie didn't ask
the right questions.

Dennis, hey, got a minute?

Uh, sure. What do you need?

Teenager with jewelry magnets

stuck to both sides of her nasal septum.

I tried to move them
with a plastic curette.

Too much pain,
and then there was bleeding.

Those need to come off before
they cause permanent damage.

Yeah, you think, uh,
you could find, like,

a senior or an attending?

We're really trying
to get off the clock here.

They're all busy.

I already took one for the team.

Yeah, fine.

Uh, labs on your yellow lady.

INR is elevated, 2.2.

Liver's in trouble but not dead yet.

Tell her to skip the turmeric.

Admit for monitoring,
and follow the LFTs.

- Got it.
- Mm-hmm.

- Central 10?
- Yeah.

"Sleepmaxxing"? Really?

I track the online trends.

Is that your secret for the tough ones?

I just think,

what's the stupidest thing
this person could have done?

Then assume they did it.

Well, I mean,
she was trying to be healthy.

Yeah, by taking advice from fools.

Turmeric is recommended
by a lot of doctors.

Yeah, then ask your doctor for the dose

or check someplace reputable,
like the CDC.

Oh, right, I forgot, it's now
a medical toxic waste site.

I mean, she's in pretty bad shape.

If things get worse, she could
need a liver transplant.

Yeah, 'cause she's a big fucking idiot.

Wow.

No, I actually appreciate her.

Our job security depends on
all these big fucking idiots.

OK.

Uh, good night, Perlah, Monica.

- Good night, Dr. Robby.
- Good night.

Bye, Emma.

You could stay to pitch in.

Mm, Dana told me to go and get some rest

before tomorrow's shift.

Yeah, you had quite a day.

Wasn't so bad.

Why can't I find Duke's results?

Oh, new patient, no EHR yet.

I can run over to Radiology,
get a printout.

Thank you, Monica.

Ready to pick up a few more.

Orlando's all tucked in for now.

- How's he doing?
- Numbers are good.

CPP 22.

OK, so he's got a shot
at a decent outcome at least.

You think he has a chance?

Oh, I don't know that survival was

the outcome he was hoping for.

What?

He told Samira he's got
$100,000 in medical debt,

- that his life is probably...
- Mrs. Diaz!

- How can we help you?
- The bathroom?

Uh, yeah. Perlah can show you the way.

Not a great idea to have
a private conversation

about a patient in a public area.

I know. I know.

You were about to start yapping...

But I didn't!

OK.

And how long have they been in there?

At least two hours.

- How did it happen?
- With my earring.

It was supposed to be, uh,
red, white, and blue

to look cool at the fireworks.

I told her for the nose, one side only,

but she never listens.

This can be pretty serious.

If we don't get them out quickly,

it can cut off the blood supply

and cause the septum to collapse.

Like, my nose could be deformed?

- Oh, my God, get them off.
- Yeah, that's the plan.

Yeah, she tried already.
It hurt like crazy.

Because they're stuck together

by a very strong magnetic force.

- Yeah.
- No, no, no.

Oh, uh, I'm not gonna use the tips.

I'm gonna flip it around
and use the handle.

It's still gonna hurt.

Probably not.

Just, uh, hold still.

OK.

Voilà.

- Really?
- That was amazing.

I think another half hour,

we can send this dry-erase
board back to storage.

With pleasure.

- Dr. Robinavitch?
- Yep.

Results on your friend.

- Fuck.
- Duke?

Are you gonna tell him?

I want to talk to a surgeon first.

Uh, Dr. Robby, I have
an update on the patient.

Now is not a great time.

Oh, I thought you were going home.

Uh, I was.

Dr. Ogilvie is just sitting

out in the ambulance bay
covered in blood.

Sorry, what...
what's he doing out there?

Kind of, uh, staring off into space.

I tried to talk to him, but it was like

- he couldn't hear me.
- Monica,

can you stat page CardioThoracic?

- I'll go check on Ogilvie.
- Please.

Oh.

Hey, Ogilvie.

Ogilvie...

y-you OK, man?

99 on 2 liters.

Scattered end expiratory wheezes.

He is so much better.

The steroids should kick in soon.

So he'll keep improving.

Um, when can I go home?

In a day or two.

And we will, uh, discharge you
with a Symbicort inhaler.

That should last about a month.

Hopefully we'll be
back on Medicaid by then.

How'd you lose it?

They sent a redetermination
letter to our old apartment.

It didn't get forwarded.

When I went to pick up his prescription,

pharmacist told me
we were no longer covered.

And you haven't been able
to get it back since?

I've been trying for months.

To get re-enrolled,
you need tax returns,

pay stubs.

I cut hair. My income fluctuates.

A lot of my regulars are struggling,

so it's been tough.

Well, if you run out of Symbicort

before your Medicaid kicks in,
you can come back,

and we'll, uh, set you up
with another one.

Oh, is there a patient in here?

'Cause everyone in this room
looks extremely healthy to me.

Dr. Shen and I will be
with Grady all night long.

Yeah. Day shift, we got this.

We're leaving you in good hands.

Um...

I was really scared.

Thank you.

You're very welcome.

Due to his injury, things have changed.

I was looking for Dr. Abbot.

I haven't seen him for a while.

Excuse me.

So now, with a long-term disability,

things may be easier.

"Easier"?

His condition will qualify him

for Medicare and Medicaid.

So, moving forward,
costs should be covered,

including home health care.

OK.

Perhaps this isn't the best time...

I just wanted to reassure you

about future costs.

Robby.

Noelle.

You're still here.

It's not the best day
to try to get out on time.

Mm.

So I guess this is it for a while.

Unless you want to come with me.

No, but thank you,

even if it isn't a legitimate offer.

- What do you mean?
- Oh, please.

I know well enough not to get in between

a man and his vision quest.

"Vision quest."

That is my nice way of putting it.

I probably don't want to hear

your not-so-nice way of putting it.

No, probably not.

I-I hope that this is not, um...

about you running away from me.

I'm a big girl.

You can tell me just to get lost.

This has nothing to do with you.

Oh, right.

It's the old, uh,
"it's not you, it's me"?

In this case, it's actually true.

Excuse me.

I'll see you next week?

It's a three-month sabbatical.

Like I said, I will see you next week.

My first day here as a med student...

there was a patient.

He was a real nice guy,

came in with belly pain.

I saw a gall stone on the ultrasound,

normal EKG, troponin.

The pain resolved,
and he was in the hall

when he had a cardiac arrest.

I couldn't save him.

People die.

And we do the best we can...

but people die.

You ever get used to it?

No.

No, you...

you try to accept it.

You try to find balance.

I don't know if I can take
another day like today.

Primary care specialty
sounds way better.

Pedes, maybe.

Yeah, maybe.

I know I'd be bored
out of my fucking mind.

Seriously, I like the challenge
of undiagnosed illness,

of quick decisions,
of life-saving procedures.

And I like being here for people

on the worst days of their lives.

You know what I think?

What?

I think you should go home.

I think you should sleep on it.

And I think you should at least wait

till the morning to decide

if you want to come back.

I don't really want to...

go back in there and see anybody.

Yeah.

OK, pull off your gown. I'll take it in.

Shift is over.

Go home.

- Oh!
- Oh, God.

- No, I'm... I'm...
- Sorry.

I'm good. I'm good. I'm good.

There's a dummy in a wheelchair.

Uh, yeah, he moves around.

I see I've been replaced.

Oh, did I take your spot?

- Not really, no.
- Are you sure?

Where the hell have you been?

I found Ogilvie.

And?

And he's going home.

That's it?

It's a long story.

Well, I got nothing but time.

I need to respect his privacy.

Where's the fun in that?

- Beep. Beep, beep.
- Sorry.

Um, the shredder jammed.

Yeah, uh, try putting it in reverse.

Perfect.

Just give it a little love tap.

- OK.
- Kick it.

Jesus Christ.

Guess Mr. Digby got a room upstairs.

In your dreams.

He's not in South 21.

Yeah, he is.

There's a new guy in the bed.

Short hair, clean-shaved?

I'll take care of it.

Scout film showed obvious pathology,

so we ordered the CT angiogram.

Textbook ascending aortic aneurysm.

Eight centimeters.

50% one-year mortality.

So he definitely needs surgery.

If he wants to live.

OK, well, he's a friend,

so I will talk to him.

I'll get him admitted to your service.

- Not today.
- Why not?

He needs to see Cardiology
and Pulmonary first

to be cleared for the OR.

They can do a stress echo, PFTs.

He needs to be admitted
and evaluated as an inpatient.

Nothing ever gets done
over a holiday weekend.

He can take it easy at home.

He's a ticking time bomb.

He's probably been that way for years.

We can get him in early next week

with a specialist
to get his testing done.

All goes well, he's on
the OR schedule in a week.

What happens if it ruptures before then?

Call 911.

Sorry, Robby. Best we can do.

Text me his number.
I'll have my office coordinate.

- Fuck!
- Hey!

Take a walk. Come on!

Two for discharge.

Yeah, please don't ring the bell.

The computers are back up and running.

Not for these two.

They don't have electronic
health records yet.

Wait, hold up.

This kid had a wrist X-ray ordered.

Ugh, it never happened.

And water-skiing lady's

still waiting on a knee series.

I canceled the X-rays.

Diagnosed them both with ultrasound.

Really?

Yeah.

The, uh, little boy had
a simple buckle fracture.

Distal radius. He got a Velcro splint.

And Mrs. Stegman had
a small medial meniscus tear.

Knee immobilizer, crutches,
and a follow up with ortho.

Could have used you
on the day shift today.

They don't teach us a lot
of musculoskeletal ultrasound.

I know.

That's why I did electives
at Harvard and Highland.

Are you applying for
an ultrasound fellowship here?

I am, but it is so competitive.

- That's what I hear.
- Kind of a long shot.

I only have one publication,

but it's a series
of case reports diagnosing

shoulder dislocations
with ultrasound only.

If you want to learn some MSK,
you can tag along.

I got three more to scan.

Maybe some other time.

Cool.

Hey, don't jam the shredder.

What is that, two charts?

No, it's my ultrasound
fellowship application.

Hey.

Uh, sorry about your patient.

Yeah, Orlando's in pretty bad shape.

Oh, no, I... I was talking about

the triple-A guy
you worked on with Ogilvie.

He didn't make it through surgery.

I tried to talk to Robby about it,

but I think he's busy.

Excuse me.

Oh, shit.

You think I'm on edge?

First you're shaming Samira,
then McKay...

They both needed to be called out

- for unacceptable behavior.
- Yeah?

Yeah, well, you do that in private.

Same place you share your thoughts

about a patient's possible suicide.

And slamming stuff? Please.

Sign out all the shit that's bugging you

and get out of here.

- I can't.
- Yes, you can.

When either of my kids
was acting like this,

I gave them a time-out in their room.

Whoa, whoa, whoa, you're not my mother.

Yeah? Well, too bad.

- You need one.
- No, I had one.

She left. I don't need another one.

What I need is someone
who can actually run this place

- while I'm gone.
- OK, I'm sorry.

- I didn't know.
- Nobody knows.

Who needs to know? Who gives a fuck?

I think you need a break.

That is what the sabbatical is for.

Then start it now. Walk away.

I have too much to do.

Let someone else talk to Duke.

No, that needs to come from me.

Why?

Because I owe him that.

It needs to come from a friend,
not a stranger,

otherwise he's gonna bail
and drop dead while I'm gone.

OK, wrap that up and then leave.

It's not just Duke.

I'm not sure that Al-Hashimi
is fit to run this place.

- What's that supposed to mean?
- I'm not sure.

I'm trying to figure that out.

Did you know that she wants
to have two attendings

- on at all times?
- No.

Is that something
she's worked out with Gloria?

- I don't know.
- I also don't know

if Langdon is going to relapse.

I don't know if Whitaker's gonna
be able to take care of my shit.

I don't know if
Javadi's gonna give up on

what she's good at
or if Samira's gonna flame out

because of some bullshit
with her mother.

- Is there anything else?
- Yeah, you.

I don't know about you running around

with a full syringe of Versed
in your pocket.

I'm worried about the people
that I care about.

We'll all manage until you come back.

We always do.

Yeah? What if I don't come back?

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