Original subtitles

[indistinct chatter]

- 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. [grunts]

- 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.

[both speaking Armenian]

- 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.

- [softly] 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-- [clicking]

[crowd murmuring] - Hey!

- Oh, all right!

[applause] - 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? - [sighs]

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."

[machine beeping]

- 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.

- [grunts]

[beeping]

- 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.

- [chuckles]

- 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. [sighs]

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.

[beeping] 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.

[beeping]

- 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.

[machines beeping]

- 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.

- [scoffs]

When he asked, it was hard to say no.

- Sure. [sighs]

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.

- [chuckles] 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?

[beeping, whirring]

- 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.

[chuckles] 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.

[scoffs]

Time flies.

- [raspy breathing]

- 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.

- [exhaling slowly]

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.

- [yawning] 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?

- [sighs] 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. [inhales deeply]

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.

- [inhales deeply]

[sighs]

- 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?

- [sniffles]

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.

- [crying] 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?

[rapid beeping]

[air whooshing] - [gasping]

- 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.

[door closes]

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.

- [sighs]

- You know, I, um...

[chair scraping]

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.

- [chuckles]

- Hey, that's a thick one.

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

[beeping, whirring]

- 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?

- [sighing] 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.

[sighs] 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.

[sighs]

Hey, Ogilvie.

Ogilvie...

y-you OK, man?

[sighs]

- 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.

[door opens]

- 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.

[sighs]

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?

- [chuckles] 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.

[clears throat]

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.

[indistinct chatter]

- Oh! - [gasps] 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. [chuckles] - Sorry.

[whirring]

- Um, the shredder jammed.

- Yeah, uh, try putting it in reverse.

[whirring]

- Perfect.

- Just give it a little love tap.

- OK. - Kick it.

[banging]

Jesus Christ.

[laughter]

- 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!

[bell dings] - 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.

[whirring]

- 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.

[sighs]

He didn't make it through surgery.

I tried to talk to Robby about it,

but I think he's busy.

- Excuse me.

- [sighing] 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?

[pensive music]

♪ ♪