Original subtitles

You know this guy? Orlando Diaz. We were treating him for DPA 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.

He was equal with sluggish.

He left against medical advice.

On my count.

Three, two, one.

Dr. Alex on the case.

Patient, we got this.

I'm saying.

Continuity of care. Dr. Alex, give me one to go. Cover send out rounds with

Abbott. Ken, you too. Got it. Okay, let me know if you need anything.

Lungs are up bilaterally.

Pelvis is stable.

Right tib, fib, hematoma.

Deformed right forearm.

Rubbed through GM1, left stereosanguineous fluid.

That means basically a skull fracture.

We've got a diabetic patient, 20 foot fall. BP 204 over 98, pulse at 6.

Dr. Mohan, what do those numbers indicate? I'm trying to treat the

The Cushing's reflex.

From increased intracranial pressure.

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

No free fluid in the belly.

Any family to notify?

Wife and three kids.

Is there a card to sign for Robbie? He said no card, no present.

Was there a cake?

Oh, he didn't want that either.

That sucks.

I need some cake.

The patient was injured when they raided a restaurant.

And they actually arrested a nurse.

The takedown and zip ties.

Hey, Cruz, you know the computer downtime drill?

Yeah, no biggie. I prefer to treat them 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 Nazly, 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 cruise control.

You hear Ice brought us a patient?

Oh, yeah?

How'd that go? There was some collateral damage to the arrest of Jesse.

For what?

Insulting a federal officer.

Are you fucking kidding me?

Dr. Alshimi, this is Nazli Tumerian, new intern.

Okay,

everybody, let's huddle up.

Before we start, let me address the elephant in the room. For those of you

don't know,

Jesse tried to intervene when a federal agent was handling this 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.

And he was a little bit more... The hospital lawyers are on the case, and we

will brief the staff every 12 hours at sign -out rounds with an official

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'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. All right.

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.

I mean, whose job is that?

Day shift. With a completed and signed T -sheet. Are you kidding me? It's going

to take forever. We will set up stations for scanning. Okay, everybody, let's

get moving.

Triage is 20 behind.

Got to help him clean up. Skipping around.

Set yourself lucky.

Should we join them?

Might as well witness the magic. It's like changing the guard at Buckingham

Palace. Except we're allowed to smile.

Mother, your heart is aching.

Clean films, right tip -fib, and right form after CT.

Got the chem -8. Blood sugar's 284. That's not too bad.

Test. Looks good.

And he got stuff 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 NSTEMI

posterior CVA.

Ready to roll.

If I could babysit him at CT.

Thank you. I'll stay in case he needs VOR.

Hey, we're back up.

Out of time.

Robbie, I got intel on where Ice is taking Jesse.

Intel from who?

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.

Okay, I'll let the hospital attorney know.

How are you doing, Oliver?

Alive and kicking.

Mr. Haas, pulmonary edema after a misdiagnosis.

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 1042.

Cut the call light and I'll come running.

South 21 next.

Mr. Digby.

You just did me.

Dr. Mohan's patient, forearm cellulitis. Admit med surge awaiting a bed. I can

take him. Sold.

Dr. Tamarian, moving right along.

Good enough to eat?

We'll be back.

Lillian Stegman, tweet your knee water skiing.

In the 360 off a five -foot ramp.

Respect. X -rays ordered in triage. That was hours ago.

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

Let's get you home real fast.

That would be wonderful.

Okay, heading to North.

It's like our first scanning station is almost ready. Whitaker, Santos, after

rounds, this will be your post.

Seriously? For how long?

Until we mop up this mess.

And away we go.

All right.

Now you know everything there is to know about rounds. Fascinating, right?

Here.

I've got something better for you.

So take me.

We're going to find you some new clothes, but my friend Emma and I

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

the shave and the 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, Carrie.

You were on scene with Orlando, right?

Did you notice anything about his fall? Like what?

Like, um, there was a break in the railing or there were security cameras.

Too busy working on the guy.

IV, intubation, backboard, splint.

Thanks. Oh, two names as a start. Pretty soon we'll retire the clipboard. Baby

Jane Doe and Peds?

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 number's on top of the

dry erase board, need a doctor.

Who's in BH1?

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 five -year -old snuck in the backseat of the

to take a nap.

Heat stroke. Mom was extremely distraught, walked out into traffic.

Barnhill wheezing and not responding to albuterol. Full Fox 87 is Mother Naomi.

Okay, trauma two's open.

On our way.

Mom, history of asthma? His whole life. Never this fast.

Barely moving air.

Using all of your accessory muscles.

Call our team.

Continuous nebs, 20 milligrams an hour.

Yeah, the whole nebula. 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 Montezuma. Why did you stop that?

Because he lost his medication two months ago.

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

No, EpiPen, 0 .3 milligrams.

That may open his lungs for the next week.

All right, Grady, shot in the thigh.

Hi.

Coming to scan?

Critical labs on North 3.

Oh, it's not my patient. She's about to be.

I'm off the clock.

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

back on track.

Sorry, everyone else is tied up. That's okay.

I should get stuck on night shifts for your first rotation.

Just lucky, I guess.

I feel like a good horror movie.

Where's med school?

UC Irvine. California, right?

Pittsburgh's a little different.

Yeah, a lot more humidity.

Yeah, that'll go away with your first foot of snow.

Hi, Mrs. Davis.

I am Dr. McKay. This is Dr. Tim Marion.

Hello.

Your labs show a lot of inflammation in your liver.

So I am so nauseated.

Definitely, yeah.

Have you 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

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

DHA from sugar beet.

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. Rock clams or oysters?

I'm a vegan.

One step at a time.

I'll be back.

Digby Haas now on the big board.

Progress. He's just been waiting in the hall the whole time?

Okay, 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. He's got more loose ends than a macrame

wall hanging.

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

Seriously, you should think about signing that and hitting the road. Yeah,

you should, too. Oh, that's right. You sent Lena home. Are you planning on

calling in a replacement, or are you just going to work till sunrise?

I have to.

Oh, so you get to go the extra mile, and the rest of us just get accused of

being martyrs.

Robbie? Excuse me.

What's the word? No subdural, no epidural. Confused brain swelling with

effacement and compression of the ventricles.

C -spine, chest, abdomen, pelvis?

Left pulmonary contusion, no intradominal hemorrhage. Which means I'm

hook. I'll send neurosurgery down.

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

Wait and see. Let's get busy.

CBP to the heart line.

Orlando.

Orlando, squeeze my hand.

Open your eyes.

We already know his GCS is going to be free.

Hey, Javadi, anti -seizure prophylaxis. Kepra, can you mix for Kela? Mixing it

now. Better get this brain swelling down, Samira. How are we going to do

Samira. What?

We have to lower the intracranial pressure.

Not at all.

Not the best in caulk, diuresis, and hypertension. And hypertonic saline.

23%, 53 % through central line.

So tight as a drum. 25 minutes to CFC.

We can have one more EpiPen.

Stats are borderline, 87.

How about BiPAP, 10 over 5?

Yes, with inline nebs.

All right, Grady, shot number two.

Might as well throw in some magnesium, 54 kilos.

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 a simicort. We're going

to give the current treatment a few more minutes to help him turn.

I could probably do this myself now that my cast is off.

That's okay.

I don't mind.

How long have you been a nurse?

My first day.

You're doing really good.

Thank you.

Shit, you okay?

Yeah, there's water in the floor. Sorry, I might have spilled.

Yeah, no worries.

I'm gonna have to sort these out by the patient before we scan them.

Is Joy still around?

I heard she left at 6 .59.

Smart girl.

You know what? Find Ogilvy. He's got some ass cancer. He might stay in

and try some stuff. Oh, he scrubbed in in the OR, scrubbed in on the ruptured

AAA. There's a 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 Robbie briefs me on all the house stuff.

Sounds fun.

When he asked, it was hard to say no.

Sure.

It's going to be very weird without him here.

Yeah. You think Dr. Al Hashimi can handle it?

A word, no.

She smart?

Yeah, it takes more than that.

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 Robbie's house once or twice a day.

Why would you do that?

I don't know.

Why not?

Hypertonics in. Maintenance. LR in the AC.

It's like a halo sign.

Cerebral spinal fluid from a basal skull fracture.

The halo sign is neither sensitive nor specific for CSF.

Saline, tap water, and runny nose is all separate from blood.

Hello, Linda.

Robbie. Vision chief working on a holiday weekend.

Somebody's got to.

Saw the scans. This guy needs an EBD.

External ventricular drain to take down the pressure.

Because CPP equals MET 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.

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 shift was over a while ago.

Okay. Masks all around. Two sterile gowns. We brought the surgical towels.

need some beta dye. 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 vulvulus case from earlier? Because 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

Durham.

Step up to the plate. Do it.

Giovanni will assist.

Excellent.

You know, I think Eileen did her first DVD 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 five millimeter mesh that vibrates over 120 ,000 times per second.

Dr. Oshimi.

You okay?

Are you telling us about aerogen?

Dr. Shen can explain.

It produces droplets in the 2 to 5 micron range.

How's it going?

Just about to start.

Secure an art line here. Measure twice, cut once.

We enter 11 centimeters back from the nasium.

Three centimeters low.

Without any direct imaging?

Nope. Straight shot into the lateral ventricle.

Tried and true since 1890.

Okay. Go ahead with the incision.

Hey, you worked with Dr. Ellis. You met the VA?

I did.

For how long?

During my R2 rotation and then one again last year.

Okay. Handrails all set.

Maybe you should do this part.

I don't know. There's a safety stop here. You can't go too deep.

It's not brain surgery.

Okay.

Stay perpendicular.

Yeah. Good.

All right. Now, four turns to get through the outer table. Yep. And half

till you penetrate the skull.

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

Nice job. How's that feel, Digby?

It's pretty good.

I bet.

Well, you say we trim up those gorgeous locksuits 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.

Come, my husband Benji's here all the time. Trust me, you're going to 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?

Yeah.

Where do you live?

Wherever I want.

You're going to pass it five to six centimeters from the inner table of the

skull. Okay.

Centered.

Perpendicular.

Aiming for the medial canthus.

All yours.

And just keep going?

You'll feel a pop when you pass the appendable lining.

All right, line is calibrated. Good to go.

I'd try the nicartapine to a MAP of 85, please.

And if we can get the intracranial pressure down to 20.

Dr. Bohan.

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.

Okay. Let it drain a bit.

And now pinch it shut.

Perfect. BP is down 190 over 88. Heart rate 67.

How are you guys doing?

Yeah, making some progress.

You seen Abbott?

Not since rounds.

Yes, I just see a patient with a night intern.

So 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, no prescription meds.

Does she eat polar bear liver?

It can cause vitamin A toxicity.

No, she doesn't eat meat, kind of a...

Health nut.

Well, maybe she's gulping down cod liver oil to prevent measles. You get no

fish.

Would you mind laying eyes on her?

Seriously. You have a way of figuring out the weird stuff.

Take the compliment.

Okay, fine.

Five minutes at the bedside, that's it.

I'm already going to be here for hours as it is. Thank you.

What am I doing?

Definitely improving.

Title volumes up.

We have 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 we need?

Neighborhood clinic.

We pay cash. Not Peter Ross cheap.

Send him to court. Without Medicaid, 400 bucks a month.

Just for a little inhaler?

Took ours on the tube.

Tunnel underneath the scalp about five centimeters and poke through.

To prevent infection?

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. You 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, am I?

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. Alashimi, 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 worked 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 sleep maxing. 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 buy vitamins from them? Oh, no, no. I don't take vitamins. Food is the

best medicine.

Kale, blueberries, kidney beans, turmeric.

Turmeric? 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. Thank you. Good to go.

Would you like to see it?

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

Your family won't recognize you.

Then how will they find me?

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?

And she will always remember you.

Hey, I was just looking for you.

What's up? You tell me, the 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. Robbie in the ED. I'm checking on a patient, Eakins.

We can take Larkin 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 already know.

Same old story, huh?

You think we should take up a collection for Jesse for bail money? They don't

usually send bail until after you've appeared in front of a judge. With the

holiday, it's not likely to happen until Monday.

So he's going to be locked up all weekend?

That sucks.

It does suck.

Dr. Langdon?

Grady's worse. Much worse.

Need an attending?

No, we have Shen.

Sat's down 83.

What's happening? Give us a minute.

He's tiring out.

Ketamine and rock. It's time to intubate. I'll call Vogue.

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 a pneumothorax. What

Dr. King?

In asthma, you can get air trapping.

When the lungs can't fully exhale, eventually they overinflate, causing

the tiny air sacs to burst.

How do you fix it?

Like that.

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

Yeah. We should probably try to find him in a neurocritical ICU, but we don't

want to board a patient like this.

Mm -hmm.

Hey, Robbie. Hey, how did the scan go?

It's fine.

It is probably going to take a little while to get the results from the

radiologist. Well, that's not a problem.

Vivian and I need a little time to coordinate our schedules over the next

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, baby?

Maybe we could have some dinner after.

Dr. Mohan, Lori Diaz is here. She wants to see her husband.

She's heading back. Okay, I'm on my way.

Mrs. Diaz? Hi.

Did Orlando go up to his room yet?

No. 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 specialist.

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 a second job.

We're going to make him stay.

He was competent.

He knew the risks.

We honored his decision to leave.

Even if it was a stupid plan. 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 okay?

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.

Well, there isn't any trauma to indicate. I should have caught it.

You know, I, um... I had a septetition today.

And all the lawyers' questions made me feel like I was a really, really bad

doctor.

We don't always get everything right first time.

You would have caught the collapsed lung.

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

I'm not sure Robbie would agree with you.

He's been...

riding me all day.

Well, Robbie's leaving for three months.

And, you know, with Robbie gone, I really don't want you to leave either.

That which does not kill me makes me stronger.

Well, Frederick needs you.

Yeah?

Needs you, yeah.

Not Kelly Clarkson.

Hey, that's a thick one. Yeah. Austin Green, Ogilvy's AAA.

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

Yeah, why? What are you doing?

Checking to see when we'll get Ogilvy 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 Ogilvy?

Oh, man.

His patient had a CT a year and a half ago that showed a 4 -centimeter AAA.

It's too small for surgery.

You were supposed to come back every six months for a leafy ultrasound, but

looks like you didn't. You would have seen that if the computers were working.

Why wouldn't you tell Ogilvy?

Maybe he forgot all about it, or Ogilvy didn't ask the right questions.

Dennis, is that a minute?

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 you

could find, like, a senior or an attending? We're really trying to get

clock here.

They're all busy.

I already took one for the team.

Fine.

Yeah, I laughed on your yell, 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.

Central time? Yeah.

Sleep maxing, 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?

Assume they did it.

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

Yeah, right. Taking advice from fools.

Tumor is recommended by a lot of doctors.

Yeah, then ask your doctor for the dose.

Or check some place reputable like the CDC.

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

She's in pretty bad shape.

Things get worse, she could need a liver transplant.

Because she's a big fucking idiot.

Wow.

No, I actually appreciate her. Our job security depends on all these big

idiots.

Okay.

Good night, Perla.

Monica, good night, Dr. Robbie.

Good night. Bye, Emma.

You can stay to pitch in.

Dana told me to go and get some rest before tomorrow's shift.

Yeah, you had quite a day.

It 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.

Atlanta's all tucked in for now. How's he doing?

Numbers are good.

CPP 22.

Okay, 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? I told Samir he's got $100 ,000 in medical debt. His life is probably...

This is Diaz.

How can we help you?

The bathroom?

Uh, yeah, probably can show you the way.

What a great idea to have a private conversation about a patient in a public

area.

You were about to start yapping. But I didn't.

Okay.

How long have they been in there?

At least two hours.

How did it happen?

With Mary.

It was supposed to be red, white, and blue to look cool with the fireworks.

I told her for the nose one side only, but she never listened. 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

very strong magnetic force.

Yeah. No, no, no.

Oh, I'm not going to use the tips. I'm going to flip it around and use the

handle. It's still going to hurt.

Probably not.

Just hold still.

Okay.

Voila.

Really? That was amazing.

I think in another half hour we can send this dry erase to Rebecca's storage.

With pleasure.

Dr. Romanovich. Yep. Results on your friend.

Fuck. Duke.

Are you going to tell him?

I want to talk to a surgeon. Dr.

Ravi, I have an update on the patient. It was not a great time.

Oh, you were going home.

I was.

Dr. Ogilvie is just sitting out in the ambulance bay covered in blood.

Sorry, what's he doing out there?

Kind of staring off into space. I tried to talk to him, but it was like he

couldn't hear me. Monica, can you step his cardiothoracic?

I'll go check on Ogilvie. Please.

Hey, Ogilvy.

Ogilvy.

You okay, man?

99 on two liters.

Scattered and expiratory wheezes.

He is so much better.

The steroids should kick in soon.

So he'll keep improving.

When can I go home?

In a day or two.

And we will discharge you with a Simbacort inhaler. That should last

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 him before your Medicaid kicks in, you can come back and

we'll set you up with another one.

Is there a patient in here? Because everyone in this room looks extremely

healthy to me.

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

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.

Abbott. 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.

Perhaps this isn't the best time. I just wanted to reassure you about future

costs.

Robbie?

Noelle? You're still here.

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

Hmm.

So I guess this is it for a while. Unless you want to come with me.

No. 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

Vision quest.

That is my nice way of putting it.

I probably don't want to hear you're not so nice when you're putting it.

No, probably not.

I hope that this is not about you running away from me. I'm a big girl.

tell me just to get lost.

This has nothing to do with you.

Oh, right.

It's the old, 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

you next week.

My first day here as a med student, there was a patient.

He was a really nice guy.

Came in with belly pain.

I saw a gallstone 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 that?

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.

Peds, 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,

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.

No.

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

Shift is over.

Go home.

Oh, God. Sorry.

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

Tummy in a wheelchair.

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 Ogilvy.

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?

Sorry.

Um, the shredder jam?

Yeah, try putting it in reverse.

Perfect. Just give it a little love tap.

Kick it.

Jesus Christ.

I 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 shades.

I'll take care of him.

Scout from Chirabi's pathology, so we ordered a CT angiogram.

Textbook is sending out again. He was in 8 centimeters.

50 % one -year mortality.

So he definitely needs surgery.

If he wants to live.

Okay. Well, he's a friend, so I will talk to him. I'll get him admitted to

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, 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, Robbie. Best we can do.

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

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.

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 little boy had a simple buccal fracture, distal radius. He got a velcro

splint. And Mrs. Stegman had a small medial meniscus tear.

The 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.

Only have one publication, but it's a series of case reports diagnosing

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 it, two charts?

No, it's my ultrasound fellowship application.

Hey,

uh, sorry, got your patient.

Yeah. Orlando's in pretty bad shape.

Oh, no. I was talking about the AAA guy you worked on with Uncle V.

He didn't make it through surgery.

I tried to talk to Robbie about it, but I think he's busy.

He's busy.

Oh, shit.

You think I'm on edge?

First you shame and smear it, then the case. They both needed to be called out

for an exception to their behavior. Yeah, well, you do that in private. Same

place you share your thoughts about a patient's possible suicide and slam and

stuff. Please, find out all the shit that's bugging you and get out of here.

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,

bad. You need... No, I had one. She left. I don't need another one. What I

is someone who can actually run this place while I'm gone. Okay, I'm sorry.

I didn't know.

Nobody knows. Who needs to know? Well, give the fuck.

I think you need a break.

That's what the sabbatical is for. Let's 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 going to bail and drop dead while I'm gone. Okay, wrap that up

and then leave.

It's not just Duke. I'm not sure that Alishimi is fit to run this place.

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 Lanyon is going to relapse. I don't know if Whitaker is

going to be able to take care of my shit. I don't know if Javadi is going to

give up on what she's good at or if Samira is going to flame out because of

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?