1 00:00:15,599 --> 00:00:17,224 Next time, maybe inform the department chair 2 00:00:17,225 --> 00:00:18,267 before the shit hits the fan. 3 00:00:18,268 --> 00:00:19,935 I was on my way to tell you. 4 00:00:19,936 --> 00:00:21,270 Make sure you get everything you need. 5 00:00:21,271 --> 00:00:22,354 OK, let's do this. 6 00:00:22,355 --> 00:00:23,939 IT called me up because 7 00:00:23,940 --> 00:00:26,275 I've trained in cyberattack prevention and response. 8 00:00:26,276 --> 00:00:27,568 Then you can tell everybody what to do. 9 00:00:27,569 --> 00:00:28,944 No, thank you. 10 00:00:28,945 --> 00:00:30,195 Best if it comes from the department chair. 11 00:00:30,196 --> 00:00:31,281 Oh, you think? 12 00:00:33,783 --> 00:00:35,951 All right, everybody, circle up. 13 00:00:35,952 --> 00:00:37,202 What the fuck? 14 00:00:37,203 --> 00:00:39,163 We may have had a cyberattack. 15 00:00:39,164 --> 00:00:41,499 No, we shut down to prevent a cyberattack. 16 00:00:43,251 --> 00:00:45,252 OK, everybody, settle down. Listen up. 17 00:00:45,253 --> 00:00:46,629 As you can see, we're doing a little 18 00:00:46,630 --> 00:00:49,131 redecorating in the central work area. 19 00:00:49,132 --> 00:00:52,009 Our hospital computers are at risk for a cyberattack, 20 00:00:52,010 --> 00:00:54,011 so we are going old school, analog. 21 00:00:54,012 --> 00:00:55,429 - For how long? - Great question. 22 00:00:55,430 --> 00:00:57,473 Our IT department has shut everything down 23 00:00:57,474 --> 00:00:59,808 to give them time to bolster our cyber defenses. 24 00:00:59,809 --> 00:01:01,727 I believe the question was, for how long? 25 00:01:01,728 --> 00:01:03,020 Uh, hard to say. 26 00:01:03,021 --> 00:01:04,313 Could be up to 24 hours. 27 00:01:04,314 --> 00:01:05,939 Jesus Christ. 28 00:01:05,940 --> 00:01:07,566 So first order of business, 29 00:01:07,567 --> 00:01:09,526 we need to replicate the electronic patient boards 30 00:01:09,527 --> 00:01:10,861 on these dry-erase boards. 31 00:01:10,862 --> 00:01:11,945 So please, somebody tell me 32 00:01:11,946 --> 00:01:13,072 they got a photo of the boards. 33 00:01:13,073 --> 00:01:14,073 Uh, yeah, yeah, yeah. 34 00:01:14,074 --> 00:01:15,574 Right here. OK. 35 00:01:15,575 --> 00:01:16,701 Oh, uh... 36 00:01:18,870 --> 00:01:20,996 It's a little blurry. 37 00:01:20,997 --> 00:01:23,624 No, more than a little blurry. 38 00:01:23,625 --> 00:01:26,418 - Sorry. - Oh, my God. 39 00:01:26,419 --> 00:01:28,170 - I remember. - Great. 40 00:01:28,171 --> 00:01:30,130 If everybody else can remember their patient names 41 00:01:30,131 --> 00:01:31,507 and their room numbers, that would be awesome. 42 00:01:31,508 --> 00:01:33,509 No, I mean I can remember all of it. 43 00:01:33,510 --> 00:01:34,635 All of what? 44 00:01:34,636 --> 00:01:36,845 Names, doctors, room numbers. 45 00:01:36,846 --> 00:01:39,264 I kind of have a photographic memory. 46 00:01:39,265 --> 00:01:41,392 Seriously? The whole board? 47 00:01:41,393 --> 00:01:43,769 Central 12, Harlow Graham, headache, 48 00:01:43,770 --> 00:01:46,522 - abdominal pain, ASL only. - Oh, shit. 49 00:01:46,523 --> 00:01:48,440 I have an interpreter waiting for me. 50 00:01:48,441 --> 00:01:50,567 - Go. - OK, for patient privacy, 51 00:01:50,568 --> 00:01:52,277 all chief complaints will be abbreviated. 52 00:01:52,278 --> 00:01:53,612 So HA for headache, 53 00:01:53,613 --> 00:01:55,572 AP for abdominal pain, and so forth. 54 00:01:55,573 --> 00:01:58,826 Central 10, Jackson Davis, new-onset psychosis. 55 00:01:58,827 --> 00:02:00,285 Javadi, psych admission. 56 00:02:00,286 --> 00:02:02,287 Greek letter psi for psych. 57 00:02:02,288 --> 00:02:04,540 Pedes is Baby Jane Doe, fever, Dr. Mohan, 58 00:02:04,541 --> 00:02:06,083 awaiting admission orders. 59 00:02:06,084 --> 00:02:07,793 Nurses need to convert to a zone defense-- 60 00:02:07,794 --> 00:02:08,836 north, central, south, trauma. 61 00:02:08,837 --> 00:02:10,003 Where's Dana? 62 00:02:10,004 --> 00:02:11,672 In with a sexual assault case. 63 00:02:11,673 --> 00:02:13,257 She can't leave until the exam is finished. 64 00:02:13,258 --> 00:02:14,550 Yeah, it could be a while. 65 00:02:14,551 --> 00:02:15,968 Princess has charge nurse experience. 66 00:02:15,969 --> 00:02:17,428 - Not really. - That's a great idea. 67 00:02:17,429 --> 00:02:18,679 Princess it is. 68 00:02:18,680 --> 00:02:19,680 You can make the nursing assignments. 69 00:02:19,681 --> 00:02:21,014 - Next. - Central 9, 70 00:02:21,015 --> 00:02:22,975 Roxie Hamler, end-stage lung cancer. 71 00:02:22,976 --> 00:02:24,351 Sorry, do we have to stand here while 72 00:02:24,352 --> 00:02:25,561 - she recites the whole board? - No. 73 00:02:25,562 --> 00:02:26,812 In fact, go check on your patients 74 00:02:26,813 --> 00:02:28,313 and then please come back here. 75 00:02:28,314 --> 00:02:29,857 Thank you. 76 00:02:29,858 --> 00:02:31,693 How many hours a day are you on your laptop? 77 00:02:34,738 --> 00:02:35,988 At least eight hours. 78 00:02:35,989 --> 00:02:37,406 I work from home. 79 00:02:37,407 --> 00:02:39,367 And are you at a desk all day? 80 00:02:41,244 --> 00:02:42,494 No, no. 81 00:02:42,495 --> 00:02:43,954 I will either sit on the sofa, 82 00:02:43,955 --> 00:02:46,206 or sometimes I'll be in bed, 83 00:02:46,207 --> 00:02:48,375 kind of sitting up with the computer on my lap, 84 00:02:48,376 --> 00:02:49,918 that kind of thing. 85 00:02:49,919 --> 00:02:52,546 So you're always looking down at the screen? 86 00:02:52,547 --> 00:02:54,173 - Yeah. - OK. 87 00:02:54,174 --> 00:02:56,676 I'm going to check the muscles in your neck. 88 00:03:03,391 --> 00:03:04,391 - Ooh! - Ooh! 89 00:03:04,392 --> 00:03:06,602 Ow, that hurts. 90 00:03:06,603 --> 00:03:09,313 All right. Well, I think we can help. 91 00:03:09,314 --> 00:03:11,482 Come on over. 92 00:03:11,483 --> 00:03:13,025 OK, gather up. 93 00:03:13,026 --> 00:03:15,235 Listen up, everybody. This is our chart rack. 94 00:03:15,236 --> 00:03:17,196 So as you can see, each slot and clipboard 95 00:03:17,197 --> 00:03:18,322 has a room number on it. 96 00:03:18,323 --> 00:03:19,740 When you pick up a new patient, 97 00:03:19,741 --> 00:03:22,117 you grab a fresh chart from the T-system. 98 00:03:22,118 --> 00:03:25,120 Pick your chart by chief complaint. 99 00:03:25,121 --> 00:03:27,331 Use the cartoon to find it. 100 00:03:27,332 --> 00:03:29,082 Why are there two bodies? 101 00:03:29,083 --> 00:03:31,084 Trauma on the left, medical on the right. 102 00:03:31,085 --> 00:03:32,461 So head injury, you go left. 103 00:03:32,462 --> 00:03:34,004 Headache, go right. 104 00:03:34,005 --> 00:03:35,547 Are those fish swimming in seaweed? 105 00:03:35,548 --> 00:03:36,632 No. 106 00:03:36,633 --> 00:03:37,966 That is bees and grass. 107 00:03:37,967 --> 00:03:39,218 That's the section for insect bites, 108 00:03:39,219 --> 00:03:40,761 skin rash, allergies. 109 00:03:40,762 --> 00:03:42,346 OK, let's say, for example, 110 00:03:42,347 --> 00:03:44,473 Dr. Al-Hashimi has a new patient with belly pain. 111 00:03:44,474 --> 00:03:47,100 For the history, circle the positives, 112 00:03:47,101 --> 00:03:49,061 like vomiting and diarrhea. 113 00:03:49,062 --> 00:03:51,688 Backslash the negative, such as recent travel, 114 00:03:51,689 --> 00:03:53,273 sick contacts, fever. 115 00:03:53,274 --> 00:03:57,194 For physical exam, checkmark normals on the left, 116 00:03:57,195 --> 00:03:59,446 and circle any abnormal findings on the right. 117 00:03:59,447 --> 00:04:00,531 Questions? 118 00:04:00,532 --> 00:04:01,740 Is your generative AI program 119 00:04:01,741 --> 00:04:02,742 still gonna be working? 120 00:04:04,202 --> 00:04:05,410 Not for a while. 121 00:04:05,411 --> 00:04:07,120 And ditch your SpectraLink phones. 122 00:04:07,121 --> 00:04:08,748 Those are voice over internet. 123 00:04:11,835 --> 00:04:12,960 PTMC Emergency. 124 00:04:12,961 --> 00:04:14,503 Go ahead, Medic Command. 125 00:04:14,504 --> 00:04:15,671 That is how we will hear about incoming runs. 126 00:04:15,672 --> 00:04:17,130 Thanks. 127 00:04:17,131 --> 00:04:18,841 Two minutes out with abdominal pain and fever. 128 00:04:18,842 --> 00:04:20,300 OK, has everybody got that so far? 129 00:04:20,301 --> 00:04:21,885 How do we write orders? 130 00:04:21,886 --> 00:04:23,512 Physician order form in triplicate. 131 00:04:23,513 --> 00:04:26,306 Labs, X-rays, IV fluid, medication. 132 00:04:26,307 --> 00:04:27,724 Will the labs still be able to run blood tests? 133 00:04:27,725 --> 00:04:29,101 Yes. 134 00:04:29,102 --> 00:04:30,519 Are the CT scanners still working? 135 00:04:30,520 --> 00:04:31,854 Yes, but the results will come back 136 00:04:31,855 --> 00:04:34,147 on paper from the radiologist. 137 00:04:34,148 --> 00:04:35,649 This is the dark ages. 138 00:04:35,650 --> 00:04:37,860 So if you have orders with labs or X-rays, 139 00:04:37,861 --> 00:04:39,403 they go into the clerk file here. 140 00:04:39,404 --> 00:04:40,696 They will sign them off. 141 00:04:40,697 --> 00:04:42,155 They will add a downtime slip on them, 142 00:04:42,156 --> 00:04:43,448 make sure they go to the correct department. 143 00:04:43,449 --> 00:04:44,992 I'm sorry, who are the clerks? 144 00:04:44,993 --> 00:04:46,285 - You're looking at them. - At your service. 145 00:04:46,286 --> 00:04:47,578 Larry and Antoine are filling in 146 00:04:47,579 --> 00:04:49,121 - until more help arrives. - We got this. 147 00:04:49,122 --> 00:04:51,206 After the clerk orders, chart gets moved 148 00:04:51,207 --> 00:04:52,958 to the nursing order rack here for IVs, 149 00:04:52,959 --> 00:04:54,710 medications, procedures. 150 00:04:54,711 --> 00:04:56,920 Medications are locked up in the PDS. 151 00:04:56,921 --> 00:04:59,715 The PDS is getting unlocked by a clinical pharmacist, 152 00:04:59,716 --> 00:05:01,300 - Dr. Megan Nordt. - We've got your back. 153 00:05:01,301 --> 00:05:02,301 This is a lot. 154 00:05:02,302 --> 00:05:04,261 Any questions? Yes. 155 00:05:04,262 --> 00:05:05,554 Uh, no. 156 00:05:05,555 --> 00:05:07,097 What's up with the third rack? 157 00:05:07,098 --> 00:05:08,640 When your patient is ready to be discharged, 158 00:05:08,641 --> 00:05:09,892 chart goes here. 159 00:05:09,893 --> 00:05:11,143 This lets everybody know 160 00:05:11,144 --> 00:05:12,394 we're about to have an open bed. 161 00:05:12,395 --> 00:05:14,187 Or that your tuna melt is up. 162 00:05:14,188 --> 00:05:15,523 Jesse? 163 00:05:16,816 --> 00:05:18,775 - What is that? - What is that? 164 00:05:18,776 --> 00:05:20,569 That is a fax machine. 165 00:05:20,570 --> 00:05:22,029 They still make those? 166 00:05:22,030 --> 00:05:23,864 This is our lifeline to labs and X-rays. 167 00:05:23,865 --> 00:05:25,741 When the results come back, they will fax to us, 168 00:05:25,742 --> 00:05:27,451 and the clerks will put them on the charts. 169 00:05:27,452 --> 00:05:28,785 - Yes? - If you say so. 170 00:05:28,786 --> 00:05:30,537 Incoming. 171 00:05:30,538 --> 00:05:33,790 OK, Dr. McKay, Dr. Whitaker, Ogilvie, you're with me. 172 00:05:33,791 --> 00:05:36,628 The rest of you, build your clipboards. 173 00:05:39,005 --> 00:05:41,632 Howard Knox, 52, abdominal pain and fever. 174 00:05:41,633 --> 00:05:44,301 152 over 90, tachy at 120. 175 00:05:44,302 --> 00:05:46,053 - Couldn't get an IV. - I wonder why. 176 00:05:46,054 --> 00:05:47,638 Hello, sir. My name is Dr. Robby. 177 00:05:47,639 --> 00:05:50,057 - Howard. - This is a teaching hospital. 178 00:05:50,058 --> 00:05:52,184 I'll be supervising Doctors McKay and Dr. Whitaker 179 00:05:52,185 --> 00:05:53,435 - and student Dr. Ogilvie. - Hey. 180 00:05:53,436 --> 00:05:54,603 - Hello. - How are you feeling? 181 00:05:54,604 --> 00:05:56,021 - Not so great. - OK. 182 00:05:56,022 --> 00:05:57,522 - Princess, what's free? - Trauma 1. 183 00:05:57,523 --> 00:05:58,942 Perlah? 184 00:06:01,402 --> 00:06:04,947 All right, orders for Mylanta and bupivacaine, Central 12. 185 00:06:04,948 --> 00:06:06,323 Wrong spot, Dr. Santos. 186 00:06:06,324 --> 00:06:08,326 And you need a sticker. 187 00:06:10,078 --> 00:06:11,328 Put it in the nursing orders rack. 188 00:06:11,329 --> 00:06:12,829 And meet me over at PDS. 189 00:06:12,830 --> 00:06:14,414 How much does this suck? 190 00:06:14,415 --> 00:06:16,124 I didn't think today could get any worse. 191 00:06:16,125 --> 00:06:18,251 This is how we rolled when I was a resident. 192 00:06:18,252 --> 00:06:19,836 Was that in the 1900s? 193 00:06:19,837 --> 00:06:22,130 Yeah, when charts were written by candlelight. 194 00:06:22,131 --> 00:06:23,966 Hey, today will be an adventure. 195 00:06:23,967 --> 00:06:26,260 Think of it like "Back to the Future." 196 00:06:28,888 --> 00:06:30,847 Or possibly "Titanic." 197 00:06:30,848 --> 00:06:32,724 Here is your antacid. 198 00:06:32,725 --> 00:06:34,101 Cheers. 199 00:06:34,102 --> 00:06:35,852 And I marked the trigger point 200 00:06:35,853 --> 00:06:37,396 that is bringing out your headache, 201 00:06:37,397 --> 00:06:39,147 and a shot of local anesthetic in that area 202 00:06:39,148 --> 00:06:41,192 could really help. 203 00:06:42,443 --> 00:06:43,443 Yeah, let's do it. 204 00:06:43,444 --> 00:06:44,737 All right. 205 00:06:45,947 --> 00:06:48,657 You are going to feel a little pinprick 206 00:06:48,658 --> 00:06:50,326 and some burning. 207 00:06:55,999 --> 00:06:57,874 OK. 208 00:06:57,875 --> 00:06:59,876 Oh, ow, ow, that really hurts. 209 00:06:59,877 --> 00:07:04,381 Temp 101.4, tachy at 128, pulse ox 92 on 2 liters. 210 00:07:04,382 --> 00:07:05,757 When did the pain start? 211 00:07:05,758 --> 00:07:07,300 It's been on and off for about a week. 212 00:07:07,301 --> 00:07:09,094 - And where do you feel it? - All over. 213 00:07:09,095 --> 00:07:11,638 It started on the left, and now there's some on the right. 214 00:07:11,639 --> 00:07:12,848 How about that fever? 215 00:07:12,849 --> 00:07:14,182 Since last night. 216 00:07:14,183 --> 00:07:15,559 I was burning up. 217 00:07:15,560 --> 00:07:17,394 Then I had chills pretty bad. 218 00:07:17,395 --> 00:07:18,395 I can't find a vein here. 219 00:07:18,396 --> 00:07:19,438 We'll try for a midline. 220 00:07:19,439 --> 00:07:21,189 Let us know if this hurts. 221 00:07:21,190 --> 00:07:22,566 - Ah, ah. - Sorry. 222 00:07:22,567 --> 00:07:24,443 - And on this side? - Yeah, yeah! 223 00:07:24,444 --> 00:07:25,569 Sorry, sir. 224 00:07:25,570 --> 00:07:26,653 Guarding with no rigidity. 225 00:07:26,654 --> 00:07:28,822 For pain, 100 of fent IM? 226 00:07:28,823 --> 00:07:30,157 Plan, Dr. Whitaker? 227 00:07:30,158 --> 00:07:32,868 Blood cultures, lactate, Zosyn. 228 00:07:32,869 --> 00:07:35,370 We're gonna need a CT to figure out what's going on. 229 00:07:35,371 --> 00:07:36,788 Ah-ah. 230 00:07:36,789 --> 00:07:38,832 - Yeah, it's not gonna work. - Yep. 231 00:07:38,833 --> 00:07:40,167 Write neatly. Penmanship counts. 232 00:07:40,168 --> 00:07:41,501 Howard, for the scan, we're gonna have 233 00:07:41,502 --> 00:07:42,586 to lay you flat on your back. 234 00:07:42,587 --> 00:07:43,837 Can you do that? 235 00:07:43,838 --> 00:07:45,088 I could ten years ago, 236 00:07:45,089 --> 00:07:46,673 but now it's too hard to breathe. 237 00:07:46,674 --> 00:07:48,383 If we can't lay you flat, 238 00:07:48,384 --> 00:07:49,885 then we're gonna have to put a tube in your windpipe 239 00:07:49,886 --> 00:07:51,386 to help you breathe-- are you OK with that? 240 00:07:51,387 --> 00:07:52,888 Intubation with rapid sequence induction? 241 00:07:52,889 --> 00:07:54,222 No, we can't lay him down. 242 00:07:54,223 --> 00:07:55,390 The tube will go in your nose 243 00:07:55,391 --> 00:07:56,516 while you're awake, sir. 244 00:07:56,517 --> 00:07:57,559 - Well... - Right. 245 00:07:57,560 --> 00:07:58,852 Does it hurt? 246 00:07:58,853 --> 00:08:00,020 You'll be numbed up completely. 247 00:08:00,021 --> 00:08:01,438 You won't feel any discomfort. 248 00:08:01,439 --> 00:08:04,316 Do you happen to know your weight? 249 00:08:04,317 --> 00:08:05,984 A little over 400. 250 00:08:05,985 --> 00:08:07,319 When was the last time you checked? 251 00:08:07,320 --> 00:08:08,820 It's been a while. 252 00:08:08,821 --> 00:08:11,281 Is it possible that you might be over 450? 253 00:08:11,282 --> 00:08:13,241 Possibly. 254 00:08:13,242 --> 00:08:15,535 Perlah, let's call for the Hoyer. 255 00:08:15,536 --> 00:08:18,538 So we're gonna place the tube and get you ready for the scan. 256 00:08:18,539 --> 00:08:20,207 Is this something serious? 257 00:08:20,208 --> 00:08:22,000 Well, it's hard to tell without a CT. 258 00:08:22,001 --> 00:08:23,710 You could just need antibiotics, 259 00:08:23,711 --> 00:08:25,504 or you could require an operation. 260 00:08:25,505 --> 00:08:26,797 If surgery is necessary, 261 00:08:26,798 --> 00:08:28,131 then your weight could make things 262 00:08:28,132 --> 00:08:29,549 - a little bit more complicated. - I know. 263 00:08:29,550 --> 00:08:31,134 - I'm sorry. - Not to worry. 264 00:08:31,135 --> 00:08:32,552 We're gonna take very good care of you. 265 00:08:32,553 --> 00:08:33,845 Team. 266 00:08:33,846 --> 00:08:34,971 OK. 267 00:08:34,972 --> 00:08:36,473 Pain medication for you, OK? 268 00:08:36,474 --> 00:08:38,350 Let's try for a midline, 269 00:08:38,351 --> 00:08:40,227 basilic vein with ultrasound guidance. 270 00:08:40,228 --> 00:08:41,686 Can ultrasound check for an appy? 271 00:08:41,687 --> 00:08:43,563 He's a little too large for an ultrasound. 272 00:08:43,564 --> 00:08:45,982 Plus, our CT can only handle 450 pounds. 273 00:08:45,983 --> 00:08:48,528 And so if he's over that, we send him to the zoo? 274 00:08:49,570 --> 00:08:50,905 He's right there. 275 00:08:53,241 --> 00:08:56,201 I--I heard that there's a large animal CT at the zoo. 276 00:08:56,202 --> 00:08:58,203 Presby's CT can handle 650. 277 00:08:58,204 --> 00:09:00,413 Yeah, if Presby's still up and running. 278 00:09:00,414 --> 00:09:01,915 Wh... 279 00:09:01,916 --> 00:09:03,917 That--that's not a jinx. It's-- 280 00:09:03,918 --> 00:09:06,545 Have any of you ever done an awake naso-tracheal? 281 00:09:06,546 --> 00:09:07,838 OK. 282 00:09:07,839 --> 00:09:08,922 Perlah, can you also ask 283 00:09:08,923 --> 00:09:10,090 Dr. Al-Hashimi to come in? 284 00:09:10,091 --> 00:09:11,174 I'm gonna need an assist. 285 00:09:11,175 --> 00:09:12,551 Yep. You got it. 286 00:09:12,552 --> 00:09:14,595 Ah, sorry. Signed. 287 00:09:15,763 --> 00:09:18,932 Hall bed F, George Francis, shortness of breath, 288 00:09:18,933 --> 00:09:21,393 Dr. Mohan, awaiting D-dimer. 289 00:09:21,394 --> 00:09:23,019 Wow. She's still going? 290 00:09:23,020 --> 00:09:25,147 Yeah. Remarkable, really. 291 00:09:25,148 --> 00:09:26,731 Dr. Al, Robby's asking for you. 292 00:09:26,732 --> 00:09:27,941 Uh, OK. 293 00:09:27,942 --> 00:09:29,693 In Trauma if you need me, Princess. 294 00:09:29,694 --> 00:09:30,903 Got it. 295 00:09:32,530 --> 00:09:34,030 Who's supposed to run the downtime slips 296 00:09:34,031 --> 00:09:35,240 to X-ray and lab? 297 00:09:35,241 --> 00:09:37,742 Uh, the charge nurse? 298 00:09:37,743 --> 00:09:39,536 Don't look at me. 299 00:09:39,537 --> 00:09:40,997 My plate's full! 300 00:09:43,040 --> 00:09:45,625 Uh, parents of Roxie Hamler? 301 00:09:45,626 --> 00:09:46,877 Central 9. 302 00:09:46,878 --> 00:09:48,170 Oh, I got it, Donnie. 303 00:09:48,171 --> 00:09:49,462 Hi, I'm Victoria Javadi, 304 00:09:49,463 --> 00:09:50,922 one of the student doctors here. 305 00:09:50,923 --> 00:09:52,465 I've been assisting with Roxie's care. 306 00:09:52,466 --> 00:09:53,842 Oh, thank you so much. 307 00:09:53,843 --> 00:09:56,052 - I'm Lloyd. - Cora. 308 00:09:56,053 --> 00:09:57,179 It's nice to meet you. 309 00:09:57,180 --> 00:09:58,346 She broke her leg? 310 00:09:58,347 --> 00:09:59,681 Um, yeah. 311 00:09:59,682 --> 00:10:01,433 There's a fracture down by the ankle. 312 00:10:01,434 --> 00:10:03,977 She's in a boot now, so there's not quite so much pain. 313 00:10:03,978 --> 00:10:06,355 But I'll take you. She's just in 9. 314 00:10:11,819 --> 00:10:13,153 The hospital Wi-Fi isn't working. 315 00:10:13,154 --> 00:10:14,529 Oh, it'll be down for a while. 316 00:10:14,530 --> 00:10:16,364 Sorry. 317 00:10:16,365 --> 00:10:18,867 Mom broke her leg, Grandpa. 318 00:10:18,868 --> 00:10:20,994 We heard. 319 00:10:20,995 --> 00:10:22,705 How are you, honey? 320 00:10:24,957 --> 00:10:27,292 You've got this, kiddo. 321 00:10:27,293 --> 00:10:29,586 Yeah. 322 00:10:29,587 --> 00:10:31,671 How long will she stay in the ER? 323 00:10:31,672 --> 00:10:35,300 Oh, until a bed opens up upstairs. 324 00:10:35,301 --> 00:10:36,928 Could be a while. 325 00:10:42,225 --> 00:10:43,892 You know, it's getting pretty crowded in here. 326 00:10:43,893 --> 00:10:45,644 Maybe we should take Tucker and Shane out for ice cream. 327 00:10:45,645 --> 00:10:49,105 - Yes, please. - No, no. I'm OK. 328 00:10:49,106 --> 00:10:52,275 Maybe your mom would like some time to rest. 329 00:10:52,276 --> 00:10:54,487 Yeah. Go. 330 00:10:56,197 --> 00:10:58,531 Can she have ice cream? 331 00:10:58,532 --> 00:11:01,743 She can have anything she wants. 332 00:11:01,744 --> 00:11:04,704 Come on, let's go. 333 00:11:04,705 --> 00:11:06,624 Bye, Mom. 334 00:11:08,334 --> 00:11:10,544 Ice cream, ice cream. 335 00:11:13,839 --> 00:11:15,131 Yep. 336 00:11:15,132 --> 00:11:17,133 Listen up. 337 00:11:17,134 --> 00:11:18,635 This is Oxymetazoline. 338 00:11:18,636 --> 00:11:19,637 This will open up the passage. 339 00:11:20,888 --> 00:11:22,264 What medication do you take? 340 00:11:22,265 --> 00:11:25,058 Uh, Lisinopril and Metformin. 341 00:11:25,059 --> 00:11:26,977 Ozempic? Wegovy? 342 00:11:26,978 --> 00:11:28,895 No. Kind of expensive. 343 00:11:28,896 --> 00:11:30,855 I'm going to squirt some numbing gel in your nose. 344 00:11:30,856 --> 00:11:34,359 If it drips back in your throat, that's OK. 345 00:11:34,360 --> 00:11:36,653 Here, in case you need it. 346 00:11:36,654 --> 00:11:38,488 Do you smoke? 347 00:11:38,489 --> 00:11:39,781 Alcohol? 348 00:11:39,782 --> 00:11:41,866 - Never. - Do you exercise? 349 00:11:41,867 --> 00:11:44,327 Moving from the bedroom to the kitchen. 350 00:11:44,328 --> 00:11:45,829 No, I'd walk more, 351 00:11:45,830 --> 00:11:48,456 but I need a bench to rest on every block. 352 00:11:48,457 --> 00:11:49,958 What about water aerobics? 353 00:11:49,959 --> 00:11:52,252 Let's focus on helping Mr. Knox. 354 00:11:52,253 --> 00:11:53,670 Agreed. 355 00:11:53,671 --> 00:11:55,672 It took me 25 years to get this way. 356 00:11:55,673 --> 00:11:58,300 Car crash, burn unit, 357 00:11:58,301 --> 00:12:01,094 four leg surgeries over ten years. 358 00:12:01,095 --> 00:12:03,305 Laid me up so much, I lost my job. 359 00:12:03,306 --> 00:12:04,973 I need to numb the back of your tongue. 360 00:12:04,974 --> 00:12:06,808 This is gonna taste pretty bad. 361 00:12:06,809 --> 00:12:08,226 Is there anyone you'd like us to call? 362 00:12:08,227 --> 00:12:09,394 No. 363 00:12:09,395 --> 00:12:10,937 Any family? 364 00:12:10,938 --> 00:12:13,523 Mm. My parents passed. 365 00:12:13,524 --> 00:12:14,733 I'm single. 366 00:12:14,734 --> 00:12:15,734 Go figure. 367 00:12:15,735 --> 00:12:16,943 Siblings? 368 00:12:16,944 --> 00:12:18,945 Sister in Arizona. 369 00:12:18,946 --> 00:12:21,364 We don't talk much. 370 00:12:21,365 --> 00:12:23,241 Now that we've numbed up the back of your tongue, 371 00:12:23,242 --> 00:12:26,786 we can anesthetize a bit deeper. 372 00:12:26,787 --> 00:12:27,787 Um, sorry to interrupt. 373 00:12:27,788 --> 00:12:28,788 I have a middle-aged woman 374 00:12:28,789 --> 00:12:30,457 with sudden onset blindness. 375 00:12:30,458 --> 00:12:31,833 - I can go. - OK. 376 00:12:31,834 --> 00:12:33,084 Will you see if Abbot's still around? 377 00:12:33,085 --> 00:12:34,085 - Yeah. - Thank you. 378 00:12:34,086 --> 00:12:35,712 What's your sister's name? 379 00:12:35,713 --> 00:12:37,422 Lauren Milford. 380 00:12:37,423 --> 00:12:38,923 Where in Arizona? 381 00:12:38,924 --> 00:12:40,550 Flagstaff, I think. 382 00:12:40,551 --> 00:12:41,760 Just gonna go over your tongue 383 00:12:41,761 --> 00:12:42,969 and numb your vocal cords. 384 00:12:42,970 --> 00:12:46,348 Ah... 385 00:12:46,349 --> 00:12:47,515 How many fingers? 386 00:12:47,516 --> 00:12:49,726 I don't see any fingers. 387 00:12:49,727 --> 00:12:51,686 And now? 388 00:12:51,687 --> 00:12:54,230 I can see a little bit of light. 389 00:12:54,231 --> 00:12:55,982 Um, Brooke, you've met Dr. King. 390 00:12:55,983 --> 00:12:57,484 This is Dr. Al-Hashimi. 391 00:12:57,485 --> 00:12:58,818 - Nice to meet you. - And her wife, Wendy. 392 00:12:58,819 --> 00:13:00,111 - Hello. - Hello. 393 00:13:00,112 --> 00:13:01,863 OK if we discuss your symptoms? 394 00:13:01,864 --> 00:13:04,074 As long as I can correct you if you get anything wrong. 395 00:13:04,075 --> 00:13:05,867 Trust me, she will. 396 00:13:05,868 --> 00:13:08,953 One hour of sudden, painless vision loss in the left eye. 397 00:13:08,954 --> 00:13:10,789 No history of hypercoagulable state 398 00:13:10,790 --> 00:13:12,165 or vascular disease. 399 00:13:12,166 --> 00:13:13,708 Could you look straight ahead, please? 400 00:13:13,709 --> 00:13:16,169 Could be a central retinal artery occlusion. 401 00:13:16,170 --> 00:13:17,629 In English, please? 402 00:13:17,630 --> 00:13:19,798 A little blood clot can block the artery 403 00:13:19,799 --> 00:13:22,384 at the back of the eye and decrease your vision. 404 00:13:22,385 --> 00:13:24,010 Sometimes it's called an eye stroke. 405 00:13:24,011 --> 00:13:25,011 Stroke? 406 00:13:25,012 --> 00:13:26,429 Like she could be paralyzed? 407 00:13:26,430 --> 00:13:27,972 No, this would be limited to the eye. 408 00:13:27,973 --> 00:13:29,391 Is it permanent? 409 00:13:29,392 --> 00:13:31,768 First, we have to make the diagnosis. 410 00:13:31,769 --> 00:13:32,977 Retinal exam? 411 00:13:32,978 --> 00:13:34,020 Hard to get a good look. 412 00:13:34,021 --> 00:13:35,605 We need the FOP. 413 00:13:35,606 --> 00:13:37,358 The what? 414 00:13:39,735 --> 00:13:41,403 Oh, Princess. 415 00:13:41,404 --> 00:13:43,363 We need patient stickers on each of these order sheets, 416 00:13:43,364 --> 00:13:45,490 or the pharmacy won't know who to give meds to. 417 00:13:45,491 --> 00:13:46,908 We're on it. 418 00:13:46,909 --> 00:13:49,077 Princess, smartphone fundoscope? 419 00:13:49,078 --> 00:13:50,453 Equipment corridor, eye cart. 420 00:13:50,454 --> 00:13:53,581 - Thanks. - You seem a little confused. 421 00:13:53,582 --> 00:13:55,375 How do I figure out which new patient to pick up? 422 00:13:55,376 --> 00:13:56,709 Top of the board. 423 00:13:56,710 --> 00:13:57,919 They're listed in the order they arrive. 424 00:13:57,920 --> 00:13:59,170 You erase the first one, then put 425 00:13:59,171 --> 00:14:00,630 your initials in the MD box. 426 00:14:00,631 --> 00:14:02,257 OK. Thanks. 427 00:14:02,258 --> 00:14:03,633 - Caleb. - Michael. 428 00:14:03,634 --> 00:14:05,468 Are you managing this chaos OK? 429 00:14:05,469 --> 00:14:08,096 Well, it's all pretty easy when you're a short-timer. 430 00:14:08,097 --> 00:14:10,724 Any more comatose patients for me to have a chat with? 431 00:14:12,518 --> 00:14:13,768 I'm kidding. 432 00:14:13,769 --> 00:14:15,353 OK. 433 00:14:15,354 --> 00:14:17,021 Victoria, this is Nicole Steadman. 434 00:14:17,022 --> 00:14:18,231 I run the parent support group 435 00:14:18,232 --> 00:14:19,691 for the psychiatric service. 436 00:14:19,692 --> 00:14:21,484 Yeah. Nicole's daughter was diagnosed 437 00:14:21,485 --> 00:14:23,236 sophomore year in college. 438 00:14:23,237 --> 00:14:26,364 You think Jackson's parents might have a chat with her? 439 00:14:26,365 --> 00:14:28,283 We can certainly ask. 440 00:14:28,284 --> 00:14:29,951 Now we can see the whole retina 441 00:14:29,952 --> 00:14:31,454 without dilating the pupil. 442 00:14:32,663 --> 00:14:34,205 You're looking in the wrong eye. 443 00:14:34,206 --> 00:14:36,458 Oh, we start with the good eye for comparison. 444 00:14:36,459 --> 00:14:38,543 Oh. 445 00:14:38,544 --> 00:14:39,627 Retina looks great. 446 00:14:39,628 --> 00:14:40,795 Now for the bad eye? 447 00:14:40,796 --> 00:14:42,131 Eyes wide open. 448 00:14:44,592 --> 00:14:45,884 How's it look? 449 00:14:45,885 --> 00:14:47,469 Extremely pale, no blood flow. 450 00:14:47,470 --> 00:14:49,596 Digital massage, 10 seconds on, 5 seconds off. 451 00:14:49,597 --> 00:14:53,058 Order non-contrast head CT. 452 00:14:54,685 --> 00:14:56,728 Come in. 453 00:14:56,729 --> 00:14:57,896 Hi. 454 00:14:57,897 --> 00:14:59,314 Heard your patient took off. 455 00:14:59,315 --> 00:15:00,857 She's taking a little break. 456 00:15:00,858 --> 00:15:03,234 How long are you gonna wait? 457 00:15:03,235 --> 00:15:05,111 You know about the cyber shutdown thing? 458 00:15:05,112 --> 00:15:06,654 Yeah. 459 00:15:06,655 --> 00:15:08,114 Wish I could help, but I gotta stay here 460 00:15:08,115 --> 00:15:09,532 till all the evidence is collected, so... 461 00:15:09,533 --> 00:15:11,159 It's a hot mess out there. 462 00:15:11,160 --> 00:15:12,536 This whole day is. 463 00:15:13,704 --> 00:15:16,164 Sorry. I was just leaving. 464 00:15:16,165 --> 00:15:18,333 You OK? 465 00:15:18,334 --> 00:15:19,792 I'm good. 466 00:15:19,793 --> 00:15:21,544 I'm glad to hear it. 467 00:15:21,545 --> 00:15:22,587 You get something to eat? 468 00:15:22,588 --> 00:15:25,465 No. 469 00:15:25,466 --> 00:15:27,592 Let's keep going. 470 00:15:27,593 --> 00:15:28,927 OK. 471 00:15:28,928 --> 00:15:30,054 Yeah. 472 00:15:40,523 --> 00:15:42,941 Why don't we keep one in the ER? 473 00:15:42,942 --> 00:15:46,611 Because our intubated patients are usually sedated. 474 00:15:46,612 --> 00:15:48,112 Right. 475 00:15:48,113 --> 00:15:49,739 Maybe you could ease up 476 00:15:49,740 --> 00:15:51,408 with your comments about his weight. 477 00:15:52,868 --> 00:15:54,744 I was just wondering how he got so big 478 00:15:54,745 --> 00:15:56,412 and how we could help. 479 00:15:56,413 --> 00:15:58,122 We can help by finding out what's wrong with him 480 00:15:58,123 --> 00:15:59,165 and treating him with respect. 481 00:15:59,166 --> 00:16:00,166 How's your belly now? 482 00:16:00,167 --> 00:16:01,501 Second pain shot helped. 483 00:16:01,502 --> 00:16:03,378 OK. There's more if you need it. 484 00:16:03,379 --> 00:16:04,629 Diminished bowel sounds. 485 00:16:04,630 --> 00:16:05,964 VidaTalk from the ICU. 486 00:16:05,965 --> 00:16:07,549 Great. 487 00:16:07,550 --> 00:16:08,841 Howard, we need to open up that passageway now 488 00:16:08,842 --> 00:16:10,093 so we can pass the tube. 489 00:16:10,094 --> 00:16:11,678 I'm gonna start with my pinky. 490 00:16:11,679 --> 00:16:13,096 Slowly, over a few minutes, I'm gonna go deeper, 491 00:16:13,097 --> 00:16:14,556 all the way to the back of my knuckle. 492 00:16:14,557 --> 00:16:16,266 Once the tube's through your vocal cords, 493 00:16:16,267 --> 00:16:17,767 you won't be able to talk. 494 00:16:17,768 --> 00:16:19,519 But this is a communication device. 495 00:16:19,520 --> 00:16:22,188 Swipe through the screen for anything you want to say. 496 00:16:22,189 --> 00:16:24,691 Hit the icon, and it talks to us. 497 00:16:24,692 --> 00:16:26,943 I would like some pain medicine. 498 00:16:26,944 --> 00:16:28,778 My pain is a nine. 499 00:16:28,779 --> 00:16:30,447 Can I get it to order a pizza? 500 00:16:32,908 --> 00:16:34,659 There's cell service in the ambulance bay. 501 00:16:34,660 --> 00:16:37,203 I found his sister's new number, left a voicemail. 502 00:16:37,204 --> 00:16:38,454 OK, I'm gonna start. 503 00:16:38,455 --> 00:16:39,664 You ready? 504 00:16:39,665 --> 00:16:41,124 Not really. 505 00:16:41,125 --> 00:16:42,125 Go ahead. 506 00:16:42,126 --> 00:16:43,501 Robby, over here. 507 00:16:43,502 --> 00:16:45,796 Here we go. Head back. 508 00:16:47,256 --> 00:16:48,464 You thinking it's surgical? 509 00:16:48,465 --> 00:16:49,924 I'm hoping for a non-perfed appy. 510 00:16:49,925 --> 00:16:51,509 - Can you do it with a scope? - Possibly, 511 00:16:51,510 --> 00:16:53,177 but he could be treated with antibiotics alone. 512 00:16:53,178 --> 00:16:55,179 And if he needs surgery? 513 00:16:55,180 --> 00:16:58,182 With his size, an emergency open laparotomy, 514 00:16:58,183 --> 00:17:00,310 death rate's close to 50%. 515 00:17:00,311 --> 00:17:01,894 OK, one step at a time. 516 00:17:01,895 --> 00:17:04,480 Let's keep trying his sister every 15 minutes. 517 00:17:04,481 --> 00:17:05,899 She'll get it. 518 00:17:09,820 --> 00:17:12,905 Half the downtime slips are blank. 519 00:17:12,906 --> 00:17:14,991 What are you talking about? 520 00:17:14,992 --> 00:17:17,160 Here and here. 521 00:17:17,161 --> 00:17:19,245 Larry, are you using a felt tip pen? 522 00:17:19,246 --> 00:17:21,539 Maybe. 523 00:17:21,540 --> 00:17:24,834 It's not going through for the copies. 524 00:17:24,835 --> 00:17:26,628 Ballpoint pen only. 525 00:17:26,629 --> 00:17:28,047 OK. 526 00:17:30,507 --> 00:17:31,799 Digby still MIA? 527 00:17:31,800 --> 00:17:33,009 Is that the homeless guy? 528 00:17:33,010 --> 00:17:34,845 We need the bed if he eloped. 529 00:17:36,263 --> 00:17:38,097 - What do you need? - An attending. 530 00:17:38,098 --> 00:17:39,932 - Or a senior resident? - Nope, I'm good. 531 00:17:39,933 --> 00:17:42,143 - Dr. Al-Hashimi, can I present? - Yes. 532 00:17:42,144 --> 00:17:44,729 32-year-old deaf woman with myofascial headache. 533 00:17:44,730 --> 00:17:47,023 Ibuprofen caused gastritis and epigastric pain, 534 00:17:47,024 --> 00:17:49,233 and she vasovagalled, but now pain-free 535 00:17:49,234 --> 00:17:51,277 after Mylanta and a trigger point injection. 536 00:17:51,278 --> 00:17:52,487 Excellent. That can take care of the pain 537 00:17:52,488 --> 00:17:54,155 - for several months. - Yeah. 538 00:17:54,156 --> 00:17:56,491 It shouldn't recur if she keeps her screen at eye level. 539 00:17:56,492 --> 00:17:57,867 There was a delay 540 00:17:57,868 --> 00:17:59,452 in getting an ASL interpreter. 541 00:17:59,453 --> 00:18:01,120 And I almost gave up and ordered 542 00:18:01,121 --> 00:18:03,289 an unnecessary brain and abdominal CT. 543 00:18:03,290 --> 00:18:04,540 Good thing you didn't. 544 00:18:04,541 --> 00:18:07,210 Dr. Al-Hashimi, for you. 545 00:18:07,211 --> 00:18:08,586 Nice job on the trigger point. 546 00:18:08,587 --> 00:18:09,796 Yeah, I know. 547 00:18:09,797 --> 00:18:11,547 How's the T-system going? 548 00:18:11,548 --> 00:18:13,633 - Quick and easy. - Yeah. 549 00:18:13,634 --> 00:18:15,885 On these MDMs, don't just circle your diagnosis. 550 00:18:15,886 --> 00:18:17,679 Also put a backslash through all the ones 551 00:18:17,680 --> 00:18:18,721 that you've ruled out. 552 00:18:18,722 --> 00:18:19,764 No problem. 553 00:18:19,765 --> 00:18:21,432 Thank you very much. 554 00:18:21,433 --> 00:18:23,434 Princess, bump Central 13 to the front of the CT line. 555 00:18:23,435 --> 00:18:24,602 What do you got? 556 00:18:24,603 --> 00:18:25,978 Sudden onset blindness patient 557 00:18:25,979 --> 00:18:27,522 has central retinal artery occlusion. 558 00:18:27,523 --> 00:18:29,190 I just spoke to an ophthalmologist 559 00:18:29,191 --> 00:18:30,775 at the VA, principal investigator 560 00:18:30,776 --> 00:18:32,443 for thrombolytics in cases like this. 561 00:18:32,444 --> 00:18:33,903 Not exactly standard of care. 562 00:18:33,904 --> 00:18:34,946 Kind of risky. 563 00:18:34,947 --> 00:18:36,572 We'll do informed consent. 564 00:18:36,573 --> 00:18:38,116 It's our best shot at saving some of her vision. 565 00:18:38,117 --> 00:18:39,909 Your patient, your call. 566 00:18:39,910 --> 00:18:41,912 I'm not gonna be around long enough for any complications. 567 00:18:44,915 --> 00:18:48,501 I'll be taking two swabs from the vagina, 568 00:18:48,502 --> 00:18:50,546 two swabs from the cervix. 569 00:18:53,966 --> 00:18:56,759 Let me know if you feel any discomfort. 570 00:18:56,760 --> 00:18:58,803 OK. 571 00:18:58,804 --> 00:19:02,974 Each swab gets labeled-- first vaginal, second vaginal. 572 00:19:02,975 --> 00:19:05,268 Smear a slide with both, and let it air dry. 573 00:19:05,269 --> 00:19:06,477 Same for the cervix? 574 00:19:06,478 --> 00:19:07,478 Yeah. 575 00:19:07,479 --> 00:19:08,856 No slide needed. 576 00:19:10,524 --> 00:19:12,650 How you doing, Ilana? 577 00:19:12,651 --> 00:19:14,694 Hanging in there. 578 00:19:14,695 --> 00:19:16,195 OK. 579 00:19:16,196 --> 00:19:17,698 Almost done. 580 00:19:20,492 --> 00:19:23,202 All these samples go in the vaginal contact envelope. 581 00:19:23,203 --> 00:19:24,620 - I can help with that. - No. 582 00:19:24,621 --> 00:19:26,330 It's gotta be me. 583 00:19:26,331 --> 00:19:29,709 I'm gonna pull this out. 584 00:19:29,710 --> 00:19:31,502 OK. 585 00:19:31,503 --> 00:19:32,587 All good here. 586 00:19:32,588 --> 00:19:34,047 Legs can come down. 587 00:19:37,885 --> 00:19:39,761 Are we done? 588 00:19:39,762 --> 00:19:41,095 One last thing. 589 00:19:41,096 --> 00:19:43,514 Four more swabs inside your mouth. 590 00:19:43,515 --> 00:19:45,224 Didn't you do that already? 591 00:19:45,225 --> 00:19:48,227 This one's different-- inside your cheek for your DNA, 592 00:19:48,228 --> 00:19:49,897 not for his. 593 00:19:52,608 --> 00:19:57,987 So it could be bipolar or schizophrenia? 594 00:19:57,988 --> 00:20:00,281 Those are the two most likely possibilities. 595 00:20:00,282 --> 00:20:01,824 How do they know which it is? 596 00:20:01,825 --> 00:20:03,993 Based on response to medicine, 597 00:20:03,994 --> 00:20:06,579 but also with therapy and observation on the ward. 598 00:20:06,580 --> 00:20:10,042 They'll monitor his mood and interactions with others. 599 00:20:12,002 --> 00:20:14,754 Is there a blood test or a brain scan 600 00:20:14,755 --> 00:20:15,797 that will tell us for sure? 601 00:20:15,798 --> 00:20:17,757 Unfortunately not. 602 00:20:17,758 --> 00:20:20,718 When properly medicated, people with bipolar disorder 603 00:20:20,719 --> 00:20:23,429 can have successful careers. 604 00:20:23,430 --> 00:20:25,348 So we hope for bipolar? 605 00:20:25,349 --> 00:20:27,350 You can hope for your son's happiness. 606 00:20:27,351 --> 00:20:29,977 With early treatment, 20% of people 607 00:20:29,978 --> 00:20:32,730 with schizophrenia have a complete recovery. 608 00:20:32,731 --> 00:20:34,649 So 80% don't? 609 00:20:34,650 --> 00:20:36,944 This is a new version of Jackson. 610 00:20:39,738 --> 00:20:40,822 How old was your daughter? 611 00:20:40,823 --> 00:20:42,740 20. 612 00:20:42,741 --> 00:20:46,160 Studying architecture at Georgetown. 613 00:20:46,161 --> 00:20:47,870 Schizophrenia. 614 00:20:47,871 --> 00:20:50,081 I'm sorry. 615 00:20:50,082 --> 00:20:51,749 Oh, she's good. 616 00:20:51,750 --> 00:20:56,629 Living at home, working as a cashier at Giant Eagle. 617 00:20:56,630 --> 00:20:59,090 Employee of the Month. 618 00:20:59,091 --> 00:21:01,300 We still have struggles, 619 00:21:01,301 --> 00:21:04,346 but there's also laughter and love. 620 00:21:11,603 --> 00:21:13,020 Good to go. 621 00:21:13,021 --> 00:21:14,021 How'd that feel? 622 00:21:14,022 --> 00:21:15,565 Very weird. 623 00:21:15,566 --> 00:21:17,650 There's no pain. Just weird. 624 00:21:17,651 --> 00:21:19,944 OK, the next step is, we're gonna take this tube 625 00:21:19,945 --> 00:21:21,946 and pass it through your nose, 626 00:21:21,947 --> 00:21:24,448 stopping at the back of your tongue. 627 00:21:24,449 --> 00:21:26,325 Best not to talk for that. 628 00:21:26,326 --> 00:21:29,954 Tube's soaking in warm water to make it more flexible. 629 00:21:29,955 --> 00:21:32,665 Do you wanna try it? 630 00:21:32,666 --> 00:21:34,542 What day and time is it? 631 00:21:34,543 --> 00:21:36,919 4th of July, 2:31 p.m. 632 00:21:36,920 --> 00:21:38,838 When is my tube coming out? 633 00:21:38,839 --> 00:21:41,716 We have to put it in first. 634 00:21:41,717 --> 00:21:42,717 I know. 635 00:21:42,718 --> 00:21:44,343 Just practicing. 636 00:21:44,344 --> 00:21:47,722 Sounds like you're an expert already. 637 00:21:47,723 --> 00:21:50,766 Before I can't talk, 638 00:21:50,767 --> 00:21:53,519 I just wanna say 639 00:21:53,520 --> 00:21:56,981 thank you for everything. 640 00:21:56,982 --> 00:21:59,109 You're very welcome. 641 00:22:04,907 --> 00:22:06,283 Here we go. 642 00:22:10,954 --> 00:22:12,330 STI prevention. 643 00:22:12,331 --> 00:22:13,956 One shot treats gonorrhea, 644 00:22:13,957 --> 00:22:16,334 then pills for chlamydia and trichomonas. 645 00:22:16,335 --> 00:22:17,877 Thank you. 646 00:22:17,878 --> 00:22:19,670 We also have morning-after contraception. 647 00:22:19,671 --> 00:22:20,755 She has an IUD. 648 00:22:20,756 --> 00:22:23,299 Over 99% effective, not 100%. 649 00:22:23,300 --> 00:22:24,842 We still offer. 650 00:22:24,843 --> 00:22:26,427 I'll pass. 651 00:22:26,428 --> 00:22:29,889 For HIV, we got PEP, Post-Exposure Prophylaxis. 652 00:22:29,890 --> 00:22:31,390 28 days. 653 00:22:31,391 --> 00:22:34,644 The sooner you start, the more effective. 654 00:22:34,645 --> 00:22:36,395 Emma, I'm pretty sure they could use 655 00:22:36,396 --> 00:22:39,565 an extra set of hands out there. 656 00:22:39,566 --> 00:22:42,026 It's nice to meet you, Ilana. 657 00:22:42,027 --> 00:22:43,444 You're a very brave woman. 658 00:22:43,445 --> 00:22:44,571 Yeah. 659 00:22:51,703 --> 00:22:53,120 She's a good nurse. 660 00:22:53,121 --> 00:22:57,625 She's still learning, but she will be. 661 00:22:57,626 --> 00:22:59,585 After this, we're done? 662 00:22:59,586 --> 00:23:01,254 Yeah. 663 00:23:04,508 --> 00:23:06,718 I'm glad you were here today. 664 00:23:11,181 --> 00:23:13,766 Me too. 665 00:23:13,767 --> 00:23:16,852 We have a decision to make. 666 00:23:16,853 --> 00:23:18,854 Studies have shown that some vision 667 00:23:18,855 --> 00:23:21,649 can be restored with a clot-busting medication. 668 00:23:21,650 --> 00:23:23,067 So give it. 669 00:23:23,068 --> 00:23:25,236 But there are possible risks. 670 00:23:25,237 --> 00:23:29,824 For eye stroke, only 17% get better without any treatment. 671 00:23:29,825 --> 00:23:31,826 - Only 17%? - Yes. 672 00:23:31,827 --> 00:23:36,163 But with the medicine, another 20% can improve. 673 00:23:36,164 --> 00:23:38,666 But there can be complications. 674 00:23:38,667 --> 00:23:42,294 2% of patients who receive the medication get worse, 675 00:23:42,295 --> 00:23:47,175 and 1% have severe disability or death. 676 00:23:52,764 --> 00:23:56,309 Honey, this one has to be your call. 677 00:23:57,561 --> 00:24:00,771 No, it's our call. 678 00:24:00,772 --> 00:24:02,648 What would you do without me? 679 00:24:02,649 --> 00:24:04,860 I'd figure out how to get by. 680 00:24:06,820 --> 00:24:09,739 And I'd probably cry for two years solid. 681 00:24:09,740 --> 00:24:12,242 Two years? That's all? 682 00:24:13,493 --> 00:24:14,869 I want the medication. 683 00:24:14,870 --> 00:24:16,830 OK. 684 00:24:20,375 --> 00:24:22,293 OK, we need your full name to make a chart. 685 00:24:22,294 --> 00:24:26,047 Jackie Liddell. 686 00:24:26,048 --> 00:24:27,089 And you are? 687 00:24:27,090 --> 00:24:28,507 Her friend Jaquie. 688 00:24:28,508 --> 00:24:30,426 - You have the same name? - No, no. 689 00:24:30,427 --> 00:24:32,636 She's Jackie with a C-K. I'm Jaquie with a Q. 690 00:24:32,637 --> 00:24:34,430 You can call me CK. 691 00:24:34,431 --> 00:24:35,514 Oh. 692 00:24:35,515 --> 00:24:36,849 Best not to talk, CK, OK? 693 00:24:36,850 --> 00:24:38,350 - Just chill. - Chill? 694 00:24:38,351 --> 00:24:41,687 - Q, I bit off half my tongue! - What? 695 00:24:41,688 --> 00:24:43,522 She said, I bit off half my tongue. 696 00:24:43,523 --> 00:24:44,899 You can understand that? 697 00:24:44,900 --> 00:24:46,567 Oh, you should hear her when she's had 698 00:24:46,568 --> 00:24:48,486 two pitchers of margaritas, fucked up and slurring. 699 00:24:48,487 --> 00:24:51,030 Ooh, you are such an idiot! 700 00:24:51,031 --> 00:24:52,656 Princess, what's open? 701 00:24:52,657 --> 00:24:54,408 South 15's clean. 702 00:24:54,409 --> 00:24:55,951 Deep tongue laceration. 703 00:24:55,952 --> 00:24:58,662 I can jump on this. 704 00:24:58,663 --> 00:25:01,624 Robby and Al-Hashimi are both with critical patients. 705 00:25:01,625 --> 00:25:02,958 Hello. 706 00:25:02,959 --> 00:25:04,210 I'm Dr. Langdon. 707 00:25:04,211 --> 00:25:06,046 I'll be supervising your care. 708 00:25:08,090 --> 00:25:10,675 Jesus, CK, your doctor's fucking hot. 709 00:25:13,595 --> 00:25:15,930 Tube's at 14 centimeters, just above the airway. 710 00:25:15,931 --> 00:25:18,307 OK, Howard, I'm going to start. 711 00:25:18,308 --> 00:25:22,478 If you want me to stop, you just put your hand up, OK? 712 00:25:22,479 --> 00:25:25,148 Blue mark tells me I'm in the tube. 713 00:25:28,568 --> 00:25:30,653 Looks like he cleared it. 714 00:25:30,654 --> 00:25:33,239 If he inhales, we should see chords. 715 00:25:33,240 --> 00:25:35,617 OK, deep breath for me, Howard. 716 00:25:38,411 --> 00:25:40,788 - OK. - Beautiful. 717 00:25:40,789 --> 00:25:42,414 Chords are sensitive, so we spray lidocaine 718 00:25:42,415 --> 00:25:44,875 - in the scope. - OK. 719 00:25:44,876 --> 00:25:48,420 1 cc going in now. 720 00:25:48,421 --> 00:25:51,132 And we'll just give that a second to work. 721 00:25:51,133 --> 00:25:52,634 How you doing, Howard? 722 00:25:54,010 --> 00:25:55,761 Once the tube's in, you'll have to breathe 723 00:25:55,762 --> 00:25:57,096 through your nose. 724 00:25:57,097 --> 00:25:58,514 OK, Howard, hold still. 725 00:25:58,515 --> 00:26:02,017 I am now going in past your vocal cords 726 00:26:02,018 --> 00:26:04,604 until we see the carina. 727 00:26:06,231 --> 00:26:07,773 Ogilvie. 728 00:26:07,774 --> 00:26:09,024 Uh, there. 729 00:26:09,025 --> 00:26:10,151 Right and left mainstem. 730 00:26:10,152 --> 00:26:12,988 And the tube slides in. 731 00:26:16,867 --> 00:26:20,120 And then the scope comes out. 732 00:26:21,955 --> 00:26:23,455 Great. 733 00:26:23,456 --> 00:26:24,790 OK, inflate the balloon. 734 00:26:24,791 --> 00:26:26,208 Deep breath through your nose. 735 00:26:26,209 --> 00:26:27,418 Amazing. 736 00:26:27,419 --> 00:26:29,545 You good? 737 00:26:29,546 --> 00:26:31,172 Great end-tidal waveform. 738 00:26:31,173 --> 00:26:32,423 Does he need a vent? 739 00:26:32,424 --> 00:26:33,632 He's breathing on his own, 740 00:26:33,633 --> 00:26:35,050 but a little CPAP wouldn't hurt. 741 00:26:35,051 --> 00:26:37,261 Starting at 5, titrate to 10. 742 00:26:37,262 --> 00:26:39,263 OK, that went really well, Howard. 743 00:26:39,264 --> 00:26:41,057 Now we're going to check your weight. 744 00:26:43,018 --> 00:26:44,560 So the nurse examiner is supposed 745 00:26:44,561 --> 00:26:46,437 to lock up the rape kit in this fridge, 746 00:26:46,438 --> 00:26:49,607 where it stays until it gets turned over to law enforcement. 747 00:26:49,608 --> 00:26:52,318 It's called preserving the chain of evidence. 748 00:26:52,319 --> 00:26:54,612 Are you fucking kidding me? 749 00:26:54,613 --> 00:26:56,488 Is there a problem? 750 00:26:56,489 --> 00:26:58,782 Jesus Christ. 751 00:26:58,783 --> 00:27:01,869 Police are supposed to pick up the rape kits within 72 hours. 752 00:27:01,870 --> 00:27:04,872 This one I did two weeks ago. 753 00:27:04,873 --> 00:27:06,374 God damn it. 754 00:27:08,627 --> 00:27:10,794 So how exactly did this happen? 755 00:27:10,795 --> 00:27:13,672 We were in between pubs taking a selfie. 756 00:27:13,673 --> 00:27:14,757 Very nice. 757 00:27:14,758 --> 00:27:17,218 Until she jerked her head up. 758 00:27:17,219 --> 00:27:18,677 Ooh. 759 00:27:18,678 --> 00:27:20,012 Ouch. 760 00:27:20,013 --> 00:27:21,680 OK, topical epi did the trick. 761 00:27:21,681 --> 00:27:23,098 - No more bleeding. - Sweet. 762 00:27:23,099 --> 00:27:24,475 I can go home now? 763 00:27:24,476 --> 00:27:26,352 I don't think so. 764 00:27:26,353 --> 00:27:27,937 It looks like the Grand Canyon across the back of your tongue. 765 00:27:27,938 --> 00:27:29,939 We need to put in some stitches. 766 00:27:29,940 --> 00:27:30,940 I don't want stitches. 767 00:27:30,941 --> 00:27:33,025 Oh. Listen to the doctor. 768 00:27:33,026 --> 00:27:34,777 Don't tell me what to do. 769 00:27:34,778 --> 00:27:36,278 This is all your fault. 770 00:27:36,279 --> 00:27:38,322 - No, it's not. - Uh, yes, it is. 771 00:27:38,323 --> 00:27:39,990 - Uh, Princess. - No, it's not. 772 00:27:39,991 --> 00:27:41,575 Princess, hey, why don't you show Q 773 00:27:41,576 --> 00:27:43,369 where she can wait while we patch up her friend? 774 00:27:43,370 --> 00:27:44,870 Of course. 775 00:27:44,871 --> 00:27:47,081 OK, this is a numbing shot for the tip. 776 00:27:47,082 --> 00:27:48,082 The tip? 777 00:27:48,083 --> 00:27:50,000 That's not where I bit it. 778 00:27:50,001 --> 00:27:51,503 One step at a time. 779 00:27:58,718 --> 00:28:01,011 That's 20 migs of TNK. 780 00:28:01,012 --> 00:28:04,056 In at 14:39. 781 00:28:04,057 --> 00:28:06,350 Feeling anything? 782 00:28:06,351 --> 00:28:07,476 Not yet. 783 00:28:07,477 --> 00:28:10,396 Could take an hour or two. 784 00:28:10,397 --> 00:28:11,855 We're going to move you to another room 785 00:28:11,856 --> 00:28:13,732 for better monitoring. 786 00:28:13,733 --> 00:28:15,360 Dr. King. 787 00:28:18,196 --> 00:28:21,532 I'd like you to stay with her. 788 00:28:21,533 --> 00:28:22,866 Why? 789 00:28:22,867 --> 00:28:24,493 In case there are complications. 790 00:28:24,494 --> 00:28:26,245 You'll be there to respond quickly 791 00:28:26,246 --> 00:28:29,164 to a blown pupil, a seizure, altered mental status. 792 00:28:29,165 --> 00:28:31,208 Or I could catch up on my charts. 793 00:28:31,209 --> 00:28:33,127 And my deposition's coming up. 794 00:28:33,128 --> 00:28:35,629 Think of this as a great way to steal some quiet time 795 00:28:35,630 --> 00:28:36,922 and get mentally prepared. 796 00:28:36,923 --> 00:28:39,217 Jesse, Mel's with you. 797 00:28:41,011 --> 00:28:42,928 Oh, excuse me, Dr. Mohan. 798 00:28:42,929 --> 00:28:44,054 Excuse me. 799 00:28:44,055 --> 00:28:45,055 Dr. Mohan. 800 00:28:45,056 --> 00:28:46,473 Uh, in a minute, George. 801 00:28:46,474 --> 00:28:47,558 I've got this. 802 00:28:47,559 --> 00:28:48,767 Thank you. 803 00:28:48,768 --> 00:28:51,103 Oh, uh, I, um-- 804 00:28:51,104 --> 00:28:53,272 D-dimer is back normal. 805 00:28:53,273 --> 00:28:54,273 Oh. 806 00:28:54,274 --> 00:28:55,607 I'm ready to go. 807 00:28:55,608 --> 00:28:57,484 Are you feeling better? 808 00:28:57,485 --> 00:29:01,239 I--I really wasn't short of breath this time. 809 00:29:02,407 --> 00:29:04,034 Then why'd you come in? 810 00:29:05,618 --> 00:29:07,578 When I found out about the blood clot in my leg, 811 00:29:07,579 --> 00:29:10,497 I just kept thinking it's gonna go to my lung and kill me. 812 00:29:10,498 --> 00:29:13,667 We've talked before about how the Eliquis would prevent that. 813 00:29:13,668 --> 00:29:16,378 I know. 814 00:29:16,379 --> 00:29:18,756 Well, I finally took your advice. 815 00:29:18,757 --> 00:29:21,216 I got out of the house, and I joined 816 00:29:21,217 --> 00:29:23,135 the Frick Park Lawn Bowling Club. 817 00:29:23,136 --> 00:29:24,428 Wonderful. 818 00:29:24,429 --> 00:29:25,554 Yeah. 819 00:29:25,555 --> 00:29:27,389 I mean, you're right, you know? 820 00:29:27,390 --> 00:29:29,434 We all need a community. 821 00:29:33,480 --> 00:29:34,855 You're gonna do what? 822 00:29:34,856 --> 00:29:36,523 In order to fix your tongue, 823 00:29:36,524 --> 00:29:39,068 we need to move it forward to access the laceration. 824 00:29:39,069 --> 00:29:40,694 You're just gonna feel some pulling, OK? 825 00:29:40,695 --> 00:29:44,073 I guess so. 826 00:29:44,074 --> 00:29:46,784 Go for it. 827 00:29:46,785 --> 00:29:48,160 What size suture is that? 828 00:29:48,161 --> 00:29:51,955 O-silk, the biggest one we got. 829 00:29:51,956 --> 00:29:54,918 As soon as I cut the needle, you're on traction, Joy. 830 00:30:03,718 --> 00:30:05,177 Oh. 831 00:30:05,178 --> 00:30:07,388 That is pretty deep. 832 00:30:07,389 --> 00:30:08,972 And now we can numb up the cut. 833 00:30:08,973 --> 00:30:10,307 It's best to start with-- 834 00:30:10,308 --> 00:30:11,725 Proximal side first so she doesn't 835 00:30:11,726 --> 00:30:14,937 feel the distal injection. 836 00:30:14,938 --> 00:30:15,938 Give it ten minutes. 837 00:30:15,939 --> 00:30:17,524 I'll be back for the repair. 838 00:30:21,736 --> 00:30:23,570 I got a rape kit sitting here for two weeks 839 00:30:23,571 --> 00:30:26,073 that was supposed to be picked up within 72 hours. 840 00:30:26,074 --> 00:30:27,116 I don't care! 841 00:30:27,117 --> 00:30:29,159 Get someone over here now! No. 842 00:30:29,160 --> 00:30:30,661 You expect us to treat your officers 843 00:30:30,662 --> 00:30:32,287 as soon as they come in, 844 00:30:32,288 --> 00:30:34,123 you get a detective to pick these kits up ASAP. 845 00:30:34,124 --> 00:30:35,124 I gotta go. 846 00:30:35,125 --> 00:30:36,708 - Dana-- - Hey, Dana. 847 00:30:36,709 --> 00:30:37,876 South 19 got their head CT before we went down. 848 00:30:37,877 --> 00:30:39,211 No results yet. 849 00:30:39,212 --> 00:30:40,379 All right, I'll send a reminder. 850 00:30:40,380 --> 00:30:41,380 - Hey, Dana. - Dana. 851 00:30:41,381 --> 00:30:42,841 Hang on. 852 00:30:43,883 --> 00:30:45,551 What's up? 853 00:30:45,552 --> 00:30:47,511 We put in an order for more pain meds for Roxie. 854 00:30:47,512 --> 00:30:49,596 All right, so put it in the nursing racks. 855 00:30:49,597 --> 00:30:52,224 Oh, I did, a long time ago. 856 00:30:52,225 --> 00:30:54,101 All right. I'll bump it to the front. 857 00:30:54,102 --> 00:30:55,644 Thank you. 858 00:30:55,645 --> 00:30:57,354 Uh, what's that noise? 859 00:30:57,355 --> 00:30:58,439 UFO landed. 860 00:30:58,440 --> 00:30:59,440 Aliens are invading. 861 00:30:59,441 --> 00:31:00,941 Hey, Dana. 862 00:31:00,942 --> 00:31:02,818 Chem 7's not back on Trauma 2 yet. 863 00:31:02,819 --> 00:31:05,112 Let me see the chart. 864 00:31:05,113 --> 00:31:06,655 Oh, Jesus. 865 00:31:06,656 --> 00:31:08,198 I bet your Chem 7 rec went to Radiology. 866 00:31:08,199 --> 00:31:10,033 Larry, Antoine. 867 00:31:10,034 --> 00:31:12,536 You put labs and chest X-ray on the same downtime form. 868 00:31:12,537 --> 00:31:14,830 You need two slips--one for labs, one for radiology. 869 00:31:14,831 --> 00:31:16,498 - Got it. - Won't happen again. 870 00:31:16,499 --> 00:31:17,624 I'll run it down myself. 871 00:31:17,625 --> 00:31:19,334 Use the iStat at bedside. 872 00:31:19,335 --> 00:31:20,752 They won't take him to CT without a creatinine. 873 00:31:20,753 --> 00:31:21,962 Oh, perfect. 874 00:31:21,963 --> 00:31:23,088 Nice to have you back. 875 00:31:23,089 --> 00:31:24,381 Thrilled to be here. 876 00:31:24,382 --> 00:31:25,507 You trying to text? 877 00:31:25,508 --> 00:31:27,050 I am just composing. 878 00:31:27,051 --> 00:31:28,594 I'm gonna send it from the bay. 879 00:31:28,595 --> 00:31:30,846 My mechanic friend, Duke, never showed up. 880 00:31:30,847 --> 00:31:32,389 I thought he was coming in this morning. 881 00:31:32,390 --> 00:31:33,599 That was the plan. 882 00:31:33,600 --> 00:31:35,893 I guess he got busy. 883 00:31:35,894 --> 00:31:37,102 What if he's a no-show? 884 00:31:37,103 --> 00:31:38,729 Tell me what he needs. 885 00:31:38,730 --> 00:31:39,813 I'll pass it on to the night shift. 886 00:31:39,814 --> 00:31:40,815 That won't be necessary. 887 00:31:43,651 --> 00:31:45,402 Oh, Princess. 888 00:31:45,403 --> 00:31:46,487 Ask and you shall receive. 889 00:31:46,488 --> 00:31:47,613 Normal head CT. 890 00:31:47,614 --> 00:31:49,990 Thanks. I'll get him discharged. 891 00:31:49,991 --> 00:31:51,825 How's your day going? 892 00:31:51,826 --> 00:31:54,328 I think I'm getting writer's cramp. 893 00:31:54,329 --> 00:31:55,662 You with the big guy? 894 00:31:55,663 --> 00:31:57,915 Yeah. It's sad. 895 00:31:57,916 --> 00:32:01,836 Bad car accident, multiple operations, tons of stress. 896 00:32:03,922 --> 00:32:05,714 Lidocaine shot to a sensitive area. 897 00:32:05,715 --> 00:32:07,466 I got a binge-drinking party girl with a tongue lac. 898 00:32:07,467 --> 00:32:08,800 Mm. 899 00:32:08,801 --> 00:32:10,052 Sounds like she needs some help. 900 00:32:10,053 --> 00:32:12,763 In more ways than one. 901 00:32:12,764 --> 00:32:16,475 How's, uh--how's your first shift back going? 902 00:32:16,476 --> 00:32:18,685 One day at a time. 903 00:32:18,686 --> 00:32:20,270 First year sober is the hardest. 904 00:32:20,271 --> 00:32:21,522 That's what they keep telling me. 905 00:32:21,523 --> 00:32:24,192 I'm nine years and counting. 906 00:32:26,653 --> 00:32:28,153 Oh. 907 00:32:28,154 --> 00:32:31,698 Special delivery for my guy. 908 00:32:31,699 --> 00:32:33,659 If you, um--if you need anything, call me. 909 00:32:33,660 --> 00:32:35,328 Thanks. 910 00:32:41,334 --> 00:32:42,876 Where are you going? 911 00:32:42,877 --> 00:32:44,253 Blisters in North 3. 912 00:32:44,254 --> 00:32:45,754 That's where I'm going. 913 00:32:45,755 --> 00:32:47,631 Did you sign up for the patient? 914 00:32:47,632 --> 00:32:49,424 I pulled the chart from the rack. 915 00:32:49,425 --> 00:32:51,176 You're supposed to sign up on the dry-erase board. 916 00:32:51,177 --> 00:32:53,053 You're supposed to have a clipboard for the patient. 917 00:32:53,054 --> 00:32:54,846 I thought the nurses had that. 918 00:32:54,847 --> 00:32:56,473 Whatever. 919 00:32:56,474 --> 00:32:57,599 Hi. 920 00:32:57,600 --> 00:32:59,017 I'm Student Doctor Ogilvie. 921 00:32:59,018 --> 00:33:01,228 And this is--wow. 922 00:33:01,229 --> 00:33:02,688 That is some rash. 923 00:33:02,689 --> 00:33:05,566 - Yeah. Tell me about it. - Student Doctor Javadi. 924 00:33:05,567 --> 00:33:07,776 - When did this start? - Last night. 925 00:33:07,777 --> 00:33:09,319 And have you been on any hikes recently 926 00:33:09,320 --> 00:33:10,445 around poison ivy? 927 00:33:10,446 --> 00:33:12,364 Nope. Haven't left the house. 928 00:33:12,365 --> 00:33:15,367 What about new medications, lotions, soaps, 929 00:33:15,368 --> 00:33:16,368 detergents, even? 930 00:33:16,369 --> 00:33:17,661 I don't take medicine. 931 00:33:17,662 --> 00:33:19,329 Nothing new with all that other stuff. 932 00:33:19,330 --> 00:33:20,414 Uh-huh. And where did this start? 933 00:33:20,415 --> 00:33:21,832 Everywhere, all at once. 934 00:33:21,833 --> 00:33:25,168 Just a lot of pain, really itchy. 935 00:33:25,169 --> 00:33:26,878 What is it? 936 00:33:26,879 --> 00:33:28,380 I'm not sure yet. 937 00:33:28,381 --> 00:33:31,133 Um, be back in a second. 938 00:33:31,134 --> 00:33:32,760 Can't--will you-- 939 00:33:37,015 --> 00:33:38,974 What are you thinking? 940 00:33:38,975 --> 00:33:40,058 I have no idea. 941 00:33:40,059 --> 00:33:41,311 Agreed. 942 00:33:43,187 --> 00:33:44,688 Bullous pemphigoid? 943 00:33:44,689 --> 00:33:46,398 Autoimmune severe pruritis? 944 00:33:46,399 --> 00:33:48,025 Yeah, but not as deadly as pemphigus vulgaris. 945 00:33:48,026 --> 00:33:50,027 Untreated, the death rate is over 90%. 946 00:33:50,028 --> 00:33:51,445 We need to check for pustules, 947 00:33:51,446 --> 00:33:52,571 mucous membrane involvement-- 948 00:33:52,572 --> 00:33:54,032 And the Nikolsky sign. 949 00:33:56,534 --> 00:33:57,910 Here you go. 950 00:33:59,412 --> 00:34:00,412 What? 951 00:34:00,413 --> 00:34:02,040 For your progress note. 952 00:34:03,416 --> 00:34:06,335 Did I hear we're making progress? 953 00:34:06,336 --> 00:34:08,629 Oh, um, it's just what we call it 954 00:34:08,630 --> 00:34:11,799 when we write down things to describe a clinical course. 955 00:34:13,343 --> 00:34:14,302 Any changes? 956 00:34:15,386 --> 00:34:16,595 Not so far. 957 00:34:16,596 --> 00:34:18,972 It's time for the next neuro check. 958 00:34:18,973 --> 00:34:21,266 Excuse me, Dr. King, do you have a minute? 959 00:34:21,267 --> 00:34:22,851 Um, no. 960 00:34:22,852 --> 00:34:24,645 I'm observing a patient right now. 961 00:34:24,646 --> 00:34:27,065 60 seconds tops. 962 00:34:28,483 --> 00:34:29,775 I'll check pupils. 963 00:34:29,776 --> 00:34:31,402 We're good here. 964 00:34:37,033 --> 00:34:38,909 Hey. 965 00:34:38,910 --> 00:34:41,244 I just finished my deposition. 966 00:34:41,245 --> 00:34:43,705 Oh, should I go up now? 967 00:34:43,706 --> 00:34:45,415 Yeah. Just wait until you get a call. 968 00:34:45,416 --> 00:34:46,792 OK. 969 00:34:46,793 --> 00:34:48,251 Well, I'd ask how it went, 970 00:34:48,252 --> 00:34:50,295 but we're not supposed to discuss the case. 971 00:34:50,296 --> 00:34:51,797 This isn't a discussion. 972 00:34:51,798 --> 00:34:55,050 It's a monologue, so shut up and listen. 973 00:34:55,051 --> 00:34:57,260 The malpractice case is frivolous. 974 00:34:57,261 --> 00:34:58,804 The mother of the measles kid claims 975 00:34:58,805 --> 00:35:00,222 we caused intellectual decline 976 00:35:00,223 --> 00:35:02,307 by performing a spinal tap. 977 00:35:02,308 --> 00:35:05,519 But the tap was perfect with no complications. 978 00:35:05,520 --> 00:35:07,270 Her son presented with altered mental status 979 00:35:07,271 --> 00:35:10,732 due to low oxygen from measles pneumonia. 980 00:35:10,733 --> 00:35:13,193 Any change in intellect was due to hypoxic brain injury. 981 00:35:13,194 --> 00:35:16,863 It had nothing to do with your spinal tap. 982 00:35:16,864 --> 00:35:18,573 End of monologue. 983 00:35:18,574 --> 00:35:21,326 We never discussed the case. 984 00:35:21,327 --> 00:35:23,662 I gotta get some sleep. 985 00:35:23,663 --> 00:35:26,999 Thanks, I guess. 986 00:35:28,668 --> 00:35:30,877 OK, are you ready to lay down? 987 00:35:30,878 --> 00:35:31,878 I got your head. 988 00:35:31,879 --> 00:35:33,088 Nice and slow. 989 00:35:33,089 --> 00:35:35,299 One, two, three. 990 00:35:36,718 --> 00:35:37,634 OK. 991 00:35:37,635 --> 00:35:38,803 How's that feel? 992 00:35:41,723 --> 00:35:42,849 Lifting up now. 993 00:35:52,859 --> 00:35:54,485 Keep going. 994 00:35:57,113 --> 00:36:00,366 And... that ought to do it right about there. 995 00:36:02,118 --> 00:36:03,869 215? 996 00:36:03,870 --> 00:36:05,872 Oh, that's in kilos. 997 00:36:08,207 --> 00:36:09,792 OK, team. 998 00:36:15,423 --> 00:36:17,090 It's not that much over 450. 999 00:36:17,091 --> 00:36:19,885 No, we can't risk breaking our CT on a holiday weekend. 1000 00:36:19,886 --> 00:36:22,012 Would the medics take him while he's intubated? 1001 00:36:22,013 --> 00:36:24,389 If I go along for the ride, I could still get a nap in 1002 00:36:24,390 --> 00:36:26,017 before my night shift. 1003 00:36:30,021 --> 00:36:32,898 474. 1004 00:36:32,899 --> 00:36:34,775 Our CT can't handle your weight, 1005 00:36:34,776 --> 00:36:38,153 but we're gonna take you over to Presbyterian Hospital. 1006 00:36:38,154 --> 00:36:40,071 Road trip. 1007 00:36:40,072 --> 00:36:42,450 I'll keep you company the whole time. 1008 00:36:44,994 --> 00:36:46,995 Sorry for all this trouble. 1009 00:36:46,996 --> 00:36:48,205 It's OK. 1010 00:36:48,206 --> 00:36:49,707 This is what we do. 1011 00:36:55,213 --> 00:36:56,713 So sub Q starts deep. 1012 00:36:56,714 --> 00:36:57,839 You want to bury the knot. 1013 00:36:57,840 --> 00:36:59,382 Yeah, I've done these before. 1014 00:36:59,383 --> 00:37:01,676 Joy, how do we cut the ends? 1015 00:37:01,677 --> 00:37:03,220 Short. Slide to the knot. 1016 00:37:03,221 --> 00:37:04,221 Turn 45 degrees. 1017 00:37:04,222 --> 00:37:06,348 Excellent. 1018 00:37:06,349 --> 00:37:08,183 Um, Dr. Langdon, we have a case. 1019 00:37:08,184 --> 00:37:09,184 It'll have to wait. 1020 00:37:09,185 --> 00:37:10,310 It could be urgent. 1021 00:37:10,311 --> 00:37:14,147 Find Robby or Al-Hashimi. 1022 00:37:14,148 --> 00:37:16,483 This girl is wasted. 1023 00:37:16,484 --> 00:37:18,527 Drunk as a skunk. 1024 00:37:18,528 --> 00:37:20,278 Should we check her blood alcohol level? 1025 00:37:20,279 --> 00:37:21,905 No, it won't change what we do. 1026 00:37:21,906 --> 00:37:23,490 She can go home when she has a steady gait. 1027 00:37:23,491 --> 00:37:25,659 I already sent one off. 1028 00:37:25,660 --> 00:37:28,328 Joy, do you want to guess her blood alcohol? 1029 00:37:28,329 --> 00:37:29,830 Why would I want to do that? 1030 00:37:29,831 --> 00:37:31,958 I don't know. 'Cause it's fun. 1031 00:37:37,964 --> 00:37:39,548 When will you have a bed? 1032 00:37:39,549 --> 00:37:41,383 I'm not sure she needs a bed. 1033 00:37:41,384 --> 00:37:43,176 She's a febrile infant. 1034 00:37:43,177 --> 00:37:45,136 Who is clearly over a month old and looks amazing. 1035 00:37:45,137 --> 00:37:47,097 Every marker is normal. She has a cold virus. 1036 00:37:47,098 --> 00:37:48,849 Infants with rhinovirus can still have 1037 00:37:48,850 --> 00:37:50,267 a serious bacterial infection. 1038 00:37:50,268 --> 00:37:51,768 Not this one. 1039 00:37:51,769 --> 00:37:53,395 We send kids like this home all the time. 1040 00:37:53,396 --> 00:37:56,440 Except this one doesn't have a home or a parent. 1041 00:37:57,817 --> 00:37:59,276 All right. 1042 00:37:59,277 --> 00:38:01,027 I can't put a kid with a virus in the nursery, 1043 00:38:01,028 --> 00:38:03,280 and I can't waste a private room on a healthy baby. 1044 00:38:03,281 --> 00:38:04,698 Then what do you propose? 1045 00:38:04,699 --> 00:38:06,658 CYF can place her in emergency foster care 1046 00:38:06,659 --> 00:38:08,201 by tomorrow morning. 1047 00:38:08,202 --> 00:38:10,412 You want to leave her down here overnight? 1048 00:38:10,413 --> 00:38:12,789 Seems to be the standard of care these days. 1049 00:38:12,790 --> 00:38:14,124 Have your attending give me a call. 1050 00:38:14,125 --> 00:38:15,166 Will do. 1051 00:38:15,167 --> 00:38:16,501 I can't believe this. 1052 00:38:16,502 --> 00:38:18,295 Let CYF know it's very urgent. 1053 00:38:18,296 --> 00:38:19,796 Got it. 1054 00:38:19,797 --> 00:38:22,340 This is turning into quite the day. 1055 00:38:22,341 --> 00:38:24,259 You know, I've been thinking 1056 00:38:24,260 --> 00:38:25,802 about applying for a fellowship. 1057 00:38:25,803 --> 00:38:27,762 I thought you had a job lined up in New Jersey. 1058 00:38:27,763 --> 00:38:29,890 I did, to be close to my mom. 1059 00:38:29,891 --> 00:38:33,435 But she sold her house to travel the world 1060 00:38:33,436 --> 00:38:35,437 with her new boyfriend. 1061 00:38:35,438 --> 00:38:37,272 So what's the point of New Jersey? 1062 00:38:37,273 --> 00:38:38,690 Yeah, good question. 1063 00:38:38,691 --> 00:38:40,317 Which fellowship? 1064 00:38:40,318 --> 00:38:44,029 I've narrowed it down to ultrasound, toxicology, 1065 00:38:44,030 --> 00:38:47,282 and sports medicine. 1066 00:38:47,283 --> 00:38:48,658 Those are very disparate fields 1067 00:38:48,659 --> 00:38:50,160 leading to very different careers. 1068 00:38:50,161 --> 00:38:51,328 I know. 1069 00:38:51,329 --> 00:38:53,413 I'm a little undecided. 1070 00:38:53,414 --> 00:38:55,040 Do you have research experience? 1071 00:38:55,041 --> 00:38:57,626 I was a part of a study on racial disparities 1072 00:38:57,627 --> 00:38:59,502 in health care until the White House 1073 00:38:59,503 --> 00:39:01,046 cut the funding last year. 1074 00:39:01,047 --> 00:39:03,465 Yeah. You are not alone. 1075 00:39:03,466 --> 00:39:06,384 Have you considered a geriatrics fellowship? 1076 00:39:06,385 --> 00:39:08,303 I have not. 1077 00:39:08,304 --> 00:39:10,430 I've seen your skills with the elderly, 1078 00:39:10,431 --> 00:39:12,557 and there are a lot of openings. 1079 00:39:12,558 --> 00:39:14,392 It might be your best shot. 1080 00:39:14,393 --> 00:39:17,228 Think about it. 1081 00:39:17,229 --> 00:39:18,229 Last stitch. 1082 00:39:18,230 --> 00:39:19,314 You want me to cut? 1083 00:39:19,315 --> 00:39:20,858 I got it. 1084 00:39:22,568 --> 00:39:23,818 It looks good. 1085 00:39:23,819 --> 00:39:25,904 OK. Let's pull the traction suture. 1086 00:39:25,905 --> 00:39:27,365 With pleasure. 1087 00:39:29,325 --> 00:39:31,368 OK, Jackie. 1088 00:39:31,369 --> 00:39:32,786 - Jackie. - Stop it. 1089 00:39:32,787 --> 00:39:33,787 Stop. 1090 00:39:33,788 --> 00:39:35,080 All done. 1091 00:39:35,081 --> 00:39:36,665 All done with what? 1092 00:39:36,666 --> 00:39:38,333 Sewing up your tongue. 1093 00:39:38,334 --> 00:39:40,043 What happened to my tongue? 1094 00:39:40,044 --> 00:39:41,252 You bit it. 1095 00:39:41,253 --> 00:39:42,253 Ha. 1096 00:39:42,254 --> 00:39:43,922 No, I didn't. 1097 00:39:43,923 --> 00:39:45,757 That is called a blackout. 1098 00:39:45,758 --> 00:39:47,592 How much did you drink? 1099 00:39:47,593 --> 00:39:49,844 A couple Bloody Marys. 1100 00:39:49,845 --> 00:39:51,054 Only a couple? 1101 00:39:51,055 --> 00:39:53,223 I don't know. Maybe more. 1102 00:39:53,224 --> 00:39:55,934 It's a holiday, a pub crawl. 1103 00:39:55,935 --> 00:39:58,645 Do you usually have a couple cocktails every day? 1104 00:39:58,646 --> 00:39:59,896 Only on weekends. 1105 00:39:59,897 --> 00:40:01,231 How about during the week? 1106 00:40:01,232 --> 00:40:02,649 Nothing much. 1107 00:40:02,650 --> 00:40:07,654 Just wine with dinner or a few beers. 1108 00:40:07,655 --> 00:40:10,824 Maybe we should recommend rehab? 1109 00:40:10,825 --> 00:40:11,908 Yeah. 1110 00:40:11,909 --> 00:40:13,411 We could try. 1111 00:40:17,999 --> 00:40:20,375 Ready to roll. 1112 00:40:20,376 --> 00:40:22,002 How are you feeling? 1113 00:40:22,003 --> 00:40:23,378 My pain is a two. 1114 00:40:23,379 --> 00:40:24,963 We got meds if you need them. 1115 00:40:24,964 --> 00:40:26,506 Scan will be quicker than the ride to Presby. 1116 00:40:26,507 --> 00:40:27,882 We'll keep trying to reach your sister. 1117 00:40:27,883 --> 00:40:29,509 - You guys are the best. - See you later. 1118 00:40:29,510 --> 00:40:31,302 Can I put a new patient in T1? 1119 00:40:31,303 --> 00:40:33,680 Uh, no, I kind of want to leave one trauma room open. 1120 00:40:33,681 --> 00:40:37,308 Why don't you double up the north if you have to? 1121 00:40:37,309 --> 00:40:40,228 Mr. Digby? 1122 00:40:40,229 --> 00:40:42,105 - It's just Digby. - Right. 1123 00:40:42,106 --> 00:40:44,649 We've been looking all over. Where you been? 1124 00:40:44,650 --> 00:40:46,192 With Louie. 1125 00:40:46,193 --> 00:40:47,694 You've been in there for an hour? 1126 00:40:47,695 --> 00:40:49,738 He was my friend. 1127 00:40:49,739 --> 00:40:51,656 - I had a lot to say. - Hmm. 1128 00:40:51,657 --> 00:40:54,035 Well, let's get you back to your bed. 1129 00:40:56,120 --> 00:40:57,912 Louie got his wings. 1130 00:40:57,913 --> 00:40:59,831 - Dr. Robby. - Dr. Robby. 1131 00:40:59,832 --> 00:41:01,416 We picked up a patient together. 1132 00:41:01,417 --> 00:41:02,834 Teamwork! 1133 00:41:02,835 --> 00:41:04,377 It's a concerning bullous rash. 1134 00:41:04,378 --> 00:41:05,962 We might need a biopsy for pemphigus vulgaris. 1135 00:41:05,963 --> 00:41:07,422 It's phytophotodermatitis. 1136 00:41:07,423 --> 00:41:09,174 - What? - I asked. 1137 00:41:09,175 --> 00:41:11,301 He was making three gallons of margaritas for a party, 1138 00:41:11,302 --> 00:41:13,553 squeezing fresh limes out in the sun. 1139 00:41:13,554 --> 00:41:14,971 Let's go take a peek. 1140 00:41:14,972 --> 00:41:16,891 I don't need to see it again. 1141 00:41:19,435 --> 00:41:20,810 How's it going out there? 1142 00:41:20,811 --> 00:41:22,395 Standing room only. 1143 00:41:22,396 --> 00:41:23,813 If I call the fire department, will they clear 1144 00:41:23,814 --> 00:41:25,106 - that waiting room? - I wish. 1145 00:41:25,107 --> 00:41:26,232 What's up? 1146 00:41:26,233 --> 00:41:28,276 12 patients need med refills. 1147 00:41:28,277 --> 00:41:29,861 Shouldn't they see their doctors? 1148 00:41:29,862 --> 00:41:31,613 With the Medicaid cuts, we are their doctor. 1149 00:41:31,614 --> 00:41:33,323 No, I can't e-prescribe to their pharmacies. 1150 00:41:33,324 --> 00:41:35,033 So get out your pen. Go old school. 1151 00:41:35,034 --> 00:41:37,368 Dana, on what? 1152 00:41:37,369 --> 00:41:39,829 Nordt, you got the security pads? 1153 00:41:39,830 --> 00:41:41,122 Sure do. 1154 00:41:41,123 --> 00:41:42,916 Just need a patient sticker. 1155 00:41:42,917 --> 00:41:45,293 - Any other questions? - Yeah. 1156 00:41:45,294 --> 00:41:47,755 What would have happened if you weren't here today? 1157 00:41:48,964 --> 00:41:50,715 You'd all be curled up in the fetal position, 1158 00:41:50,716 --> 00:41:53,051 crying like babies. 1159 00:41:53,052 --> 00:41:54,677 Were you wearing flip-flops? 1160 00:41:54,678 --> 00:41:56,012 I was. 1161 00:41:56,013 --> 00:41:57,931 - What is it? - Phytophotodermatitis. 1162 00:41:57,932 --> 00:42:00,141 Otherwise known as margarita burn. 1163 00:42:00,142 --> 00:42:01,684 For some people, limes plus sunshine 1164 00:42:01,685 --> 00:42:03,019 can cause a horrible rash. 1165 00:42:03,020 --> 00:42:05,146 This is all because of limes? 1166 00:42:05,147 --> 00:42:07,982 Have you ever squeezed limes outside in the sun before? 1167 00:42:07,983 --> 00:42:09,651 I don't think so. 1168 00:42:09,652 --> 00:42:12,112 You will feel better after a day of steroid pills. 1169 00:42:12,113 --> 00:42:14,030 But once these heal, you gotta wear sunscreen. 1170 00:42:14,031 --> 00:42:16,157 Because these blisters can turn into dark scars 1171 00:42:16,158 --> 00:42:17,409 and stay a while if you don't. 1172 00:42:19,120 --> 00:42:22,372 I'll be right back with your aftercare instructions. 1173 00:42:22,373 --> 00:42:24,332 - Hey, Robby. - Yep. 1174 00:42:24,333 --> 00:42:26,501 My, uh-- my hospice patient Roxie 1175 00:42:26,502 --> 00:42:28,419 is still in a ton of pain. 1176 00:42:28,420 --> 00:42:29,712 Where are we with the morphine? 1177 00:42:29,713 --> 00:42:31,673 10 milligrams an hour. 1178 00:42:31,674 --> 00:42:34,217 OK, you can bolus another 2 and go up to 12. 1179 00:42:34,218 --> 00:42:35,593 I will let Princess know. 1180 00:42:35,594 --> 00:42:36,970 12 an hour is a lot. 1181 00:42:36,971 --> 00:42:38,429 Yeah, on top of the MS Contin, 1182 00:42:38,430 --> 00:42:41,391 she could stop breathing. 1183 00:42:41,392 --> 00:42:44,727 Are you familiar with the doctrine of double effect? 1184 00:42:44,728 --> 00:42:46,813 - Not really. - No. 1185 00:42:46,814 --> 00:42:49,315 It is an ethical principle in palliative care. 1186 00:42:49,316 --> 00:42:51,025 We treat pain. 1187 00:42:51,026 --> 00:42:52,986 And if, in doing so, there's a negative side effect, 1188 00:42:52,987 --> 00:42:54,612 we accept it. 1189 00:42:54,613 --> 00:42:57,448 Even if the negative side effect is death? 1190 00:42:57,449 --> 00:43:00,161 In some cases, that could be the best outcome. 1191 00:43:06,000 --> 00:43:07,375 Maybe the nurse has it. 1192 00:43:07,376 --> 00:43:10,086 Emma. Emma, where does-- 1193 00:43:10,087 --> 00:43:11,838 Maybe the fax ran out of paper? 1194 00:43:11,839 --> 00:43:14,549 No, there is enough paper. I don't know what's wrong. 1195 00:43:14,550 --> 00:43:16,050 - Could be in another room. - We should call IT. 1196 00:43:16,051 --> 00:43:18,052 You want me to check every room? 1197 00:43:18,053 --> 00:43:19,637 How are we gonna get through this mess? 1198 00:43:19,638 --> 00:43:22,599 I was about to ask you. 1199 00:43:22,600 --> 00:43:24,142 Ask the pharmacist. 1200 00:43:24,143 --> 00:43:25,727 She can't leave the PDS. 1201 00:43:25,728 --> 00:43:27,521 Nothing's getting done here.