1 00:00:00,000 --> 00:00:04,162 WWW.MY-SUBS.CO 1 00:00:07,725 --> 00:00:11,527 Sync and corrections by btsix www.MY-SUBS.com 2 00:00:11,528 --> 00:00:13,863 [INDISTINCT ANNOUNCEMENT OVER P.A. SYSTEM] 3 00:00:13,864 --> 00:00:15,990 - Robby. - Yep. 4 00:00:15,991 --> 00:00:18,117 Cellulitis on the dorsum of the foot, 5 00:00:18,118 --> 00:00:20,119 now spreading up the leg. 6 00:00:20,120 --> 00:00:21,328 Hello, I'm Dr. Robby. 7 00:00:21,329 --> 00:00:23,039 Mind if I take a look? 8 00:00:23,040 --> 00:00:25,124 How long do you think this is gonna take? 9 00:00:25,125 --> 00:00:26,709 I took an early lunch break. 10 00:00:26,710 --> 00:00:27,877 [GASPS] 11 00:00:27,878 --> 00:00:29,045 I don't know that you're gonna 12 00:00:29,046 --> 00:00:30,921 make it back to work today. 13 00:00:30,922 --> 00:00:32,590 Erythema and warmth halfway up her knee. 14 00:00:32,591 --> 00:00:33,716 When did you see her, Donnie? 15 00:00:33,717 --> 00:00:36,218 He didn't. I did. 16 00:00:36,219 --> 00:00:37,720 - When? - About four hours ago. 17 00:00:37,721 --> 00:00:39,096 Gave her a dose of Keflex, 18 00:00:39,097 --> 00:00:40,639 told her to come back if things got worse. 19 00:00:40,640 --> 00:00:42,600 Things have definitely gotten worse. 20 00:00:42,601 --> 00:00:43,601 Dana, what's open? 21 00:00:43,602 --> 00:00:45,061 Trauma Two. 22 00:00:45,062 --> 00:00:46,562 Jesse, can you get her started in Trauma Two 23 00:00:46,563 --> 00:00:47,855 with some vanco and blood cultures, please? 24 00:00:47,856 --> 00:00:49,315 - Got it, boss. - I'm coming with. 25 00:00:49,316 --> 00:00:51,400 Suit yourself. 26 00:00:51,401 --> 00:00:54,695 Santos, you want in on Trauma Two? 27 00:00:54,696 --> 00:00:57,656 Too much charting, too little time. 28 00:00:57,657 --> 00:01:01,410 62-year-old male presents with chief complaint 29 00:01:01,411 --> 00:01:02,578 of left lower back pain. 30 00:01:02,579 --> 00:01:04,080 - Considered the diagnosis... - Hey. 31 00:01:04,081 --> 00:01:05,247 Oh, Jesus Christ. 32 00:01:05,248 --> 00:01:06,749 I'm charting. 33 00:01:06,750 --> 00:01:08,250 Sorry. 34 00:01:08,251 --> 00:01:09,251 [SIGHS] 35 00:01:09,252 --> 00:01:10,795 Did I do something wrong? 36 00:01:10,796 --> 00:01:12,588 Besides interrupting me? Probably. 37 00:01:12,589 --> 00:01:14,173 Then I apologize. 38 00:01:14,174 --> 00:01:17,802 I know that second year of residency can be stressful, 39 00:01:17,803 --> 00:01:21,013 so if there's anything I can do to help you... 40 00:01:21,014 --> 00:01:22,264 like stop talking. 41 00:01:22,265 --> 00:01:24,600 - That's a great idea. - Yeah. 42 00:01:24,601 --> 00:01:28,771 Considered the diagnosis of aortic aneurysm or dissection. 43 00:01:28,772 --> 00:01:30,481 Got a new one for you in 13. 44 00:01:30,482 --> 00:01:33,109 I'm 20 charts behind, and the new attending 45 00:01:33,110 --> 00:01:34,276 is threatening to make me repeat 46 00:01:34,277 --> 00:01:35,444 a year if I can't catch up. 47 00:01:35,445 --> 00:01:36,654 Cry me a river. 48 00:01:36,655 --> 00:01:37,780 Old lady with bad abdominal pain. 49 00:01:37,781 --> 00:01:38,948 Somebody's gotta see her. 50 00:01:38,949 --> 00:01:40,449 Dana, please do me a solid. 51 00:01:40,450 --> 00:01:42,118 Holiday weekend. 52 00:01:42,119 --> 00:01:43,786 Westbridge is down, and our waiting room's on overdrive. 53 00:01:43,787 --> 00:01:45,121 I'm sorry, but your charting's gonna have to wait 54 00:01:45,122 --> 00:01:47,581 until after your shift. 55 00:01:47,582 --> 00:01:49,041 Ogilvie. 56 00:01:49,042 --> 00:01:52,920 Dr. Santos needs you to pick up a new patient in 13. 57 00:01:52,921 --> 00:01:56,799 Y-yes, ma'am. I'm on it. 58 00:01:56,800 --> 00:01:58,092 Chart while you supervise. 59 00:01:58,093 --> 00:01:59,885 Best I can do. 60 00:01:59,886 --> 00:02:02,972 [BOTH SPEAKING SPANISH] 61 00:02:02,973 --> 00:02:05,891 Setting up a GoFundMe, that's what her generation does. 62 00:02:05,892 --> 00:02:07,810 That's how they support each other. 63 00:02:07,811 --> 00:02:08,853 Doctor, tell him. 64 00:02:08,854 --> 00:02:10,479 Your wife's right. 65 00:02:10,480 --> 00:02:12,815 Staying here's gonna cost more than we can afford. 66 00:02:12,816 --> 00:02:14,650 Look, I'm feeling better. 67 00:02:14,651 --> 00:02:16,193 I'll just leave. 68 00:02:16,194 --> 00:02:19,155 Mr. Diaz, even if your blood sugar is back to normal, 69 00:02:19,156 --> 00:02:21,115 we have to continue with the insulin drip 70 00:02:21,116 --> 00:02:23,033 until we clear the ketones from your bloodstream. 71 00:02:23,034 --> 00:02:25,578 Otherwise, you could experience electrolyte disorders, 72 00:02:25,579 --> 00:02:26,912 heart and kidney problems... 73 00:02:26,913 --> 00:02:30,457 Mi amor, your health is what matters. 74 00:02:30,458 --> 00:02:31,917 I'll make you a deal. 75 00:02:31,918 --> 00:02:33,752 You agree to stay on the insulin drip, 76 00:02:33,753 --> 00:02:35,254 and I'll go find our case manager 77 00:02:35,255 --> 00:02:37,173 to discuss cost-cutting options for your stay. 78 00:02:37,174 --> 00:02:38,549 Deal. 79 00:02:38,550 --> 00:02:40,843 And I'm sitting here making sure he doesn't move. 80 00:02:40,844 --> 00:02:42,928 - You should go look for Ana. - Mm-hmm. 81 00:02:42,929 --> 00:02:44,013 I can find her. 82 00:02:44,014 --> 00:02:45,640 BRB. 83 00:02:47,767 --> 00:02:48,976 Hanging vanco. 84 00:02:48,977 --> 00:02:50,519 What's vanco? 85 00:02:50,520 --> 00:02:53,022 A really strong antibiotic to kill skin germs. 86 00:02:53,023 --> 00:02:55,566 - Need a hand? - No. We got this. 87 00:02:55,567 --> 00:02:57,401 I'll just observe. 88 00:02:57,402 --> 00:02:58,861 Pretend I'm not even here. 89 00:02:58,862 --> 00:03:02,323 Let's send off a CBC, blood cultures, and CMP. 90 00:03:02,324 --> 00:03:05,367 And also a lactic acid, CRP, and calcitonin. 91 00:03:05,368 --> 00:03:07,453 Wait, she's not febrile, not tachycardic. 92 00:03:07,454 --> 00:03:09,079 No evidence of SIRS. 93 00:03:09,080 --> 00:03:11,040 - Yet. - What's SIRS? 94 00:03:11,041 --> 00:03:14,793 Systemic inflammatory response syndrome. 95 00:03:14,794 --> 00:03:15,878 Sorry. 96 00:03:15,879 --> 00:03:17,546 An exaggerated defense response. 97 00:03:17,547 --> 00:03:18,881 A what? 98 00:03:18,882 --> 00:03:20,925 Sometimes the human body can have an overreaction 99 00:03:20,926 --> 00:03:22,843 to an infection, so we're gonna monitor you 100 00:03:22,844 --> 00:03:24,470 to make sure that this does not progress. 101 00:03:24,471 --> 00:03:27,223 [PHONE BUZZING] 102 00:03:27,224 --> 00:03:28,682 It's my boss. 103 00:03:28,683 --> 00:03:30,684 Sorry, I have to take this, or he's gonna fire me. 104 00:03:30,685 --> 00:03:32,770 OK. 105 00:03:32,771 --> 00:03:34,313 Hello. 106 00:03:34,314 --> 00:03:37,942 No, I'm still at the hospital. 107 00:03:37,943 --> 00:03:39,443 Being seen right now. 108 00:03:39,444 --> 00:03:40,736 Ow. 109 00:03:40,737 --> 00:03:43,906 No, they just stuck me with a needle. 110 00:03:43,907 --> 00:03:45,616 I don't know. 111 00:03:45,617 --> 00:03:48,077 You wanna talk to them? 112 00:03:48,078 --> 00:03:51,080 They're kind of busy right now. 113 00:03:51,081 --> 00:03:52,539 I know you are. 114 00:03:52,540 --> 00:03:53,999 Second IV's in. 115 00:03:54,000 --> 00:03:55,709 No, I'm not overreacting. 116 00:03:55,710 --> 00:03:58,045 My body's overreacting. 117 00:03:58,046 --> 00:04:00,047 Please... please don't fire me. 118 00:04:00,048 --> 00:04:01,340 I... 119 00:04:01,341 --> 00:04:02,800 This is Dr. Michael Robinavitch. 120 00:04:02,801 --> 00:04:04,843 I am the chief of emergency medicine at PTMC. 121 00:04:04,844 --> 00:04:06,804 If you fire her, she will sue you, 122 00:04:06,805 --> 00:04:09,807 and I will testify on her behalf. 123 00:04:09,808 --> 00:04:12,101 OK. 124 00:04:12,102 --> 00:04:14,020 Don't worry about it. We got you. 125 00:04:18,858 --> 00:04:20,818 Do you know how long Jackson's gonna be asleep? 126 00:04:20,819 --> 00:04:24,071 So there's no exact timeline with the sedatives we gave him, 127 00:04:24,072 --> 00:04:25,781 but he should be awake soon. 128 00:04:25,782 --> 00:04:27,449 Have you spoken to your parents yet? 129 00:04:27,450 --> 00:04:29,076 Yeah, they're on their way back from Columbus. 130 00:04:29,077 --> 00:04:31,537 Maybe you should take some time for yourself 131 00:04:31,538 --> 00:04:32,955 before they arrive. 132 00:04:32,956 --> 00:04:34,623 Yeah, cafeteria's right down the hall. 133 00:04:34,624 --> 00:04:35,666 Decent grilled cheese. 134 00:04:35,667 --> 00:04:36,792 Stay away from the tuna. 135 00:04:36,793 --> 00:04:38,836 Thanks, but I'm not hungry. 136 00:04:38,837 --> 00:04:41,547 You know, I just can't believe that a campus security guard 137 00:04:41,548 --> 00:04:43,007 tased my brother. 138 00:04:43,008 --> 00:04:44,508 Aren't they supposed to be helping students 139 00:04:44,509 --> 00:04:46,635 and protect them, not shoot at them? 140 00:04:46,636 --> 00:04:48,304 You have every right to be upset, 141 00:04:48,305 --> 00:04:50,973 and you should absolutely pursue accountability. 142 00:04:50,974 --> 00:04:53,267 But right now, we are taking care of your brother. 143 00:04:53,268 --> 00:04:56,103 And you should really take care of yourself. 144 00:04:56,104 --> 00:04:57,688 I... I have your number. 145 00:04:57,689 --> 00:05:00,065 I'll text you as soon as Jackson's LP results get back 146 00:05:00,066 --> 00:05:02,276 or if he wakes up. 147 00:05:02,277 --> 00:05:03,986 OK. 148 00:05:03,987 --> 00:05:05,321 OK, thank you. 149 00:05:05,322 --> 00:05:06,488 Of course. 150 00:05:06,489 --> 00:05:09,658 - Oh. - OK. 151 00:05:09,659 --> 00:05:11,327 Hypoactive bowel sounds. 152 00:05:11,328 --> 00:05:14,163 Soft, with moderate tenderness in the left lower quadrant. 153 00:05:14,164 --> 00:05:17,416 Mrs. Randolph, do you take Percocet every day? 154 00:05:17,417 --> 00:05:19,335 - No. - Huh. 155 00:05:19,336 --> 00:05:20,836 And what about your water intake, 'cause... 156 00:05:20,837 --> 00:05:22,338 Pause. 157 00:05:22,339 --> 00:05:24,506 Mrs. Randolph, you said you don't take Percocet every day, 158 00:05:24,507 --> 00:05:26,508 but when was the last time you took some? 159 00:05:26,509 --> 00:05:29,803 Maybe three or four times last week. 160 00:05:29,804 --> 00:05:33,432 Assisted living had a ballroom dance competition, 161 00:05:33,433 --> 00:05:35,642 - and I tweaked my back. - Mm. 162 00:05:35,643 --> 00:05:39,730 Any further questions, Ogilvie? 163 00:05:39,731 --> 00:05:43,442 When was your last bowel movement? 164 00:05:43,443 --> 00:05:45,944 I don't know. Sometime last week. 165 00:05:45,945 --> 00:05:48,947 I've been stopped up for at least five or six days. 166 00:05:48,948 --> 00:05:52,409 Mm-hmm, painkillers can cause constipation. 167 00:05:52,410 --> 00:05:53,702 I know. 168 00:05:53,703 --> 00:05:56,246 That's why they put me on a stool softener, 169 00:05:56,247 --> 00:05:57,581 and then they tried an enema. 170 00:05:57,582 --> 00:05:59,625 - And... and no movements? - Yep. 171 00:05:59,626 --> 00:06:02,920 And then they gave me this horrible drink. 172 00:06:02,921 --> 00:06:04,546 Mag citrate. 173 00:06:04,547 --> 00:06:05,589 Yeah. 174 00:06:05,590 --> 00:06:07,925 Mag citrate. 175 00:06:07,926 --> 00:06:09,218 Made me puke. 176 00:06:09,219 --> 00:06:11,428 All right, what's next, Ogilvie? 177 00:06:11,429 --> 00:06:13,472 Let's get you an X-ray and see how we can help you, 178 00:06:13,473 --> 00:06:14,473 Mrs. Randolph. 179 00:06:14,474 --> 00:06:16,392 - Thank you. - Yeah. 180 00:06:16,393 --> 00:06:18,560 Differential? 181 00:06:18,561 --> 00:06:20,229 Probable stool impaction. 182 00:06:20,230 --> 00:06:21,772 But with her history of cholecystectomy, 183 00:06:21,773 --> 00:06:23,565 it could be small bowel obstruction. 184 00:06:23,566 --> 00:06:24,650 Or worse. 185 00:06:24,651 --> 00:06:26,902 Sigmoid volvulus? 186 00:06:26,903 --> 00:06:29,279 But that's a surgical emergency. 187 00:06:29,280 --> 00:06:30,823 Wouldn't she have tons of pain? 188 00:06:30,824 --> 00:06:34,327 Not always, especially when you're in your 80s. 189 00:06:39,916 --> 00:06:41,583 I am getting concerned. 190 00:06:41,584 --> 00:06:44,128 This is a millimeter past the line. 191 00:06:44,129 --> 00:06:45,504 Or my line was sloppy. 192 00:06:45,505 --> 00:06:47,089 - Any increase in pain? - Oh. 193 00:06:47,090 --> 00:06:49,633 OK, sorry. Let's try four morphine. 194 00:06:49,634 --> 00:06:50,968 White count's only 10,000. 195 00:06:50,969 --> 00:06:53,011 It'd be over 12,000 for SIRS. 196 00:06:53,012 --> 00:06:54,805 There are other criteria. 197 00:06:54,806 --> 00:06:56,265 Still afebrile. 198 00:06:56,266 --> 00:06:57,850 Did you ask about past history of MRSA? 199 00:06:57,851 --> 00:06:59,643 Not specifically, but she's never been hospitalized. 200 00:06:59,644 --> 00:07:01,145 Any evidence of an immunocompromised state? 201 00:07:01,146 --> 00:07:02,396 - No, she's healthy. - Steroid use? 202 00:07:02,397 --> 00:07:03,397 Never. 203 00:07:03,398 --> 00:07:04,940 Maximum heart rate's only 89. 204 00:07:04,941 --> 00:07:06,108 Is that OK? 205 00:07:06,109 --> 00:07:08,193 That's good, very good. 206 00:07:08,194 --> 00:07:09,194 Stay with her. 207 00:07:09,195 --> 00:07:10,779 Monitor her closely. 208 00:07:10,780 --> 00:07:12,614 If there's any change in her condition, come find me. 209 00:07:12,615 --> 00:07:13,783 I mean any change. 210 00:07:16,870 --> 00:07:19,538 Roxie Hamler, 42, home hospice patient 211 00:07:19,539 --> 00:07:21,123 with a history of lung cancer. 212 00:07:21,124 --> 00:07:24,334 New-onset tonic-clonic seizure with right lower leg pain. 213 00:07:24,335 --> 00:07:26,462 She hit it on the coffee table. 214 00:07:26,463 --> 00:07:28,130 [MOANING SOFTLY] 215 00:07:28,131 --> 00:07:29,923 Initially nonverbal, now coming around. 216 00:07:29,924 --> 00:07:31,425 That's normal after a seizure. 217 00:07:31,426 --> 00:07:33,010 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 218 00:07:33,011 --> 00:07:34,803 - Nope, we got it. - She hit her head? 219 00:07:34,804 --> 00:07:35,971 No. I was there. 220 00:07:35,972 --> 00:07:37,598 - I caught her. - No IV? 221 00:07:37,599 --> 00:07:38,891 Couldn't get one in. 222 00:07:38,892 --> 00:07:40,392 Gave her four of IM versed for the seizure, 223 00:07:40,393 --> 00:07:41,935 - 25 of fent for the pain. - OK. 224 00:07:41,936 --> 00:07:43,812 - Dana, where to? - Trauma One. 225 00:07:43,813 --> 00:07:45,063 This way. 226 00:07:45,064 --> 00:07:47,399 Haven't seen you guys in a hot minute. 227 00:07:47,400 --> 00:07:49,985 Pickup from SCI Jones Forge. 228 00:07:49,986 --> 00:07:51,487 Was supposed to go to Westbridge but got 229 00:07:51,488 --> 00:07:52,488 diverted to you. 230 00:07:52,489 --> 00:07:53,906 Yeah, you and everybody else. 231 00:07:53,907 --> 00:07:55,491 Princess, I need you pivot to Central 9. 232 00:07:55,492 --> 00:07:56,825 Got it. 233 00:07:56,826 --> 00:07:58,494 Gus Varney, 54, victim of assault 234 00:07:58,495 --> 00:07:59,870 with diffuse blunt trauma. 235 00:07:59,871 --> 00:08:01,872 He's got bruising to the face, the right chest, 236 00:08:01,873 --> 00:08:03,540 10-centimeter laceration to the left arm. 237 00:08:03,541 --> 00:08:05,125 BP's 136 over 84, pulse 102, 238 00:08:05,126 --> 00:08:07,878 good sats, 95 on room air. 239 00:08:07,879 --> 00:08:09,588 How you feeling there, Mr. Varney? 240 00:08:09,589 --> 00:08:11,089 - Fucking hurts. - Where? 241 00:08:11,090 --> 00:08:13,425 - Everywhere. - I am Dr. Robby. 242 00:08:13,426 --> 00:08:14,718 This is Dr. Al-Hashimi. 243 00:08:14,719 --> 00:08:16,178 We'll get you something for the pain. 244 00:08:16,179 --> 00:08:17,721 I've got a progressing cellulitis in Trauma Two. 245 00:08:17,722 --> 00:08:19,348 - Go. I'm good. - Thank you. 246 00:08:19,349 --> 00:08:21,391 Gus, do you know who hurt you? 247 00:08:21,392 --> 00:08:24,061 One of the fine, upstanding citizens of cell block 6. 248 00:08:24,062 --> 00:08:27,022 It's a deep lac through the muscle fascia. 249 00:08:27,023 --> 00:08:28,524 Can we get the cuffs off once he settles? 250 00:08:28,525 --> 00:08:29,691 Not a chance. 251 00:08:29,692 --> 00:08:31,652 Orange jumpsuit. He's cuffed for a reason. 252 00:08:31,653 --> 00:08:33,738 Let's go. 253 00:08:44,082 --> 00:08:47,626 OK, everyone, on my count. 254 00:08:47,627 --> 00:08:49,253 1, 2... 255 00:08:49,254 --> 00:08:50,755 Hold on. 256 00:08:54,342 --> 00:08:57,928 - Go. - 1, 2, 3. 257 00:08:57,929 --> 00:08:59,429 - [GROANS] - Mel, E-FAST. 258 00:08:59,430 --> 00:09:01,014 Whitaker, primary assessment. 259 00:09:01,015 --> 00:09:02,267 On it. 260 00:09:07,397 --> 00:09:08,564 Oh, weird bruise. 261 00:09:08,565 --> 00:09:09,898 Did he fall on something? 262 00:09:09,899 --> 00:09:11,400 Footprint, got stomped. 263 00:09:11,401 --> 00:09:13,319 Jesus. 264 00:09:14,571 --> 00:09:16,280 Is it... is that necessary? 265 00:09:16,281 --> 00:09:18,448 Afraid so. 266 00:09:18,449 --> 00:09:21,076 Airway's patent. 267 00:09:21,077 --> 00:09:23,829 Good lung sliding on the left. 268 00:09:23,830 --> 00:09:25,080 - [YELLS] - Sorry. 269 00:09:25,081 --> 00:09:26,331 Good on the right, too. 270 00:09:26,332 --> 00:09:27,749 How are the lungs? 271 00:09:27,750 --> 00:09:28,834 Good breath sounds. 272 00:09:28,835 --> 00:09:31,587 - No crepitus. - No effusion. 273 00:09:31,588 --> 00:09:34,881 Pulse ox 97, BP 118 over 78, heart rate 112. 274 00:09:34,882 --> 00:09:36,258 Tachycardic from the pain. 275 00:09:36,259 --> 00:09:37,801 Start with four of morphine. Repeat prn. 276 00:09:37,802 --> 00:09:38,802 On it. 277 00:09:38,803 --> 00:09:40,929 OK. Swollen mandible. 278 00:09:40,930 --> 00:09:42,347 Open your mouth for me, Gus. 279 00:09:42,348 --> 00:09:44,182 Little wider. 280 00:09:44,183 --> 00:09:45,434 Can't. 281 00:09:45,435 --> 00:09:46,810 Whitaker, you know the tongue blade exam? 282 00:09:46,811 --> 00:09:48,270 Yeah. 283 00:09:48,271 --> 00:09:49,730 It's a great test for mandible fracture. 284 00:09:49,731 --> 00:09:52,941 Gus, bite down hard on this for me. 285 00:09:52,942 --> 00:09:55,152 [YELLING] 286 00:09:55,153 --> 00:09:56,528 Sorry, Gus. 287 00:09:56,529 --> 00:09:58,655 - Positive test. - [GROANS] 288 00:09:58,656 --> 00:10:00,198 No free fluid in the belly. 289 00:10:00,199 --> 00:10:01,199 Any idea how long this will take? 290 00:10:01,200 --> 00:10:02,576 Too soon to tell. 291 00:10:02,577 --> 00:10:03,660 Whitaker, your assessment? 292 00:10:03,661 --> 00:10:05,120 Fractured left mandible, 293 00:10:05,121 --> 00:10:07,289 multiple rib fractures. 294 00:10:07,290 --> 00:10:08,790 Complex forearm lac. 295 00:10:08,791 --> 00:10:10,792 OK, log roll to the left, then pan scan. 296 00:10:10,793 --> 00:10:12,711 Where were you when Mr. Varney got assaulted? 297 00:10:12,712 --> 00:10:14,296 I just move 'em. I don't get to know 'em. 298 00:10:14,297 --> 00:10:16,048 CT's ready for us. 299 00:10:16,049 --> 00:10:17,883 Cycling the BP. 300 00:10:17,884 --> 00:10:20,552 OK, this redness is now a centimeter over that line, 301 00:10:20,553 --> 00:10:22,054 and this might be a bulla forming. 302 00:10:22,055 --> 00:10:23,347 The vanco takes a little time to work. 303 00:10:23,348 --> 00:10:26,892 Vital signs are still stable, 122 over 78. 304 00:10:26,893 --> 00:10:27,976 I got it. 305 00:10:27,977 --> 00:10:30,979 How are you feeling, Debbie? 306 00:10:30,980 --> 00:10:32,648 I'm feeling a little warm. 307 00:10:32,649 --> 00:10:34,066 That can happen with vanco. 308 00:10:34,067 --> 00:10:36,026 Thanks, man. 309 00:10:36,027 --> 00:10:39,071 Lactic acid 4.2. 310 00:10:39,072 --> 00:10:40,864 - OK. - What's wrong? 311 00:10:40,865 --> 00:10:43,575 That can be a sign of a more serious infection, 312 00:10:43,576 --> 00:10:45,202 but the good news is, we know what to do. 313 00:10:45,203 --> 00:10:48,914 Jesse, 2 liters of LR wide open. 314 00:10:48,915 --> 00:10:50,374 This is severe sepsis. 315 00:10:50,375 --> 00:10:52,000 I know, but at 7:00 AM, it was a simple cellulitis. 316 00:10:52,001 --> 00:10:53,627 Anyone would have given her Keflex. 317 00:10:53,628 --> 00:10:55,629 We could add carbapenem or Zosyn to broaden 318 00:10:55,630 --> 00:10:56,672 our antibiotic coverage. 319 00:10:56,673 --> 00:10:57,839 OK, I got it. 320 00:10:57,840 --> 00:10:59,257 Thanks. 321 00:10:59,258 --> 00:11:02,260 Jesse, 1 gram meropenem, 900 milligrams clinda, 322 00:11:02,261 --> 00:11:04,304 and page Dr. Garcia, please. 323 00:11:04,305 --> 00:11:05,722 What's going on? 324 00:11:05,723 --> 00:11:07,182 We're adding new antibiotics. 325 00:11:07,183 --> 00:11:08,600 It's serious? 326 00:11:08,601 --> 00:11:09,851 We wanna get ahead of it and make sure 327 00:11:09,852 --> 00:11:11,646 it doesn't become serious. 328 00:11:13,272 --> 00:11:14,356 What else can I do? 329 00:11:14,357 --> 00:11:15,524 I think you've done enough. 330 00:11:15,525 --> 00:11:16,693 You can go. 331 00:11:20,405 --> 00:11:21,405 All good in there? 332 00:11:21,406 --> 00:11:22,531 Code sepsis. 333 00:11:22,532 --> 00:11:23,865 Stable for the moment. 334 00:11:23,866 --> 00:11:25,200 How about you? 335 00:11:25,201 --> 00:11:27,536 Perfect vitals, E-FAST negative, off to CT. 336 00:11:27,537 --> 00:11:28,745 Good. 337 00:11:28,746 --> 00:11:30,372 Keep me posted. 338 00:11:30,373 --> 00:11:31,666 Ditto. 339 00:11:35,253 --> 00:11:36,712 How's it going? 340 00:11:36,713 --> 00:11:38,672 Great, if you ignore the hot mess in chairs. 341 00:11:38,673 --> 00:11:40,590 Any update on our little baby Jane Doe? 342 00:11:40,591 --> 00:11:42,592 Security's reviewing the CCTV from last night 343 00:11:42,593 --> 00:11:43,845 and this morning. 344 00:11:46,180 --> 00:11:47,639 You two kiss and make up yet? 345 00:11:47,640 --> 00:11:49,224 I think someone needs to smoke a cigarette. 346 00:11:49,225 --> 00:11:50,642 I'm trying to quit. 347 00:11:50,643 --> 00:11:52,185 Why don't you quit when I'm on my trip? 348 00:11:52,186 --> 00:11:53,437 Everyone's glad to have you back. 349 00:11:53,438 --> 00:11:55,940 - Asshole. - Well, not everyone. 350 00:11:57,400 --> 00:11:59,860 Hey, you want in on this betting board? 351 00:11:59,861 --> 00:12:02,821 Look, all you gotta do is pick why Westbridge went down, 352 00:12:02,822 --> 00:12:04,448 how many of their patients we're gonna get, 353 00:12:04,449 --> 00:12:06,074 and when they'll be back in action. 354 00:12:06,075 --> 00:12:08,827 Hey, already up to $500. 355 00:12:08,828 --> 00:12:11,163 Oh, ah, gotta pass. 356 00:12:11,164 --> 00:12:13,331 Still catching up on rehab bills. 357 00:12:13,332 --> 00:12:15,835 Respect. 358 00:12:17,420 --> 00:12:18,587 All right. 359 00:12:18,588 --> 00:12:20,255 What's the rules on me changing my bet? 360 00:12:20,256 --> 00:12:22,466 Only if you double down. 361 00:12:22,467 --> 00:12:24,509 [CHUCKLES] 362 00:12:24,510 --> 00:12:25,928 Sinkhole. 363 00:12:28,598 --> 00:12:32,100 You watch too many movies, man. 364 00:12:32,101 --> 00:12:35,145 Considered the diagnosis of aortic aneurysm 365 00:12:35,146 --> 00:12:37,439 or dissection, but the point-of-care ultrasound was... 366 00:12:37,440 --> 00:12:39,983 You done want that gridlocked granny? 367 00:12:39,984 --> 00:12:41,902 Ordered an acute abdominal series 368 00:12:41,903 --> 00:12:43,153 to rule out obstruction. 369 00:12:43,154 --> 00:12:44,404 - Still waiting on the X-rays. - Great. 370 00:12:44,405 --> 00:12:45,530 Then you're free to treat our latest 371 00:12:45,531 --> 00:12:46,740 and greatest in South 16. 372 00:12:46,741 --> 00:12:49,534 Oh, come on, D, it's like, every time 373 00:12:49,535 --> 00:12:51,119 I get a moment to chart, I barely get 374 00:12:51,120 --> 00:12:53,830 - a sentence out before I get... - Interrupted? 375 00:12:53,831 --> 00:12:55,874 Sucks to be you, but trust me, it sucks worse 376 00:12:55,875 --> 00:12:57,793 for the poor gal in 16. 377 00:12:57,794 --> 00:13:00,545 I'm beginning to think you enjoy torturing me. 378 00:13:00,546 --> 00:13:02,672 Perks of the job. 379 00:13:02,673 --> 00:13:04,008 Ogilvie, let's go. 380 00:13:07,595 --> 00:13:10,348 Hold out your hand, Louie. 381 00:13:11,307 --> 00:13:12,974 A little shaky. 382 00:13:12,975 --> 00:13:13,975 No surprise. 383 00:13:13,976 --> 00:13:16,144 I've been here since 4:00 AM. 384 00:13:16,145 --> 00:13:17,521 We can get you something for that. 385 00:13:17,522 --> 00:13:18,855 Or I can take care of it myself 386 00:13:18,856 --> 00:13:20,982 if you cut me loose right now. 387 00:13:20,983 --> 00:13:23,151 Let's get Louie 50 milligrams of Librium. 388 00:13:23,152 --> 00:13:24,737 I'll put in the order. 389 00:13:26,823 --> 00:13:29,617 I will get it from the PDS. 390 00:13:33,162 --> 00:13:35,705 I'm already assigned as Louie's treating physician. 391 00:13:35,706 --> 00:13:38,166 Just makes sense that I put it in. 392 00:13:38,167 --> 00:13:40,253 Yeah. Yeah, yeah. Of course. 393 00:13:45,341 --> 00:13:47,843 Any changes with our septic waitress? 394 00:13:47,844 --> 00:13:48,969 Not yet. 395 00:13:48,970 --> 00:13:50,053 Wait, if you have a second, I... 396 00:13:50,054 --> 00:13:51,221 I don't. 397 00:13:51,222 --> 00:13:52,639 But the point-of-care ultrasound 398 00:13:52,640 --> 00:13:54,057 was negative for both. 399 00:13:54,058 --> 00:13:56,476 I considered the diagnosis of cauda equina syndrome. 400 00:13:56,477 --> 00:13:59,604 You writing the great American novel? 401 00:13:59,605 --> 00:14:01,565 Charting and supervising. 402 00:14:01,566 --> 00:14:02,607 It's Dana's idea. 403 00:14:02,608 --> 00:14:04,150 Who's the lucky patient? 404 00:14:04,151 --> 00:14:06,027 Unhoused woman with a bad cough. 405 00:14:06,028 --> 00:14:07,821 Ogilvie's all over it. 406 00:14:07,822 --> 00:14:09,197 OK. 407 00:14:09,198 --> 00:14:10,740 Say "eee." 408 00:14:10,741 --> 00:14:12,492 Eee. 409 00:14:12,493 --> 00:14:14,244 OK, deep breath in. 410 00:14:14,245 --> 00:14:16,204 Blow it out real hard. 411 00:14:16,205 --> 00:14:17,914 You haven't heard enough already? 412 00:14:17,915 --> 00:14:21,960 I need to check for wheezing with forced exhalation. 413 00:14:21,961 --> 00:14:25,130 [BREATHES DEEPLY, COUGHS] 414 00:14:25,131 --> 00:14:27,090 Fucking cough is killing me. 415 00:14:27,091 --> 00:14:28,717 You smoke, Mrs. Yardley? 416 00:14:28,718 --> 00:14:30,886 Yeah, but I haven't been able to 417 00:14:30,887 --> 00:14:32,304 for a couple days 'cause of this cough. 418 00:14:32,305 --> 00:14:34,556 Mm. You ever consider quitting? 419 00:14:34,557 --> 00:14:38,019 You ever considered minding your own business? 420 00:14:41,898 --> 00:14:44,149 Well, the good news is that your test from earlier 421 00:14:44,150 --> 00:14:46,359 came back negative for both COVID and influenza, 422 00:14:46,360 --> 00:14:48,028 but I'm gonna order a chest X-ray 423 00:14:48,029 --> 00:14:49,571 so that we can see what's really going on in those lungs. 424 00:14:49,572 --> 00:14:51,532 You got time to let us do that? 425 00:14:52,783 --> 00:14:55,744 Where the fuck else you think I gotta be? 426 00:14:55,745 --> 00:14:57,537 And we're in. 427 00:14:57,538 --> 00:14:59,205 3 grams Keppra over 10 minutes. 428 00:14:59,206 --> 00:15:00,916 That'll prevent another seizure. 429 00:15:00,917 --> 00:15:02,000 Thank you. 430 00:15:02,001 --> 00:15:03,919 Nobody can ever get an IV in her. 431 00:15:03,920 --> 00:15:05,879 Yeah, midline cath is the way to go 432 00:15:05,880 --> 00:15:07,505 when your veins are shot. 433 00:15:07,506 --> 00:15:12,093 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 434 00:15:12,094 --> 00:15:14,804 - OK. - Cold. 435 00:15:14,805 --> 00:15:18,266 Is it possible to get her a blanket and some socks? 436 00:15:18,267 --> 00:15:20,018 Can do. 437 00:15:20,019 --> 00:15:22,604 When was she diagnosed? 438 00:15:22,605 --> 00:15:24,522 Seven years ago. 439 00:15:24,523 --> 00:15:27,108 Resected a lobe. 440 00:15:27,109 --> 00:15:29,653 Four cycles of platinum chemo gave us a couple good years, 441 00:15:29,654 --> 00:15:32,113 but then it spread to the bones. 442 00:15:32,114 --> 00:15:34,324 Has she had radiation therapy? 443 00:15:34,325 --> 00:15:36,785 Shrunk down the mets, but they're still there. 444 00:15:36,786 --> 00:15:38,787 That's why you're at hospice at home. 445 00:15:38,788 --> 00:15:39,788 Yep. 446 00:15:39,789 --> 00:15:41,790 I'm sorry. 447 00:15:41,791 --> 00:15:43,124 Me too. 448 00:15:43,125 --> 00:15:45,669 Ah. 449 00:15:45,670 --> 00:15:46,795 Sorry. 450 00:15:46,796 --> 00:15:48,338 You have kids? 451 00:15:48,339 --> 00:15:50,799 Yeah, two boys. 452 00:15:50,800 --> 00:15:52,884 15 and 9. 453 00:15:52,885 --> 00:15:54,469 My son's 12. 454 00:15:54,470 --> 00:15:56,680 Goes fast. 455 00:15:56,681 --> 00:15:58,515 Too fast. 456 00:15:58,516 --> 00:16:03,144 Swelling and bruising over the distal tibia. 457 00:16:03,145 --> 00:16:05,772 50 of fentanyl once her systolic's over 100. 458 00:16:05,773 --> 00:16:08,359 What do you usually take for pain? 459 00:16:11,320 --> 00:16:14,531 MS Contin, 30 milligrams twice a day, 460 00:16:14,532 --> 00:16:16,950 oxycodone for breakthrough, and sublingual Actiq 461 00:16:16,951 --> 00:16:20,745 for when it gets really bad. 462 00:16:20,746 --> 00:16:21,913 That's a lot. 463 00:16:21,914 --> 00:16:23,707 You handle her pain meds? 464 00:16:23,708 --> 00:16:24,833 Sometimes. 465 00:16:24,834 --> 00:16:26,668 All the time. 466 00:16:26,669 --> 00:16:29,546 A hospice nurse comes by a few times a week, 467 00:16:29,547 --> 00:16:31,923 but I was alone when she had the seizure. 468 00:16:31,924 --> 00:16:33,883 They told us that it could happen, 469 00:16:33,884 --> 00:16:35,510 but she couldn't breathe. 470 00:16:35,511 --> 00:16:39,931 And I freaked out, and I called 911. 471 00:16:39,932 --> 00:16:42,225 I'm so sorry. 472 00:16:42,226 --> 00:16:44,185 I'm sorry. 473 00:16:44,186 --> 00:16:46,022 I'm sorry. 474 00:16:55,656 --> 00:16:58,825 Due to your family income, you make too much 475 00:16:58,826 --> 00:17:00,702 to be eligible for either PENNIE 476 00:17:00,703 --> 00:17:03,121 or the hospital's "charity care." 477 00:17:03,122 --> 00:17:05,248 But we can't afford health-care premiums. 478 00:17:05,249 --> 00:17:08,043 It's unfortunately very common for people 479 00:17:08,044 --> 00:17:09,335 to fall between the cracks. 480 00:17:09,336 --> 00:17:11,463 It's an imperfect system. 481 00:17:11,464 --> 00:17:13,631 Can PTMC help with the costs in any way? 482 00:17:13,632 --> 00:17:16,092 We can offer financial assistance. 483 00:17:16,093 --> 00:17:17,927 You'd pay the same that Medicare 484 00:17:17,928 --> 00:17:19,554 and Medicaid would pay. 485 00:17:19,555 --> 00:17:20,722 How much is that? 486 00:17:20,723 --> 00:17:24,601 You pay 60%, we cover 40%. 487 00:17:24,602 --> 00:17:25,977 Thank you. 488 00:17:25,978 --> 00:17:27,855 Uh-huh. 489 00:17:29,065 --> 00:17:31,107 Where have you been? 490 00:17:31,108 --> 00:17:33,610 - How are you doing? - I'm sorry, mijita. 491 00:17:33,611 --> 00:17:36,738 You were being thoughtful, and I just blew up. 492 00:17:36,739 --> 00:17:39,616 Well, Ms. Noelle was just telling us that the hospital 493 00:17:39,617 --> 00:17:41,326 is gonna give us a big discount. 494 00:17:41,327 --> 00:17:43,995 We can knock 40% off your final bill. 495 00:17:43,996 --> 00:17:45,955 - That's great. - Mm-hmm. 496 00:17:45,956 --> 00:17:47,832 I stay here for a few days, 497 00:17:47,833 --> 00:17:50,086 my bill could be over $100,000, right? 498 00:17:51,754 --> 00:17:53,505 Yes, unfortunately. 499 00:17:53,506 --> 00:17:55,590 It could end up being lower, 500 00:17:55,591 --> 00:17:58,009 depending on your level of needed care. 501 00:17:58,010 --> 00:18:00,011 Or higher? 502 00:18:00,012 --> 00:18:03,973 So we would still have to pay $60,000? 503 00:18:03,974 --> 00:18:05,517 Which we don't have. 504 00:18:05,518 --> 00:18:07,727 He has to stay here to get better, right? 505 00:18:07,728 --> 00:18:10,105 - Yes. - No. 506 00:18:10,106 --> 00:18:11,356 Excuse me? 507 00:18:11,357 --> 00:18:13,566 I mean, not necessarily. 508 00:18:13,567 --> 00:18:16,236 Couldn't we just admit him to med-surg instead of ICU? 509 00:18:16,237 --> 00:18:18,071 Wouldn't that be a lot cheaper? 510 00:18:18,072 --> 00:18:20,198 Med-surg won't accept him with an insulin drip. 511 00:18:20,199 --> 00:18:21,991 Usually true. 512 00:18:21,992 --> 00:18:25,662 But let me talk to the charge nurse upstairs, and I'll... 513 00:18:25,663 --> 00:18:26,830 I'll see what she says. 514 00:18:26,831 --> 00:18:28,332 Thank you. 515 00:18:30,292 --> 00:18:32,335 Food poisoning in the hall's asking to leave, 516 00:18:32,336 --> 00:18:34,379 wants to take her kids to the water park. 517 00:18:34,380 --> 00:18:36,965 Those places are cesspools. 518 00:18:36,966 --> 00:18:38,466 Preaching to the choir. 519 00:18:38,467 --> 00:18:40,051 If she's feeling fine on Zofran, she's good to go. 520 00:18:40,052 --> 00:18:41,511 All right. 521 00:18:41,512 --> 00:18:43,471 Louie's in South 15. Meds are coming down. 522 00:18:43,472 --> 00:18:45,473 Another couple hours of monitoring, and he can broom. 523 00:18:45,474 --> 00:18:46,724 Straight to the liquor store. 524 00:18:46,725 --> 00:18:47,851 Don't pass "go." 525 00:18:47,852 --> 00:18:48,852 What about that clamshell case 526 00:18:48,853 --> 00:18:50,311 that went up... anything? 527 00:18:50,312 --> 00:18:52,313 Out of surgery, in recovery, still sedated. 528 00:18:52,314 --> 00:18:54,190 Good. Keep me posted on that. 529 00:18:54,191 --> 00:18:55,568 Will do. 530 00:18:57,736 --> 00:18:59,070 Three times in one day. 531 00:18:59,071 --> 00:19:00,655 To what do we owe the pleasure? 532 00:19:00,656 --> 00:19:02,365 I came down for a consult 533 00:19:02,366 --> 00:19:04,784 and to persuade Ahmad to start a new betting board. 534 00:19:04,785 --> 00:19:06,369 Why, is the Westbridge board full already? 535 00:19:06,370 --> 00:19:08,413 Mm-hmm, was gonna ask him to start one about you 536 00:19:08,414 --> 00:19:10,707 and your midlife crisis trip. 537 00:19:10,708 --> 00:19:12,709 I give it four weeks. 538 00:19:12,710 --> 00:19:15,253 Seven, tops. 539 00:19:15,254 --> 00:19:16,504 Ye of little faith. 540 00:19:16,505 --> 00:19:19,257 Not about faith, just facts. 541 00:19:19,258 --> 00:19:20,550 Facts? 542 00:19:20,551 --> 00:19:22,468 Based on my experience, you're a seven-week-itch 543 00:19:22,469 --> 00:19:23,928 kind of guy. 544 00:19:23,929 --> 00:19:26,181 Hey, Robby, med student's got a pickleball player 545 00:19:26,182 --> 00:19:28,099 in the North Hall with possible Achilles rupture, 546 00:19:28,100 --> 00:19:29,100 asking for your opinion. 547 00:19:29,101 --> 00:19:30,685 Thank you, Perlah. 548 00:19:30,686 --> 00:19:32,854 At least somebody down here has a little faith in me. 549 00:19:32,855 --> 00:19:35,440 [CHUCKLES] 550 00:19:35,441 --> 00:19:38,193 You know what Motorcycle Mike's sabbatical is really about? 551 00:19:38,194 --> 00:19:41,029 I never try to guess what's going on in that head of his. 552 00:19:41,030 --> 00:19:44,240 Three months being on the open road by himself. 553 00:19:44,241 --> 00:19:46,409 Man can't stand to be alone for more than a few hours. 554 00:19:46,410 --> 00:19:49,454 He sleeps with the TV on in his bedroom. 555 00:19:49,455 --> 00:19:52,291 I really don't think I needed to know that. 556 00:19:53,709 --> 00:19:56,878 Look, maybe he's looking for something new 557 00:19:56,879 --> 00:19:59,797 or trying to outrun some old ghosts. 558 00:19:59,798 --> 00:20:03,092 Well, I hope he finds what he's looking for. 559 00:20:03,093 --> 00:20:05,261 Man deserves some peace. 560 00:20:05,262 --> 00:20:06,638 Amen. 561 00:20:06,639 --> 00:20:09,307 I considered the diagnosis of cauda equina syndrome, 562 00:20:09,308 --> 00:20:11,142 but the motor and sensory exam 563 00:20:11,143 --> 00:20:13,519 were both intact in the sacral nerve root... 564 00:20:13,520 --> 00:20:14,854 Our unhoused cougher has pneumonia. 565 00:20:14,855 --> 00:20:17,732 I'm cursed, fucking cursed. 566 00:20:17,733 --> 00:20:19,234 Fuck. 567 00:20:19,235 --> 00:20:20,985 What? 568 00:20:20,986 --> 00:20:23,404 That is a cavitary lesion in the right upper lobe. 569 00:20:23,405 --> 00:20:25,198 Active TB. 570 00:20:25,199 --> 00:20:27,575 What's next? 571 00:20:27,576 --> 00:20:29,118 AFB stain to confirm, 572 00:20:29,119 --> 00:20:31,663 move her to a negative airflow room, start her on meds. 573 00:20:31,664 --> 00:20:33,790 Call infection control and public health. 574 00:20:33,791 --> 00:20:36,084 And now you get to sign in as a patient 575 00:20:36,085 --> 00:20:38,586 and get your blood drawn for a QuantiFERON Gold. 576 00:20:38,587 --> 00:20:40,588 It's too soon to be positive. 577 00:20:40,589 --> 00:20:41,756 Yeah, but you were exposed. 578 00:20:41,757 --> 00:20:43,341 You need a baseline test 579 00:20:43,342 --> 00:20:46,594 and then again in eight weeks to see if you convert. 580 00:20:46,595 --> 00:20:47,929 And if I do? 581 00:20:47,930 --> 00:20:50,014 Then meds every day for three or four months 582 00:20:50,015 --> 00:20:52,934 with regular blood tests to check for toxicity. 583 00:20:52,935 --> 00:20:54,269 - Jesus. - All right. 584 00:20:54,270 --> 00:20:55,770 Let Dana know what's up. 585 00:20:55,771 --> 00:20:58,815 And for the love of God, mask up when you move her. 586 00:20:58,816 --> 00:21:02,861 [INDISTINCT ANNOUNCEMENT OVER P.A. SYSTEM] 587 00:21:07,283 --> 00:21:09,492 - Dr. Langdon. - Hey, man. Alex. 588 00:21:09,493 --> 00:21:10,661 Let's take a look. 589 00:21:13,247 --> 00:21:16,207 Ah. 590 00:21:16,208 --> 00:21:17,208 Is it bad? 591 00:21:17,209 --> 00:21:18,751 It's not good. 592 00:21:18,752 --> 00:21:21,379 Sorry, your chart says you were burned with dry ice? 593 00:21:21,380 --> 00:21:23,423 - What happened? - My jack-off brother. 594 00:21:23,424 --> 00:21:25,008 Does he not like you? 595 00:21:25,009 --> 00:21:28,636 I asked him to do it, just not like this exactly. 596 00:21:28,637 --> 00:21:30,221 What? Why? 597 00:21:30,222 --> 00:21:31,889 He was gonna brand me like I branded him. 598 00:21:31,890 --> 00:21:33,725 Branded? Like cattle? 599 00:21:33,726 --> 00:21:36,853 Instead of hot branding, you stick the iron in dry ice, 600 00:21:36,854 --> 00:21:39,814 let it get super cold, and then you put it on your skin. 601 00:21:39,815 --> 00:21:41,482 Cool, huh? 602 00:21:41,483 --> 00:21:42,692 [SPEAKING TAGALOG] 603 00:21:42,693 --> 00:21:43,985 Let's get some LET on this. 604 00:21:43,986 --> 00:21:45,696 I'll get some snips to debride. 605 00:21:48,157 --> 00:21:49,824 You good? 606 00:21:49,825 --> 00:21:52,160 Yeah. Yeah, good. 607 00:21:52,161 --> 00:21:53,578 You sure? 608 00:21:53,579 --> 00:21:56,664 Doesn't seem like Robby's all that happy I'm back. 609 00:21:56,665 --> 00:21:59,334 Well, he's not going to be here, 610 00:21:59,335 --> 00:22:01,085 and I'm happy you're back. 611 00:22:01,086 --> 00:22:03,005 Thanks. 612 00:22:07,343 --> 00:22:11,513 Head and neck CT is negative, except for mandible fracture. 613 00:22:12,431 --> 00:22:13,806 OK, let's get him off the board. 614 00:22:13,807 --> 00:22:15,099 Roll him, right side up. 615 00:22:15,100 --> 00:22:16,852 Hey, we're gonna need the cuffs off. 616 00:22:18,062 --> 00:22:19,854 [HANDCUFFS CLATTER] 617 00:22:19,855 --> 00:22:22,690 Ready. And 1, 2, 3. 618 00:22:22,691 --> 00:22:25,068 - Ah, gentle. - [GROANS] 619 00:22:25,069 --> 00:22:26,736 Dr. King, how are the chest and belly? 620 00:22:26,737 --> 00:22:29,989 We have three anterior rib fractures 621 00:22:29,990 --> 00:22:31,908 and a small pulmonary contusion. 622 00:22:31,909 --> 00:22:33,201 - Not too bad. - Mm-mm. 623 00:22:33,202 --> 00:22:34,869 When do pulmonary contusions peak? 624 00:22:34,870 --> 00:22:36,287 After a few hours. 625 00:22:36,288 --> 00:22:37,872 And do we always admit for three-rib fractures? 626 00:22:37,873 --> 00:22:39,207 In the elderly, yes, 627 00:22:39,208 --> 00:22:40,958 but not if a patient can manage the pain 628 00:22:40,959 --> 00:22:42,960 and doesn't need supplemental oxygen. 629 00:22:42,961 --> 00:22:44,212 [GROANS] 630 00:22:44,213 --> 00:22:45,713 OK, he's really hurting here. 631 00:22:45,714 --> 00:22:47,382 You think you could set us up with a serratus anterior 632 00:22:47,383 --> 00:22:48,591 - field block? - No problem. 633 00:22:48,592 --> 00:22:50,718 Oh, as long as that's OK 634 00:22:50,719 --> 00:22:51,886 with Dr. Al-Hashimi. 635 00:22:51,887 --> 00:22:54,055 If the patient consents. 636 00:22:54,056 --> 00:22:57,892 Mr. Varney, we wanna give you a shot to numb your broken ribs 637 00:22:57,893 --> 00:22:59,060 so you can breathe easier. 638 00:22:59,061 --> 00:23:00,311 Uh-huh. 639 00:23:00,312 --> 00:23:01,979 OK, get Mr. Varney prepped and draped. 640 00:23:01,980 --> 00:23:03,564 Dr. Mohan, you're in charge. 641 00:23:03,565 --> 00:23:05,400 Let's identify the landmarks. 642 00:23:05,401 --> 00:23:06,527 Cuffs. 643 00:23:07,861 --> 00:23:09,529 Yeah, you can just leave them off, man. 644 00:23:09,530 --> 00:23:12,448 He's clearly not moving on his own. 645 00:23:12,449 --> 00:23:14,033 We follow protocol, 646 00:23:14,034 --> 00:23:17,412 for his safety and yours. 647 00:23:17,413 --> 00:23:19,122 [PHONE BUZZING] 648 00:23:19,123 --> 00:23:20,790 - Do you need to get that? - [GROANING] 649 00:23:20,791 --> 00:23:23,626 Nope. It's my mom. 650 00:23:23,627 --> 00:23:25,878 Ignore it. Just ignore it. 651 00:23:25,879 --> 00:23:27,713 - Amen, sister. - Forearm is numb. 652 00:23:27,714 --> 00:23:29,006 We can irrigate. 653 00:23:29,007 --> 00:23:30,591 If I ignore a problem for long enough, 654 00:23:30,592 --> 00:23:32,218 it just goes away, right? 655 00:23:32,219 --> 00:23:34,470 I wish I could ignore my deposition. 656 00:23:34,471 --> 00:23:36,764 That, you can't ignore. 657 00:23:36,765 --> 00:23:37,974 But you'll be fine. 658 00:23:37,975 --> 00:23:39,517 What's up with you, Whitaker? 659 00:23:39,518 --> 00:23:41,018 Trouble in roomie land? 660 00:23:41,019 --> 00:23:42,603 No, not really. 661 00:23:42,604 --> 00:23:45,857 I think I overstepped with Dr. Langdon earlier. 662 00:23:45,858 --> 00:23:47,108 Oh. 663 00:23:47,109 --> 00:23:49,777 He was trying to prescribe a patient benzos, 664 00:23:49,778 --> 00:23:52,655 and I told Langdon that it'd be better if I did it. 665 00:23:52,656 --> 00:23:54,115 Oof. 666 00:23:54,116 --> 00:23:56,492 Only because I was already the assigned physician. 667 00:23:56,493 --> 00:23:58,327 But yeah, now I feel like an asshole. 668 00:23:58,328 --> 00:23:59,620 Langdon's fine. 669 00:23:59,621 --> 00:24:01,956 He went to rehab, he's working the steps, 670 00:24:01,957 --> 00:24:06,502 and hopefully it's all behind him. 671 00:24:06,503 --> 00:24:08,212 Place the needle in-plane, 672 00:24:08,213 --> 00:24:10,089 superficial to the serratus anterior, 673 00:24:10,090 --> 00:24:12,341 between it and the latissimus dorsi. 674 00:24:12,342 --> 00:24:13,676 Mm-hmm. 675 00:24:13,677 --> 00:24:15,845 You can see the fluid dissect and diffuse... 676 00:24:15,846 --> 00:24:17,180 Dr. Mohan, we need you. 677 00:24:17,181 --> 00:24:18,806 We've got two more rigs from Westbridge 678 00:24:18,807 --> 00:24:21,017 pulling up right now. 679 00:24:21,018 --> 00:24:22,518 Go. We got this. 680 00:24:22,519 --> 00:24:23,519 Thanks. 681 00:24:23,520 --> 00:24:26,022 How we doing in here? 682 00:24:26,023 --> 00:24:29,650 Spiked a temp to 102, gave Tylenol. 683 00:24:29,651 --> 00:24:31,402 Check out her leg. 684 00:24:31,403 --> 00:24:33,321 That is a definite bulla. 685 00:24:33,322 --> 00:24:34,780 Did surgery come down yet? 686 00:24:34,781 --> 00:24:36,532 - Not yet. - I need surgery? 687 00:24:36,533 --> 00:24:37,658 Page them again. 688 00:24:37,659 --> 00:24:39,410 Surgery would be a last resort. 689 00:24:39,411 --> 00:24:41,746 We would like them to come down and check out your leg 690 00:24:41,747 --> 00:24:44,332 in case we need to remove this infected skin. 691 00:24:44,333 --> 00:24:45,833 I thought it was just a little swelling 692 00:24:45,834 --> 00:24:46,876 'cause I'm on my feet all day. 693 00:24:46,877 --> 00:24:48,753 [MONITOR BEEPS] 694 00:24:48,754 --> 00:24:50,671 BP's down to 85 over 40. 695 00:24:50,672 --> 00:24:52,340 - How much LR is in? - Full bolus. 696 00:24:52,341 --> 00:24:54,008 Do another liter and then start Levophed. 697 00:24:54,009 --> 00:24:55,510 Titrate to a MAP of 65. 698 00:24:55,511 --> 00:24:56,761 [MONITOR BEEPS] 699 00:24:56,762 --> 00:24:58,346 Can someone please tell me what's going on? 700 00:24:58,347 --> 00:24:59,388 Pulse ox down to 89. 701 00:24:59,389 --> 00:25:00,890 100% non-rebreather. 702 00:25:00,891 --> 00:25:03,935 Sometimes an infection can cause your blood pressure 703 00:25:03,936 --> 00:25:06,854 to drop and lower the amount of oxygen in your blood. 704 00:25:06,855 --> 00:25:08,022 Am I gonna be OK? 705 00:25:08,023 --> 00:25:09,232 We're doing everything that we can 706 00:25:09,233 --> 00:25:10,525 to make sure that you are. 707 00:25:10,526 --> 00:25:11,777 Jesse. 708 00:25:14,154 --> 00:25:15,530 What's up? 709 00:25:15,531 --> 00:25:16,864 Be ready to intubate if you need to. 710 00:25:16,865 --> 00:25:18,366 - You want me to call Langdon? - No. 711 00:25:18,367 --> 00:25:19,951 I will be right back, and you can call surgery 712 00:25:19,952 --> 00:25:21,661 and tell them to get their heads out of their asses 713 00:25:21,662 --> 00:25:23,288 and get down here. 714 00:25:31,797 --> 00:25:33,214 Did you bring Langdon back here? 715 00:25:33,215 --> 00:25:34,966 No, Al-Hashimi did. 716 00:25:34,967 --> 00:25:36,342 You banished him to scut purgatory. 717 00:25:36,343 --> 00:25:37,510 He did everything you would've done 718 00:25:37,511 --> 00:25:39,136 with that cellulitis patient. 719 00:25:39,137 --> 00:25:40,638 If you think he missed something, tell him. 720 00:25:40,639 --> 00:25:42,223 Well, we're probably gonna need to intubate. 721 00:25:42,224 --> 00:25:43,808 We're definitely gonna need an ICU bed. 722 00:25:43,809 --> 00:25:45,059 What happened? 723 00:25:45,060 --> 00:25:47,228 She is in septic shock, on pressors. 724 00:25:47,229 --> 00:25:49,063 Open shoulder dislocation is back. 725 00:25:49,064 --> 00:25:50,898 Westbridge shut down all their ORs, so they told us 726 00:25:50,899 --> 00:25:52,733 - to bring them back here. - You joking? 727 00:25:52,734 --> 00:25:53,734 This ain't the Radisson. 728 00:25:53,735 --> 00:25:54,902 Not my problem. 729 00:25:54,903 --> 00:25:56,445 - Where should we park him? - Grab a wall. 730 00:25:56,446 --> 00:25:57,905 Call Noelle. Call ortho. 731 00:25:57,906 --> 00:25:59,156 Call the OR and tell them we got a patient back 732 00:25:59,157 --> 00:26:00,741 that needs surgery and admission. 733 00:26:00,742 --> 00:26:02,743 Hey, so sorry about this ambulance tour 734 00:26:02,744 --> 00:26:04,745 of Allegheny County, Mr. Billings, 735 00:26:04,746 --> 00:26:06,330 but we got you from here, I promise. 736 00:26:06,331 --> 00:26:07,748 Yeah, I'm starving. 737 00:26:07,749 --> 00:26:09,250 Is there any way I can get something to eat? 738 00:26:09,251 --> 00:26:11,043 Sorry, not before surgery. 739 00:26:11,044 --> 00:26:12,295 Can I have a visitor? 740 00:26:12,296 --> 00:26:13,796 Sure. 741 00:26:13,797 --> 00:26:15,590 Any word from Gloria about what's going on at Westbridge? 742 00:26:15,591 --> 00:26:17,216 Radio silence from the ivory tower. 743 00:26:17,217 --> 00:26:18,884 And the charge nurse over there isn't responding. 744 00:26:18,885 --> 00:26:20,511 Must be bad. 745 00:26:20,512 --> 00:26:21,887 I wonder if it's something that security needs to know about. 746 00:26:21,888 --> 00:26:23,389 I'll keep you posted. 747 00:26:23,390 --> 00:26:25,182 Hey, you're kind of buds with Gloria. 748 00:26:25,183 --> 00:26:26,475 Did she say anything to you about what's 749 00:26:26,476 --> 00:26:28,227 - happening at Westbridge? - No. You? 750 00:26:28,228 --> 00:26:30,771 Nope. How are your patients? 751 00:26:30,772 --> 00:26:33,190 Our prisoner, Gus, has stable injuries, 752 00:26:33,191 --> 00:26:35,401 and our law student in Central 10 is awake, 753 00:26:35,402 --> 00:26:37,612 normal LP, and awaiting a psych consult. 754 00:26:37,613 --> 00:26:38,946 Good. 755 00:26:38,947 --> 00:26:40,615 Quicker we can treat 'em, street 'em, move 'em 756 00:26:40,616 --> 00:26:42,116 up the food chain, the better. 757 00:26:42,117 --> 00:26:44,160 Question. 758 00:26:44,161 --> 00:26:48,456 Why are you treating me like one of your residents? 759 00:26:48,457 --> 00:26:49,624 I'm not. 760 00:26:49,625 --> 00:26:51,459 As the attending, I like to know the status 761 00:26:51,460 --> 00:26:53,169 of all the patients and doctors in the ED 762 00:26:53,170 --> 00:26:55,463 in case I need to jump in quickly. 763 00:26:55,464 --> 00:26:56,464 Makes sense. 764 00:26:56,465 --> 00:26:58,883 Now your turn. 765 00:26:58,884 --> 00:27:00,217 What? 766 00:27:00,218 --> 00:27:02,345 As your fellow attending in our ED, 767 00:27:02,346 --> 00:27:04,138 it only makes sense for me to know the status 768 00:27:04,139 --> 00:27:06,223 of all the patients and all the doctors 769 00:27:06,224 --> 00:27:09,810 in case I need to jump in on a moment's notice. 770 00:27:09,811 --> 00:27:11,271 Touché. 771 00:27:13,940 --> 00:27:16,567 You have a non-displaced fracture, distal tibia. 772 00:27:16,568 --> 00:27:18,736 So if you look at the bone here, it's pretty well aligned. 773 00:27:18,737 --> 00:27:20,112 Sorry. Hi. 774 00:27:20,113 --> 00:27:22,490 Hi, I was in the shower, and I came as soon 775 00:27:22,491 --> 00:27:23,616 as I got Paul's message. 776 00:27:23,617 --> 00:27:25,242 - Lena? - Hi. 777 00:27:25,243 --> 00:27:27,119 What happened? 778 00:27:27,120 --> 00:27:28,579 I had a seizure. 779 00:27:28,580 --> 00:27:30,206 You load her with Keppra? 780 00:27:30,207 --> 00:27:31,582 Yeah. 781 00:27:31,583 --> 00:27:33,584 Yeah, she's back to baseline mental status. 782 00:27:33,585 --> 00:27:35,836 I'm sorry, I'm confused. Aren't you off duty? 783 00:27:35,837 --> 00:27:39,006 - I'm Roxie's death doula. - Oh. 784 00:27:39,007 --> 00:27:40,716 Her... her what? 785 00:27:40,717 --> 00:27:42,718 I help advocate for people like Roxie 786 00:27:42,719 --> 00:27:45,721 to make their transition to death a more peaceful process. 787 00:27:45,722 --> 00:27:48,724 It's like a birth doula but for the end of life. 788 00:27:48,725 --> 00:27:52,353 She's been a real lifesaver for our family. 789 00:27:52,354 --> 00:27:55,189 My husband cracking jokes while I'm dying. 790 00:27:55,190 --> 00:27:56,941 See why I married him? 791 00:27:56,942 --> 00:27:58,776 Whatever you have to say about my condition, 792 00:27:58,777 --> 00:28:00,695 you can share with Lena too. 793 00:28:00,696 --> 00:28:02,697 We were just explaining that Roxie 794 00:28:02,698 --> 00:28:05,866 has a pathological fracture through a metastatic lesion. 795 00:28:05,867 --> 00:28:07,368 Can you fix that? 796 00:28:07,369 --> 00:28:10,204 The bones are well aligned, so she won't need surgery. 797 00:28:10,205 --> 00:28:11,706 The treatment is immobilization 798 00:28:11,707 --> 00:28:12,873 and a long leg boot. 799 00:28:12,874 --> 00:28:14,583 Oh! 800 00:28:14,584 --> 00:28:16,127 Maybe we up her pain meds. 801 00:28:16,128 --> 00:28:17,670 Yeah, sure. 802 00:28:17,671 --> 00:28:19,046 We can do that. 803 00:28:19,047 --> 00:28:21,340 The bones should heal in about six weeks. 804 00:28:21,341 --> 00:28:23,927 If I live that long. 805 00:28:25,804 --> 00:28:26,846 Still numb here? 806 00:28:26,847 --> 00:28:28,431 Yeah, bro. 807 00:28:28,432 --> 00:28:30,766 Great. 808 00:28:30,767 --> 00:28:32,643 You think it's gonna leave a scar? 809 00:28:32,644 --> 00:28:36,689 I don't think it. I know it. 810 00:28:36,690 --> 00:28:38,482 Holy shit. 811 00:28:38,483 --> 00:28:40,025 Fuck are you doing here? 812 00:28:40,026 --> 00:28:41,026 I'm sorry, who are you? 813 00:28:41,027 --> 00:28:42,153 Concerned brother. 814 00:28:42,154 --> 00:28:44,655 That looks not too bad. 815 00:28:44,656 --> 00:28:46,031 You gooning me? 816 00:28:46,032 --> 00:28:47,658 Yeah, it's nasty. 817 00:28:47,659 --> 00:28:49,076 Thanks to you. 818 00:28:49,077 --> 00:28:50,244 You did this? 819 00:28:50,245 --> 00:28:51,645 Oh, yeah. You wanna see the video? 820 00:28:53,790 --> 00:28:55,750 - Yes. - Definitely. 821 00:28:55,751 --> 00:28:57,169 Got you. 822 00:28:58,420 --> 00:29:00,921 All right. All right, get in close. 823 00:29:00,922 --> 00:29:02,590 Brothers unite! 824 00:29:02,591 --> 00:29:04,258 - Ooh! - Ooh! 825 00:29:04,259 --> 00:29:06,093 Dude, why in the world 826 00:29:06,094 --> 00:29:07,762 would you ask to have that done to you? 827 00:29:07,763 --> 00:29:11,349 He was trying to brand me with our family crest. 828 00:29:13,685 --> 00:29:15,936 Your family crest is the Penguins logo? 829 00:29:15,937 --> 00:29:17,688 We were gonna be bonded for life. 830 00:29:17,689 --> 00:29:19,523 You already are, with DNA. 831 00:29:19,524 --> 00:29:20,691 Yeah. 832 00:29:20,692 --> 00:29:22,234 I love you, man. 833 00:29:22,235 --> 00:29:24,069 - I'm real sorry. - It's OK. 834 00:29:24,070 --> 00:29:27,740 Doc said it's gonna take some time, but it'll heal OK. 835 00:29:27,741 --> 00:29:29,283 Awesome. 836 00:29:29,284 --> 00:29:31,076 So maybe we can try again in a couple of months or... 837 00:29:31,077 --> 00:29:32,537 BOTH: No. 838 00:29:33,955 --> 00:29:35,665 OK, bag her. 839 00:29:37,667 --> 00:29:39,126 Yellow on the end-tidal. 840 00:29:39,127 --> 00:29:40,878 - Sorry, got backed up. - Sounds a little wet. 841 00:29:40,879 --> 00:29:42,004 Someone asked for a surgical consult? 842 00:29:42,005 --> 00:29:43,255 That's because all the fluid. 843 00:29:43,256 --> 00:29:44,673 TKO the lines for now. 844 00:29:44,674 --> 00:29:47,009 Vent settings 50%, tidal volume 500, AC 12? 845 00:29:47,010 --> 00:29:48,385 Yep, that's perfect. 846 00:29:48,386 --> 00:29:49,720 Surgery here. Hello. 847 00:29:49,721 --> 00:29:51,305 Hey, it's about time. Where's Garcia? 848 00:29:51,306 --> 00:29:53,140 Stuck in the ER. She sent me down. What you got? 849 00:29:53,141 --> 00:29:54,642 Septic shock, respiratory failure, 850 00:29:54,643 --> 00:29:56,310 and possible necrotizing fasciitis. 851 00:29:56,311 --> 00:29:58,020 She needs to go to the OR ASAP. 852 00:29:58,021 --> 00:30:00,314 The infection was isolated to the dorsum of the foot 853 00:30:00,315 --> 00:30:01,899 five hours ago, but now we're almost to the knee 854 00:30:01,900 --> 00:30:03,567 with bullae, crepitus, and edema. 855 00:30:03,568 --> 00:30:05,236 - Yeah. - You seen nec fasc before? 856 00:30:05,237 --> 00:30:06,487 In a textbook. 857 00:30:06,488 --> 00:30:08,656 I was a med student two weeks ago. 858 00:30:08,657 --> 00:30:10,491 [CAMERA SHUTTER SNAPPING] 859 00:30:10,492 --> 00:30:13,035 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 860 00:30:13,036 --> 00:30:14,703 Go get anybody else from your service down here... 861 00:30:14,704 --> 00:30:15,996 Shamsi, Miller, Walsh... 862 00:30:15,997 --> 00:30:17,164 I don't know any of this people, but... 863 00:30:17,165 --> 00:30:18,499 Don't take this personally. 864 00:30:18,500 --> 00:30:21,544 I just need a fucking grown-up down here. 865 00:30:21,545 --> 00:30:23,504 Nice job on the sub-Qs. 866 00:30:23,505 --> 00:30:25,256 Really took the tension off the wound. 867 00:30:25,257 --> 00:30:26,340 Thanks. 868 00:30:26,341 --> 00:30:28,008 I can help with the skin layer. 869 00:30:28,009 --> 00:30:30,011 Four hands are faster than two. 870 00:30:32,430 --> 00:30:33,848 - Whoa. - Whoa. 871 00:30:33,849 --> 00:30:36,183 That just tore right through the skin. 872 00:30:36,184 --> 00:30:37,518 You may need to take bigger bites 873 00:30:37,519 --> 00:30:39,228 farther away from the wound edges. 874 00:30:39,229 --> 00:30:41,564 Yep. 875 00:30:41,565 --> 00:30:44,901 Skin seems pretty fragile. 876 00:30:48,989 --> 00:30:50,447 Oh. 877 00:30:50,448 --> 00:30:52,116 Yeah, this is not working. 878 00:30:52,117 --> 00:30:54,076 He has the skin strength of an 80-year-old. 879 00:30:54,077 --> 00:30:56,245 Put down Steri-Strips with benzoin, 880 00:30:56,246 --> 00:30:59,540 not across the wound but along each wound edge, both sides. 881 00:30:59,541 --> 00:31:01,083 It'll hold the sutures. 882 00:31:01,084 --> 00:31:04,545 - Yup. - What say you, Dr. Robby? 883 00:31:04,546 --> 00:31:06,547 Great. MacGyver move. 884 00:31:06,548 --> 00:31:09,425 Go for it. 885 00:31:09,426 --> 00:31:13,220 Does a Dr. MacGyver work here? 886 00:31:13,221 --> 00:31:15,723 I don't know. 887 00:31:15,724 --> 00:31:17,641 The patient symptoms are consistent with lumbar 888 00:31:17,642 --> 00:31:21,604 radiculopathy at L4, L5, most likely due to disc herniation. 889 00:31:21,605 --> 00:31:23,105 Coughing patient admitted to isolation 890 00:31:23,106 --> 00:31:25,065 for verified medication administration 891 00:31:25,066 --> 00:31:26,442 and started on RIPE therapy. 892 00:31:26,443 --> 00:31:27,985 Yeah, why do I even bother? 893 00:31:27,986 --> 00:31:29,028 Just fail me now. 894 00:31:29,029 --> 00:31:30,195 OK. 895 00:31:30,196 --> 00:31:31,697 Get in touch with a social worker. 896 00:31:31,698 --> 00:31:33,198 They're gonna wanna do contact tracing 897 00:31:33,199 --> 00:31:35,034 and help her figure out transitional housing 898 00:31:35,035 --> 00:31:36,410 for when she's discharged. 899 00:31:36,411 --> 00:31:37,745 Got it. 900 00:31:37,746 --> 00:31:39,705 And make sure infection control responded. 901 00:31:39,706 --> 00:31:41,165 The people in the waiting room could have been exposed. 902 00:31:41,166 --> 00:31:44,501 They need to be notified and tested. 903 00:31:44,502 --> 00:31:45,753 OK. 904 00:31:45,754 --> 00:31:48,672 - [COUGHS] - Relax. 905 00:31:48,673 --> 00:31:50,925 You can take the mask off. You don't have TB. 906 00:31:50,926 --> 00:31:54,094 At least not yet. 907 00:31:54,095 --> 00:31:56,639 Oh, great. 908 00:31:56,640 --> 00:31:59,600 This is fucked up. 909 00:31:59,601 --> 00:32:01,852 How are you so calm? 910 00:32:01,853 --> 00:32:03,520 Expected job hazard. 911 00:32:03,521 --> 00:32:04,772 You get used to it. 912 00:32:04,773 --> 00:32:06,357 Yeah, no, thanks. 913 00:32:06,358 --> 00:32:08,943 70% of doctors in training at urban hospitals 914 00:32:08,944 --> 00:32:11,278 get exposed to TB and wind up on meds. 915 00:32:11,279 --> 00:32:13,614 - Jesus. - Mm-hmm. 916 00:32:13,615 --> 00:32:15,991 They don't teach you that in med school. 917 00:32:15,992 --> 00:32:18,160 Mrs. Randolph's back. 918 00:32:18,161 --> 00:32:20,037 Pulled up her X-ray. 919 00:32:20,038 --> 00:32:21,205 OK. 920 00:32:21,206 --> 00:32:23,332 No volvulus, no air fluid levels. 921 00:32:23,333 --> 00:32:25,918 What do you think of this? 922 00:32:25,919 --> 00:32:28,003 Fecal material? 923 00:32:28,004 --> 00:32:29,713 A shit ton. 924 00:32:29,714 --> 00:32:31,340 Sorry, had to be said. 925 00:32:31,341 --> 00:32:32,925 So, what, she needs an enema? 926 00:32:32,926 --> 00:32:34,510 No. Tried and failed, remember? 927 00:32:34,511 --> 00:32:35,511 Yeah. 928 00:32:35,512 --> 00:32:37,179 Time to dig in. 929 00:32:37,180 --> 00:32:38,806 How are we gonna do that? 930 00:32:38,807 --> 00:32:42,769 Oh, there is no "we" in disimpaction. 931 00:32:47,691 --> 00:32:49,942 I haven't done one before. 932 00:32:49,943 --> 00:32:52,903 Shouldn't I observe first? 933 00:32:52,904 --> 00:32:55,490 I know just the guy to teach you. 934 00:33:04,708 --> 00:33:07,543 I spoke to the charge nurse in med-surg. 935 00:33:07,544 --> 00:33:08,836 They can take Orlando today. 936 00:33:08,837 --> 00:33:10,671 - Yes! - That's wonderful. 937 00:33:10,672 --> 00:33:12,214 They know he's on an insulin drip? 938 00:33:12,215 --> 00:33:14,758 They know, and they can change to a SQUID protocol. 939 00:33:14,759 --> 00:33:15,759 SQUID? 940 00:33:15,760 --> 00:33:17,511 Sub-Q insulin in DKA. 941 00:33:17,512 --> 00:33:19,221 So no IV drip? 942 00:33:19,222 --> 00:33:22,016 Just shots of short-acting insulin every four hours prn. 943 00:33:22,017 --> 00:33:25,436 The med-surg nurses have time to check a glucose every hour? 944 00:33:25,437 --> 00:33:26,437 They say so. 945 00:33:26,438 --> 00:33:28,480 And five days on med-surge 946 00:33:28,481 --> 00:33:32,234 is gonna cut your hospital bill down by 2/3. 947 00:33:32,235 --> 00:33:34,111 OK. 948 00:33:34,112 --> 00:33:35,988 So what's that gonna cost? 949 00:33:35,989 --> 00:33:37,406 Well, I can't give you an exact amount, 950 00:33:37,407 --> 00:33:39,491 but roughly $35,000. 951 00:33:39,492 --> 00:33:42,619 So after about 40%, I'll still have to pay, 952 00:33:42,620 --> 00:33:44,455 what, like, 20 grand? 953 00:33:44,456 --> 00:33:46,707 The hospital can work out a payment plan. 954 00:33:46,708 --> 00:33:48,417 Orlando, we'll be OK. 955 00:33:48,418 --> 00:33:49,960 We'll figure it out. 956 00:33:49,961 --> 00:33:52,421 I'll take on extra shifts at the coffee shop. 957 00:33:52,422 --> 00:33:55,424 We got you, Dad. 958 00:33:55,425 --> 00:33:58,635 Let's give you some private time with your family. 959 00:33:58,636 --> 00:34:01,138 Thanks. 960 00:34:01,139 --> 00:34:02,765 Sorry. Thank you. 961 00:34:02,766 --> 00:34:04,391 I was worried he might bail. 962 00:34:04,392 --> 00:34:05,601 My pleasure. 963 00:34:05,602 --> 00:34:07,311 The real thanks goes to the newbie here 964 00:34:07,312 --> 00:34:09,022 for thinking outside the box. 965 00:34:11,733 --> 00:34:13,650 Sorry I doubted your med-surg pitch. 966 00:34:13,651 --> 00:34:15,235 Oh, no sweat. 967 00:34:15,236 --> 00:34:17,446 How'd you think of that? 968 00:34:17,447 --> 00:34:20,115 My family had to think of a lot of creative ways 969 00:34:20,116 --> 00:34:23,160 to help my uninsured grandma. 970 00:34:23,161 --> 00:34:24,745 Leukemia. 971 00:34:24,746 --> 00:34:28,082 System doesn't work for you, you gotta work the system. 972 00:34:28,083 --> 00:34:30,292 She survive? 973 00:34:30,293 --> 00:34:32,503 For a while, till she didn't. 974 00:34:32,504 --> 00:34:34,963 She died before my freshman year in college. 975 00:34:34,964 --> 00:34:37,299 Sorry. 976 00:34:37,300 --> 00:34:39,468 Her death taught me a lot. 977 00:34:39,469 --> 00:34:42,388 Mainly that I don't wanna be around people dying. 978 00:34:44,224 --> 00:34:46,892 So they got her, and we can get out of here soon? 979 00:34:46,893 --> 00:34:48,352 Yeah. Oh, I think so. 980 00:34:48,353 --> 00:34:49,770 - I think so, yeah. - OK. 981 00:34:49,771 --> 00:34:53,023 Hi. 982 00:34:53,024 --> 00:34:55,609 Morphine PCA looks ready to go. 983 00:34:55,610 --> 00:34:57,611 This should do the trick. 984 00:34:57,612 --> 00:34:59,029 Do you notice a difference? 985 00:34:59,030 --> 00:35:00,030 Better. 986 00:35:00,031 --> 00:35:02,533 Oh, great. Great. 987 00:35:02,534 --> 00:35:04,284 How does this thing work? 988 00:35:04,285 --> 00:35:06,703 There's a baseline rate of morphine. 989 00:35:06,704 --> 00:35:08,789 And if you're having pain, you can push this button. 990 00:35:08,790 --> 00:35:09,790 You'll get some extra. 991 00:35:09,791 --> 00:35:11,125 And you can push for another dose 992 00:35:11,126 --> 00:35:12,543 every 10 minutes if needed. 993 00:35:12,544 --> 00:35:14,754 Your very own morphine butler. 994 00:35:17,298 --> 00:35:18,465 Amazing. 995 00:35:18,466 --> 00:35:20,008 She can go home with this? 996 00:35:20,009 --> 00:35:21,552 Yeah. 997 00:35:21,553 --> 00:35:23,679 Though you'll need more equipment for the house 998 00:35:23,680 --> 00:35:25,889 now that she can't bear weight on her leg. 999 00:35:25,890 --> 00:35:27,808 OK. Like what? 1000 00:35:27,809 --> 00:35:31,979 A wheelchair to go to the bathroom, a shower chair, 1001 00:35:31,980 --> 00:35:34,189 wall bars, if you don't already have them. 1002 00:35:34,190 --> 00:35:37,317 And a hospital bed could be helpful too. 1003 00:35:37,318 --> 00:35:38,652 How do we get all that? 1004 00:35:38,653 --> 00:35:40,529 You don't. I do. 1005 00:35:40,530 --> 00:35:42,406 I will get everything so that the two of you 1006 00:35:42,407 --> 00:35:44,616 can get out of here and back to the kids. 1007 00:35:44,617 --> 00:35:46,744 - At home. - Thank you. 1008 00:35:53,793 --> 00:35:55,752 Nice of you to join us, Huckleberry. 1009 00:35:55,753 --> 00:35:57,045 What do you need? 1010 00:35:57,046 --> 00:35:58,840 Some help with a disimpaction. 1011 00:36:00,675 --> 00:36:02,718 That is a med student procedure. 1012 00:36:02,719 --> 00:36:04,178 Oh, you know the old adage... 1013 00:36:04,179 --> 00:36:06,388 see one, do one, teach one. 1014 00:36:06,389 --> 00:36:08,682 Say hello to teaching young Ogilvie here. 1015 00:36:08,683 --> 00:36:11,351 [SIGHS] OK. 1016 00:36:11,352 --> 00:36:13,437 - Double glove, Ogilvie. - All right. 1017 00:36:13,438 --> 00:36:14,938 Mrs. Randolph, we're going to need 1018 00:36:14,939 --> 00:36:17,566 to manually unblock your rectum so that we can 1019 00:36:17,567 --> 00:36:19,067 get your bowels moving again. 1020 00:36:19,068 --> 00:36:20,068 I know. 1021 00:36:20,069 --> 00:36:22,863 Here we go. 1022 00:36:22,864 --> 00:36:25,949 Mrs. Randolph, I would like you to relax 1023 00:36:25,950 --> 00:36:28,869 like you're having a bowel movement. 1024 00:36:28,870 --> 00:36:31,455 Nice and deep. 1025 00:36:31,456 --> 00:36:33,749 [CLEARS THROAT] OK. 1026 00:36:33,750 --> 00:36:37,961 Curve the finger like an ice cream scoop. 1027 00:36:37,962 --> 00:36:42,591 And bring it out. 1028 00:36:42,592 --> 00:36:44,385 You're up, Ogilvie. 1029 00:36:48,640 --> 00:36:50,849 Some more pressure, Mrs. Randolph. 1030 00:36:50,850 --> 00:36:52,352 I'm ready. 1031 00:36:56,481 --> 00:36:59,066 [INHALES SHARPLY] 1032 00:36:59,067 --> 00:37:03,195 And here I thought you weren't a quick study. 1033 00:37:03,196 --> 00:37:05,113 Keep going. 1034 00:37:05,114 --> 00:37:07,324 Mrs. Randolph, in order to prevent this 1035 00:37:07,325 --> 00:37:08,742 from happening again, I think you 1036 00:37:08,743 --> 00:37:10,327 need a better stool softener. 1037 00:37:10,328 --> 00:37:11,912 You can try MiraLAX. 1038 00:37:11,913 --> 00:37:14,414 Just a tablespoon with a big glass of water every morning 1039 00:37:14,415 --> 00:37:15,415 should do the trick. 1040 00:37:15,416 --> 00:37:16,625 OK. 1041 00:37:16,626 --> 00:37:18,002 [FLATULENCE] 1042 00:37:18,836 --> 00:37:19,836 Oh. 1043 00:37:19,837 --> 00:37:21,421 Sorry. 1044 00:37:21,422 --> 00:37:22,589 Passing gas is good. 1045 00:37:22,590 --> 00:37:24,299 Means we're making progress. 1046 00:37:24,300 --> 00:37:26,009 Does that mean that I can... I can stop? 1047 00:37:26,010 --> 00:37:27,804 No. Nope. Keep going. 1048 00:37:30,098 --> 00:37:32,808 [STOMACH RUMBLING] 1049 00:37:32,809 --> 00:37:36,061 OK, Ogilvie, you... you might wanna... 1050 00:37:36,062 --> 00:37:37,814 Oh! 1051 00:37:38,773 --> 00:37:41,650 [SIGHS] 1052 00:37:41,651 --> 00:37:43,194 Much better. 1053 00:37:44,195 --> 00:37:46,196 MAP's holding on Levophed. 1054 00:37:46,197 --> 00:37:48,156 1 mike per kg per minute. 1055 00:37:48,157 --> 00:37:49,366 Do me a favor. 1056 00:37:49,367 --> 00:37:50,575 Give me some 4x4s on some Betadine. 1057 00:37:50,576 --> 00:37:51,868 Sorry, we're getting killed 1058 00:37:51,869 --> 00:37:53,287 with transfers from Westbridge. 1059 00:37:53,288 --> 00:37:55,455 Mesenteric ischemia, perforated bowel. 1060 00:37:55,456 --> 00:37:56,456 Got a hot one here. 1061 00:37:56,457 --> 00:37:57,457 Yeah. 1062 00:37:57,458 --> 00:37:58,583 Possible nec fasc. 1063 00:37:58,584 --> 00:37:59,960 Possible? 1064 00:37:59,961 --> 00:38:01,336 Need CT with contrast to confirm. 1065 00:38:01,337 --> 00:38:03,046 This is spreading like wildfire. 1066 00:38:03,047 --> 00:38:04,423 By the time you get your CT, it's gonna be up to her waist. 1067 00:38:04,424 --> 00:38:05,507 She's gonna need a hemicorporectomy. 1068 00:38:05,508 --> 00:38:06,842 She needs a CT scan. 1069 00:38:06,843 --> 00:38:09,511 How about a stainless steel scan? 1070 00:38:09,512 --> 00:38:11,722 For Christ's sake. Robinavitch! 1071 00:38:11,723 --> 00:38:15,183 Robby, what the fuck are you doing? 1072 00:38:15,184 --> 00:38:16,893 Oh, God, I think I might puke. 1073 00:38:16,894 --> 00:38:19,354 That's called dirty dishwater exudate without purulence. 1074 00:38:19,355 --> 00:38:21,565 There's a gray appearance to the fascia, and in the OR, 1075 00:38:21,566 --> 00:38:23,817 you'll see easy separation in the tissue planes. 1076 00:38:23,818 --> 00:38:25,152 When do you start your sabbatical? 1077 00:38:25,153 --> 00:38:26,862 - Tomorrow. - Not a moment too soon. 1078 00:38:26,863 --> 00:38:28,823 Thanks for coming down. 1079 00:38:31,993 --> 00:38:35,579 I'm catching up on my charting as fast as I can. 1080 00:38:35,580 --> 00:38:38,457 Why don't you give my generative AI app a try? 1081 00:38:38,458 --> 00:38:40,959 It's 30% more efficient, and providers report 1082 00:38:40,960 --> 00:38:42,836 increased job satisfaction. 1083 00:38:42,837 --> 00:38:45,839 And you'll rarely have to stay overtime to complete charts. 1084 00:38:45,840 --> 00:38:47,591 Yeah? 1085 00:38:47,592 --> 00:38:48,884 OK. 1086 00:38:48,885 --> 00:38:50,469 Yeah, I'm usually here at least a couple hours 1087 00:38:50,470 --> 00:38:52,346 after every shift trying to catch up, so... 1088 00:38:52,347 --> 00:38:54,765 Sure, AI will make doctors more efficient, 1089 00:38:54,766 --> 00:38:57,059 but hospitals will expect us to treat more patients 1090 00:38:57,060 --> 00:38:59,061 without any extra pay, of course, 1091 00:38:59,062 --> 00:39:00,854 all the while eliminating staff positions 1092 00:39:00,855 --> 00:39:02,564 for attending and residents. 1093 00:39:02,565 --> 00:39:04,149 Oh, Dr. Robby, I am not an advocate 1094 00:39:04,150 --> 00:39:06,276 for erasing my own profession. 1095 00:39:06,277 --> 00:39:09,780 But I am advocating for getting to spend more time with my son. 1096 00:39:09,781 --> 00:39:12,741 Nothing can replace family. 1097 00:39:12,742 --> 00:39:14,743 What's the status of your septic patient? 1098 00:39:14,744 --> 00:39:17,537 Nec fasc. Surgery's taking her up. 1099 00:39:17,538 --> 00:39:20,082 Think they'll be able to save her leg? 1100 00:39:20,083 --> 00:39:22,042 Right now, I'm just hoping they can save her life. 1101 00:39:22,043 --> 00:39:24,628 Hey, how's Ogilvie doing? 1102 00:39:24,629 --> 00:39:28,465 A little TB exposure, a touch of ass-plosion. 1103 00:39:28,466 --> 00:39:30,592 All in all, pretty good day so far. 1104 00:39:30,593 --> 00:39:31,885 Kaison, you came. 1105 00:39:31,886 --> 00:39:33,428 Hey, ain't no way I was gonna let you 1106 00:39:33,429 --> 00:39:35,389 miss Peter and Aubrey's epic Fourth of July party. 1107 00:39:35,390 --> 00:39:37,557 Come on, now. Hey. 1108 00:39:37,558 --> 00:39:39,226 Brought some brew. 1109 00:39:39,227 --> 00:39:40,602 Oh, you are the man. 1110 00:39:40,603 --> 00:39:42,062 Appreciate the bromance over here, 1111 00:39:42,063 --> 00:39:44,398 but no food 'cause you might go into surgery. 1112 00:39:44,399 --> 00:39:47,026 And no beer 'cause we're a goddamn hospital. 1113 00:39:50,613 --> 00:39:52,823 Starting your sabbatical early? 1114 00:39:52,824 --> 00:39:54,658 I know someone who could really use a drink right now. 1115 00:39:54,659 --> 00:39:55,951 In the hospital? 1116 00:39:55,952 --> 00:39:58,413 As a parting gift. 1117 00:40:02,417 --> 00:40:04,042 How's it looking? 1118 00:40:04,043 --> 00:40:05,293 Good. 1119 00:40:05,294 --> 00:40:07,254 The Steri-Strips did the trick. 1120 00:40:07,255 --> 00:40:08,380 CT's ready. 1121 00:40:08,381 --> 00:40:10,006 We already scanned him. 1122 00:40:10,007 --> 00:40:12,426 Head and neck want thin cuts and a 3D reconstruction 1123 00:40:12,427 --> 00:40:14,428 of the mandible before they decide 1124 00:40:14,429 --> 00:40:15,846 if Mr. Varney needs surgery. 1125 00:40:15,847 --> 00:40:17,764 Have they even come down to examine him in person? 1126 00:40:17,765 --> 00:40:19,349 No, they must be backed up. 1127 00:40:19,350 --> 00:40:23,145 Or there's a July Fourth sale at the BMW dealership. 1128 00:40:23,146 --> 00:40:24,438 Labs are back. 1129 00:40:24,439 --> 00:40:26,273 Albumin's low. Total protein's low. 1130 00:40:26,274 --> 00:40:27,858 He also has megaloblastic anemia. 1131 00:40:27,859 --> 00:40:29,109 - Malnutrition. - Probably. 1132 00:40:29,110 --> 00:40:30,277 Jail cuisine. 1133 00:40:30,278 --> 00:40:31,653 Whitaker, what labs should we add? 1134 00:40:31,654 --> 00:40:33,780 B12, folate, iron levels. 1135 00:40:33,781 --> 00:40:35,282 Good. 1136 00:40:35,283 --> 00:40:36,950 We're gonna run some more tests, Mr. Varney. 1137 00:40:36,951 --> 00:40:38,286 Hang in there. 1138 00:40:42,874 --> 00:40:45,375 I have to pee. 1139 00:40:45,376 --> 00:40:46,835 There's no PureWick here. 1140 00:40:46,836 --> 00:40:48,086 But here you go, hon. 1141 00:40:48,087 --> 00:40:50,046 - I'll help you get on. - No. No. 1142 00:40:50,047 --> 00:40:52,466 No bedpan. I can walk to the bathroom. 1143 00:40:52,467 --> 00:40:54,134 - I just need a little help. - Are you sure? 1144 00:40:54,135 --> 00:40:55,218 I'm here, babe. 1145 00:40:55,219 --> 00:40:56,720 Oh, we got this Mr. Hamler. 1146 00:40:56,721 --> 00:40:59,973 You'll have to bring your IV and portable oxygen. 1147 00:40:59,974 --> 00:41:01,975 Please? 1148 00:41:01,976 --> 00:41:04,394 I'll grab a wheelchair. 1149 00:41:04,395 --> 00:41:06,354 Let's try to sit you up and dangle your legs. 1150 00:41:06,355 --> 00:41:07,857 OK. 1151 00:41:10,526 --> 00:41:13,905 1, 2, 3. 1152 00:41:16,657 --> 00:41:19,576 [GASPS, YELPS] 1153 00:41:19,577 --> 00:41:21,328 This is not a good idea. 1154 00:41:21,329 --> 00:41:23,413 I don't think we're gonna need this. 1155 00:41:23,414 --> 00:41:25,040 Hey, Paul, Paul, 1156 00:41:25,041 --> 00:41:27,209 why don't you come grab a cup of coffee with me? 1157 00:41:27,210 --> 00:41:29,169 I'm still zonked from my all-nighter, 1158 00:41:29,170 --> 00:41:32,839 and I wanna go over some delivery instructions with you. 1159 00:41:32,840 --> 00:41:35,509 Sure. 1160 00:41:35,510 --> 00:41:37,385 Rox, you OK? 1161 00:41:37,386 --> 00:41:40,264 - Mm-hmm. - Yeah. It's OK. 1162 00:41:46,938 --> 00:41:48,940 Bedpan it is. 1163 00:41:50,441 --> 00:41:53,736 [ALARM BEEPING] 1164 00:41:56,906 --> 00:41:58,782 You lose your pulse ox again, bud? 1165 00:41:58,783 --> 00:42:01,953 [SUSTAINED BEEP] 1166 00:42:04,330 --> 00:42:05,747 Louie. 1167 00:42:05,748 --> 00:42:07,624 Louie! 1168 00:42:07,625 --> 00:42:10,210 He kept pulling off his pulse ox. 1169 00:42:10,211 --> 00:42:11,628 It's on. It's at 71. 1170 00:42:11,629 --> 00:42:13,089 Louie, wake up. 1171 00:42:14,674 --> 00:42:16,466 - I'm not getting a carotid. - I got the airway. 1172 00:42:16,467 --> 00:42:19,636 Hey, Perlah, crash cart, intubation tray, please. 1173 00:42:19,637 --> 00:42:22,806 [SUSTAINED BEEP] 1174 00:42:22,807 --> 00:42:25,809 [DRAMATIC MUSIC] 1175 00:42:28,406 --> 00:42:33,345 Sync and corrections by btsix www.MY-SUBS.com