Original subtitles

Baby, it's all right.

Maybe you stay here tonight.

Baby, it's all right.

Maybe you can stay here tonight.

Out on the street.

You're going to want.

True. Timmy told Hector that Dr. Durangian said the hospital was up for

They might turn into an ortho center with no ER.

Oh, they're always threatening to shut us down, but they never do.

Gloria is looking for you.

No guts, no Gloria.

Must be time for my weekly spanking.

That'd be nice for all I think.

You sure you're cool being here today?

Yeah, why wouldn't I be?

Well, if you need to talk.

Yeah, I won't, but thanks.

Where's Abbott?

Getting some air.

I like to say it goes away, but I had morning sickness for six months with my

second daughter.

No, no, I'm kidding.

I was so worried they'd say.

Thanks. It's worth it.

You tell anybody yet?

Oh, no.

Not until I pass 12 weeks. Not this time.

Nothing but good vibes.

But just so you know, Robbie's working today.

Today's the day Doc Adamson died. He hasn't worked here in four years.

So why is he here?

All I know is he still blames himself for Adamson's death. But if he's a

prickly today, give him a pass, okay?

Great. Thank you.

Hang in there, kid.

Good

morning,

Jack.

What are you doing here?

I'm working.

And you?

Well, I don't know.

Had a guy come in, hit by a drunk driver in a crosswalk.

39 -year -old vet.

Survived three tours without a scratch.

I spent the last two hours coding him.

That's always a rough way to end the night.

Must have had a reason at one time to keep coming back, but I can't think of

right now.

Because this is the job that keeps on giving.

Nightmares.

Ulcers.

Suicidal tendencies.

Besides, if you jump on my shift, that's just rude, man.

Hope I'm never one of your patients.

That makes two of us, my friend.

I got a pregnant teen coming back today for a mifepristone.

And a small bowel obstruction waiting on surgery for the last three hours.

Oh, and unfortunately, the Kraken is still boarding a VH. Phil?

Guy's been here for a week waiting on a psych, man.

Yep, he's only getting worse.

He's catching some Zyprex disease at the moment, but when he wakes up, God help

you all.

I wrote a note for the family of my dead vet, if anyone shows.

Oh, and you got the med students and new interns starting today, so good luck

with that. Like you like me.

Sir, come back here! No more needles!

Sir! No more needles!

Stop!

Sure you want to work today, huh?

They're going to hurt me!

I promise nobody's going to hurt you.

Sir?

You left this mess.

You had a rough night.

Good morning, sunshine.

You obviously haven't seen this board.

Oh, we've seen worse.

Nothing like a little challenge every now and then to keep everybody on their

toes. Dr. Rabinovich?

Melissa King.

I will be joining you today. I just came from two months in the VA. Hey, welcome

to the pit.

This is Dr. Jack Abbott.

Nice to meet you.

I can't take how excited I am to be here today, so... Talk to me at the end of

the day.

Ignore him. He had a rough night.

And is having an ongoing existential crisis.

Don't worry.

You'll get there soon enough.

I married my second husband, Everett, in 1964.

He unfortunately passed in 1976 from a heart attack while we were vacationing

Kissimmee, Florida. It was... Awful. Good morning.

Wait around, Dr. Moyan.

Excuse me, Estelle.

We'll be right back.

So, you know we track every resident's patient for an hour. I was just taking

her history. A brief backstory about what brought them in, not an

I was almost done. You hadn't even made it to this century.

Patients, they check in for registration here.

A nurse eyeballs them, makes sure they're not dying.

If not, they're moved to one of two triage rooms for vitals and a quick

exam where you can go to the labs and your x -rays. And then they come back to

the waiting room until the bed opens up. For how long?

Eight hours if they're lucky. A lot of times 12.

Uh, is it always this busy?

Uh, no.

It gets a lot busier.

Take this.

Hey, Mateo.

Morning, Kath.

This is Sherry.

Hi. Sherry, I'm Dr. McKay. I have some student doctors with me today. Do you

mind if they observe?

Sure. Okay.

What's going on, Sherry?

I burned my hand on a sterno. What were you doing with a sterno?

Cooking. You were cooking with a sterno?

Yeah. We were making s'mores.

Sweet. It's on the board.

We... I've been here for hours, and I have to get them to school. Do you know

how much longer this will take?

Uh, yeah.

Let's see.

You take anything for the pain?

Not yet.

A thousand of Tylenol, 400 ibuprofen, and saline dressing? Yes, please.

Okay, we'll go around.

And the fun begins.

All right, Sherry, we're going to patch you up and get you out of here as soon

as possible, okay?

I'll be back.

As you can see...

We have some new faces with us this morning. Good morning, good morning.

over. Starting with second -year resident Dr. Melissa King, fresh from

Everyone calls me Mel.

I'm so happy to be here.

Trinity Santos, intern.

Victoria Javadi, MS3.

Dennis Whitaker, MS4.

Welcome to the pit. We got two traumas from the tea. Five minutes out. Okay,

copy that.

Actually, this is the most important person that you're going to meet today.

This is Dana. She's our charge nurse.

She is the ringleader of our circus.

Do what she says when she says it.

As you can see, our house is always packed, and our department is mostly

up with boarders. Those are admitted patients waiting for a room upstairs,

sometimes for days.

Beds are a very precious commodity around here, so please be quick and

with your workups.

What else? We treat the sicker patients back here, but please keep your eye on

that waiting room. Make sure nobody's going to die out there.

Your senior residents are Dr. Collins and Dr. Langdon.

You report to them.

And they report to me.

Okay. Great. Senior residents, you got your sign -offs?

Yep. Yep. Okay.

Let's do this.

Virgil Straker.

Nine millimeter GSW to the left shoulder.

CT angiogram negative. Surgery wants to admit for overnight observation.

Good vitals. Does that repeat a crit? All right. Stable crits every two hours

times three. Discharge it on Sefton. Recheck tomorrow. He'll get way more

at home.

Good morning, Mr. Straker. You want to go home?

Hell yeah.

Okay.

Murphy Rothenstein, 48 -year -old woman with cirrhosis and upper GI, bleed

intubated and stable after one unit.

Awaiting ICU bed.

Hey, Doc.

And we all know Louis Cloverfield.

Blood alcohol of 420 at 11 p .m. I've been cutting back.

How is he still breathing?

That's a lethal dose for you and me. That's happy hour for Louis.

Sobered up, had two rounds of lorazepam.

Hold out your hands for me, Louis.

Nothing to Lirazepam. All right. Any script for Librium? It's good to see

Louie. It's always a pleasure, Doc.

Bar fight with complete evulsion of tooth number eight.

Smile, Charlie.

Oh, where's your tooth, Charlie?

If I could find out.

Cancel the discharge.

Order a chest x -ray. Got to rule out aspiration.

Incoming.

42 -year -old male, Sam Wallace, blunt head with agonal respiration. Dropped

down on the T -tracks. Couldn't tube him, LMA in place.

Suicide attempt. Rescue.

He's a good Samaritan. Took a spill, helping a woman who fell off the tracks.

She's right behind him.

Trauma one, go ahead.

Woman falls from T -platforms. Good vitals, no head injuries.

De -gloving injury, right lower leg with open fracture, dislocation of the

ankle.

Trauma two, trauma two, let's go.

How we doing? Ready?

Here we go. Ready? One, two, three.

Good breath sounds bilaterally, but we need to protect it. Apparently, he

down to save the lady. When he climbed back up, he flipped, fell back, and hit

his head.

That's more of an R2.

Mel, right?

I need you on the eighth bath.

Pupils, four millimeters, and reactive. Okay, that's encouraging.

What do you want for men? 120 ketamine, 80 of rock.

A -tip on a monitor.

Morrison's clear.

That's a lot more blood than expected.

He's probably anticoagulated for a fifth check his medical records TV's on a

dough act stand by before factor PCC There's a brain bleed.

This is a PCC. No Clotting factors two seven nine and ten. Okay, you're back

To the offense didn't touch it. Did she faint or did she trip off the platform?

The other guy jumped down pulled her off the tracks just as the train was

rolling in I slayed the engine to the foot the train ran over her foot got

caught between the platform and the incoming train

Do you speak any English?

Airway and breathing are perfect.

As is circulation.

BP 140 over 85.

Student.

What might have made her faint on the platform?

TIA, CBA.

Close she needs.

EKG and a troponin. Okay, good.

Subway trained to glove your foot with an open fracture dislocation. Ooh, and I

thought my heels were painful. You're dynamically stable.

Ma 'am, I'm Dr. Yolanda Garcia. Any pain in your chest or belly?

Can we please push the morphine? No. It could cloud her mental status. I can't

do an exam like this. Push the damn morphine.

We're doing a popliteal block.

Numbs to lower leg. No side effects. Wonderful. Where's the other guy? Next

door. He's a bit worse.

Pan scanner, let me know when she stops screaming.

The cords are very interior.

Yeah, that's because we can't flex the neck. Keep the hockey stick straight up.

I'm in.

Good. Well done. Bring me up to speed.

Intubated for agnal respirations, GCS5, probably anticoagulated. With what?

First time here. There's no medical records.

Call for FFP? No, we got four -factor PCC.

80 of mannitol to reduce brain swelling, then right up to CT.

Do me a favor. Swap it with Jesse for me, would you? Of course.

Dr. Rabinovich, can you have a moment? I'm just a little busy right now,

One sec.

Nerve block complete.

Seems like it's starting to work.

Swapping out, Jessie.

Takes ten minutes for the full effect, and the marquee lasts a good four hours.

She's next for CT.

You have any idea what language that is?

Oh, definitely not Tagalog. Maybe Hindi or Urdu?

Yeah, I'm gonna go get language services. Don't you speak, like, five

Six, but that's not one of them. Six?

And I thought Collins was smart.

Oh, way too early for you to start being an ass, London.

Open a facility in front of a patient? She doesn't speak English.

Judgmental and dismissive.

How we doing?

Vital stable.

Unlike these two.

Ooh, good for you. Princess made a joke.

And I thank you for that beautiful blessing. Namaste.

Okay, do we have a phone or anything with the relative's name on it? Uh, EMT

said the purse got obliterated when the subway ran over it.

Anyway, I can speak with her? Highly doubt it. We don't know what language

speaks. Hey, um... Any chance she jumped?

She may have been pushed.

Yeah.

Could be looking at a possible he -crown.

I take it you're free now?

We need to talk about your numbers.

Uh, people we've saved?

Metrics. Our daughter balloon times beat federal standards.

You're talking about press gaining scores?

Patient satisfaction?

If they're still alive, they should be satisfied.

Our goal is 36 % very satisfied with their care. Your department is at eight.

Do you know how likely patients are to recommend this hospital? This is an

emergency department, not a Taco Bell.

11%. Well, if you want people to be happier, don't make them wait for 12

There's a nursing shortage across the country.

Most of our patients are boarders who are waiting for a bed upstairs.

We don't have the beds.

That's bullshit. The beds are up there. You just don't want to hire the staff

you need to care for.

Oh, Doc.

Doc. It ain't working.

And whatever they're giving me, it's not working.

No response from exit to it.

Should I send in the fleet?

It's okay, sir. We're going to try an enema.

Like I said, there's a nursing shortage. Well, if you paid them a living wage,

they'd be lining up to work here. Our budget can't support that.

Here's a dirty little secret. The hospital saves money keeping patients

here in the pit. It's way cheaper than staffing upstairs.

I have asked you repeatedly to stop referring to the emergency department as

pit. It is derogatory and incompatible to the institution's image. You know

I think about with the institution's image? Me, speaking to the media about

people who code in our waiting rooms and people who get shitty care in our

hallways waiting for an ICU bed for days.

I've heard about doctors who have tried that and find themselves out of work.

Uh -huh.

I know today is difficult for you. Every day is difficult down here. Boarding is

a nationwide problem.

Your predecessor, Adamson, sure as hell knew that. Or wasn't that something he

taught you? Fuck.

Wow. Really?

Yes, really.

Other hospitals are managing this crisis much more effectively.

So you can either step up your game, or you can step aside.

Good Samaritan dude has a small left temporal intraparenchymal bleed.

No epidural, no subdural, no midline shift in the brain. Good news.

You can recover.

D .D. can take her in five. Let's have a look. All right.

If an artery is totally transected, the smooth muscle in the tunica media

contracts with hemostasis. But if it's a partial cut, get out your umbrella.

Grab a culture from the open fibula before you reduce.

You're up.

I'll stabilize the knee for the reduction. Dr.

Langdon will be distracting distally before moving medially to clear the

Good.

Ready?

Med student down.

Good catch on bar fight Billy.

It was an aspirated tooth on chest x -ray. Would have been dead in a week

lung abscess. They could let him be discharged.

We're calling the pulmonary.

Cardiac arrest.

PTA, ten minutes. Where should we put it?

Anywhere. We'll have to put somebody in the hall.

Dr. Ravi?

She, uh, took a fall.

I tripped on the gurney. I'm fine.

Why don't you go get a cool drink in the staff lounge?

I'm fine, really, I swear.

Oh, I know, but it's hospital policy. Anytime someone gets a paper cut around

here, we have to fill out a worker's comp report.

Other way.

I was fine until about two weeks ago after the Rochester Marathon. Okay. Any

falls or injuries?

Just tired, sore muscles.

Yeah, I'd be in bed for a month.

Was this your first triathlon?

God, no. No, I do one every few months.

Have you seen a doctor yet?

No.

I went for a run this morning.

Had to quit after a minute.

Pretty short of breath.

This goes under your tongue.

No current meds, no allergies.

We're going to check a few labs in the EKG. Draw a red and purple top.

Yep.

It's at 98 .2.

Take a deep breath for me, Otis.

A little pimp it now, okay?

Otis?

Otis?

Didn't take him for a lightweight, huh?

Shit. No pulse. Craft card, lane flat.

Let's check a rhythm.

Saline pads.

Quick look paddles.

VTEC. Charging at 200.

Charge. Clear.

All right, he's back to normal sinus.

Need a gurney in here.

So what's the plan?

I see you when you can get a bed and admit for supportive care.

Repeat head CT in three hours.

Or sooner, if he blows a pupil.

Want a Kepler, Lola? Order's already in.

Nice job.

Do you think he'll wake up?

Maybe.

Maybe not.

No good deed goes unpunished.

Oh, has anyone, um, notified the family?

I could try.

Otis Williams, healthy 31 -year -old, VTAC arrest two weeks after triathlon.

And it's all with one shock.

Pulse 98, BP 110 over 60.

He's a little young for the mind, huh? Exactly right with the differential, Dr.

Cullen. Uh, drug overdose, electrolytes on QT.

Oh, forgot a syndrome, WPW.

How you doing there, Otis?

Okay.

What happened?

VTEC again. 200 joules.

Charged and clear.

Back in sinus.

Otis?

Otis?

Oh, groaning's good. Five of nasal, O2, CBC, CMP, proponent, and D -dimer.

What are you doing? One gram calcium glutonate, IV push.

We don't have the last back. Click the monitor. Wine QRS and peak T waves,

hyperkalemia. How'd you get that? I sent him to exercise, caused a muscle

breakdown, rubbed him to my ulcers, knocked out his kidneys. Now he's not

clearing potassium.

I bet it's over 7 .5. Wait two minutes, honey. I don't know. If you risk it, you

only might not get him back.

Calcini, you got to tell him to wait. Oh, my ass.

Not yours.

Pan scan is negative. That means he can admit to orthopedics.

But there may have been a medical etiology if she fainted.

That's not surgical. Get an internal medicine consult.

Or admit to medicine with ortho consulting.

Either way, I'm off the case.

Okay, thanks for nothing.

And substance.

I'll grab the check.

Did we figure out what she's speaking?

Last interpreter thought she might be from Pakistan.

There are 77 languages in Pakistan.

Okay, well, I will buy lunch for whoever figures it out. Good luck. If you need

me, I'll be saving lives.

That was wicked.

That was...

Gross. Yeah, too much for little Miss Crash and Burn.

What'd you do with her?

Nothing. I think she'll be fine.

Are you kidding?

If that took her out, she'll be lucky to make it through this rotation.

I got 50 bucks so she doesn't laugh through this shift.

Come on.

Put your money where your mouth is. No, I didn't say anything, okay?

I sure as hell don't have 50 bucks.

I'll be this lady's age by the time I pay off my student loans. Not that

Hey.

You want to sell a kidney?

I could get you 30K as soon as this weekend.

That's just between you and me.

Think about it.

How you doing?

Yeah.

QRS is narrowed. Much better.

Potassium is 7 .7, creatinine 5 .6.

High potassium and renal failure.

What you thought.

Must be my lucky day.

Ordering 10 units of regular insulin and 25 grams of glucose.

Why insulin and glucose?

Strict potassium intracellularly. Exactly, but the definitive treatment

I'll call renal and get a tech down with the machine.

Have you ever seen a dialysis catheter inserted?

Dr. Collins is going to place ephemeral quentin under ultrasound guidance. It's

an excellent way to learn.

Oh, my chest.

Yeah, we had to shock you. You're going to be sore for a while.

You struck my heart.

Long story.

Dr. Collins will fill you in.

You got a sec?

You okay?

Why wouldn't I be?

Are you okay?

Why wouldn't I be?

You seem annoyed with me already, and I just got here.

Not always about you, Robbie.

Am I going to be okay?

Yeah. You just need to take it easy on yourself.

Muscle breakdown and myoglobin damage your kidneys.

Why'd you shock my heart?

When your kidneys don't work, potassium builds up and messes with the electrical

activity in your heart.

Can it happen again?

We gave you medicine to lower your potassium, and you'll need dialysis to

it all out.

And I'll be okay.

Yeah.

You might need a week or two for your kidneys to recover, but yeah.

You really need to hydrate like crazy before and after a triathlon.

Trust me.

I won't let this happen again.

Good.

Be kind to yourself.

Okay.

Oh, hey, Abbott's told me that he's got a pregnant teen coming back today from

Mifepristone. Let me know when she gets here. Yep.

Bowel obstruction.

Still waiting on a surgery consult. What about Garcia? She was just here for the

traumas. I think she was waiting for her attending to sign off.

Okay.

Oh, one of the med students took a header.

I parked her in the lounge under the guise of a work comp report.

Will you just go in there eyeballing and make sure she's all right?

She's going to miss the morning arrival of the living dead.

How many are we expecting?

We're getting three, but one died en route.

I don't know who's luckier, us or them. What's open?

Fourteen. Eighty -nine -year -old woman from a SNP. History of emphysema, CHF,

MS, B -fib, unresponsive to three shocks, two rounds of epi. What is that?

Lucas chest compression system.

Robotic CPR.

We're going to get a hold.

One, two, three.

Students are dropping like flies.

Take a break, ice the finger. You can count on getting a couple elderly

every day around 7 .30 after the nursing homes and assisted living facilities do

their morning bed checks. You can practically set your watch.

Was there an advance directive?

No. Full coat for the nursing home.

Seriously?

Lucas off.

Still beep him.

Lucas on.

One more round of epi, one more shock, and then we call it.

Joseph Spencer, 79, fever and cough from assisted living. He has a history of

mild Alzheimer's.

One, two, three.

Heart rate 130, BP 90 over 60, gave him 500 cc's and almost daily.

I'm Mr. Spencer. I'm Dr.

King. This is Dr. Collins.

How are you feeling today?

It's dinner time. I'm not really hungry.

Do we have any paperwork from the facility?

He has a pulse.

IV fluids and medications are fine, but no intubation and no chest compression.

That's helpful.

Core trunk right here.

Right middle lobe infiltrate.

Temp 102.

Call a code sepsis. Mm -hmm. Code? To make sure we check all of our boxes. The

federal government audits our sepsis bundle performance and publishes the

online. Today, it better be perfect.

Two sets of blood cultures, lactic acid, 30 cc per kilo NS, the gram of

ceftriaxone, 500 of azithromycin, repeat lactic in three hours.

Nice.

Charging and... Stop.

Call it.

Nurse and I were just back with the DNR.

Are you kidding?

Power out the defibrillator and the lupus. A complete waste of time and

Who the hell worked at that place? A nurse taking care of 60 patients who

couldn't find the form. She called 911 so she could take care of the others.

Okay, let's move her to the viewing room and notify the family.

One of the things we do here is to take a moment of silence when we lose a

patient.

To respect their humanity and also to remember that this was somebody's child

sibling or parent friend

I'm

so sorry, maybe leave it on

vibrate while you're working

Later, Doc. You behave yourself now.

Always.

Your med student's back on her feet.

How old's that kid?

I don't know. I didn't know.

Is she some sort of savant? I don't know. Maybe.

Dr. Rabinovich, I just wanted to apologize for any trouble my clumsiness

have caused.

I feel ridiculous. Oh, I can't tell you how many times I've hit my head on an

overhead lamp.

Twice. I needed to get staples.

Why don't you go work with Dr. McKay and triage? That would help both of us.

Oh, I... I don't need special treatment.

Good, because I don't give it.

Look, I know I might look too young, but I studied my ass off to get here.

Probably harder than the others.

I earned this.

Okay, look, I respect your dedication and your determination, but while you're

here, you're my responsibility.

And when one of my responsibilities takes a header... Wow!

Abbott called for a surgical consult on the SBO three hours ago. You're very

lucky they didn't perf. I'm here to see my daughter.

I'm sorry, is that a patient?

You're talking to her.

Am I interrupting?

No.

No. We're done.

We're good.

Come find me when you're ready to present your next case.

Thank you.

So, how's your birthday going?

Great. Yeah, really great. Hey, Crash.

They're doing a dialysis catheter insertion in North 1 if you want to

out. Mm -hmm.

Did she say Crash?

No.

No, no, it's not crash.

She said crush.

I was crushing it.

Thanks for coming down, Mom, but I've got a patient.

Bye.

What do you want?

I just wanted to make sure you're comfortable.

I am taking a dump in the...

Stop peeing.

So what's that fucking tell you?

I'm clearly in the wrong room. I'm sorry.

So it would have been nice if someone had told me that Eileen Shamsie's

was one of our med students.

We're all at the pride.

Was it as awkward as I had to have been? You have a mean streak in you, you know

that?

What's the deal with the body in 19 let's have its unbeceived that from last

night still waiting on next to Ken's Okay,

can we move him to the viewing room at least nursing home DNR's head and

joining last night's Jane Doe coroner's office is backed up Well, then our

Morton needs to take her then Perla Triathlete Otis

he's stable repeat potassium a 6 .1 renal wrote the dialysis order tech

be down 15 minutes. Thank you

Language mystery solved yet?

No. Hey, what's your take on dogs?

In what context?

For kids.

Kids and puppies go together like fish and chips.

Man's best friend, you know.

Well, you don't have a dog.

I don't have a best friend.

What am I?

You're my best resident. Big difference.

Yeah, but we're still friends.

Not if this conversation goes on much longer.

I have a lethargic four -year -old.

No PMH, no innocent illness.

No fever, vomiting.

Parents just couldn't wake him up this morning. What room?

Oh, cell 15.

There's no nuchal rigidity, no skin lesions, no focal neuro.

He looks well fed and cared for.

DKA from new onset diabetes?

No, BG85.

Can you wake up for me, Tyler?

He's not usually this sleepy? No, and he barely flinched for the blood test.

He wakes up at 90 miles an hour and doesn't stop until he passes out at

He passes out?

No, he just means he goes all day.

Any chance he could have ingested something?

Any pills, vitamins, any prescriptions that may have been left around?

No, that's all kept locked in the medicine cabinet. The whole house is

childproof. What about alcohol? Anything left out? No. What about pets?

No. He's usually quite active. Very.

Any injuries lately?

No.

Bumped his head recently.

Not that I'm aware of, but he does love rough housing with Drew.

But he never gets hurt.

Oxygen level is normal.

Good pulse and blood pressure.

No signs of infection. We're going to start with blood and urine tests to

for any metabolic abnormalities.

Really throbbing.

Yeah, the blood's under pressure. Gotta drain it.

No anesthesia, or...? No.

Stop before I hit the nail bed.

I hope.

Hey, eyes down here.

Watch and learn.

I'm just looking who to see next.

You're supposed to take them in the order they arrive.

Yeah, I know how it works. Okay, no need to cry about it.

Do you want me to choose for you? No.

Wow.

Pain's gone. Thank you.

All right. How about a 20 -year -old cough in eight?

Should be easy. Probably viral.

I don't need an easy one.

Suit yourself, Huckleberry.

I'm going to take the splitting headache.

Maybe I'll catch a subarachnoid hemorrhage or something cool.

Hey, why do you keep calling me that?

Huckleberry?

Term of endearment.

Sounds like a sarcasm. You think?

Ordering on harassment.

Where are you from?

Broken bone, Nebraska.

Jesus, where the hell is that?

About three and a half hours west of Omaha.

Oh, yeah, just a little south of nowhere.

What the hell do you do there?

My parents have a farm, so... You're a farm boy?

Yeah, I guess.

I rest my case, Huckleberry.

I'm so sorry, ma 'am. We don't understand you.

Me? I'm Dr.

Heather Collins.

I'm from here.

Portland, Oregon.

You.

Where are you from?

Uh -huh.

Uh, Chana?

India? I can't tell where you're pointing to. You can stand.

Nepal. You're from Nepal.

Nepali.

Mom's got a bad burn. Needs room checks and hand therapy.

And I got a suspicion she may be unhoused.

I'll talk to her. We can offer them help. Thank you. I appreciate it. Oh,

back.

Dr. Robbie suggested I might be of assistance.

Yeah, I could use the company.

Victoria Javadi, Chiara Alfaro.

She's a department social worker, which pretty much makes her an angel.

Welcome. Thanks. Thank you.

So what rotation is this for you?

Third. I've done OBGYN and PEDS. Are you on your favorites?

Not really.

Well, what are you leaning towards?

I'm not really sure yet.

Okay, well, you have time.

Can I actually ask you a personal question?

I'm 20, and I've earned the right to be here.

Oh. Yeah, I don't doubt that for a minute. I was actually wondering if Dr.

Eileen Shamsi from surgery is a friend or relative of yours.

I saw you talking to her in the hall. Yeah, she's my mother.

Oh.

Oh, wow.

Oh, that's cool.

You're really only 20?

Yeah. And for the record, my father also works here. He's an endocrinologist.

I always think it's like a family business.

I'm sorry, that was a joke. That was a joke. And I'm sure that comes with a lot

of pressure.

And as for the age thing, I'm a 42 -year -old R2, so I have my own haters, trust

me.

Okay.

Sometimes when it gets busy, we'll help the nurses bring back patients.

Okay.

Okay, next to come back is Fred Saida, knee pain after a fall.

Great. Doug, hey, Doug. Hi, Doug Driscoll. Any chance someone could see

I've been here for like two hours. Unfortunately, Mr. Driscoll, there's a

patients still ahead of you. Some of whom are severely ill. Yeah, and I got

chest pains that woke me up in the middle of the night.

Chest pain? Yeah.

No, it's not plural. It's just chest pain, not chest pain.

Yeah, and if I have more than one, it's chest pains.

Are you even a real doctor? She's a student doctor.

Yeah, well, keep her the hell away from me.

I just need to see someone, okay? Not her.

Isn't chest pain an emergency? I don't... It looks here like you get an

minutes after arrival, so it's not a heart attack.

Yeah, but I'm supposed to get a chest X -ray and blood test.

Ah, and you are next in line for lab tech. Okay, so listen for your name.

me. Fred.

Can you get me a wheelchair, please?

Hi, I'm Dr. McKay. What's going on?

I found her on the floor in the bathroom. She can't stop puking. What's

name? Teresa. She's my mom.

Teresa? Teresa, are you taking any medication?

No. Any previous stomach problems? No.

When does the vomiting begin?

Last night.

Last night.

Do you have any dizziness or fatigue?

Mystery solved.

Our lady with the degloved foot is Natali.

Oh, hey.

Congratulations.

Otis' BP is crashing. 70 over 50. Still waiting for dialysis.

How you doing there, Otis?

Okay, that's okay. 15 liters, non -rebreather, please.

Oh, crap.

Diastolic collapse of the right atrium and right ventricle. Tamponade from your

remake of fusion. That's why his BP is low? Yep. Too much fluid and pressure

around the heart. Chambers can't fill.

Otis, you've got some fluid around your heart. We need to get it off.

25 in propofol. 10 cc's of lidocaine with epi, pericardia, and synthesis

have to get the... No, no, just open a central light kit.

Dr. Santos, take the head of the bed and bag him if he stops breathing.

Compressions if we lose the carotid.

Prep and drip the subzyphoid. Please send CCTs at 1 % weight.

Chlorhexidine here.

25 for 20. Long 25. Long 25.

Thank you.

Injecting lidocaine.

Pressure down 60 over 40.

Right.

Wait, you can't ultrasound on place. I know, that's why I'm taking the pro.

18 gauge thin wall 60cc syringe please dr collins let's go you're going in

over the center of my probe advancing very slowly looking for the hyper echo

very very slowly do not hit that hard dr santos you see that see a black and

that's the effusion we're looking for a little white dot there it is got it

aspirating three cc should be enough

Good. Next, we'll place the guide wire and then the triple lumen catheter.

Pulse oxygen 99.

Pressure's up. 124 over 78.

Looks like things are back to normal.

That was cool.

Four of his old friends on board.

That should stop the nausea.

David, have you had any vomiting?

No. Anyone else sick at home?

It's just us.

My husband passed away a few years ago from COVID.

Sorry. Tethium 3 .1.

Isn't that bad?

It can cause heart problems, but we're going to correct it.

Ten in the bag, 20 PO.

Roddy, any questions?

Um... David, have you two traveled out of the country recently?

No, I never go anywhere.

Is she going to have to stay here?

If the rest of the tests are good and she responds to treatment, she can go

home.

Mr. Milton, my name is Dennis Whitaker.

I'm one of the student doctors here. I'll be seeing you first.

Nice to meet you. BP is 150 over 90.

Just a touch high.

I forgot to take my damn enalapril this morning.

We'll get that for you.

Tell me about this belly pain.

Started about here.

Woke me up at like 2 a .m.

Pretty intense.

Lasted about an hour.

Now it's gone.

Any fever, vomiting?

Nah, I never get sick.

Okay. What did you eat last night?

Oh, it was my wife's birthday.

Took her out to Sullivan's birthday.

Well,

the exam is pretty benign. I'm going to touch the gallstone.

If there is a stone...

And you eat fatty food.

There can be pain when the gallbladder contracts.

Oh, bingo.

One stone, there it is.

Do I need surgery?

You should be able to manage with a low -fat diet, but we'll send off labs for

liver and pancreas. Just let us know if you have any more pain.

Okay.

Thanks.

Yeah, you bet.

Great.

You want any Gigi?

For?

Heart attacks can present as upper abdominal pain.

Um, yeah.

No, yeah, that's a great idea. Thank you.

I'm going as fast as I can.

I'm picking up two more patients. I didn't say anything.

I need a fresh set of eyes. On what?

A 54 -year -old woman brought in with intractable vomiting by her 18 -year

son. I'm getting a weird vibe.

How so?

I don't know. Maybe she was given something.

Some sort of elder abuse.

This is a strange dynamic I can't quite figure out. You're really good at

something like that sort of thing.

I don't know about that.

Excuse me, Dr. Langdon?

Almost all of our labs are back on sleeping boy Tyler.

All 100 % normal.

What are we missing?

Is he waking up? No, he's still fast asleep.

Most of the lab results are in and they look great. No abnormal blood count, no

electrolyte abnormalities, no diabetes, no kidney disease.

Good, so what's wrong with him? We're still trying to figure that out.

Did he have a play date yesterday by chance?

No, he had preschool, but he was fine when I picked him up. Any kids in his

class still?

No, my phone tree would have lit up if someone else was sick.

He eat anything this morning?

No.

Why?

It looks like some sort of gelatin.

Any chance he could have gotten into some bath beets or laundry pods?

No, and there's no such thing in our house.

What about gummies?

No, we're very strict about candy.

Right?

Danny. What about Danny?

Your brother, he... He gave me some gummies he got in Cleveland. They were

coat pocket.

Are you fucking serious?

Pot gummies?

Yes. I'm so sorry.

Let me call the lab. Maybe the tox screen is back. Hey, this is Dr. Langdon

the ED.

Can I fast -track a lab on a little boy, last name Jones, first name Tyler, tox

screen? Fuck out! I mean it. Why don't we step outside and maybe you can help

figure out how much he may have taken.

Thanks. I appreciate that quick turnaround.

Labs confirm it. Your son tested positive for cannabis.

It's a fucking nightmare.

Teresa.

David, this is my attendee, Dr.

Rabinovich. Hi, Dr. Robbie.

We need to do a pelvic exam.

David, I don't think you want to be in here for that.

Definitely not.

Can you have Nurse Perla come join me, please?

You want a coffee or a soda or something?

Why do I need a pelvic exam?

Uh, you don't.

Your son seems like a nice kid. He's clearly worried about you.

But your exam and your labs are not matching any of the usual diagnoses, so

not really sure what's going on.

I'm not here for me.

I'm here for David.

I don't understand. He said that you've had persistent vomiting, some... I made

myself sick with Ipecac.

To induce vomiting? Why would you do that?

So David would bring me here.

My son has some problems. He needs professional help.

Okay, what kind of problems?

Drugs? Alcohol?

I found some of his writing.

I thought it was schoolwork, but it wasn't.

It was a list of girls he wanted to hurt.

Heard them out.

He said they should all be eliminated.

Has David seen a therapist?

No.

He's not a bad kid, but I'm afraid he's troubled, and I didn't want to call the

police because I was afraid they'd overreact. He's just a kid. How old is

He just turned 18 last month.

Then he's considered an adult, and he would have to consent to treatment.

Do you have any guns in the house? No.

My husband did, but I got rid of all of them after he passed.

He's a good soul.

I just don't want to see him hurt anyone or himself.

How you feeling, Crash?

I'd really appreciate it if you didn't call me that. Why not?

It's a cool nickname. You earned it. You should own it.

I don't like it.

Whatever. It's just a joke.

You know, if it makes you feel any better, I sharted the first time I saw

emergency C -section.

Really?

Of course not.

I got a situation.

18 -year -old kid brings in his dehydrated mom. Dad died during the

Mom's vomiting is self -induced for the sole purpose of getting him here after

she finds his death list for classmates.

I... Okay.

What does she want us to do?

Help him, protect him, save him. Where is he now?

Talking to McKay.

How are you doing?

Me? I'm good. I'm always good. You know that. Do I? Does anybody?

I'm an open book.

Not even close.

You do know you can always come talk to me, right?

How's it going over here?

Good, good.

We're just going over aftercare instructions, prescription medications,

diet for the next few days.

Dr. McKay, can you check with aesthetics on mom?

I can.

David, I wanted you to meet Kiara. She's a social worker here who helps in

situations like this.

We heard about your father's passing.

We're really sorry.

And we know they can put a lot of pressure on somebody your age which

with school And now having to take care of your mom.

That's a lot fine We just want to make sure that when your mom goes home you

handle it You want to make sure you have someone you can talk to if you need to

I'm okay.

I don't need to talk to anybody After a parent dies the sadness can last a long

time. How's that going for you?

What about school What about it?

Anything you enjoy there?

Not really.

A lot of people have thoughts that can disturb them.

If you've had any, it's okay to talk about it. Does that have to do with my

Is she gonna be okay?

Yeah, she's gonna be fine. She's probably got a stomach virus, maybe food

poisoning. I think she's more worried about you.

She always worries about me.

Does she have a reason to?

No.

I almost ate. I gotta go.

You sure you wouldn't prefer to wait with your mom?

I'm late for school. She'll just call me when she's ready.

It would actually be kind of helpful to talk to you some more.

Hey, David?

David?

Hey, just give me five minutes. Leave me alone.

Hey, David!

Got a college kid.

Respiratory rest. Coming in hot.

to be here.

Dr. Adamson just went down with a full size of 65.

You're not so tough.

You need to be loved.

You're lost in the dead.

You're caught up there.

No matter where you come from.

You're a monster back to all the mirrors.

You're not

so tough.