1
00:00:05,507 --> 00:00:09,976
<b>Sync and corrections by btsix
www.addic7ed.com</b>

2
00:00:11,470 --> 00:00:13,221
Next time, maybe inform
the department chair

3
00:00:13,222 --> 00:00:14,222
before the shit hits the fan.

4
00:00:14,223 --> 00:00:15,890
I was on my way to tell you.

5
00:00:15,891 --> 00:00:17,225
Make sure you get everything you need.

6
00:00:17,226 --> 00:00:18,309
OK, let's do this.

7
00:00:18,310 --> 00:00:19,894
IT called me up because

8
00:00:19,895 --> 00:00:22,230
I've trained in cyberattack
prevention and response.

9
00:00:22,231 --> 00:00:23,564
Then you can tell everybody what to do.

10
00:00:23,565 --> 00:00:24,673
No, thank you.

11
00:00:24,674 --> 00:00:26,192
Best if it comes
from the department chair.

12
00:00:26,193 --> 00:00:27,236
Oh, you think?

13
00:00:29,696 --> 00:00:31,906
All right, everybody, circle up.

14
00:00:31,907 --> 00:00:33,199
What the fuck?

15
00:00:33,200 --> 00:00:35,117
We may have had a cyberattack.

16
00:00:35,118 --> 00:00:37,412
No, we shut down
to prevent a cyberattack.

17
00:00:39,122 --> 00:00:41,249
OK, everybody, settle down. Listen up.

18
00:00:41,250 --> 00:00:42,583
As you can see, we're doing a little

19
00:00:42,584 --> 00:00:45,086
redecorating in the central work area.

20
00:00:45,087 --> 00:00:47,964
Our hospital computers are
at risk for a cyberattack,

21
00:00:47,965 --> 00:00:49,966
so we are going old school, analog.

22
00:00:49,967 --> 00:00:51,425
- For how long?
- Great question.

23
00:00:51,426 --> 00:00:53,427
Our IT department
has shut everything down

24
00:00:53,428 --> 00:00:55,763
to give them time to bolster
our cyber defenses.

25
00:00:55,764 --> 00:00:57,723
I believe the question was,
for how long?

26
00:00:57,724 --> 00:00:58,975
Uh, hard to say.

27
00:00:58,976 --> 00:01:00,268
Could be up to 24 hours.

28
00:01:00,269 --> 00:01:01,936
Jesus Christ.

29
00:01:01,937 --> 00:01:03,563
So first order of business,

30
00:01:03,564 --> 00:01:05,481
we need to replicate
the electronic patient boards

31
00:01:05,482 --> 00:01:06,816
on these dry-erase boards.

32
00:01:06,817 --> 00:01:07,942
So please, somebody tell me

33
00:01:07,943 --> 00:01:09,068
they got a photo of the boards.

34
00:01:09,069 --> 00:01:10,069
Uh, yeah, yeah, yeah.

35
00:01:10,070 --> 00:01:11,529
Right here. OK.

36
00:01:11,530 --> 00:01:12,614
Oh, uh...

37
00:01:14,783 --> 00:01:16,951
It's a little blurry.

38
00:01:16,952 --> 00:01:19,620
No, more than a little blurry.

39
00:01:19,621 --> 00:01:22,373
- Sorry.
- Oh, my God.

40
00:01:22,374 --> 00:01:24,125
- I remember.
- Great.

41
00:01:24,126 --> 00:01:26,127
If everybody else can remember
their patient names

42
00:01:26,128 --> 00:01:27,461
and their room numbers,
that would be awesome.

43
00:01:27,462 --> 00:01:29,463
No, I mean I can remember all of it.

44
00:01:29,464 --> 00:01:30,631
All of what?

45
00:01:30,632 --> 00:01:32,800
Names, doctors, room numbers.

46
00:01:32,801 --> 00:01:35,261
I kind of have a photographic memory.

47
00:01:35,262 --> 00:01:37,346
Seriously? The whole board?

48
00:01:37,347 --> 00:01:39,765
Central 12, Harlow Graham, headache,

49
00:01:39,766 --> 00:01:42,476
- abdominal pain, ASL only.
- Oh, shit.

50
00:01:42,477 --> 00:01:44,395
I have an interpreter waiting for me.

51
00:01:44,396 --> 00:01:46,522
- Go.
- OK, for patient privacy,

52
00:01:46,523 --> 00:01:48,232
all chief complaints
will be abbreviated.

53
00:01:48,233 --> 00:01:49,567
So HA for headache,

54
00:01:49,568 --> 00:01:51,527
AP for abdominal pain, and so forth.

55
00:01:51,528 --> 00:01:54,822
Central 10, Jackson Davis,
new-onset psychosis.

56
00:01:54,823 --> 00:01:56,240
Javadi, psych admission.

57
00:01:56,241 --> 00:01:58,284
Greek letter psi for psych.

58
00:01:58,285 --> 00:02:00,494
Pedes is Baby Jane Doe,
fever, Dr. Mohan,

59
00:02:00,495 --> 00:02:02,038
awaiting admission orders.

60
00:02:02,039 --> 00:02:03,789
Nurses need to convert
to a zone defense...

61
00:02:03,790 --> 00:02:04,832
north, central, south, trauma.

62
00:02:04,833 --> 00:02:06,000
Where's Dana?

63
00:02:06,001 --> 00:02:07,668
In with a sexual assault case.

64
00:02:07,669 --> 00:02:09,211
She can't leave
until the exam is finished.

65
00:02:09,212 --> 00:02:10,504
Yeah, it could be a while.

66
00:02:10,505 --> 00:02:11,964
Princess has charge nurse experience.

67
00:02:11,965 --> 00:02:13,382
- Not really.
- That's a great idea.

68
00:02:13,383 --> 00:02:14,675
Princess it is.

69
00:02:14,676 --> 00:02:15,676
You can make the nursing assignments.

70
00:02:15,677 --> 00:02:17,011
- Next.
- Central 9,

71
00:02:17,012 --> 00:02:18,929
Roxie Hamler, end-stage lung cancer.

72
00:02:18,930 --> 00:02:20,348
Sorry, do we have to stand here while

73
00:02:20,349 --> 00:02:21,515
- she recites the whole board?
- No.

74
00:02:21,516 --> 00:02:22,767
In fact, go check on your patients

75
00:02:22,768 --> 00:02:24,268
and then please come back here.

76
00:02:24,269 --> 00:02:25,811
Thank you.

77
00:02:25,812 --> 00:02:27,612
How many hours a day
are you on your laptop?

78
00:02:30,651 --> 00:02:31,984
At least eight hours.

79
00:02:31,985 --> 00:02:33,361
I work from home.

80
00:02:33,362 --> 00:02:35,280
And are you at a desk all day?

81
00:02:37,157 --> 00:02:38,491
No, no.

82
00:02:38,492 --> 00:02:39,909
I will either sit on the sofa,

83
00:02:39,910 --> 00:02:42,203
or sometimes I'll be in bed,

84
00:02:42,204 --> 00:02:44,372
kind of sitting up
with the computer on my lap,

85
00:02:44,373 --> 00:02:45,873
that kind of thing.

86
00:02:45,874 --> 00:02:48,501
So you're always looking down
at the screen?

87
00:02:48,502 --> 00:02:50,127
- Yeah.
- OK.

88
00:02:50,128 --> 00:02:52,589
I'm going to check
the muscles in your neck.

89
00:02:59,262 --> 00:03:00,388
- Ooh!
- Ooh!

90
00:03:00,389 --> 00:03:02,556
Ow, that hurts.

91
00:03:02,557 --> 00:03:05,267
All right. Well, I think we can help.

92
00:03:05,268 --> 00:03:07,436
Come on over.

93
00:03:07,437 --> 00:03:09,021
OK, gather up.

94
00:03:09,022 --> 00:03:11,190
Listen up, everybody.
This is our chart rack.

95
00:03:11,191 --> 00:03:13,192
So as you can see,
each slot and clipboard

96
00:03:13,193 --> 00:03:14,276
has a room number on it.

97
00:03:14,277 --> 00:03:15,736
When you pick up a new patient,

98
00:03:15,737 --> 00:03:18,072
you grab a fresh chart
from the T-system.

99
00:03:18,073 --> 00:03:21,075
Pick your chart by chief complaint.

100
00:03:21,076 --> 00:03:23,285
Use the cartoon to find it.

101
00:03:23,286 --> 00:03:25,037
Why are there two bodies?

102
00:03:25,038 --> 00:03:27,081
Trauma on the left,
medical on the right.

103
00:03:27,082 --> 00:03:28,416
So head injury, you go left.

104
00:03:28,417 --> 00:03:29,959
Headache, go right.

105
00:03:29,960 --> 00:03:31,544
Are those fish swimming in seaweed?

106
00:03:31,545 --> 00:03:32,586
No.

107
00:03:32,587 --> 00:03:33,921
That is bees and grass.

108
00:03:33,922 --> 00:03:35,214
That's the section for insect bites,

109
00:03:35,215 --> 00:03:36,757
skin rash, allergies.

110
00:03:36,758 --> 00:03:38,300
OK, let's say, for example,

111
00:03:38,301 --> 00:03:40,428
Dr. Al-Hashimi has
a new patient with belly pain.

112
00:03:40,429 --> 00:03:43,097
For the history, circle the positives,

113
00:03:43,098 --> 00:03:45,057
like vomiting and diarrhea.

114
00:03:45,058 --> 00:03:47,643
Backslash the negative,
such as recent travel,

115
00:03:47,644 --> 00:03:49,228
sick contacts, fever.

116
00:03:49,229 --> 00:03:53,149
For physical exam,
checkmark normals on the left,

117
00:03:53,150 --> 00:03:55,443
and circle any
abnormal findings on the right.

118
00:03:55,444 --> 00:03:56,485
Questions?

119
00:03:56,486 --> 00:03:57,695
Is your generative AI program

120
00:03:57,696 --> 00:03:58,696
still gonna be working?

121
00:04:00,115 --> 00:04:01,365
Not for a while.

122
00:04:01,366 --> 00:04:03,117
And ditch your SpectraLink phones.

123
00:04:03,118 --> 00:04:04,744
Those are voice over internet.

124
00:04:07,748 --> 00:04:08,956
PTMC Emergency.

125
00:04:08,957 --> 00:04:10,458
Go ahead, Medic Command.

126
00:04:10,459 --> 00:04:11,625
That is how we will hear
about incoming runs.

127
00:04:11,626 --> 00:04:13,085
Thanks.

128
00:04:13,086 --> 00:04:14,795
Two minutes out with
abdominal pain and fever.

129
00:04:14,796 --> 00:04:16,297
OK, has everybody got that so far?

130
00:04:16,298 --> 00:04:17,840
How do we write orders?

131
00:04:17,841 --> 00:04:19,467
Physician order form in triplicate.

132
00:04:19,468 --> 00:04:22,303
Labs, X-rays, IV fluid, medication.

133
00:04:22,304 --> 00:04:23,679
Will the labs still be able
to run blood tests?

134
00:04:23,680 --> 00:04:25,055
Yes.

135
00:04:25,056 --> 00:04:26,474
Are the CT scanners still working?

136
00:04:26,475 --> 00:04:27,808
Yes, but the results will come back

137
00:04:27,809 --> 00:04:30,144
on paper from the radiologist.

138
00:04:30,145 --> 00:04:31,604
This is the dark ages.

139
00:04:31,605 --> 00:04:33,814
So if you have orders
with labs or X-rays,

140
00:04:33,815 --> 00:04:35,357
they go into the clerk file here.

141
00:04:35,358 --> 00:04:36,650
They will sign them off.

142
00:04:36,651 --> 00:04:38,152
They will add a downtime slip on them,

143
00:04:38,153 --> 00:04:39,445
make sure they go
to the correct department.

144
00:04:39,446 --> 00:04:40,988
I'm sorry, who are the clerks?

145
00:04:40,989 --> 00:04:42,281
- You're looking at them.
- At your service.

146
00:04:42,282 --> 00:04:43,532
Larry and Antoine are filling in

147
00:04:43,533 --> 00:04:45,117
- until more help arrives.
- We got this.

148
00:04:45,118 --> 00:04:47,161
After the clerk orders, chart gets moved

149
00:04:47,162 --> 00:04:48,913
to the nursing order rack here for IVs,

150
00:04:48,914 --> 00:04:50,664
medications, procedures.

151
00:04:50,665 --> 00:04:52,875
Medications are locked up in the PDS.

152
00:04:52,876 --> 00:04:55,669
The PDS is getting unlocked
by a clinical pharmacist,

153
00:04:55,670 --> 00:04:57,254
- Dr. Megan Nordt.
- We've got your back.

154
00:04:57,255 --> 00:04:58,255
This is a lot.

155
00:04:58,256 --> 00:05:00,216
Any questions? Yes.

156
00:05:00,217 --> 00:05:01,509
Uh, no.

157
00:05:01,510 --> 00:05:03,052
What's up with the third rack?

158
00:05:03,053 --> 00:05:04,637
When your patient is
ready to be discharged,

159
00:05:04,638 --> 00:05:05,846
chart goes here.

160
00:05:05,847 --> 00:05:07,139
This lets everybody know

161
00:05:07,140 --> 00:05:08,349
we're about to have an open bed.

162
00:05:08,350 --> 00:05:10,184
Or that your tuna melt is up.

163
00:05:10,185 --> 00:05:11,436
Jesse?

164
00:05:12,687 --> 00:05:14,730
- What is that?
- What is that?

165
00:05:14,731 --> 00:05:16,524
That is a fax machine.

166
00:05:16,525 --> 00:05:18,025
They still make those?

167
00:05:18,026 --> 00:05:19,819
This is our lifeline to labs and X-rays.

168
00:05:19,820 --> 00:05:21,695
When the results come back,
they will fax to us,

169
00:05:21,696 --> 00:05:23,405
and the clerks will
put them on the charts.

170
00:05:23,406 --> 00:05:24,740
- Yes?
- If you say so.

171
00:05:24,741 --> 00:05:26,492
Incoming.

172
00:05:26,493 --> 00:05:29,745
OK, Dr. McKay, Dr. Whitaker,
Ogilvie, you're with me.

173
00:05:29,746 --> 00:05:32,581
The rest of you, build your clipboards.

174
00:05:34,876 --> 00:05:37,586
Howard Knox, 52,
abdominal pain and fever.

175
00:05:37,587 --> 00:05:40,256
152 over 90, tachy at 120.

176
00:05:40,257 --> 00:05:42,049
- Couldn't get an IV.
- I wonder why.

177
00:05:42,050 --> 00:05:43,592
Hello, sir. My name is Dr. Robby.

178
00:05:43,593 --> 00:05:46,053
- Howard.
- This is a teaching hospital.

179
00:05:46,054 --> 00:05:48,180
I'll be supervising
Doctors McKay and Dr. Whitaker

180
00:05:48,181 --> 00:05:49,390
- and student Dr. Ogilvie.
- Hey.

181
00:05:49,391 --> 00:05:50,558
- Hello.
- How are you feeling?

182
00:05:50,559 --> 00:05:51,976
- Not so great.
- OK.

183
00:05:51,977 --> 00:05:53,477
- Princess, what's free?
- Trauma 1.

184
00:05:53,478 --> 00:05:54,855
Perlah?

185
00:05:57,274 --> 00:06:00,901
All right, orders for Mylanta
and bupivacaine, Central 12.

186
00:06:00,902 --> 00:06:02,278
Wrong spot, Dr. Santos.

187
00:06:02,279 --> 00:06:04,239
And you need a sticker.

188
00:06:05,949 --> 00:06:07,283
Put it in the nursing orders rack.

189
00:06:07,284 --> 00:06:08,784
And meet me over at PDS.

190
00:06:08,785 --> 00:06:10,411
How much does this suck?

191
00:06:10,412 --> 00:06:12,079
I didn't think
today could get any worse.

192
00:06:12,080 --> 00:06:14,248
This is how we rolled
when I was a resident.

193
00:06:14,249 --> 00:06:15,791
Was that in the 1900s?

194
00:06:15,792 --> 00:06:18,085
Yeah, when charts were
written by candlelight.

195
00:06:18,086 --> 00:06:19,920
Hey, today will be an adventure.

196
00:06:19,921 --> 00:06:22,173
Think of it like "Back to the Future."

197
00:06:24,759 --> 00:06:26,802
Or possibly "Titanic."

198
00:06:26,803 --> 00:06:28,679
Here is your antacid.

199
00:06:28,680 --> 00:06:30,097
Cheers.

200
00:06:30,098 --> 00:06:31,807
And I marked the trigger point

201
00:06:31,808 --> 00:06:33,350
that is bringing out your headache,

202
00:06:33,351 --> 00:06:35,102
and a shot of local anesthetic
in that area

203
00:06:35,103 --> 00:06:37,105
could really help.

204
00:06:38,315 --> 00:06:39,440
Yeah, let's do it.

205
00:06:39,441 --> 00:06:40,650
All right.

206
00:06:41,818 --> 00:06:44,612
You are going to feel a little pinprick

207
00:06:44,613 --> 00:06:46,281
and some burning.

208
00:06:51,912 --> 00:06:53,829
OK.

209
00:06:53,830 --> 00:06:55,831
Oh, ow, ow, that really hurts.

210
00:06:55,832 --> 00:07:00,336
Temp 101.4, tachy at 128,
pulse ox 92 on 2 liters.

211
00:07:00,337 --> 00:07:01,712
When did the pain start?

212
00:07:01,713 --> 00:07:03,297
It's been on and off for about a week.

213
00:07:03,298 --> 00:07:05,049
- And where do you feel it?
- All over.

214
00:07:05,050 --> 00:07:07,635
It started on the left, and now
there's some on the right.

215
00:07:07,636 --> 00:07:08,802
How about that fever?

216
00:07:08,803 --> 00:07:10,137
Since last night.

217
00:07:10,138 --> 00:07:11,513
I was burning up.

218
00:07:11,514 --> 00:07:13,349
Then I had chills pretty bad.

219
00:07:13,350 --> 00:07:14,350
I can't find a vein here.

220
00:07:14,351 --> 00:07:15,434
We'll try for a midline.

221
00:07:15,435 --> 00:07:17,144
Let us know if this hurts.

222
00:07:17,145 --> 00:07:18,520
- Ah, ah.
- Sorry.

223
00:07:18,521 --> 00:07:20,439
- And on this side?
- Yeah, yeah!

224
00:07:20,440 --> 00:07:21,523
Sorry, sir.

225
00:07:21,524 --> 00:07:22,650
Guarding with no rigidity.

226
00:07:22,651 --> 00:07:24,818
For pain, 100 of fent IM?

227
00:07:24,819 --> 00:07:26,153
Plan, Dr. Whitaker?

228
00:07:26,154 --> 00:07:28,822
Blood cultures, lactate, Zosyn.

229
00:07:28,823 --> 00:07:31,325
We're gonna need a CT
to figure out what's going on.

230
00:07:31,326 --> 00:07:32,743
Ah-ah.

231
00:07:32,744 --> 00:07:34,828
- Yeah, it's not gonna work.
- Yep.

232
00:07:34,829 --> 00:07:36,163
Write neatly. Penmanship counts.

233
00:07:36,164 --> 00:07:37,498
Howard, for the scan, we're gonna have

234
00:07:37,499 --> 00:07:38,540
to lay you flat on your back.

235
00:07:38,541 --> 00:07:39,833
Can you do that?

236
00:07:39,834 --> 00:07:41,043
I could ten years ago,

237
00:07:41,044 --> 00:07:42,670
but now it's too hard to breathe.

238
00:07:42,671 --> 00:07:44,338
If we can't lay you flat,

239
00:07:44,339 --> 00:07:45,839
then we're gonna have to put
a tube in your windpipe

240
00:07:45,840 --> 00:07:47,341
to help you breathe...
are you OK with that?

241
00:07:47,342 --> 00:07:48,842
Intubation with rapid
sequence induction?

242
00:07:48,843 --> 00:07:50,177
No, we can't lay him down.

243
00:07:50,178 --> 00:07:51,345
The tube will go in your nose

244
00:07:51,346 --> 00:07:52,513
while you're awake, sir.

245
00:07:52,514 --> 00:07:53,514
- Well...
- Right.

246
00:07:53,515 --> 00:07:54,848
Does it hurt?

247
00:07:54,849 --> 00:07:56,016
You'll be numbed up completely.

248
00:07:56,017 --> 00:07:57,393
You won't feel any discomfort.

249
00:07:57,394 --> 00:08:00,270
Do you happen to know your weight?

250
00:08:00,271 --> 00:08:01,939
A little over 400.

251
00:08:01,940 --> 00:08:03,273
When was the last time you checked?

252
00:08:03,274 --> 00:08:04,775
It's been a while.

253
00:08:04,776 --> 00:08:07,236
Is it possible
that you might be over 450?

254
00:08:07,237 --> 00:08:09,196
Possibly.

255
00:08:09,197 --> 00:08:11,490
Perlah, let's call for the Hoyer.

256
00:08:11,491 --> 00:08:14,535
So we're gonna place the tube
and get you ready for the scan.

257
00:08:14,536 --> 00:08:16,203
Is this something serious?

258
00:08:16,204 --> 00:08:17,997
Well, it's hard to tell without a CT.

259
00:08:17,998 --> 00:08:19,707
You could just need antibiotics,

260
00:08:19,708 --> 00:08:21,500
or you could require an operation.

261
00:08:21,501 --> 00:08:22,751
If surgery is necessary,

262
00:08:22,752 --> 00:08:24,086
then your weight could make things

263
00:08:24,087 --> 00:08:25,546
- a little bit more complicated.
- I know.

264
00:08:25,547 --> 00:08:27,089
- I'm sorry.
- Not to worry.

265
00:08:27,090 --> 00:08:28,549
We're gonna take very good care of you.

266
00:08:28,550 --> 00:08:29,800
Team.

267
00:08:29,801 --> 00:08:30,926
OK.

268
00:08:30,927 --> 00:08:32,428
Pain medication for you, OK?

269
00:08:32,429 --> 00:08:34,304
Let's try for a midline,

270
00:08:34,305 --> 00:08:36,181
basilic vein with ultrasound guidance.

271
00:08:36,182 --> 00:08:37,641
Can ultrasound check for an appy?

272
00:08:37,642 --> 00:08:39,560
He's a little too large
for an ultrasound.

273
00:08:39,561 --> 00:08:41,937
Plus, our CT can only handle 450 pounds.

274
00:08:41,938 --> 00:08:44,441
And so if he's over that,
we send him to the zoo?

275
00:08:45,442 --> 00:08:46,818
He's right there.

276
00:08:49,112 --> 00:08:52,156
I... I heard that there's
a large animal CT at the zoo.

277
00:08:52,157 --> 00:08:54,158
Presby's CT can handle 650.

278
00:08:54,159 --> 00:08:56,410
Yeah, if Presby's still up and running.

279
00:08:56,411 --> 00:08:57,911
Wh...

280
00:08:57,912 --> 00:08:59,913
That... that's not a jinx. It's...

281
00:08:59,914 --> 00:09:02,541
Have any of you ever done
an awake naso-tracheal?

282
00:09:02,542 --> 00:09:03,792
OK.

283
00:09:03,793 --> 00:09:04,918
Perlah, can you also ask

284
00:09:04,919 --> 00:09:06,086
Dr. Al-Hashimi to come in?

285
00:09:06,087 --> 00:09:07,129
I'm gonna need an assist.

286
00:09:07,130 --> 00:09:08,547
Yep. You got it.

287
00:09:08,548 --> 00:09:10,508
Ah, sorry. Signed.

288
00:09:11,634 --> 00:09:14,928
Hall bed F, George Francis,
shortness of breath,

289
00:09:14,929 --> 00:09:17,389
Dr. Mohan, awaiting D-dimer.

290
00:09:17,390 --> 00:09:18,974
Wow. She's still going?

291
00:09:18,975 --> 00:09:21,101
Yeah. Remarkable, really.

292
00:09:21,102 --> 00:09:22,728
Dr. Al, Robby's asking for you.

293
00:09:22,729 --> 00:09:23,937
Uh, OK.

294
00:09:23,938 --> 00:09:25,647
In Trauma if you need me, Princess.

295
00:09:25,648 --> 00:09:26,899
Got it.

296
00:09:28,443 --> 00:09:29,985
Who's supposed to run the downtime slips

297
00:09:29,986 --> 00:09:31,195
to X-ray and lab?

298
00:09:31,196 --> 00:09:33,697
Uh, the charge nurse?

299
00:09:33,698 --> 00:09:35,491
Don't look at me.

300
00:09:35,492 --> 00:09:36,910
My plate's full!

301
00:09:38,953 --> 00:09:41,622
Uh, parents of Roxie Hamler?

302
00:09:41,623 --> 00:09:42,831
Central 9.

303
00:09:42,832 --> 00:09:44,124
Oh, I got it, Donnie.

304
00:09:44,125 --> 00:09:45,459
Hi, I'm Victoria Javadi,

305
00:09:45,460 --> 00:09:46,877
one of the student doctors here.

306
00:09:46,878 --> 00:09:48,462
I've been assisting with Roxie's care.

307
00:09:48,463 --> 00:09:49,797
Oh, thank you so much.

308
00:09:49,798 --> 00:09:52,007
- I'm Lloyd.
- Cora.

309
00:09:52,008 --> 00:09:53,133
It's nice to meet you.

310
00:09:53,134 --> 00:09:54,301
She broke her leg?

311
00:09:54,302 --> 00:09:55,636
Um, yeah.

312
00:09:55,637 --> 00:09:57,387
There's a fracture down by the ankle.

313
00:09:57,388 --> 00:09:59,973
She's in a boot now, so there's
not quite so much pain.

314
00:09:59,974 --> 00:10:02,310
But I'll take you. She's just in 9.

315
00:10:07,690 --> 00:10:09,149
The hospital Wi-Fi isn't working.

316
00:10:09,150 --> 00:10:10,484
Oh, it'll be down for a while.

317
00:10:10,485 --> 00:10:12,319
Sorry.

318
00:10:12,320 --> 00:10:14,822
Mom broke her leg, Grandpa.

319
00:10:14,823 --> 00:10:16,990
We heard.

320
00:10:16,991 --> 00:10:18,660
How are you, honey?

321
00:10:20,829 --> 00:10:23,288
You've got this, kiddo.

322
00:10:23,289 --> 00:10:25,541
Yeah.

323
00:10:25,542 --> 00:10:27,668
How long will she stay in the ER?

324
00:10:27,669 --> 00:10:31,255
Oh, until a bed opens up upstairs.

325
00:10:31,256 --> 00:10:32,841
Could be a while.

326
00:10:38,096 --> 00:10:39,847
You know, it's getting
pretty crowded in here.

327
00:10:39,848 --> 00:10:41,598
Maybe we should take Tucker
and Shane out for ice cream.

328
00:10:41,599 --> 00:10:45,060
- Yes, please.
- No, no. I'm OK.

329
00:10:45,061 --> 00:10:48,230
Maybe your mom would like
some time to rest.

330
00:10:48,231 --> 00:10:50,400
Yeah. Go.

331
00:10:52,068 --> 00:10:54,528
Can she have ice cream?

332
00:10:54,529 --> 00:10:57,698
She can have anything she wants.

333
00:10:57,699 --> 00:11:00,701
Come on, let's go.

334
00:11:00,702 --> 00:11:02,537
Bye, Mom.

335
00:11:04,205 --> 00:11:06,457
Ice cream, ice cream.

336
00:11:09,711 --> 00:11:11,086
Yep.

337
00:11:11,087 --> 00:11:13,088
Listen up.

338
00:11:13,089 --> 00:11:14,590
This is Oxymetazoline.

339
00:11:14,591 --> 00:11:15,791
This will open up the passage.

340
00:11:16,759 --> 00:11:18,218
What medication do you take?

341
00:11:18,219 --> 00:11:21,013
Uh, Lisinopril and Metformin.

342
00:11:21,014 --> 00:11:22,931
Ozempic? Wegovy?

343
00:11:22,932 --> 00:11:24,850
No. Kind of expensive.

344
00:11:24,851 --> 00:11:26,852
I'm going to squirt
some numbing gel in your nose.

345
00:11:26,853 --> 00:11:30,355
If it drips back
in your throat, that's OK.

346
00:11:30,356 --> 00:11:32,608
Here, in case you need it.

347
00:11:32,609 --> 00:11:34,443
Do you smoke?

348
00:11:34,444 --> 00:11:35,736
Alcohol?

349
00:11:35,737 --> 00:11:37,821
- Never.
- Do you exercise?

350
00:11:37,822 --> 00:11:40,282
Moving from the bedroom to the kitchen.

351
00:11:40,283 --> 00:11:41,783
No, I'd walk more,

352
00:11:41,784 --> 00:11:44,411
but I need a bench
to rest on every block.

353
00:11:44,412 --> 00:11:45,913
What about water aerobics?

354
00:11:45,914 --> 00:11:48,248
Let's focus on helping Mr. Knox.

355
00:11:48,249 --> 00:11:49,625
Agreed.

356
00:11:49,626 --> 00:11:51,627
It took me 25 years to get this way.

357
00:11:51,628 --> 00:11:54,254
Car crash, burn unit,

358
00:11:54,255 --> 00:11:57,090
four leg surgeries over ten years.

359
00:11:57,091 --> 00:11:59,259
Laid me up so much, I lost my job.

360
00:11:59,260 --> 00:12:00,928
I need to numb the back of your tongue.

361
00:12:00,929 --> 00:12:02,763
This is gonna taste pretty bad.

362
00:12:02,764 --> 00:12:04,181
Is there anyone you'd like us to call?

363
00:12:04,182 --> 00:12:05,390
No.

364
00:12:05,391 --> 00:12:06,934
Any family?

365
00:12:06,935 --> 00:12:09,478
Mm. My parents passed.

366
00:12:09,479 --> 00:12:10,729
I'm single.

367
00:12:10,730 --> 00:12:11,730
Go figure.

368
00:12:11,731 --> 00:12:12,940
Siblings?

369
00:12:12,941 --> 00:12:14,942
Sister in Arizona.

370
00:12:14,943 --> 00:12:17,319
We don't talk much.

371
00:12:17,320 --> 00:12:19,238
Now that we've numbed up
the back of your tongue,

372
00:12:19,239 --> 00:12:22,783
we can anesthetize a bit deeper.

373
00:12:22,784 --> 00:12:23,784
Um, sorry to interrupt.

374
00:12:23,785 --> 00:12:24,785
I have a middle-aged woman

375
00:12:24,786 --> 00:12:26,453
with sudden onset blindness.

376
00:12:26,454 --> 00:12:27,788
- I can go.
- OK.

377
00:12:27,789 --> 00:12:29,081
Will you see if Abbot's still around?

378
00:12:29,082 --> 00:12:30,082
- Yeah.
- Thank you.

379
00:12:30,083 --> 00:12:31,667
What's your sister's name?

380
00:12:31,668 --> 00:12:33,418
Lauren Milford.

381
00:12:33,419 --> 00:12:34,920
Where in Arizona?

382
00:12:34,921 --> 00:12:36,505
Flagstaff, I think.

383
00:12:36,506 --> 00:12:37,714
Just gonna go over your tongue

384
00:12:37,715 --> 00:12:38,966
and numb your vocal cords.

385
00:12:38,967 --> 00:12:39,967
Ah.

386
00:12:39,968 --> 00:12:42,302
Ah...

387
00:12:42,303 --> 00:12:43,470
How many fingers?

388
00:12:43,471 --> 00:12:45,681
I don't see any fingers.

389
00:12:45,682 --> 00:12:47,641
And now?

390
00:12:47,642 --> 00:12:50,185
I can see a little bit of light.

391
00:12:50,186 --> 00:12:51,979
Um, Brooke, you've met Dr. King.

392
00:12:51,980 --> 00:12:53,480
This is Dr. Al-Hashimi.

393
00:12:53,481 --> 00:12:54,815
- Nice to meet you.
- And her wife, Wendy.

394
00:12:54,816 --> 00:12:56,066
- Hello.
- Hello.

395
00:12:56,067 --> 00:12:57,818
OK if we discuss your symptoms?

396
00:12:57,819 --> 00:13:00,028
As long as I can correct you
if you get anything wrong.

397
00:13:00,029 --> 00:13:01,822
Trust me, she will.

398
00:13:01,823 --> 00:13:04,908
One hour of sudden, painless
vision loss in the left eye.

399
00:13:04,909 --> 00:13:06,743
No history of hypercoagulable state

400
00:13:06,744 --> 00:13:08,161
or vascular disease.

401
00:13:08,162 --> 00:13:09,663
Could you look straight ahead, please?

402
00:13:09,664 --> 00:13:12,165
Could be a central
retinal artery occlusion.

403
00:13:12,166 --> 00:13:13,625
In English, please?

404
00:13:13,626 --> 00:13:15,794
A little blood clot can block the artery

405
00:13:15,795 --> 00:13:18,338
at the back of the eye
and decrease your vision.

406
00:13:18,339 --> 00:13:19,965
Sometimes it's called an eye stroke.

407
00:13:19,966 --> 00:13:21,008
Stroke?

408
00:13:21,009 --> 00:13:22,384
Like she could be paralyzed?

409
00:13:22,385 --> 00:13:23,969
No, this would be limited to the eye.

410
00:13:23,970 --> 00:13:25,345
Is it permanent?

411
00:13:25,346 --> 00:13:27,723
First, we have to make the diagnosis.

412
00:13:27,724 --> 00:13:28,974
Retinal exam?

413
00:13:28,975 --> 00:13:30,017
Hard to get a good look.

414
00:13:30,018 --> 00:13:31,560
We need the FOP.

415
00:13:31,561 --> 00:13:33,353
The what?

416
00:13:35,648 --> 00:13:37,357
Oh, Princess.

417
00:13:37,358 --> 00:13:39,359
We need patient stickers
on each of these order sheets,

418
00:13:39,360 --> 00:13:41,445
or the pharmacy won't know
who to give meds to.

419
00:13:41,446 --> 00:13:42,863
We're on it.

420
00:13:42,864 --> 00:13:45,032
Princess, smartphone fundoscope?

421
00:13:45,033 --> 00:13:46,408
Equipment corridor, eye cart.

422
00:13:46,409 --> 00:13:49,536
- Thanks.
- You seem a little confused.

423
00:13:49,537 --> 00:13:51,371
How do I figure out
which new patient to pick up?

424
00:13:51,372 --> 00:13:52,706
Top of the board.

425
00:13:52,707 --> 00:13:53,874
They're listed in the order they arrive.

426
00:13:53,875 --> 00:13:55,125
You erase the first one, then put

427
00:13:55,126 --> 00:13:56,585
your initials in the MD box.

428
00:13:56,586 --> 00:13:58,211
OK. Thanks.

429
00:13:58,212 --> 00:13:59,588
- Caleb.
- Michael.

430
00:13:59,589 --> 00:14:01,423
Are you managing this chaos OK?

431
00:14:01,424 --> 00:14:04,051
Well, it's all pretty easy
when you're a short-timer.

432
00:14:04,052 --> 00:14:06,637
Any more comatose patients
for me to have a chat with?

433
00:14:08,389 --> 00:14:09,723
I'm kidding.

434
00:14:09,724 --> 00:14:11,350
OK.

435
00:14:11,351 --> 00:14:13,018
Victoria, this is Nicole Steadman.

436
00:14:13,019 --> 00:14:14,227
I run the parent support group

437
00:14:14,228 --> 00:14:15,687
for the psychiatric service.

438
00:14:15,688 --> 00:14:17,439
Yeah. Nicole's daughter was diagnosed

439
00:14:17,440 --> 00:14:19,191
sophomore year in college.

440
00:14:19,192 --> 00:14:22,361
You think Jackson's parents
might have a chat with her?

441
00:14:22,362 --> 00:14:24,237
We can certainly ask.

442
00:14:24,238 --> 00:14:25,906
Now we can see the whole retina

443
00:14:25,907 --> 00:14:27,407
without dilating the pupil.

444
00:14:28,576 --> 00:14:30,202
You're looking in the wrong eye.

445
00:14:30,203 --> 00:14:32,412
Oh, we start with
the good eye for comparison.

446
00:14:32,413 --> 00:14:34,539
Oh.

447
00:14:34,540 --> 00:14:35,582
Retina looks great.

448
00:14:35,583 --> 00:14:36,750
Now for the bad eye?

449
00:14:36,751 --> 00:14:38,086
Eyes wide open.

450
00:14:40,463 --> 00:14:41,838
How's it look?

451
00:14:41,839 --> 00:14:43,423
Extremely pale, no blood flow.

452
00:14:43,424 --> 00:14:45,592
Digital massage,
10 seconds on, 5 seconds off.

453
00:14:45,593 --> 00:14:49,012
Order non-contrast head CT.

454
00:14:50,598 --> 00:14:52,682
Come in.

455
00:14:52,683 --> 00:14:53,850
Hi.

456
00:14:53,851 --> 00:14:55,268
Heard your patient took off.

457
00:14:55,269 --> 00:14:56,812
She's taking a little break.

458
00:14:56,813 --> 00:14:59,189
How long are you gonna wait?

459
00:14:59,190 --> 00:15:01,066
You know about the cyber shutdown thing?

460
00:15:01,067 --> 00:15:02,609
Yeah.

461
00:15:02,610 --> 00:15:04,111
Wish I could help, but I gotta stay here

462
00:15:04,112 --> 00:15:05,487
till all the evidence
is collected, so...

463
00:15:05,488 --> 00:15:07,114
It's a hot mess out there.

464
00:15:07,115 --> 00:15:08,490
This whole day is.

465
00:15:09,617 --> 00:15:12,119
Sorry. I was just leaving.

466
00:15:12,120 --> 00:15:14,287
You OK?

467
00:15:14,288 --> 00:15:15,789
I'm good.

468
00:15:15,790 --> 00:15:17,499
I'm glad to hear it.

469
00:15:17,500 --> 00:15:18,583
You get something to eat?

470
00:15:18,584 --> 00:15:21,461
No.

471
00:15:21,462 --> 00:15:23,588
Let's keep going.

472
00:15:23,589 --> 00:15:24,923
OK.

473
00:15:24,924 --> 00:15:25,967
Yeah.

474
00:15:36,436 --> 00:15:38,937
Why don't we keep one in the ER?

475
00:15:38,938 --> 00:15:42,607
Because our intubated
patients are usually sedated.

476
00:15:42,608 --> 00:15:44,067
Right.

477
00:15:44,068 --> 00:15:45,694
Maybe you could ease up

478
00:15:45,695 --> 00:15:47,362
with your comments about his weight.

479
00:15:48,739 --> 00:15:50,699
I was just wondering how he got so big

480
00:15:50,700 --> 00:15:52,367
and how we could help.

481
00:15:52,368 --> 00:15:54,077
We can help by finding out
what's wrong with him

482
00:15:54,078 --> 00:15:55,162
and treating him with respect.

483
00:15:55,163 --> 00:15:56,163
How's your belly now?

484
00:15:56,164 --> 00:15:57,497
Second pain shot helped.

485
00:15:57,498 --> 00:15:59,332
OK. There's more if you need it.

486
00:15:59,333 --> 00:16:00,584
Diminished bowel sounds.

487
00:16:00,585 --> 00:16:01,918
VidaTalk from the ICU.

488
00:16:01,919 --> 00:16:03,503
Great.

489
00:16:03,504 --> 00:16:04,838
Howard, we need to open up
that passageway now

490
00:16:04,839 --> 00:16:06,047
so we can pass the tube.

491
00:16:06,048 --> 00:16:07,674
I'm gonna start with my pinky.

492
00:16:07,675 --> 00:16:09,050
Slowly, over a few minutes,
I'm gonna go deeper,

493
00:16:09,051 --> 00:16:10,510
all the way to the back of my knuckle.

494
00:16:10,511 --> 00:16:12,220
Once the tube's
through your vocal cords,

495
00:16:12,221 --> 00:16:13,722
you won't be able to talk.

496
00:16:13,723 --> 00:16:15,515
But this is a communication device.

497
00:16:15,516 --> 00:16:18,185
Swipe through the screen
for anything you want to say.

498
00:16:18,186 --> 00:16:20,687
Hit the icon, and it talks to us.

499
00:16:20,688 --> 00:16:22,898
<i>I would like some pain medicine.</i>

500
00:16:22,899 --> 00:16:24,733
<i>My pain is a nine.</i>

501
00:16:24,734 --> 00:16:26,401
Can I get it to order a pizza?

502
00:16:28,821 --> 00:16:30,655
There's cell service
in the ambulance bay.

503
00:16:30,656 --> 00:16:33,200
I found his sister's
new number, left a voicemail.

504
00:16:33,201 --> 00:16:34,409
OK, I'm gonna start.

505
00:16:34,410 --> 00:16:35,660
You ready?

506
00:16:35,661 --> 00:16:37,078
Not really.

507
00:16:37,079 --> 00:16:38,079
Go ahead.

508
00:16:38,080 --> 00:16:39,498
Robby, over here.

509
00:16:39,499 --> 00:16:41,709
Here we go. Head back.

510
00:16:43,169 --> 00:16:44,419
You thinking it's surgical?

511
00:16:44,420 --> 00:16:45,879
I'm hoping for a non-perfed appy.

512
00:16:45,880 --> 00:16:47,464
- Can you do it with a scope?
- Possibly,

513
00:16:47,465 --> 00:16:49,132
but he could be treated
with antibiotics alone.

514
00:16:49,133 --> 00:16:51,134
And if he needs surgery?

515
00:16:51,135 --> 00:16:54,137
With his size,
an emergency open laparotomy,

516
00:16:54,138 --> 00:16:56,264
death rate's close to 50%.

517
00:16:56,265 --> 00:16:57,849
OK, one step at a time.

518
00:16:57,850 --> 00:17:00,435
Let's keep trying his sister
every 15 minutes.

519
00:17:00,436 --> 00:17:01,812
She'll get it.

520
00:17:05,691 --> 00:17:08,902
Half the downtime slips are blank.

521
00:17:08,903 --> 00:17:10,946
What are you talking about?

522
00:17:10,947 --> 00:17:13,114
Here and here.

523
00:17:13,115 --> 00:17:15,242
Larry, are you using a felt tip pen?

524
00:17:15,243 --> 00:17:17,536
Maybe.

525
00:17:17,537 --> 00:17:20,789
It's not going through for the copies.

526
00:17:20,790 --> 00:17:22,582
Ballpoint pen only.

527
00:17:22,583 --> 00:17:23,960
OK.

528
00:17:26,379 --> 00:17:27,754
Digby still MIA?

529
00:17:27,755 --> 00:17:28,964
Is that the homeless guy?

530
00:17:28,965 --> 00:17:30,758
We need the bed if he eloped.

531
00:17:32,134 --> 00:17:34,094
- What do you need?
- An attending.

532
00:17:34,095 --> 00:17:35,929
- Or a senior resident?
- Nope, I'm good.

533
00:17:35,930 --> 00:17:38,098
- Dr. Al-Hashimi, can I present?
- Yes.

534
00:17:38,099 --> 00:17:40,725
32-year-old deaf woman
with myofascial headache.

535
00:17:40,726 --> 00:17:42,978
Ibuprofen caused gastritis
and epigastric pain,

536
00:17:42,979 --> 00:17:45,230
and she vasovagalled, but now pain-free

537
00:17:45,231 --> 00:17:47,274
after Mylanta
and a trigger point injection.

538
00:17:47,275 --> 00:17:48,441
Excellent.
That can take care of the pain

539
00:17:48,442 --> 00:17:50,110
- for several months.
- Yeah.

540
00:17:50,111 --> 00:17:52,445
It shouldn't recur if she keeps
her screen at eye level.

541
00:17:52,446 --> 00:17:53,822
There was a delay

542
00:17:53,823 --> 00:17:55,448
in getting an ASL interpreter.

543
00:17:55,449 --> 00:17:57,117
And I almost gave up and ordered

544
00:17:57,118 --> 00:17:59,286
an unnecessary brain and abdominal CT.

545
00:17:59,287 --> 00:18:00,495
Good thing you didn't.

546
00:18:00,496 --> 00:18:03,164
Dr. Al-Hashimi, for you.

547
00:18:03,165 --> 00:18:04,541
Nice job on the trigger point.

548
00:18:04,542 --> 00:18:05,792
Yeah, I know.

549
00:18:05,793 --> 00:18:07,502
How's the T-system going?

550
00:18:07,503 --> 00:18:09,629
- Quick and easy.
- Yeah.

551
00:18:09,630 --> 00:18:11,840
On these MDMs, don't just
circle your diagnosis.

552
00:18:11,841 --> 00:18:13,633
Also put a backslash
through all the ones

553
00:18:13,634 --> 00:18:14,676
that you've ruled out.

554
00:18:14,677 --> 00:18:15,719
No problem.

555
00:18:15,720 --> 00:18:17,387
Thank you very much.

556
00:18:17,388 --> 00:18:19,431
Princess, bump Central 13
to the front of the CT line.

557
00:18:19,432 --> 00:18:20,599
What do you got?

558
00:18:20,600 --> 00:18:21,975
Sudden onset blindness patient

559
00:18:21,976 --> 00:18:23,476
has central retinal artery occlusion.

560
00:18:23,477 --> 00:18:25,145
I just spoke to an ophthalmologist

561
00:18:25,146 --> 00:18:26,771
at the VA, principal investigator

562
00:18:26,772 --> 00:18:28,440
for thrombolytics in cases like this.

563
00:18:28,441 --> 00:18:29,858
Not exactly standard of care.

564
00:18:29,859 --> 00:18:30,942
Kind of risky.

565
00:18:30,943 --> 00:18:32,527
We'll do informed consent.

566
00:18:32,528 --> 00:18:34,426
It's our best shot at saving
some of her vision.

567
00:18:34,427 --> 00:18:35,694
Your patient, your call.

568
00:18:35,695 --> 00:18:38,145
I'm not gonna be around long
enough for any complications.

569
00:18:40,786 --> 00:18:44,497
I'll be taking
two swabs from the vagina,

570
00:18:44,498 --> 00:18:46,500
two swabs from the cervix.

571
00:18:49,837 --> 00:18:52,714
Let me know if you feel any discomfort.

572
00:18:52,715 --> 00:18:54,758
OK.

573
00:18:54,759 --> 00:18:58,928
Each swab gets labeled...
first vaginal, second vaginal.

574
00:18:58,929 --> 00:19:01,222
Smear a slide with both,
and let it air dry.

575
00:19:01,223 --> 00:19:02,432
Same for the cervix?

576
00:19:02,433 --> 00:19:03,433
Yeah.

577
00:19:03,434 --> 00:19:04,769
No slide needed.

578
00:19:06,395 --> 00:19:08,605
How you doing, Ilana?

579
00:19:08,606 --> 00:19:10,690
Hanging in there.

580
00:19:10,691 --> 00:19:12,192
OK.

581
00:19:12,193 --> 00:19:13,611
Almost done.

582
00:19:16,364 --> 00:19:19,199
All these samples go in
the vaginal contact envelope.

583
00:19:19,200 --> 00:19:20,575
- I can help with that.
- No.

584
00:19:20,576 --> 00:19:22,327
It's gotta be me.

585
00:19:22,328 --> 00:19:25,705
I'm gonna pull this out.

586
00:19:25,706 --> 00:19:27,499
OK.

587
00:19:27,500 --> 00:19:28,541
All good here.

588
00:19:28,542 --> 00:19:29,960
Legs can come down.

589
00:19:33,756 --> 00:19:35,715
Are we done?

590
00:19:35,716 --> 00:19:37,050
One last thing.

591
00:19:37,051 --> 00:19:39,511
Four more swabs inside your mouth.

592
00:19:39,512 --> 00:19:41,179
Didn't you do that already?

593
00:19:41,180 --> 00:19:44,224
This one's different...
inside your cheek for your DNA,

594
00:19:44,225 --> 00:19:45,810
not for his.

595
00:19:48,521 --> 00:19:53,942
So it could be bipolar or schizophrenia?

596
00:19:53,943 --> 00:19:56,236
Those are the two
most likely possibilities.

597
00:19:56,237 --> 00:19:57,779
How do they know which it is?

598
00:19:57,780 --> 00:19:59,948
Based on response to medicine,

599
00:19:59,949 --> 00:20:02,575
but also with therapy
and observation on the ward.

600
00:20:02,576 --> 00:20:05,995
They'll monitor his mood
and interactions with others.

601
00:20:07,915 --> 00:20:10,709
Is there a blood test or a brain scan

602
00:20:10,710 --> 00:20:11,751
that will tell us for sure?

603
00:20:11,752 --> 00:20:13,712
Unfortunately not.

604
00:20:13,713 --> 00:20:16,673
When properly medicated,
people with bipolar disorder

605
00:20:16,674 --> 00:20:19,426
can have successful careers.

606
00:20:19,427 --> 00:20:21,302
So we hope for bipolar?

607
00:20:21,303 --> 00:20:23,304
You can hope for your son's happiness.

608
00:20:23,305 --> 00:20:25,932
With early treatment, 20% of people

609
00:20:25,933 --> 00:20:28,727
with schizophrenia have
a complete recovery.

610
00:20:28,728 --> 00:20:30,603
So 80% don't?

611
00:20:30,604 --> 00:20:32,857
This is a new version of Jackson.

612
00:20:35,609 --> 00:20:36,776
How old was your daughter?

613
00:20:36,777 --> 00:20:38,737
20.

614
00:20:38,738 --> 00:20:42,115
Studying architecture at Georgetown.

615
00:20:42,116 --> 00:20:43,825
Schizophrenia.

616
00:20:43,826 --> 00:20:46,077
I'm sorry.

617
00:20:46,078 --> 00:20:47,746
Oh, she's good.

618
00:20:47,747 --> 00:20:52,625
Living at home, working
as a cashier at Giant Eagle.

619
00:20:52,626 --> 00:20:55,044
Employee of the Month.

620
00:20:55,045 --> 00:20:57,297
We still have struggles,

621
00:20:57,298 --> 00:21:00,259
but there's also laughter and love.

622
00:21:07,475 --> 00:21:08,975
Good to go.

623
00:21:08,976 --> 00:21:09,976
How'd that feel?

624
00:21:09,977 --> 00:21:11,519
Very weird.

625
00:21:11,520 --> 00:21:13,605
There's no pain. Just weird.

626
00:21:13,606 --> 00:21:15,899
OK, the next step is,
we're gonna take this tube

627
00:21:15,900 --> 00:21:17,901
and pass it through your nose,

628
00:21:17,902 --> 00:21:20,403
stopping at the back of your tongue.

629
00:21:20,404 --> 00:21:22,280
Best not to talk for that.

630
00:21:22,281 --> 00:21:25,950
Tube's soaking in warm water
to make it more flexible.

631
00:21:25,951 --> 00:21:28,661
Do you wanna try it?

632
00:21:28,662 --> 00:21:30,497
<i>What day and time is it?</i>

633
00:21:30,498 --> 00:21:32,874
4th of July, 2:31 p.m.

634
00:21:32,875 --> 00:21:34,834
<i>When is my tube coming out?</i>

635
00:21:34,835 --> 00:21:37,670
We have to put it in first.

636
00:21:37,671 --> 00:21:38,671
<i>I know.</i>

637
00:21:38,672 --> 00:21:40,340
<i>Just practicing.</i>

638
00:21:40,341 --> 00:21:43,676
Sounds like you're an expert already.

639
00:21:43,677 --> 00:21:46,721
Before I can't talk,

640
00:21:46,722 --> 00:21:49,516
I just wanna say

641
00:21:49,517 --> 00:21:52,977
thank you for everything.

642
00:21:52,978 --> 00:21:55,022
You're very welcome.

643
00:22:00,778 --> 00:22:02,196
Here we go.

644
00:22:06,867 --> 00:22:08,284
STI prevention.

645
00:22:08,285 --> 00:22:09,911
One shot treats gonorrhea,

646
00:22:09,912 --> 00:22:12,288
then pills for chlamydia
and trichomonas.

647
00:22:12,289 --> 00:22:13,832
Thank you.

648
00:22:13,833 --> 00:22:15,625
We also have
morning-after contraception.

649
00:22:15,626 --> 00:22:16,709
She has an IUD.

650
00:22:16,710 --> 00:22:19,254
Over 99% effective, not 100%.

651
00:22:19,255 --> 00:22:20,797
We still offer.

652
00:22:20,798 --> 00:22:22,382
I'll pass.

653
00:22:22,383 --> 00:22:25,885
For HIV, we got PEP,
Post-Exposure Prophylaxis.

654
00:22:25,886 --> 00:22:27,345
28 days.

655
00:22:27,346 --> 00:22:30,598
The sooner you start,
the more effective.

656
00:22:30,599 --> 00:22:32,392
Emma, I'm pretty sure they could use

657
00:22:32,393 --> 00:22:35,562
an extra set of hands out there.

658
00:22:35,563 --> 00:22:38,022
It's nice to meet you, Ilana.

659
00:22:38,023 --> 00:22:39,399
You're a very brave woman.

660
00:22:39,400 --> 00:22:40,484
Yeah.

661
00:22:47,575 --> 00:22:49,075
She's a good nurse.

662
00:22:49,076 --> 00:22:53,580
She's still learning, but she will be.

663
00:22:53,581 --> 00:22:55,540
After this, we're done?

664
00:22:55,541 --> 00:22:57,250
Yeah.

665
00:23:00,421 --> 00:23:02,631
I'm glad you were here today.

666
00:23:07,094 --> 00:23:09,762
Me too.

667
00:23:09,763 --> 00:23:12,807
We have a decision to make.

668
00:23:12,808 --> 00:23:14,809
Studies have shown that some vision

669
00:23:14,810 --> 00:23:17,604
can be restored
with a clot-busting medication.

670
00:23:17,605 --> 00:23:19,022
So give it.

671
00:23:19,023 --> 00:23:21,190
But there are possible risks.

672
00:23:21,191 --> 00:23:25,778
For eye stroke, only 17% get
better without any treatment.

673
00:23:25,779 --> 00:23:27,780
- Only 17%?
- Yes.

674
00:23:27,781 --> 00:23:32,118
But with the medicine,
another 20% can improve.

675
00:23:32,119 --> 00:23:34,621
But there can be complications.

676
00:23:34,622 --> 00:23:38,291
2% of patients who receive
the medication get worse,

677
00:23:38,292 --> 00:23:43,130
and 1% have severe disability or death.

678
00:23:48,636 --> 00:23:52,222
Honey, this one has to be your call.

679
00:23:53,474 --> 00:23:56,768
No, it's our call.

680
00:23:56,769 --> 00:23:58,645
What would you do without me?

681
00:23:58,646 --> 00:24:00,814
I'd figure out how to get by.

682
00:24:02,691 --> 00:24:05,693
And I'd probably cry
for two years solid.

683
00:24:05,694 --> 00:24:08,155
Two years? That's all?

684
00:24:09,365 --> 00:24:10,823
I want the medication.

685
00:24:10,824 --> 00:24:12,743
OK.

686
00:24:16,246 --> 00:24:18,247
<i>OK, we need your full name
to make a chart.</i>

687
00:24:18,248 --> 00:24:20,333
Jackie Liddell.

688
00:24:20,334 --> 00:24:22,001
Jackie Liddell.

689
00:24:22,002 --> 00:24:23,044
And you are?

690
00:24:23,045 --> 00:24:24,504
Her friend Jaquie.

691
00:24:24,505 --> 00:24:26,381
- You have the same name?
- No, no.

692
00:24:26,382 --> 00:24:28,591
She's Jackie with a C-K.
I'm Jaquie with a Q.

693
00:24:28,592 --> 00:24:30,385
You can call me CK.

694
00:24:30,386 --> 00:24:31,511
Oh.

695
00:24:31,512 --> 00:24:32,845
Best not to talk, CK, OK?

696
00:24:32,846 --> 00:24:34,347
- Just chill.
- Chill?

697
00:24:34,348 --> 00:24:37,684
- Q, I bit off half my tongue!
- What?

698
00:24:37,685 --> 00:24:39,519
She said, I bit off half my tongue.

699
00:24:39,520 --> 00:24:40,853
You can understand that?

700
00:24:40,854 --> 00:24:42,522
Oh, you should hear her when she's had

701
00:24:42,523 --> 00:24:44,482
two pitchers of margaritas,
fucked up and slurring.

702
00:24:44,483 --> 00:24:47,026
Ooh, you are such an idiot!

703
00:24:47,027 --> 00:24:48,653
Princess, what's open?

704
00:24:48,654 --> 00:24:50,363
South 15's clean.

705
00:24:50,364 --> 00:24:51,906
Deep tongue laceration.

706
00:24:51,907 --> 00:24:54,659
I can jump on this.

707
00:24:54,660 --> 00:24:57,578
Robby and Al-Hashimi are
both with critical patients.

708
00:24:57,579 --> 00:24:58,913
Hello.

709
00:24:58,914 --> 00:25:00,206
I'm Dr. Langdon.

710
00:25:00,207 --> 00:25:01,959
I'll be supervising your care.

711
00:25:03,961 --> 00:25:06,629
Jesus, CK, your doctor's fucking hot.

712
00:25:09,466 --> 00:25:11,884
Tube's at 14 centimeters,
just above the airway.

713
00:25:11,885 --> 00:25:14,262
OK, Howard, I'm going to start.

714
00:25:14,263 --> 00:25:18,433
If you want me to stop,
you just put your hand up, OK?

715
00:25:18,434 --> 00:25:21,061
Blue mark tells me I'm in the tube.

716
00:25:24,440 --> 00:25:26,607
Looks like he cleared it.

717
00:25:26,608 --> 00:25:29,235
If he inhales, we should see chords.

718
00:25:29,236 --> 00:25:31,571
OK, deep breath for me, Howard.

719
00:25:34,283 --> 00:25:36,743
- OK.
- Beautiful.

720
00:25:36,744 --> 00:25:38,411
Chords are sensitive,
so we spray lidocaine

721
00:25:38,412 --> 00:25:40,872
- in the scope.
- OK.

722
00:25:40,873 --> 00:25:44,417
1 cc going in now.

723
00:25:44,418 --> 00:25:47,086
And we'll just give that
a second to work.

724
00:25:47,087 --> 00:25:48,589
How you doing, Howard?

725
00:25:49,882 --> 00:25:51,758
Once the tube's in,
you'll have to breathe

726
00:25:51,759 --> 00:25:53,092
through your nose.

727
00:25:53,093 --> 00:25:54,469
OK, Howard, hold still.

728
00:25:54,470 --> 00:25:57,972
I am now going in past your vocal cords

729
00:25:57,973 --> 00:26:00,517
until we see the carina.

730
00:26:02,102 --> 00:26:03,770
Ogilvie.

731
00:26:03,771 --> 00:26:04,979
Uh, there.

732
00:26:04,980 --> 00:26:06,105
Right and left mainstem.

733
00:26:06,106 --> 00:26:08,901
And the tube slides in.

734
00:26:12,780 --> 00:26:16,033
And then the scope comes out.

735
00:26:17,826 --> 00:26:19,452
Great.

736
00:26:19,453 --> 00:26:20,787
OK, inflate the balloon.

737
00:26:20,788 --> 00:26:22,163
Deep breath through your nose.

738
00:26:22,164 --> 00:26:23,372
Amazing.

739
00:26:23,373 --> 00:26:25,500
You good?

740
00:26:25,501 --> 00:26:27,126
Great end-tidal waveform.

741
00:26:27,127 --> 00:26:28,377
Does he need a vent?

742
00:26:28,378 --> 00:26:29,629
He's breathing on his own,

743
00:26:29,630 --> 00:26:31,005
but a little CPAP wouldn't hurt.

744
00:26:31,006 --> 00:26:33,216
Starting at 5, titrate to 10.

745
00:26:33,217 --> 00:26:35,218
OK, that went really well, Howard.

746
00:26:35,219 --> 00:26:36,970
Now we're going to check your weight.

747
00:26:38,931 --> 00:26:40,515
So the nurse examiner is supposed

748
00:26:40,516 --> 00:26:42,433
to lock up the rape kit in this fridge,

749
00:26:42,434 --> 00:26:45,603
where it stays until it gets
turned over to law enforcement.

750
00:26:45,604 --> 00:26:48,314
It's called preserving
the chain of evidence.

751
00:26:48,315 --> 00:26:50,608
Are you fucking kidding me?

752
00:26:50,609 --> 00:26:52,485
Is there a problem?

753
00:26:52,486 --> 00:26:54,779
Jesus Christ.

754
00:26:54,780 --> 00:26:57,824
Police are supposed to pick up
the rape kits within 72 hours.

755
00:26:57,825 --> 00:27:00,827
This one I did two weeks ago.

756
00:27:00,828 --> 00:27:02,329
God damn it.

757
00:27:04,498 --> 00:27:06,791
So how exactly did this happen?

758
00:27:06,792 --> 00:27:09,669
We were in between pubs taking a selfie.

759
00:27:09,670 --> 00:27:10,711
Very nice.

760
00:27:10,712 --> 00:27:13,172
Until she jerked her head up.

761
00:27:13,173 --> 00:27:14,674
Ooh.

762
00:27:14,675 --> 00:27:16,008
Ouch.

763
00:27:16,009 --> 00:27:17,677
OK, topical epi did the trick.

764
00:27:17,678 --> 00:27:19,053
- No more bleeding.
- Sweet.

765
00:27:19,054 --> 00:27:20,429
I can go home now?

766
00:27:20,430 --> 00:27:22,348
I don't think so.

767
00:27:22,349 --> 00:27:23,891
It looks like the Grand Canyon
across the back of your tongue.

768
00:27:23,892 --> 00:27:25,893
We need to put in some stitches.

769
00:27:25,894 --> 00:27:26,894
I don't want stitches.

770
00:27:26,895 --> 00:27:29,021
Oh. Listen to the doctor.

771
00:27:29,022 --> 00:27:30,731
Don't tell me what to do.

772
00:27:30,732 --> 00:27:32,233
This is all your fault.

773
00:27:32,234 --> 00:27:34,277
- No, it's not.
- Uh, yes, it is.

774
00:27:34,278 --> 00:27:35,945
- Uh, Princess.
- No, it's not.

775
00:27:35,946 --> 00:27:37,530
Princess, hey, why don't you show Q

776
00:27:37,531 --> 00:27:39,365
where she can wait
while we patch up her friend?

777
00:27:39,366 --> 00:27:40,867
Of course.

778
00:27:40,868 --> 00:27:43,035
OK, this is a numbing shot for the tip.

779
00:27:43,036 --> 00:27:44,036
The tip?

780
00:27:44,037 --> 00:27:45,997
That's not where I bit it.

781
00:27:45,998 --> 00:27:47,416
One step at a time.

782
00:27:54,590 --> 00:27:57,008
That's 20 migs of TNK.

783
00:27:57,009 --> 00:28:00,052
In at 14:39.

784
00:28:00,053 --> 00:28:02,346
Feeling anything?

785
00:28:02,347 --> 00:28:03,431
Not yet.

786
00:28:03,432 --> 00:28:06,350
Could take an hour or two.

787
00:28:06,351 --> 00:28:07,852
We're going to move you to another room

788
00:28:07,853 --> 00:28:09,729
for better monitoring.

789
00:28:09,730 --> 00:28:11,273
Dr. King.

790
00:28:14,067 --> 00:28:17,486
I'd like you to stay with her.

791
00:28:17,487 --> 00:28:18,821
Why?

792
00:28:18,822 --> 00:28:20,448
In case there are complications.

793
00:28:20,449 --> 00:28:22,241
You'll be there to respond quickly

794
00:28:22,242 --> 00:28:25,119
to a blown pupil, a seizure,
altered mental status.

795
00:28:25,120 --> 00:28:27,163
Or I could catch up on my charts.

796
00:28:27,164 --> 00:28:29,081
And my deposition's coming up.

797
00:28:29,082 --> 00:28:31,584
Think of this as a great way
to steal some quiet time

798
00:28:31,585 --> 00:28:32,919
and get mentally prepared.

799
00:28:32,920 --> 00:28:35,130
Jesse, Mel's with you.

800
00:28:36,924 --> 00:28:38,925
Oh, excuse me, Dr. Mohan.

801
00:28:38,926 --> 00:28:40,009
Excuse me.

802
00:28:40,010 --> 00:28:41,010
Dr. Mohan.

803
00:28:41,011 --> 00:28:42,428
Uh, in a minute, George.

804
00:28:42,429 --> 00:28:43,554
I've got this.

805
00:28:43,555 --> 00:28:44,764
Thank you.

806
00:28:44,765 --> 00:28:47,099
Oh, uh, I, um...

807
00:28:47,100 --> 00:28:49,268
D-dimer is back normal.

808
00:28:49,269 --> 00:28:50,269
Oh.

809
00:28:50,270 --> 00:28:51,604
I'm ready to go.

810
00:28:51,605 --> 00:28:53,439
Are you feeling better?

811
00:28:53,440 --> 00:28:57,152
I... I really wasn't
short of breath this time.

812
00:28:58,278 --> 00:28:59,987
Then why'd you come in?

813
00:29:01,490 --> 00:29:03,574
When I found out about
the blood clot in my leg,

814
00:29:03,575 --> 00:29:06,452
I just kept thinking it's gonna
go to my lung and kill me.

815
00:29:06,453 --> 00:29:09,622
We've talked before about how
the Eliquis would prevent that.

816
00:29:09,623 --> 00:29:12,333
I know.

817
00:29:12,334 --> 00:29:14,710
Well, I finally took your advice.

818
00:29:14,711 --> 00:29:17,171
I got out of the house, and I joined

819
00:29:17,172 --> 00:29:19,131
the Frick Park Lawn Bowling Club.

820
00:29:19,132 --> 00:29:20,383
Wonderful.

821
00:29:20,384 --> 00:29:21,509
Yeah.

822
00:29:21,510 --> 00:29:23,344
I mean, you're right, you know?

823
00:29:23,345 --> 00:29:25,347
We all need a community.

824
00:29:29,351 --> 00:29:30,810
You're gonna do what?

825
00:29:30,811 --> 00:29:32,478
In order to fix your tongue,

826
00:29:32,479 --> 00:29:35,022
we need to move it forward
to access the laceration.

827
00:29:35,023 --> 00:29:36,649
You're just gonna feel some pulling, OK?

828
00:29:36,650 --> 00:29:40,027
I guess so.

829
00:29:40,028 --> 00:29:42,738
Go for it.

830
00:29:42,739 --> 00:29:44,156
What size suture is that?

831
00:29:44,157 --> 00:29:47,952
O-silk, the biggest one we got.

832
00:29:47,953 --> 00:29:50,831
As soon as I cut the needle,
you're on traction, Joy.

833
00:29:59,631 --> 00:30:01,173
Oh.

834
00:30:01,174 --> 00:30:03,342
That is pretty deep.

835
00:30:03,343 --> 00:30:04,969
And now we can numb up the cut.

836
00:30:04,970 --> 00:30:06,304
It's best to start with...

837
00:30:06,305 --> 00:30:07,680
Proximal side first so she doesn't

838
00:30:07,681 --> 00:30:10,891
feel the distal injection.

839
00:30:10,892 --> 00:30:11,892
Give it ten minutes.

840
00:30:11,893 --> 00:30:13,437
I'll be back for the repair.

841
00:30:17,607 --> 00:30:19,525
I got a rape kit
sitting here for two weeks

842
00:30:19,526 --> 00:30:22,028
that was supposed to be
picked up within 72 hours.

843
00:30:22,029 --> 00:30:23,070
I don't care!

844
00:30:23,071 --> 00:30:25,114
Get someone over here now! No.

845
00:30:25,115 --> 00:30:26,615
You expect us to treat your officers

846
00:30:26,616 --> 00:30:28,242
as soon as they come in,

847
00:30:28,243 --> 00:30:30,077
you get a detective
to pick these kits up ASAP.

848
00:30:30,078 --> 00:30:31,078
I gotta go.

849
00:30:31,079 --> 00:30:32,705
- Dana...
- Hey, Dana.

850
00:30:32,706 --> 00:30:33,873
South 19 got their head CT
before we went down.

851
00:30:33,874 --> 00:30:35,207
No results yet.

852
00:30:35,208 --> 00:30:36,375
All right, I'll send a reminder.

853
00:30:36,376 --> 00:30:37,376
- Hey, Dana.
- Dana.

854
00:30:37,377 --> 00:30:38,754
Hang on.

855
00:30:39,755 --> 00:30:41,547
What's up?

856
00:30:41,548 --> 00:30:43,466
We put in an order
for more pain meds for Roxie.

857
00:30:43,467 --> 00:30:45,551
All right, so put it
in the nursing racks.

858
00:30:45,552 --> 00:30:48,220
Oh, I did, a long time ago.

859
00:30:48,221 --> 00:30:50,056
All right. I'll bump it to the front.

860
00:30:50,057 --> 00:30:51,599
Thank you.

861
00:30:51,600 --> 00:30:53,351
Uh, what's that noise?

862
00:30:53,352 --> 00:30:54,393
UFO landed.

863
00:30:54,394 --> 00:30:55,394
Aliens are invading.

864
00:30:55,395 --> 00:30:56,896
Hey, Dana.

865
00:30:56,897 --> 00:30:58,773
Chem 7's not back on Trauma 2 yet.

866
00:30:58,774 --> 00:31:01,067
Let me see the chart.

867
00:31:01,068 --> 00:31:02,610
Oh, Jesus.

868
00:31:02,611 --> 00:31:04,195
I bet your Chem 7 rec went to Radiology.

869
00:31:04,196 --> 00:31:06,030
Larry, Antoine.

870
00:31:06,031 --> 00:31:08,532
You put labs and chest X-ray
on the same downtime form.

871
00:31:08,533 --> 00:31:10,785
You need two slips... one
for labs, one for radiology.

872
00:31:10,786 --> 00:31:12,453
- Got it.
- Won't happen again.

873
00:31:12,454 --> 00:31:13,579
I'll run it down myself.

874
00:31:13,580 --> 00:31:15,289
Use the iStat at bedside.

875
00:31:15,290 --> 00:31:16,749
They won't take him to CT
without a creatinine.

876
00:31:16,750 --> 00:31:17,917
Oh, perfect.

877
00:31:17,918 --> 00:31:19,085
Nice to have you back.

878
00:31:19,086 --> 00:31:20,336
Thrilled to be here.

879
00:31:20,337 --> 00:31:21,462
You trying to text?

880
00:31:21,463 --> 00:31:23,005
I am just composing.

881
00:31:23,006 --> 00:31:24,590
I'm gonna send it from the bay.

882
00:31:24,591 --> 00:31:26,801
My mechanic friend, Duke,
never showed up.

883
00:31:26,802 --> 00:31:28,344
I thought he was coming in this morning.

884
00:31:28,345 --> 00:31:29,595
That was the plan.

885
00:31:29,596 --> 00:31:31,847
I guess he got busy.

886
00:31:31,848 --> 00:31:33,099
What if he's a no-show?

887
00:31:33,100 --> 00:31:34,683
Tell me what he needs.

888
00:31:34,684 --> 00:31:35,768
I'll pass it on to the night shift.

889
00:31:35,769 --> 00:31:36,769
That won't be necessary.

890
00:31:39,523 --> 00:31:41,357
Oh, Princess.

891
00:31:41,358 --> 00:31:42,441
Ask and you shall receive.

892
00:31:42,442 --> 00:31:43,609
Normal head CT.

893
00:31:43,610 --> 00:31:45,945
Thanks. I'll get him discharged.

894
00:31:45,946 --> 00:31:47,780
How's your day going?

895
00:31:47,781 --> 00:31:50,282
I think I'm getting writer's cramp.

896
00:31:50,283 --> 00:31:51,617
You with the big guy?

897
00:31:51,618 --> 00:31:53,911
Yeah. It's sad.

898
00:31:53,912 --> 00:31:57,790
Bad car accident, multiple
operations, tons of stress.

899
00:31:59,793 --> 00:32:01,669
Lidocaine shot to a sensitive area.

900
00:32:01,670 --> 00:32:03,462
I got a binge-drinking
party girl with a tongue lac.

901
00:32:03,463 --> 00:32:04,797
Mm.

902
00:32:04,798 --> 00:32:06,006
Sounds like she needs some help.

903
00:32:06,007 --> 00:32:08,759
In more ways than one.

904
00:32:08,760 --> 00:32:12,471
How's, uh... how's
your first shift back going?

905
00:32:12,472 --> 00:32:14,640
One day at a time.

906
00:32:14,641 --> 00:32:16,267
First year sober is the hardest.

907
00:32:16,268 --> 00:32:17,476
That's what they keep telling me.

908
00:32:17,477 --> 00:32:20,147
I'm nine years and counting.

909
00:32:22,524 --> 00:32:24,150
Oh.

910
00:32:24,151 --> 00:32:27,653
Special delivery for my guy.

911
00:32:27,654 --> 00:32:29,655
If you, um... if you
need anything, call me.

912
00:32:29,656 --> 00:32:31,241
Thanks.

913
00:32:37,205 --> 00:32:38,831
Where are you going?

914
00:32:38,832 --> 00:32:40,207
Blisters in North 3.

915
00:32:40,208 --> 00:32:41,709
That's where I'm going.

916
00:32:41,710 --> 00:32:43,586
Did you sign up for the patient?

917
00:32:43,587 --> 00:32:45,379
I pulled the chart from the rack.

918
00:32:45,380 --> 00:32:47,131
You're supposed to sign up
on the dry-erase board.

919
00:32:47,132 --> 00:32:49,008
You're supposed to have
a clipboard for the patient.

920
00:32:49,009 --> 00:32:50,843
I thought the nurses had that.

921
00:32:50,844 --> 00:32:52,470
Whatever.

922
00:32:52,471 --> 00:32:53,554
Hi.

923
00:32:53,555 --> 00:32:55,014
I'm Student Doctor Ogilvie.

924
00:32:55,015 --> 00:32:57,183
And this is... wow.

925
00:32:57,184 --> 00:32:58,642
That is some rash.

926
00:32:58,643 --> 00:33:01,520
- Yeah. Tell me about it.
- Student Doctor Javadi.

927
00:33:01,521 --> 00:33:03,731
- When did this start?
- Last night.

928
00:33:03,732 --> 00:33:05,316
And have you been on any hikes recently

929
00:33:05,317 --> 00:33:06,400
around poison ivy?

930
00:33:06,401 --> 00:33:08,360
Nope. Haven't left the house.

931
00:33:08,361 --> 00:33:11,363
What about new medications,
lotions, soaps,

932
00:33:11,364 --> 00:33:12,364
detergents, even?

933
00:33:12,365 --> 00:33:13,657
I don't take medicine.

934
00:33:13,658 --> 00:33:15,326
Nothing new with all that other stuff.

935
00:33:15,327 --> 00:33:16,368
Uh-huh. And where did this start?

936
00:33:16,369 --> 00:33:17,828
Everywhere, all at once.

937
00:33:17,829 --> 00:33:21,165
Just a lot of pain, really itchy.

938
00:33:21,166 --> 00:33:22,875
What is it?

939
00:33:22,876 --> 00:33:24,376
I'm not sure yet.

940
00:33:24,377 --> 00:33:27,087
Um, be back in a second.

941
00:33:27,088 --> 00:33:28,714
Can't... will you...

942
00:33:32,886 --> 00:33:34,929
What are you thinking?

943
00:33:34,930 --> 00:33:36,055
I have no idea.

944
00:33:36,056 --> 00:33:37,224
Agreed.

945
00:33:39,059 --> 00:33:40,643
Bullous pemphigoid?

946
00:33:40,644 --> 00:33:42,394
Autoimmune severe pruritis?

947
00:33:42,395 --> 00:33:43,979
Yeah, but not as deadly
as pemphigus vulgaris.

948
00:33:43,980 --> 00:33:45,981
Untreated, the death rate is over 90%.

949
00:33:45,982 --> 00:33:47,399
We need to check for pustules,

950
00:33:47,400 --> 00:33:48,567
mucous membrane involvement...

951
00:33:48,568 --> 00:33:49,945
And the Nikolsky sign.

952
00:33:52,405 --> 00:33:53,823
Here you go.

953
00:33:55,283 --> 00:33:56,408
What?

954
00:33:56,409 --> 00:33:57,953
For your progress note.

955
00:33:59,287 --> 00:34:02,289
Did I hear we're making progress?

956
00:34:02,290 --> 00:34:04,583
Oh, um, it's just what we call it

957
00:34:04,584 --> 00:34:07,754
when we write down things
to describe a clinical course.

958
00:34:09,256 --> 00:34:10,256
Any changes?

959
00:34:11,258 --> 00:34:12,591
Not so far.

960
00:34:12,592 --> 00:34:14,927
It's time for the next neuro check.

961
00:34:14,928 --> 00:34:17,221
Excuse me, Dr. King,
do you have a minute?

962
00:34:17,222 --> 00:34:18,806
Um, no.

963
00:34:18,807 --> 00:34:20,599
I'm observing a patient right now.

964
00:34:20,600 --> 00:34:22,978
60 seconds tops.

965
00:34:24,396 --> 00:34:25,771
I'll check pupils.

966
00:34:25,772 --> 00:34:27,315
We're good here.

967
00:34:32,946 --> 00:34:34,863
Hey.

968
00:34:34,864 --> 00:34:37,199
I just finished my deposition.

969
00:34:37,200 --> 00:34:39,660
Oh, should I go up now?

970
00:34:39,661 --> 00:34:41,370
Yeah. Just wait until you get a call.

971
00:34:41,371 --> 00:34:42,788
OK.

972
00:34:42,789 --> 00:34:44,206
Well, I'd ask how it went,

973
00:34:44,207 --> 00:34:46,292
but we're not supposed
to discuss the case.

974
00:34:46,293 --> 00:34:47,793
This isn't a discussion.

975
00:34:47,794 --> 00:34:51,005
It's a monologue, so shut up and listen.

976
00:34:51,006 --> 00:34:53,215
The malpractice case is frivolous.

977
00:34:53,216 --> 00:34:54,800
The mother of the measles kid claims

978
00:34:54,801 --> 00:34:56,176
we caused intellectual decline

979
00:34:56,177 --> 00:34:58,262
by performing a spinal tap.

980
00:34:58,263 --> 00:35:01,473
But the tap was perfect
with no complications.

981
00:35:01,474 --> 00:35:03,267
Her son presented
with altered mental status

982
00:35:03,268 --> 00:35:06,687
due to low oxygen
from measles pneumonia.

983
00:35:06,688 --> 00:35:09,148
Any change in intellect was
due to hypoxic brain injury.

984
00:35:09,149 --> 00:35:12,818
It had nothing to do
with your spinal tap.

985
00:35:12,819 --> 00:35:14,528
End of monologue.

986
00:35:14,529 --> 00:35:17,323
We never discussed the case.

987
00:35:17,324 --> 00:35:19,658
I gotta get some sleep.

988
00:35:19,659 --> 00:35:22,912
Thanks, I guess.

989
00:35:24,539 --> 00:35:26,832
OK, are you ready to lay down?

990
00:35:26,833 --> 00:35:27,833
I got your head.

991
00:35:27,834 --> 00:35:29,043
Nice and slow.

992
00:35:29,044 --> 00:35:31,212
One, two, three.

993
00:35:32,589 --> 00:35:33,589
OK.

994
00:35:33,590 --> 00:35:34,716
How's that feel?

995
00:35:37,594 --> 00:35:38,844
Lifting up now.

996
00:35:48,730 --> 00:35:50,398
Keep going.

997
00:35:53,026 --> 00:35:56,279
And... that ought to do it
right about there.

998
00:35:58,031 --> 00:35:59,865
215?

999
00:35:59,866 --> 00:36:01,785
Oh, that's in kilos.

1000
00:36:04,079 --> 00:36:05,705
OK, team.

1001
00:36:11,336 --> 00:36:13,045
It's not that much over 450.

1002
00:36:13,046 --> 00:36:15,881
No, we can't risk breaking
our CT on a holiday weekend.

1003
00:36:15,882 --> 00:36:18,008
Would the medics take him
while he's intubated?

1004
00:36:18,009 --> 00:36:20,386
If I go along for the ride,
I could still get a nap in

1005
00:36:20,387 --> 00:36:21,930
before my night shift.

1006
00:36:25,892 --> 00:36:28,852
474.

1007
00:36:28,853 --> 00:36:30,729
Our CT can't handle your weight,

1008
00:36:30,730 --> 00:36:34,108
but we're gonna take you over
to Presbyterian Hospital.

1009
00:36:34,109 --> 00:36:36,068
<i>Road trip.</i>

1010
00:36:36,069 --> 00:36:38,363
I'll keep you company the whole time.

1011
00:36:40,907 --> 00:36:42,950
<i>Sorry for all this trouble.</i>

1012
00:36:42,951 --> 00:36:44,159
It's OK.

1013
00:36:44,160 --> 00:36:45,620
This is what we do.

1014
00:36:51,084 --> 00:36:52,668
So sub Q starts deep.

1015
00:36:52,669 --> 00:36:53,794
You want to bury the knot.

1016
00:36:53,795 --> 00:36:55,337
Yeah, I've done these before.

1017
00:36:55,338 --> 00:36:57,631
Joy, how do we cut the ends?

1018
00:36:57,632 --> 00:36:59,174
Short. Slide to the knot.

1019
00:36:59,175 --> 00:37:00,175
Turn 45 degrees.

1020
00:37:00,176 --> 00:37:02,302
Excellent.

1021
00:37:02,303 --> 00:37:04,138
Um, Dr. Langdon, we have a case.

1022
00:37:04,139 --> 00:37:05,139
It'll have to wait.

1023
00:37:05,140 --> 00:37:06,265
It could be urgent.

1024
00:37:06,266 --> 00:37:10,102
Find Robby or Al-Hashimi.

1025
00:37:10,103 --> 00:37:12,438
This girl is wasted.

1026
00:37:12,439 --> 00:37:14,481
Drunk as a skunk.

1027
00:37:14,482 --> 00:37:16,275
Should we check her blood alcohol level?

1028
00:37:16,276 --> 00:37:17,901
No, it won't change what we do.

1029
00:37:17,902 --> 00:37:19,445
She can go home
when she has a steady gait.

1030
00:37:19,446 --> 00:37:21,613
I already sent one off.

1031
00:37:21,614 --> 00:37:24,283
Joy, do you want to guess
her blood alcohol?

1032
00:37:24,284 --> 00:37:25,784
Why would I want to do that?

1033
00:37:25,785 --> 00:37:27,871
I don't know. 'Cause it's fun.

1034
00:37:33,835 --> 00:37:35,502
When will you have a bed?

1035
00:37:35,503 --> 00:37:37,337
I'm not sure she needs a bed.

1036
00:37:37,338 --> 00:37:39,131
She's a febrile infant.

1037
00:37:39,132 --> 00:37:41,133
Who is clearly over a month
old and looks amazing.

1038
00:37:41,134 --> 00:37:43,051
Every marker is normal.
She has a cold virus.

1039
00:37:43,052 --> 00:37:44,803
Infants with rhinovirus can still have

1040
00:37:44,804 --> 00:37:46,221
a serious bacterial infection.

1041
00:37:46,222 --> 00:37:47,723
Not this one.

1042
00:37:47,724 --> 00:37:49,349
We send kids like this home
all the time.

1043
00:37:49,350 --> 00:37:52,353
Except this one doesn't have
a home or a parent.

1044
00:37:53,688 --> 00:37:55,230
All right.

1045
00:37:55,231 --> 00:37:56,982
I can't put a kid
with a virus in the nursery,

1046
00:37:56,983 --> 00:37:59,234
and I can't waste a private
room on a healthy baby.

1047
00:37:59,235 --> 00:38:00,652
Then what do you propose?

1048
00:38:00,653 --> 00:38:02,654
CYF can place her
in emergency foster care

1049
00:38:02,655 --> 00:38:04,156
by tomorrow morning.

1050
00:38:04,157 --> 00:38:06,366
You want to leave her
down here overnight?

1051
00:38:06,367 --> 00:38:08,786
Seems to be the standard
of care these days.

1052
00:38:08,787 --> 00:38:10,120
Have your attending give me a call.

1053
00:38:10,121 --> 00:38:11,163
Will do.

1054
00:38:11,164 --> 00:38:12,498
I can't believe this.

1055
00:38:12,499 --> 00:38:14,291
Let CYF know it's very urgent.

1056
00:38:14,292 --> 00:38:15,793
Got it.

1057
00:38:15,794 --> 00:38:18,337
This is turning into quite the day.

1058
00:38:18,338 --> 00:38:20,214
You know, I've been thinking

1059
00:38:20,215 --> 00:38:21,799
about applying for a fellowship.

1060
00:38:21,800 --> 00:38:23,717
I thought you had a job
lined up in New Jersey.

1061
00:38:23,718 --> 00:38:25,844
I did, to be close to my mom.

1062
00:38:25,845 --> 00:38:29,389
But she sold her house
to travel the world

1063
00:38:29,390 --> 00:38:31,391
with her new boyfriend.

1064
00:38:31,392 --> 00:38:33,227
So what's the point of New Jersey?

1065
00:38:33,228 --> 00:38:34,686
Yeah, good question.

1066
00:38:34,687 --> 00:38:36,271
Which fellowship?

1067
00:38:36,272 --> 00:38:40,025
I've narrowed it down
to ultrasound, toxicology,

1068
00:38:40,026 --> 00:38:43,237
and sports medicine.

1069
00:38:43,238 --> 00:38:44,613
Those are very disparate fields

1070
00:38:44,614 --> 00:38:46,114
leading to very different careers.

1071
00:38:46,115 --> 00:38:47,282
I know.

1072
00:38:47,283 --> 00:38:49,368
I'm a little undecided.

1073
00:38:49,369 --> 00:38:50,994
Do you have research experience?

1074
00:38:50,995 --> 00:38:53,580
I was a part of a study
on racial disparities

1075
00:38:53,581 --> 00:38:55,457
in health care until the White House

1076
00:38:55,458 --> 00:38:57,042
cut the funding last year.

1077
00:38:57,043 --> 00:38:59,419
Yeah. You are not alone.

1078
00:38:59,420 --> 00:39:02,381
Have you considered
a geriatrics fellowship?

1079
00:39:02,382 --> 00:39:04,258
I have not.

1080
00:39:04,259 --> 00:39:06,385
I've seen your skills with the elderly,

1081
00:39:06,386 --> 00:39:08,554
and there are a lot of openings.

1082
00:39:08,555 --> 00:39:10,389
It might be your best shot.

1083
00:39:10,390 --> 00:39:13,225
Think about it.

1084
00:39:13,226 --> 00:39:14,226
Last stitch.

1085
00:39:14,227 --> 00:39:15,269
You want me to cut?

1086
00:39:15,270 --> 00:39:16,771
I got it.

1087
00:39:18,439 --> 00:39:19,773
It looks good.

1088
00:39:19,774 --> 00:39:21,900
OK. Let's pull the traction suture.

1089
00:39:21,901 --> 00:39:23,278
With pleasure.

1090
00:39:25,238 --> 00:39:27,364
OK, Jackie.

1091
00:39:27,365 --> 00:39:28,740
- Jackie.
- Stop it.

1092
00:39:28,741 --> 00:39:29,741
Stop.

1093
00:39:29,742 --> 00:39:31,076
All done.

1094
00:39:31,077 --> 00:39:32,619
All done with what?

1095
00:39:32,620 --> 00:39:34,288
Sewing up your tongue.

1096
00:39:34,289 --> 00:39:36,039
What happened to my tongue?

1097
00:39:36,040 --> 00:39:37,249
You bit it.

1098
00:39:37,250 --> 00:39:38,250
Ha.

1099
00:39:38,251 --> 00:39:39,877
No, I didn't.

1100
00:39:39,878 --> 00:39:41,753
That is called a blackout.

1101
00:39:41,754 --> 00:39:43,589
How much did you drink?

1102
00:39:43,590 --> 00:39:45,799
A couple Bloody Marys.

1103
00:39:45,800 --> 00:39:47,009
Only a couple?

1104
00:39:47,010 --> 00:39:49,177
I don't know. Maybe more.

1105
00:39:49,178 --> 00:39:51,930
It's a holiday, a pub crawl.

1106
00:39:51,931 --> 00:39:54,600
Do you usually have
a couple cocktails every day?

1107
00:39:54,601 --> 00:39:55,851
Only on weekends.

1108
00:39:55,852 --> 00:39:57,185
How about during the week?

1109
00:39:57,186 --> 00:39:58,604
Nothing much.

1110
00:39:58,605 --> 00:40:03,609
Just wine with dinner or a few beers.

1111
00:40:03,610 --> 00:40:06,778
Maybe we should recommend rehab?

1112
00:40:06,779 --> 00:40:07,905
Yeah.

1113
00:40:07,906 --> 00:40:09,324
We could try.

1114
00:40:13,912 --> 00:40:16,330
Ready to roll.

1115
00:40:16,331 --> 00:40:17,956
How are you feeling?

1116
00:40:17,957 --> 00:40:19,333
<i>My pain is a two.</i>

1117
00:40:19,334 --> 00:40:20,959
We got meds if you need them.

1118
00:40:20,960 --> 00:40:22,461
Scan will be quicker
than the ride to Presby.

1119
00:40:22,462 --> 00:40:23,837
We'll keep trying to reach your sister.

1120
00:40:23,838 --> 00:40:25,464
<i>- You guys are the best.</i>
- See you later.

1121
00:40:25,465 --> 00:40:27,299
Can I put a new patient in T1?

1122
00:40:27,300 --> 00:40:29,635
Uh, no, I kind of want
to leave one trauma room open.

1123
00:40:29,636 --> 00:40:33,305
Why don't you double up
the north if you have to?

1124
00:40:33,306 --> 00:40:36,183
Mr. Digby?

1125
00:40:36,184 --> 00:40:38,101
- It's just Digby.
- Right.

1126
00:40:38,102 --> 00:40:40,646
We've been looking all over.
Where you been?

1127
00:40:40,647 --> 00:40:42,147
With Louie.

1128
00:40:42,148 --> 00:40:43,649
You've been in there for an hour?

1129
00:40:43,650 --> 00:40:45,692
He was my friend.

1130
00:40:45,693 --> 00:40:47,653
- I had a lot to say.
- Hmm.

1131
00:40:47,654 --> 00:40:49,988
Well, let's get you back to your bed.

1132
00:40:51,991 --> 00:40:53,867
Louie got his wings.

1133
00:40:53,868 --> 00:40:55,827
- Dr. Robby.
- Dr. Robby.

1134
00:40:55,828 --> 00:40:57,371
We picked up a patient together.

1135
00:40:57,372 --> 00:40:58,830
Teamwork!

1136
00:40:58,831 --> 00:41:00,332
It's a concerning bullous rash.

1137
00:41:00,333 --> 00:41:01,917
We might need a biopsy
for pemphigus vulgaris.

1138
00:41:01,918 --> 00:41:03,377
It's phytophotodermatitis.

1139
00:41:03,378 --> 00:41:05,170
- What?
- I asked.

1140
00:41:05,171 --> 00:41:07,255
He was making three gallons
of margaritas for a party,

1141
00:41:07,256 --> 00:41:09,508
squeezing fresh limes out in the sun.

1142
00:41:09,509 --> 00:41:10,968
Let's go take a peek.

1143
00:41:10,969 --> 00:41:12,845
I don't need to see it again.

1144
00:41:15,348 --> 00:41:16,807
How's it going out there?

1145
00:41:16,808 --> 00:41:18,350
Standing room only.

1146
00:41:18,351 --> 00:41:19,810
If I call the fire department,
will they clear

1147
00:41:19,811 --> 00:41:21,061
- that waiting room?
- I wish.

1148
00:41:21,062 --> 00:41:22,187
What's up?

1149
00:41:22,188 --> 00:41:24,231
12 patients need med refills.

1150
00:41:24,232 --> 00:41:25,816
Shouldn't they see their doctors?

1151
00:41:25,817 --> 00:41:27,567
With the Medicaid cuts,
we are their doctor.

1152
00:41:27,568 --> 00:41:29,319
No, I can't e-prescribe
to their pharmacies.

1153
00:41:29,320 --> 00:41:31,029
So get out your pen. Go old school.

1154
00:41:31,030 --> 00:41:33,365
Dana, on what?

1155
00:41:33,366 --> 00:41:35,826
Nordt, you got the security pads?

1156
00:41:35,827 --> 00:41:37,077
Sure do.

1157
00:41:37,078 --> 00:41:38,870
Just need a patient sticker.

1158
00:41:38,871 --> 00:41:41,248
- Any other questions?
- Yeah.

1159
00:41:41,249 --> 00:41:43,668
What would have happened
if you weren't here today?

1160
00:41:44,836 --> 00:41:46,712
You'd all be curled up
in the fetal position,

1161
00:41:46,713 --> 00:41:49,047
crying like babies.

1162
00:41:49,048 --> 00:41:50,632
Were you wearing flip-flops?

1163
00:41:50,633 --> 00:41:51,967
I was.

1164
00:41:51,968 --> 00:41:53,885
- What is it?
- Phytophotodermatitis.

1165
00:41:53,886 --> 00:41:56,096
Otherwise known as margarita burn.

1166
00:41:56,097 --> 00:41:57,639
For some people, limes plus sunshine

1167
00:41:57,640 --> 00:41:58,974
can cause a horrible rash.

1168
00:41:58,975 --> 00:42:01,101
This is all because of limes?

1169
00:42:01,102 --> 00:42:03,937
Have you ever squeezed limes
outside in the sun before?

1170
00:42:03,938 --> 00:42:05,605
I don't think so.

1171
00:42:05,606 --> 00:42:08,066
You will feel better
after a day of steroid pills.

1172
00:42:08,067 --> 00:42:09,985
But once these heal,
you gotta wear sunscreen.

1173
00:42:09,986 --> 00:42:12,112
Because these blisters
can turn into dark scars

1174
00:42:12,113 --> 00:42:13,405
and stay a while if you don't.

1175
00:42:15,033 --> 00:42:18,368
I'll be right back with
your aftercare instructions.

1176
00:42:18,369 --> 00:42:20,287
- Hey, Robby.
- Yep.

1177
00:42:20,288 --> 00:42:22,456
My, uh... my hospice patient Roxie

1178
00:42:22,457 --> 00:42:24,416
is still in a ton of pain.

1179
00:42:24,417 --> 00:42:25,709
Where are we with the morphine?

1180
00:42:25,710 --> 00:42:27,627
10 milligrams an hour.

1181
00:42:27,628 --> 00:42:30,213
OK, you can bolus another 2
and go up to 12.

1182
00:42:30,214 --> 00:42:31,590
I will let Princess know.

1183
00:42:31,591 --> 00:42:32,924
12 an hour is a lot.

1184
00:42:32,925 --> 00:42:34,426
Yeah, on top of the MS Contin,

1185
00:42:34,427 --> 00:42:37,387
she could stop breathing.

1186
00:42:37,388 --> 00:42:40,724
Are you familiar with
the doctrine of double effect?

1187
00:42:40,725 --> 00:42:42,768
- Not really.
- No.

1188
00:42:42,769 --> 00:42:45,270
It is an ethical principle
in palliative care.

1189
00:42:45,271 --> 00:42:46,980
We treat pain.

1190
00:42:46,981 --> 00:42:48,940
And if, in doing so,
there's a negative side effect,

1191
00:42:48,941 --> 00:42:50,609
we accept it.

1192
00:42:50,610 --> 00:42:53,445
Even if the negative
side effect is death?

1193
00:42:53,446 --> 00:42:56,074
In some cases,
that could be the best outcome.

1194
00:43:01,871 --> 00:43:03,330
Maybe the nurse has it.

1195
00:43:03,331 --> 00:43:06,041
Emma. Emma, where does...

1196
00:43:06,042 --> 00:43:07,793
Maybe the fax ran out of paper?

1197
00:43:07,794 --> 00:43:10,504
No, there is enough paper.
I don't know what's wrong.

1198
00:43:10,505 --> 00:43:12,005
- Could be in another room.
- We should call IT.

1199
00:43:12,006 --> 00:43:14,007
You want me to check every room?

1200
00:43:14,008 --> 00:43:15,634
How are we gonna get through this mess?

1201
00:43:15,635 --> 00:43:18,595
I was about to ask you.

1202
00:43:18,596 --> 00:43:20,138
Ask the pharmacist.

1203
00:43:20,139 --> 00:43:21,681
She can't leave the PDS.

1204
00:43:21,682 --> 00:43:23,475
Nothing's getting done here.

1205
00:43:23,476 --> 00:43:28,048
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