All language subtitles for The.Pitt.S02E15.9.00.P.M.2160p.10bit.AMZN.WEB-DL.DDP5.1.HEVC-Vyndros.eng

Baran, is this you?

It began after a bad case
of viral meningitis

when I was five.

They tried every
anti-seizure medication,

but I still had episodes
every few months or so.

No one's ever noticed before.

They just think I'm thoughtful.

Are you driving?

I couldn't
until laser ablation

to my left temporal lobe
12 years ago.

Between that and the Keppra,
I've been seizure-free,

cleared by Neurology to drive
and to work as an attending.

How long, uh,
between the seizure

you had today and the last one?

It's been well over a year.

But I had two today.

I don't know why.

It could be sleep deprivation,
new job stress.

I--I haven't had to deal
with Peds cases

since Afghanistan.

What are your options now?

Um...

up my Keppra or maybe try

one of the newer
anti-seizure meds.

But if that doesn't work,
I'm left with two choices--

um, a temporal lobectomy,
which could impair my speech,

or get a neuromodulation
device,

which can sense
and stop the seizures

almost immediately.

You need to disclose this.

I know. I have a plan.

Hey, Robby,
Dana's looking for you.

She's in Peds.

Yeah, OK,
I'll be right there.

Sounds like
you're needed in Peds,

and I have patients to see.

Robby, pregnant woman
with severe headache

on her way in by ambulance.

Find Abbot
or a night shift resident.

Need you to turn out
your pockets.

OK. Show me your hands.

Come here often?

What's going on?

Oh, sorry--false alarm.

We thought she spiked a fever,
but it was the wrong chart

from our analog hell.

You know anybody who might
consider kinship adoption?

Doctors and nurses qualify.

Don't look at me.

Hey, can your staff
keep an eye on Dr. Al-Hashimi

until she leaves?

Why?

Uh, because I think
she's tired,

and I don't want her
to make any mistakes.

Oh, great advice.
Maybe you should take it.

Yeah.

I'm gonna go get
some fresh air.

Grab some for me
while you're out there.

Your lungs wouldn't know
what to do with it.

Screw you!

In front of the baby? Nice.

Yeah.

We are the night crawlers.

We deal with the weirdest
and the wildest because...

all: We are the weirdest
and the wildest of them all.

That is right, and tonight,

they are really gonna be
crawling.

Now go get some!

all: Hooah!

Sorry to wake you.

I--I was thinking.

Doubt PTX.

You're supposed
to be leaving.

I am.

You know,
this spirit quest of yours

has a lot of people
up in arms around here.

Everyone's gonna be fine
without me,

and it's hardly a spirit quest.

Whatever it is,
it seems you've given people

the impression
you might not be coming back.

Well, who knows

what the future has in store
for any of us?

Yeah, saying shit
like that right there

isn't helping.

People are worried about you.

Dr. Abbot,
the patient in South 21,

Digby, he's missing again.

Sounds like
a day shift problem.

Not if he was
handed off already.

Best I can do
under the circumstances.

Thank you.

Hey, don't leave
before I get back, yeah?

Hell, I feel like
I live here now.

Your friend fixing your bike?

Ambulance clipped it

while it was just
parked here today.

Jesus Christ.

That's a sign
if I've ever seen one.

Yeah, here's the thing--
when people worry about you,

it makes me think that
I should be worried about you,

and I don't like worrying
about things.

Ooh. Now you're a shrink?

No, I'm trying
to be your friend.

You got--you got Dana convinced

that you're gonna
hurt yourself.

- Dana's got her own issues.
- That sounds like projection.

Are you seriously trying
to have this fucking

conversation with me
right now, man?

I--I'm not the one

who spends his free time
getting shot at.

Hooah!

Hey, Dr. Robby,
this is Judith Lastrade--

36 weeks pregnant
with two days of headache,

now a 10 out of 10
with blurred vision.

BP 174/120, heart rate 92.

- No relief with fentanyl.
- Judith, I'm Dr. Abbot.

Any weakness
in your arms or legs?

No, no. Is this a stroke?

We need to check
for everything.

Pitting edema
with severe preeclampsia.

Where are you doing
your prenatal care?

Nowhere.

It's a wild pregnancy.

I want a free birth.

This 81-year-old nun
presents with red, itchy eyes

with secretions
for the past two days.

Patient complains
of no URI symptoms,

- no contact with any chemical...
- Hey.

Agents,
no known exposures--

Want half a Monster?

Oh, no, thanks.

I--I don't really want
to stay awake

any longer than I have to.

Yeah, I hear you.

Did you find your ID badge?

Uh, no.

You any closer to deciding
what's next for you?

Uh, yeah, I'm seriously
considering law school.

What?
What are you talking about?

You're gonna be a great doctor.

I mean, no offense, but look
what this place does to you.

Langdon's an addict.

Is a person with
a substance use disorder.

McKay was on house arrest.

Dana's a time bomb.

Santos is one
of the angriest people

you are ever going to meet.

Sarcastic, yes.
Cynical, definitely.

I don't know
if she's, you know--

Mel?

Samira has no life.

Abbot's an adrenaline junkie
who gets shot at for fun.

Robby's got, like, PTSD
or something way fucking worse.

OK, well, I--I mean,

I'd hate to know
what you think about me.

I don't know, I just--

the more time I spend here,

the more I realize
the importance

of my mental health.

Mm.

For patients and for us.

And this is...

Yeah.

Well, you know,

maybe that's
what you should focus on.

- What?
- Mental health.

Clearly, you have
a passion for it, right?

I mean, that's--that's great.

I don't know if
I'd call it a passion.

I would call it, like, a...

Oh, my God.

You might be right.

Oh, you're a genius, Whitaker.

Oh, OK.

CTG is on.

- CTG?
- Cardiotocography.

Measures the baby's heart rate
and checks for contractions.

Fetal heart rate 128.

Normal range, Nazely?

110 to 160.

So the baby's OK?

Right now, yes.

128 is reassuring.

BP's 170/119.

6 grams of magnesium
running in.

Your next move, Crus?

20 of labetalol,
IV push over two minutes.

Uh, what's happening?

Uh, you have a condition
called preeclampsia.

And how did it happen?

Uh, nobody really knows, actually.

It affects about 10%
of the pregnancies.

High blood pressure, headaches,

protein in the urine,
and swollen ankles.

OK, well,
it's a wild pregnancy,

so that means no medical care.

Then why are you here?

I just need to get rid
of this headache.

Well, if we don't lower
your blood pressure

and treat with magnesium,
there can be problems.

Like what?

Seizures, bleeding,

even death,
for you and the baby.

Oh, my God.

Robby, your VIP's
ready to go.

OK, I'll be right there.

- You good?
- Yeah, I'm good.

I got it.
With my eyes closed.

But I won't. Maybe one eye.

Hey--

Hey, Becca.
How you feeling?

I'm better. Thanks.

Where are you?

I'm at Adam's house.

Can I call you later?
We're watching a movie.

Oh, sure.
I just--I thought

you were gonna see
the fireworks.

Nope, we decided
to watch "Elf" instead.

Ah.

- Of course you did.
- OK.

- I'll call you tomorrow!
- Tomorrow? Wait.

Uh, are--are you
spending the night?

Um, uh, yes.

His parents invited me.

They--they need
to ask me that.

Are--are you
staying here too?

No, they--they needed to ask
if it was OK if you stayed.

Why?

Be--because, uh,
it's polite.

It's the right--
it's the right thing to do.

Um, I need to talk to them.

Um, they're not here.
They're at a barbecue.

OK, um,
can you have them call me

as soon as they get home?

- Yes.
- Can you promise?

I promise.
OK, bye, Mel!

Bye. Have fun--

Thanks for fixing my bike.

Well, you keep me running,
I'll keep her going.

You know, the Cree don't have
a word for goodbye.

You know a lot of Cree?

A bit.

I got around, man.

I don't doubt it.

Look, I'll come back
for all this other shit...

Great.

If you promise to come back

and let me take
the Bonnie for a ride.

Uh, I don't know.

I've seen you ride, old man.

Fuck you.

I mean it.

We got a deal?

I'll think about it.

This looks like an ambush.

We got a slight hiccup
in chairs.

ICE is back?

No, we got a dead body.

- Somebody died out there?
- Yeah.

Poor devil checked in
at 5:00 this morning.

He was a DNR.

- What was his chief complaint?
- Hemorrhoids

- and constipation.
- No shit.

Hence the constipation.

Throw me a slow one,
I'm gonna hit it.

Tell the night shift.
I'm saying that's when he died.

We all in agreement on that?

To the grave.

Just like poor Jasper.

You're on fire.

Just getting my second wind.

How's the headache?

Still a 10.

More fentanyl?

- Yep.
- BP's good. Another 50.

Hey, Abbot.

Attending and resident
are stuck in the OR.

Oh, you're
the next best thing.

Better, some would say.

Mm.

- What do you got?
- This is Judith.

G1, P0 with no prenatal care.

Preeclampsia
with severe hypertension.

Hi, Judith.
Nurse Garvin from OB.

Some jelly on the belly.

Gonna take a quick look
with ultrasound.

No, no, no.
Ultrasound can harm the baby.

- Not true.
- Not doing the ultrasound

could end up harming you
and the baby.

OK.
Just do it as fast as you can.

Why no prenatal care, Judith?

I wanted a free birth--

no doctors, no hospital,
no medicine.

Mm. You have a midwife?

A birth doula?

No, I don't need one.

Women have been having
children on their own

for thousands of years.

Yeah, with
an infant mortality rate

of 30% for most of those
thousands of years.

- Femur length 7 centimeters.
- 37 weeks.

They'll probably induce.

What? No.

No, no, no, no. Absolutely not.

At 37 weeks,

the cure for preeclampsia
is to deliver the baby.

We need to get you upstairs
so the OB doctors

can induce labor
to save you and your baby.

No. No, no, no, no. Mm-mm.

Yep, that's
definitely Jasper.

He was alive and kicking

when my shift ended
this morning.

This is definitely
a day shift patient.

Now he's not a patient.

He's a DB that
we gotta deal with.

Is this dude dead?

both: Nope.

All right, Mr. Reed,
time to take you back

and get you checked out, OK?

- He sure looks dead.
- Are you a doctor?

- No, but he--
- Has hypernarcolepsy.

- It's no joke.
- Mm-hmm.

Excuse me.

Oh, sometimes I hate nights.

- Yep.
- Oof.

Wow.

Crazy how muggy
it still is out here.

You, uh--you seen Robby?

Uh, not for a bit.

You catch up on your charts

from the beginning
of the shift?

Yeah.

What are you still
doing here?

Uh, just gonna...

You staying
for the fireworks?

Yeah.

I was supposed to see them
with Becca,

but she is
at her boyfriend Adam's

family's house instead.

Your sister seems like
she's, uh, pretty put-together.

Yeah.

Uh, a lot more than I realized.

How was your day?

I've had better.

You?

Yeah.

But then again,
I've had a lot worse.

Hell, I did a closed cervical
reduction, like, an hour ago.

Oh, I heard.
That must have been so intense.

My hands are still shaking.

Hey, um, do you think
you could teach me

how to do that sometime?

Uh, yeah.

- Yeah?
- Yeah, sure. I mean,

I hope you never
have to use it.

I could have paralyzed
that guy.

Yeah, but you didn't.

No, I didn't.

Thank you...

by the way, for...

talking me down earlier.

I'm sorry I snapped.

It's OK.

Dr. Mohan, you ever heard
of kinship fostering?

It's where a nurse
or doctor can

- become an emergency foster--
- Oh, no.

I don't need any kids.

I need to find a job first.

Candice O'Grady is
an 82-year-old female

brought in by her son
for intractable vomiting.

No fever, no chills,
no abdominal pain, no rash.

Beep.

Oh, I've already got one
I can barely keep up with.

What about Sleeping Beauty
over here?

She's already babysitting
Whitaker.

Well, if you know anyone
who'd like to help us out

with Baby Jane Doe,
have them call the main desk.

Sure thing.

I'd take her myself,
but Benji'd kill me.

BP's 164/114.

Another 40 of labetalol.

Mag bolus is in.

Now infusing 2 grams an hour.

Labs are coming back.

Hemoglobin 7.5, platelets 40.

LFTs are sky high.

- HELLP syndrome.
- Hemolytic anemia,

elevated liver enzymes,
and low platelets.

They're cleaning a room.

We can bring her up
in ten minutes.

How you doing, Judith?

I--I--

Oh, she's seizing.

Oh, shit.

10 of IV diazepam.
Have another 10 ready.

With all the movement,
we can't get a fetal heartbeat.

Putting on 15 liters by mask.
Should we intubate?

Hold intubation.
Let's try to break this.

We don't want to mask seizures
with paralysis

unless we have to.

OK, um...

Crus, CTG isn't reading.

- Check with ultrasound.
- On it.

Nazely, what's the diagnosis?

Um, with the seizure,
now it's eclampsia.

- Fetal heart rate is about 90.
- Way too low.

Mom's sats are going down.

Time to tube her?

Set up for it, but wait.

Another 10 of diazepam.

Push 4 grams of Keppra.

History of hypertension

presents to the emergency
department

with a chief complaint
of dizziness

after inadvertently
ingesting 80 milligrams--

Hey, how are you guys
making out?

Yeah, we're getting there.

Have you seen Dr. Al-Hashimi?

- No.
- Can I talk to you for a sec?

So I just wanted
to let you know that I've been

checking out some
of your online posts--

Look, I was just
trying to help

get some health messages
out there,

- especially for young people.
- I think they're great.

Really good.

- You do?
- Yeah.

Yeah, um, keep it up.

OK.

As long as you follow
the HIPAA laws.

I do.

And wait until
you're done charting.

Sure.

Actually, Dr. Robby--sorry,
um, can I ask you a question?

Shoot.

Um, I--I may be

considering
emergency psychiatry.

Very cool.

Think I could do it?

I think that you could do

anything that you put
your mind to, Victoria.

OK.

Pulse ox is 88.

Dr. Abbot?

- Intubate?
- Let's do it.

Nazely, what do you suggest
for rapid sequence induction?

Etomidate and roc.

Mm, not quite.

120 of propofol,

60 of succinylcholine.

Why is that, Crus?

Propofol
for the anti-seizure effect,

sux to avoid
prolonged paralysis

- so we can check her neuro exam.
- Exactly.

Pushing the propofol.

Once she's flat
for intubation,

we need to displace
the uterus to the left.

Nazely, that's you.
Big hug, both arms.

- Get the baby off the vena cava.
- Sux is on board.

But after she's paralyzed,
the seizing stops, right?

It might look like that,

but an ongoing seizure
will still fry the brain.

We monitor with EEG.

- Is there time for that?
- Wait and see.

Paralytics kicked in.

Let's go.
Roll her to her back.

Intubate, then EEG

to see if her brain is
still seizing.

I need first pass success.

You and me both.

Have you seen Dr. Al-Hashimi?

No.

Have you seen Dr. Al-Hashimi?

Al-Hashimi?

With how this day's going,
she probably quit.

Last I saw her, she was
in Peds with Baby Jane Doe.

Nope, I was just in there.

Want me to page her?

Uh, no, that's OK.

I will find her.

Hello.

Hey, how did our people do
at the deposition?

Oh, well,
Dr. Ellis is a pit bull.

Dr. King is a petunia.

They were pretty brutal
with her.

- She's sensitive.
- Very.

And I'm afraid it isn't over.

They want to call her back.

Oh, that's unfortunate.

Maybe I should go with you

to break that news to her, actually.

- Misery loves company.
- Um, hey, while I have you,

can I pose a hypothetical
to you?

If a doctor suspects
another physician

of having a medical condition
that could negatively

affect the way they
would treat a patient,

where would
disclosing that fall

on the HIPAA violation scale?

First, do no harm.

Dr. King, do you have a second?

Mm...

Good lung sliding
bilaterally.

Fetal heart rate
borderline at 98.

Roll her to the left again.
That can help.

One, two, three.

OK, all set here.

EEG monitor's good to go.

That was fast.

Still seizing
while paralyzed.

It's nonconvulsive status.

What's she had so far?

30 of diazepam,
a full load of mag,

Keppra, and propofol.

Damn. What's your next step?

Any ideas?

Hmm? Nazely?

Dilantin? Valproate?

Mm, infusion is too long.

So is onset of action.

Push 100 of ketamine.

That's had results
with refractory status.

She also has HELLP syndrome--
hemoglobin only 7,

- platelets down to 30.
- Two units whole blood?

O-neg is going up on
the rapid infuser as we speak.

Uh, put the AP pads on,
just in case.

And 10 of Decadron IV push
for the inflammatory storm.

- Fetal heart rate up to 104.
- Hmm.

- Little better.
- Yeah.

She should be upstairs with OB.

She will be
after we break this seizure.

There was a delay
in history-taking

due to a malfunctioning
VRI interpretation device.

During this time,
there was a normal CBC

and comprehensive
metabolic panel

that came back from the lab.

What's wrong with you,
Malfeasance?

I have to do
another deposition.

Oh, that sucks.

You must have really messed up.

Dude, I'm joking.

You gotta lighten up.

It's all just bullshit.

God, you know what?
Fuck all this.

Do you want to go get a drink?

Me?

Yes, you.

You--you do go out, don't you?

Well, I'm usually with Becca.

Well, bring her along.

Can she drive?

No, and she's
with her boyfriend.

OK, Becca.

So it's just you and me.

Do you like karaoke?

You do karaoke?

Well, what I do is more like
primal scream therapy.

There's nothing like
getting wasted

and just absolutely wailing

to shake off a shit show
like today.

I could use a fun night.

You and me both, sister.

There's been no improvement.

Still seizing on the EEG.

- Neurology has been called.
- OK. Got it.

OB says send her up.
They have an OR ready.

About time.

Baby's been bradying down
a bit more.

This one looks like
it took a turn for the worse.

Eclampsia,
refractory seizures,

HELLP syndrome with anemia
and thrombocytopenia.

Yeah,
about as bad as it gets.

V-fib!

Chest compressions, Nazely.

Charge to 200.

Prep the belly.

Get a baby warmer.

Call the NICU. Start a timer.

Charged.

Clear.

Continue compressions.

We'll check a rhythm
in a minute.

Gown up.

Robby, it's you and me.

Nazely,
what's the four-minute rule?

Uh, not sure.

Pregnant patient
with a viable fetus,

you have four minutes
after cardiac arrest

- to save the baby.
- And the mom.

We don't call it a postmortem
C-section anymore.

It's a resuscitative
hysterotomy

to try to save them both.

But she doesn't want
any medical intervention.

That doesn't matter.

Mom and baby are both dead
if we do nothing.

OK, charge to 200.

One more rhythm check and then
Abbot and I are gonna cut.

Ellis, you and Crus
on Mom resuscitation.

Shen, you and Nazely
take the baby.

OK, hold compressions.

Still V-fib.

Clear.

No change.
Resume compression, amp of epi.

OK, showtime.

We need to get this baby out
right now.

OK, take a break.

OK, 10 blade. Good.

First incision is
from the xiphoid

to the pubic symphysis

through the skin
to the linea alba.

Units three and four
on the infuser.

Second incision goes
through the peritoneum,

exposing the uterus.

Where do you need me?

You're with the baby.
Nazely's got the bag mask.

You're on suction.
Stand by for intubation.

Bladder retractors.

Neonatal monitor
and pulse ox ready to go.

Ellis, gentle traction.

OK, making a small
vertical incision

through the lower uterus
so as not to cut the baby.

Mm-hmm.

- Got it?
- Yep, I got it.

- OK.
- OK.

Using scissors
to extend superiorly.

Ellis, hand retract
the uterus with me.

Amniotic fluid looks good.

Give me some fundal pressure.

Breech position.

OK, baby's out.

- It's a girl.
- All right.

Milking the cord.

Clamping.

Cutting.

OK, blue and flaccid.
Coming to you, Shen.

- You ready?
- Yeah, you got her.

I got it, yep.

OK.

Poor tone, no movement.

Keep the blow-by closer.

She's really blue.

Some blue is normal,
but not this much.

- Do we need to intubate?
- Not yet, no.

They usually pink up
with stimulation and blow-by.

OK, removing the placenta.

Sweeping to the left,
trying to get it in one piece.

- Looks intact.
- Yeah.

Nicely done.

10 of IV Pitocin
to contract the uterus.

And lots of massage.

Heart rate 76.

Less than 100 means
we need to bag.

Suction first.

OK.

Hey, Jord, charge to 200.

Stand by for the next
rhythm check.

She grimaced. Good sign.

Bagging.

Pulse ox 45%.

Oh, I've never seen it
that low.

It's not as bad as it sounds.

I'm more worried
about the heart rate.

McKay, get ready with an IO
in case we need epi.

OK.

Rhythm check.
Hold compressions.

Still V-fib.

- OK, shock it.
- Clear.

Resume compressions.

Shen, how's she doing
over there?

Heart rate's up to 104.

Uh, at one minute,

she's 0 for color,
2 for heart rate,

1 for reflex, tone, breathing.

APGAR of 5.

5 out of 10. Not great.

Pulse ox 58%.

- Intubation?
- Uh, not yet.

O2 sat in the 60s is normal
at one minute.

Her heart rate and pulse ox
are trending higher.

Let's keep doing
what we're doing.

A little tincture of time.

Hold compressions.

Looks like sinus.

Can't feel a carotid.

No.

Heart's barely pumping.
It's PEA.

Back on compressions.

Transfuse two more units.

She needs more red cells
and platelets.

Ongoing blood loss
from the uterus.

Give me all the lap pads
we got, please.

Yeah.

OK, yeah, thanks.

I appreciate it, honey.

Oh, gotta go.

Whoa, whoa, whoa!

Hold up.

Is there a problem here?

Yeah, you two aren't leaving
empty-handed.

What?

One of you follow me.

Rape kits are supposed
to be picked up

within 72 hours
of collecting 'em.

This one's been here
for over two weeks.

That's not on us.

Well, it's on somebody.

It's not bad enough
these poor women

go through an assault,
plus the indignity

of the whole
collection process,

but nobody from
the police department

even has the human decency
to come get these things?

Like nobody there
gives a flying fuck?

OK, we got it.

We'll see that these get
put into evidence properly.

Thank you.

How hard was that?

Units five and six are in.

Down to a slow ooze here.

Hold compressions.

Looks like sinus.

- And I got a weak carotid.
- OK.

Cycle the BP.

Better filling,
better squeeze.

No seizure activity
on the EEG.

That's progress.
That's progress.

We're at five minutes.

Uh, heart rate is 132.

Uh, pulse ox 79%.

Nazely, the APGAR?

Um...

1 off for color,
1 off for tone,

1 off for respiration
with hypoxia, total of 7.

Respiration score is
for observed breathing,

not pulse ox.

Sat of 80 is normal
at five minutes.

With no crying,
she still gets 1 off.

Yeah.

Ah!

She just scored
the winning point!

APGAR of 8 is pretty normal.

Holy shit. What did I miss?

Eclampsia with status,
HELLP syndrome,

cardiac arrest,
resuscitative hysterotomy.

I was in the OR
with a septic twin C-section.

Got your text 12 minutes ago.

Shit happens fast down here.

Resuscitative hysterotomy
in 36 seconds.

- Impressive.
- BP's 102/64.

Hemoglobin is up to 9.

That'll do.

NICU's sending a team down.

We can take Mom.
You guys are rock stars.

We like to be referred to
as crawlers of the night.

If you're not careful,

you're gonna get stuck
here all night.

Nah, Henny said she'd
be here in 30 minutes.

- How's Mom and baby?
- Whew.

They're both gonna go upstairs.

Good. You leaving now?

Yeah, pretty soon.

I gotta find Whitaker,
I gotta find Al-Hashimi,

and I gotta find Langdon
before I leave.

You missed Langdon.
He just checked out.

Shit.

Can I help you?

Uh, yeah, I'm Dr. Langdon
from the ED.

I was just, uh,
checking in on the status

of someone we sent up here
earlier.

Patient's name is, uh, Cohen.

Let me check.

What was she up here for?

Uh, clean out
a nasty neck fash.

Oh, yeah, she's good.

She's in 4202,
recovering nicely.

Great, great.

I mean, she was--she was
in not-great shape earlier.

It was a good catch.

Saved her life, even if
we couldn't save her leg.

Uh, was it below the knee?

Unfortunately, it was above.

My cell phone
and the building manager's.

He can help if there's
any emergencies.

Yeah,
what kind of emergencies?

Whatever.

And follow up with Duke

in a couple days, yeah?

Yeah.

You, um--you sure about this?

I trust you, Whitaker.

Great.

Any questions?

Uh, when are you back, exactly?

You know, I'll text you.

I'm trying to keep my dates
kind of fluid.

I think this is your ride.

Yeah, uh, yes.

I--I promise I'll check in
on your house tomorrow.

Sounds good.

- Hey.
- Hey.

OK. Hey, Theo.

You're up late, huh?

What you got there?

OK.

He's been fussy all day.

I think he's got
another tooth coming in.

Aw, right on, big guy.

Are you ready to get funky?

Yeah?

Hey.

Any luck picking an elective?

Don't know.

Maybe I will go
into geriatrics.

It's a smart choice.

I know that life can be
challenging,

especially when
it doesn't work out

the way you expected.

OK.

I thought I would be married

with two kids in college
by now.

Maybe have some property
with a pond,

and we could play hockey on it
in the wintertime.

And yet look at me now.

No wife, no kids, no pond.

It's never too late.

Do you really believe that?

Yeah.

Only for me, or for you too?

OK.

I see what you did there.

Was that true, or something
you just said to make a point?

Have you worked things out
with your mom?

We're not talking.

I am sorry that, um,
I let it distract me.

She was treating me
like a child,

and I was letting her.

Have a good trip.

Please be safe.

We need you here.

Even if you can be
a dick sometimes.

Good luck.

You too.

Hey, I didn't think
you were still here.

I was just talking
to the neurologist on call.

And?

We had a nice chat.

She agrees I can work
with double coverage.

That's not her call to make.

You can't do anything critical

where a five-second lapse
in consciousness

could potentially
kill a patient.

I agree.

But 90% of our patients

don't require
critical procedures.

And the ones that do?

Will be handled by
whomever is working with me.

Unless they're also tied up
with a critical patient.

What if it's a double
or triple trauma?

- Robby, I can handle it.
- No, you can't.

And I can't let you.

I am fully capable
of handling--

No, you are not
fully capable,

and you know it.

What do you want from me?

I want what's best
for this department--

patients and staff.

Best-case scenario,
you get a handle on this,

you're seizure-free
for six months,

you get your
driver's license back,

you are cleared to work.

I am cleared
for my driver's license.

You shouldn't be driving
at all like this.

If you were a patient,
we would have to report you.

I am not
your fucking patient.

No, but I cannot let you work

in my emergency department

until you're fully capable
of doing so.

That is not
your fucking call!

You're fucking-A right,
that's my call!

I'm trying to protect you
and my patients,

and you know I'm right
about this.

Oh, "my department,"
"my patients."

All you fucking think about
is yourself!

Do you hear yourself?

You didn't rat out Langdon

for stealing fucking drugs.

No, but I kicked him
out of this department

until he got the appropriate
help that he needs,

and the same goes for you.

You've got until Monday
to let the administration know,

or I will.

I am finished.

Last chart.

- You and me both.
- Really?

Is this a thing?
I finished a while ago.

I never want to hear
that fucking bell again.

- Where's Dana?
- Not sure.

A bunch of day shift
just headed to the roof

to watch the fireworks.

You want me to call her?

No, that's OK.

Yo.

Thanks for your help in there.

- Almost out?
- Yep, just about.

Is this where you try
to talk me out of going?

Me?

No, not a chance.

Why, are you having
second thoughts?

- Nope.
- No?

Nope.

Don't have to convince me.

I mean, it is a little strange
the only place

you talked about going
is somewhere

they used to drive buffalo
off a cliff to die.

- Here it comes.
- I looked it up,

and as far
as summer vacations go,

it's not exactly
a holiday hotspot.

I mean, what's in
the fucking gift shop, man?

It's just one place
I'm going.

As long as it's not the last.

Don't be pulling a "Thelma
and Louise" out there.

I am minutes from taking
a three-month vacation.

When's the last time
you took any time off, Jack?

Yeah, but I've dealt
with my demons.

It's a process.

You want to know why
I never killed myself?

After what I saw,
lived through?

Losing my leg, losing my wife?

Because it comes
for all of us, man.

You and I know it
more than most.

We see it every shift,

but we can't let ourselves
succumb to it.

Yes, life can suck.

It can be unbearable

and--and brutal

and ugly and heartbreaking.

But it's also beautiful--
and hilarious.

And that woman today...

Her baby, they'd both be
in the morgue

if you hadn't been here.

That's us.
That's you and me.

That's what we're here for.

The most important things
I've ever done in my life

have been in this hospital.

Nothing will ever matter more
than what I've done

in this hospital,
but it is killing me.

You know how they say
that a part of you dies

when you lose someone you love?

I'm not convinced that
a part of you doesn't die

every time you see
a fellow human pass.

And I've seen
so many people die

that I feel like it's leaching
something from my soul.

Go on a cruise, man.

Knock off this
helmetless motorcycle shit.

Yeah, people talk.

That's death-wish behavior.

I'm tired of being
a role model.

I'm tired of feeling
like you can't get ahead.

I'm tired of feeling
like I'm drowning every day.

I'm tired of all of it.

You need to get away
for a while,

and you need to get some help.

You need this place
as much as it needs you.

Am I fucked up?

100%.

But nobody works here
as long as you and me

and doesn't get screwed up.

You--you gotta find somebody

to help you dance
through the darkness.

Did you just make that up?

Maybe it's a song lyric.

I don't--
maybe my therapist said it.

I don't know.

Some dude just pulled up.

Looks like he blew
half his face off.

How can you not love
this place?

Look, don't make me
look stupid.

You come back to us
in one piece.

I'm still your
emergency contact,

and I do not want
to be contacted.

All right, night crawlers,

what the hell's going on
out here?

25-year-old man...

history,

no meds, no allergies.

More than 2,000 years ago,

the Chinese were throwing
bamboo into fire

to make explosions.

They went on
to invent gunpowder.

And boom! The rest is history.

They had chemicals to get
the different colors, you know?

Sodium gives you yellow,
strontium gives you red,

and barium is green.

Who knew chemistry could be
so damn pretty?

- Hey.
- Hey.

- I thought you'd left already.
- On my way out.

Hey, I'm sorry that
I didn't find the time today

to have that conversation.

Yeah, that's all right.

Seems like you
didn't really want to.

I didn't.

Did you?

Uh...

yeah, actually.

Look, I'm doing the work.

I'm--I've been sober 186 days.

I'm going to meetings.
I'm taking the drug tests.

- That's good.
- And you're still riding me.

What would have happened
if I'd paralyzed that guy?

I don't know.

What would have happened
if I hadn't been here today?

You'd still be
questioning yourself.

Now you know you can do it.
You're welcome.

Oh, so that's--
that's how you teach now?

Sometimes.

You know who I saw in rehab?

I saw a bunch of guys
just like you.

The only difference is,

they've accepted
that they need help.

I think you're afraid
to admit that

the mighty Dr. Robinavitch
isn't perfect.

Oh, I never claimed
to be perfect.

No, but you expect it
of yourself,

and it's not realistic, man.

How can any of us live up
to your standards

if you can't even do it?

You need help, Robby.

You need help.

Finished?

You don't gotta be honest
with me, man.

At least be honest
with yourself.

She is due for a new bottle.

I was hoping to get her some
formula before I clocked out.

I'll stay with her.

Thanks.

Why are you--will you hit
those lights on your way out?

- Yep.
- Why are you crying?

Why are you crying, little one?

You're OK. You're safe.

Yeah, you're not alone.

Yeah, you're OK.

Do you need to be
swaddled again?

Is that it?

I can do that. Look.

Aww.

I wish somebody
would swaddle me.

Yes, I do.

Oh.

You got off to kind of
a rough start,

didn't you, little one?

Yeah, you did.

Well, that makes two of us.

I got abandoned too.

When I was eight.

But I got through
all of that, and so will you.

I got a good feeling that
you're gonna be just fine.

Everything's gonna be
just fine.

You got so many
wonderful things to see

and so many people to love
ahead of you.

So many wonderful
things to see,

people to love ahead of you.

Shh.

It's OK. It's gonna be OK.

It's OK.