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Would you like to inspect the original subtitles? These are the user uploaded subtitles that are being translated: 1 00:00:04,394 --> 00:00:05,525 - Move the CR! 2 00:00:05,570 --> 00:00:06,570 Stay with me. 3 00:00:06,613 --> 00:00:07,876 - So this is how it's gonna be? 4 00:00:07,919 --> 00:00:09,679 All day long, you've been talking down to me. 5 00:00:09,704 --> 00:00:11,141 - I should have given you credit. 6 00:00:11,183 --> 00:00:12,205 I was very impressed with the way 7 00:00:12,228 --> 00:00:13,839 you nearly killed our patient. 8 00:00:15,971 --> 00:00:20,454 - We are running low on a number of key supplies. 9 00:00:20,498 --> 00:00:22,716 - No, no, no, no, no! Stop! Stop! I need that dye. 10 00:00:22,760 --> 00:00:25,981 - We can't have one patient depleting our supplies. 11 00:00:26,024 --> 00:00:27,088 - So call into the hospital. 12 00:00:27,112 --> 00:00:28,809 - We're all in the same boat. 13 00:00:28,853 --> 00:00:30,768 - Dr. Cuevas and I have a strong hunch 14 00:00:30,812 --> 00:00:33,250 that David is developing schizoaffective disorder. 15 00:00:33,292 --> 00:00:35,078 - No! My boy isn't crazy. 16 00:00:35,121 --> 00:00:36,557 Stay away from us. 17 00:00:36,600 --> 00:00:39,256 - How is that boy supposed to get any help? 18 00:00:40,822 --> 00:00:42,345 - It is a real pleasure 19 00:00:42,389 --> 00:00:44,216 to finally meet you, Dr. Hawthorne. 20 00:00:44,261 --> 00:00:47,219 My colleague at Med, David Kwan, 21 00:00:47,264 --> 00:00:49,743 he sings your praises highly. 22 00:00:49,787 --> 00:00:51,572 - Oh, I'm not the doctor. 23 00:00:51,615 --> 00:00:53,792 I'm her assistant, Katherine. 24 00:00:53,835 --> 00:00:55,097 - Okay. 25 00:00:55,140 --> 00:00:57,795 - Sign and date these forms, please. 26 00:01:01,887 --> 00:01:04,281 Just wherever you see a highlight. 27 00:01:07,197 --> 00:01:08,522 While you're finishing up with that, 28 00:01:08,545 --> 00:01:11,287 I'll go over our policies and procedures. 29 00:01:13,899 --> 00:01:15,596 Everything you discuss with Dr. Hawthorne 30 00:01:15,640 --> 00:01:17,771 is confidential, except in the event she feels 31 00:01:17,816 --> 00:01:19,402 you're a danger to yourself. - You know what, Katherine? 32 00:01:19,426 --> 00:01:21,448 I'm... I'm actually a practicing psychiatrist myself, 33 00:01:21,472 --> 00:01:24,736 so, I mean, if you'd like, you can skip that part. 34 00:01:24,778 --> 00:01:26,040 - I totally get it, 35 00:01:26,085 --> 00:01:28,521 but Dr. Hawthorne, who you'll meet next week, 36 00:01:28,566 --> 00:01:31,307 requires we go through the policies together. 37 00:01:31,350 --> 00:01:33,807 If the doctor feels that you're a danger to yourself or others, 38 00:01:33,831 --> 00:01:35,635 she's required to report... - You know what, Katherine? 39 00:01:35,659 --> 00:01:38,228 I appreciate you're just trying to do your job. 40 00:01:38,271 --> 00:01:42,145 But, um, maybe you could tell Dr. Hawthorne 41 00:01:42,188 --> 00:01:45,539 to give me a call when she has a chance 42 00:01:45,582 --> 00:01:48,151 to meet me herself in person, okay? 43 00:01:49,194 --> 00:01:51,545 Um, you know what? 44 00:01:51,588 --> 00:01:56,158 On second thought, maybe tell her not to bother. 45 00:01:57,985 --> 00:01:58,985 Yeah. 46 00:02:02,382 --> 00:02:04,036 - It's been a long time since 47 00:02:04,078 --> 00:02:05,230 you had to hunt for a therapist. 48 00:02:05,254 --> 00:02:06,492 Want me to shoot you some names? 49 00:02:06,516 --> 00:02:08,909 I got a small stockpile of referrals. 50 00:02:08,954 --> 00:02:10,061 - I gotta be honest, Sharon, 51 00:02:10,085 --> 00:02:11,478 after these last two experiences, 52 00:02:11,521 --> 00:02:13,828 my interest in the process might be waning. 53 00:02:13,872 --> 00:02:16,657 I mean, this morning in particular 54 00:02:16,700 --> 00:02:18,920 actually had me questioning the state of psychiatry. 55 00:02:18,963 --> 00:02:21,227 - Well, that assembly-line mentality 56 00:02:21,271 --> 00:02:23,272 is plaguing much of medicine these days, 57 00:02:23,316 --> 00:02:24,752 not just psychiatry. 58 00:02:24,795 --> 00:02:27,319 But don't worry, you'll find your person. 59 00:02:27,364 --> 00:02:29,408 See you later. - No coffee? 60 00:02:29,453 --> 00:02:31,019 - Ugh, no. I don't have any time. 61 00:02:31,062 --> 00:02:33,718 We're implementing a new drug shortage protocol, 62 00:02:33,760 --> 00:02:36,415 so I'll be in the ED all morning walking the staff 63 00:02:36,460 --> 00:02:37,852 through the new guidelines. 64 00:02:37,896 --> 00:02:39,637 - You couldn't get the enforcer, 65 00:02:39,680 --> 00:02:41,465 otherwise known as Maggie Lockwood on that? 66 00:02:41,508 --> 00:02:43,248 She's in Paris. 67 00:02:43,293 --> 00:02:44,945 She and Ben never took their honeymoon, 68 00:02:44,990 --> 00:02:47,340 and she was gonna lose her vacation days. 69 00:02:47,384 --> 00:02:49,037 - Wow. - Yeah. 70 00:02:49,081 --> 00:02:50,231 - Well, still, not a great time 71 00:02:50,256 --> 00:02:51,276 to be short-staffed, though, right? 72 00:02:51,300 --> 00:02:52,954 - There's never a good time. 73 00:02:52,997 --> 00:02:55,174 - Yep, you got that right. - See you later. 74 00:02:56,567 --> 00:02:58,133 - Get these off me! 75 00:02:58,176 --> 00:02:59,414 - David Sullivan, 17-year-old male. 76 00:02:59,438 --> 00:03:01,441 - Oh, we've met. David, it's me, Dr. Archer. 77 00:03:01,485 --> 00:03:02,765 Do you remember me? - I can't stay here. 78 00:03:02,789 --> 00:03:04,550 They're gonna find me. I have to keep moving. 79 00:03:04,574 --> 00:03:06,116 I can't stay in one place! - It's okay, honey. 80 00:03:06,140 --> 00:03:07,554 You're safe. You're safe. - He ran naked into the street. 81 00:03:07,578 --> 00:03:09,710 Dad managed to grab him before he got hit by a car. 82 00:03:09,753 --> 00:03:11,625 No visible injuries that I can see. 83 00:03:11,669 --> 00:03:13,888 Gave him 0.5 of lorazepam en route. 84 00:03:13,931 --> 00:03:16,282 - Hello, again, Mrs. Sullivan. Is your husband all right? 85 00:03:16,325 --> 00:03:19,198 - He's fine, yeah. - He's just a bit shaken up. 86 00:03:19,241 --> 00:03:20,957 - He drove behind us, should be here any minute. 87 00:03:20,981 --> 00:03:23,070 - Doris, would you... - Page psych. I'm on it. 88 00:03:23,115 --> 00:03:24,745 - Okay, finish my sentences for me, why don't you? 89 00:03:24,769 --> 00:03:27,205 Okay, David, we're gonna loosen your restraints now 90 00:03:27,250 --> 00:03:28,902 and move you to the bed. 91 00:03:28,947 --> 00:03:30,861 I need you to stay still. 92 00:03:30,905 --> 00:03:33,473 Keep your hands by your side, all right? 93 00:03:33,516 --> 00:03:34,735 Okay, ready, everybody? 94 00:03:34,778 --> 00:03:38,260 On my count, one, two, three. 95 00:03:38,304 --> 00:03:40,914 Good. Okay. 96 00:03:40,959 --> 00:03:42,569 Very good, okay. 97 00:03:42,612 --> 00:03:44,155 - Oh, no, no, no, no, no! - It's all right. 98 00:03:44,179 --> 00:03:45,442 It's all right. - David, please. 99 00:03:45,485 --> 00:03:47,270 Just let the doctor look at you, okay, honey? 100 00:03:47,312 --> 00:03:48,706 - They came inside the light. 101 00:03:48,748 --> 00:03:51,925 They're trying to steal my DNA so they can clone me. 102 00:03:51,969 --> 00:03:53,599 - Okay, so what do you think could have triggered this? 103 00:03:53,623 --> 00:03:55,365 - We were at a stoplight, 104 00:03:55,408 --> 00:03:57,192 and David became fixated on this billboard. 105 00:03:57,235 --> 00:03:59,412 It was just some random man selling car insurance. 106 00:03:59,456 --> 00:04:01,632 - He's not random. He works for them. 107 00:04:01,675 --> 00:04:03,131 There's a whole network. - I don't know. 108 00:04:03,155 --> 00:04:04,959 He started taking his clothes off and telling us 109 00:04:04,983 --> 00:04:08,028 that they were... they were bugged with recording devices. 110 00:04:08,073 --> 00:04:09,485 And then right when the light turned green, he bolted. 111 00:04:09,509 --> 00:04:11,728 He ran across four lanes of oncoming traffic. 112 00:04:11,771 --> 00:04:12,771 There was... 113 00:04:14,600 --> 00:04:16,622 There was a pickup truck that was coming right at him. 114 00:04:16,646 --> 00:04:18,518 - And he... - Eric. 115 00:04:18,562 --> 00:04:19,800 - Sir, are you all right? - Oh, my God, Eric! 116 00:04:19,824 --> 00:04:21,322 - All right, let's get him to the ground. 117 00:04:21,346 --> 00:04:22,740 - Eric! Eric! - Come on. 118 00:04:22,783 --> 00:04:24,064 - What's going on with him? - It was meant for me. 119 00:04:24,088 --> 00:04:25,370 They're gonna kill us all! - It's okay, honey. 120 00:04:25,394 --> 00:04:26,675 - Mom, we gotta get out of here now. 121 00:04:26,699 --> 00:04:27,721 - Let's get a gurney over here! - It's okay. 122 00:04:27,745 --> 00:04:28,658 - Come on! - Oh, my God. 123 00:04:28,701 --> 00:04:30,574 - No, no, no! No, no! 124 00:04:40,932 --> 00:04:43,716 - Your husband's CT angiogram showed an aortic dissection. 125 00:04:43,761 --> 00:04:46,764 That's essentially a tear in the wall of his aorta. 126 00:04:46,807 --> 00:04:48,374 - So Eric didn't have a heart attack? 127 00:04:48,418 --> 00:04:50,637 - Well, a dissection can often mimic 128 00:04:50,680 --> 00:04:52,422 heart attacks in presentation. 129 00:04:52,465 --> 00:04:55,598 This particular tear is very close to his heart, 130 00:04:55,641 --> 00:04:58,731 which is why we need to get him to surgery as soon as possible 131 00:04:58,776 --> 00:05:00,125 in order to repair it. 132 00:05:00,168 --> 00:05:02,432 - Open heart surgery? - Mm-hmm, yes. 133 00:05:02,475 --> 00:05:05,129 Dr. Morris, one of our cardiothoracic surgeons, 134 00:05:05,173 --> 00:05:06,565 will be performing the operation. 135 00:05:06,610 --> 00:05:08,612 He's on his way here now. 136 00:05:08,654 --> 00:05:10,091 - Oh. 137 00:05:10,134 --> 00:05:12,920 Okay, can I see Eric before he goes under? 138 00:05:12,963 --> 00:05:14,617 - Yes, of course. 139 00:05:14,661 --> 00:05:17,011 Once we get him to pre-op, I'll have a nurse come get you. 140 00:05:19,362 --> 00:05:21,165 - How about we go somewhere and chat for a bit? 141 00:05:21,189 --> 00:05:22,755 Thank you. 142 00:05:22,800 --> 00:05:24,062 Okay. 143 00:05:24,105 --> 00:05:25,584 I don't understand. 144 00:05:25,629 --> 00:05:28,762 Why would David think that this man on a billboard 145 00:05:28,805 --> 00:05:30,459 was after him? 146 00:05:30,502 --> 00:05:32,504 - It's what we call a delusion of persecution. 147 00:05:32,548 --> 00:05:36,334 - Yeah, one becomes convinced that some individual, 148 00:05:36,379 --> 00:05:38,990 you know, or group is conspiring to harm them 149 00:05:39,033 --> 00:05:40,382 or the people that they love. 150 00:05:40,425 --> 00:05:43,995 - And these delusions, that's something that 151 00:05:44,038 --> 00:05:45,430 you see with schizophrenia? 152 00:05:45,475 --> 00:05:46,562 - It is, yeah. 153 00:05:49,216 --> 00:05:53,612 - I know Eric and I weren't exactly receptive 154 00:05:53,656 --> 00:05:54,875 the last time we all spoke. 155 00:05:54,918 --> 00:05:56,007 - We completely understand. 156 00:05:56,050 --> 00:05:57,922 It's... it's a lot to take in. 157 00:05:57,965 --> 00:05:59,488 - I Just thought that David was going 158 00:05:59,531 --> 00:06:05,103 through some kind of phase, growing pains, you know? 159 00:06:05,146 --> 00:06:10,324 But in these last couple of days, it's like he's... 160 00:06:10,369 --> 00:06:14,199 He's lost all touch with reality. 161 00:06:14,242 --> 00:06:18,245 It's just like, I feel him slipping away. 162 00:06:18,290 --> 00:06:21,466 - Mrs. Sullivan, I promise you, David is still there. 163 00:06:21,511 --> 00:06:24,165 - Yeah, and with treatment, these episodes will become 164 00:06:24,209 --> 00:06:26,211 less severe and less frequent. 165 00:06:26,254 --> 00:06:28,952 - And with proper management, they can even go away. 166 00:06:28,995 --> 00:06:30,389 - What do you mean, medication? 167 00:06:30,432 --> 00:06:33,478 - That's a crucial component, yeah. 168 00:06:33,523 --> 00:06:36,481 - David thinks people are trying to poison him. 169 00:06:36,526 --> 00:06:39,398 How am I going to convince him to take pills? 170 00:06:39,442 --> 00:06:41,704 - There are actually injectable versions 171 00:06:41,747 --> 00:06:44,228 of many antipsychotics. 172 00:06:44,271 --> 00:06:45,882 - Though we don't generally start there. 173 00:06:45,925 --> 00:06:47,274 Those are usually held in reserve 174 00:06:47,319 --> 00:06:49,060 for non-compliant patients. 175 00:06:49,103 --> 00:06:50,670 - Of course. 176 00:06:50,713 --> 00:06:54,108 I'm just saying, if he refuses or becomes non-cooperative, 177 00:06:54,151 --> 00:06:56,283 they're an option. - Right. 178 00:06:56,327 --> 00:06:59,069 But we'll cross that bridge if and when we get there. 179 00:06:59,112 --> 00:07:00,569 In the long run, it's just much better 180 00:07:00,593 --> 00:07:03,377 if we can get David on board with taking medication. 181 00:07:03,422 --> 00:07:05,511 - Okay. 182 00:07:08,382 --> 00:07:10,646 Ms. Martin, I'm Doctor... 183 00:07:10,689 --> 00:07:14,737 Liza. 184 00:07:14,781 --> 00:07:17,523 Sorry, you were saying? 185 00:07:17,567 --> 00:07:19,045 - Uh, I'm Dr. Choi. 186 00:07:19,089 --> 00:07:20,918 I understand you haven't been feeling well. 187 00:07:20,961 --> 00:07:22,920 - Yeah I can't keep anything down. 188 00:07:22,963 --> 00:07:25,312 - And you're 12 weeks along. 189 00:07:25,356 --> 00:07:29,360 - Uh, that's just an estimate. 190 00:07:29,403 --> 00:07:33,365 I only just recently found out I was pregnant. 191 00:07:33,408 --> 00:07:36,367 I haven't gotten around to see a doctor just yet. 192 00:07:36,411 --> 00:07:39,326 - Well, in that case, we'll go ahead and run an ultrasound. 193 00:07:39,370 --> 00:07:41,067 Doris, will you mind grabbing Dr. Asher? 194 00:07:41,112 --> 00:07:43,548 - Sure thing. - Thanks. 195 00:07:43,593 --> 00:07:45,942 - So when did the vomiting and diarrhea start? 196 00:07:45,985 --> 00:07:47,161 - Just last night. 197 00:07:47,204 --> 00:07:48,771 - And you haven't taken any medication? 198 00:07:48,814 --> 00:07:51,514 - No, nothing. 199 00:07:51,557 --> 00:07:53,776 I don't want to take anything while I'm pregnant. 200 00:07:53,819 --> 00:07:56,127 - Well, you know there are some nausea medications 201 00:07:56,170 --> 00:07:57,519 that are safe for pregnancy. 202 00:07:57,562 --> 00:07:59,696 - Still, I just... 203 00:07:59,738 --> 00:08:01,392 I would rather not. 204 00:08:03,089 --> 00:08:04,613 I'll be fine. 205 00:08:04,656 --> 00:08:07,572 I just really came in here to make sure the baby's okay. 206 00:08:07,617 --> 00:08:10,096 - Understood. Mind if I press on your belly? 207 00:08:10,141 --> 00:08:11,814 I just want to see if anything feels tender. 208 00:08:11,838 --> 00:08:13,665 - Mm-hmm. 209 00:08:16,016 --> 00:08:17,800 No, no, no. No, no, no. 210 00:08:17,843 --> 00:08:19,629 I don't want her. 211 00:08:19,672 --> 00:08:21,630 You'll have to get me another doctor. 212 00:08:21,673 --> 00:08:23,197 - Dr. Asher? 213 00:08:23,240 --> 00:08:25,504 - Hannah Asher, right? 214 00:08:25,548 --> 00:08:27,158 - Yeah. She's an excellent physician. 215 00:08:27,201 --> 00:08:29,769 - She's an addict. 216 00:08:29,812 --> 00:08:31,466 You get me another doctor, or I'm leaving. 217 00:08:31,509 --> 00:08:32,990 - Whoa, whoa, whoa. Okay, okay, okay. 218 00:08:33,033 --> 00:08:34,033 Just hold on a moment. 219 00:08:38,648 --> 00:08:42,216 Hey, Hannah, sorry, I jumped the gun, actually. 220 00:08:42,259 --> 00:08:43,913 We're all good. 221 00:08:43,956 --> 00:08:45,610 - Oh, okay. 222 00:08:45,654 --> 00:08:47,067 Well, in that case, I'm grabbing breakfast 223 00:08:47,091 --> 00:08:50,268 if anybody's looking for me. 224 00:08:57,187 --> 00:08:59,320 - Dr. Tanaka-Reed, hold up a minute. 225 00:08:59,364 --> 00:09:01,192 Can you have them update that for me? 226 00:09:01,235 --> 00:09:02,628 Thank you. 227 00:09:02,672 --> 00:09:05,456 Look, I... I wanted to clear the air. 228 00:09:05,500 --> 00:09:09,243 The other day, I may have come off a little condescending. 229 00:09:09,287 --> 00:09:11,549 - I appreciate the acknowledgment, Dr. Marcel. 230 00:09:11,594 --> 00:09:15,684 - Of course, and if there's anything you'd like to say... 231 00:09:15,727 --> 00:09:18,034 - No, don't think so. 232 00:09:18,077 --> 00:09:20,645 We're all good. 233 00:09:20,690 --> 00:09:22,101 - What, you didn't have time to grab him 234 00:09:22,125 --> 00:09:24,475 flowers from the gift shop? 235 00:09:24,519 --> 00:09:26,259 Huh? 236 00:09:26,303 --> 00:09:27,542 I mean, I expect the other docs 237 00:09:27,566 --> 00:09:30,394 to go soft on the residents. 238 00:09:30,437 --> 00:09:32,222 I thought you had grit. 239 00:09:32,265 --> 00:09:33,832 - Well, no man's an island, right? 240 00:09:33,876 --> 00:09:35,225 - Aha. 241 00:09:35,269 --> 00:09:36,595 You know, island life's really not so bad. 242 00:09:36,619 --> 00:09:38,403 Maybe you just don't have the stomach for it. 243 00:09:38,446 --> 00:09:40,797 - Dr. Marcel, you've got a trauma incoming. 244 00:09:40,840 --> 00:09:43,059 - Well, thanks for that pep talk, coach. 245 00:09:43,102 --> 00:09:44,626 - Any time. 246 00:09:46,932 --> 00:09:48,369 - What do we got? 247 00:09:48,413 --> 00:09:50,807 - Marcus Walker, 50-year-old male, fall from standing. 248 00:09:50,850 --> 00:09:53,331 Gave him a 500 liter bolus en route. 249 00:09:53,374 --> 00:09:55,028 Pressure's hanging around 100, systolic. 250 00:09:55,072 --> 00:09:56,463 Heart rate's 120. 251 00:09:56,508 --> 00:09:58,466 - Yeah, I've never seen him in this much pain. 252 00:09:58,509 --> 00:10:00,860 It hasn't let up since he hit the pavement. 253 00:10:00,903 --> 00:10:01,923 - This is his sister, Janet. 254 00:10:01,947 --> 00:10:03,471 - Did you witness the fall, Janet? 255 00:10:03,514 --> 00:10:04,927 - He lost his balance stepping off the sidewalk. 256 00:10:04,951 --> 00:10:06,885 It didn't look that bad, but then he couldn't get up. 257 00:10:06,909 --> 00:10:08,365 - Okay, we'll give him something for the pain. 258 00:10:08,389 --> 00:10:09,539 We just got to find the source of it first. 259 00:10:09,563 --> 00:10:10,585 - Any medications we should know about? 260 00:10:10,609 --> 00:10:11,957 - Dialysis. 261 00:10:12,001 --> 00:10:13,413 Oh, and he takes ramipril for his blood pressure. 262 00:10:13,437 --> 00:10:14,568 - Okay, here we go, guys. 263 00:10:14,613 --> 00:10:15,918 Nice and easy on my count, okay? 264 00:10:15,961 --> 00:10:17,659 One, two, three. 265 00:10:17,702 --> 00:10:20,226 I'm sorry, Marcus. 266 00:10:20,270 --> 00:10:22,664 - I'm right here, Marcus. I'm right here. 267 00:10:22,707 --> 00:10:24,730 - Janet, let's give the doctor some room to work, okay? 268 00:10:24,754 --> 00:10:26,644 - We're gonna take care of him, Janet, we got this. 269 00:10:26,668 --> 00:10:28,028 - Let's hang a unit of whole blood. 270 00:10:28,061 --> 00:10:29,453 Pressure it in, Ron. 271 00:10:29,496 --> 00:10:32,456 Hey, Marcus, put your arms by your side for me. 272 00:10:32,500 --> 00:10:34,327 There you go, bud. Deep breaths. 273 00:10:34,371 --> 00:10:35,721 Okay, lungs are clear. 274 00:10:35,764 --> 00:10:37,461 - He's still shocking. - Yeah. 275 00:10:37,504 --> 00:10:39,028 He's bleeding from somewhere. 276 00:10:39,072 --> 00:10:40,812 Let's fast him, Dr. Taylor. 277 00:10:48,125 --> 00:10:49,517 Belly's negative. 278 00:10:49,561 --> 00:10:51,084 - Really? 279 00:10:51,128 --> 00:10:52,825 - Yeah. 280 00:10:52,869 --> 00:10:54,870 - All right, let's get him on his side. 281 00:10:54,913 --> 00:10:57,700 Herbert, come over, please. 282 00:10:57,743 --> 00:10:59,745 All right, here we go. Nice and easy, all right? 283 00:10:59,788 --> 00:11:01,225 One, two, three. 284 00:11:02,922 --> 00:11:04,203 - There you go. You're doing great. 285 00:11:04,227 --> 00:11:05,969 You're doing great, Marcus. 286 00:11:10,015 --> 00:11:11,931 - What is it? 287 00:11:11,975 --> 00:11:12,975 - Oh. 288 00:11:13,019 --> 00:11:14,150 - An abscess. 289 00:11:14,193 --> 00:11:15,152 - Looks like it. 290 00:11:15,195 --> 00:11:16,500 Pus under pressure. 291 00:11:16,543 --> 00:11:18,067 It's gotta be the source of the pain. 292 00:11:18,110 --> 00:11:20,678 All right, let's drain it. 293 00:11:20,722 --> 00:11:21,811 Scalpel. 294 00:11:27,817 --> 00:11:29,600 - Hematoma. 295 00:11:36,129 --> 00:11:37,260 - Yep. 296 00:11:37,303 --> 00:11:39,959 Hold pressure and pack it in. 297 00:11:40,003 --> 00:11:41,177 You got it? - Yeah. 298 00:11:41,221 --> 00:11:42,570 - Okay. - Got it. 299 00:11:42,614 --> 00:11:44,533 - All right, give me another unit of whole blood. 300 00:11:44,572 --> 00:11:48,880 Start DDAVP and a unit of platelets, stat. 301 00:11:48,924 --> 00:11:50,490 Come on, let's move, folks. 302 00:11:58,150 --> 00:11:59,630 - Ms. Arya, hello again. 303 00:11:59,673 --> 00:12:01,284 - Indrani, please. 304 00:12:01,327 --> 00:12:04,027 - Indrani, I got the results back on your culture. 305 00:12:04,070 --> 00:12:05,592 Unfortunately, you tested positive 306 00:12:05,636 --> 00:12:07,378 for an infection called MRSA. 307 00:12:07,421 --> 00:12:10,860 - From an ingrown toenail? 308 00:12:10,903 --> 00:12:13,950 MRSA is really hard to treat, isn't it? 309 00:12:13,993 --> 00:12:16,081 - While it is resistant to many antibiotics, 310 00:12:16,125 --> 00:12:17,972 luckily, there are a couple that still work for it. 311 00:12:17,996 --> 00:12:20,086 - How long do I have to be on antibiotics? 312 00:12:20,129 --> 00:12:21,870 - About seven to ten days. - Oh. 313 00:12:21,913 --> 00:12:25,091 - See, I told you you wouldn't have to cancel your trip. 314 00:12:25,134 --> 00:12:26,831 - Oh, yeah? Where are you headed? 315 00:12:26,875 --> 00:12:28,833 - Well, I'm going to Scotland in a few weeks 316 00:12:28,878 --> 00:12:30,443 to hike the West Highland Way. 317 00:12:30,488 --> 00:12:33,838 It's a 96-mile trail through the Scottish Highlands. 318 00:12:33,883 --> 00:12:35,144 - 96 miles? 319 00:12:35,187 --> 00:12:37,364 - I've been training for the last year. 320 00:12:37,408 --> 00:12:40,149 I may be pushing 60, but I don't feel it. 321 00:12:40,192 --> 00:12:42,152 - Let's start with vancomycin. 322 00:12:42,195 --> 00:12:44,807 - No, I can't take vancomycin. I'm allergic. 323 00:12:44,850 --> 00:12:46,373 - Aha, I see that. 324 00:12:46,417 --> 00:12:48,679 - I had a terrible reaction when I was a kid. 325 00:12:48,722 --> 00:12:49,942 My throat closed up. 326 00:12:49,985 --> 00:12:51,769 - Then we will steer clear. Nancy? 327 00:12:51,813 --> 00:12:54,163 - Linezolid? On it. - Mm-hmm. 328 00:12:54,206 --> 00:12:55,967 We'll get you in tip top shape for Scotland, Indrani. 329 00:12:55,991 --> 00:12:57,994 - I've been wanting to do this a long time. 330 00:12:58,037 --> 00:13:00,996 - Um, Dr. Halstead, the pharmacy 331 00:13:01,039 --> 00:13:03,520 won't release the medication. 332 00:13:03,563 --> 00:13:05,349 - What? 333 00:13:05,392 --> 00:13:06,393 - Is there a problem? 334 00:13:09,221 --> 00:13:12,051 - No, just probably a system glitch. 335 00:13:12,095 --> 00:13:14,183 Sit tight, and I'll be right back. 336 00:13:14,226 --> 00:13:16,533 - Look, per the new protocol, 337 00:13:16,576 --> 00:13:19,014 you're gonna have to go through Infectious Disease first. 338 00:13:19,057 --> 00:13:21,712 And they're going to want to try incising 339 00:13:21,755 --> 00:13:23,366 and draining the infected tissue 340 00:13:23,409 --> 00:13:25,803 before they approve giving linezolid. 341 00:13:25,847 --> 00:13:26,892 - Incising and draining? 342 00:13:26,936 --> 00:13:28,371 So source control. 343 00:13:28,414 --> 00:13:29,938 That is not gonna cut it, Ms. Goodwin. 344 00:13:29,981 --> 00:13:31,809 She needs linezolid. 345 00:13:34,203 --> 00:13:36,206 I mean, can't we just say that, um, 346 00:13:36,249 --> 00:13:39,034 you know, Infectious Disease already signed off? 347 00:13:39,077 --> 00:13:41,037 - No, we cannot, Dr. Halstead. 348 00:13:41,080 --> 00:13:43,125 Linezolid is on the restricted list 349 00:13:43,168 --> 00:13:45,605 due to extremely low inventory. 350 00:13:45,649 --> 00:13:48,304 There's a region-wide shortage. 351 00:13:48,347 --> 00:13:50,873 - And we are dealing with a systemic MRSA infection. 352 00:13:50,915 --> 00:13:53,701 - You're looking at the patient in front of you. 353 00:13:53,745 --> 00:13:56,922 But the Oversight Committee designed the guidelines 354 00:13:56,966 --> 00:14:00,926 to ration these drugs to the most severe cases. 355 00:14:00,970 --> 00:14:05,888 I have seen early source control work wonders. 356 00:14:05,931 --> 00:14:07,541 Give it a shot. 357 00:14:12,807 --> 00:14:14,418 Dr. Marcel. 358 00:14:14,461 --> 00:14:16,594 - Yeah? - I got Marcus' CAT scans. 359 00:14:16,636 --> 00:14:17,942 - Uh-huh. 360 00:14:17,986 --> 00:14:19,813 - Two very severe lumbar burst fractures. 361 00:14:19,857 --> 00:14:21,250 - All from a spill on the sidewalk? 362 00:14:21,293 --> 00:14:22,294 - Take a look. 363 00:14:23,817 --> 00:14:25,081 - Oof. 364 00:14:25,124 --> 00:14:27,169 Renal disease definitely sped up his bone loss. 365 00:14:27,212 --> 00:14:29,432 - He's gonna need spinal stabilization surgery. 366 00:14:29,475 --> 00:14:33,263 - Yeah, agreed, only option to get him walking again. 367 00:14:33,306 --> 00:14:34,960 Given his co-morbidities, without it, 368 00:14:35,004 --> 00:14:37,135 he's just gonna circle the drain. 369 00:14:37,179 --> 00:14:41,096 All right, let's... Let's go talk to neurosurgery. 370 00:14:42,489 --> 00:14:45,404 - And David, this voice that you're hearing, 371 00:14:45,448 --> 00:14:47,885 is it male or female? 372 00:14:47,929 --> 00:14:49,408 - I don't know. 373 00:14:49,452 --> 00:14:52,282 It's more like it has its own language, 374 00:14:52,325 --> 00:14:54,240 its own way of communicating. 375 00:14:54,283 --> 00:14:57,113 And then my brain translates messages 376 00:14:57,155 --> 00:14:59,115 so I can understand them. - Mm. 377 00:14:59,158 --> 00:15:01,333 Are you getting any messages right now? 378 00:15:01,378 --> 00:15:03,466 - That you're writing down everything 379 00:15:03,509 --> 00:15:05,556 I say because you work for them. 380 00:15:10,474 --> 00:15:13,825 You're one of their spies, aren't you? 381 00:15:13,868 --> 00:15:15,260 - No, I'm not a spy. 382 00:15:15,304 --> 00:15:17,437 - Then give me your notebook. 383 00:15:17,480 --> 00:15:18,937 - I'm not gonna give you my notebook, David. 384 00:15:18,961 --> 00:15:20,048 - Give it to me. 385 00:15:20,091 --> 00:15:21,005 - David, I need you to listen to me. 386 00:15:21,049 --> 00:15:22,268 I'm a doctor. 387 00:15:22,312 --> 00:15:23,418 I'm writing things down so I can 388 00:15:23,442 --> 00:15:24,681 better understand what's going... 389 00:15:24,705 --> 00:15:26,490 - Get out of here! 390 00:15:26,533 --> 00:15:27,926 Out, now! 391 00:15:27,970 --> 00:15:29,667 - David, David, how about Dr. Cuevas 392 00:15:29,710 --> 00:15:30,948 puts her notebook away for now. 393 00:15:30,972 --> 00:15:33,149 Would that make you feel better? 394 00:15:33,192 --> 00:15:37,240 And I notice you've been checking out this vent. 395 00:15:37,283 --> 00:15:38,501 - There's a camera in there. 396 00:15:40,243 --> 00:15:42,158 - Huh. 397 00:15:42,201 --> 00:15:43,506 - They're always watching me. 398 00:15:43,549 --> 00:15:45,422 - There isn't a camera in there, David. 399 00:15:45,465 --> 00:15:47,510 - Yeah, I'm pretty sure that there isn't. 400 00:15:47,553 --> 00:15:48,903 But, you know, we're... 401 00:15:48,947 --> 00:15:50,010 We're happy to cover it up if it'll 402 00:15:50,034 --> 00:15:52,690 make you more comfortable. 403 00:15:52,732 --> 00:15:54,169 Okay, good. 404 00:15:54,212 --> 00:15:56,868 So why don't I go see what I can scrounge up. 405 00:15:56,911 --> 00:15:59,043 And I have another couple of patients 406 00:15:59,087 --> 00:16:00,543 I need to check in on, but in the meantime, 407 00:16:00,567 --> 00:16:02,047 is there anything else I can get you? 408 00:16:02,091 --> 00:16:03,527 - Can I have a Coke? 409 00:16:03,570 --> 00:16:04,571 - Absolutely. 410 00:16:06,703 --> 00:16:08,226 Okay, so back in a bit. 411 00:16:08,270 --> 00:16:11,534 And Dr. Cuevas, can I just get a quick word, please? 412 00:16:18,498 --> 00:16:21,023 So with patients experiencing paranoia, 413 00:16:21,066 --> 00:16:24,330 I've found that it's probably not the best idea to push back 414 00:16:24,374 --> 00:16:25,940 too hard on their version of events, 415 00:16:25,984 --> 00:16:28,029 you know, especially at the outset. 416 00:16:28,072 --> 00:16:29,900 - There's actually evidence-based research 417 00:16:29,943 --> 00:16:31,816 suggesting the opposite, 418 00:16:31,859 --> 00:16:34,384 that you shouldn't reinforce a patient's delusion. 419 00:16:34,427 --> 00:16:36,057 Instead, you should try to explain to them 420 00:16:36,081 --> 00:16:38,213 why they're experiencing things differently. 421 00:16:38,256 --> 00:16:40,042 - I hear you, except that that's 422 00:16:40,085 --> 00:16:42,086 pretty much impossible if you haven't 423 00:16:42,130 --> 00:16:43,957 first established trust. 424 00:16:44,001 --> 00:16:46,048 But very glad to hear that you are 425 00:16:46,091 --> 00:16:47,440 keeping up on the literature. 426 00:16:47,484 --> 00:16:49,051 Way to go. 427 00:16:54,838 --> 00:16:57,101 - Ooh, got Choi as your advisor. 428 00:16:57,145 --> 00:16:59,408 Luck really isn't on your side. 429 00:16:59,451 --> 00:17:00,322 - Why? 430 00:17:00,365 --> 00:17:02,063 He's been really cool with me. 431 00:17:02,106 --> 00:17:03,890 - Yeah, well, I wouldn't get too comfortable. 432 00:17:03,934 --> 00:17:06,111 Word is, he's a real hard-ass. 433 00:17:06,154 --> 00:17:08,200 Got his last resident fired. 434 00:17:13,162 --> 00:17:15,032 - Olga, what are you doing down here? 435 00:17:15,076 --> 00:17:16,444 - I was gonna ask you the same thing. 436 00:17:16,469 --> 00:17:18,776 I assumed you were out today. - Why's that? 437 00:17:18,818 --> 00:17:20,865 - Oh, well, Dr. Choi asked me to ultrasound 438 00:17:20,907 --> 00:17:21,996 his pregnant patient. 439 00:17:24,868 --> 00:17:27,088 - I don't understand. Why would he ask you? 440 00:17:27,132 --> 00:17:28,786 I cover the ED. 441 00:17:33,182 --> 00:17:35,183 So do you have a question about my qualifications 442 00:17:35,227 --> 00:17:37,142 or something? - Of course not, Hannah. 443 00:17:37,185 --> 00:17:39,188 - Then why would you ask another obstetrician 444 00:17:39,230 --> 00:17:41,885 to do an ultrasound in the ED when I'm here? 445 00:17:41,929 --> 00:17:43,626 Obviously, you don't trust me. 446 00:17:43,670 --> 00:17:44,758 - It's not that. 447 00:17:44,801 --> 00:17:46,933 I... 448 00:17:46,978 --> 00:17:49,153 The patient requested another doctor. 449 00:17:49,198 --> 00:17:52,809 She... she knew about your past. 450 00:17:52,853 --> 00:17:54,115 - What? How? 451 00:17:55,855 --> 00:17:57,292 Does she know me personally? 452 00:17:57,336 --> 00:17:58,617 - She didn't volunteer that information, 453 00:17:58,642 --> 00:18:00,338 so I didn't press it. - Fine. 454 00:18:00,383 --> 00:18:02,124 Forget it. - Hannah. 455 00:18:02,166 --> 00:18:06,039 - I'm just so sick of this following me everywhere I go. 456 00:18:06,084 --> 00:18:07,651 No matter how much progress I make, 457 00:18:07,693 --> 00:18:10,219 everyone's still judging me for who I used to be. 458 00:18:15,875 --> 00:18:17,008 - Nope. 459 00:18:17,050 --> 00:18:18,662 Medically, it's just too risky. 460 00:18:18,704 --> 00:18:21,143 Chronic hypertension, end-stage renal disease... 461 00:18:21,185 --> 00:18:22,816 The list goes on and on with this patient. 462 00:18:22,839 --> 00:18:24,450 The real kicker is that platelet count. 463 00:18:24,493 --> 00:18:27,278 I'm not touching anyone whose platelet count's below 100k. 464 00:18:27,323 --> 00:18:29,890 - Listen, we know that he's not an ideal candidate. 465 00:18:29,933 --> 00:18:31,195 - Oh, wait, I almost forgot. 466 00:18:31,240 --> 00:18:33,154 You guys also hacked his back open in the ED, 467 00:18:33,198 --> 00:18:35,243 making a posterior approach impossible. 468 00:18:35,287 --> 00:18:36,680 Should I go on? 469 00:18:36,722 --> 00:18:38,811 - Look, I can give you great anterior exposure. 470 00:18:38,855 --> 00:18:40,683 All you have to do is stabilize his spine. 471 00:18:40,727 --> 00:18:42,207 I'll take care of everything else. 472 00:18:42,250 --> 00:18:44,817 - Oh, you'd be assisting me on this one? 473 00:18:44,862 --> 00:18:47,691 Wow, way to save your strongest argument for last. 474 00:18:47,733 --> 00:18:49,823 - Maybe you're just worried about your stats, Sam. 475 00:18:51,868 --> 00:18:53,522 Send him up to interventional radiology. 476 00:18:53,566 --> 00:18:55,567 Have them inject cement into his fractures. 477 00:18:55,612 --> 00:18:57,527 That'll at least get him sitting up. 478 00:18:57,569 --> 00:18:59,223 - But that won't get him walking. 479 00:18:59,268 --> 00:19:00,834 And lack of movement is dangerous 480 00:19:00,877 --> 00:19:02,357 in Marcus's condition. 481 00:19:02,401 --> 00:19:04,663 He can develop pressure sores, blood clots, pneumonia. 482 00:19:04,708 --> 00:19:07,101 - All preferable to him bleeding out on my table. 483 00:19:13,759 --> 00:19:16,198 We just need to get his platelet count up. 484 00:19:16,240 --> 00:19:17,740 - Yeah, it's the only way to get Marcus 485 00:19:17,763 --> 00:19:20,027 healthy enough for surgery and Abrams on board. 486 00:19:20,070 --> 00:19:21,681 All right, I'll... 487 00:19:21,724 --> 00:19:24,249 I'll order a couple of units of platelets, all right? 488 00:19:30,429 --> 00:19:33,563 - Patty, any updates on your husband? 489 00:19:33,605 --> 00:19:35,259 - Oh, he just went into surgery. 490 00:19:35,304 --> 00:19:36,869 Dr. Archer said it will be a while 491 00:19:36,913 --> 00:19:38,088 before there's any updates. 492 00:19:38,132 --> 00:19:40,090 - Okay, well, he's in very good hands. 493 00:19:40,134 --> 00:19:41,788 You can trust me on that. 494 00:19:41,832 --> 00:19:44,400 David, got that Coke you asked for 495 00:19:44,442 --> 00:19:46,402 and some stuff for the vent. 496 00:19:46,444 --> 00:19:49,273 Do you think you might be up for chatting a bit? 497 00:19:52,190 --> 00:19:53,322 You all right, pal? 498 00:19:55,976 --> 00:19:59,197 - Trini gave him something just to calm him down. 499 00:19:59,240 --> 00:20:00,328 - Huh. 500 00:20:03,156 --> 00:20:05,811 Okay, back in a second. 501 00:20:07,988 --> 00:20:08,945 - What did you give him? 502 00:20:08,989 --> 00:20:10,556 - 6 of risperidone. 503 00:20:10,599 --> 00:20:11,513 - What? 504 00:20:11,557 --> 00:20:13,516 Who the hell ordered that? 505 00:20:13,558 --> 00:20:14,558 - I did. 506 00:20:23,874 --> 00:20:26,397 He became extremely agitated and was resisting restraints. 507 00:20:26,442 --> 00:20:27,877 - Lorazepam worked this morning. 508 00:20:27,921 --> 00:20:29,444 - You didn't see how upset he was. 509 00:20:29,488 --> 00:20:30,794 - Haldol then. 510 00:20:30,836 --> 00:20:32,709 - He was going to tear out his IV. 511 00:20:32,751 --> 00:20:34,121 His mom was freaking out, begging me to do... 512 00:20:34,144 --> 00:20:35,711 - Well, you cannot let a family member 513 00:20:35,755 --> 00:20:37,844 pressure you into making a rushed treatment call. 514 00:20:37,887 --> 00:20:40,804 - It wasn't rushed. It was necessary. 515 00:20:40,846 --> 00:20:42,935 And besides, the meds will clear his system 516 00:20:42,980 --> 00:20:44,328 by tomorrow morning at the latest. 517 00:20:44,373 --> 00:20:45,698 - At which point, we'll be back at square one 518 00:20:45,721 --> 00:20:47,549 with David, if we're lucky, all right? 519 00:20:47,593 --> 00:20:50,161 Any trust established, down the drain. 520 00:20:50,203 --> 00:20:52,336 How about this, in the future, maybe at least page me 521 00:20:52,381 --> 00:20:55,601 before administering a very high dose of antipsychotics 522 00:20:55,644 --> 00:20:57,994 to a patient we're still evaluating? 523 00:20:58,038 --> 00:21:01,172 - With all due respect, Dr. Charles, 524 00:21:01,214 --> 00:21:03,479 I am not a trainee. 525 00:21:03,521 --> 00:21:06,568 And 6 milligrams is well within the standard of care, I... 526 00:21:06,612 --> 00:21:08,134 - Standard of care, whatever that is, 527 00:21:08,179 --> 00:21:10,398 is not some blanket template you follow 528 00:21:10,442 --> 00:21:13,357 without any regard for the person in front of you 529 00:21:13,402 --> 00:21:14,707 you're supposed to be helping! 530 00:21:27,720 --> 00:21:29,200 - Hey, Janet. 531 00:21:29,242 --> 00:21:31,308 I just want to let you know, the nurse will be by soon 532 00:21:31,333 --> 00:21:33,509 to start Marcus' platelet transfusion, okay? 533 00:21:40,342 --> 00:21:42,778 I know it's been a rough day. 534 00:21:42,822 --> 00:21:45,825 - More like a rough year. 535 00:21:45,868 --> 00:21:48,523 Lost my husband in January. 536 00:21:48,567 --> 00:21:51,353 - I'm so sorry. 537 00:21:51,395 --> 00:21:54,181 - Marcus came out from California for the funeral 538 00:21:54,224 --> 00:21:58,403 and just never went home, 539 00:21:58,447 --> 00:21:59,925 moved in with me. 540 00:21:59,970 --> 00:22:01,753 - You must really get on. 541 00:22:03,451 --> 00:22:08,369 Never had a choice in the matter. 542 00:22:08,413 --> 00:22:11,198 We're twins, actually. 543 00:22:11,241 --> 00:22:15,420 Marcus was born 45 seconds before me, 544 00:22:15,463 --> 00:22:19,292 but you'd think he was years older, the way he acts. 545 00:22:19,336 --> 00:22:24,603 Seeing him here like this, so fragile... 546 00:22:27,300 --> 00:22:29,520 - It's really hard. 547 00:22:38,661 --> 00:22:42,011 I want you to know that, uh, 548 00:22:42,055 --> 00:22:47,670 we're gonna do everything we can for Marcus, I promise. 549 00:22:47,712 --> 00:22:48,932 Okay. 550 00:22:53,458 --> 00:22:55,721 What is it? 551 00:22:55,765 --> 00:22:57,941 - I was just looking back in Marcus's history. 552 00:22:57,983 --> 00:23:00,116 His platelets have always been low. 553 00:23:00,160 --> 00:23:01,465 - Huh. 554 00:23:01,509 --> 00:23:02,945 Do you think this is chronic? 555 00:23:02,989 --> 00:23:05,557 Some kind of undiagnosed blood disorder, or...? 556 00:23:05,601 --> 00:23:07,645 - ITP would be my guess. - Oh, man. 557 00:23:07,690 --> 00:23:08,865 - And if that's the case, 558 00:23:08,907 --> 00:23:10,190 a transfusion is not gonna do much. 559 00:23:10,213 --> 00:23:11,625 I mean, his body would just keep chewing up 560 00:23:11,650 --> 00:23:13,130 any new platelets we give him. 561 00:23:13,173 --> 00:23:15,480 - Well, unless... 562 00:23:15,523 --> 00:23:17,176 - Unless what? 563 00:23:18,961 --> 00:23:22,487 - Um, forget it, actually. 564 00:23:22,530 --> 00:23:23,880 I thought I had something. 565 00:23:23,923 --> 00:23:25,282 But let's just hope the transfusion 566 00:23:25,316 --> 00:23:28,362 moves the needle a little, okay? 567 00:23:36,326 --> 00:23:39,155 - Podiatry incised and drained the toe. 568 00:23:39,199 --> 00:23:42,072 They had to cut the nail out. 569 00:23:42,115 --> 00:23:43,855 - I'm not a doctor, but it looks like 570 00:23:43,900 --> 00:23:44,943 it's getting worse to me. 571 00:23:44,988 --> 00:23:46,945 - Don't worry. I'm on it. 572 00:23:46,990 --> 00:23:48,315 We're gonna get you the medicine you need. 573 00:23:48,338 --> 00:23:51,820 - Dr. Halstead, can I speak with you outside? 574 00:23:51,864 --> 00:23:54,519 - What's wrong? 575 00:23:54,563 --> 00:23:56,868 - Just give us a moment. 576 00:24:02,483 --> 00:24:05,095 - We're now completely out of linezolid. 577 00:24:05,137 --> 00:24:07,663 - You've gotta be kidding me. 578 00:24:07,705 --> 00:24:09,185 I knew it. 579 00:24:09,229 --> 00:24:11,928 I knew source control wasn't gonna cut it. 580 00:24:11,971 --> 00:24:13,601 How soon are we expecting to get it back in stock? 581 00:24:13,625 --> 00:24:15,713 - Tomorrow morning, at the earliest. 582 00:24:19,457 --> 00:24:21,327 - Order vancomycin. 583 00:24:21,372 --> 00:24:22,590 - She's allergic. 584 00:24:22,634 --> 00:24:25,419 - I know, all right, but I've got an idea. 585 00:24:29,075 --> 00:24:31,512 Hey, Liza. 586 00:24:33,384 --> 00:24:35,429 So got your labs back, and they look good. 587 00:24:35,472 --> 00:24:38,040 Your white blood count is slightly elevated, 588 00:24:38,084 --> 00:24:40,346 but that's pretty common in pregnancy. 589 00:24:40,391 --> 00:24:43,262 I think we're just looking at a stomach bug. 590 00:24:43,307 --> 00:24:44,613 - Makes sense. 591 00:24:44,655 --> 00:24:45,961 I can go home then? 592 00:24:46,005 --> 00:24:48,050 - Yeah, Dr. Patchefsky sent down a list 593 00:24:48,094 --> 00:24:50,052 of OB-GYN referrals, 594 00:24:50,096 --> 00:24:52,445 as well as some genetic testing counselors. 595 00:24:52,490 --> 00:24:54,797 We'll just add those to your discharge. 596 00:24:54,839 --> 00:24:56,711 - Genetic testing? 597 00:24:56,755 --> 00:24:58,496 I thought she said the... 598 00:24:58,539 --> 00:25:01,064 The baby looked healthy on the ultrasound. 599 00:25:01,106 --> 00:25:03,413 - Genetic testing for hereditary conditions 600 00:25:03,457 --> 00:25:04,457 is completely optional. 601 00:25:05,938 --> 00:25:09,594 - But the baby's healthy, right? 602 00:25:09,637 --> 00:25:10,769 - Yeah. 603 00:25:13,031 --> 00:25:14,859 Hey, listen, if... 604 00:25:14,903 --> 00:25:16,557 - Liza, my dear. 605 00:25:18,384 --> 00:25:20,778 I have your discharge paperwork. 606 00:25:25,435 --> 00:25:28,656 - I'm not sure I'm following you. 607 00:25:28,700 --> 00:25:32,095 You want to give me a drug I told you almost killed me? 608 00:25:32,137 --> 00:25:34,401 - And we'll do everything we can to mitigate the chances 609 00:25:34,444 --> 00:25:36,621 of another adverse reaction. - How, exactly? 610 00:25:36,664 --> 00:25:39,144 - Through a process called desensitizing. 611 00:25:39,189 --> 00:25:41,407 We'll pre-medicate you with steroids and antihistamines 612 00:25:41,451 --> 00:25:44,498 and then administer the vancomycin via a slow IV drip. 613 00:25:44,541 --> 00:25:47,458 - And can you promise me that my throat 614 00:25:47,500 --> 00:25:48,676 won't close up again? 615 00:25:48,720 --> 00:25:50,416 - I can't promise that, no. 616 00:25:50,461 --> 00:25:52,028 But if you do go into anaphylaxis, 617 00:25:52,070 --> 00:25:53,395 we'll have epinephrine at the ready. 618 00:25:53,420 --> 00:25:55,007 Worst case scenario, we might need to intubate, 619 00:25:55,030 --> 00:25:56,641 but that would only be temporary. 620 00:25:56,684 --> 00:25:58,034 - Intubate me? No, no. 621 00:25:58,076 --> 00:25:59,425 I'll go to another hospital. 622 00:25:59,470 --> 00:26:01,253 - Well, we've called everywhere. 623 00:26:01,298 --> 00:26:02,797 The earliest anyone has linezolid is tomorrow. 624 00:26:02,820 --> 00:26:04,736 - So I'll wait. 625 00:26:04,779 --> 00:26:07,130 - As you're seeing, MRSA moves fast. 626 00:26:07,173 --> 00:26:08,498 I am afraid if we wait until tomorrow, 627 00:26:08,521 --> 00:26:10,349 it will have already spread to the bone. 628 00:26:10,394 --> 00:26:11,742 You could lose your leg, Indrani. 629 00:26:19,490 --> 00:26:21,491 - Give me the vancomycin. 630 00:26:21,535 --> 00:26:22,535 - Okay. 631 00:26:26,627 --> 00:26:29,805 - Marcus' platelet count rose from 50,000 to 105,000. 632 00:26:29,847 --> 00:26:30,806 Can you believe it? 633 00:26:30,848 --> 00:26:32,589 - That's great. 634 00:26:32,634 --> 00:26:34,330 - It's fantastic. 635 00:26:34,374 --> 00:26:36,375 He must not have ITP after all. 636 00:26:36,420 --> 00:26:37,638 - Do me a favor. 637 00:26:37,682 --> 00:26:39,641 Show Abrams these updated labs. 638 00:26:39,683 --> 00:26:43,513 I think he'll be more receptive if you deliver them solo. 639 00:26:43,557 --> 00:26:45,690 - How could he possibly refuse to operate now? 640 00:26:45,733 --> 00:26:47,473 - It's Abrams. 641 00:26:47,518 --> 00:26:49,214 - I'll get him on board. 642 00:26:49,259 --> 00:26:53,393 - Dr. Choi? We've got a problem. 643 00:26:53,436 --> 00:26:55,700 Liza? 644 00:26:55,743 --> 00:26:56,788 I thought she had left. 645 00:26:56,832 --> 00:26:57,895 I came in to turn over the room, 646 00:26:57,920 --> 00:26:59,137 and I found her passed out. 647 00:26:59,182 --> 00:27:00,201 - Let's get her back in the bed 648 00:27:00,226 --> 00:27:01,334 and up on the monitors. Ready? 649 00:27:01,357 --> 00:27:03,708 One, two, three. 650 00:27:03,751 --> 00:27:05,840 All right. All right. 651 00:27:05,884 --> 00:27:07,711 Liza? Liza, can you hear me? 652 00:27:07,756 --> 00:27:09,864 All right, let's re-start her IV and get a Foley in her. 653 00:27:09,887 --> 00:27:11,019 Grab OB. - Patchefsky, right? 654 00:27:11,063 --> 00:27:12,020 - No, no, no. No time. 655 00:27:12,064 --> 00:27:13,413 Grab Asher. - Okay. 656 00:27:13,457 --> 00:27:15,851 She's hypotensive. 657 00:27:15,894 --> 00:27:17,374 Maybe she vasovagaled? 658 00:27:17,416 --> 00:27:19,537 - Her white count was more significant than I thought. 659 00:27:21,813 --> 00:27:23,380 - Liza. 660 00:27:23,423 --> 00:27:25,686 - You know her? - Yeah, Doris filled me in. 661 00:27:25,730 --> 00:27:26,968 How long had she been experiencing symptoms 662 00:27:26,991 --> 00:27:28,037 when she came in? 663 00:27:28,079 --> 00:27:29,298 - Less than 24 hours. 664 00:27:29,342 --> 00:27:31,344 - And that's self-reported from the patient? 665 00:27:31,387 --> 00:27:32,650 - Yeah, why? 666 00:27:36,087 --> 00:27:37,394 - Bolus a liter of normal saline. 667 00:27:37,436 --> 00:27:38,893 - Hannah, we've been giving her fluids. 668 00:27:38,916 --> 00:27:40,396 Could this be sepsis? 669 00:27:40,440 --> 00:27:41,895 We could start a broad spectrum antibiotic. 670 00:27:41,920 --> 00:27:43,244 - Let's just see what this does first. 671 00:27:43,269 --> 00:27:44,749 I don't think we're looking at sepsis. 672 00:27:44,792 --> 00:27:48,752 I think she's hypovolemic from massive volume depletion. 673 00:27:48,797 --> 00:27:52,887 I suspect she's been sick a lot longer than she reported. 674 00:27:52,931 --> 00:27:54,846 - BP's starting to come up. 675 00:28:16,780 --> 00:28:19,653 - Appreciate you stepping up to the plate on this one, Sam. 676 00:28:19,696 --> 00:28:21,719 - His platelets sure turned around fast, didn't they? 677 00:28:21,742 --> 00:28:22,961 - Marcus is a fighter. 678 00:28:25,484 --> 00:28:27,009 - All right, this is my show. 679 00:28:27,051 --> 00:28:29,029 Once we get to the spine, you follow my lead, understood? 680 00:28:29,054 --> 00:28:30,534 - Fair enough. 681 00:28:30,576 --> 00:28:33,276 - Mia, start my playlist. 682 00:28:34,798 --> 00:28:37,061 All right, after you. 683 00:28:37,105 --> 00:28:38,237 - Scalpel. 684 00:28:51,642 --> 00:28:52,861 - Where are we at? 685 00:28:52,903 --> 00:28:55,166 - I gave 125 of the methylprednisolone 686 00:28:55,211 --> 00:28:57,125 and 50 of diphenhydramine. 687 00:28:57,169 --> 00:28:59,867 - All right, we're ready to start the vancomycin. 688 00:28:59,911 --> 00:29:01,607 Now, we're gonna take it slowly, 689 00:29:01,652 --> 00:29:03,609 gradually increase the dose over time. 690 00:29:03,653 --> 00:29:05,394 Are you ready? 691 00:29:05,438 --> 00:29:07,135 - As I'll ever be. 692 00:29:19,712 --> 00:29:21,932 Something doesn't feel right. 693 00:29:21,977 --> 00:29:23,630 - Okay. - Oh, my God. 694 00:29:23,673 --> 00:29:25,545 Oh, my God. My throat... I can't swallow. 695 00:29:25,588 --> 00:29:27,808 - Okay, we got you. Nancy, 0.3 of Epi. 696 00:29:27,852 --> 00:29:31,247 I can't... 697 00:29:31,289 --> 00:29:32,422 - It takes time to work. 698 00:29:32,464 --> 00:29:33,989 Just stay calm. Keep your eyes on me. 699 00:29:36,948 --> 00:29:39,994 Another 0.3 of Epi and another 50 of diphenhydramine. 700 00:29:43,563 --> 00:29:45,478 Mask. 701 00:29:45,521 --> 00:29:46,827 There you go. 702 00:29:52,181 --> 00:29:55,052 Get ready to intubate. 703 00:29:55,096 --> 00:29:56,489 Just a precaution. 704 00:30:10,807 --> 00:30:12,330 - I think it's working. 705 00:30:12,375 --> 00:30:13,636 - Slow, deep breaths. 706 00:30:13,680 --> 00:30:15,726 In through the nose, out through the mouth. 707 00:30:21,426 --> 00:30:22,558 - That's it. 708 00:30:29,958 --> 00:30:33,265 - So how long have you actually been sick? 709 00:30:33,308 --> 00:30:35,701 - This is day six. 710 00:30:35,746 --> 00:30:40,707 Ever since I stopped using. 711 00:30:41,925 --> 00:30:43,536 - Did you know that these symptoms 712 00:30:43,579 --> 00:30:46,670 are a result of withdrawal? 713 00:30:46,712 --> 00:30:48,759 - I figured. 714 00:30:51,282 --> 00:30:54,503 Dr. Asher, if I outed you to your colleagues... 715 00:30:54,547 --> 00:30:56,375 - No. 716 00:30:56,419 --> 00:30:57,855 No, you didn't. 717 00:30:57,898 --> 00:31:01,684 Everyone here knows that I'm in recovery. 718 00:31:01,728 --> 00:31:05,253 And you don't have to call me Dr. Asher. 719 00:31:06,298 --> 00:31:10,346 - It does feel kind of weird calling you by your last name. 720 00:31:11,781 --> 00:31:14,088 I won't tell anyone in group. 721 00:31:14,132 --> 00:31:15,916 - Thank you. 722 00:31:15,960 --> 00:31:17,743 - I don't even know if the drugs 723 00:31:17,788 --> 00:31:20,224 have cleared my system yet. 724 00:31:20,269 --> 00:31:23,054 I couldn't risk you running a drug test on me, 725 00:31:23,097 --> 00:31:25,448 given everything you know about me. 726 00:31:25,490 --> 00:31:30,105 I just... I don't want anyone taking my baby away. 727 00:31:32,193 --> 00:31:36,198 - Well, I commend you for quitting, Liza. 728 00:31:36,240 --> 00:31:38,590 Going cold turkey is really hard. 729 00:31:40,680 --> 00:31:43,944 There are some medications like Suboxone and methadone 730 00:31:43,988 --> 00:31:46,511 that can help curb the cravings. 731 00:31:46,556 --> 00:31:48,557 - Those are opiates, right? 732 00:31:48,601 --> 00:31:50,255 - Yes. 733 00:31:50,298 --> 00:31:52,561 But when you're medically supervised, 734 00:31:52,605 --> 00:31:55,694 you are allowed to be on them while you're pregnant. 735 00:31:55,739 --> 00:31:57,435 The risk to the fetus is minimal... 736 00:31:57,480 --> 00:31:59,002 - No. 737 00:31:59,047 --> 00:32:02,093 If there are any risks, then no. 738 00:32:03,964 --> 00:32:08,011 I probably shot up, 739 00:32:08,056 --> 00:32:11,406 like, a half dozen times during my first trimester. 740 00:32:13,625 --> 00:32:19,675 And still, by some miracle, the baby seems to be okay. 741 00:32:22,287 --> 00:32:26,290 I can't do anything to jeopardize that. 742 00:32:26,335 --> 00:32:27,335 I won't. 743 00:32:31,688 --> 00:32:32,863 - Come in. 744 00:32:38,825 --> 00:32:40,697 - I was going to check with Mrs. Sullivan 745 00:32:40,740 --> 00:32:43,003 to see if she would agree to David spending 746 00:32:43,047 --> 00:32:45,744 a couple of nights in the psych ward. 747 00:32:45,788 --> 00:32:48,051 I figure we can talk to him more, 748 00:32:48,096 --> 00:32:52,751 begin to find the correct medication and dosage. 749 00:32:52,796 --> 00:32:54,405 - Well, that sounds good, Dr. Cuevas. 750 00:32:54,450 --> 00:32:56,017 Thank you. 751 00:32:56,059 --> 00:32:58,627 - Oh, and his father is out of surgery. 752 00:32:58,671 --> 00:33:00,064 No complications. 753 00:33:00,107 --> 00:33:04,112 - Well, good stuff. I'm glad to... glad to hear too. 754 00:33:08,811 --> 00:33:12,945 - I should have spoken to you first before medicating David. 755 00:33:12,990 --> 00:33:15,601 - Look, you know it was a chaotic situation, 756 00:33:15,644 --> 00:33:18,778 and I understand that you felt the need to act swiftly. 757 00:33:18,821 --> 00:33:20,214 I do. 758 00:33:20,258 --> 00:33:23,392 - I probably did jump to medication too quickly, 759 00:33:23,434 --> 00:33:24,696 if I'm being honest. 760 00:33:27,743 --> 00:33:31,529 I know I rely heavily on the literature 761 00:33:31,574 --> 00:33:33,836 and the standard of care, 762 00:33:33,880 --> 00:33:38,624 but I just don't always feel 763 00:33:38,667 --> 00:33:41,845 like I can trust my own instincts. 764 00:33:44,847 --> 00:33:49,634 - I mean, it took me years, years. 765 00:33:49,679 --> 00:33:50,854 And still, I have... 766 00:33:50,896 --> 00:33:55,076 I have my days when... you know? 767 00:33:55,118 --> 00:33:58,165 But this, I can promise you, you will get there. 768 00:33:58,209 --> 00:33:59,427 You will. 769 00:33:59,471 --> 00:34:01,211 There's not a shred of doubt in my mind. 770 00:34:02,734 --> 00:34:03,997 Trust me on that. 771 00:34:20,318 --> 00:34:22,407 - Hey, Janet. 772 00:34:22,451 --> 00:34:24,016 Marcus did great. 773 00:34:27,760 --> 00:34:29,414 - I can't thank you both enough. 774 00:34:29,458 --> 00:34:30,675 - No need. 775 00:34:30,719 --> 00:34:31,894 He's got a long road ahead, 776 00:34:31,938 --> 00:34:33,635 but with physical therapy, I'm confident 777 00:34:33,679 --> 00:34:36,028 he'll be back on his feet. 778 00:34:36,072 --> 00:34:37,378 Can... can I see him? 779 00:34:37,422 --> 00:34:39,423 - Of course. I'll take you to recovery. 780 00:34:39,467 --> 00:34:42,166 Now, he's just waking up, so he might be a bit groggy, okay? 781 00:34:42,210 --> 00:34:43,427 This way. 782 00:34:47,867 --> 00:34:49,913 - Dr. Abrams, I heard the good news. 783 00:34:49,956 --> 00:34:51,262 I really appreciate... 784 00:34:51,306 --> 00:34:53,786 - Yeah, you two ever pull a stunt like that again, 785 00:34:53,829 --> 00:34:54,849 I won't keep it to myself. 786 00:34:54,873 --> 00:34:56,266 I'll go straight to Goodwin. 787 00:34:56,311 --> 00:34:57,572 - Excuse me? 788 00:34:57,615 --> 00:34:59,416 - I don't appreciate being conned into surgery 789 00:34:59,443 --> 00:35:01,445 under false pretenses. - Wait. 790 00:35:01,489 --> 00:35:03,666 I'm sorry, Dr. Abrams. What are you talking about? 791 00:35:07,452 --> 00:35:09,585 - My antenna went up when Marcus's platelets 792 00:35:09,628 --> 00:35:11,021 corrected so quickly. 793 00:35:11,063 --> 00:35:13,110 So I had the lab run an anti-platelet antibody test 794 00:35:13,153 --> 00:35:14,371 while we were in surgery. 795 00:35:14,416 --> 00:35:17,027 You might be interested in the results. 796 00:35:21,771 --> 00:35:23,293 - Marcus has ITP. - Mm-hmm. 797 00:35:23,338 --> 00:35:24,773 - But this doesn't make any sense. 798 00:35:24,817 --> 00:35:26,297 If Marcus has ITP, the transfusion 799 00:35:26,340 --> 00:35:28,646 shouldn't have worked. - Correct. 800 00:35:28,690 --> 00:35:31,519 Unless someone gave him a little assistance. 801 00:35:41,530 --> 00:35:44,054 - You gave Marcus steroids, didn't you? 802 00:35:44,097 --> 00:35:45,422 And that's why his platelet count went up. 803 00:35:45,447 --> 00:35:47,231 - I know steroids can be controversial 804 00:35:47,275 --> 00:35:49,233 in the surgical settings... - To put it lightly. 805 00:35:49,277 --> 00:35:52,367 You put him at greater risk of post-op infection. 806 00:35:52,409 --> 00:35:53,865 - Vanessa, believe me when I tell you, 807 00:35:53,889 --> 00:35:56,414 this was our only play. 808 00:35:56,458 --> 00:35:57,762 - Ouronly play? 809 00:35:57,806 --> 00:36:00,375 I was left in the dark. 810 00:36:00,418 --> 00:36:02,090 - Look, I didn't want you catching any heat 811 00:36:02,114 --> 00:36:03,594 if things went south, okay? 812 00:36:03,639 --> 00:36:05,902 I have more cover as an attending. 813 00:36:05,945 --> 00:36:07,251 I was trying to protect you. 814 00:36:09,210 --> 00:36:10,862 - I do not need your protection. 815 00:36:10,907 --> 00:36:12,081 I need your respect. 816 00:36:12,125 --> 00:36:14,083 - Vanessa, of course I respect you. 817 00:36:14,126 --> 00:36:16,260 - It does not feel that way right now. 818 00:36:25,050 --> 00:36:27,184 - Looking much better, Indrani. 819 00:36:27,228 --> 00:36:29,161 Some techs will be back soon to move you upstairs. 820 00:36:29,186 --> 00:36:31,492 We're gonna keep you on IV vancomycin for a few days 821 00:36:31,536 --> 00:36:34,364 and then switch you over to the oral version. 822 00:36:34,409 --> 00:36:37,367 - Dr. Halstead, I can't thank you enough. 823 00:36:37,411 --> 00:36:39,762 - I'm just sorry we had to put you through all that. 824 00:36:39,804 --> 00:36:41,458 - Oh, it was worth it, believe me. 825 00:36:44,505 --> 00:36:46,376 That's where I'm going to be next month. 826 00:36:48,378 --> 00:36:50,163 - I'm adding it to my bucket list. 827 00:36:54,777 --> 00:36:55,927 Would you excuse me for a moment? 828 00:36:55,952 --> 00:36:57,170 - Of course. 829 00:36:59,650 --> 00:37:01,523 - Ms. Goodwin. 830 00:37:01,565 --> 00:37:03,829 - Stop by my office before you leave tonight. 831 00:37:03,873 --> 00:37:05,177 I'd like a word. 832 00:37:07,268 --> 00:37:09,139 - Will do. 833 00:37:13,012 --> 00:37:15,666 - Dr. Choi, 834 00:37:15,710 --> 00:37:19,235 uh, this is for you. 835 00:37:19,280 --> 00:37:20,648 I saw you were staying on for the night shift, 836 00:37:20,672 --> 00:37:23,806 so I figured you might need a caffeine boost. 837 00:37:23,849 --> 00:37:25,416 Oh, and these are also for you. 838 00:37:25,460 --> 00:37:27,809 It's my CV, in-progress research papers, 839 00:37:27,853 --> 00:37:29,246 and all my case logs to date. 840 00:37:31,030 --> 00:37:33,336 For our first advisor meeting tomorrow. 841 00:37:33,380 --> 00:37:38,429 - Ah, well, you are really prepared, Zach. 842 00:37:38,472 --> 00:37:39,561 Will you excuse me? 843 00:37:39,603 --> 00:37:41,518 - Yeah, of course. 844 00:37:41,563 --> 00:37:43,521 See you tomorrow. 845 00:37:43,565 --> 00:37:45,827 - See you tomorrow. 846 00:37:45,871 --> 00:37:48,177 Hey. - Hey. 847 00:37:48,221 --> 00:37:50,789 Liza agreed to be admitted overnight for observation. 848 00:37:50,833 --> 00:37:52,704 - Good. 849 00:37:52,748 --> 00:37:55,097 She's in withdrawal, I take it. 850 00:37:55,141 --> 00:37:57,012 Don't worry, I won't say anything. 851 00:37:57,056 --> 00:37:59,101 - I appreciate that, Ethan. 852 00:37:59,144 --> 00:38:00,885 And while I suspect that the drugs 853 00:38:00,929 --> 00:38:02,210 have already cleared her system, 854 00:38:02,235 --> 00:38:03,932 she's terrified someone might report her. 855 00:38:03,976 --> 00:38:05,630 - The last thing she needs is to be 856 00:38:05,673 --> 00:38:09,112 penalized for seeking care. 857 00:38:09,155 --> 00:38:11,201 - Look, you were absolutely right, by the way, 858 00:38:11,244 --> 00:38:13,246 to bring in Dr. Patchefsky. 859 00:38:13,289 --> 00:38:15,117 I never should have given you flack for that. 860 00:38:15,161 --> 00:38:18,121 - Look, I know how frustrating it is 861 00:38:18,164 --> 00:38:20,862 to always feel like you're being held 862 00:38:20,905 --> 00:38:23,518 to some former version of yourself. 863 00:38:23,561 --> 00:38:26,215 But on the flip side, because of who you were 864 00:38:26,259 --> 00:38:27,956 and what you went through, 865 00:38:28,000 --> 00:38:29,567 you were able to connect to Liza 866 00:38:29,610 --> 00:38:31,481 in a way no one else could. 867 00:38:33,005 --> 00:38:35,137 - Yeah. 868 00:38:35,181 --> 00:38:36,400 I guess that's true. 869 00:38:38,184 --> 00:38:40,403 - Maybe it's not always such a bad thing, 870 00:38:40,447 --> 00:38:42,579 having your reputation precede you. 871 00:38:50,545 --> 00:38:52,634 - Great work today, Sam. 872 00:38:58,856 --> 00:39:00,032 Goodnight, Dr. Taylor. 873 00:39:05,646 --> 00:39:07,431 - Ooh, ouch. 874 00:39:07,474 --> 00:39:12,175 Why, I see you've got yourself quite the fan club. 875 00:39:12,217 --> 00:39:14,177 You know, maybe I was wrong about you. 876 00:39:14,219 --> 00:39:16,744 You might be cut out for island life after all. 877 00:39:21,139 --> 00:39:24,447 - So let me get this straight. 878 00:39:24,492 --> 00:39:27,320 You gave the patient an antibiotic 879 00:39:27,364 --> 00:39:29,322 you knew she was allergic to... 880 00:39:29,365 --> 00:39:31,934 - Only after I advised her of the potential risks 881 00:39:31,976 --> 00:39:33,675 and with her full consent. 882 00:39:33,717 --> 00:39:35,981 - Which, trust me, wouldn't hold up in court 883 00:39:36,025 --> 00:39:38,592 if this thing had gone sideways. 884 00:39:38,635 --> 00:39:40,637 - Well, Ms. Goodwin, it wasn't my first choice. 885 00:39:40,681 --> 00:39:43,032 - I understand the new protocols got off 886 00:39:43,074 --> 00:39:44,860 to a bit of a rocky start today, but... 887 00:39:44,902 --> 00:39:47,123 - They're not working. 888 00:39:47,166 --> 00:39:48,690 I have no doubt they were designed 889 00:39:48,733 --> 00:39:49,994 with the best of intentions, 890 00:39:50,039 --> 00:39:51,146 but as your boots on the ground, 891 00:39:51,170 --> 00:39:52,364 I have to give it to you straight. 892 00:39:52,389 --> 00:39:54,652 - Let me give it to youstraight. 893 00:39:54,695 --> 00:39:59,090 These supply chain issues are not gonna resolve anytime soon, 894 00:39:59,135 --> 00:40:02,094 and not for lack of trying on my part. 895 00:40:02,137 --> 00:40:06,489 So as imperfect as these new protocols may be, 896 00:40:06,534 --> 00:40:12,626 we need some sort of semblance of order in the ED. 897 00:40:12,670 --> 00:40:16,543 I can't have it turning into the Wild West! 898 00:40:18,371 --> 00:40:21,548 - Honestly, Ms. Goodwin, I think we're already there. 66053

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