Oh, sorry.
Dinner, my place?
I thought we finished with all that about five years ago.
Doctor Amed?
Bash.
Lockdown. Code silver.
Lockdown. Code Silver.
Can I help?
No. I got it. It's fine. Go.
I'll go find some gauze and come right back.
No. There's gauze in the cabinet. I can make it. Go.
You'll be okay, I can stop the bleeding as soon as the shooter clears.
You're going to be okay.
Can you move?
Did you see him?
The last shots came from hallway J.
- You shouldn't be in the open. - Are you okay?
I've got a through-and-through to the neck.
Another in the thigh.
Mine's an abdominal wound and a shot to the right humerus.
I applied a tourniquet to try and stabilize his pressure,
but it's still dropping in critical.
Pressure right there.
There might not be anything else you can do for him.
Well, maybe if I...
Maybe if I bolus him with fluids,
we'll keep him going until we can activate massive contusion.
Get down, get down.
Lights on.
That concludes the active shooter drill.
- God... - Thank you everyone.
Well, I lost mine, how'd you manage to stabilize yours?
Bash?
Hey, don't worry, I was going to die no matter what you did.
And now we find out how we did.
My guy was gonna die all along.
If I had no hope of saving him, what was the point?
Maybe that was the point. To see how you'd handle it.
- Well then, I failed. - Pretty sure it's not pass or fail.
Whole purpose of the drill is to make sure
we're prepared for the real thing.
Alright, thanks.
We're gonna have a full post-mortem with the observers tomorrow.
We're gonna review the tape,
and we're gonna discuss any course corrections in depth.
In the interim,
I want you to think about how you're feeling right now.
And how you responded to the situations you've faced.
You were trying to solve a problem that couldn't be solved.
You should've called that patient and moved on.
Learn to control what you can, and let go of what you can't.
Right? You're an island. But you work on a team.
You could've stopped the bleeding quicker
if you'd let Dr. Hamed help you get supplies.
Calm under pressure, no surprise there, but you took huge risks.
You can't save lives if you've sacrificed your own.
Huh? Alright.
- Synced and corrected by martythecrazy - - www.addic7ed.com -
Changed your mind?
I... I pressed the wrong button.
Heard there was an active shooter drill today.
Always cracks a few residents.
Did your patient fake die?
Fake lived, actually.
Mr. Gomes?
I'm Dr. Hamed.
I understand you've been experiencing some
chest pains and dizziness.
- When did this start? - Earlier this week.
I was trying to ignore it,
but I think that was a bad idea because...
now my left arm is tingling.
Deep breath.
It can't be... it can't be a heart attack, right?
I mean, I'm too young.
Are you a smoker, Mr. Gomes?
Kevin. No, never.
I got scared straight by that
shrivelled lung they showed us in sixth grade.
Any family history of heart problems?
Not that I know of.
They don't keep me in the loop on everything.
Hello, I'm Dr. Leblanc.
You're from Station 19 around the corner?
Take a deep breath.
Best post I've had.
Busy, though. We stretched three times last night.
Mm.
Do you wear a respirator?
The tanks are only good for 20 minutes,
sometimes we're in longer.
They're heavy, so we just ditch them when they run out.
Did you run out last night?
Yeah.
We pulled a couple from a bad house fire.
Got in as fast as we could, but they didn't make it.
Have you ever been diagnosed with high blood pressure?
No. I eat right, I exercise,
I don't drink.
I just can't catch a break right now.
First I, uh... First I lose my job, and then...
And then I had to move.
Deep breath. Deep breath.
Alright. Your blood pressure is high,
and your heart rate has elevated since you got here.
Is that what you were feeling before?
What do you... What do you think is wrong with me?
Um, we'll order some tests.
Uh, some blood work and an ECG, and uh...
Try not to worry, this is standard procedure.
Right. Thanks, Doc.
My dad was a firefighter,
and he always said you save the next one.
Yeah.
Okay.
Mm. Your nails are blue.
How long have they been like that?
They are? I dunno.
And your O2 sats are 88%.
I want to send you for pulmonary function testing.
I've been doing this ten years. I bounce back every time.
Yeah, I don't doubt it. But you're here now,
so better be safe than sorry, right?
If the thing you loved was slowly killing you,
would you, A, stop and save yourself,
or B, continue and risk it?
I would decide not to follow you down this particular
rabbit hole today.
Oh my God, it's your birthday!
I baked cupcakes and I totally forgot about them.
When do you have time to bake?
I know, I needed something to relax me.
You know what could help you to relax? Sleeping.
- Did you do something special? - Mel threw the annual barbecue.
Some friends, some family, some coconut cream pie.
- Oh, that's nice. - It was.
You know, usual suspects.
We should shake things up and let's go for drinks tonight.
- A kid in four is waiting for you. - Okay?
How'd this happened?
Rolled it during soccer practice, and wiped out.
Could've walked it off, but Coach forced me to come.
My mom's on her way.
You should consider a beard.
Beards are in. Plus it'll help with your chin.
Okay, good to know.
How's the pain on a scale from 1 to 10?
Six.
Eight when you do that!
Well, it's probably a sprain, but we'll X-ray.
Either way, you're gonna have to rest it.
But playoffs are coming up.
But you gotta think long-term.
You push it now, it could only make it worse.
And uh, I'll get a nurse in here disinfect these scrapes.
- Does it hurt when I press? - No. All good.
What happened to your ribs?
Nothing. They're fine.
Danny is binding.
If it wasn't on the chart, I'd never have known he was born a girl.
What did he say?
Not much,
he clammed up when I asked about the tensor bandage.
I'm worried he's cutting off circulation.
What's the protocol?
Is this your first transgender patient?
No, I saw some adults when I was doing residency,
but never someone this young.
But I'm just treating this kid for a sprained ankle.
He may not have anyone he trusts to help him with this.
Sorry.
Sir, you really have to hold still, okay? Ah!!
Uh, nurse?
Ugh... So stupid. I should've had security there.
Dr. Curtis, are you okay?
Yeah, just blood splatter from a displaced IV.
The patient is an intravenous user.
You need to fill out an incident report.
Get blood work on him, including HIV, Hep B, Hep C.
I want you to start PEP immediately.
Uh, I have surgery today, so...
Not anymore.
- I can draw your blood. - I'll go to the lab.
Blood work is normal, as is your ECG, so no evidence of a heart attack.
Then what was I feeling?
You're tachycardic, which means you have an elevated heart rate.
Is that serious?
We need to determine the underlying cause.
Do you still feel numbness?
It... It comes and goes,
along with this splitting headache.
Well, the next step is an echo and then a stress test, but...
What's happening to me?
Kevin?
I need help over here!
You were saying something about an X-ray?
We'll get you one right away, now just give me a minute.
Kevin Gomes, the heart patient. Is he in the echo lab?
Uh no, you sent him for a CT to rule out stroke.
When?
About an hour ago.
Arnold, have you seen my patient Kevin Gomes?
Porters are bringing him back down.
Why, thought you lost him?
No, just uh...
Hey, you forget something bud?
- You left this in the lounge. - Thank you.
I'm Amanda Gomes, you left me a message?
Uh, Dr. Hamed. You're Kevin Gomes's emergency contact?
His sister, yes. Is he okay?
I'm just about to pick up his latest test results.
Did Kevin ask you to call me?
It's protocol when somebody loses consciousness.
He lost consciousness?
What happened? Where is he?
Um, if you check at the nurse's desk, they'll be able to direct you.
I'll be there shortly.
Why did you even come here?
I want to help you!
You being here only makes things worse!
If you really want to help me, you'll leave.
Take care of him.
You called my sister?
You collapsed. We had her on file from a prior visit...
You shouldn't have called her. My family is...
They don't know how to handle this kind of thing.
Well, good news, your CT came back clear.
No sign of a stroke.
But we still don't know why I passed out?
It could be a cardiogenic syncope.
Sometimes with an irregular heartbeat,
your blood pressure drops suddenly.
Is your headache worse?
Like a dull creeping ache across the back of my skull.
Could you have missed something?
Doctors make mistakes all the time, right?
Uh, we'll order an MRI.
It can detect subtleties that sometimes a CT can't.
Four weeks. No training.
Seriously? That's like forever.
It'll fly by before you know it.
But listen...
When you rewrap your other tensor,
go easy.
Too tight, and it can cause other problems.
Too loose, and they'll still show.
You can buy compression chest binders.
They are easier on your skin.
Still, you shouldn't wear them more than eight hours a day.
Yeah, but...
you need a credit card to buy them online.
So your parents don't know that you're...
A boy?
They're fine with the pronouns
and keeping my hair short, and wearing boy's clothes, but...
that's about it.
They don't know that you bind.
I don't know, we don't talk about it.
I know about gender dysphoria.
I've seen a therapist a couple times for it.
Okay.
Is there anything I can do to help?
I want top surgery.
Okay, Danny wants a double mastectomy.
He asked you to help him get it?
Thirteen's pretty young to make a call on gender reassignment.
So, you're on the conservative side of the medical?
The kid is still growing.
And we don't have proper long-term studies on hormones.
If he's considering it, he should know the risks.
Hmm, well, it's a little outside the lines of emergency medicine.
You sure you want to wade into this?
I want to make sure he has the support he needs.
When the mother comes in, I'd... I'd like to talk to her.
Well, let me know what you need.
Does your patient know what triggered this event?
He thinks so.
And you said he lost time.
About an hour's worth.
He can't remember anything over that span.
Well, sounds like a dissociative event.
Right.
He retraced his steps,
and he functioned perfectly throughout. No one even noticed.
With dissociation, the patient's emotional centre detaches
but his decision-making and instincts remain the same.
Is this something he has a history of?
Sometimes he says he zones out.
But no, nothing like this.
Normally when I'm being referred to a patient,
there's a chart of some kind.
- I'm just gathering information. - Mm.
You said you have experience with PTSD.
Yes, I do, and with post-traumatic stress injuries,
the only way out is through.
You should encourage your patient to get therapy.
And if he's not ready for that?
Well, does he have a good support system?
Family, friends?
He would rather not involve them.
Mm. Well, maybe he should start.
Why are you looking at the discharged patients' files?
I'm checking to make sure there's nothing I missed today.
Sometimes it... it all feels like it all blends together
Mm. I'd trade you if I could. I remember every patient.
Every detail. It's like a curse.
Can't remember what I had for breakfast, though.
I can help you review if you want.
If you're worried you missed something.
Doesn't look like I did.
Did you get your antivirals?
Check.
Why are you still here? You can't see patients.
- I have files to finish. - We can cover that.
Why? If I have something, I'm gonna have it at home too.
Hey, your results are in from Respiratory.
Perfect.
- Absolutely not. - Jessica.
Last night was a grind. I came in for O2 and an all-clear.
I'm not sidelining myself.
Jessica, you may have COPD.
You said my chest X-ray was clear of cancer.
That's good enough for me.
Your lung capacity is significantly reduced.
Ignoring this could actually kill you.
- Well, so could a fire. - Listen, it's just a few tests!
It's a consult with one of our respirologists.
Let me help you get this under control.
Look, I know you're doing your job, but I gotta do mine.
My dad did this job 'til he was 50, I'm not about to give it up.
Well, if you leave against medical advice,
I need you to sign something that says you understand the risks.
No problem.
I'm sorry, he shouldn't have gotten you involved.
- We've been through this. - Eighteen is too long to wait!
We had a long talk with his pediatrician,
and we all agreed we won't even consider surgery until
- Danny is an adult. - I don't agree!
What do you think?
I think holding off on a surgical procedure
is a wise decision.
- You're on her side?! - I'm on your side.
Surgery is a big commitment.
- Your body is still changing. - That's the point!
- I need it to stop! - Danny, you're thirteen!
I know what I want!
- You pass as a boy. - With breasts!
They won't let me play for the guy's soccer team.
What if this is a phase?
You think I'm just gonna get over it?!
Yes! You might!
Look, when we get home, we can talk some more.
Okay?
You don't believe me
Come on Danny.
No one is saying that.
She just did.
You're all the same.
- Good night, sir. - You ordered a CT, an ECG
and an MRI for the patient in two?
Along with Kevin's racing heart,
headaches, and slurred speech,
he's also presenting with severe abdominal pain.
The nurses say he's vomited several times.
I looked at the MRI. He hasn't had a stroke.
- Mm-hmm. - You were expecting that?
Does that mean you have a theory?
There may be nothing wrong with him at all.
Keep talking.
I think Kevin's tachycardia's brought on by a stress reaction.
And yet he's still here.
Are you saying you want me to send him home?
I'm saying you better have a very good reason if you don't.
Are you going somewhere?
Daneesha's, remember?
You said I can sleep over.
It's Friday already?
I thought we could make our own pizzas again
She asked for me to eat there.
Her cousins are coming over too.
That will be fun.
Will you be okay alone?
You think I need a babysitter?
Only sometimes. How was work?
It was fine. I'll walk you over.
Look, the next one's on you.
Hey! You made it!
He's the best.
Happy birthday.
It's a Baharat. A spice mix we use at home.
Amira toasts it.
Thanks, man. Uh Aiden Miller.
Surgeon. We were in the same year in med school.
Bashir.
Go, big guy.
Mm. You haven't changed a bit.
That is not true.
Says the guy who's wearing the same khakis he wore to graduation
When I find pants that fit, I stick with them!
There's nothing wrong with that. Am I right?
- No, he's right. - I'm right.
You sure you don't want something?
Early surgery tomorrow, so...
So you're not coming over later?
Don't you have your son?
He's with his mom.
Can I get a soda with lime, please.
Oh, so y'all are gonna make me drink alone?
- Are you okay? - Never better.
Hey, hey, hey!
It's my favourite not-a-couple!
Wait, so you're here together?
That means you're here together.
Right?
Are you still thinking about your fake patient fake dying?
No, no, no. I've let that go.
Oh.
Okay, no I haven't.
But I'm also thinking about this firefighter I saw today.
COPD. And I tried getting her to see all the risks of ignoring it,
and she just discharged herself to run right back into the fire.
Sounds like no one I know.
So basically you went from obsessing over a fake patient,
to obsessing over a real one,
both of which are outside of your control?
I gave her all the intel, it wasn't enough to stop her.
Joanie! The paramedics came out tonight too?
I got you.
How did I lose my wallet already?
Sign of someone who's having a good birthday.
- Yeah. - How old exactly?
Thirty-two.
One more year, and I've outlasted Jesus.
Hey, what do you think?
Should I...
- Should I grow a beard? - Like Jesus?
Ha! I was thinking more like... like a lumberjack.
Yeah! Yeah, I think you could handle it.
Thank you.
One more drink, and they'll cross over from lubricated to morose.
Is that why you're hiding?
I always hoping that a night out will help with a tough day.
Do you want to talk about it?
I'm really better a listener.
But you're not much of a talker.
In that case...
Should we go?
Organic...
fair trade...
dark orange.
- You remembered. - Mm.
That's it?
That's all I want.
Mm.
Why don't you stay the night?
We don't do that.
You could leave Eric, you know?
For you?
The workaholic with a hole in his head?
Get some rest.
Hey. Sorry to call you in so early.
It's fine, Arnold, I asked you to. What's happening?
Uh, Kevin took a turn for the worse.
I know you said to send him home,
but he could be having an aortic dissection,
which, if went untreated, could be fatal.
Because of the widened mediastinum?
And because dissection already mimics everything I've tested for.
- Heart attack, stroke... - Get him a CTA to confirm stat.
Put cardio-thoracics on standby.
If you're right, every second counts.
Dr. Hunter!
Paula? What, what happened?
I found him trembling on the floor,
he was burning up! He passed out on the way over!
Hey. Danny? Can you hear me?
Did he take anything?
He said he bought testosterone off some guy at a gym.
Would it do that to him?
We need to get him inside.
Mike, Mike! Bring a chair!
Just take a step back.
Alright...
I need a resus, stat!
Code pink! Trauma bay!
Heart rate elevated.
Hyperthermic, temp is 39 and rising.
Cooling packs.
He may have ingested some form of amphetamine.
Start 1 mg Lorazepam.
Rate's spiking! Temp won't stabilize!
Normal, give me that syringe.
Can I get a flesh?
Okay, okay.
110... 106...
100... 99!
Okay, start fluids, get a CBC,
lytes, and a CK to check if there's rhabdo.
Tell lab to rush a full tox screen.
- Okay. - Oh, my baby!
And finally after every test that I ran,
my patient's CTA is normal.
So what's next, Dr. Hamed?
Full-body PET scan?
A course of prophylactic chemotherapy?
There is nothing physically wrong with Kevin Gomes.
You knew that ages ago.
I could have missed something.
You've never doubted your instinct before. Why now?
Why do you think you've missed something?
Next time this happens, don't keep it to yourself.
Come and talk to me.
Your labs aren't back yet,
but your vitals have stabilized. You're doing good.
What do you care?
I care.
Your mom cares too. We all do.
If she did, she'd do something.
Your mom is scared.
I saw the way she looked when she brought you in,
she loves you very much, Danny.
Not enough to let me have surgery.
Mastectomy is a big deal
Look at me.
What do you see?
Right.
Do you know what it's like?
I feel caught in between.
I just wanna be like the rest of the guys.
I can't live a lie
another four years.
Are they in yet? Your results.
I haven't checked.
June, it's okay if you're worried, you know.
- I'm fine. - Incoming!
Woman collapsed in a fire.
That's all I know.
Female, 33, unconscious.
- Is she a firefighter? - No, a civilian.
Wendy Newman, hypotensive.
Penetrating trauma to the chest. 80 on 40.
She fell through a window during an apartment fire,
and the glass cut deep.
Pericardial effusion.
She needs a bilateral chest tubes and a sternotomy.
- Call OR. - Pressure's 70 over 30.
There's no time, that's a penetrating wound to the heart.
- You're saying she needs a thoracotomy? - She needs it now.
- I'll page Atwater. - I've got it.
ED thoracotomies have less than a five percent success rate
We don't control the odds, doctor.
Just have to face them.
Dr. Curtis, you can't help, so why are you here?
I can help talk Mags through it.
Okay, let's do it.
- Sats are dropping! - I'm going to bag.
Now would be a good time!
Alright, let's get the left arm out of the way.
Prep the chest.
Alright, so,
you're gonna make an incision between the 5th intercostal space,
from the sternum to the bed.
Scissors.
Ready to open the chest.
Alright.
Just pretend I'm Dr. Curtis.
When's the last time you got your hands dirty?
On three.
One, two, three.
She needs blood.
O-Negative. Four units.
Activate MTP and 2 grams of TXA.
Keep talking, Dr. Curtis.
Okay, you're gonna need to make an incision
in the pericardium from apex to base.
Okay, let's do it.
Just medial to the phrenic nerve.
She's arresting!
Don't think, just cut.
- Is the clamp secure? - Mm-hmm.
- Arnold, what's the count? - She's been down 10 seconds!
Do you see anything?
A single cardiac wound. I can plug it with my finger.
Good, do it.
And BP's rising, 80 60.
Needle driver. 1.0 sutures.
You rolled with an imperfect situation and you had her back.
It's good to see that when it's not a training exercise,
you two remember what we taught you.
Good work.
Good to see you got home okay.
Hey.
Was I supposed to text you?
I'm glad we ran into each other last night.
- I had fun. - Me too.
It was good not talking with you.
Our family doctor called it somatic symptom disorder.
He said Kevin can actually feel the symptoms,
even though they're just in his head.
How long has he been like this?
It started young.
Always finding some new thing wrong with him.
Mom and Dad would rush him to the doctor,
but he was never really sick.
- They didn't get him help? - He hated therapy.
Our parents did their best, but...
he only got worse after he moved out.
Are there any specific triggers?
When things change,
or he has setbacks,
it could be anything.
And then anyone who doesn't believe him is gone.
Including you.
Why didn't you tell me any of this before?
You said he collapsed.
What if this time, something really was wrong?
I couldn't be the reason you didn't look closely enough.
You saw what happened when I tried to talk to him.
I love my brother,
and I feel so bad knowing he's in pain, but...
The second he decides he wants help,
I'll be there to support him.
Labs came back.
The shot of testosterone you bought was laced with an amphetamine.
It was a large dose. And that's what caused you to OD.
Why would someone sell a kid something so dangerous?
Guys think using it gives them a better workout.
It doesn't.
What were you thinking?!
You won't let me start T or get surgery.
Danny, please. Let's not get into this.
I did do some digging,
and there is a gender clinic in the city
who specializes in building action plans for transgendered youth.
Action plans? What does that mean?
Like surgery?
There are interim options.
It's a bit late to put you on puberty blockers,
but you don't have to do a full cross-hormone to see an effect.
So, hormone therapy.
Which means my breasts will stop growing?
I can refer you,
if it's something you'd like to consider.
Please, Mom.
I want this
No more buying hormones off the street.
I cannot go through this again, Danny.
I'm sorry.
I promise.
Okay.
We'll hear what they have to say together,
and we'll take it from there.
I won't change my mind.
I'm not promising to change mine.
Just...
one step at a time, okay baby?
Will you be disappointed in me
if this isn't a phase?
Danny, you're my kid.
You're my son.
I love you no matter what.
You know who you are.
That's pretty amazing.
Uh...
The results are up.
I'm gonna... Can you...?
I can't. I need you to look at them.
Jesus, it's not Moby Dick.
It's all clear.
You're gonna tell me there's nothing wrong with me,
that's why they had me get dressed.
Actually, I'm not.
You're worried about being sick,
so your body is manifesting symptoms.
No, I have a heart problem,
it's... it's real, I know it.
I know it feels real.
You're just like the rest of them!
It's all in my head!
This? Coming into the emergency department,
isn't going to stop this from happening.
You have no idea what it's like.
I'm scared I'm gonna die all the time.
There are people who you can speak to.
I can refer you to our staff psychiatrist, Dr. Mitchell.
I've talked to shrinks before. They do nothing!
Because, Kevin, you have to want that help.
You have to accept that you need it.
- No, you are not listening! - I'm listening.
Forget it! Just forget it!
There he is!
Ah, I'm such a lightweight.
Are you still good for later?
Listen, maybe I didn't mention this,
but I'm married.
You told me. She's a real estate agent.
You showed me pictures of your kids.
What does that have to do with you coming on a ride along?
I can't today.
But thanks anyway.
Well, if you find yourself stuck here bored some other weekend,
I usually work on Saturdays.
Offer's open.
Is he doing alright?
Your patient who wanted to transition.
Better. He still wants surgery,
but he's relieved there's a way forward.
Thank you for organizing that referral to the gender clinic.
How does your family cope with you being away this much?
We make it work.
You know, there's a full-time position in Emerg pediatrics opening up.
If you want to apply, you'd have my recommendation.
I don't know what to say,
thank you.
I'd have to discuss that with my wife.
Ah, maybe they could move here?
The kind of experience you get at a city hospital like this,
you're not gonna find that back home.
Could be an exciting new chapter.
- Hi. - Hi.
You okay?
Yeah.
Yeah, yeah, I'm just, I'm like...
I'm just, I don't know.
Heard you did a trauma bay thoracotomy?
Yeah.
The patient's recovering in ICU.
Looks like she's gonna pull through.
Saves like that are why we do this.
You know, my mother never wanted me to?
Become a doctor, I mean.
I thought all parents want that.
Mine are always worried I'll push myself too hard.
Do you?
Well, if there's any another way to do this job,
I haven't found it.
I spent the last two days trying to help a patient
who didn't want the kind of help he needed.
Seems like that's going around.
Did you find what you were looking for at the library?
Yeah, I did. I finished my homework.
- All of it? - Yeah.
- Was it hard? - Mm... It was okay.
Are those our things?
What happened?
- Synced and corrected by martythecrazy - - www.addic7ed.com -