[indistinct chatter]
[police radio chatter]
- The man is in his element. - What's he doing?
- Age-old ritual, meant to capitalize
off the unknown origins
of Westbridge's current state of affairs.
Whoever guesses the reason they went code black wins the pot.
- Ah, interesting. We didn't do this at the VA.
- You game? - Of course.
- Now, how's this look to you?
- My wager is on flooding.
They're going to be down for 3 hours,
and we're going to get 20 of their patients.
- Put me down for flooding, 4 hours and 30 patients.
- Okay, okay, okay.
Hey, Dr. Robby, looks like you got some competition.
- Yes, it would appear that I do.
- All right, guys and gals, enough fun.
We have people to take care of.
You want to bring Langdon back from triage
for the extra hands?
- No, I do not. I don't think that's necessary.
We're doing just fine without him.
- You're the boss, boss.
[indistinct chatter]
- Daniel Ortiz, tu licencia en el mostrador.
- Next. [phone notifications pinging]
- Hi. Uh, the doctor guy told me
to put this mineral oil on my eye for 20 minutes.
That was 2 hours ago.
- We're really busy, but we'll get to you.
- Oh, my God. Okay, when? - I will check.
Listen for your name to be called.
- Thanks. - Next.
- Excuse me.
Uh, hi. I heard my brother was brought here.
His name is Jackson Davis. - Do you have ID?
- Yes, yes, um,
I am his sister Jada Davis.
I'm sorry. I just, uh--
my friend told me that he was brought in by campus police.
There was some sort of fight that broke out at his school.
Is he okay? Is he here? - Don't know, hon.
- Can you just tell me if he's a patient here?
- I'll check. Take a seat. And I'll let you know.
- Okay. - Next.
- Is Harlow feeling lightheaded or faint now?
- It's not as bad as it was before,
but my head still hurts.
And now my stomach does, too.
- Well, did she eat before she took her ibuprofen?
- Ugh, it's not my...
- Breakfast is my least favorite meal of the day.
- It's okay to look at me.
- I don't bite.
- [sighs] I'm sorry.
Um, we're going to get started with some blood tests.
- Is that baby from the bathroom going to be okay?
- She'll be fine.
Uh, good news--
nose swab came back negative for COVID,
influenza, and RSV,
but a lot of other viruses can cause a cough.
- Lucky me. [device beeps]
- You can take off your mask.
- Pulse ox is at 91.
- Your oxygen level is down
since we checked you an hour ago,
and your temp is up to 102.4.
Let's get you some Tylenol.
- Have you been outside today? It's already stifling.
- Could be heat-related, but we're going to take you
back to the big ER for a full evaluation.
- Can't you just
write me a prescription for some medicine?
I'm sure it's just a summer cold.
- Got somewhere to be? - Work.
I know. It's Saturday.
But I don't think I've had a day off since...
- Well, your holiday weekend starts now.
- Hey, Javadi.
What are you doing for your birthday?
- Who told you? - Word gets around.
- Nothing. I hate celebrating my birthday.
- You only turn 21 once.
- It's your birthday?
Oh, that makes you a Cancer, right?
- I didn't peg you for an astrology girlie.
- [chuckles] - Yeah.
Been spending too much time around Santos.
- Yes, you have.
- I don't know how you guys do it.
Live together and work together?
- It's my cross to bear.
- It can't be as bad as having to live with your parents.
- I don't know. I haven't lived at home in years.
I kind of miss it. - I can tell.
You've been spending a lot of time on that farm.
- "Farm"?
- Remember the burned farmer who came in last year?
Propane tank exploded, he died in the ICU?
- Yeah, that was sad.
- Well, this guy has been playing house
with his widow and their baby.
- Oh, that's messy.
- No.
It's not like that, okay?
I've been helping Amy out on the farm
after her husband died, and she is a friend.
She's just a friend.
- Sure, just a friend, with farm benefits.
- What are farm benefits?
- Oh, use your imagination.
You ever see a milking machine?
- Oh, can we not talk about this, please?
- We're getting two runs rerouted
from Westbridge already-- chest pain and belly pain.
Robby wants you three out back. - Thank you.
- Come on.
- Dr. Santos, making progress on your charting, I hope?
- Getting there.
- Deficient charts leave a gap for the providers
who give continuity of care and delays hospital billing.
- Oh, I'd hate to delay billing.
- Timely documentation is essential.
Let's fix this before end of shift.
- I'm on it, boss. - Good.
You wouldn't want to repeat your R2 year again
because of this.
- [softly] Fuck.
- God, it's humid as shit out here.
It is.
- What's going on at Westbridge?
- They're closed, so we're covering their paramedic runs
until they come back up.
- As if a holiday weekend wasn't enough.
- So, Dr. Al-Hashimi...
- Yes?
- Do we like her?
- [laughs] - She seems pretty cool so far.
- You're trying to gossip about an attending with an attending?
- Dr. Robby doesn't mind. Do you?
- Oh, uh, that's a nice bike, by the way.
- Thank you. - Yeah.
- Pamela Perry, 48, abdominal pain
with vomiting after eating chilaquiles with fried eggs.
BP 108 over 64, pulse 98, good sats.
- Okay, let's see how she feels with some Zofran
and a liter wide open. - Got it.
- Yo, Whitaker. - How are you feeling? OK?
- Not so good.
- Who do we have here? - Jean Samba--
54, half an hour of left-sided chest pain.
History of hypertension, on lisinopril and Crestor.
Some relief with two nitro.
Decent vitals, no STEMI on 12-lead.
Gave him 324 of chewable aspirin.
- Okay, we're going to give you a full evaluation, sir.
- Oh, if I am to die, God willing,
I will see His pearly gates.
- What's the plan?
- Repeat 12-lead, check a troponin,
admit for new onset angina.
- Evaluate for PE, aortic dissection.
- That goes without saying. - Sounds good.
I'm a minute behind you.
[sirens wailing]
[siren chirps]
And who do we have here?
- Vince Cole, 23, fell through the skylight of a florist shop,
10 feet down to a bunch of ferns.
Complained of headache, asking repetitive questions,
and only responds to pain.
- Multiple lacs from the glass.
BP, 118 over 72, pulse 98, sats, 99 on 5 liters.
No meds, no allergies.
- Hey, Vince, how'd you fall through a skylight?
Vince?
Were you with him?
- Yeah, we were parkouring, and he overshot a kong vault.
- What, like, jumping off of buildings?
People still do that?
- It was almost an Olympic sport.
- Now we know why it isn't.
Pupils are equal and reactive.
- What do you got? - A 10-foot fall, altered.
- That's a long way down. - 10 feet is the threshold
for trauma center activation-- 10 feet, 10% mortality.
- 0%, anything over 0% is a concern.
- Somebody's annoying, and it's not me.
- Hey, you said two. You missed one.
- Sent you backup, didn't I?
- One, two, three.
- Okay. Thanks, guys. Good to see you.
- Get the EFAST.
- Ogilvie, Joy, GCS, please.
- Uh, open your eyes, sir.
- [groans] - Two for eyes, two for verbal.
- Uh, good lung sliding bilaterally.
- Joy, finish GCS.
- Squeeze my hand.
He gets a 4 for motor.
- Pulse ox 99, heart rate 102, blood pressure 114 over 78.
- And EFAST is negative. - Music to my ears.
- Somebody shooting a documentary here?
- Whoa, whoa, whoa, you can't film in here.
We've got patient-privacy laws.
What happened to your hand? - Cut it.
- Can somebody show Spielberg here out to the waiting room
and get her registered at triage, please?
- He's my creative partner-- I have his written consent
to film everything for our TikTok page.
- Put the camera down.
- We have to drop this video for the Fourth tonight.
- That literally means nothing to me.
- Seriously, Sean, can you escort her out, please?
Somebody will come and find you once he's stabilized.
Thank you.
- I would have let her stay if she'd asked nicely.
- What is the, uh, story with surgery?
You guys getting any Westbridge transfers yet?
- Not yet, but I'm sure it's coming.
Pan scan, head through pelvis. Let's get him to CT ASAP.
- Absent gag.
We need to intubate before CT.
- C-can I do it?
Uh, I'm keeping a procedure log,
and I need more intubations on this rotation.
- If Dr. McKay wants to teach?
- Sure.
- Okay, uh, I need suction.
8-oh tube, etomidate and sux, end tidal CO2.
- Ambitious.
He reminds me of someone I know very well.
[mouse clicking]
- Can you not?
- Yeah, sorry.
- Hot off the press.
- Okay.
No STEMI, doesn't need to go right to the cath lab.
And orders are in.
Whitaker, try another nitro
and let me know when the troponin's back.
- Yeah. Hey, hey, Jesse?
Do you think you could repeat this
but with the chest leads on his back?
- Why?
- T Waves are kind of high with ST depression anterior.
- We see ST depression all the time.
- Yeah, but it could be a posterior MI.
- All right, run it by the attending.
If they agree, we'll do it.
- Thank you.
Uh, Victoria, if his CT's normal, he'll need an LP.
- Got it.
- Dr. Al-Hashimi.
This is Jada Davis, Jackson's sister.
- Oh, thank you. Hi. - Is he okay?
And why is he asleep?
- Well, he was uncooperative when he first arrived
and needed to be sedated. - "Uncooperative"?
That doesn't make any sense. What happened?
- We're still trying to piece the story together.
He was brought in by a campus security guard
who Tased him after he was allegedly...
- "Tased him"? - Combative and violent.
- Wait, what do you mean, Tased him?
- We've treated his injury, and now we're trying
to understand why he was so agitated.
- Okay, this doesn't sound like my brother.
- Well, his drug screen came back negative,
so now we're taking Jackson to get a CT scan of his brain
to look for any abnormalities. - Can I go with him?
- You can't go into the CT,
but you can wait for him to come back.
And then we can discuss next steps.
- Okay.
- Just did my first ER intubation.
- That's great, man. - Such a prick.
- You got a second? - What's up?
- 12-lead on my chest-pain patient shows no STEMI,
but the anterior leads might be suspicious for a posterior MI?
- Uh... agreed.
- Yeah, I was going to repeat, but with the chest leads
on the back. - V7 through V9.
Good idea. - Thank you.
- Hey, Dr. Robby gave the go-ahead for the back leads.
- Sorry, man, I got a call report
on a septic patient going to the ICU.
- Busy today, huh?
- Uh, well, it's 10:15.
We're actually just getting started.
- Oh. - There she is.
Dr. Mohan, uh, this is Lorrie Diaz, Orlando's wife.
- Thank you, Perlah. - Thank you.
- Hi, Mrs. Diaz. - Hi.
- Let me take you to your husband.
- Ay, mi amor.
I'm sorry you have to be here alone.
I missed my first bus transfer and--
Anyway...
Hey.
- How'd I get here?
- You fell at your construction site.
A coworker brought you in.
- He's a lot better but doesn't remember anything.
- That's common after a concussion or DKA.
- DKA?
- It's a serious complication of your husband's diabetes.
- How serious? Can he go home?
- We still have to clear the ketones from his bloodstream.
He'll need to be on an insulin drip for a while
until things get back to normal.
Best if he stays in the hospital.
- It's okay, Mom.
- Things are headed in the right direction, Mrs. Diaz.
He's going to be better. - Mm.
[door clicks]
- Sorry. I got to check his blood sugar.
- Oh, do you mind? - Absolutely.
- So the thing is...
we don't have health insurance.
So...
[voice breaking] I don't think that we can afford this.
- I'll have our case manager, Noelle Hastings, come by.
She's an expert in health insurance.
She might have some options for you for coverage.
Okay. - Thank you.
[door clicks]
- [sighs]
Crap. - What's wrong?
- Uh, some of the leads aren't sticking here.
- Can I lay down now? I'm tired.
- Yeah, as soon as we're done here.
- Whitaker, Louie's all numb. His tooth is ready for you.
- That's great.
Hey, I'm having some trouble here with adherence.
- Oh. Of course you are.
Uh, try this.
- Oh, yeah. That makes sense.
Uh, you think you could--
[sighs]
Do you mind if I paint some sticky stuff on you?
- Oh.
If you must prolong the inevitable, so be it.
- You'll get to lie down afterwards.
- No success with the mineral oil.
- That's what I said.
So now what?
- You can wait one to two weeks
for the superglue to break down on its own.
- I'm hosting a Fourth of July party tonight.
You want me to show up like this?
- The other option is I trim your eyelashes halfway down.
That'll lower the strength of the glue holding them together.
- Let's do that.
- Lie back, please.
I need you to hold your head perfectly still,
keep your eye closed.
- My eye can't open. That's why I'm here.
- No, I mean, your other eye, too.
Okay, here we go.
- Perfect, Mr. Samba.
All good here.
[medical machine beeping] - Feeling... dizzy.
- We'll put you down in a second.
Holy shit.
ST elevation, V7, V8, V9.
It's a posterior STEMI. - What's that?
- It's the worst kind of heart attack.
[alarm blaring] Mr. Samba.
Mr. Samba!
Hey, I could use a second set of hands here!
Pulseless V tach.
Start compressions.
Charging to 200.
[machine whirs, beeping continues]
Clear.
Okay, resume compressions.
Code STEMI. It was posterior.
- Yeah, good call.
- You put the defib pads on? - Yeah, just in case.
Hold compressions.
[steady beeping]
Normal sinus. - All right.
- Got a strong pulse. Check the BP.
- All right, we'll prep him for cath lab.
- [mumbles]
- Hey, Mr. Samba, you're going to be okay.
No pearly gates today.
- Really good pickup, Whitaker. - Thank you.
Ah... [chuckles]
- Has a patient ever flirted with you?
- Sure. Why?
- There was this guy this morning--
he turned out to be a criminal,
but, yeah, it was a nice distraction
from the deposition.
- [sighs] You still worried about that?
- Yep. Yeah, counting down the hours.
There are five left, if you're wondering.
- [coughing]
- Hi, Miss Ronson.
- Phylicia, please.
- Phylicia, I'm Dr. King.
This is my colleague Dr. Santos.
What brings you in today?
- I've had this pretty bad cough for a few days now.
- Do you smoke?
Are coughing up anything, any chest pain?
- No, no, and no.
I honestly think I picked it up at work.
It was going around. - Oh, where do you work?
- I'm in corporate at PNC Bank. - Sit forward, please.
- It could be an office bug.
- Or I got it from the gym. I'm there all the time.
[coughs]
- Do you have anything to ask, Dr. Santos?
- What?
- Do you have any questions to ask our patient?
- Uh, no, I'm good.
- Okay. What'd you hear?
- Maybe some crackles at the right base.
- Okay, well, we're going to need a chest X-ray
to check your lungs.
- Will that take long?
Maybe I can still make it to the office.
- It shouldn't.
You can go put the orders in. - Yeah.
- How are we doing in here? - Oh, this is thrilling.
Definitely worth $200,000 worth of student debt.
Ha.
- Superficial ones get a steri-strip.
Full thickness, try Dermabond.
How can you tell they need a suture, Joy?
- If the edges are under significant tension.
- I didn't realize your name was Joy.
I'm going to have to tell my parents how trendy they were.
[object clanks]
- CT head, neck, chest, abdomen, and pelvis,
all normal on preliminary read. - Lucky guy.
- Little bit of oozing.
- Uh, pressure for two minutes.
Lidocaine and epi if that doesn't work.
- Are the admit orders in for Surgical ICU?
- Fuck!
- What?
- This. - Ah.
- Irrigation saline. - It's just a small cut.
- It is a work-related blood exposure,
which means you're a patient now.
- Are you serious? - Needle stick?
- Piece of glass.
- Here you go. - Thanks.
[device beeps]
- No past records on this guy.
We don't know HIV or hepatitis status.
- I'll put the orders in, HIV antibody, Hep B surface,
and Hep C.
- She needs post-exposure medication.
- Maybe not.
For occupational exposure, the rapid HIV test
takes an hour or two. - Subcutaneous puncture wound.
No risk of joint or tendon involvement.
Elevate, pressure, and then a Band-Aid.
- Give yourself a dose of PEP if you want
while you're waiting for results.
- Start a chart, and I'll find another nurse
for your blood draw.
- Great.
- Looks like we've got a couple more diverted from Westbridge.
- Any estimate on their downtime?
- Not yet.
Time to pull Dr. Langdon from triage?
- No, no. First day back.
I want to let him kind of ease into things.
- Understood. I'll keep an eye on it.
- Thank you very much.
- Thinking about changing your bet?
- I am just weighing my odds.
- Don't worry. I'll buy you a drink with my winnings.
[indistinct PA announcements]
- Your brother should be back shortly.
There was a little holdup at CT.
- Um, should I be worried?
- Let's wait and see what his test results say.
- This is just, um...
this just doesn't make any sense.
It doesn't sound like my brother at all.
He's the--the friendliest guy I know.
He never even gets angry, barely yells.
- He's never had an episode like this in the past?
- No, or not that I know of.
He's in a great relationship.
And he's in law school
'cause he wants to help people.
He always tells me that I should, um...
follow my dreams,
even if it means my parents may disown me.
Should I call them?
- I think that's a good idea.
This--this could be pretty serious.
Thanks. - Mm-hmm.
- The new radiologist is a hottie.
- Okay.
Um...
his head CT is normal, as are his blood and urine tests.
- Then--then what's wrong with him?
- We're not, um, sure yet.
There is another test-- a-a spinal tap.
This could be, um, an infection
in the fluid that surrounds the brain--viral encephalitis.
Um, it can also cause...
altered mental status and confusion.
Can you treat it, if it is?
- Yes.
- Okay.
Okay.
- I'll go find Dr. Al-Hashimi, and--and we'll do it together.
- Thank you. - Of course.
- Just what we thought-- it's a fracture of your coccyx.
It's your tailbone.
Yeah, see, these pieces here
should be lined up with that part here.
- Do I need surgery? - No.
No, no, these heal pretty well, but it'll take about six weeks.
- "Six weeks"?
I have dinner dates every weekend.
- [chuckles] You can keep your--
still keep your dinner plans.
- Dinner starts at Pino's, the best Italian in town.
- Mm-hmm.
- A nightcap at my place usually follows,
and then breakfast in bed.
- Ah, okay.
Well, in that case, you might--
you might need to take a little break.
- [sighs] My greatest joy in life is my social calendar.
- Mm. - Hmm?
Is there something else you can do?
- W-well, there-- there is a procedure
to push the fragments back in place.
It could help it heal faster. - Now we're talking.
- Yeah, but it'll hurt pretty bad but only for a second.
- I can take it.
- Okay.
Come here. Back in the gown.
How's it going over here?
- Better now.
- Uh...
Oh, the X-ray is back on your foot,
and no fracture.
So, um, ACE wrap, ice, rest, and elevate,
and you can take ibuprofen if you need it.
- So that's it?
- Well, if it's--if it's too painful to bear weight,
we can give you crutches to use for a day or two.
- So I won't be seeing you again.
- [chuckles] Uh...
as a patient, no, but...
it was nice meeting you, Brian.
- It was nice meeting you, too, Dr. McKay.
- [sighs]
You know, I was-- I was going to go check out
a few of the art galleries in Lawrenceville tonight.
- Have you been to that one on 40th and Butler?
- No, I was, um, gonna go by.
Maybe around 9:00?
- Okay. [chuckles]
Cool. - Cool.
- Dude, I resuscitated that parkour guy
and--and intubated a STEMI.
I think I can handle this.
- It's best if you watch the first one.
How's that tooth feeling?
- [groans] The whole side of my face is numb.
- That's how we like it.
Okay, we've got a...
a fluctuant gumline at--
- Tooth number 23, lateral incisor.
- With an extension to an-- - Apical abscess.
- Right again. - Ah, the kid's smart.
- Hook up the Yankauer. Get ready to retract the gum.
- Hey, Louie, this is a temporary fix, okay?
You're going to need to get that tooth pulled by a dentist.
- Hey, you going to find me one?
- We can have you talk to Dylan.
- Is Dr. Collins around?
Sister always helps me out.
- Uh, Dr. Collins finished her residency,
took up a job in Portland as an attending physician.
- "Portland"?
- Yeah, I think that's where she's from.
She's adopting a baby.
Wanted to be closer to her family.
- Well, that's a beautiful thing.
- We're set. - Okay. Ready?
Okay, 3-cc syringe,
20-gauge needle entering at the juiciest part,
aiming for the apex.
- Send that for culture? - No.
Pen V.K. for a few days.
Bugs in the mouth are old school.
- Ah, just like me.
[elevator bell dings]
- Both parents work,
but neither of them have health coverage?
- Orlando and his wife have multiple part-time jobs
that don't offer insurance.
- Can they qualify for Medicaid?
- Unfortunately, no, because their combined annual income
is over the Medicaid threshold for a family of five.
- So they make too much money?
- And not enough at the same time.
They live over the poverty line,
and yet they are still living paycheck to paycheck.
I think their best option
would be to buy private insurance
through the Affordable Care Act.
- Thank you.
- My parents don't have insurance?
- I'm sorry, Ana.
- How much will it cost to keep my dad in the hospital?
- I don't know.
But the ER visit alone will likely be in the thousands.
We will figure something out, okay?
- Purple top for the CBC.
Red top for chemistries and serologies.
- Okay.
Ready? - Uh, yeah.
I can be a hard stick, though.
- Now or never, hon.
- Okay.
One, two...
three.
- Good blood return. - Oh, thank God.
- Pop one on.
- You're supposed to release the tourniquet now.
- Right. Sorry.
- Lab won't take it without your initials,
time, and date drawn.
How you feeling? - Peachy.
Hopefully I get to do this several times every day.
- All set.
Keep some pressure here for a minute.
- Initials, time, and date.
- Oh.
Shit.
- Environmental to North.
- Sorry.
- How is he?
- He's stable. He's doing great.
- Doesn't look great.
Is there brain damage?
- The head CT showed no bleeding or skull fracture.
It's most likely a bad concussion.
It's hard to know when he'll regain consciousness.
- Did he break any bones? - We don't think so.
- He should thank those ferns.
Uh, chest and abdomen CT scans
also showed no major internal injuries.
- Mm-hmm.
- What's that?
- Whoa, whoa, whoa, whoa, whoa.
We need respiratory therapy in here!
Okay.
One, two, three, over.
- You got a problem with the vent?
- No, he's bleeding from the back.
Got to prone him to take a look.
Back away, Tanya. One, two, three, up.
One, two, three, over.
Good. - Oh, shit.
- Left-flank area. - Careful. Careful, everybody.
There might be glass. - That's a lot of blood.
- 2-centimeter simple laceration.
Open a suture kit, 4-0 Prolene.
- He wasn't bleeding when we flipped him on arrival.
- No, but when we moved him around for CT,
it might have rubbed off a clot.
- Slow venous oozing.
- I might need a figure of eight.
[beeping]
- Yeah, little piece of glass in there.
It's just under the skin.
- Is it a loose fragment? - Yeah, I can wiggle it around.
Here, I'll pull it out. - No, don't--
Shit. [alarm blaring]
- Uh, that's--it's bigger than I thought it would be.
- Shit. - That looks arterial.
Can I get some 4-by-4s over here, please?
- Oh, I'm going to be sick.
- Put some pressure on this from all sides.
Hard and deep, please.
- I can push it back in. both: No!
- No, you've done enough damage.
- Should I keep pulling it out, then?
- Absolutely not. The glass was tamponading a vessel.
- Not anymore. BP's down. Page surgery!
[blaring continues]
- Ah, I was looking for you. - Well, you found me.
- Um, the X-ray came back on the lady with the cough.
Weird infiltrate. Have you seen it yet?
- No, I've been trying to catch up on my charting.
- Right here. - [clears throat]
Yep, stringy right lower lobe.
- It looks like aspiration pneumonia.
Think about it.
How do oral and gastric fluids end up in lungs?
- Um, dysphagia, swallowing disorders.
But she's not an old person choking on their food.
- Right, and there's protracted vomiting.
- Okay, maybe recent gastroenteritis,
food poisoning.
- Yeah, or...
or...
[sighs] An eating disorder.
- You think she's bulimic?
- I mean, she's fixated on working out.
Check the, uh, enamel behind her front incisors.
Um, oh, it's, uh--
if it's not in the differential,
it won't be in the diagnosis.
You know that--
Yeah, you know-- you know that.
- [sighs]
- Nice job on the tap.
- Thanks.
- Hi. You called for a consult on Jackson Davis?
- Yes, we did.
- I'll let Victoria present the case.
- This is Jada, Jackson's sister.
This is Dr. Jefferson from psychiatry.
- "Psychiatry"?
Do you think this is a mental-health problem?
- We thought it best to cover all our bases.
- We'll know more once I speak with your brother.
- Okay.
- Hi, Jackson.
Jackson, can you wake up?
Jackson. - They said he's sedated.
- I'll come back a little later.
- Oh, that was fast. - Yeah.
Next time, maybe wait until the patient wakes up
before calling me down.
Psychiatrists do best
when we can actually talk to our patients.
- I got a little ahead of myself.
Um, will do.
Thank you. [chuckles awkwardly]
Sorry.
- Pressure's up with one unit type specific.
[alarm blaring]
- What the fuck? He was stable.
- Slight change in status. - Okay, get the clamp ready.
- Who's the genius who pulled that out?
- I thought it was a loose fragment.
- Next time, leave the decisions to the adults.
- Okay, Dr. McKay, ready to go?
- Whoa. - Hoo.
Looks like an icicle.
- Christmas in July. [telephone ringing]
- Hey, Sophie, can you answer that?
- Okay, I am injecting the X-stat.
- Hello? - What is that?
- It's a syringe filled
with tiny, rapid-expanding hemostatic sponges.
- Okay, got it. Thanks.
Radiology attending says a resident missed something.
There's a radiopaque foreign body
in the left paralumbar musculature.
- Not anymore.
- Sounds like "first week in July" syndrome.
- Mm-hmm.
- Okay.
That looks pretty dry. - On the surface.
- Okay, let's turn him back down.
Okay, one, two, three, over.
One, two, three, flip.
One, two, three, down.
All right, CT is ready to rescan.
Interventional radiology is holding a room.
- Look at you-- so on top of things.
Hasta la próxima.
- How you doing over here?
- Definitely not great.
- Right, well, let's get you a ginger ale.
- So we never, ever remove a deep foreign body in the ER.
We always leave that to surgery.
- It won't happen again.
- I was just coming to find you.
- Sure you were.
It's almost like you're avoiding me.
- Me? Never.
No, I'm just having one of those busy days,
you know, living the dream, saving America's tired,
poor, huddled masses yearning to breathe free.
- You're a saint. - I tell myself that every day.
- I heard you had a, uh, motorcycle crash
come through about an hour ago. - Yeah.
Couldn't save him.
And, no, he was not wearing a helmet.
- Interesting.
- One motorcycle crash is not going to scare me off my trip.
- I didn't say it should.
- I hope he died doing what he loved.
- That's... optimistic.
- "Glass half full" kind of guy.
I am not on your couch. - I'm aware.
Conflict of interest here. - Why? Because we're friends?
- Ooh, look at you, using the F word.
That's growth.
- I use F words all the time.
I guess this therapy must be working.
- Ah, I got somebody new for you.
She takes no shit. You'll love her.
- I hope so.
The last two have not exactly been... my speed.
- Meaning what, empathetic? - [exhales]
- Look, sometimes it just takes a little while
to, you know, find the right fit.
- Well, it's going to have to wait,
because I'm going on my sabbatical tomorrow.
- There's always Zoom therapy.
- Motorcycle trip is zoom therapy.
- I'll bet somebody set off fireworks in the shitter.
[imitates explosion] - How dumb is that?
- [scoffs] You think people are smart?
- [laughs] - [chuckles] Yeah.
- What's up, man?
You want to get on the books?
- Uh, yeah.
Yeah, yeah. May--maybe. Yeah.
- Hey, look here.
I only take real money,
none of that "I owe you" bullshit.
- [scoffs]
Okay, I have money, okay?
My first direct deposit finally hit, so...
- Nice. Hmm.
- Put me down for $40...
for power outage.
- [chuckles] - Nice.
- We got a big baller on our hands.
- Congrats, Doctor. - Thank you.
- I like this side of you, man.
- Any improvement? - No.
- What kind of super glue did you use?
- Does it matter? My eye is still fucking shut.
- Okay, there's one other thing I can try.
- No. I'm done. I asked for Dr. J earlier,
and I would like to see her now.
- I haven't been in the hospital for a while.
I don't know a Dr. J.
- She's one of the best doctors in Pittsburgh.
- Oh, Dr. J.
Hmm.
- Do what you must, milady. - Mm-hmm.
Okay, first, I need to get a good grip for the reduction.
- Uh-huh.
- Here we go.
Try to relax.
Deep breath, with your mouth open.
- [exhales sharply] Not how I imagined
our first intimate encounter.
- Okay, got it.
Now, on three, okay?
One... [crack]
- Ah! Motherfucker.
Ho-ho! You said "on three."
- I--I know.
Sorry. It keeps you from tensing up.
- [exhales] - Okay, I think that worked.
How does it feel? - Can I sit up?
- Uh-huh. - Oh.
Oh.
[sighing] Oh, my God.
Oh.
That is definitely better.
Oh, my God.
- Great. - [laughing]
Can I give you a hug?
- Mm, maybe--maybe later, okay?
[chuckles]
- Aspiration pneumonia? How does that happen?
- It's when bacteria from the mouth or stomach
get into the breathing tube,
uh, when you're choking,
if you're eating or vomiting.
- Oh.
- Do you ever drink a lot of alcohol,
maybe so much that you pass out?
- No, I'm not a big drinker.
- Have you had the stomach flu recently, food poisoning?
- No and no.
- Do you mind if we take a look inside your mouth?
- [coughing]
- You can lean your head back...
and open up wide.
[monitor beeping]
- What?
- The enamel on the back of your teeth is worn away.
- What does that mean?
- Um, it can happen
if someone makes themselves vomit repeatedly.
All the stomach acid dissolves the enamel.
- What does that have to do with having pneumonia?
- It may have caused it.
- Can you just give me some medicine?
- Yeah, we can do that.
- Dr. J, finally.
- It is so nice to meet you, Dr. J.
This is Willow, your new patient.
- I'm actually a student doctor.
- I, uh, watch all of your videos.
The one about coping with difficult coworkers
was super helpful.
- I got to watch that.
- Um, um, so--so what is Willow's health issue?
- Uh, my eye-- it's superglued shut.
- Halfway trim and mineral oil didn't work?
- Nope.
- Then--then I would suggest cutting the full lash down.
- I concur, Dr. J.
- As long as you're the one doing it.
- Oh.
Okay, yeah, sure.
[chuckles] Um, yeah.
Uh, sit back for me.
I'll get you to close both your eyes
and be as still as possible.
- Okay.
- All you, Doc.
- Thank you, Dr. Langdon.
Okay, here we go.
- How many followers do you have, Dr. J?
- More than you'd guess, Dr. Langdon.
There.
- [sighs]
- [chuckles] You did it.
[giggles, sighs in relief]
Oh, my God. This looks terrible.
I can still put a false lash on it, though, right?
- How are you feeling, Mr. Diaz?
- Much better.
- We need to talk about how your diabetes
progressed to this place.
This is Student Dr. Kwon.
What you say here remains between us.
- I'm taking a lower dose of insulin than I should be.
- How much of your prescribed dose are you using at a time?
- Half.
I used to have insurance through work,
but I lost that job when the pandemic hit.
It was easy to keep up with my medication then.
I had a great primary doctor, too.
Now I'm kind of on my own.
- Do you have a glucose monitor?
- Uh, yes.
But I can't afford the test strips every week.
They're too expensive.
Can we not talk about this in front of my family?
- Hi. - Hi.
- There are my girls. [sighs]
Did you call your brothers? - They're still at soccer.
- I have good news. I started a GoFundMe for Dad.
- A what?
- To help raise money for Dad's medical care
since we don't have insurance. - No, no.
Take it down, now. - But why?
- I work hard. I don't need charity.
- But, Dad, we've already--
- Ana, you heard me!
Take it down.
- Jesus, Orlando.
- No necesito eso.
- Louie, thought I'd sneak back here to check on you.
- How we doing in here? - Good.
Tooth's feeling much better. - Glad to hear it.
Looks like you're stuck with us for the next three hours.
We need to monitor your blood pressure.
- How about a drink while I wait?
[chuckles]
- Water or orange juice?
- Uh, never mind.
So, uh...
how are the kids doing?
- Oh, they're perfect little monsters.
Tanner's five now. Penny's three.
- Oh, ain't that a blessing.
- It is, but they have zero interest in bedtime.
And there's the dog always digging up the yard.
- [chuckles]
How much sun does your lawn get?
- I don't know. Plenty.
- Seed it with perennial ryegrass.
And you want to lightly water it
and put up a temporary fence so the dog can't get back to it.
- Color me impressed.
- What can I say? I like grass.
[both chuckle]
- No, seriously, how do you-- how do you know all that?
- [sighs] I was a groundskeeper.
I worked with gardens and lawns back in the day.
- Robby.
Got a sec?
- Dr. Langdon. - Dr. Al-Hashimi.
- How's triage looking?
- Donnie and I have it under control.
- Good. I want you to wrap up what you're doing out there
and join us back here.
We're expecting more diverted traffic from Westbridge.
- Will do.
- And I just want to say, I think it's great
that you're in the Physicians' Health Program.
I know it's a big commitment.
- Uh, yeah, it was hard at the beginning,
but, you know, I'm almost done with year one now.
Only four more years to go. - [chuckles]
- Penny for your thoughts.
- Oh, they're way more expensive than that.
- I'm on a budget. Take it or leave it.
- My day is not turning out the way that I expected.
- We had a callout. Langdon was available.
- I was sort of hoping to be on my sabbatical
when he came back.
- You two were very close.
Maybe this is the universe's way
of telling you it's time to clear the air.
- Maybe it is.
Maybe it isn't.
- Okay, so, um, we'll need to keep you for the day
for your IV antibiotics and to monitor your oxygen level.
- Okay.
- What if...
[sighs]
I have been making myself vomit?
- Well...
bulimia is treatable.
- I was going to stop.
I stopped before.
My family gathers around food.
We eat when we're celebrating. We eat when we're mourning.
We just eat.
But then I got to college,
and it was all about how you looked.
- That's a lot of pressure.
- I started vomiting.
Everyone said I looked great.
So I went to the gym more.
I didn't need to purge as much.
[heavy sigh]
Last year, I went through a breakup.
It all came back.
[sniffles]
- You're...
doing long-term damage to your body.
And it doesn't just go away on its own.
It's okay to ask for help.
- We can set you up
with our eating-disorder program upstairs.
- It's here in the hospital? - It's an outpatient program.
You'd meet with a therapist
for individual and group therapy once or twice a week.
Would you be open to meeting with a therapist?
- I guess.
- Do you have any preference for type of therapist--
male, female?
- [crying] If there's a Black woman, I'd like that.
[sighs]
- Yeah, we can arrange that.
- [sniffles]
Thank you.
- That was a good catch.
- Black women tend to go underdiagnosed
when it comes to eating disorders.
- Really? - Yeah, unfortunately.
You know, I thought I had an eating disorder in high school,
and so I did a lot of research on the subject.
I didn't--no, I just--
My sister and I were really picky eaters growing up,
you know?
Color and texture.
Vegetables and fish.
Oh, eggs.
Slimy okra, asparagus-- ugh, disgusting.
Drove our parents crazy.
- Oh, eggs, weird.
- It's not that weird.
- I got to catch up on my charting.
- Ah.
You know, if--if you want to talk, I'm around.
- Talk about what?
- Being an R2?
Way harder than intern year.
- Oh, yeah, um...
yeah, overseeing the med students, the interns,
having no time to do my own charts.
- Yeah, just wait until you get into Medical,
Surgical, and Cardiac ICU.
I stands for "intense." - [chuckles]
Somehow that seems like an understatement.
- Well, it does help you grow your clinical skills,
you know, caring for the sickest patients.
- Tell that to these charts.
- Um, dictate. Helps you go faster.
- Oh, uh, what happened with our patient from Westbridge?
You never grabbed me for his troponin.
- Mr. Samba-- it was a posterior STEMI.
- What? Didn't show on the 12-lead.
- Oh, usually doesn't.
And I think most clinicians would have missed it.
- But you didn't.
- [scoffs]
Guess I got lucky.
- Whatever, Fuckleberry.
- Okay, I'm sorry. Did I do something to bother you?
- Nope.
- [sighs] Okay.
- Yo. - What's up?
- I got a bounce-back. You remember Debbie Cohen?
- Not really. I've seen 16 patients this morning.
- The restaurant worker with cellulitis
on the dorsum of the foot? - Yes, yes, she's on Keflex.
I marked the border.
- Yeah, I got a hot pack on it, but, uh, you should take a look.
- Hi. Dr. Langdon.
- I wasn't expecting to see you back so soon.
Meds upset your stomach? - Uh, no.
The pain got worse, and you said to come back
if the redness spread outside the Sharpie line.
- Let's take a look.
- Ah.
[wincing]
- It looks like the infection
isn't responding to the pills I prescribed you,
so we need to get you on some IV antibiotics
and get you back to the ED now.
- Uh, i-is it bad?
- Not if we can get a handle on it.
- MRSA? - Or maybe worse.
[tense music]