1 00:00:11,594 --> 00:00:13,888 [indistinct announcement over P.A. system] 2 00:00:13,930 --> 00:00:15,974 - Robby. - Yep. 3 00:00:16,056 --> 00:00:18,101 - Cellulitis on the dorsum of the foot, 4 00:00:18,184 --> 00:00:20,103 now spreading up the leg. 5 00:00:20,186 --> 00:00:21,312 - Hello, I'm Dr. Robby. 6 00:00:21,396 --> 00:00:23,064 Mind if I take a look? 7 00:00:23,106 --> 00:00:25,108 - How long do you think this is gonna take? 8 00:00:25,191 --> 00:00:26,735 I took an early lunch break. 9 00:00:26,776 --> 00:00:27,861 [gasps] 10 00:00:27,944 --> 00:00:29,070 - I don't know that you're gonna 11 00:00:29,112 --> 00:00:30,947 make it back to work today. 12 00:00:30,989 --> 00:00:32,615 Erythema and warmth halfway up her knee. 13 00:00:32,656 --> 00:00:33,742 When did you see her, Donnie? 14 00:00:33,783 --> 00:00:36,202 - He didn't. I did. 15 00:00:36,286 --> 00:00:37,704 - When? - About four hours ago. 16 00:00:37,787 --> 00:00:39,122 Gave her a dose of Keflex, 17 00:00:39,164 --> 00:00:40,623 told her to come back if things got worse. 18 00:00:40,707 --> 00:00:42,625 - Things have definitely gotten worse. 19 00:00:42,667 --> 00:00:43,626 Dana, what's open? 20 00:00:43,668 --> 00:00:45,086 - Trauma Two. 21 00:00:45,128 --> 00:00:46,588 - Jesse, can you get her started in Trauma Two 22 00:00:46,629 --> 00:00:47,839 with some vanco and blood cultures, please? 23 00:00:47,922 --> 00:00:49,299 - Got it, boss. - I'm coming with. 24 00:00:49,382 --> 00:00:51,426 - Suit yourself. 25 00:00:51,468 --> 00:00:54,679 - Santos, you want in on Trauma Two? 26 00:00:54,763 --> 00:00:57,640 - Too much charting, too little time. 27 00:00:57,724 --> 00:01:01,436 62-year-old male presents with chief complaint 28 00:01:01,478 --> 00:01:02,604 of left lower back pain. 29 00:01:02,645 --> 00:01:04,063 Considered the diagnosis-- - Hey. 30 00:01:04,147 --> 00:01:05,272 - Oh, Jesus Christ. 31 00:01:05,315 --> 00:01:06,733 I'm charting. 32 00:01:06,816 --> 00:01:08,234 - Sorry. 33 00:01:08,318 --> 00:01:09,235 [sighs] 34 00:01:09,319 --> 00:01:10,820 Did I do something wrong? 35 00:01:10,862 --> 00:01:12,572 - Besides interrupting me? Probably. 36 00:01:12,655 --> 00:01:14,157 - Then I apologize. 37 00:01:14,240 --> 00:01:17,827 I know that second year of residency can be stressful, 38 00:01:17,869 --> 00:01:20,997 so if there's anything I can do to help you... 39 00:01:21,081 --> 00:01:22,289 like stop talking. 40 00:01:22,332 --> 00:01:24,626 - That's a great idea. - Yeah. 41 00:01:24,667 --> 00:01:28,797 - Considered the diagnosis of aortic aneurysm or dissection. 42 00:01:28,838 --> 00:01:30,507 - Got a new one for you in 13. 43 00:01:30,548 --> 00:01:33,134 - I'm 20 charts behind, and the new attending 44 00:01:33,176 --> 00:01:34,301 is threatening to make me repeat 45 00:01:34,344 --> 00:01:35,428 a year if I can't catch up. 46 00:01:35,512 --> 00:01:36,679 - Cry me a river. 47 00:01:36,721 --> 00:01:37,806 Old lady with bad abdominal pain. 48 00:01:37,847 --> 00:01:38,973 Somebody's gotta see her. 49 00:01:39,015 --> 00:01:40,475 - Dana, please do me a solid. 50 00:01:40,517 --> 00:01:42,143 - Holiday weekend. 51 00:01:42,185 --> 00:01:43,770 Westbridge is down, and our waiting room's on overdrive. 52 00:01:43,853 --> 00:01:45,146 I'm sorry, but your charting's gonna have to wait 53 00:01:45,188 --> 00:01:47,565 until after your shift. 54 00:01:47,649 --> 00:01:49,025 Ogilvie. 55 00:01:49,109 --> 00:01:52,904 Dr. Santos needs you to pick up a new patient in 13. 56 00:01:52,987 --> 00:01:56,825 - Y-yes, ma'am. I'm on it. 57 00:01:56,866 --> 00:01:58,076 - Chart while you supervise. 58 00:01:58,158 --> 00:01:59,869 Best I can do. 59 00:01:59,953 --> 00:02:02,956 [both speaking Spanish] 60 00:02:03,039 --> 00:02:05,875 - Setting up a GoFundMe, that's what her generation does. 61 00:02:05,959 --> 00:02:07,794 That's how they support each other. 62 00:02:07,877 --> 00:02:08,877 Doctor, tell him. 63 00:02:08,919 --> 00:02:10,463 - Your wife's right. 64 00:02:10,547 --> 00:02:12,799 - Staying here's gonna cost more than we can afford. 65 00:02:12,882 --> 00:02:14,676 Look, I'm feeling better. 66 00:02:14,717 --> 00:02:16,219 I'll just leave. 67 00:02:16,261 --> 00:02:19,180 - Mr. Diaz, even if your blood sugar is back to normal, 68 00:02:19,222 --> 00:02:21,099 we have to continue with the insulin drip 69 00:02:21,182 --> 00:02:23,059 until we clear the ketones from your bloodstream. 70 00:02:23,101 --> 00:02:25,562 Otherwise, you could experience electrolyte disorders, 71 00:02:25,645 --> 00:02:26,896 heart and kidney problems-- 72 00:02:26,980 --> 00:02:30,441 - Mi amor, your health is what matters. 73 00:02:30,525 --> 00:02:31,901 - I'll make you a deal. 74 00:02:31,985 --> 00:02:33,736 You agree to stay on the insulin drip, 75 00:02:33,820 --> 00:02:35,238 and I'll go find our case manager 76 00:02:35,321 --> 00:02:37,198 to discuss cost-cutting options for your stay. 77 00:02:37,240 --> 00:02:38,575 - Deal. 78 00:02:38,616 --> 00:02:40,827 And I'm sitting here making sure he doesn't move. 79 00:02:40,910 --> 00:02:42,912 - You should go look for Ana. - Mm-hmm. 80 00:02:42,996 --> 00:02:44,038 - I can find her. 81 00:02:44,079 --> 00:02:45,707 BRB. 82 00:02:47,834 --> 00:02:48,960 - Hanging vanco. 83 00:02:49,043 --> 00:02:50,545 - What's vanco? 84 00:02:50,587 --> 00:02:53,047 - A really strong antibiotic to kill skin germs. 85 00:02:53,089 --> 00:02:55,591 - Need a hand? - No. We got this. 86 00:02:55,633 --> 00:02:57,427 - I'll just observe. 87 00:02:57,468 --> 00:02:58,887 Pretend I'm not even here. 88 00:02:58,928 --> 00:03:02,307 - Let's send off a CBC, blood cultures, and CMP. 89 00:03:02,390 --> 00:03:05,393 - And also a lactic acid, CRP, and calcitonin. 90 00:03:05,435 --> 00:03:07,437 - Wait, she's not febrile, not tachycardic. 91 00:03:07,520 --> 00:03:09,105 No evidence of SIRS. 92 00:03:09,147 --> 00:03:11,065 - Yet. - What's SIRS? 93 00:03:11,107 --> 00:03:14,777 - Systemic inflammatory response syndrome. 94 00:03:14,861 --> 00:03:15,862 Sorry. 95 00:03:15,945 --> 00:03:17,530 - An exaggerated defense response. 96 00:03:17,614 --> 00:03:18,865 - A what? 97 00:03:18,948 --> 00:03:20,950 - Sometimes the human body can have an overreaction 98 00:03:20,992 --> 00:03:22,827 to an infection, so we're gonna monitor you 99 00:03:22,911 --> 00:03:24,454 to make sure that this does not progress. 100 00:03:24,537 --> 00:03:27,248 [phone buzzing] 101 00:03:27,290 --> 00:03:28,666 - It's my boss. 102 00:03:28,750 --> 00:03:30,668 Sorry, I have to take this, or he's gonna fire me. 103 00:03:30,752 --> 00:03:32,795 - OK. 104 00:03:32,837 --> 00:03:34,297 - Hello. 105 00:03:34,380 --> 00:03:37,966 No, I'm still at the hospital. 106 00:03:38,009 --> 00:03:39,469 Being seen right now. 107 00:03:39,510 --> 00:03:40,762 Ow. 108 00:03:40,803 --> 00:03:43,932 No, they just stuck me with a needle. 109 00:03:43,973 --> 00:03:45,642 I don't know. 110 00:03:45,683 --> 00:03:48,061 You wanna talk to them? 111 00:03:48,144 --> 00:03:51,105 They're kind of busy right now. 112 00:03:51,147 --> 00:03:52,523 I know you are. 113 00:03:52,607 --> 00:03:53,983 - Second IV's in. 114 00:03:54,067 --> 00:03:55,692 - No, I'm not overreacting. 115 00:03:55,777 --> 00:03:58,029 My body's overreacting. 116 00:03:58,112 --> 00:04:00,031 Please--please don't fire me. 117 00:04:00,114 --> 00:04:01,324 I-- 118 00:04:01,407 --> 00:04:02,825 - This is Dr. Michael Robinavitch. 119 00:04:02,867 --> 00:04:04,827 I am the chief of emergency medicine at PTMC. 120 00:04:04,911 --> 00:04:06,829 If you fire her, she will sue you, 121 00:04:06,871 --> 00:04:09,832 and I will testify on her behalf. 122 00:04:09,874 --> 00:04:12,126 OK. 123 00:04:12,168 --> 00:04:14,087 Don't worry about it. We got you. 124 00:04:18,925 --> 00:04:20,843 - Do you know how long Jackson's gonna be asleep? 125 00:04:20,885 --> 00:04:24,055 - So there's no exact timeline with the sedatives we gave him, 126 00:04:24,138 --> 00:04:25,807 but he should be awake soon. 127 00:04:25,848 --> 00:04:27,475 - Have you spoken to your parents yet? 128 00:04:27,517 --> 00:04:29,060 - Yeah, they're on their way back from Columbus. 129 00:04:29,143 --> 00:04:31,521 - Maybe you should take some time for yourself 130 00:04:31,604 --> 00:04:32,981 before they arrive. 131 00:04:33,022 --> 00:04:34,649 - Yeah, cafeteria's right down the hall. 132 00:04:34,691 --> 00:04:35,692 Decent grilled cheese. 133 00:04:35,733 --> 00:04:36,818 Stay away from the tuna. 134 00:04:36,859 --> 00:04:38,861 - Thanks, but I'm not hungry. 135 00:04:38,903 --> 00:04:41,531 You know, I just can't believe that a campus security guard 136 00:04:41,614 --> 00:04:43,032 tased my brother. 137 00:04:43,074 --> 00:04:44,534 Aren't they supposed to be helping students 138 00:04:44,575 --> 00:04:46,619 and protect them, not shoot at them? 139 00:04:46,703 --> 00:04:48,329 - You have every right to be upset, 140 00:04:48,371 --> 00:04:50,999 and you should absolutely pursue accountability. 141 00:04:51,040 --> 00:04:53,251 But right now, we are taking care of your brother. 142 00:04:53,334 --> 00:04:56,087 And you should really take care of yourself. 143 00:04:56,170 --> 00:04:57,714 - I--I have your number. 144 00:04:57,755 --> 00:05:00,049 I'll text you as soon as Jackson's LP results get back 145 00:05:00,133 --> 00:05:02,260 or if he wakes up. 146 00:05:02,343 --> 00:05:04,012 - OK. 147 00:05:04,053 --> 00:05:05,346 OK, thank you. 148 00:05:05,388 --> 00:05:06,514 - Of course. 149 00:05:06,556 --> 00:05:09,684 - Oh. - OK. 150 00:05:09,726 --> 00:05:11,311 Hypoactive bowel sounds. 151 00:05:11,394 --> 00:05:14,188 Soft, with moderate tenderness in the left lower quadrant. 152 00:05:14,230 --> 00:05:17,400 Mrs. Randolph, do you take Percocet every day? 153 00:05:17,483 --> 00:05:19,360 - No. - Huh. 154 00:05:19,402 --> 00:05:20,820 And what about your water intake, 'cause-- 155 00:05:20,903 --> 00:05:22,363 - Pause. 156 00:05:22,405 --> 00:05:24,532 Mrs. Randolph, you said you don't take Percocet every day, 157 00:05:24,574 --> 00:05:26,534 but when was the last time you took some? 158 00:05:26,576 --> 00:05:29,787 - Maybe three or four times last week. 159 00:05:29,871 --> 00:05:33,416 Assisted living had a ballroom dance competition, 160 00:05:33,499 --> 00:05:35,626 and I tweaked my back. - Mm. 161 00:05:35,710 --> 00:05:39,756 - Any further questions, Ogilvie? 162 00:05:39,797 --> 00:05:43,426 - When was your last bowel movement? 163 00:05:43,509 --> 00:05:45,928 - I don't know. Sometime last week. 164 00:05:46,012 --> 00:05:48,931 I've been stopped up for at least five or six days. 165 00:05:49,015 --> 00:05:52,435 - Mm-hmm, painkillers can cause constipation. 166 00:05:52,477 --> 00:05:53,728 - I know. 167 00:05:53,770 --> 00:05:56,272 That's why they put me on a stool softener, 168 00:05:56,314 --> 00:05:57,607 and then they tried an enema. 169 00:05:57,648 --> 00:05:59,609 - And--and no movements? - Yep. 170 00:05:59,692 --> 00:06:02,945 And then they gave me this horrible drink. 171 00:06:02,987 --> 00:06:04,572 - Mag citrate. 172 00:06:04,614 --> 00:06:05,615 - Yeah. 173 00:06:05,656 --> 00:06:07,950 Mag citrate. 174 00:06:07,992 --> 00:06:09,243 Made me puke. 175 00:06:09,285 --> 00:06:11,454 - All right, what's next, Ogilvie? 176 00:06:11,496 --> 00:06:13,456 - Let's get you an X-ray and see how we can help you, 177 00:06:13,539 --> 00:06:14,457 Mrs. Randolph. 178 00:06:14,540 --> 00:06:16,376 - Thank you. - Yeah. 179 00:06:16,459 --> 00:06:18,544 - Differential? 180 00:06:18,628 --> 00:06:20,213 - Probable stool impaction. 181 00:06:20,296 --> 00:06:21,798 But with her history of cholecystectomy, 182 00:06:21,839 --> 00:06:23,549 it could be small bowel obstruction. 183 00:06:23,633 --> 00:06:24,634 - Or worse. 184 00:06:24,717 --> 00:06:26,928 - Sigmoid volvulus? 185 00:06:26,969 --> 00:06:29,305 But that's a surgical emergency. 186 00:06:29,347 --> 00:06:30,807 Wouldn't she have tons of pain? 187 00:06:30,890 --> 00:06:34,394 - Not always, especially when you're in your 80s. 188 00:06:39,982 --> 00:06:41,567 - I am getting concerned. 189 00:06:41,651 --> 00:06:44,153 This is a millimeter past the line. 190 00:06:44,195 --> 00:06:45,488 - Or my line was sloppy. 191 00:06:45,571 --> 00:06:47,073 - Any increase in pain? - Oh. 192 00:06:47,156 --> 00:06:49,659 - OK, sorry. Let's try four morphine. 193 00:06:49,700 --> 00:06:50,993 - White count's only 10,000. 194 00:06:51,034 --> 00:06:52,995 It'd be over 12,000 for SIRS. 195 00:06:53,079 --> 00:06:54,831 - There are other criteria. 196 00:06:54,872 --> 00:06:56,290 - Still afebrile. 197 00:06:56,332 --> 00:06:57,834 - Did you ask about past history of MRSA? 198 00:06:57,917 --> 00:06:59,669 - Not specifically, but she's never been hospitalized. 199 00:06:59,710 --> 00:07:01,170 - Any evidence of an immunocompromised state? 200 00:07:01,212 --> 00:07:02,380 - No, she's healthy. - Steroid use? 201 00:07:02,463 --> 00:07:03,381 - Never. 202 00:07:03,464 --> 00:07:04,966 - Maximum heart rate's only 89. 203 00:07:05,007 --> 00:07:06,134 - Is that OK? 204 00:07:06,175 --> 00:07:08,177 - That's good, very good. 205 00:07:08,261 --> 00:07:09,178 - Stay with her. 206 00:07:09,262 --> 00:07:10,805 Monitor her closely. 207 00:07:10,847 --> 00:07:12,640 If there's any change in her condition, come find me. 208 00:07:12,682 --> 00:07:13,850 I mean any change. 209 00:07:16,936 --> 00:07:19,522 - Roxie Hamler, 42, home hospice patient 210 00:07:19,605 --> 00:07:21,149 with a history of lung cancer. 211 00:07:21,190 --> 00:07:24,360 New-onset tonic-clonic seizure with right lower leg pain. 212 00:07:24,402 --> 00:07:26,487 - She hit it on the coffee table. 213 00:07:26,529 --> 00:07:28,114 - [moaning softly] 214 00:07:28,197 --> 00:07:29,907 - Initially nonverbal, now coming around. 215 00:07:29,991 --> 00:07:31,409 - That's normal after a seizure. 216 00:07:31,492 --> 00:07:33,034 Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 217 00:07:33,077 --> 00:07:34,829 - Nope, we got it. - She hit her head? 218 00:07:34,871 --> 00:07:35,997 - No. I was there. 219 00:07:36,038 --> 00:07:37,582 I caught her. - No IV? 220 00:07:37,665 --> 00:07:38,875 - Couldn't get one in. 221 00:07:38,957 --> 00:07:40,376 Gave her four of IM versed for the seizure, 222 00:07:40,460 --> 00:07:41,919 25 of fent for the pain. - OK. 223 00:07:42,003 --> 00:07:43,838 Dana, where to? - Trauma One. 224 00:07:43,880 --> 00:07:45,047 - This way. 225 00:07:45,131 --> 00:07:47,383 - Haven't seen you guys in a hot minute. 226 00:07:47,467 --> 00:07:50,011 - Pickup from SCI Jones Forge. 227 00:07:50,052 --> 00:07:51,512 Was supposed to go to Westbridge but got 228 00:07:51,554 --> 00:07:52,513 diverted to you. 229 00:07:52,555 --> 00:07:53,890 - Yeah, you and everybody else. 230 00:07:53,973 --> 00:07:55,475 - Princess, I need you pivot to Central 9. 231 00:07:55,558 --> 00:07:56,808 - Got it. 232 00:07:56,893 --> 00:07:58,519 - Gus Varney, 54, victim of assault 233 00:07:58,561 --> 00:07:59,896 with diffuse blunt trauma. 234 00:07:59,937 --> 00:08:01,898 He's got bruising to the face, the right chest, 235 00:08:01,939 --> 00:08:03,566 10-centimeter laceration to the left arm. 236 00:08:03,608 --> 00:08:05,109 BP's 136 over 84, pulse 102, 237 00:08:05,193 --> 00:08:07,904 good sats, 95 on room air. 238 00:08:07,945 --> 00:08:09,572 - How you feeling there, Mr. Varney? 239 00:08:09,655 --> 00:08:11,073 - Fucking hurts. - Where? 240 00:08:11,157 --> 00:08:13,409 - Everywhere. - I am Dr. Robby. 241 00:08:13,493 --> 00:08:14,744 This is Dr. Al-Hashimi. 242 00:08:14,785 --> 00:08:16,204 - We'll get you something for the pain. 243 00:08:16,245 --> 00:08:17,747 - I've got a progressing cellulitis in Trauma Two. 244 00:08:17,788 --> 00:08:19,373 - Go. I'm good. - Thank you. 245 00:08:19,415 --> 00:08:21,417 - Gus, do you know who hurt you? 246 00:08:21,459 --> 00:08:24,086 - One of the fine, upstanding citizens of cell block 6. 247 00:08:24,128 --> 00:08:27,006 - It's a deep lac through the muscle fascia. 248 00:08:27,089 --> 00:08:28,549 Can we get the cuffs off once he settles? 249 00:08:28,591 --> 00:08:29,717 - Not a chance. 250 00:08:29,759 --> 00:08:31,636 Orange jumpsuit. He's cuffed for a reason. 251 00:08:31,719 --> 00:08:33,804 - Let's go. 252 00:08:44,148 --> 00:08:47,610 OK, everyone, on my count. 253 00:08:47,693 --> 00:08:49,278 1, 2-- 254 00:08:49,320 --> 00:08:50,821 - Hold on. 255 00:08:54,408 --> 00:08:57,954 Go. - 1, 2, 3. 256 00:08:57,995 --> 00:08:59,455 - [groans] - Mel, E-FAST. 257 00:08:59,497 --> 00:09:00,998 Whitaker, primary assessment. 258 00:09:01,082 --> 00:09:02,333 - On it. 259 00:09:07,463 --> 00:09:08,589 - Oh, weird bruise. 260 00:09:08,631 --> 00:09:09,882 Did he fall on something? 261 00:09:09,966 --> 00:09:11,384 - Footprint, got stomped. 262 00:09:11,467 --> 00:09:13,386 - Jesus. 263 00:09:14,637 --> 00:09:16,305 - Is it--is that necessary? 264 00:09:16,347 --> 00:09:18,474 - Afraid so. 265 00:09:18,516 --> 00:09:21,102 - Airway's patent. 266 00:09:21,143 --> 00:09:23,813 - Good lung sliding on the left. 267 00:09:23,896 --> 00:09:25,064 - [yells] - Sorry. 268 00:09:25,147 --> 00:09:26,315 Good on the right, too. 269 00:09:26,399 --> 00:09:27,733 - How are the lungs? 270 00:09:27,817 --> 00:09:28,818 - Good breath sounds. 271 00:09:28,901 --> 00:09:31,612 No crepitus. - No effusion. 272 00:09:31,654 --> 00:09:34,865 - Pulse ox 97, BP 118 over 78, heart rate 112. 273 00:09:34,949 --> 00:09:36,284 - Tachycardic from the pain. 274 00:09:36,325 --> 00:09:37,827 - Start with four of morphine. Repeat prn. 275 00:09:37,868 --> 00:09:38,828 - On it. 276 00:09:38,869 --> 00:09:40,955 - OK. Swollen mandible. 277 00:09:40,997 --> 00:09:42,331 Open your mouth for me, Gus. 278 00:09:42,415 --> 00:09:44,165 Little wider. 279 00:09:44,250 --> 00:09:45,459 - Can't. 280 00:09:45,501 --> 00:09:46,836 - Whitaker, you know the tongue blade exam? 281 00:09:46,877 --> 00:09:48,296 - Yeah. 282 00:09:48,337 --> 00:09:49,714 - It's a great test for mandible fracture. 283 00:09:49,797 --> 00:09:52,967 - Gus, bite down hard on this for me. 284 00:09:53,009 --> 00:09:55,177 - [yelling] 285 00:09:55,219 --> 00:09:56,512 - Sorry, Gus. 286 00:09:56,596 --> 00:09:58,681 Positive test. - [groans] 287 00:09:58,723 --> 00:10:00,182 - No free fluid in the belly. 288 00:10:00,266 --> 00:10:01,183 - Any idea how long this will take? 289 00:10:01,267 --> 00:10:02,560 - Too soon to tell. 290 00:10:02,643 --> 00:10:03,686 Whitaker, your assessment? 291 00:10:03,728 --> 00:10:05,104 - Fractured left mandible, 292 00:10:05,187 --> 00:10:07,273 multiple rib fractures. 293 00:10:07,356 --> 00:10:08,774 Complex forearm lac. 294 00:10:08,858 --> 00:10:10,776 - OK, log roll to the left, then pan scan. 295 00:10:10,860 --> 00:10:12,695 - Where were you when Mr. Varney got assaulted? 296 00:10:12,778 --> 00:10:14,322 - I just move 'em. I don't get to know 'em. 297 00:10:14,363 --> 00:10:16,032 - CT's ready for us. 298 00:10:16,115 --> 00:10:17,867 - Cycling the BP. 299 00:10:17,950 --> 00:10:20,536 - OK, this redness is now a centimeter over that line, 300 00:10:20,620 --> 00:10:22,038 and this might be a bulla forming. 301 00:10:22,121 --> 00:10:23,372 - The vanco takes a little time to work. 302 00:10:23,414 --> 00:10:26,876 - Vital signs are still stable, 122 over 78. 303 00:10:26,959 --> 00:10:28,002 I got it. 304 00:10:28,044 --> 00:10:31,005 - How are you feeling, Debbie? 305 00:10:31,047 --> 00:10:32,673 - I'm feeling a little warm. 306 00:10:32,715 --> 00:10:34,050 - That can happen with vanco. 307 00:10:34,133 --> 00:10:36,052 - Thanks, man. 308 00:10:36,093 --> 00:10:39,055 Lactic acid 4.2. 309 00:10:39,138 --> 00:10:40,890 - OK. - What's wrong? 310 00:10:40,931 --> 00:10:43,559 - That can be a sign of a more serious infection, 311 00:10:43,643 --> 00:10:45,227 but the good news is, we know what to do. 312 00:10:45,269 --> 00:10:48,898 Jesse, 2 liters of LR wide open. 313 00:10:48,981 --> 00:10:50,399 - This is severe sepsis. 314 00:10:50,441 --> 00:10:52,026 - I know, but at 7:00 AM, it was a simple cellulitis. 315 00:10:52,068 --> 00:10:53,611 Anyone would have given her Keflex. 316 00:10:53,694 --> 00:10:55,613 We could add carbapenem or Zosyn to broaden 317 00:10:55,696 --> 00:10:56,697 our antibiotic coverage. 318 00:10:56,739 --> 00:10:57,865 - OK, I got it. 319 00:10:57,907 --> 00:10:59,241 Thanks. 320 00:10:59,325 --> 00:11:02,244 Jesse, 1 gram meropenem, 900 milligrams clinda, 321 00:11:02,328 --> 00:11:04,288 and page Dr. Garcia, please. 322 00:11:04,372 --> 00:11:05,748 - What's going on? 323 00:11:05,790 --> 00:11:07,208 - We're adding new antibiotics. 324 00:11:07,249 --> 00:11:08,584 - It's serious? 325 00:11:08,668 --> 00:11:09,835 - We wanna get ahead of it and make sure 326 00:11:09,919 --> 00:11:11,712 it doesn't become serious. 327 00:11:13,339 --> 00:11:14,382 What else can I do? 328 00:11:14,423 --> 00:11:15,549 - I think you've done enough. 329 00:11:15,591 --> 00:11:16,759 You can go. 330 00:11:20,471 --> 00:11:21,430 - All good in there? 331 00:11:21,472 --> 00:11:22,556 - Code sepsis. 332 00:11:22,598 --> 00:11:23,891 Stable for the moment. 333 00:11:23,933 --> 00:11:25,184 How about you? 334 00:11:25,267 --> 00:11:27,561 - Perfect vitals, E-FAST negative, off to CT. 335 00:11:27,603 --> 00:11:28,771 - Good. 336 00:11:28,813 --> 00:11:30,356 Keep me posted. 337 00:11:30,439 --> 00:11:31,732 - Ditto. 338 00:11:35,319 --> 00:11:36,696 - How's it going? 339 00:11:36,779 --> 00:11:38,656 - Great, if you ignore the hot mess in chairs. 340 00:11:38,739 --> 00:11:40,616 - Any update on our little baby Jane Doe? 341 00:11:40,658 --> 00:11:42,618 - Security's reviewing the CCTV from last night 342 00:11:42,660 --> 00:11:43,911 and this morning. 343 00:11:46,247 --> 00:11:47,623 You two kiss and make up yet? 344 00:11:47,707 --> 00:11:49,250 - I think someone needs to smoke a cigarette. 345 00:11:49,290 --> 00:11:50,626 - I'm trying to quit. 346 00:11:50,710 --> 00:11:52,169 - Why don't you quit when I'm on my trip? 347 00:11:52,253 --> 00:11:53,462 - Everyone's glad to have you back. 348 00:11:53,504 --> 00:11:56,006 - Asshole. - Well, not everyone. 349 00:11:57,466 --> 00:11:59,844 - Hey, you want in on this betting board? 350 00:11:59,927 --> 00:12:02,805 Look, all you gotta do is pick why Westbridge went down, 351 00:12:02,888 --> 00:12:04,473 how many of their patients we're gonna get, 352 00:12:04,515 --> 00:12:06,100 and when they'll be back in action. 353 00:12:06,142 --> 00:12:08,811 Hey, already up to $500. 354 00:12:08,894 --> 00:12:11,147 - Oh, ah, gotta pass. 355 00:12:11,230 --> 00:12:13,315 Still catching up on rehab bills. 356 00:12:13,399 --> 00:12:15,901 - Respect. 357 00:12:17,486 --> 00:12:18,571 - All right. 358 00:12:18,654 --> 00:12:20,281 What's the rules on me changing my bet? 359 00:12:20,322 --> 00:12:22,491 - Only if you double down. 360 00:12:22,533 --> 00:12:24,493 - [chuckles] 361 00:12:24,577 --> 00:12:25,995 Sinkhole. 362 00:12:28,664 --> 00:12:32,084 - You watch too many movies, man. 363 00:12:32,168 --> 00:12:35,171 - Considered the diagnosis of aortic aneurysm 364 00:12:35,212 --> 00:12:37,423 or dissection, but the point-of-care ultrasound was-- 365 00:12:37,506 --> 00:12:40,009 - You done want that gridlocked granny? 366 00:12:40,050 --> 00:12:41,886 - Ordered an acute abdominal series 367 00:12:41,969 --> 00:12:43,179 to rule out obstruction. 368 00:12:43,220 --> 00:12:44,388 Still waiting on the X-rays. - Great. 369 00:12:44,472 --> 00:12:45,514 Then you're free to treat our latest 370 00:12:45,598 --> 00:12:46,724 and greatest in South 16. 371 00:12:46,807 --> 00:12:49,518 - Oh, come on, D, it's like, every time 372 00:12:49,602 --> 00:12:51,145 I get a moment to chart, I barely get 373 00:12:51,187 --> 00:12:53,856 a sentence out before I get-- - Interrupted? 374 00:12:53,898 --> 00:12:55,858 Sucks to be you, but trust me, it sucks worse 375 00:12:55,941 --> 00:12:57,818 for the poor gal in 16. 376 00:12:57,860 --> 00:13:00,529 - I'm beginning to think you enjoy torturing me. 377 00:13:00,613 --> 00:13:02,698 - Perks of the job. 378 00:13:02,740 --> 00:13:04,074 - Ogilvie, let's go. 379 00:13:07,661 --> 00:13:10,414 - Hold out your hand, Louie. 380 00:13:11,373 --> 00:13:13,000 A little shaky. 381 00:13:13,042 --> 00:13:14,001 - No surprise. 382 00:13:14,043 --> 00:13:16,170 I've been here since 4:00 AM. 383 00:13:16,212 --> 00:13:17,546 - We can get you something for that. 384 00:13:17,588 --> 00:13:18,881 - Or I can take care of it myself 385 00:13:18,923 --> 00:13:21,008 if you cut me loose right now. 386 00:13:21,050 --> 00:13:23,177 - Let's get Louie 50 milligrams of Librium. 387 00:13:23,219 --> 00:13:24,804 - I'll put in the order. 388 00:13:26,889 --> 00:13:29,683 - I will get it from the PDS. 389 00:13:33,229 --> 00:13:35,731 - I'm already assigned as Louie's treating physician. 390 00:13:35,773 --> 00:13:38,150 Just makes sense that I put it in. 391 00:13:38,234 --> 00:13:40,319 - Yeah. Yeah, yeah. Of course. 392 00:13:45,407 --> 00:13:47,868 Any changes with our septic waitress? 393 00:13:47,910 --> 00:13:48,953 - Not yet. 394 00:13:49,036 --> 00:13:50,079 - Wait, if you have a second, I-- 395 00:13:50,120 --> 00:13:51,247 - I don't. 396 00:13:51,288 --> 00:13:52,623 - But the point-of-care ultrasound 397 00:13:52,706 --> 00:13:54,083 was negative for both. 398 00:13:54,124 --> 00:13:56,460 I considered the diagnosis of cauda equina syndrome. 399 00:13:56,544 --> 00:13:59,588 - You writing the great American novel? 400 00:13:59,672 --> 00:14:01,590 - Charting and supervising. 401 00:14:01,632 --> 00:14:02,591 It's Dana's idea. 402 00:14:02,675 --> 00:14:04,134 - Who's the lucky patient? 403 00:14:04,218 --> 00:14:06,053 - Unhoused woman with a bad cough. 404 00:14:06,095 --> 00:14:07,805 Ogilvie's all over it. 405 00:14:07,888 --> 00:14:09,223 - OK. 406 00:14:09,265 --> 00:14:10,766 - Say "eee." 407 00:14:10,808 --> 00:14:12,476 - Eee. 408 00:14:12,560 --> 00:14:14,270 - OK, deep breath in. 409 00:14:14,311 --> 00:14:16,188 Blow it out real hard. 410 00:14:16,272 --> 00:14:17,940 - You haven't heard enough already? 411 00:14:17,982 --> 00:14:21,944 - I need to check for wheezing with forced exhalation. 412 00:14:22,027 --> 00:14:25,114 - [breathes deeply, coughs] 413 00:14:25,197 --> 00:14:27,116 Fucking cough is killing me. 414 00:14:27,157 --> 00:14:28,701 - You smoke, Mrs. Yardley? 415 00:14:28,784 --> 00:14:30,911 - Yeah, but I haven't been able to 416 00:14:30,953 --> 00:14:32,288 for a couple days 'cause of this cough. 417 00:14:32,371 --> 00:14:34,582 - Mm. You ever consider quitting? 418 00:14:34,623 --> 00:14:38,085 - You ever considered minding your own business? 419 00:14:41,964 --> 00:14:44,133 - Well, the good news is that your test from earlier 420 00:14:44,216 --> 00:14:46,343 came back negative for both COVID and influenza, 421 00:14:46,427 --> 00:14:48,012 but I'm gonna order a chest X-ray 422 00:14:48,095 --> 00:14:49,597 so that we can see what's really going on in those lungs. 423 00:14:49,638 --> 00:14:51,599 You got time to let us do that? 424 00:14:52,850 --> 00:14:55,769 - Where the fuck else you think I gotta be? 425 00:14:55,811 --> 00:14:57,521 - And we're in. 426 00:14:57,605 --> 00:14:59,189 3 grams Keppra over 10 minutes. 427 00:14:59,273 --> 00:15:00,941 That'll prevent another seizure. 428 00:15:00,983 --> 00:15:01,984 - Thank you. 429 00:15:02,067 --> 00:15:03,944 Nobody can ever get an IV in her. 430 00:15:03,986 --> 00:15:05,863 - Yeah, midline cath is the way to go 431 00:15:05,946 --> 00:15:07,489 when your veins are shot. 432 00:15:07,573 --> 00:15:12,119 - Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 433 00:15:12,161 --> 00:15:14,830 - OK. - Cold. 434 00:15:14,872 --> 00:15:18,292 - Is it possible to get her a blanket and some socks? 435 00:15:18,334 --> 00:15:20,002 - Can do. 436 00:15:20,085 --> 00:15:22,588 - When was she diagnosed? 437 00:15:22,671 --> 00:15:24,506 - Seven years ago. 438 00:15:24,590 --> 00:15:27,134 Resected a lobe. 439 00:15:27,176 --> 00:15:29,678 Four cycles of platinum chemo gave us a couple good years, 440 00:15:29,720 --> 00:15:32,139 but then it spread to the bones. 441 00:15:32,181 --> 00:15:34,350 - Has she had radiation therapy? 442 00:15:34,391 --> 00:15:36,810 - Shrunk down the mets, but they're still there. 443 00:15:36,852 --> 00:15:38,771 - That's why you're at hospice at home. 444 00:15:38,854 --> 00:15:39,772 - Yep. 445 00:15:39,855 --> 00:15:41,815 - I'm sorry. 446 00:15:41,857 --> 00:15:43,108 - Me too. 447 00:15:43,192 --> 00:15:45,694 - Ah. 448 00:15:45,736 --> 00:15:46,820 - Sorry. 449 00:15:46,862 --> 00:15:48,364 - You have kids? 450 00:15:48,405 --> 00:15:50,824 - Yeah, two boys. 451 00:15:50,866 --> 00:15:52,868 15 and 9. 452 00:15:52,952 --> 00:15:54,495 - My son's 12. 453 00:15:54,536 --> 00:15:56,705 - Goes fast. 454 00:15:56,747 --> 00:15:58,540 Too fast. 455 00:15:58,582 --> 00:16:03,170 - Swelling and bruising over the distal tibia. 456 00:16:03,212 --> 00:16:05,756 - 50 of fentanyl once her systolic's over 100. 457 00:16:05,839 --> 00:16:08,425 - What do you usually take for pain? 458 00:16:11,387 --> 00:16:14,556 - MS Contin, 30 milligrams twice a day, 459 00:16:14,598 --> 00:16:16,934 oxycodone for breakthrough, and sublingual Actiq 460 00:16:17,017 --> 00:16:20,729 for when it gets really bad. 461 00:16:20,813 --> 00:16:21,897 - That's a lot. 462 00:16:21,981 --> 00:16:23,732 - You handle her pain meds? 463 00:16:23,774 --> 00:16:24,817 - Sometimes. 464 00:16:24,900 --> 00:16:26,694 - All the time. 465 00:16:26,735 --> 00:16:29,571 - A hospice nurse comes by a few times a week, 466 00:16:29,613 --> 00:16:31,907 but I was alone when she had the seizure. 467 00:16:31,991 --> 00:16:33,909 They told us that it could happen, 468 00:16:33,951 --> 00:16:35,494 but she couldn't breathe. 469 00:16:35,577 --> 00:16:39,915 And I freaked out, and I called 911. 470 00:16:39,999 --> 00:16:42,251 - I'm so sorry. 471 00:16:42,292 --> 00:16:44,169 - I'm sorry. 472 00:16:44,253 --> 00:16:46,088 I'm sorry. 473 00:16:55,723 --> 00:16:58,809 - Due to your family income, you make too much 474 00:16:58,892 --> 00:17:00,728 to be eligible for either PENNIE 475 00:17:00,769 --> 00:17:03,105 or the hospital's "charity care." 476 00:17:03,188 --> 00:17:05,273 - But we can't afford health-care premiums. 477 00:17:05,315 --> 00:17:08,068 - It's unfortunately very common for people 478 00:17:08,109 --> 00:17:09,319 to fall between the cracks. 479 00:17:09,403 --> 00:17:11,446 It's an imperfect system. 480 00:17:11,530 --> 00:17:13,615 - Can PTMC help with the costs in any way? 481 00:17:13,699 --> 00:17:16,117 - We can offer financial assistance. 482 00:17:16,160 --> 00:17:17,953 You'd pay the same that Medicare 483 00:17:17,994 --> 00:17:19,579 and Medicaid would pay. 484 00:17:19,621 --> 00:17:20,705 - How much is that? 485 00:17:20,789 --> 00:17:24,626 - You pay 60%, we cover 40%. 486 00:17:24,667 --> 00:17:25,961 - Thank you. 487 00:17:26,045 --> 00:17:27,921 Uh-huh. 488 00:17:29,131 --> 00:17:31,133 Where have you been? 489 00:17:31,175 --> 00:17:33,635 - How are you doing? - I'm sorry, mijita. 490 00:17:33,677 --> 00:17:36,722 You were being thoughtful, and I just blew up. 491 00:17:36,805 --> 00:17:39,641 - Well, Ms. Noelle was just telling us that the hospital 492 00:17:39,683 --> 00:17:41,310 is gonna give us a big discount. 493 00:17:41,393 --> 00:17:43,979 - We can knock 40% off your final bill. 494 00:17:44,063 --> 00:17:45,981 - That's great. - Mm-hmm. 495 00:17:46,023 --> 00:17:47,816 - I stay here for a few days, 496 00:17:47,900 --> 00:17:50,152 my bill could be over $100,000, right? 497 00:17:51,820 --> 00:17:53,489 - Yes, unfortunately. 498 00:17:53,572 --> 00:17:55,616 It could end up being lower, 499 00:17:55,657 --> 00:17:57,993 depending on your level of needed care. 500 00:17:58,077 --> 00:17:59,995 - Or higher? 501 00:18:00,079 --> 00:18:03,999 So we would still have to pay $60,000? 502 00:18:04,041 --> 00:18:05,501 Which we don't have. 503 00:18:05,584 --> 00:18:07,711 - He has to stay here to get better, right? 504 00:18:07,795 --> 00:18:10,130 - Yes. - No. 505 00:18:10,172 --> 00:18:11,340 - Excuse me? 506 00:18:11,423 --> 00:18:13,550 - I mean, not necessarily. 507 00:18:13,634 --> 00:18:16,220 Couldn't we just admit him to med-surg instead of ICU? 508 00:18:16,303 --> 00:18:18,055 Wouldn't that be a lot cheaper? 509 00:18:18,138 --> 00:18:20,182 - Med-surg won't accept him with an insulin drip. 510 00:18:20,265 --> 00:18:22,017 - Usually true. 511 00:18:22,059 --> 00:18:25,687 But let me talk to the charge nurse upstairs, and I'll-- 512 00:18:25,729 --> 00:18:26,855 I'll see what she says. 513 00:18:26,897 --> 00:18:28,398 - Thank you. 514 00:18:30,359 --> 00:18:32,361 - Food poisoning in the hall's asking to leave, 515 00:18:32,402 --> 00:18:34,363 wants to take her kids to the water park. 516 00:18:34,446 --> 00:18:36,949 - Those places are cesspools. 517 00:18:37,032 --> 00:18:38,450 - Preaching to the choir. 518 00:18:38,534 --> 00:18:40,035 - If she's feeling fine on Zofran, she's good to go. 519 00:18:40,119 --> 00:18:41,537 - All right. 520 00:18:41,578 --> 00:18:43,455 Louie's in South 15. Meds are coming down. 521 00:18:43,539 --> 00:18:45,457 Another couple hours of monitoring, and he can broom. 522 00:18:45,541 --> 00:18:46,708 - Straight to the liquor store. 523 00:18:46,792 --> 00:18:47,876 - Don't pass "go." 524 00:18:47,918 --> 00:18:48,877 - What about that clamshell case 525 00:18:48,919 --> 00:18:50,337 that went up--anything? 526 00:18:50,379 --> 00:18:52,297 - Out of surgery, in recovery, still sedated. 527 00:18:52,381 --> 00:18:54,216 - Good. Keep me posted on that. 528 00:18:54,258 --> 00:18:55,634 - Will do. 529 00:18:57,803 --> 00:18:59,054 - Three times in one day. 530 00:18:59,138 --> 00:19:00,681 To what do we owe the pleasure? 531 00:19:00,722 --> 00:19:02,391 - I came down for a consult 532 00:19:02,432 --> 00:19:04,768 and to persuade Ahmad to start a new betting board. 533 00:19:04,852 --> 00:19:06,395 - Why, is the Westbridge board full already? 534 00:19:06,436 --> 00:19:08,397 - Mm-hmm, was gonna ask him to start one about you 535 00:19:08,480 --> 00:19:10,732 and your midlife crisis trip. 536 00:19:10,774 --> 00:19:12,734 I give it four weeks. 537 00:19:12,776 --> 00:19:15,237 Seven, tops. 538 00:19:15,320 --> 00:19:16,530 - Ye of little faith. 539 00:19:16,572 --> 00:19:19,241 - Not about faith, just facts. 540 00:19:19,324 --> 00:19:20,576 - Facts? 541 00:19:20,617 --> 00:19:22,452 - Based on my experience, you're a seven-week-itch 542 00:19:22,536 --> 00:19:23,912 kind of guy. 543 00:19:23,996 --> 00:19:26,165 - Hey, Robby, med student's got a pickleball player 544 00:19:26,248 --> 00:19:28,083 in the North Hall with possible Achilles rupture, 545 00:19:28,167 --> 00:19:29,084 asking for your opinion. 546 00:19:29,168 --> 00:19:30,711 - Thank you, Perlah. 547 00:19:30,752 --> 00:19:32,880 At least somebody down here has a little faith in me. 548 00:19:32,921 --> 00:19:35,424 - [chuckles] 549 00:19:35,507 --> 00:19:38,177 You know what Motorcycle Mike's sabbatical is really about? 550 00:19:38,260 --> 00:19:41,054 - I never try to guess what's going on in that head of his. 551 00:19:41,096 --> 00:19:44,266 - Three months being on the open road by himself. 552 00:19:44,308 --> 00:19:46,435 Man can't stand to be alone for more than a few hours. 553 00:19:46,476 --> 00:19:49,438 He sleeps with the TV on in his bedroom. 554 00:19:49,521 --> 00:19:52,357 - I really don't think I needed to know that. 555 00:19:53,775 --> 00:19:56,904 Look, maybe he's looking for something new 556 00:19:56,945 --> 00:19:59,781 or trying to outrun some old ghosts. 557 00:19:59,865 --> 00:20:03,118 - Well, I hope he finds what he's looking for. 558 00:20:03,160 --> 00:20:05,287 Man deserves some peace. 559 00:20:05,329 --> 00:20:06,622 - Amen. 560 00:20:06,705 --> 00:20:09,291 - I considered the diagnosis of cauda equina syndrome, 561 00:20:09,374 --> 00:20:11,126 but the motor and sensory exam 562 00:20:11,210 --> 00:20:13,503 were both intact in the sacral nerve root-- 563 00:20:13,587 --> 00:20:14,838 - Our unhoused cougher has pneumonia. 564 00:20:14,922 --> 00:20:17,758 - I'm cursed, fucking cursed. 565 00:20:17,799 --> 00:20:19,259 Fuck. 566 00:20:19,301 --> 00:20:20,969 - What? 567 00:20:21,053 --> 00:20:23,430 - That is a cavitary lesion in the right upper lobe. 568 00:20:23,472 --> 00:20:25,182 Active TB. 569 00:20:25,265 --> 00:20:27,559 What's next? 570 00:20:27,643 --> 00:20:29,144 - AFB stain to confirm, 571 00:20:29,186 --> 00:20:31,647 move her to a negative airflow room, start her on meds. 572 00:20:31,730 --> 00:20:33,815 - Call infection control and public health. 573 00:20:33,857 --> 00:20:36,109 And now you get to sign in as a patient 574 00:20:36,151 --> 00:20:38,570 and get your blood drawn for a QuantiFERON Gold. 575 00:20:38,654 --> 00:20:40,572 - It's too soon to be positive. 576 00:20:40,656 --> 00:20:41,740 - Yeah, but you were exposed. 577 00:20:41,823 --> 00:20:43,325 You need a baseline test 578 00:20:43,408 --> 00:20:46,578 and then again in eight weeks to see if you convert. 579 00:20:46,662 --> 00:20:47,913 - And if I do? 580 00:20:47,996 --> 00:20:49,998 - Then meds every day for three or four months 581 00:20:50,082 --> 00:20:52,918 with regular blood tests to check for toxicity. 582 00:20:53,001 --> 00:20:54,253 - Jesus. - All right. 583 00:20:54,336 --> 00:20:55,754 Let Dana know what's up. 584 00:20:55,837 --> 00:20:58,840 And for the love of God, mask up when you move her. 585 00:20:58,882 --> 00:21:02,928 [indistinct announcement over P.A. system] 586 00:21:07,349 --> 00:21:09,518 - Dr. Langdon. - Hey, man. Alex. 587 00:21:09,559 --> 00:21:10,727 - Let's take a look. 588 00:21:13,313 --> 00:21:16,191 - Ah. 589 00:21:16,275 --> 00:21:17,192 - Is it bad? 590 00:21:17,276 --> 00:21:18,735 - It's not good. 591 00:21:18,819 --> 00:21:21,363 - Sorry, your chart says you were burned with dry ice? 592 00:21:21,446 --> 00:21:23,407 What happened? - My jack-off brother. 593 00:21:23,490 --> 00:21:25,033 - Does he not like you? 594 00:21:25,075 --> 00:21:28,662 - I asked him to do it, just not like this exactly. 595 00:21:28,704 --> 00:21:30,205 - What? Why? 596 00:21:30,289 --> 00:21:31,873 - He was gonna brand me like I branded him. 597 00:21:31,957 --> 00:21:33,709 - Branded? Like cattle? 598 00:21:33,792 --> 00:21:36,878 - Instead of hot branding, you stick the iron in dry ice, 599 00:21:36,920 --> 00:21:39,840 let it get super cold, and then you put it on your skin. 600 00:21:39,881 --> 00:21:41,508 Cool, huh? 601 00:21:41,550 --> 00:21:42,718 - [speaking Tagalog] 602 00:21:42,759 --> 00:21:43,969 - Let's get some LET on this. 603 00:21:44,052 --> 00:21:45,762 I'll get some snips to debride. 604 00:21:48,223 --> 00:21:49,850 - You good? 605 00:21:49,891 --> 00:21:52,185 - Yeah. Yeah, good. 606 00:21:52,227 --> 00:21:53,562 - You sure? 607 00:21:53,645 --> 00:21:56,690 - Doesn't seem like Robby's all that happy I'm back. 608 00:21:56,732 --> 00:21:59,318 - Well, he's not going to be here, 609 00:21:59,401 --> 00:22:01,069 and I'm happy you're back. 610 00:22:01,153 --> 00:22:03,071 - Thanks. 611 00:22:07,409 --> 00:22:11,580 - Head and neck CT is negative, except for mandible fracture. 612 00:22:12,497 --> 00:22:13,790 - OK, let's get him off the board. 613 00:22:13,874 --> 00:22:15,083 - Roll him, right side up. 614 00:22:15,167 --> 00:22:16,918 - Hey, we're gonna need the cuffs off. 615 00:22:18,128 --> 00:22:19,880 [handcuffs clatter] 616 00:22:19,921 --> 00:22:22,716 - Ready. And 1, 2, 3. 617 00:22:22,758 --> 00:22:25,093 - Ah, gentle. - [groans] 618 00:22:25,135 --> 00:22:26,762 - Dr. King, how are the chest and belly? 619 00:22:26,803 --> 00:22:29,973 - We have three anterior rib fractures 620 00:22:30,057 --> 00:22:31,933 and a small pulmonary contusion. 621 00:22:31,975 --> 00:22:33,185 - Not too bad. - Mm-mm. 622 00:22:33,268 --> 00:22:34,895 - When do pulmonary contusions peak? 623 00:22:34,936 --> 00:22:36,271 - After a few hours. 624 00:22:36,355 --> 00:22:37,856 - And do we always admit for three-rib fractures? 625 00:22:37,939 --> 00:22:39,191 - In the elderly, yes, 626 00:22:39,274 --> 00:22:40,942 but not if a patient can manage the pain 627 00:22:41,026 --> 00:22:42,944 and doesn't need supplemental oxygen. 628 00:22:43,028 --> 00:22:44,196 - [groans] 629 00:22:44,279 --> 00:22:45,739 - OK, he's really hurting here. 630 00:22:45,781 --> 00:22:47,407 You think you could set us up with a serratus anterior 631 00:22:47,449 --> 00:22:48,617 field block? - No problem. 632 00:22:48,658 --> 00:22:50,744 - Oh, as long as that's OK 633 00:22:50,786 --> 00:22:51,912 with Dr. Al-Hashimi. 634 00:22:51,953 --> 00:22:54,039 - If the patient consents. 635 00:22:54,122 --> 00:22:57,918 - Mr. Varney, we wanna give you a shot to numb your broken ribs 636 00:22:57,959 --> 00:22:59,086 so you can breathe easier. 637 00:22:59,127 --> 00:23:00,295 - Uh-huh. 638 00:23:00,379 --> 00:23:01,963 - OK, get Mr. Varney prepped and draped. 639 00:23:02,047 --> 00:23:03,590 Dr. Mohan, you're in charge. 640 00:23:03,632 --> 00:23:05,425 - Let's identify the landmarks. 641 00:23:05,467 --> 00:23:06,593 - Cuffs. 642 00:23:07,928 --> 00:23:09,513 Yeah, you can just leave them off, man. 643 00:23:09,596 --> 00:23:12,474 He's clearly not moving on his own. 644 00:23:12,516 --> 00:23:14,017 - We follow protocol, 645 00:23:14,101 --> 00:23:17,437 for his safety and yours. 646 00:23:17,479 --> 00:23:19,147 [phone buzzing] 647 00:23:19,189 --> 00:23:20,816 - Do you need to get that? - [groaning] 648 00:23:20,857 --> 00:23:23,652 - Nope. It's my mom. 649 00:23:23,693 --> 00:23:25,862 Ignore it. Just ignore it. 650 00:23:25,946 --> 00:23:27,697 - Amen, sister. - Forearm is numb. 651 00:23:27,781 --> 00:23:28,990 We can irrigate. 652 00:23:29,074 --> 00:23:30,617 - If I ignore a problem for long enough, 653 00:23:30,659 --> 00:23:32,202 it just goes away, right? 654 00:23:32,285 --> 00:23:34,496 - I wish I could ignore my deposition. 655 00:23:34,538 --> 00:23:36,748 - That, you can't ignore. 656 00:23:36,832 --> 00:23:37,999 But you'll be fine. 657 00:23:38,041 --> 00:23:39,501 What's up with you, Whitaker? 658 00:23:39,584 --> 00:23:41,002 Trouble in roomie land? 659 00:23:41,086 --> 00:23:42,587 - No, not really. 660 00:23:42,671 --> 00:23:45,841 I think I overstepped with Dr. Langdon earlier. 661 00:23:45,924 --> 00:23:47,134 - Oh. 662 00:23:47,175 --> 00:23:49,761 - He was trying to prescribe a patient benzos, 663 00:23:49,845 --> 00:23:52,681 and I told Langdon that it'd be better if I did it. 664 00:23:52,722 --> 00:23:54,141 - Oof. 665 00:23:54,182 --> 00:23:56,518 - Only because I was already the assigned physician. 666 00:23:56,560 --> 00:23:58,353 But yeah, now I feel like an asshole. 667 00:23:58,395 --> 00:23:59,604 - Langdon's fine. 668 00:23:59,688 --> 00:24:01,982 He went to rehab, he's working the steps, 669 00:24:02,023 --> 00:24:06,528 and hopefully it's all behind him. 670 00:24:06,570 --> 00:24:08,196 Place the needle in-plane, 671 00:24:08,280 --> 00:24:10,073 superficial to the serratus anterior, 672 00:24:10,157 --> 00:24:12,367 between it and the latissimus dorsi. 673 00:24:12,409 --> 00:24:13,702 - Mm-hmm. 674 00:24:13,743 --> 00:24:15,871 - You can see the fluid dissect and diffuse-- 675 00:24:15,912 --> 00:24:17,205 - Dr. Mohan, we need you. 676 00:24:17,247 --> 00:24:18,832 We've got two more rigs from Westbridge 677 00:24:18,874 --> 00:24:21,042 pulling up right now. 678 00:24:21,084 --> 00:24:22,544 - Go. We got this. 679 00:24:22,586 --> 00:24:23,545 - Thanks. 680 00:24:23,587 --> 00:24:26,047 - How we doing in here? 681 00:24:26,089 --> 00:24:29,676 - Spiked a temp to 102, gave Tylenol. 682 00:24:29,718 --> 00:24:31,386 Check out her leg. 683 00:24:31,470 --> 00:24:33,346 - That is a definite bulla. 684 00:24:33,388 --> 00:24:34,764 Did surgery come down yet? 685 00:24:34,848 --> 00:24:36,558 - Not yet. - I need surgery? 686 00:24:36,600 --> 00:24:37,642 - Page them again. 687 00:24:37,726 --> 00:24:39,394 Surgery would be a last resort. 688 00:24:39,478 --> 00:24:41,730 We would like them to come down and check out your leg 689 00:24:41,813 --> 00:24:44,357 in case we need to remove this infected skin. 690 00:24:44,399 --> 00:24:45,859 - I thought it was just a little swelling 691 00:24:45,901 --> 00:24:46,902 'cause I'm on my feet all day. 692 00:24:46,943 --> 00:24:48,737 [monitor beeps] 693 00:24:48,820 --> 00:24:50,697 - BP's down to 85 over 40. 694 00:24:50,739 --> 00:24:52,365 - How much LR is in? - Full bolus. 695 00:24:52,407 --> 00:24:53,992 - Do another liter and then start Levophed. 696 00:24:54,075 --> 00:24:55,494 Titrate to a MAP of 65. 697 00:24:55,577 --> 00:24:56,745 [monitor beeps] 698 00:24:56,828 --> 00:24:58,330 - Can someone please tell me what's going on? 699 00:24:58,413 --> 00:24:59,414 - Pulse ox down to 89. 700 00:24:59,456 --> 00:25:00,916 - 100% non-rebreather. 701 00:25:00,957 --> 00:25:03,919 Sometimes an infection can cause your blood pressure 702 00:25:04,002 --> 00:25:06,880 to drop and lower the amount of oxygen in your blood. 703 00:25:06,922 --> 00:25:08,048 - Am I gonna be OK? 704 00:25:08,089 --> 00:25:09,257 - We're doing everything that we can 705 00:25:09,299 --> 00:25:10,550 to make sure that you are. 706 00:25:10,592 --> 00:25:11,843 Jesse. 707 00:25:14,221 --> 00:25:15,555 - What's up? 708 00:25:15,597 --> 00:25:16,890 - Be ready to intubate if you need to. 709 00:25:16,932 --> 00:25:18,391 - You want me to call Langdon? - No. 710 00:25:18,433 --> 00:25:19,935 I will be right back, and you can call surgery 711 00:25:20,018 --> 00:25:21,645 and tell them to get their heads out of their asses 712 00:25:21,728 --> 00:25:23,355 and get down here. 713 00:25:31,863 --> 00:25:33,240 Did you bring Langdon back here? 714 00:25:33,281 --> 00:25:34,950 - No, Al-Hashimi did. 715 00:25:35,033 --> 00:25:36,326 You banished him to scut purgatory. 716 00:25:36,409 --> 00:25:37,494 He did everything you would've done 717 00:25:37,577 --> 00:25:39,120 with that cellulitis patient. 718 00:25:39,204 --> 00:25:40,622 If you think he missed something, tell him. 719 00:25:40,705 --> 00:25:42,249 - Well, we're probably gonna need to intubate. 720 00:25:42,290 --> 00:25:43,792 We're definitely gonna need an ICU bed. 721 00:25:43,875 --> 00:25:45,085 - What happened? 722 00:25:45,126 --> 00:25:47,254 - She is in septic shock, on pressors. 723 00:25:47,295 --> 00:25:49,089 - Open shoulder dislocation is back. 724 00:25:49,130 --> 00:25:50,882 - Westbridge shut down all their ORs, so they told us 725 00:25:50,966 --> 00:25:52,717 to bring them back here. - You joking? 726 00:25:52,801 --> 00:25:53,718 This ain't the Radisson. 727 00:25:53,802 --> 00:25:54,928 - Not my problem. 728 00:25:54,970 --> 00:25:56,471 Where should we park him? - Grab a wall. 729 00:25:56,513 --> 00:25:57,889 - Call Noelle. Call ortho. 730 00:25:57,973 --> 00:25:59,140 Call the OR and tell them we got a patient back 731 00:25:59,224 --> 00:26:00,725 that needs surgery and admission. 732 00:26:00,809 --> 00:26:02,727 Hey, so sorry about this ambulance tour 733 00:26:02,811 --> 00:26:04,729 of Allegheny County, Mr. Billings, 734 00:26:04,813 --> 00:26:06,314 but we got you from here, I promise. 735 00:26:06,398 --> 00:26:07,732 - Yeah, I'm starving. 736 00:26:07,816 --> 00:26:09,234 Is there any way I can get something to eat? 737 00:26:09,317 --> 00:26:11,027 - Sorry, not before surgery. 738 00:26:11,111 --> 00:26:12,320 - Can I have a visitor? 739 00:26:12,362 --> 00:26:13,822 - Sure. 740 00:26:13,863 --> 00:26:15,615 Any word from Gloria about what's going on at Westbridge? 741 00:26:15,657 --> 00:26:17,200 - Radio silence from the ivory tower. 742 00:26:17,284 --> 00:26:18,868 And the charge nurse over there isn't responding. 743 00:26:18,952 --> 00:26:20,495 - Must be bad. 744 00:26:20,579 --> 00:26:21,871 I wonder if it's something that security needs to know about. 745 00:26:21,955 --> 00:26:23,373 - I'll keep you posted. 746 00:26:23,456 --> 00:26:25,166 - Hey, you're kind of buds with Gloria. 747 00:26:25,250 --> 00:26:26,501 Did she say anything to you about what's 748 00:26:26,543 --> 00:26:28,211 happening at Westbridge? - No. You? 749 00:26:28,295 --> 00:26:30,797 - Nope. How are your patients? 750 00:26:30,839 --> 00:26:33,174 - Our prisoner, Gus, has stable injuries, 751 00:26:33,258 --> 00:26:35,385 and our law student in Central 10 is awake, 752 00:26:35,468 --> 00:26:37,637 normal LP, and awaiting a psych consult. 753 00:26:37,679 --> 00:26:38,972 - Good. 754 00:26:39,014 --> 00:26:40,640 Quicker we can treat 'em, street 'em, move 'em 755 00:26:40,682 --> 00:26:42,100 up the food chain, the better. 756 00:26:42,183 --> 00:26:44,185 - Question. 757 00:26:44,227 --> 00:26:48,440 Why are you treating me like one of your residents? 758 00:26:48,523 --> 00:26:49,649 - I'm not. 759 00:26:49,691 --> 00:26:51,443 As the attending, I like to know the status 760 00:26:51,526 --> 00:26:53,194 of all the patients and doctors in the ED 761 00:26:53,236 --> 00:26:55,488 in case I need to jump in quickly. 762 00:26:55,530 --> 00:26:56,489 - Makes sense. 763 00:26:56,531 --> 00:26:58,867 Now your turn. 764 00:26:58,950 --> 00:27:00,201 - What? 765 00:27:00,285 --> 00:27:02,370 - As your fellow attending in our ED, 766 00:27:02,412 --> 00:27:04,164 it only makes sense for me to know the status 767 00:27:04,205 --> 00:27:06,207 of all the patients and all the doctors 768 00:27:06,291 --> 00:27:09,794 in case I need to jump in on a moment's notice. 769 00:27:09,878 --> 00:27:11,338 - Touché. 770 00:27:14,007 --> 00:27:16,551 - You have a non-displaced fracture, distal tibia. 771 00:27:16,635 --> 00:27:18,720 So if you look at the bone here, it's pretty well aligned. 772 00:27:18,803 --> 00:27:20,096 - Sorry. Hi. 773 00:27:20,180 --> 00:27:22,515 Hi, I was in the shower, and I came as soon 774 00:27:22,557 --> 00:27:23,600 as I got Paul's message. 775 00:27:23,683 --> 00:27:25,226 - Lena? - Hi. 776 00:27:25,310 --> 00:27:27,103 What happened? 777 00:27:27,187 --> 00:27:28,563 - I had a seizure. 778 00:27:28,647 --> 00:27:30,231 - You load her with Keppra? 779 00:27:30,273 --> 00:27:31,566 - Yeah. 780 00:27:31,650 --> 00:27:33,568 Yeah, she's back to baseline mental status. 781 00:27:33,652 --> 00:27:35,862 I'm sorry, I'm confused. Aren't you off duty? 782 00:27:35,904 --> 00:27:39,032 - I'm Roxie's death doula. - Oh. 783 00:27:39,074 --> 00:27:40,742 - Her--her what? 784 00:27:40,784 --> 00:27:42,744 - I help advocate for people like Roxie 785 00:27:42,786 --> 00:27:45,747 to make their transition to death a more peaceful process. 786 00:27:45,789 --> 00:27:48,750 It's like a birth doula but for the end of life. 787 00:27:48,792 --> 00:27:52,379 - She's been a real lifesaver for our family. 788 00:27:52,420 --> 00:27:55,215 - My husband cracking jokes while I'm dying. 789 00:27:55,256 --> 00:27:56,925 See why I married him? 790 00:27:57,008 --> 00:27:58,760 Whatever you have to say about my condition, 791 00:27:58,843 --> 00:28:00,720 you can share with Lena too. 792 00:28:00,762 --> 00:28:02,681 - We were just explaining that Roxie 793 00:28:02,764 --> 00:28:05,850 has a pathological fracture through a metastatic lesion. 794 00:28:05,934 --> 00:28:07,394 - Can you fix that? 795 00:28:07,435 --> 00:28:10,230 - The bones are well aligned, so she won't need surgery. 796 00:28:10,271 --> 00:28:11,690 - The treatment is immobilization 797 00:28:11,773 --> 00:28:12,857 and a long leg boot. 798 00:28:12,941 --> 00:28:14,609 - Oh! 799 00:28:14,651 --> 00:28:16,111 - Maybe we up her pain meds. 800 00:28:16,194 --> 00:28:17,654 - Yeah, sure. 801 00:28:17,737 --> 00:28:19,072 We can do that. 802 00:28:19,114 --> 00:28:21,324 - The bones should heal in about six weeks. 803 00:28:21,408 --> 00:28:23,993 - If I live that long. 804 00:28:25,870 --> 00:28:26,830 - Still numb here? 805 00:28:26,913 --> 00:28:28,456 - Yeah, bro. 806 00:28:28,498 --> 00:28:30,792 - Great. 807 00:28:30,834 --> 00:28:32,627 - You think it's gonna leave a scar? 808 00:28:32,711 --> 00:28:36,673 - I don't think it. I know it. 809 00:28:36,756 --> 00:28:38,466 - Holy shit. 810 00:28:38,550 --> 00:28:40,009 - Fuck are you doing here? 811 00:28:40,093 --> 00:28:41,010 - I'm sorry, who are you? 812 00:28:41,094 --> 00:28:42,137 - Concerned brother. 813 00:28:42,220 --> 00:28:44,639 - That looks not too bad. 814 00:28:44,723 --> 00:28:46,015 - You gooning me? 815 00:28:46,099 --> 00:28:47,642 - Yeah, it's nasty. 816 00:28:47,726 --> 00:28:49,102 - Thanks to you. 817 00:28:49,144 --> 00:28:50,228 - You did this? 818 00:28:50,311 --> 00:28:51,688 - Oh, yeah. You wanna see the video? 819 00:28:53,857 --> 00:28:55,775 - Yes. - Definitely. 820 00:28:55,817 --> 00:28:57,235 - Got you. 821 00:28:58,486 --> 00:29:00,905 All right. All right, get in close. 822 00:29:00,989 --> 00:29:02,574 - Brothers unite! 823 00:29:02,657 --> 00:29:04,284 - Ooh! - Ooh! 824 00:29:04,325 --> 00:29:06,119 Dude, why in the world 825 00:29:06,161 --> 00:29:07,746 would you ask to have that done to you? 826 00:29:07,829 --> 00:29:11,416 - He was trying to brand me with our family crest. 827 00:29:13,752 --> 00:29:15,920 - Your family crest is the Penguins logo? 828 00:29:16,004 --> 00:29:17,672 - We were gonna be bonded for life. 829 00:29:17,756 --> 00:29:19,507 - You already are, with DNA. 830 00:29:19,591 --> 00:29:20,675 - Yeah. 831 00:29:20,759 --> 00:29:22,218 - I love you, man. 832 00:29:22,302 --> 00:29:24,053 I'm real sorry. - It's OK. 833 00:29:24,137 --> 00:29:27,724 Doc said it's gonna take some time, but it'll heal OK. 834 00:29:27,807 --> 00:29:29,309 - Awesome. 835 00:29:29,350 --> 00:29:31,060 So maybe we can try again in a couple of months or-- 836 00:29:31,144 --> 00:29:32,604 both: No. 837 00:29:34,022 --> 00:29:35,732 - OK, bag her. 838 00:29:37,734 --> 00:29:39,152 - Yellow on the end-tidal. 839 00:29:39,194 --> 00:29:40,862 - Sorry, got backed up. - Sounds a little wet. 840 00:29:40,945 --> 00:29:42,030 - Someone asked for a surgical consult? 841 00:29:42,071 --> 00:29:43,239 - That's because all the fluid. 842 00:29:43,323 --> 00:29:44,699 TKO the lines for now. 843 00:29:44,741 --> 00:29:47,035 - Vent settings 50%, tidal volume 500, AC 12? 844 00:29:47,076 --> 00:29:48,369 - Yep, that's perfect. 845 00:29:48,453 --> 00:29:49,704 - Surgery here. Hello. 846 00:29:49,788 --> 00:29:51,331 - Hey, it's about time. Where's Garcia? 847 00:29:51,372 --> 00:29:53,166 - Stuck in the ER. She sent me down. What you got? 848 00:29:53,208 --> 00:29:54,626 - Septic shock, respiratory failure, 849 00:29:54,709 --> 00:29:56,294 and possible necrotizing fasciitis. 850 00:29:56,377 --> 00:29:58,046 She needs to go to the OR ASAP. 851 00:29:58,087 --> 00:30:00,298 The infection was isolated to the dorsum of the foot 852 00:30:00,381 --> 00:30:01,883 five hours ago, but now we're almost to the knee 853 00:30:01,966 --> 00:30:03,551 with bullae, crepitus, and edema. 854 00:30:03,635 --> 00:30:05,220 - Yeah. - You seen nec fasc before? 855 00:30:05,303 --> 00:30:06,471 - In a textbook. 856 00:30:06,554 --> 00:30:08,681 I was a med student two weeks ago. 857 00:30:08,723 --> 00:30:10,475 [camera shutter snapping] 858 00:30:10,558 --> 00:30:13,061 Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 859 00:30:13,102 --> 00:30:14,729 Go get anybody else from your service down here-- 860 00:30:14,771 --> 00:30:16,022 Shamsi, Miller, Walsh-- 861 00:30:16,064 --> 00:30:17,148 - I don't know any of this people, but-- 862 00:30:17,232 --> 00:30:18,525 - Don't take this personally. 863 00:30:18,566 --> 00:30:21,569 I just need a fucking grown-up down here. 864 00:30:21,611 --> 00:30:23,530 - Nice job on the sub-Qs. 865 00:30:23,571 --> 00:30:25,240 Really took the tension off the wound. 866 00:30:25,323 --> 00:30:26,366 - Thanks. 867 00:30:26,407 --> 00:30:28,034 - I can help with the skin layer. 868 00:30:28,076 --> 00:30:30,078 Four hands are faster than two. 869 00:30:32,497 --> 00:30:33,873 - Whoa. - Whoa. 870 00:30:33,915 --> 00:30:36,209 - That just tore right through the skin. 871 00:30:36,251 --> 00:30:37,544 - You may need to take bigger bites 872 00:30:37,585 --> 00:30:39,254 farther away from the wound edges. 873 00:30:39,295 --> 00:30:41,589 - Yep. 874 00:30:41,631 --> 00:30:44,968 Skin seems pretty fragile. 875 00:30:49,055 --> 00:30:50,431 - Oh. 876 00:30:50,515 --> 00:30:52,100 - Yeah, this is not working. 877 00:30:52,183 --> 00:30:54,102 - He has the skin strength of an 80-year-old. 878 00:30:54,143 --> 00:30:56,271 - Put down Steri-Strips with benzoin, 879 00:30:56,312 --> 00:30:59,566 not across the wound but along each wound edge, both sides. 880 00:30:59,607 --> 00:31:01,109 It'll hold the sutures. 881 00:31:01,150 --> 00:31:04,571 - Yup. - What say you, Dr. Robby? 882 00:31:04,612 --> 00:31:06,531 - Great. MacGyver move. 883 00:31:06,614 --> 00:31:09,450 Go for it. 884 00:31:09,492 --> 00:31:13,204 - Does a Dr. MacGyver work here? 885 00:31:13,288 --> 00:31:15,707 - I don't know. 886 00:31:15,790 --> 00:31:17,625 - The patient symptoms are consistent with lumbar 887 00:31:17,709 --> 00:31:21,629 radiculopathy at L4, L5, most likely due to disc herniation. 888 00:31:21,671 --> 00:31:23,131 - Coughing patient admitted to isolation 889 00:31:23,172 --> 00:31:25,091 for verified medication administration 890 00:31:25,133 --> 00:31:26,467 and started on RIPE therapy. 891 00:31:26,509 --> 00:31:27,969 - Yeah, why do I even bother? 892 00:31:28,052 --> 00:31:29,012 Just fail me now. 893 00:31:29,095 --> 00:31:30,179 OK. 894 00:31:30,263 --> 00:31:31,681 Get in touch with a social worker. 895 00:31:31,764 --> 00:31:33,182 They're gonna wanna do contact tracing 896 00:31:33,266 --> 00:31:35,018 and help her figure out transitional housing 897 00:31:35,101 --> 00:31:36,436 for when she's discharged. 898 00:31:36,477 --> 00:31:37,770 - Got it. 899 00:31:37,812 --> 00:31:39,689 - And make sure infection control responded. 900 00:31:39,772 --> 00:31:41,149 The people in the waiting room could have been exposed. 901 00:31:41,232 --> 00:31:44,485 They need to be notified and tested. 902 00:31:44,569 --> 00:31:45,778 - OK. 903 00:31:45,820 --> 00:31:48,656 [coughs] - Relax. 904 00:31:48,740 --> 00:31:50,950 You can take the mask off. You don't have TB. 905 00:31:50,992 --> 00:31:54,078 At least not yet. 906 00:31:54,162 --> 00:31:56,664 - Oh, great. 907 00:31:56,706 --> 00:31:59,584 This is fucked up. 908 00:31:59,667 --> 00:32:01,836 How are you so calm? 909 00:32:01,920 --> 00:32:03,504 - Expected job hazard. 910 00:32:03,588 --> 00:32:04,797 You get used to it. 911 00:32:04,839 --> 00:32:06,341 - Yeah, no, thanks. 912 00:32:06,424 --> 00:32:08,968 - 70% of doctors in training at urban hospitals 913 00:32:09,010 --> 00:32:11,304 get exposed to TB and wind up on meds. 914 00:32:11,346 --> 00:32:13,640 - Jesus. - Mm-hmm. 915 00:32:13,681 --> 00:32:16,017 - They don't teach you that in med school. 916 00:32:16,059 --> 00:32:18,186 - Mrs. Randolph's back. 917 00:32:18,227 --> 00:32:20,021 Pulled up her X-ray. 918 00:32:20,104 --> 00:32:21,189 - OK. 919 00:32:21,272 --> 00:32:23,358 No volvulus, no air fluid levels. 920 00:32:23,399 --> 00:32:25,902 - What do you think of this? 921 00:32:25,985 --> 00:32:28,029 - Fecal material? 922 00:32:28,071 --> 00:32:29,697 - A shit ton. 923 00:32:29,781 --> 00:32:31,366 - Sorry, had to be said. 924 00:32:31,407 --> 00:32:32,909 - So, what, she needs an enema? 925 00:32:32,992 --> 00:32:34,535 - No. Tried and failed, remember? 926 00:32:34,577 --> 00:32:35,536 - Yeah. 927 00:32:35,578 --> 00:32:37,205 - Time to dig in. 928 00:32:37,246 --> 00:32:38,831 - How are we gonna do that? 929 00:32:38,873 --> 00:32:42,835 - Oh, there is no "we" in disimpaction. 930 00:32:47,757 --> 00:32:49,926 - I haven't done one before. 931 00:32:50,009 --> 00:32:52,887 Shouldn't I observe first? 932 00:32:52,971 --> 00:32:55,556 - I know just the guy to teach you. 933 00:33:04,774 --> 00:33:07,568 - I spoke to the charge nurse in med-surg. 934 00:33:07,610 --> 00:33:08,861 They can take Orlando today. 935 00:33:08,903 --> 00:33:10,655 - Yes! - That's wonderful. 936 00:33:10,738 --> 00:33:12,240 - They know he's on an insulin drip? 937 00:33:12,281 --> 00:33:14,742 - They know, and they can change to a SQUID protocol. 938 00:33:14,826 --> 00:33:15,743 - SQUID? 939 00:33:15,827 --> 00:33:17,537 - Sub-Q insulin in DKA. 940 00:33:17,578 --> 00:33:19,247 - So no IV drip? 941 00:33:19,288 --> 00:33:22,041 - Just shots of short-acting insulin every four hours prn. 942 00:33:22,083 --> 00:33:25,420 - The med-surg nurses have time to check a glucose every hour? 943 00:33:25,503 --> 00:33:26,421 - They say so. 944 00:33:26,504 --> 00:33:28,464 And five days on med-surge 945 00:33:28,548 --> 00:33:32,260 is gonna cut your hospital bill down by 2/3. 946 00:33:32,301 --> 00:33:34,095 - OK. 947 00:33:34,178 --> 00:33:35,972 So what's that gonna cost? 948 00:33:36,055 --> 00:33:37,432 - Well, I can't give you an exact amount, 949 00:33:37,473 --> 00:33:39,475 but roughly $35,000. 950 00:33:39,559 --> 00:33:42,603 - So after about 40%, I'll still have to pay, 951 00:33:42,687 --> 00:33:44,439 what, like, 20 grand? 952 00:33:44,522 --> 00:33:46,733 - The hospital can work out a payment plan. 953 00:33:46,774 --> 00:33:48,443 - Orlando, we'll be OK. 954 00:33:48,484 --> 00:33:49,944 We'll figure it out. 955 00:33:50,028 --> 00:33:52,447 - I'll take on extra shifts at the coffee shop. 956 00:33:52,488 --> 00:33:55,450 We got you, Dad. 957 00:33:55,491 --> 00:33:58,619 - Let's give you some private time with your family. 958 00:33:58,703 --> 00:34:01,122 - Thanks. 959 00:34:01,205 --> 00:34:02,790 - Sorry. Thank you. 960 00:34:02,832 --> 00:34:04,375 I was worried he might bail. 961 00:34:04,459 --> 00:34:05,626 - My pleasure. 962 00:34:05,668 --> 00:34:07,295 The real thanks goes to the newbie here 963 00:34:07,378 --> 00:34:09,088 for thinking outside the box. 964 00:34:11,799 --> 00:34:13,634 - Sorry I doubted your med-surg pitch. 965 00:34:13,717 --> 00:34:15,261 - Oh, no sweat. 966 00:34:15,303 --> 00:34:17,472 - How'd you think of that? 967 00:34:17,513 --> 00:34:20,141 - My family had to think of a lot of creative ways 968 00:34:20,183 --> 00:34:23,143 to help my uninsured grandma. 969 00:34:23,226 --> 00:34:24,728 Leukemia. 970 00:34:24,812 --> 00:34:28,065 System doesn't work for you, you gotta work the system. 971 00:34:28,149 --> 00:34:30,318 - She survive? 972 00:34:30,359 --> 00:34:32,487 - For a while, till she didn't. 973 00:34:32,570 --> 00:34:34,989 She died before my freshman year in college. 974 00:34:35,031 --> 00:34:37,324 - Sorry. 975 00:34:37,366 --> 00:34:39,494 - Her death taught me a lot. 976 00:34:39,534 --> 00:34:42,455 Mainly that I don't wanna be around people dying. 977 00:34:44,290 --> 00:34:46,876 - So they got her, and we can get out of here soon? 978 00:34:46,958 --> 00:34:48,335 - Yeah. Oh, I think so. 979 00:34:48,418 --> 00:34:49,795 I think so, yeah. - OK. 980 00:34:49,837 --> 00:34:53,007 - Hi. 981 00:34:53,091 --> 00:34:55,635 Morphine PCA looks ready to go. 982 00:34:55,676 --> 00:34:57,637 This should do the trick. 983 00:34:57,678 --> 00:34:59,013 Do you notice a difference? 984 00:34:59,097 --> 00:35:00,014 - Better. 985 00:35:00,098 --> 00:35:02,517 - Oh, great. Great. 986 00:35:02,600 --> 00:35:04,310 - How does this thing work? 987 00:35:04,352 --> 00:35:06,687 - There's a baseline rate of morphine. 988 00:35:06,771 --> 00:35:08,773 And if you're having pain, you can push this button. 989 00:35:08,856 --> 00:35:09,774 You'll get some extra. 990 00:35:09,857 --> 00:35:11,109 And you can push for another dose 991 00:35:11,192 --> 00:35:12,527 every 10 minutes if needed. 992 00:35:12,610 --> 00:35:14,821 - Your very own morphine butler. 993 00:35:17,365 --> 00:35:18,491 - Amazing. 994 00:35:18,533 --> 00:35:20,034 - She can go home with this? 995 00:35:20,076 --> 00:35:21,536 - Yeah. 996 00:35:21,619 --> 00:35:23,704 Though you'll need more equipment for the house 997 00:35:23,746 --> 00:35:25,873 now that she can't bear weight on her leg. 998 00:35:25,957 --> 00:35:27,834 - OK. Like what? 999 00:35:27,875 --> 00:35:32,004 - A wheelchair to go to the bathroom, a shower chair, 1000 00:35:32,046 --> 00:35:34,215 wall bars, if you don't already have them. 1001 00:35:34,257 --> 00:35:37,343 And a hospital bed could be helpful too. 1002 00:35:37,385 --> 00:35:38,678 - How do we get all that? 1003 00:35:38,719 --> 00:35:40,555 - You don't. I do. 1004 00:35:40,596 --> 00:35:42,390 I will get everything so that the two of you 1005 00:35:42,473 --> 00:35:44,600 can get out of here and back to the kids. 1006 00:35:44,684 --> 00:35:46,811 At home. - Thank you. 1007 00:35:53,860 --> 00:35:55,736 - Nice of you to join us, Huckleberry. 1008 00:35:55,820 --> 00:35:57,071 - What do you need? 1009 00:35:57,113 --> 00:35:58,906 - Some help with a disimpaction. 1010 00:36:00,741 --> 00:36:02,743 - That is a med student procedure. 1011 00:36:02,785 --> 00:36:04,162 - Oh, you know the old adage-- 1012 00:36:04,245 --> 00:36:06,414 see one, do one, teach one. 1013 00:36:06,455 --> 00:36:08,666 Say hello to teaching young Ogilvie here. 1014 00:36:08,749 --> 00:36:11,335 - [sighs] OK. 1015 00:36:11,419 --> 00:36:13,421 Double glove, Ogilvie. - All right. 1016 00:36:13,504 --> 00:36:14,922 Mrs. Randolph, we're going to need 1017 00:36:15,006 --> 00:36:17,592 to manually unblock your rectum so that we can 1018 00:36:17,633 --> 00:36:19,093 get your bowels moving again. 1019 00:36:19,135 --> 00:36:20,094 - I know. 1020 00:36:20,136 --> 00:36:22,847 - Here we go. 1021 00:36:22,930 --> 00:36:25,933 Mrs. Randolph, I would like you to relax 1022 00:36:26,017 --> 00:36:28,895 like you're having a bowel movement. 1023 00:36:28,936 --> 00:36:31,439 Nice and deep. 1024 00:36:31,522 --> 00:36:33,774 [clears throat] OK. 1025 00:36:33,816 --> 00:36:37,945 Curve the finger like an ice cream scoop. 1026 00:36:38,029 --> 00:36:42,617 And bring it out. 1027 00:36:42,658 --> 00:36:44,452 You're up, Ogilvie. 1028 00:36:48,706 --> 00:36:50,833 - Some more pressure, Mrs. Randolph. 1029 00:36:50,917 --> 00:36:52,418 - I'm ready. 1030 00:36:56,547 --> 00:36:59,091 [inhales sharply] 1031 00:36:59,133 --> 00:37:03,179 - And here I thought you weren't a quick study. 1032 00:37:03,262 --> 00:37:05,139 Keep going. 1033 00:37:05,181 --> 00:37:07,308 Mrs. Randolph, in order to prevent this 1034 00:37:07,391 --> 00:37:08,768 from happening again, I think you 1035 00:37:08,809 --> 00:37:10,311 need a better stool softener. 1036 00:37:10,394 --> 00:37:11,896 You can try MiraLAX. 1037 00:37:11,979 --> 00:37:14,440 Just a tablespoon with a big glass of water every morning 1038 00:37:14,482 --> 00:37:15,441 should do the trick. 1039 00:37:15,483 --> 00:37:16,651 - OK. 1040 00:37:16,692 --> 00:37:18,069 [flatulence] 1041 00:37:18,903 --> 00:37:19,820 Oh. 1042 00:37:19,904 --> 00:37:21,447 Sorry. 1043 00:37:21,489 --> 00:37:22,615 - Passing gas is good. 1044 00:37:22,657 --> 00:37:24,325 Means we're making progress. 1045 00:37:24,367 --> 00:37:25,993 - Does that mean that I can-- I can stop? 1046 00:37:26,077 --> 00:37:27,870 - No. Nope. Keep going. 1047 00:37:30,164 --> 00:37:32,833 [stomach rumbling] 1048 00:37:32,875 --> 00:37:36,045 - OK, Ogilvie, you-- you might wanna-- 1049 00:37:36,128 --> 00:37:37,880 - Oh! 1050 00:37:38,839 --> 00:37:41,676 [sighs] 1051 00:37:41,717 --> 00:37:43,261 Much better. 1052 00:37:44,262 --> 00:37:46,180 - MAP's holding on Levophed. 1053 00:37:46,264 --> 00:37:48,182 1 mike per kg per minute. 1054 00:37:48,224 --> 00:37:49,350 - Do me a favor. 1055 00:37:49,433 --> 00:37:50,559 Give me some 4x4s on some Betadine. 1056 00:37:50,643 --> 00:37:51,852 - Sorry, we're getting killed 1057 00:37:51,936 --> 00:37:53,312 with transfers from Westbridge. 1058 00:37:53,354 --> 00:37:55,481 Mesenteric ischemia, perforated bowel. 1059 00:37:55,523 --> 00:37:56,482 - Got a hot one here. 1060 00:37:56,524 --> 00:37:57,483 - Yeah. 1061 00:37:57,525 --> 00:37:58,567 Possible nec fasc. 1062 00:37:58,651 --> 00:37:59,986 - Possible? 1063 00:38:00,027 --> 00:38:01,362 - Need CT with contrast to confirm. 1064 00:38:01,404 --> 00:38:03,030 - This is spreading like wildfire. 1065 00:38:03,114 --> 00:38:04,407 By the time you get your CT, it's gonna be up to her waist. 1066 00:38:04,490 --> 00:38:05,533 She's gonna need a hemicorporectomy. 1067 00:38:05,574 --> 00:38:06,867 - She needs a CT scan. 1068 00:38:06,909 --> 00:38:09,537 - How about a stainless steel scan? 1069 00:38:09,578 --> 00:38:11,706 - For Christ's sake. Robinavitch! 1070 00:38:11,789 --> 00:38:15,209 Robby, what the fuck are you doing? 1071 00:38:15,251 --> 00:38:16,877 - Oh, God, I think I might puke. 1072 00:38:16,961 --> 00:38:19,380 - That's called dirty dishwater exudate without purulence. 1073 00:38:19,422 --> 00:38:21,549 There's a gray appearance to the fascia, and in the OR, 1074 00:38:21,632 --> 00:38:23,801 you'll see easy separation in the tissue planes. 1075 00:38:23,884 --> 00:38:25,136 - When do you start your sabbatical? 1076 00:38:25,219 --> 00:38:26,887 - Tomorrow. - Not a moment too soon. 1077 00:38:26,929 --> 00:38:28,889 - Thanks for coming down. 1078 00:38:32,059 --> 00:38:35,563 - I'm catching up on my charting as fast as I can. 1079 00:38:35,646 --> 00:38:38,441 - Why don't you give my generative AI app a try? 1080 00:38:38,524 --> 00:38:40,943 It's 30% more efficient, and providers report 1081 00:38:41,027 --> 00:38:42,862 increased job satisfaction. 1082 00:38:42,903 --> 00:38:45,865 And you'll rarely have to stay overtime to complete charts. 1083 00:38:45,906 --> 00:38:47,575 - Yeah? 1084 00:38:47,658 --> 00:38:48,909 OK. 1085 00:38:48,951 --> 00:38:50,453 Yeah, I'm usually here at least a couple hours 1086 00:38:50,536 --> 00:38:52,371 after every shift trying to catch up, so... 1087 00:38:52,413 --> 00:38:54,749 - Sure, AI will make doctors more efficient, 1088 00:38:54,832 --> 00:38:57,084 but hospitals will expect us to treat more patients 1089 00:38:57,126 --> 00:38:59,086 without any extra pay, of course, 1090 00:38:59,128 --> 00:39:00,880 all the while eliminating staff positions 1091 00:39:00,921 --> 00:39:02,590 for attending and residents. 1092 00:39:02,631 --> 00:39:04,133 - Oh, Dr. Robby, I am not an advocate 1093 00:39:04,216 --> 00:39:06,260 for erasing my own profession. 1094 00:39:06,344 --> 00:39:09,764 But I am advocating for getting to spend more time with my son. 1095 00:39:09,847 --> 00:39:12,767 Nothing can replace family. 1096 00:39:12,808 --> 00:39:14,769 What's the status of your septic patient? 1097 00:39:14,810 --> 00:39:17,563 - Nec fasc. Surgery's taking her up. 1098 00:39:17,605 --> 00:39:20,107 - Think they'll be able to save her leg? 1099 00:39:20,149 --> 00:39:22,068 - Right now, I'm just hoping they can save her life. 1100 00:39:22,109 --> 00:39:24,612 Hey, how's Ogilvie doing? 1101 00:39:24,695 --> 00:39:28,449 - A little TB exposure, a touch of ass-plosion. 1102 00:39:28,532 --> 00:39:30,618 All in all, pretty good day so far. 1103 00:39:30,659 --> 00:39:31,911 - Kaison, you came. 1104 00:39:31,952 --> 00:39:33,454 - Hey, ain't no way I was gonna let you 1105 00:39:33,496 --> 00:39:35,373 miss Peter and Aubrey's epic Fourth of July party. 1106 00:39:35,456 --> 00:39:37,583 Come on, now. Hey. 1107 00:39:37,625 --> 00:39:39,251 Brought some brew. 1108 00:39:39,293 --> 00:39:40,628 - Oh, you are the man. 1109 00:39:40,669 --> 00:39:42,088 - Appreciate the bromance over here, 1110 00:39:42,129 --> 00:39:44,423 but no food 'cause you might go into surgery. 1111 00:39:44,465 --> 00:39:47,093 And no beer 'cause we're a goddamn hospital. 1112 00:39:50,679 --> 00:39:52,807 - Starting your sabbatical early? 1113 00:39:52,890 --> 00:39:54,642 - I know someone who could really use a drink right now. 1114 00:39:54,725 --> 00:39:55,976 - In the hospital? 1115 00:39:56,018 --> 00:39:58,479 - As a parting gift. 1116 00:40:02,483 --> 00:40:04,026 - How's it looking? 1117 00:40:04,110 --> 00:40:05,319 - Good. 1118 00:40:05,361 --> 00:40:07,279 The Steri-Strips did the trick. 1119 00:40:07,321 --> 00:40:08,364 - CT's ready. 1120 00:40:08,447 --> 00:40:09,990 - We already scanned him. 1121 00:40:10,074 --> 00:40:12,410 - Head and neck want thin cuts and a 3D reconstruction 1122 00:40:12,493 --> 00:40:14,412 of the mandible before they decide 1123 00:40:14,495 --> 00:40:15,830 if Mr. Varney needs surgery. 1124 00:40:15,913 --> 00:40:17,790 - Have they even come down to examine him in person? 1125 00:40:17,832 --> 00:40:19,333 - No, they must be backed up. 1126 00:40:19,417 --> 00:40:23,170 - Or there's a July Fourth sale at the BMW dealership. 1127 00:40:23,212 --> 00:40:24,463 - Labs are back. 1128 00:40:24,505 --> 00:40:26,298 Albumin's low. Total protein's low. 1129 00:40:26,340 --> 00:40:27,842 He also has megaloblastic anemia. 1130 00:40:27,925 --> 00:40:29,135 - Malnutrition. - Probably. 1131 00:40:29,176 --> 00:40:30,302 Jail cuisine. 1132 00:40:30,344 --> 00:40:31,679 Whitaker, what labs should we add? 1133 00:40:31,720 --> 00:40:33,806 - B12, folate, iron levels. 1134 00:40:33,848 --> 00:40:35,307 - Good. 1135 00:40:35,349 --> 00:40:36,934 We're gonna run some more tests, Mr. Varney. 1136 00:40:37,017 --> 00:40:38,352 Hang in there. 1137 00:40:42,940 --> 00:40:45,359 - I have to pee. 1138 00:40:45,443 --> 00:40:46,861 - There's no PureWick here. 1139 00:40:46,902 --> 00:40:48,070 But here you go, hon. 1140 00:40:48,154 --> 00:40:50,030 I'll help you get on. - No. No. 1141 00:40:50,114 --> 00:40:52,491 No bedpan. I can walk to the bathroom. 1142 00:40:52,533 --> 00:40:54,160 I just need a little help. - Are you sure? 1143 00:40:54,201 --> 00:40:55,202 - I'm here, babe. 1144 00:40:55,286 --> 00:40:56,704 - Oh, we got this Mr. Hamler. 1145 00:40:56,787 --> 00:40:59,999 - You'll have to bring your IV and portable oxygen. 1146 00:41:00,040 --> 00:41:02,001 - Please? 1147 00:41:02,042 --> 00:41:04,378 - I'll grab a wheelchair. 1148 00:41:04,462 --> 00:41:06,380 - Let's try to sit you up and dangle your legs. 1149 00:41:06,422 --> 00:41:07,923 - OK. 1150 00:41:10,593 --> 00:41:13,971 1, 2, 3. 1151 00:41:16,724 --> 00:41:19,560 - [gasps, yelps] 1152 00:41:19,643 --> 00:41:21,312 - This is not a good idea. 1153 00:41:21,395 --> 00:41:23,397 - I don't think we're gonna need this. 1154 00:41:23,481 --> 00:41:25,065 Hey, Paul, Paul, 1155 00:41:25,107 --> 00:41:27,234 why don't you come grab a cup of coffee with me? 1156 00:41:27,276 --> 00:41:29,195 I'm still zonked from my all-nighter, 1157 00:41:29,236 --> 00:41:32,865 and I wanna go over some delivery instructions with you. 1158 00:41:32,907 --> 00:41:35,534 - Sure. 1159 00:41:35,576 --> 00:41:37,411 Rox, you OK? 1160 00:41:37,453 --> 00:41:40,331 - Mm-hmm. - Yeah. It's OK. 1161 00:41:47,004 --> 00:41:49,006 - Bedpan it is. 1162 00:41:50,508 --> 00:41:53,802 [alarm beeping] 1163 00:41:56,972 --> 00:41:58,766 - You lose your pulse ox again, bud? 1164 00:41:58,849 --> 00:42:02,019 [sustained beep] 1165 00:42:04,396 --> 00:42:05,773 Louie. 1166 00:42:05,814 --> 00:42:07,608 Louie! 1167 00:42:07,691 --> 00:42:10,236 He kept pulling off his pulse ox. 1168 00:42:10,277 --> 00:42:11,612 - It's on. It's at 71. 1169 00:42:11,695 --> 00:42:13,155 - Louie, wake up. 1170 00:42:14,740 --> 00:42:16,450 - I'm not getting a carotid. - I got the airway. 1171 00:42:16,534 --> 00:42:19,620 - Hey, Perlah, crash cart, intubation tray, please. 1172 00:42:19,703 --> 00:42:22,790 [sustained beep] 1173 00:42:22,873 --> 00:42:25,793 [dramatic music] 1174 00:42:25,876 --> 00:42:32,800 ♪ ♪