1 00:00:15,641 --> 00:00:17,059 - You know this guy? - Orlando Diaz. 2 00:00:17,142 --> 00:00:18,810 We were treating him for DKA when he eloped. 3 00:00:18,894 --> 00:00:20,395 - How far did he fall? - 20 feet or so. 4 00:00:20,479 --> 00:00:22,231 - Anyone see him pass out? - No. 5 00:00:22,314 --> 00:00:24,358 They went looking for him after he didn't answer his radio. 6 00:00:24,441 --> 00:00:25,567 Pupils equal but sluggish. 7 00:00:25,651 --> 00:00:26,944 He left against medical advice. 8 00:00:27,027 --> 00:00:29,655 On my count, three, two, one. 9 00:00:30,906 --> 00:00:33,116 Dr. Ellis on the case. Day shift, we got this. 10 00:00:33,200 --> 00:00:35,494 - I'm staying. - Continuity of care. 11 00:00:35,577 --> 00:00:36,870 Dr. Al-Hashimi, why don't you go cover 12 00:00:36,954 --> 00:00:38,163 sign-out rounds with Dr. Abbot? 13 00:00:38,247 --> 00:00:39,498 - Shen, you too. - Got it. 14 00:00:39,581 --> 00:00:41,583 OK, let me know if you need anything. 15 00:00:41,667 --> 00:00:44,169 - Lungs are up bilaterally. - Pelvis is stable. 16 00:00:44,253 --> 00:00:48,048 Right tib-fib hematoma, deformed right forearm. 17 00:00:48,131 --> 00:00:50,050 Ruptured TM on the left with sero-sanguinous fluid. 18 00:00:50,133 --> 00:00:51,843 That means basilar skull fracture. 19 00:00:51,927 --> 00:00:53,637 We've got a diabetic patient, 20-foot fall. 20 00:00:53,720 --> 00:00:55,973 BP 204 over 98, pulse 56. 21 00:00:56,056 --> 00:00:57,641 Dr. Mohan, what do those numbers indicate? 22 00:00:57,724 --> 00:00:59,434 I'm trying to treat the patient. 23 00:00:59,518 --> 00:01:00,727 It's the Cushing's reflex. 24 00:01:00,811 --> 00:01:02,854 From increased intracranial pressure. 25 00:01:02,938 --> 00:01:05,190 Yeah, we need to get him to CT right away. 26 00:01:05,274 --> 00:01:06,858 No free fluid in the belly. 27 00:01:06,942 --> 00:01:10,195 - Any family to notify? - Wife and three kids. 28 00:01:10,279 --> 00:01:12,281 Is there a card to sign for Robby? 29 00:01:12,364 --> 00:01:14,324 No, he said no card, no presents. 30 00:01:14,408 --> 00:01:15,742 Oh. Was there a cake? 31 00:01:15,826 --> 00:01:17,327 Oh, he didn't want that either. 32 00:01:17,411 --> 00:01:19,288 That sucks. I need some cake. 33 00:01:19,371 --> 00:01:21,498 Patient was injured when they raided a restaurant. 34 00:01:21,582 --> 00:01:23,292 And they actually arrested the nurse? 35 00:01:23,375 --> 00:01:25,836 - With a takedown and zip ties. - Damn. 36 00:01:25,919 --> 00:01:27,963 Crus, you, uh, know the computer downtime drill? 37 00:01:28,045 --> 00:01:29,423 Yeah, no biggie. 38 00:01:29,506 --> 00:01:31,091 I prefer to treat 'em without labs and X-rays. 39 00:01:31,174 --> 00:01:32,593 Welcome back. 40 00:01:32,676 --> 00:01:34,469 If you do have orders for labs and X-rays, 41 00:01:34,553 --> 00:01:36,555 clipboards go here. 42 00:01:36,638 --> 00:01:39,308 If it's just nursing orders, here. 43 00:01:39,390 --> 00:01:41,101 Please write neatly, for God's sake. 44 00:01:41,184 --> 00:01:43,645 Oh, Monica, this is Nazely, new intern. 45 00:01:43,729 --> 00:01:46,523 - I don't need to know that. - So nice to meet you. 46 00:01:47,691 --> 00:01:49,318 Looks like you and me, Jack. 47 00:01:49,401 --> 00:01:50,777 Yeah, who's our senior? 48 00:01:50,860 --> 00:01:53,905 - Dr. Henderson. - Excellent. 49 00:01:53,989 --> 00:01:55,782 Night shift's on Crus control. 50 00:01:55,866 --> 00:01:57,908 You hear ICE brought us a patient? 51 00:01:57,993 --> 00:01:59,703 Oh, yeah? How'd that go? 52 00:01:59,786 --> 00:02:00,829 There was some collateral damage. 53 00:02:00,912 --> 00:02:02,331 They arrested Jesse. 54 00:02:02,414 --> 00:02:04,333 - For what? - Assaulting a federal officer. 55 00:02:04,416 --> 00:02:05,876 Are you fucking kidding me? 56 00:02:05,959 --> 00:02:07,252 Oh, Dr. Al-Hashimi, 57 00:02:07,336 --> 00:02:09,545 this is Nazely Toomarian-- new intern. 58 00:02:16,345 --> 00:02:18,180 OK, everybody, let's huddle up. 59 00:02:18,263 --> 00:02:19,514 Before we start, 60 00:02:19,598 --> 00:02:21,141 let me address the elephant in the room. 61 00:02:21,224 --> 00:02:22,934 For those of you who don't know, 62 00:02:23,018 --> 00:02:24,394 Jesse tried to intervene 63 00:02:24,478 --> 00:02:26,188 when a federal agent was handling his patient, 64 00:02:26,271 --> 00:02:28,565 and both he and the patient were taken away by ICE. 65 00:02:28,649 --> 00:02:30,233 - Did he punch the guy? - No. 66 00:02:30,317 --> 00:02:32,653 He put out a hand to stop him, made physical contact. 67 00:02:32,736 --> 00:02:34,237 It was a little bit more than that. 68 00:02:34,321 --> 00:02:35,822 The hospital lawyers are on the case, 69 00:02:35,906 --> 00:02:38,158 and we will brief the staff every 12 hours 70 00:02:38,241 --> 00:02:39,910 at sign-out rounds with an official update. 71 00:02:39,993 --> 00:02:42,412 In the meantime, don't feed the rumor mill. 72 00:02:42,496 --> 00:02:44,748 You may have also heard that new grad nurse Emma here 73 00:02:44,831 --> 00:02:47,250 - was assaulted by a patient. - I--I'm fine. 74 00:02:47,334 --> 00:02:48,877 Please don't forget "code hula hoop," 75 00:02:48,960 --> 00:02:50,212 and with risky patients, 76 00:02:50,295 --> 00:02:52,547 always keep a path to the door clear. 77 00:02:52,631 --> 00:02:54,216 Sounds like one hell of a day. 78 00:02:54,299 --> 00:02:56,051 And we're still dealing with downtime, 79 00:02:56,134 --> 00:02:58,220 so day shift should brief night residents 80 00:02:58,303 --> 00:02:59,554 about the protocol-- 81 00:02:59,638 --> 00:03:00,514 Hey! 82 00:03:00,597 --> 00:03:02,182 Oh, all right! 83 00:03:02,265 --> 00:03:04,393 Oh, thank God. 84 00:03:04,476 --> 00:03:05,769 Yeah, not so fast. 85 00:03:05,852 --> 00:03:07,646 Every chart from the last five hours 86 00:03:07,729 --> 00:03:09,981 needs to be scanned into the Electronic Health Record 87 00:03:10,065 --> 00:03:12,025 and checked for accuracy... 88 00:03:12,109 --> 00:03:14,194 - Um, whose job is that? - Day shift. 89 00:03:14,277 --> 00:03:16,154 With a completed and signed T-sheet. 90 00:03:16,238 --> 00:03:17,864 - Are you kidding me? - That's gonna take forever. 91 00:03:17,948 --> 00:03:19,616 We will set up stations for scanning. 92 00:03:19,700 --> 00:03:21,410 OK, everybody, let's get moving. 93 00:03:21,493 --> 00:03:23,578 Triage is 20 behind. Gotta help 'em clean up. 94 00:03:23,662 --> 00:03:24,829 I'm skipping rounds. 95 00:03:24,913 --> 00:03:26,665 Consider yourself lucky. 96 00:03:26,748 --> 00:03:27,916 Should we join them? 97 00:03:29,334 --> 00:03:30,961 Might as well witness the magic. 98 00:03:31,044 --> 00:03:33,213 It's like changing of the guard at Buckingham Palace. 99 00:03:33,296 --> 00:03:35,090 Except we're allowed to smile. 100 00:03:35,173 --> 00:03:37,384 "Smile though your heart is aching." 101 00:03:38,552 --> 00:03:39,553 Plain films, right tib-fib 102 00:03:39,636 --> 00:03:41,513 and right forearm after CT. 103 00:03:41,596 --> 00:03:43,515 Got the chem-8. Blood sugar's 284. 104 00:03:43,598 --> 00:03:46,143 That's not too bad. Potassium looks good. 105 00:03:46,226 --> 00:03:48,395 Mm-hmm. Anion gap's up at 14. 106 00:03:48,478 --> 00:03:49,646 It was 24 this morning. 107 00:03:49,730 --> 00:03:51,314 He's definitely improving. 108 00:03:51,398 --> 00:03:52,691 The DKA is resolving. 109 00:03:52,774 --> 00:03:54,317 So what made him pass out? 110 00:03:54,401 --> 00:03:56,153 It's hot as hell out there. 111 00:03:56,236 --> 00:03:58,321 He could have been dehydrated from sweating. 112 00:03:58,405 --> 00:04:01,783 Or he could have had an N-STEMI or a posterior CVA. 113 00:04:01,867 --> 00:04:03,326 Ready to roll. 114 00:04:05,078 --> 00:04:07,706 - I can babysit him at CT. - Thank you. 115 00:04:07,789 --> 00:04:10,000 I'll stay in case he needs the OR. 116 00:04:11,835 --> 00:04:13,712 Hey, we're back up. 117 00:04:13,795 --> 00:04:15,714 It's about time. 118 00:04:15,797 --> 00:04:17,173 - Ooh, Robby. - Yeah. 119 00:04:17,257 --> 00:04:19,384 I got intel on where ICE has taken Jesse. 120 00:04:19,468 --> 00:04:20,635 Intel from who? 121 00:04:20,719 --> 00:04:22,512 Uh, my brother-in-law's a cop. 122 00:04:22,596 --> 00:04:24,848 So he'll be processed at DHS Southside 123 00:04:24,931 --> 00:04:27,350 and then transferred to ICE detention in Clearfield. 124 00:04:27,434 --> 00:04:28,643 Clearfield? That's two hours away. 125 00:04:28,727 --> 00:04:30,145 Mm-hmm. 126 00:04:30,228 --> 00:04:32,272 OK, I'll let the hospital attorneys know. 127 00:04:32,355 --> 00:04:34,191 - How are you doing, Oliver? - Alive and kicking. 128 00:04:34,274 --> 00:04:35,567 Uh, Mr. Haas. 129 00:04:35,650 --> 00:04:37,861 Pulmonary edema after missed dialysis, 130 00:04:37,944 --> 00:04:40,447 now stable with his son Mason at the bedside. 131 00:04:40,530 --> 00:04:42,073 - Hello. - I'm Dr. Shen. 132 00:04:42,157 --> 00:04:43,283 I'll be back. 133 00:04:43,366 --> 00:04:44,326 Dialysis tech says 134 00:04:44,409 --> 00:04:46,119 I'm off the machine at 10:42. 135 00:04:46,203 --> 00:04:48,246 Hit the call light, and I'll come running. 136 00:04:48,330 --> 00:04:50,415 South 21 next... 137 00:04:52,375 --> 00:04:54,127 Mr. Digby. 138 00:04:54,211 --> 00:04:55,712 J-just Digby. 139 00:04:55,796 --> 00:04:57,380 Dr. Mohan's patient. 140 00:04:57,464 --> 00:04:59,591 Forearm cellulitis, admit med-surge. 141 00:04:59,674 --> 00:05:01,176 - Awaiting a bed. - I can take him. 142 00:05:01,259 --> 00:05:03,011 Sold to Dr. Toomarian. 143 00:05:03,094 --> 00:05:05,430 Moving right along. 144 00:05:05,514 --> 00:05:07,224 Get enough to eat? 145 00:05:07,307 --> 00:05:09,559 We'll be back. 146 00:05:09,643 --> 00:05:12,979 Lillian Stegman. Tweaked her knee water-skiing. 147 00:05:13,063 --> 00:05:15,023 Doing a 360 off a 5-foot ramp. 148 00:05:15,106 --> 00:05:16,483 Ooh, respect. 149 00:05:16,566 --> 00:05:17,818 X-rays ordered in triage. 150 00:05:17,901 --> 00:05:19,110 That was hours ago. 151 00:05:19,194 --> 00:05:21,321 Ma'am, I'm Dr. Crus Henderson. 152 00:05:21,404 --> 00:05:23,573 Let's get you home real fast. 153 00:05:23,657 --> 00:05:25,325 - That would be wonderful. - OK, heading to North. 154 00:05:25,408 --> 00:05:27,035 Thank you. 155 00:05:27,118 --> 00:05:29,579 Looks like our first scanning station is almost ready. 156 00:05:29,663 --> 00:05:32,332 Whitaker, Santos, after rounds, this will be your post. 157 00:05:32,415 --> 00:05:35,001 - Seriously? - For...how long? 158 00:05:35,085 --> 00:05:37,128 Till we mop up this mess. 159 00:05:37,212 --> 00:05:38,797 And away we go. 160 00:05:38,880 --> 00:05:40,966 All right, now you know everything 161 00:05:41,049 --> 00:05:42,175 there is to know about rounds. 162 00:05:42,259 --> 00:05:43,343 Fascinating, right? 163 00:05:43,426 --> 00:05:45,512 Uh...yeah. 164 00:05:45,595 --> 00:05:47,806 Here, I got something better for you. 165 00:05:49,599 --> 00:05:52,394 So, Digby, we're gonna find you some new clothes, 166 00:05:52,477 --> 00:05:54,187 but my friend Emma and I wondered if you'd like 167 00:05:54,271 --> 00:05:56,815 to get cleaned up a bit first. 168 00:05:56,898 --> 00:05:58,567 I already had a shower. 169 00:05:58,650 --> 00:06:00,193 I know, and you look good. 170 00:06:00,277 --> 00:06:02,279 But the offer also comes with a shave and a haircut, 171 00:06:02,362 --> 00:06:03,530 if you're interested. 172 00:06:03,613 --> 00:06:04,739 No pressure--like I said, 173 00:06:04,823 --> 00:06:05,991 you already look great. 174 00:06:07,409 --> 00:06:10,328 - Sure, I guess. - Fantastic. 175 00:06:10,412 --> 00:06:12,330 All right, kid, fill that basin with some warm water 176 00:06:12,414 --> 00:06:14,040 and lather him up. 177 00:06:16,960 --> 00:06:19,379 - Hey, stay safe out there. - Back at you in here. 178 00:06:19,462 --> 00:06:21,381 Hey, Cary. 179 00:06:21,464 --> 00:06:23,508 You were on scene with Orlando, right? 180 00:06:23,592 --> 00:06:25,927 Did you notice anything about his fall? 181 00:06:26,011 --> 00:06:27,429 Like what? 182 00:06:27,512 --> 00:06:30,599 Like, um, if there was a break in the railing 183 00:06:30,682 --> 00:06:33,602 or if there were security cameras? 184 00:06:33,685 --> 00:06:35,186 Too busy working on the guy-- 185 00:06:35,270 --> 00:06:37,647 IV, intubation, backboard, splint. 186 00:06:37,731 --> 00:06:38,815 Thanks. 187 00:06:38,899 --> 00:06:40,442 Oh, two names is a start. 188 00:06:40,525 --> 00:06:42,193 Pretty soon, we'll retire the clipboards. 189 00:06:42,277 --> 00:06:43,528 Baby Jane Doe in Pedes? 190 00:06:43,612 --> 00:06:45,405 Uh, yeah, abandoned 191 00:06:45,488 --> 00:06:48,158 in the waiting room bathroom at 7:30 a.m. 192 00:06:48,241 --> 00:06:50,619 - Safe haven drop-off? - No, she's too old for that. 193 00:06:50,702 --> 00:06:52,454 - At least two months. - I'll take her. 194 00:06:52,537 --> 00:06:54,623 Awaiting foster placement by CYF. 195 00:06:54,706 --> 00:06:56,957 - What if the mom comes back? - Call the cops. 196 00:06:57,042 --> 00:06:58,418 Day shift, get to work scanning. 197 00:06:58,501 --> 00:06:59,961 Night shift, the room numbers 198 00:07:00,045 --> 00:07:02,130 on top of the dry-erase board need a doctor. 199 00:07:02,213 --> 00:07:05,050 - Who's in BH-1? - Psych hold, danger to self. 200 00:07:05,133 --> 00:07:06,509 What's the story? 201 00:07:06,593 --> 00:07:08,386 Doctors King and Langdon were on the case. 202 00:07:08,470 --> 00:07:10,639 It's a sad story-- she says her 5-year-old 203 00:07:10,722 --> 00:07:12,515 snuck into the back seat of the car to take a nap. 204 00:07:12,599 --> 00:07:14,184 Heat stroke. 205 00:07:14,267 --> 00:07:16,561 Mom was extremely distraught. Walked out into traffic. 206 00:07:16,645 --> 00:07:18,104 Grady Barnhill, wheezing 207 00:07:18,188 --> 00:07:19,731 and not responding to albuterol. 208 00:07:19,814 --> 00:07:21,608 Pulse ox 87. His mother, Naomi. 209 00:07:21,691 --> 00:07:23,818 - OK, Trauma Two's open. - On our way. 210 00:07:23,902 --> 00:07:26,321 - Uh, Mom, history of asthma? - His whole life. 211 00:07:26,404 --> 00:07:28,448 - Never this bad. - Barely moving air. 212 00:07:28,531 --> 00:07:31,076 Using all his accessory muscles. 213 00:07:31,159 --> 00:07:32,534 Call RT! 214 00:07:32,619 --> 00:07:35,288 Uh, continuous nebs, 20 milligrams an hour. 215 00:07:35,372 --> 00:07:36,790 We have a home nebulizer. 216 00:07:36,873 --> 00:07:39,668 I've been giving him albuterol every hour. 217 00:07:39,751 --> 00:07:40,794 Ready? 218 00:07:40,877 --> 00:07:43,713 On my count, one, two, three. 219 00:07:43,797 --> 00:07:45,173 Does he take any other medications? 220 00:07:45,256 --> 00:07:46,675 Just the albuterol. 221 00:07:46,758 --> 00:07:48,218 He used to be on montelukast and Symbicort. 222 00:07:48,301 --> 00:07:49,803 Why did you stop that? 223 00:07:49,886 --> 00:07:51,846 Because he lost his Medicaid two months ago. 224 00:07:51,930 --> 00:07:53,682 He's so tight, nothing's getting through. 225 00:07:53,765 --> 00:07:55,266 - Mel, EpiPen. - On it. 226 00:07:55,350 --> 00:07:56,768 0.3 milligrams. 227 00:07:56,851 --> 00:07:59,896 That may open his lungs so the nebs can work. 228 00:07:59,980 --> 00:08:01,982 All right, Grady, shot in the thigh. 229 00:08:07,028 --> 00:08:08,780 Hey. 230 00:08:08,863 --> 00:08:10,240 Something to scan? 231 00:08:10,323 --> 00:08:11,783 Critical labs on North Three. 232 00:08:11,866 --> 00:08:13,368 Oh, it's, uh-- it's not my patient. 233 00:08:13,451 --> 00:08:14,703 She's about to be. 234 00:08:16,621 --> 00:08:18,873 I'm, uh-- I'm off the clock, so... 235 00:08:18,957 --> 00:08:21,543 These were ordered three hours ago from triage, 236 00:08:21,626 --> 00:08:24,004 so, technically, she is a day-shift patient. 237 00:08:24,087 --> 00:08:25,296 Just get the intern started. 238 00:08:25,380 --> 00:08:26,840 I got a meeting upstairs with admin 239 00:08:26,923 --> 00:08:28,842 to get things back on track. 240 00:08:28,925 --> 00:08:30,593 Sorry. Everyone else is tied up. 241 00:08:30,677 --> 00:08:31,970 That's OK. 242 00:08:32,053 --> 00:08:33,179 How'd you get stuck on night shift 243 00:08:33,263 --> 00:08:34,347 for your first rotation? 244 00:08:34,431 --> 00:08:35,807 Just lucky, I guess. 245 00:08:35,890 --> 00:08:37,350 Yeah, if you like a good horror movie. 246 00:08:38,768 --> 00:08:40,645 - Where was med school? - Uh, UC Irvine. 247 00:08:40,729 --> 00:08:42,438 - California, right? - Yep. 248 00:08:42,522 --> 00:08:43,690 Pittsburgh's a little different. 249 00:08:43,773 --> 00:08:44,899 Yeah, a lot more humidity. 250 00:08:44,983 --> 00:08:45,984 Yeah, that'll go away 251 00:08:46,067 --> 00:08:47,902 with your first foot of snow. 252 00:08:47,986 --> 00:08:50,697 Uh, hi, Mrs. Davis. 253 00:08:50,780 --> 00:08:52,741 I am Dr. McKay. This is Doctor... 254 00:08:52,824 --> 00:08:54,993 - Toomarian. - Hello. 255 00:08:55,076 --> 00:08:58,121 Uh, your labs show a lot of inflammation in your liver. 256 00:08:58,204 --> 00:09:01,499 - Is that why I'm so nauseated? - Definitely, yeah. 257 00:09:01,583 --> 00:09:04,586 Have you, um, noticed a change in your skin coloration? 258 00:09:04,669 --> 00:09:06,629 I've been using this bronzing cream 259 00:09:06,713 --> 00:09:09,299 so I don't look like a ghost in my bathing suit. 260 00:09:09,382 --> 00:09:11,259 Do you remember the name of the bronzer? 261 00:09:11,342 --> 00:09:12,802 It could have a chemical that can cause-- 262 00:09:12,886 --> 00:09:14,846 Oh, no, no, it's 100% natural. 263 00:09:14,929 --> 00:09:18,099 - It's DHA from sugar beets. - OK. 264 00:09:18,183 --> 00:09:20,268 Why would my liver be inflamed? 265 00:09:20,351 --> 00:09:22,228 Uh, there's a lot of possibilities. 266 00:09:22,312 --> 00:09:24,064 Are you taking any prescription medications? 267 00:09:24,147 --> 00:09:25,065 Not a single one. 268 00:09:25,148 --> 00:09:26,649 - Tylenol? - God, no. 269 00:09:26,733 --> 00:09:28,860 We have to ask everybody about injection drug use. 270 00:09:28,943 --> 00:09:29,986 Never. 271 00:09:30,070 --> 00:09:31,654 Raw clams or oysters? 272 00:09:31,738 --> 00:09:33,490 I'm a vegan. 273 00:09:33,573 --> 00:09:35,700 One step at a time, OK? 274 00:09:35,784 --> 00:09:36,868 We'll be back. 275 00:09:38,286 --> 00:09:40,121 Digby, Haas, now on the big board. 276 00:09:40,205 --> 00:09:41,122 Progress. 277 00:09:41,206 --> 00:09:42,123 So he's just been waiting 278 00:09:42,207 --> 00:09:43,792 in the hall the whole time? 279 00:09:43,875 --> 00:09:46,753 OK, well, can you maybe get to him next? 280 00:09:48,046 --> 00:09:49,089 Thank you. 281 00:09:50,215 --> 00:09:51,800 Duke goes to CT, and they bump him. 282 00:09:51,883 --> 00:09:54,302 Yeah, he may end up waiting for hours over there. 283 00:09:54,385 --> 00:09:56,805 Oh, look at that. 7:15 already. 284 00:09:56,888 --> 00:09:58,765 Just a few more loose ends to tie up. 285 00:09:58,848 --> 00:10:01,976 You got more loose ends than a macramé wall hanging. 286 00:10:02,060 --> 00:10:04,270 My mom had one. Took up the whole goddamn wall. 287 00:10:04,354 --> 00:10:05,980 Seriously, you should think about signing out 288 00:10:06,064 --> 00:10:07,774 - and hitting the road. - Yeah, maybe you should too. 289 00:10:07,857 --> 00:10:09,526 Oh, that's right, you sent Lena home. 290 00:10:09,609 --> 00:10:11,402 Are you planning on calling in a replacement, 291 00:10:11,486 --> 00:10:13,196 or are you just gonna work till sunrise? 292 00:10:13,279 --> 00:10:14,614 If I have to. 293 00:10:14,697 --> 00:10:16,699 Oh, so you get to go the extra mile, 294 00:10:16,783 --> 00:10:19,202 and the rest of us just get accused of being martyrs. 295 00:10:19,285 --> 00:10:20,578 - Robby. - Excuse me. 296 00:10:22,622 --> 00:10:24,499 - What's the word? - No subdural, no epidural. 297 00:10:24,582 --> 00:10:26,501 Diffuse brain swelling with effacement 298 00:10:26,584 --> 00:10:28,211 and compression of the ventricles. 299 00:10:28,294 --> 00:10:30,421 C-spine? Chest-abdomen-pelvis? 300 00:10:30,505 --> 00:10:32,715 Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 301 00:10:32,799 --> 00:10:33,883 Which means I'm off the hook. 302 00:10:33,967 --> 00:10:35,343 I'll send Neurosurgery down. 303 00:10:35,426 --> 00:10:37,887 If he doesn't need the OR, why Neurosurgery? 304 00:10:37,971 --> 00:10:39,305 - Wait and see. - Let's get busy. 305 00:10:39,389 --> 00:10:40,557 CVP and an art line. 306 00:10:40,640 --> 00:10:43,726 Orlando. Orlando, squeeze my hand. 307 00:10:44,894 --> 00:10:46,104 Open your eyes. 308 00:10:46,187 --> 00:10:48,648 We already know his GCS is going to be three. 309 00:10:48,731 --> 00:10:50,650 Hey, Javadi, anti-seizure prophylaxis? 310 00:10:50,733 --> 00:10:52,652 - Keppra, 20 migs per kilo. - Mixing it now. 311 00:10:52,735 --> 00:10:54,320 Gotta get this brain swelling down, Samira. 312 00:10:54,404 --> 00:10:55,488 How we gonna do that? 313 00:10:56,781 --> 00:10:58,283 - Samira? - What? 314 00:10:58,366 --> 00:11:01,494 We have to lower the intracranial pressure. 315 00:11:01,578 --> 00:11:03,204 - Mannitol. - Not the best. 316 00:11:03,288 --> 00:11:04,539 Can cause diuresis and hypotension. 317 00:11:04,622 --> 00:11:05,915 Then hypertonic saline. 318 00:11:05,999 --> 00:11:08,418 23%. 50 cc's through a central line. 319 00:11:10,336 --> 00:11:11,838 Still tight as a drum. 320 00:11:11,921 --> 00:11:12,964 Five minutes since the epi. 321 00:11:13,047 --> 00:11:14,340 He can have one more EpiPen. 322 00:11:14,424 --> 00:11:16,092 Sats are borderline, 87. 323 00:11:16,176 --> 00:11:17,510 How about BiPap? 10 over 5. 324 00:11:17,594 --> 00:11:19,679 Yes, with in-line nebs. 325 00:11:19,762 --> 00:11:21,514 All right, Grady, shot number two. 326 00:11:21,598 --> 00:11:23,725 Might as well throw in some magnesium, 50 per kilo. 327 00:11:23,808 --> 00:11:25,059 I'm sorry. He's not ventilating. 328 00:11:25,143 --> 00:11:26,436 We should be ready to intubate. 329 00:11:26,519 --> 00:11:27,812 With an asthma patient? 330 00:11:27,896 --> 00:11:29,731 There's a high risk of cardiac arrest. 331 00:11:29,814 --> 00:11:31,983 Naomi, has he ever been put on a breathing machine before? 332 00:11:32,066 --> 00:11:33,651 - Never. - Hospitalized? 333 00:11:33,735 --> 00:11:35,570 No, we could always break him with the Symbicort. 334 00:11:35,653 --> 00:11:37,030 We're gonna give the current treatment 335 00:11:37,113 --> 00:11:39,157 a few more minutes to help him turn the corner. 336 00:11:42,327 --> 00:11:44,162 I could probably do this myself 337 00:11:44,245 --> 00:11:45,580 now that my cast is off. 338 00:11:45,663 --> 00:11:47,498 Oh, that's OK. 339 00:11:47,582 --> 00:11:49,209 I don't mind. 340 00:11:53,129 --> 00:11:55,006 How long have you been a nurse? 341 00:11:56,424 --> 00:11:58,092 This is my first day. 342 00:12:00,803 --> 00:12:02,805 You're doing really good. 343 00:12:04,766 --> 00:12:06,309 Thank you. 344 00:12:10,313 --> 00:12:12,023 - Oh, shit, you OK? - Yeah. 345 00:12:12,106 --> 00:12:13,524 There's water on the floor. 346 00:12:13,608 --> 00:12:15,026 Sorry! I--I might have spilled. 347 00:12:15,109 --> 00:12:16,444 Yeah, no worries. 348 00:12:16,527 --> 00:12:18,488 We're gonna have to sort these all by patient 349 00:12:18,571 --> 00:12:20,281 before we scan them. 350 00:12:20,365 --> 00:12:22,951 Is, uh, Joy still around? 351 00:12:23,034 --> 00:12:25,620 I heard she left at 6:59. 352 00:12:25,703 --> 00:12:27,622 - Smart girl. - Mm-hmm. 353 00:12:27,705 --> 00:12:29,791 You know what? Find Ogilvie. He's such an ass-kisser. 354 00:12:29,874 --> 00:12:31,459 He might stay and scan all the charts himself. 355 00:12:31,542 --> 00:12:33,628 Oh, he, uh, scrubbed in in the OR, 356 00:12:33,711 --> 00:12:35,546 scrubbed in on the ruptured triple-A. 357 00:12:35,630 --> 00:12:37,257 Oh, the kidney stone that wasn't. 358 00:12:37,340 --> 00:12:39,133 That'll be four hours at least. 359 00:12:41,094 --> 00:12:44,430 So are you still going to Amy's after work? 360 00:12:44,514 --> 00:12:46,349 Yeah, maybe just for tonight, 361 00:12:46,432 --> 00:12:48,726 after Robby briefs me on all the house stuff. 362 00:12:49,852 --> 00:12:51,271 Sounds fun. 363 00:12:52,689 --> 00:12:54,607 When he asked, it was hard to say no. 364 00:12:54,691 --> 00:12:56,025 Sure. 365 00:12:58,278 --> 00:13:00,446 It's gonna be very weird without him here. 366 00:13:00,530 --> 00:13:01,864 Yeah. 367 00:13:01,948 --> 00:13:04,409 You think Dr. Al-Hashimi can handle it? 368 00:13:04,492 --> 00:13:05,952 In a word, no. 369 00:13:06,035 --> 00:13:07,370 She's smart. 370 00:13:07,453 --> 00:13:08,663 It takes more than that. 371 00:13:08,746 --> 00:13:10,290 Yeah, well, at least 372 00:13:10,373 --> 00:13:11,666 it's only three months. 373 00:13:11,749 --> 00:13:13,793 Yeah, three long months. 374 00:13:13,876 --> 00:13:15,503 Then you need to find a new home. 375 00:13:16,462 --> 00:13:17,839 Not necessarily. 376 00:13:17,922 --> 00:13:19,924 I mean, if I wanted, I could just check on 377 00:13:20,008 --> 00:13:23,011 Robby's house once or twice a day, you know. 378 00:13:23,094 --> 00:13:24,762 Why would you do that? 379 00:13:26,139 --> 00:13:28,266 I don't know. Why not? 380 00:13:31,352 --> 00:13:32,729 Hypertonic's in. 381 00:13:32,812 --> 00:13:34,856 Maintenance LR in the AC. 382 00:13:34,939 --> 00:13:36,649 Looks like a halo sign. 383 00:13:36,733 --> 00:13:39,235 Cerebrospinal fluid from a basilar skull fracture. 384 00:13:39,319 --> 00:13:43,239 The halo sign is neither sensitive nor specific for CSF. 385 00:13:43,323 --> 00:13:45,533 Saline, tap water, and runny noses 386 00:13:45,616 --> 00:13:46,743 all separate from blood. 387 00:13:46,826 --> 00:13:48,244 - Hello, Linda. - Robby. 388 00:13:48,328 --> 00:13:50,705 Division chief working on a holiday weekend. 389 00:13:50,788 --> 00:13:52,832 Well, somebody's got to. 390 00:13:52,915 --> 00:13:55,626 Saw the scans. This guy needs an EVD. 391 00:13:55,710 --> 00:13:57,920 External ventricular drain to take down the pressure. 392 00:13:58,004 --> 00:14:01,174 Because CPP equals "MAP" minus ICP. 393 00:14:01,257 --> 00:14:03,843 Cerebral perfusion pressure in the brain 394 00:14:03,926 --> 00:14:05,762 equals mean arterial blood pressure 395 00:14:05,845 --> 00:14:07,263 minus the pressure in the skull. 396 00:14:07,347 --> 00:14:08,973 ICP less than 22 397 00:14:09,057 --> 00:14:11,517 predicts survival and favorable outcome. 398 00:14:11,601 --> 00:14:15,897 CPP from 60 to 70 reduces morbidity and mortality. 399 00:14:15,980 --> 00:14:17,315 Can somebody assist? 400 00:14:17,398 --> 00:14:18,483 Dr. Mohan? 401 00:14:18,566 --> 00:14:19,650 I'm good. 402 00:14:20,777 --> 00:14:22,278 Samira, you should lend a hand. 403 00:14:22,362 --> 00:14:24,030 I said I'm good. 404 00:14:24,113 --> 00:14:26,908 - Javadi? - I don't think so. 405 00:14:26,991 --> 00:14:28,451 Javadi? 406 00:14:28,534 --> 00:14:31,871 As in, daughter of Raymond and Eileen? 407 00:14:31,954 --> 00:14:34,332 I was at your mother's baby shower. 408 00:14:34,415 --> 00:14:35,290 She was a resident. 409 00:14:35,375 --> 00:14:36,751 You were in utero. 410 00:14:38,252 --> 00:14:39,295 I don't know how she got through 411 00:14:39,379 --> 00:14:41,089 motherhood and training. 412 00:14:41,172 --> 00:14:42,673 Feel free to join me. 413 00:14:42,757 --> 00:14:44,550 Oh, my--my shift was over a while ago. 414 00:14:44,634 --> 00:14:46,010 OK. 415 00:14:46,094 --> 00:14:48,054 Masks all around. Two sterile gowns. 416 00:14:48,137 --> 00:14:50,681 We brought the surgical towels. Just need some Betadine. 417 00:14:50,765 --> 00:14:52,350 This is kind of an amazing opportunity. 418 00:14:53,518 --> 00:14:54,727 I'm exhausted. 419 00:14:54,811 --> 00:14:56,687 The Chief of Neurosurgery is here. 420 00:14:56,771 --> 00:14:58,147 She's kind of a legend. 421 00:14:58,231 --> 00:15:00,191 Maybe one of the night residents can do it. 422 00:15:00,274 --> 00:15:02,443 Is this about the volvulus case from earlier? 423 00:15:02,527 --> 00:15:04,028 'Cause if it is, you made a mistake. 424 00:15:04,112 --> 00:15:05,947 You need to move on. 425 00:15:06,030 --> 00:15:07,615 I do not want to come back here and find that 426 00:15:07,698 --> 00:15:10,827 you've applied for a residency in derm. 427 00:15:10,910 --> 00:15:13,496 Step up to the plate. Do it. 428 00:15:13,579 --> 00:15:14,705 Javadi will assist. 429 00:15:14,789 --> 00:15:16,374 Excellent. 430 00:15:16,457 --> 00:15:18,126 You know, I think Eileen did her first EVD with me 431 00:15:18,209 --> 00:15:20,670 back when I was a brand-new assistant professor. 432 00:15:22,088 --> 00:15:23,506 Time flies. 433 00:15:26,467 --> 00:15:27,510 How you doing, Grady? 434 00:15:27,593 --> 00:15:28,970 Still retracting. 435 00:15:29,053 --> 00:15:30,680 - Any improvement? - Not really. 436 00:15:30,763 --> 00:15:31,806 You feeling tired? 437 00:15:33,683 --> 00:15:36,185 - Do we have Aerogen in the ED? - Just in the unit. 438 00:15:36,269 --> 00:15:37,812 How fast can you get back? 439 00:15:37,895 --> 00:15:38,980 Two minutes if I take the stairs. 440 00:15:39,063 --> 00:15:40,022 Go. 441 00:15:40,106 --> 00:15:41,357 Uh, Aerogen? 442 00:15:41,441 --> 00:15:43,317 It has a 5-millimeter mesh 443 00:15:43,401 --> 00:15:46,571 that vibrates over 120,000 times per second. 444 00:15:51,742 --> 00:15:53,077 Dr. Al-Hashimi? 445 00:15:57,415 --> 00:15:58,833 You OK? 446 00:16:01,294 --> 00:16:03,296 Uh, you were telling us about Aerogen. 447 00:16:04,464 --> 00:16:05,798 Dr. Shen can explain. 448 00:16:07,216 --> 00:16:10,094 It produces droplets in the 2- to 5-micron range 449 00:16:10,178 --> 00:16:12,096 for medication delivery. 450 00:16:19,395 --> 00:16:21,856 - How's it going? - Just about to start. 451 00:16:21,939 --> 00:16:23,065 Securing the art line here. 452 00:16:23,149 --> 00:16:25,318 Measure twice, cut once. 453 00:16:25,401 --> 00:16:29,113 We enter 11 centimeters back from the nasion, 454 00:16:29,197 --> 00:16:30,740 3 centimeters lateral. 455 00:16:30,823 --> 00:16:32,325 Without any direct imaging? 456 00:16:32,408 --> 00:16:35,369 No, straight shot into the lateral ventricle-- 457 00:16:35,453 --> 00:16:38,956 tried and true since 1890. 458 00:16:39,040 --> 00:16:41,334 OK, go ahead with the incision. 459 00:16:42,877 --> 00:16:45,004 Hey, you worked with Dr. Al-Hashimi at the VA. 460 00:16:45,087 --> 00:16:46,130 I did. 461 00:16:46,214 --> 00:16:47,632 For how long? 462 00:16:47,715 --> 00:16:49,592 During my R2 rotation 463 00:16:49,675 --> 00:16:51,802 and then one again last year. 464 00:16:55,223 --> 00:16:58,309 OK. Hand drill's all set. 465 00:16:58,392 --> 00:16:59,727 Maybe you should do this part. 466 00:16:59,810 --> 00:17:01,103 No, no, there's a safety stop here. 467 00:17:01,187 --> 00:17:02,605 You can't go too deep. 468 00:17:02,688 --> 00:17:04,648 It's not brain surgery. 469 00:17:06,901 --> 00:17:08,109 OK. 470 00:17:11,321 --> 00:17:13,074 - Stay perpendicular. - OK. 471 00:17:13,156 --> 00:17:15,034 Good. 472 00:17:15,117 --> 00:17:16,786 All right, now, four turns 473 00:17:16,868 --> 00:17:17,994 to get through the outer table... 474 00:17:18,079 --> 00:17:19,288 - Yep. - Then half turns 475 00:17:19,372 --> 00:17:20,957 till you penetrate the skull. 476 00:17:31,801 --> 00:17:35,388 Three, four. 477 00:17:35,471 --> 00:17:36,722 One... 478 00:17:38,724 --> 00:17:40,309 Holy smoke! 479 00:17:40,393 --> 00:17:43,729 I thought it was Tom Cruise for a second over here. 480 00:17:43,813 --> 00:17:46,774 Nice job. How's that feel, Digby? 481 00:17:46,857 --> 00:17:48,359 - Pretty good. - I bet. 482 00:17:48,442 --> 00:17:49,652 What do you say we trim up 483 00:17:49,735 --> 00:17:51,445 those gorgeous locks of yours now? 484 00:17:53,155 --> 00:17:55,116 I don't like having my hair cut. 485 00:17:55,199 --> 00:17:58,452 I get it, Rapunzel, but you need your ears lowered. 486 00:17:58,536 --> 00:18:00,580 You'll feel better with a fresh summer look 487 00:18:00,663 --> 00:18:02,665 that won't go unnoticed by the ladies. 488 00:18:04,584 --> 00:18:06,877 - Maybe just a trim? - Great. 489 00:18:06,961 --> 00:18:09,088 I'm thinking a pixie cut. 490 00:18:09,171 --> 00:18:10,881 - What? - I'm kidding. 491 00:18:10,965 --> 00:18:12,675 I cut my husband Benji's hair all the time. 492 00:18:12,758 --> 00:18:14,176 Trust me, you're gonna look fabulous. 493 00:18:14,260 --> 00:18:15,845 When's the last time you had a haircut? 494 00:18:17,471 --> 00:18:20,683 Maybe my daughter's wedding a few years ago. 495 00:18:20,766 --> 00:18:22,018 Where? 496 00:18:22,101 --> 00:18:23,227 St. Sebastian, 497 00:18:23,311 --> 00:18:25,229 Our Lady of Mount Carmel Parish. 498 00:18:25,313 --> 00:18:27,857 Does your daughter know where you are? 499 00:18:27,940 --> 00:18:31,027 Of course. We all live in Pittsburgh. 500 00:18:31,110 --> 00:18:33,321 In fact, they live in my old house. 501 00:18:35,948 --> 00:18:38,200 Your daughter lives in your house? 502 00:18:38,284 --> 00:18:40,077 Yep. 503 00:18:40,161 --> 00:18:42,622 Where do you live? 504 00:18:42,705 --> 00:18:44,874 Wherever I want. 505 00:18:46,667 --> 00:18:48,711 You're gonna pass it 5 to 6 centimeters 506 00:18:48,794 --> 00:18:51,297 from the inner table of the skull, OK? 507 00:18:53,257 --> 00:18:55,343 Centered... 508 00:18:55,426 --> 00:18:57,178 perpendicular... 509 00:18:57,261 --> 00:18:59,055 aiming for the medial canthus. 510 00:19:00,222 --> 00:19:01,807 All yours. 511 00:19:01,891 --> 00:19:03,142 A-and just keep going? 512 00:19:03,225 --> 00:19:04,602 You'll feel a pop when you pass 513 00:19:04,685 --> 00:19:07,188 the ependymal lining. 514 00:19:07,271 --> 00:19:08,981 Art line is calibrated. Good to go. 515 00:19:09,065 --> 00:19:12,902 Titrate the nicardipine to a MAP of 85, please. 516 00:19:12,985 --> 00:19:14,320 And if we can get the intracranial pressure 517 00:19:14,403 --> 00:19:16,155 down to 20? 518 00:19:17,615 --> 00:19:18,991 Dr. Mohan? 519 00:19:19,075 --> 00:19:20,451 I'm sorry. 520 00:19:20,534 --> 00:19:22,745 MAP of 85, ICP of 20? 521 00:19:22,828 --> 00:19:25,748 Um, cerebral perfusion pressure 65. 522 00:19:25,831 --> 00:19:28,501 Which gives him the best shot at survival. 523 00:19:28,584 --> 00:19:30,002 A third of patients like this die. 524 00:19:30,086 --> 00:19:32,588 Half have long-term disability. 525 00:19:32,672 --> 00:19:34,548 We'll know in two weeks if there's a possibility 526 00:19:34,632 --> 00:19:36,884 for a good prognosis. 527 00:19:36,967 --> 00:19:38,094 Felt a pop. 528 00:19:38,177 --> 00:19:39,762 Remove the stylet. 529 00:19:42,306 --> 00:19:45,059 OK, let it drain a bit. 530 00:19:47,019 --> 00:19:49,230 And now pinch it shut. 531 00:19:50,731 --> 00:19:51,649 Perfect. 532 00:19:51,732 --> 00:19:53,526 BP is down, 190 over 88. 533 00:19:53,609 --> 00:19:54,944 Heart rate's 67. 534 00:19:59,073 --> 00:20:00,950 How are you guys doing? 535 00:20:01,033 --> 00:20:02,868 Yeah, making some progress. 536 00:20:02,952 --> 00:20:04,203 You seen Abbot? 537 00:20:04,286 --> 00:20:05,996 Not since rounds. 538 00:20:06,080 --> 00:20:08,708 He asked me to see a patient with the night intern. 539 00:20:08,791 --> 00:20:10,334 And you said yes? 540 00:20:10,418 --> 00:20:13,212 48-year-old woman, new onset jaundice, 541 00:20:13,295 --> 00:20:16,298 elevated liver enzymes, no history of alcohol use. 542 00:20:16,382 --> 00:20:17,633 Take your pick-- 543 00:20:17,717 --> 00:20:20,344 hepatitis A, B, C, D, or E. 544 00:20:20,428 --> 00:20:23,222 - No risk factors, no fever. - Tylenol? 545 00:20:23,305 --> 00:20:25,099 Never, and no prescription meds. 546 00:20:25,182 --> 00:20:27,393 Does she eat polar bear liver? 547 00:20:28,602 --> 00:20:30,813 It can cause vitamin A toxicity. 548 00:20:31,772 --> 00:20:32,773 - No. - Yeah. 549 00:20:32,857 --> 00:20:34,024 She, uh, doesn't eat meat, 550 00:20:34,108 --> 00:20:35,651 kind of a health nut. 551 00:20:35,735 --> 00:20:37,069 Well, maybe she's gulping down 552 00:20:37,153 --> 00:20:38,696 cod liver oil to prevent measles. 553 00:20:38,779 --> 00:20:40,906 No. Vegan, no fish. 554 00:20:40,990 --> 00:20:43,033 Would you, uh, mind laying eyes on her? 555 00:20:43,826 --> 00:20:44,744 Seriously? 556 00:20:44,827 --> 00:20:46,912 You have a way of figuring out the weird stuff. 557 00:20:46,996 --> 00:20:48,456 Take the compliment. 558 00:20:49,874 --> 00:20:51,208 OK, fine. 559 00:20:51,292 --> 00:20:53,502 Five minutes at the bedside-- that's it. 560 00:20:53,586 --> 00:20:55,463 I'm already gonna be here for hours as it is. 561 00:20:55,546 --> 00:20:57,715 Thank you. 562 00:20:57,798 --> 00:20:59,341 What am I doing-- 563 00:21:02,553 --> 00:21:04,847 - Definitely improving. - Tidal volume's up. 564 00:21:04,930 --> 00:21:07,349 Wheezes now expiratory only. 565 00:21:07,433 --> 00:21:08,934 Oh, making some progress. 566 00:21:09,018 --> 00:21:11,061 You feeling better, baby? 567 00:21:11,145 --> 00:21:14,315 - You scared the shit out of me. - Language! 568 00:21:14,398 --> 00:21:16,692 Does he have a primary-care doctor? 569 00:21:16,776 --> 00:21:18,068 Not anymore. 570 00:21:18,152 --> 00:21:20,654 How do you get his prescriptions renewed? 571 00:21:20,738 --> 00:21:22,865 Neighborhood clinic. We pay cash. 572 00:21:22,948 --> 00:21:24,658 - Albuterol's cheap. - Symbicort? 573 00:21:24,742 --> 00:21:27,620 Without Medicaid, 400 bucks a month. 574 00:21:27,703 --> 00:21:29,121 Just for a little inhaler? 575 00:21:31,290 --> 00:21:32,792 Trocar is on the tube. 576 00:21:33,876 --> 00:21:37,087 I tunnel underneath the scalp about 5 centimeters 577 00:21:37,171 --> 00:21:38,589 and poke through. 578 00:21:38,672 --> 00:21:40,341 - To prevent infection? - Mm-hmm, exactly. 579 00:21:41,926 --> 00:21:44,470 Now you hold the knuckle steady while I pull it through. 580 00:21:47,848 --> 00:21:49,975 And you can staple the wound shut. 581 00:21:51,477 --> 00:21:53,521 That looks like something from Home Depot. 582 00:21:53,604 --> 00:21:55,356 Yeah, big Fourth of July sale. 583 00:21:55,439 --> 00:21:56,690 The brain pressure is measured by 584 00:21:56,774 --> 00:21:58,567 the height of the fluid column. 585 00:21:58,651 --> 00:22:01,111 We need to calibrate it to zero at the level of the tragus. 586 00:22:01,195 --> 00:22:03,155 Stopcock's on, ready to attach. 587 00:22:03,239 --> 00:22:04,532 First troponin's normal, 588 00:22:04,615 --> 00:22:06,992 but you need a second to rule out MI. 589 00:22:07,076 --> 00:22:08,869 Hey, can you step out for a second? 590 00:22:15,042 --> 00:22:16,418 I really did do everything I could 591 00:22:16,502 --> 00:22:18,003 to try to make Orlando stay. 592 00:22:18,087 --> 00:22:19,004 Yeah, I don't doubt it. 593 00:22:19,088 --> 00:22:20,005 I wanted to ask you about 594 00:22:20,089 --> 00:22:22,216 Dr. Al-Hashimi at the VA. 595 00:22:22,299 --> 00:22:24,927 Did you ever notice anything unusual about her behavior? 596 00:22:25,010 --> 00:22:26,929 Um, like what? 597 00:22:27,012 --> 00:22:29,557 Lapses in focus, attention? 598 00:22:29,640 --> 00:22:32,142 No, she was always on top of her game. 599 00:22:35,145 --> 00:22:38,774 But this morning when she was checking labs on Baby Jane Doe, 600 00:22:38,858 --> 00:22:41,193 it was like she zoned out for a few seconds. 601 00:22:42,695 --> 00:22:44,446 Maybe she was just tired. 602 00:22:51,495 --> 00:22:53,747 No congestion, nodules, 603 00:22:53,831 --> 00:22:55,207 or cirrhosis. 604 00:22:55,291 --> 00:22:56,876 Good-looking liver. 605 00:22:56,959 --> 00:22:58,752 I should not be sick. 606 00:22:58,836 --> 00:23:01,380 I work so hard to stay healthy-- 607 00:23:01,463 --> 00:23:04,300 diet, exercise, eight hours of sleep. 608 00:23:04,383 --> 00:23:08,137 I can't remember the last time I got eight hours. 609 00:23:08,220 --> 00:23:10,139 Maybe you should try sleepmaxxing. 610 00:23:10,222 --> 00:23:12,057 Oh, you definitely should. 611 00:23:12,141 --> 00:23:14,977 Yeah, cold room, white noise, eye shades. 612 00:23:15,060 --> 00:23:18,814 Kiwis before bedtime, lettuce water, mouth taping. 613 00:23:18,898 --> 00:23:20,482 Who do you follow for health? 614 00:23:20,566 --> 00:23:22,818 A few naturopaths and some functional healers. 615 00:23:22,902 --> 00:23:24,778 Do you--do you buy vitamins from them? 616 00:23:24,862 --> 00:23:26,614 Oh, no, no, I don't take vitamins. 617 00:23:26,697 --> 00:23:29,408 Food is the best medicine-- kale, blueberries, 618 00:23:29,491 --> 00:23:31,994 - kidney beans, turmeric. - Turmeric? 619 00:23:32,077 --> 00:23:33,704 Uh, how long have you been taking that? 620 00:23:33,787 --> 00:23:36,248 For a few months. It's an anti-inflammatory. 621 00:23:36,332 --> 00:23:38,792 It detoxes the body, and it can prevent Alzheimer's. 622 00:23:38,876 --> 00:23:40,252 How much do you take? 623 00:23:40,336 --> 00:23:42,254 500 milligram capsules, 624 00:23:42,338 --> 00:23:43,547 but I take five a day. 625 00:23:45,299 --> 00:23:46,800 What? 626 00:23:46,884 --> 00:23:48,636 With doses that large of turmeric, 627 00:23:48,719 --> 00:23:51,263 there have been cases of liver failure. 628 00:23:51,347 --> 00:23:52,973 From eating a spice? 629 00:23:53,057 --> 00:23:55,643 All right, Digby, I think you're good to go. 630 00:23:55,726 --> 00:23:57,811 Mm-hmm. Would you like to see? 631 00:24:10,449 --> 00:24:12,826 I haven't looked like this in a long time. 632 00:24:12,910 --> 00:24:15,329 Your family won't recognize you. 633 00:24:17,247 --> 00:24:19,333 Then how will they find me? 634 00:24:19,416 --> 00:24:21,335 They--they won't know what I look like. 635 00:24:21,418 --> 00:24:22,419 They won't know this is me. 636 00:24:22,503 --> 00:24:23,545 Of course they will. 637 00:24:23,629 --> 00:24:24,797 They know your voice. 638 00:24:24,880 --> 00:24:26,632 They know where you hang out. 639 00:24:26,715 --> 00:24:30,469 They even remember that you used to look like this. 640 00:24:30,552 --> 00:24:32,554 They remember the wedding. 641 00:24:35,516 --> 00:24:37,685 Did you dance with your daughter 642 00:24:37,768 --> 00:24:39,186 at her wedding? 643 00:24:40,604 --> 00:24:42,731 I did. 644 00:24:42,815 --> 00:24:45,818 Then she will always remember you. 645 00:24:48,570 --> 00:24:50,114 - Yeah. - OK. 646 00:24:51,615 --> 00:24:53,158 Hey, I was just looking for you. 647 00:24:53,242 --> 00:24:54,493 - What's up? - You tell me. 648 00:24:54,576 --> 00:24:56,829 - The, uh, asthma patient. - What about him? 649 00:24:56,912 --> 00:24:58,205 Seemed like you were hesitating 650 00:24:58,288 --> 00:24:59,873 talking about using Aerogen. 651 00:24:59,957 --> 00:25:01,583 I was wondering if you were having second thoughts. 652 00:25:01,667 --> 00:25:03,335 No. Just thinking. 653 00:25:03,419 --> 00:25:04,628 About? 654 00:25:04,712 --> 00:25:06,630 The best treatment plan for the patient. 655 00:25:06,714 --> 00:25:08,716 And I think he's on it. 656 00:25:08,799 --> 00:25:10,217 - Anything else? - I don't know. 657 00:25:10,300 --> 00:25:12,803 You tell me. Anything else I need to know? 658 00:25:12,886 --> 00:25:14,138 I don't think so. 659 00:25:15,806 --> 00:25:17,266 This is Dr. Robby in the ED. 660 00:25:17,349 --> 00:25:18,976 I'm checking on a patient, Ekins. 661 00:25:19,059 --> 00:25:21,520 We can take Larson and Stevens off the dry-erase. 662 00:25:21,603 --> 00:25:22,563 Consider it done. 663 00:25:22,646 --> 00:25:23,772 He's in the scanner now? 664 00:25:23,856 --> 00:25:25,232 Oh, great. 665 00:25:25,315 --> 00:25:26,316 No, I was just calling to confirm. 666 00:25:26,400 --> 00:25:27,609 Thank you. 667 00:25:27,693 --> 00:25:29,403 Any new information from upstairs? 668 00:25:29,486 --> 00:25:30,863 Nothing we don't already know. 669 00:25:30,946 --> 00:25:32,531 Same old story, huh? 670 00:25:32,614 --> 00:25:33,949 You think we should take up a collection 671 00:25:34,033 --> 00:25:35,743 for Jesse for--for bail money? 672 00:25:35,826 --> 00:25:37,327 They don't usually set bail 673 00:25:37,411 --> 00:25:39,121 until after you've appeared in front of a judge. 674 00:25:39,204 --> 00:25:40,998 With the holiday, it's not likely to happen till Monday. 675 00:25:41,081 --> 00:25:43,167 So he's gonna be locked up all weekend? 676 00:25:43,250 --> 00:25:44,877 That sucks. 677 00:25:44,960 --> 00:25:46,879 It does suck. 678 00:25:46,962 --> 00:25:49,923 Dr. Langdon, Grady's worse-- much worse. 679 00:25:50,007 --> 00:25:52,718 - Need an attending? - Uh, no, we have Shen. 680 00:25:52,801 --> 00:25:54,136 Sat's down to 83. 681 00:25:54,219 --> 00:25:56,221 - What's happening? - Give us a minute. 682 00:25:56,305 --> 00:25:57,723 He's tiring out. 683 00:25:57,806 --> 00:25:59,767 Ketamine and rock. It's time to intubate. 684 00:25:59,850 --> 00:26:00,976 I'll call Volk. 685 00:26:01,060 --> 00:26:02,728 Ma'am, we have to put a tube 686 00:26:02,811 --> 00:26:03,979 down your son's windpipe 687 00:26:04,063 --> 00:26:05,439 so a machine can breathe for him. 688 00:26:05,522 --> 00:26:06,774 Oh, my God. 689 00:26:06,857 --> 00:26:08,317 Hold on, hold on. 690 00:26:08,400 --> 00:26:09,526 No lung sliding on the right. 691 00:26:09,610 --> 00:26:11,028 Pneumothorax. 692 00:26:11,111 --> 00:26:13,072 No need to intubate. 693 00:26:13,155 --> 00:26:14,364 What's going on? 694 00:26:14,448 --> 00:26:16,325 He has a collapsed lung. 695 00:26:16,408 --> 00:26:18,243 There was no history of trauma 696 00:26:18,327 --> 00:26:19,745 that would have caused pneumothorax. 697 00:26:19,828 --> 00:26:21,789 Glove up, Dr. King. 698 00:26:21,872 --> 00:26:24,124 In asthma, you can get "air trapping." 699 00:26:24,208 --> 00:26:25,876 When the lungs can't fully exhale, 700 00:26:25,959 --> 00:26:27,252 eventually they overinflate, 701 00:26:27,336 --> 00:26:29,171 causing some of the tiny air sacs to burst. 702 00:26:29,254 --> 00:26:30,422 How do you fix it? 703 00:26:36,345 --> 00:26:37,262 Like that. 704 00:26:42,976 --> 00:26:45,521 It's a good thing Dr. Conley was here. 705 00:26:45,604 --> 00:26:46,814 - Yeah. - We should probably try 706 00:26:46,897 --> 00:26:48,357 to find him a Neuro-Critical ICU bed. 707 00:26:48,440 --> 00:26:49,942 We don't want to board a patient like this. 708 00:26:50,025 --> 00:26:51,610 - Mm-hmm. - Hey, Robby. 709 00:26:51,693 --> 00:26:54,196 - Hey, how did the scan go? - Fine. 710 00:26:54,279 --> 00:26:55,656 It is probably gonna take a little while 711 00:26:55,739 --> 00:26:57,116 to get the results from the radiologist. 712 00:26:57,199 --> 00:26:58,575 Well, that's not a problem. 713 00:26:58,659 --> 00:27:00,786 Nurse Vivi and I need a little time 714 00:27:00,869 --> 00:27:03,372 to coordinate our schedules over the next few months. 715 00:27:03,455 --> 00:27:04,373 - Really? - Yeah. 716 00:27:04,456 --> 00:27:05,374 I've always wanted to learn 717 00:27:05,457 --> 00:27:06,416 how to ride a motorcycle, 718 00:27:06,500 --> 00:27:07,918 and Duke offered to teach me. 719 00:27:08,001 --> 00:27:10,212 Well, nobody knows motorcycles like Duke. 720 00:27:10,295 --> 00:27:12,631 He's giving me the health care worker discount. 721 00:27:12,714 --> 00:27:13,966 He's quite the gentleman. 722 00:27:14,049 --> 00:27:15,759 Let's get him back to his room. 723 00:27:15,843 --> 00:27:18,554 How would next Saturday be for you, Vivi? 724 00:27:18,637 --> 00:27:21,890 Uh, maybe we could have some dinner after. 725 00:27:21,974 --> 00:27:23,517 Dr. Mohan, Lorrie Diaz is here. 726 00:27:23,600 --> 00:27:25,269 She wants to see her husband. She's heading back. 727 00:27:25,352 --> 00:27:26,854 OK, I'm on my way. 728 00:27:29,022 --> 00:27:30,941 - Mrs. Diaz? - Hi. 729 00:27:31,024 --> 00:27:33,819 Did Orlando go up to his room yet? 730 00:27:33,902 --> 00:27:35,320 No. Um-- 731 00:27:35,404 --> 00:27:37,447 I brought him some dinner from Burgatory. 732 00:27:37,531 --> 00:27:38,824 It's a chicken burger-- 733 00:27:38,907 --> 00:27:40,450 no bun, just lettuce. 734 00:27:40,534 --> 00:27:43,162 Figured it would be better than hospital food. 735 00:27:46,498 --> 00:27:50,669 He's being treated by our top brain-injury specialists. 736 00:27:50,752 --> 00:27:52,171 Will he wake up? 737 00:27:52,254 --> 00:27:54,089 We won't know for several weeks. 738 00:27:54,173 --> 00:27:56,675 And then he could be back to normal? 739 00:27:56,758 --> 00:27:59,803 Best-case scenario, it would take about a year 740 00:27:59,887 --> 00:28:02,431 before he could be independent at home. 741 00:28:02,514 --> 00:28:04,099 And the worst case? 742 00:28:04,183 --> 00:28:07,603 Round-the-clock nursing care for severe disability. 743 00:28:11,231 --> 00:28:13,358 You let him leave? 744 00:28:13,442 --> 00:28:17,362 He insisted on leaving to work at his second job. 745 00:28:17,446 --> 00:28:19,573 You couldn't make him stay? 746 00:28:19,656 --> 00:28:22,576 He was competent. He knew the risks. 747 00:28:22,659 --> 00:28:24,578 We honored his decision to leave. 748 00:28:24,661 --> 00:28:26,371 Even if it was a stupid one? 749 00:28:26,455 --> 00:28:27,873 I tried to stop him. 750 00:28:27,956 --> 00:28:29,499 Offered to get him all the supplies he'd need 751 00:28:29,583 --> 00:28:31,001 to take care of himself at home. 752 00:28:31,084 --> 00:28:33,545 But he left before I could give them to him. 753 00:28:33,629 --> 00:28:36,048 He said he couldn't afford to lose a paycheck. 754 00:28:43,597 --> 00:28:45,766 Dr. Langdon. 755 00:28:48,018 --> 00:28:49,686 Are you OK? 756 00:28:49,770 --> 00:28:52,814 Yeah. I'm just kind of, uh... 757 00:28:52,898 --> 00:28:55,275 wondering if I'm really ready to be back here. 758 00:28:55,359 --> 00:28:57,569 Well, of course you are. 759 00:28:57,653 --> 00:28:59,696 Ten months is a long time. 760 00:28:59,780 --> 00:29:02,950 I almost killed that kid with an intubation. 761 00:29:03,033 --> 00:29:06,245 Didn't even occur to me to check for pneumothorax. 762 00:29:06,328 --> 00:29:07,955 There wasn't any trauma to indicate-- 763 00:29:08,038 --> 00:29:09,164 - I should have caught it. - OK. 764 00:29:15,921 --> 00:29:17,214 You know, I, um... 765 00:29:19,132 --> 00:29:21,969 I had a deposition today, 766 00:29:22,052 --> 00:29:25,430 and all the lawyer's questions made me feel like 767 00:29:25,514 --> 00:29:27,808 I was a really, really bad doctor. 768 00:29:30,185 --> 00:29:33,647 We don't always get everything right the first time. 769 00:29:34,815 --> 00:29:37,276 You would have caught the collapsed lung. 770 00:29:37,359 --> 00:29:39,987 And it may have taken a minute, but you would have saved him. 771 00:29:41,238 --> 00:29:43,573 I'm not sure Robby would agree with you. 772 00:29:43,657 --> 00:29:46,285 He's been riding me all day. 773 00:29:46,368 --> 00:29:48,161 Well, Robby's leaving for three months. 774 00:29:48,245 --> 00:29:50,998 And, you know, with Robby gone... 775 00:29:51,081 --> 00:29:53,041 I really don't want you to leave either. 776 00:29:56,628 --> 00:29:59,172 That which does not kill me makes me stronger. 777 00:29:59,256 --> 00:30:02,467 Wow, Friedrich Nietzsche. 778 00:30:02,551 --> 00:30:05,679 Yeah, Nietzsche, yeah... 779 00:30:05,762 --> 00:30:08,056 not Kelly Clarkson. 780 00:30:10,058 --> 00:30:11,977 Hey, that's a thick one. 781 00:30:12,060 --> 00:30:14,896 Yeah, Austin Green. Ogilvie's triple-A. 782 00:30:17,941 --> 00:30:20,485 Uh, G-R-E-E-N? 783 00:30:20,569 --> 00:30:21,903 Yeah. Why? What are you doing? 784 00:30:21,987 --> 00:30:23,363 Checking to see when we'll get Ogilvie 785 00:30:23,447 --> 00:30:25,282 back from the OR. 786 00:30:25,365 --> 00:30:27,326 - Oh, shit. - What? 787 00:30:27,409 --> 00:30:29,077 The guy didn't make it. 788 00:30:29,161 --> 00:30:31,371 He died on the table about 40 minutes ago. 789 00:30:31,455 --> 00:30:33,540 Then where's Ogilvie? 790 00:30:33,623 --> 00:30:35,500 Oh, man. 791 00:30:35,584 --> 00:30:38,128 His patient had a CT a year and a half ago 792 00:30:38,211 --> 00:30:40,422 that showed a 4-centimeter triple-A. 793 00:30:40,505 --> 00:30:42,090 That's too small for surgery. 794 00:30:42,174 --> 00:30:43,425 He was supposed to come back 795 00:30:43,508 --> 00:30:45,177 every six months for a repeat ultrasound, 796 00:30:45,260 --> 00:30:46,887 but looks like he didn't. 797 00:30:46,970 --> 00:30:49,556 We would've seen that if the computers were working. 798 00:30:49,639 --> 00:30:51,224 Why wouldn't he tell Ogilvie? 799 00:30:51,308 --> 00:30:53,101 I don't know. Maybe he forgot all about it. 800 00:30:53,185 --> 00:30:55,145 Or Ogilvie didn't ask the right questions. 801 00:30:56,271 --> 00:30:58,231 Dennis, hey, got a minute? 802 00:30:58,315 --> 00:31:00,776 Uh, sure. What do you need? 803 00:31:00,859 --> 00:31:02,444 Teenager with jewelry magnets 804 00:31:02,527 --> 00:31:04,446 stuck to both sides of her nasal septum. 805 00:31:04,529 --> 00:31:06,448 I tried to move them with a plastic curette. 806 00:31:06,531 --> 00:31:08,283 Too much pain, and then there was bleeding. 807 00:31:08,367 --> 00:31:10,577 Those need to come off before they cause permanent damage. 808 00:31:10,660 --> 00:31:12,162 Yeah, you think, uh, you could find, like, 809 00:31:12,245 --> 00:31:14,081 a senior or an attending? 810 00:31:14,164 --> 00:31:15,957 We're really trying to get off the clock here. 811 00:31:16,041 --> 00:31:17,125 They're all busy. 812 00:31:19,878 --> 00:31:21,421 I already took one for the team. 813 00:31:21,505 --> 00:31:23,382 Yeah, fine. 814 00:31:23,465 --> 00:31:26,927 Uh, labs on your yellow lady. 815 00:31:27,010 --> 00:31:29,388 INR is elevated, 2.2. 816 00:31:29,471 --> 00:31:31,348 Liver's in trouble but not dead yet. 817 00:31:31,431 --> 00:31:32,933 Tell her to skip the turmeric. 818 00:31:33,016 --> 00:31:35,102 Admit for monitoring, and follow the LFTs. 819 00:31:35,185 --> 00:31:36,311 - Got it. - Mm-hmm. 820 00:31:36,395 --> 00:31:37,813 - Central 10? - Yeah. 821 00:31:42,192 --> 00:31:44,277 "Sleepmaxxing"? Really? 822 00:31:44,361 --> 00:31:45,862 I track the online trends. 823 00:31:45,946 --> 00:31:48,240 Is that your secret for the tough ones? 824 00:31:48,323 --> 00:31:49,950 I just think, 825 00:31:50,033 --> 00:31:52,327 what's the stupidest thing this person could have done? 826 00:31:52,411 --> 00:31:53,578 Then assume they did it. 827 00:31:55,038 --> 00:31:57,165 Well, I mean, she was trying to be healthy. 828 00:31:57,249 --> 00:31:59,501 Yeah, by taking advice from fools. 829 00:31:59,584 --> 00:32:01,711 Turmeric is recommended by a lot of doctors. 830 00:32:01,795 --> 00:32:03,713 Yeah, then ask your doctor for the dose 831 00:32:03,797 --> 00:32:06,299 or check someplace reputable, like the CDC. 832 00:32:06,383 --> 00:32:09,594 Oh, right, I forgot, it's now a medical toxic waste site. 833 00:32:09,678 --> 00:32:12,639 I mean, she's in pretty bad shape. 834 00:32:12,722 --> 00:32:14,933 If things get worse, she could need a liver transplant. 835 00:32:15,016 --> 00:32:17,060 Yeah, 'cause she's a big fucking idiot. 836 00:32:18,645 --> 00:32:20,397 Wow. 837 00:32:20,480 --> 00:32:22,649 No, I actually appreciate her. 838 00:32:22,732 --> 00:32:25,402 Our job security depends on all these big fucking idiots. 839 00:32:27,863 --> 00:32:29,072 OK. 840 00:32:31,408 --> 00:32:34,786 Uh, good night, Perlah, Monica. 841 00:32:34,870 --> 00:32:37,539 - Good night, Dr. Robby. - Good night. 842 00:32:37,622 --> 00:32:39,124 Bye, Emma. 843 00:32:39,207 --> 00:32:40,584 You could stay to pitch in. 844 00:32:40,667 --> 00:32:42,544 Mm, Dana told me to go and get some rest 845 00:32:42,627 --> 00:32:43,962 before tomorrow's shift. 846 00:32:44,045 --> 00:32:45,630 Yeah, you had quite a day. 847 00:32:45,714 --> 00:32:47,007 Wasn't so bad. 848 00:32:49,050 --> 00:32:50,802 Why can't I find Duke's results? 849 00:32:50,886 --> 00:32:53,555 Oh, new patient, no EHR yet. 850 00:32:53,638 --> 00:32:56,349 I can run over to Radiology, get a printout. 851 00:32:56,433 --> 00:32:57,809 Thank you, Monica. 852 00:33:00,353 --> 00:33:02,272 Ready to pick up a few more. 853 00:33:02,355 --> 00:33:03,690 Orlando's all tucked in for now. 854 00:33:03,773 --> 00:33:05,317 - How's he doing? - Numbers are good. 855 00:33:05,400 --> 00:33:07,152 CPP 22. 856 00:33:07,235 --> 00:33:09,779 OK, so he's got a shot at a decent outcome at least. 857 00:33:09,863 --> 00:33:11,406 You think he has a chance? 858 00:33:11,490 --> 00:33:13,617 Oh, I don't know that survival was 859 00:33:13,700 --> 00:33:15,619 the outcome he was hoping for. 860 00:33:15,702 --> 00:33:17,245 What? 861 00:33:17,329 --> 00:33:19,456 He told Samira he's got $100,000 in medical debt, 862 00:33:19,539 --> 00:33:21,958 - that his life is probably-- - Mrs. Diaz! 863 00:33:24,294 --> 00:33:26,713 - How can we help you? - The bathroom? 864 00:33:26,796 --> 00:33:29,424 Uh, yeah. Perlah can show you the way. 865 00:33:31,218 --> 00:33:33,553 Not a great idea to have a private conversation 866 00:33:33,637 --> 00:33:34,804 about a patient in a public area. 867 00:33:34,888 --> 00:33:36,806 I know. I know. 868 00:33:36,890 --> 00:33:38,183 You were about to start yapping-- 869 00:33:38,266 --> 00:33:39,768 But I didn't! 870 00:33:42,312 --> 00:33:45,190 OK. 871 00:33:45,273 --> 00:33:47,526 And how long have they been in there? 872 00:33:47,609 --> 00:33:48,985 At least two hours. 873 00:33:49,069 --> 00:33:51,404 - How did it happen? - With my earring. 874 00:33:51,488 --> 00:33:54,324 It was supposed to be, uh, red, white, and blue 875 00:33:54,407 --> 00:33:56,117 to look cool at the fireworks. 876 00:33:56,201 --> 00:33:57,827 I told her for the nose, one side only, 877 00:33:57,911 --> 00:33:59,079 but she never listens. 878 00:33:59,162 --> 00:34:00,330 This can be pretty serious. 879 00:34:00,413 --> 00:34:01,623 If we don't get them out quickly, 880 00:34:01,706 --> 00:34:03,041 it can cut off the blood supply 881 00:34:03,124 --> 00:34:04,960 and cause the septum to collapse. 882 00:34:05,043 --> 00:34:08,547 Like, my nose could be deformed? 883 00:34:10,840 --> 00:34:13,342 - Oh, my God, get them off. - Yeah, that's the plan. 884 00:34:13,426 --> 00:34:15,053 Yeah, she tried already. It hurt like crazy. 885 00:34:15,136 --> 00:34:16,221 Because they're stuck together 886 00:34:16,304 --> 00:34:18,348 by a very strong magnetic force. 887 00:34:18,431 --> 00:34:20,266 - Yeah. - No, no, no. 888 00:34:20,350 --> 00:34:22,018 Oh, uh, I'm not gonna use the tips. 889 00:34:22,101 --> 00:34:25,063 I'm gonna flip it around and use the handle. 890 00:34:25,146 --> 00:34:26,690 It's still gonna hurt. 891 00:34:26,773 --> 00:34:27,899 Probably not. 892 00:34:27,983 --> 00:34:29,317 Just, uh, hold still. 893 00:34:31,860 --> 00:34:33,280 OK. 894 00:34:37,534 --> 00:34:38,743 Voilà. 895 00:34:38,827 --> 00:34:41,454 - Really? - That was amazing. 896 00:34:41,538 --> 00:34:43,290 I think another half hour, 897 00:34:43,373 --> 00:34:45,000 we can send this dry-erase board back to storage. 898 00:34:45,083 --> 00:34:46,208 With pleasure. 899 00:34:46,293 --> 00:34:47,585 - Dr. Robinavitch? - Yep. 900 00:34:47,668 --> 00:34:49,087 Results on your friend. 901 00:34:53,757 --> 00:34:55,885 - Fuck. - Duke? 902 00:34:59,889 --> 00:35:01,516 Are you gonna tell him? 903 00:35:01,600 --> 00:35:03,143 I want to talk to a surgeon first. 904 00:35:03,226 --> 00:35:05,186 Uh, Dr. Robby, I have an update on the patient. 905 00:35:05,270 --> 00:35:06,605 Now is not a great time. 906 00:35:06,688 --> 00:35:08,023 Oh, I thought you were going home. 907 00:35:08,106 --> 00:35:09,232 Uh, I was. 908 00:35:09,316 --> 00:35:10,984 Dr. Ogilvie is just sitting 909 00:35:11,067 --> 00:35:12,736 out in the ambulance bay covered in blood. 910 00:35:12,819 --> 00:35:14,362 Sorry, what-- what's he doing out there? 911 00:35:14,446 --> 00:35:16,323 Kind of, uh, staring off into space. 912 00:35:16,406 --> 00:35:17,616 I tried to talk to him, but it was like 913 00:35:17,699 --> 00:35:19,075 - he couldn't hear me. - Monica, 914 00:35:19,159 --> 00:35:20,660 can you stat page CardioThoracic? 915 00:35:20,744 --> 00:35:22,871 - I'll go check on Ogilvie. - Please. 916 00:35:25,206 --> 00:35:26,416 Oh. 917 00:35:37,844 --> 00:35:39,971 Hey, Ogilvie. 918 00:35:42,599 --> 00:35:44,517 Ogilvie... 919 00:35:44,601 --> 00:35:46,436 y-you OK, man? 920 00:35:51,524 --> 00:35:53,568 99 on 2 liters. 921 00:35:53,652 --> 00:35:55,904 Scattered end expiratory wheezes. 922 00:35:55,987 --> 00:35:58,114 He is so much better. 923 00:35:58,198 --> 00:36:00,158 The steroids should kick in soon. 924 00:36:00,241 --> 00:36:02,535 So he'll keep improving. 925 00:36:02,619 --> 00:36:04,871 Um, when can I go home? 926 00:36:04,954 --> 00:36:06,539 In a day or two. 927 00:36:06,623 --> 00:36:09,834 And we will, uh, discharge you with a Symbicort inhaler. 928 00:36:09,918 --> 00:36:12,003 That should last about a month. 929 00:36:12,087 --> 00:36:14,547 Hopefully we'll be back on Medicaid by then. 930 00:36:14,631 --> 00:36:16,591 How'd you lose it? 931 00:36:16,675 --> 00:36:20,095 They sent a redetermination letter to our old apartment. 932 00:36:20,178 --> 00:36:22,639 It didn't get forwarded. 933 00:36:22,722 --> 00:36:24,683 When I went to pick up his prescription, 934 00:36:24,766 --> 00:36:28,520 pharmacist told me we were no longer covered. 935 00:36:28,603 --> 00:36:30,772 And you haven't been able to get it back since? 936 00:36:30,855 --> 00:36:33,108 I've been trying for months. 937 00:36:33,191 --> 00:36:35,568 To get re-enrolled, you need tax returns, 938 00:36:35,652 --> 00:36:36,986 pay stubs. 939 00:36:37,070 --> 00:36:39,906 I cut hair. My income fluctuates. 940 00:36:39,989 --> 00:36:42,367 A lot of my regulars are struggling, 941 00:36:42,450 --> 00:36:45,495 so it's been tough. 942 00:36:45,578 --> 00:36:47,414 Well, if you run out of Symbicort 943 00:36:47,497 --> 00:36:49,791 before your Medicaid kicks in, you can come back, 944 00:36:49,874 --> 00:36:52,711 and we'll, uh, set you up with another one. 945 00:36:52,794 --> 00:36:54,713 Oh, is there a patient in here? 946 00:36:54,796 --> 00:36:57,799 'Cause everyone in this room looks extremely healthy to me. 947 00:36:57,882 --> 00:37:00,260 Dr. Shen and I will be with Grady all night long. 948 00:37:00,343 --> 00:37:02,220 Yeah. Day shift, we got this. 949 00:37:02,303 --> 00:37:04,180 We're leaving you in good hands. 950 00:37:04,264 --> 00:37:06,015 Um... 951 00:37:06,099 --> 00:37:08,435 I was really scared. 952 00:37:08,518 --> 00:37:09,644 Thank you. 953 00:37:11,354 --> 00:37:13,356 You're very welcome. 954 00:37:17,277 --> 00:37:19,863 Due to his injury, things have changed. 955 00:37:21,322 --> 00:37:23,533 I was looking for Dr. Abbot. 956 00:37:23,616 --> 00:37:26,369 I haven't seen him for a while. 957 00:37:26,453 --> 00:37:27,704 Excuse me. 958 00:37:30,749 --> 00:37:32,667 So now, with a long-term disability, 959 00:37:32,751 --> 00:37:35,378 things may be easier. 960 00:37:35,462 --> 00:37:36,546 "Easier"? 961 00:37:36,629 --> 00:37:38,047 His condition will qualify him 962 00:37:38,131 --> 00:37:39,549 for Medicare and Medicaid. 963 00:37:39,632 --> 00:37:42,051 So, moving forward, costs should be covered, 964 00:37:42,135 --> 00:37:43,845 including home health care. 965 00:37:43,928 --> 00:37:45,180 OK. 966 00:37:45,263 --> 00:37:46,639 Perhaps this isn't the best time-- 967 00:37:46,723 --> 00:37:48,016 I just wanted to reassure you 968 00:37:48,099 --> 00:37:49,893 about future costs. 969 00:37:58,151 --> 00:37:59,486 Robby. 970 00:37:59,569 --> 00:38:01,654 Noelle. 971 00:38:01,738 --> 00:38:03,281 You're still here. 972 00:38:03,364 --> 00:38:05,617 It's not the best day to try to get out on time. 973 00:38:05,700 --> 00:38:07,285 Mm. 974 00:38:07,368 --> 00:38:08,745 So I guess this is it for a while. 975 00:38:08,828 --> 00:38:10,246 Unless you want to come with me. 976 00:38:10,330 --> 00:38:12,624 No, but thank you, 977 00:38:12,707 --> 00:38:14,667 even if it isn't a legitimate offer. 978 00:38:14,751 --> 00:38:16,169 - What do you mean? - Oh, please. 979 00:38:16,252 --> 00:38:18,046 I know well enough not to get in between 980 00:38:18,129 --> 00:38:20,173 a man and his vision quest. 981 00:38:21,591 --> 00:38:22,842 "Vision quest." 982 00:38:22,926 --> 00:38:26,012 That is my nice way of putting it. 983 00:38:27,263 --> 00:38:28,556 I probably don't want to hear 984 00:38:28,640 --> 00:38:30,433 your not-so-nice way of putting it. 985 00:38:30,517 --> 00:38:31,851 No, probably not. 986 00:38:33,603 --> 00:38:37,148 I-I hope that this is not, um... 987 00:38:37,232 --> 00:38:38,525 about you running away from me. 988 00:38:38,608 --> 00:38:39,776 I'm a big girl. 989 00:38:39,859 --> 00:38:41,444 You can tell me just to get lost. 990 00:38:41,528 --> 00:38:43,279 This has nothing to do with you. 991 00:38:43,363 --> 00:38:44,572 Oh, right. 992 00:38:44,656 --> 00:38:47,367 It's the old, uh, "it's not you, it's me"? 993 00:38:48,868 --> 00:38:51,037 In this case, it's actually true. 994 00:38:57,252 --> 00:38:58,878 Excuse me. 995 00:39:04,968 --> 00:39:06,261 I'll see you next week? 996 00:39:06,344 --> 00:39:07,595 It's a three-month sabbatical. 997 00:39:07,679 --> 00:39:09,639 Like I said, I will see you next week. 998 00:39:16,312 --> 00:39:19,524 My first day here as a med student... 999 00:39:19,607 --> 00:39:21,234 there was a patient. 1000 00:39:23,069 --> 00:39:24,737 He was a real nice guy, 1001 00:39:24,821 --> 00:39:27,574 came in with belly pain. 1002 00:39:27,657 --> 00:39:31,202 I saw a gall stone on the ultrasound, 1003 00:39:31,286 --> 00:39:33,371 normal EKG, troponin. 1004 00:39:33,454 --> 00:39:36,749 The pain resolved, and he was in the hall 1005 00:39:36,833 --> 00:39:38,710 when he had a cardiac arrest. 1006 00:39:41,504 --> 00:39:42,839 I couldn't save him. 1007 00:39:44,465 --> 00:39:45,884 People die. 1008 00:39:47,343 --> 00:39:50,805 And we do the best we can... 1009 00:39:50,889 --> 00:39:53,224 but people die. 1010 00:39:54,475 --> 00:39:56,436 You ever get used to it? 1011 00:39:58,229 --> 00:39:59,314 No. 1012 00:40:00,982 --> 00:40:03,735 No, you... 1013 00:40:03,818 --> 00:40:05,695 you try to accept it. 1014 00:40:07,697 --> 00:40:09,449 You try to find balance. 1015 00:40:14,913 --> 00:40:17,790 I don't know if I can take another day like today. 1016 00:40:19,334 --> 00:40:22,629 Primary care specialty sounds way better. 1017 00:40:22,712 --> 00:40:24,422 Pedes, maybe. 1018 00:40:24,505 --> 00:40:26,049 Yeah, maybe. 1019 00:40:27,592 --> 00:40:30,678 I know I'd be bored out of my fucking mind. 1020 00:40:32,013 --> 00:40:36,017 Seriously, I like the challenge of undiagnosed illness, 1021 00:40:36,100 --> 00:40:41,022 of quick decisions, of life-saving procedures. 1022 00:40:41,105 --> 00:40:43,441 And I like being here for people 1023 00:40:43,524 --> 00:40:45,902 on the worst days of their lives. 1024 00:40:54,077 --> 00:40:56,037 You know what I think? 1025 00:40:56,120 --> 00:40:57,747 What? 1026 00:40:57,830 --> 00:41:00,083 I think you should go home. 1027 00:41:00,166 --> 00:41:01,501 I think you should sleep on it. 1028 00:41:01,584 --> 00:41:03,002 And I think you should at least wait 1029 00:41:03,086 --> 00:41:04,253 till the morning to decide 1030 00:41:04,337 --> 00:41:05,755 if you want to come back. 1031 00:41:08,758 --> 00:41:11,052 I don't really want to... 1032 00:41:11,135 --> 00:41:13,680 go back in there and see anybody. 1033 00:41:13,763 --> 00:41:14,889 Yeah. 1034 00:41:16,432 --> 00:41:18,935 OK, pull off your gown. I'll take it in. 1035 00:41:19,018 --> 00:41:21,396 Shift is over. 1036 00:41:21,479 --> 00:41:22,939 Go home. 1037 00:41:35,827 --> 00:41:37,036 - Oh! - Oh, God. 1038 00:41:37,120 --> 00:41:38,121 - No, I'm--I'm-- - Sorry. 1039 00:41:38,204 --> 00:41:39,539 I'm good. I'm good. I'm good. 1040 00:41:39,622 --> 00:41:41,249 There's a dummy in a wheelchair. 1041 00:41:41,332 --> 00:41:43,209 Uh, yeah, he moves around. 1042 00:41:46,295 --> 00:41:48,423 I see I've been replaced. 1043 00:41:48,506 --> 00:41:49,966 Oh, did I take your spot? 1044 00:41:50,049 --> 00:41:51,634 - Not really, no. - Are you sure? 1045 00:41:51,718 --> 00:41:53,094 Where the hell have you been? 1046 00:41:53,177 --> 00:41:54,721 I found Ogilvie. 1047 00:41:54,804 --> 00:41:56,014 And? 1048 00:41:56,097 --> 00:41:58,349 And he's going home. 1049 00:41:58,433 --> 00:41:59,559 That's it? 1050 00:41:59,642 --> 00:42:00,893 It's a long story. 1051 00:42:00,977 --> 00:42:02,353 Well, I got nothing but time. 1052 00:42:02,437 --> 00:42:04,522 I need to respect his privacy. 1053 00:42:04,605 --> 00:42:06,107 Where's the fun in that? 1054 00:42:06,190 --> 00:42:08,151 - Beep. Beep, beep. - Sorry. 1055 00:42:16,743 --> 00:42:18,077 Um, the shredder jammed. 1056 00:42:18,161 --> 00:42:21,122 Yeah, uh, try putting it in reverse. 1057 00:42:23,499 --> 00:42:24,667 Perfect. 1058 00:42:24,751 --> 00:42:26,753 Just give it a little love tap. 1059 00:42:26,836 --> 00:42:28,337 - OK. - Kick it. 1060 00:42:29,505 --> 00:42:31,049 Jesus Christ. 1061 00:42:33,051 --> 00:42:35,136 Guess Mr. Digby got a room upstairs. 1062 00:42:35,219 --> 00:42:36,596 In your dreams. 1063 00:42:36,679 --> 00:42:38,598 He's not in South 21. 1064 00:42:38,681 --> 00:42:40,016 Yeah, he is. 1065 00:42:40,099 --> 00:42:42,351 There's a new guy in the bed. 1066 00:42:42,435 --> 00:42:44,353 Short hair, clean-shaved? 1067 00:42:44,437 --> 00:42:46,773 I'll take care of it. 1068 00:42:46,856 --> 00:42:48,483 Scout film showed obvious pathology, 1069 00:42:48,566 --> 00:42:50,026 so we ordered the CT angiogram. 1070 00:42:50,109 --> 00:42:51,694 Textbook ascending aortic aneurysm. 1071 00:42:51,778 --> 00:42:53,529 Eight centimeters. 1072 00:42:53,613 --> 00:42:55,406 50% one-year mortality. 1073 00:42:55,490 --> 00:42:56,699 So he definitely needs surgery. 1074 00:42:56,783 --> 00:42:57,700 If he wants to live. 1075 00:42:57,784 --> 00:42:58,743 OK, well, he's a friend, 1076 00:42:58,826 --> 00:43:00,036 so I will talk to him. 1077 00:43:00,119 --> 00:43:01,204 I'll get him admitted to your service. 1078 00:43:01,287 --> 00:43:03,331 - Not today. - Why not? 1079 00:43:03,414 --> 00:43:05,166 He needs to see Cardiology and Pulmonary first 1080 00:43:05,249 --> 00:43:06,417 to be cleared for the OR. 1081 00:43:06,501 --> 00:43:08,336 They can do a stress echo, PFTs. 1082 00:43:08,419 --> 00:43:10,588 He needs to be admitted and evaluated as an inpatient. 1083 00:43:10,671 --> 00:43:12,256 Nothing ever gets done over a holiday weekend. 1084 00:43:12,340 --> 00:43:13,341 He can take it easy at home. 1085 00:43:13,424 --> 00:43:14,759 He's a ticking time bomb. 1086 00:43:14,842 --> 00:43:16,094 He's probably been that way for years. 1087 00:43:16,177 --> 00:43:17,386 We can get him in early next week 1088 00:43:17,470 --> 00:43:18,971 with a specialist to get his testing done. 1089 00:43:19,055 --> 00:43:20,932 All goes well, he's on the OR schedule in a week. 1090 00:43:21,015 --> 00:43:22,558 What happens if it ruptures before then? 1091 00:43:22,642 --> 00:43:24,393 Call 911. 1092 00:43:24,477 --> 00:43:26,062 Sorry, Robby. Best we can do. 1093 00:43:26,145 --> 00:43:28,064 Text me his number. I'll have my office coordinate. 1094 00:43:30,274 --> 00:43:31,818 - Fuck! - Hey! 1095 00:43:31,901 --> 00:43:33,569 Take a walk. Come on! 1096 00:43:37,907 --> 00:43:38,825 Two for discharge. 1097 00:43:38,908 --> 00:43:40,326 Yeah, please don't ring the bell. 1098 00:43:40,409 --> 00:43:41,953 The computers are back up and running. 1099 00:43:42,036 --> 00:43:43,496 Not for these two. 1100 00:43:43,579 --> 00:43:44,914 They don't have electronic health records yet. 1101 00:43:44,997 --> 00:43:46,290 Wait, hold up. 1102 00:43:46,374 --> 00:43:48,543 This kid had a wrist X-ray ordered. 1103 00:43:48,626 --> 00:43:49,794 Ugh, it never happened. 1104 00:43:49,877 --> 00:43:51,129 And water-skiing lady's 1105 00:43:51,212 --> 00:43:52,463 still waiting on a knee series. 1106 00:43:52,547 --> 00:43:53,714 I canceled the X-rays. 1107 00:43:53,798 --> 00:43:56,050 Diagnosed them both with ultrasound. 1108 00:43:56,134 --> 00:43:57,301 Really? 1109 00:43:57,385 --> 00:43:59,053 Yeah. 1110 00:43:59,137 --> 00:44:01,514 The, uh, little boy had a simple buckle fracture. 1111 00:44:01,597 --> 00:44:04,142 Distal radius. He got a Velcro splint. 1112 00:44:04,225 --> 00:44:06,853 And Mrs. Stegman had a small medial meniscus tear. 1113 00:44:06,936 --> 00:44:09,272 Knee immobilizer, crutches, and a follow up with ortho. 1114 00:44:09,355 --> 00:44:11,607 Could have used you on the day shift today. 1115 00:44:11,691 --> 00:44:14,026 They don't teach us a lot of musculoskeletal ultrasound. 1116 00:44:14,110 --> 00:44:15,570 I know. 1117 00:44:15,653 --> 00:44:18,197 That's why I did electives at Harvard and Highland. 1118 00:44:18,281 --> 00:44:21,033 Are you applying for an ultrasound fellowship here? 1119 00:44:21,117 --> 00:44:23,828 I am, but it is so competitive. 1120 00:44:23,911 --> 00:44:26,080 - That's what I hear. - Kind of a long shot. 1121 00:44:26,164 --> 00:44:27,498 I only have one publication, 1122 00:44:27,582 --> 00:44:29,417 but it's a series of case reports diagnosing 1123 00:44:29,500 --> 00:44:31,961 shoulder dislocations with ultrasound only. 1124 00:44:32,044 --> 00:44:33,963 If you want to learn some MSK, you can tag along. 1125 00:44:34,046 --> 00:44:35,464 I got three more to scan. 1126 00:44:35,548 --> 00:44:37,466 Maybe some other time. 1127 00:44:37,550 --> 00:44:39,886 Cool. 1128 00:44:42,305 --> 00:44:44,223 Hey, don't jam the shredder. 1129 00:44:44,307 --> 00:44:45,766 What is that, two charts? 1130 00:44:45,850 --> 00:44:48,352 No, it's my ultrasound fellowship application. 1131 00:44:50,188 --> 00:44:51,731 Hey. 1132 00:44:51,814 --> 00:44:54,734 Uh, sorry about your patient. 1133 00:44:54,817 --> 00:44:57,737 Yeah, Orlando's in pretty bad shape. 1134 00:44:57,820 --> 00:44:59,655 Oh, no, I--I was talking about 1135 00:44:59,739 --> 00:45:03,326 the triple-A guy you worked on with Ogilvie. 1136 00:45:05,953 --> 00:45:08,497 He didn't make it through surgery. 1137 00:45:08,581 --> 00:45:10,041 I tried to talk to Robby about it, 1138 00:45:10,124 --> 00:45:12,043 but I think he's busy. 1139 00:45:12,126 --> 00:45:13,753 Excuse me. 1140 00:45:16,130 --> 00:45:17,882 Oh, shit. 1141 00:45:22,136 --> 00:45:23,554 You think I'm on edge? 1142 00:45:23,638 --> 00:45:25,348 First you're shaming Samira, then McKay-- 1143 00:45:25,431 --> 00:45:26,682 They both needed to be called out 1144 00:45:26,766 --> 00:45:28,017 - for unacceptable behavior. - Yeah? 1145 00:45:28,100 --> 00:45:29,310 Yeah, well, you do that in private. 1146 00:45:29,393 --> 00:45:30,728 Same place you share your thoughts 1147 00:45:30,811 --> 00:45:31,938 about a patient's possible suicide. 1148 00:45:32,021 --> 00:45:33,397 And slamming stuff? Please. 1149 00:45:33,481 --> 00:45:34,607 Sign out all the shit that's bugging you 1150 00:45:34,690 --> 00:45:35,775 and get out of here. 1151 00:45:35,858 --> 00:45:37,610 - I can't. - Yes, you can. 1152 00:45:37,693 --> 00:45:38,945 When either of my kids was acting like this, 1153 00:45:39,028 --> 00:45:40,404 I gave them a time-out in their room. 1154 00:45:40,488 --> 00:45:41,572 Whoa, whoa, whoa, you're not my mother. 1155 00:45:41,656 --> 00:45:42,782 Yeah? Well, too bad. 1156 00:45:42,865 --> 00:45:43,991 - You need one. - No, I had one. 1157 00:45:44,075 --> 00:45:45,701 She left. I don't need another one. 1158 00:45:45,785 --> 00:45:47,036 What I need is someone who can actually run this place 1159 00:45:47,119 --> 00:45:48,955 - while I'm gone. - OK, I'm sorry. 1160 00:45:49,038 --> 00:45:50,289 - I didn't know. - Nobody knows. 1161 00:45:50,373 --> 00:45:52,583 Who needs to know? Who gives a fuck? 1162 00:45:52,667 --> 00:45:53,918 I think you need a break. 1163 00:45:54,001 --> 00:45:55,503 That is what the sabbatical is for. 1164 00:45:55,586 --> 00:45:57,046 Then start it now. Walk away. 1165 00:45:57,129 --> 00:45:58,297 I have too much to do. 1166 00:45:58,381 --> 00:46:00,007 Let someone else talk to Duke. 1167 00:46:00,091 --> 00:46:01,759 No, that needs to come from me. 1168 00:46:01,842 --> 00:46:03,094 Why? 1169 00:46:03,177 --> 00:46:04,679 Because I owe him that. 1170 00:46:04,762 --> 00:46:06,514 It needs to come from a friend, not a stranger, 1171 00:46:06,597 --> 00:46:08,557 otherwise he's gonna bail and drop dead while I'm gone. 1172 00:46:08,641 --> 00:46:11,435 OK, wrap that up and then leave. 1173 00:46:11,519 --> 00:46:13,062 It's not just Duke. 1174 00:46:13,145 --> 00:46:14,814 I'm not sure that Al-Hashimi is fit to run this place. 1175 00:46:14,897 --> 00:46:16,023 - What's that supposed to mean? - I'm not sure. 1176 00:46:16,107 --> 00:46:17,650 I'm trying to figure that out. 1177 00:46:17,733 --> 00:46:18,901 Did you know that she wants to have two attendings 1178 00:46:18,985 --> 00:46:20,528 - on at all times? - No. 1179 00:46:20,611 --> 00:46:22,029 Is that something she's worked out with Gloria? 1180 00:46:22,113 --> 00:46:23,572 - I don't know. - I also don't know 1181 00:46:23,656 --> 00:46:24,907 if Langdon is going to relapse. 1182 00:46:24,991 --> 00:46:25,908 I don't know if Whitaker's gonna be able 1183 00:46:25,992 --> 00:46:27,285 to take care of my shit. 1184 00:46:27,368 --> 00:46:28,869 I don't know if Javadi's gonna give up on 1185 00:46:28,953 --> 00:46:30,746 what she's good at or if Samira's gonna flame out 1186 00:46:30,830 --> 00:46:32,164 because of some bullshit with her mother. 1187 00:46:32,248 --> 00:46:34,583 - Is there anything else? - Yeah, you. 1188 00:46:34,667 --> 00:46:36,794 I don't know about you running around 1189 00:46:36,877 --> 00:46:38,587 with a full syringe of Versed in your pocket. 1190 00:46:38,671 --> 00:46:40,965 I'm worried about the people that I care about. 1191 00:46:41,048 --> 00:46:43,384 We'll all manage until you come back. 1192 00:46:43,467 --> 00:46:44,552 We always do. 1193 00:46:44,635 --> 00:46:46,387 Yeah? What if I don't come back?