[indistinct chatter]
- You know this guy? - Orlando Diaz.
We were treating him for DKA when he eloped.
- How far did he fall? - 20 feet or so.
- Anyone see him pass out? - No.
They went looking for him after he didn't answer his radio.
- Pupils equal but sluggish.
- He left against medical advice.
- On my count, three, two, one. [grunts]
- Dr. Ellis on the case. Day shift, we got this.
- I'm staying. - Continuity of care.
Dr. Al-Hashimi, why don't you go cover
sign-out rounds with Dr. Abbot?
Shen, you too. - Got it.
- OK, let me know if you need anything.
- Lungs are up bilaterally. - Pelvis is stable.
Right tib-fib hematoma, deformed right forearm.
- Ruptured TM on the left with sero-sanguinous fluid.
- That means basilar skull fracture.
- We've got a diabetic patient, 20-foot fall.
- BP 204 over 98, pulse 56.
- Dr. Mohan, what do those numbers indicate?
- I'm trying to treat the patient.
- It's the Cushing's reflex.
- From increased intracranial pressure.
- Yeah, we need to get him to CT right away.
- No free fluid in the belly.
- Any family to notify? - Wife and three kids.
- Is there a card to sign for Robby?
- No, he said no card, no presents.
- Oh. Was there a cake?
- Oh, he didn't want that either.
- That sucks. I need some cake.
- Patient was injured when they raided a restaurant.
- And they actually arrested the nurse?
- With a takedown and zip ties. - Damn.
- Crus, you, uh, know the computer downtime drill?
- Yeah, no biggie.
I prefer to treat 'em without labs and X-rays.
Welcome back.
- If you do have orders for labs and X-rays,
clipboards go here.
If it's just nursing orders, here.
- Please write neatly, for God's sake.
- Oh, Monica, this is Nazely, new intern.
- I don't need to know that. - So nice to meet you.
- Looks like you and me, Jack.
- Yeah, who's our senior?
- Dr. Henderson. - Excellent.
Night shift's on Crus control.
- You hear ICE brought us a patient?
- Oh, yeah? How'd that go?
- There was some collateral damage.
They arrested Jesse.
- For what? - Assaulting a federal officer.
- Are you fucking kidding me?
- Oh, Dr. Al-Hashimi,
this is Nazely Toomarian-- new intern.
[both speaking Armenian]
- OK, everybody, let's huddle up.
- Before we start,
let me address the elephant in the room.
For those of you who don't know,
Jesse tried to intervene
when a federal agent was handling his patient,
and both he and the patient were taken away by ICE.
- Did he punch the guy? - No.
He put out a hand to stop him, made physical contact.
- [softly] It was a little bit more than that.
- The hospital lawyers are on the case,
and we will brief the staff every 12 hours
at sign-out rounds with an official update.
- In the meantime, don't feed the rumor mill.
- You may have also heard that new grad nurse Emma here
was assaulted by a patient. - I--I'm fine.
- Please don't forget "code hula hoop,"
and with risky patients,
always keep a path to the door clear.
- Sounds like one hell of a day.
And we're still dealing with downtime,
so day shift should brief night residents
about the protocol-- [clicking]
[crowd murmuring] - Hey!
- Oh, all right!
[applause] - Oh, thank God.
- Yeah, not so fast.
Every chart from the last five hours
needs to be scanned into the Electronic Health Record
and checked for accuracy...
- Um, whose job is that? - Day shift.
- With a completed and signed T-sheet.
- Are you kidding me? - That's gonna take forever.
- We will set up stations for scanning.
OK, everybody, let's get moving.
- Triage is 20 behind. Gotta help 'em clean up.
I'm skipping rounds.
- Consider yourself lucky.
- Should we join them? - [sighs]
Might as well witness the magic.
It's like changing of the guard at Buckingham Palace.
- Except we're allowed to smile.
- "Smile though your heart is aching."
[machine beeping]
- Plain films, right tib-fib
and right forearm after CT.
- Got the chem-8. Blood sugar's 284.
- That's not too bad. Potassium looks good.
- Mm-hmm. Anion gap's up at 14.
- It was 24 this morning.
He's definitely improving.
- The DKA is resolving.
- So what made him pass out?
- It's hot as hell out there.
He could have been dehydrated from sweating.
Or he could have had an N-STEMI or a posterior CVA.
- Ready to roll.
- I can babysit him at CT. - Thank you.
- I'll stay in case he needs the OR.
- Hey, we're back up.
- It's about time.
- Ooh, Robby. - Yeah.
- I got intel on where ICE has taken Jesse.
- Intel from who?
- Uh, my brother-in-law's a cop.
So he'll be processed at DHS Southside
and then transferred to ICE detention in Clearfield.
- Clearfield? That's two hours away.
- Mm-hmm.
- OK, I'll let the hospital attorneys know.
- How are you doing, Oliver? - Alive and kicking.
- Uh, Mr. Haas.
Pulmonary edema after missed dialysis,
now stable with his son Mason at the bedside.
- Hello. - I'm Dr. Shen.
I'll be back.
- Dialysis tech says
I'm off the machine at 10:42.
- Hit the call light, and I'll come running.
- South 21 next...
Mr. Digby.
- J-just Digby.
- Dr. Mohan's patient.
Forearm cellulitis, admit med-surge.
Awaiting a bed. - I can take him.
- Sold to Dr. Toomarian.
Moving right along.
- Get enough to eat?
We'll be back.
- Lillian Stegman. Tweaked her knee water-skiing.
- Doing a 360 off a 5-foot ramp.
- Ooh, respect.
- X-rays ordered in triage.
- That was hours ago.
- Ma'am, I'm Dr. Crus Henderson.
Let's get you home real fast.
- That would be wonderful. - OK, heading to North.
- Thank you.
- Looks like our first scanning station is almost ready.
Whitaker, Santos, after rounds, this will be your post.
- Seriously? - For...how long?
- Till we mop up this mess.
And away we go.
- All right, now you know everything
there is to know about rounds.
Fascinating, right?
- Uh...yeah.
- Here, I got something better for you.
So, Digby, we're gonna find you some new clothes,
but my friend Emma and I wondered if you'd like
to get cleaned up a bit first.
- I already had a shower.
- I know, and you look good.
But the offer also comes with a shave and a haircut,
if you're interested.
No pressure--like I said,
you already look great.
- Sure, I guess. - Fantastic.
All right, kid, fill that basin with some warm water
and lather him up.
- Hey, stay safe out there. - Back at you in here.
- Hey, Cary.
You were on scene with Orlando, right?
Did you notice anything about his fall?
- Like what?
- Like, um, if there was a break in the railing
or if there were security cameras?
- Too busy working on the guy--
IV, intubation, backboard, splint.
- Thanks.
- Oh, two names is a start.
Pretty soon, we'll retire the clipboards.
- Baby Jane Doe in Pedes?
- Uh, yeah, abandoned
in the waiting room bathroom at 7:30 a.m.
- Safe haven drop-off? - No, she's too old for that.
At least two months. - I'll take her.
- Awaiting foster placement by CYF.
- What if the mom comes back? - Call the cops.
- Day shift, get to work scanning.
Night shift, the room numbers
on top of the dry-erase board need a doctor.
- Who's in BH-1? - Psych hold, danger to self.
- What's the story?
- Doctors King and Langdon were on the case.
- It's a sad story-- she says her 5-year-old
snuck into the back seat of the car to take a nap.
- Heat stroke.
- Mom was extremely distraught. Walked out into traffic.
- Grady Barnhill, wheezing
and not responding to albuterol.
Pulse ox 87. His mother, Naomi.
- OK, Trauma Two's open. - On our way.
Uh, Mom, history of asthma? - His whole life.
Never this bad. - Barely moving air.
- Using all his accessory muscles.
- Call RT!
Uh, continuous nebs, 20 milligrams an hour.
- We have a home nebulizer.
I've been giving him albuterol every hour.
- Ready?
On my count, one, two, three.
- Does he take any other medications?
- Just the albuterol.
He used to be on montelukast and Symbicort.
- Why did you stop that?
- Because he lost his Medicaid two months ago.
- He's so tight, nothing's getting through.
- Mel, EpiPen. - On it.
- 0.3 milligrams.
- That may open his lungs so the nebs can work.
- All right, Grady, shot in the thigh.
- [grunts]
[beeping]
- Hey.
- Something to scan?
- Critical labs on North Three.
- Oh, it's, uh-- it's not my patient.
- She's about to be.
- I'm, uh-- I'm off the clock, so...
- These were ordered three hours ago from triage,
so, technically, she is a day-shift patient.
Just get the intern started.
I got a meeting upstairs with admin
to get things back on track.
- Sorry. Everyone else is tied up.
- That's OK.
How'd you get stuck on night shift
for your first rotation?
- Just lucky, I guess.
- Yeah, if you like a good horror movie.
- [chuckles]
- Where was med school? - Uh, UC Irvine.
- California, right? - Yep.
- Pittsburgh's a little different.
- Yeah, a lot more humidity.
- Yeah, that'll go away
with your first foot of snow.
Uh, hi, Mrs. Davis.
I am Dr. McKay. This is Doctor...
- Toomarian. - Hello.
- Uh, your labs show a lot of inflammation in your liver.
- Is that why I'm so nauseated? - Definitely, yeah.
Have you, um, noticed a change in your skin coloration?
- I've been using this bronzing cream
so I don't look like a ghost in my bathing suit.
- Do you remember the name of the bronzer?
It could have a chemical that can cause--
- Oh, no, no, it's 100% natural.
It's DHA from sugar beets. - OK.
- Why would my liver be inflamed?
- Uh, there's a lot of possibilities.
- Are you taking any prescription medications?
- Not a single one.
- Tylenol? - God, no.
- We have to ask everybody about injection drug use.
- Never.
- Raw clams or oysters?
- I'm a vegan.
- One step at a time, OK?
We'll be back.
- Digby, Haas, now on the big board.
- Progress.
- So he's just been waiting
in the hall the whole time?
OK, well, can you maybe get to him next?
Thank you. [sighs]
Duke goes to CT, and they bump him.
- Yeah, he may end up waiting for hours over there.
- Oh, look at that. 7:15 already.
- Just a few more loose ends to tie up.
- You got more loose ends than a macramé wall hanging.
My mom had one. Took up the whole goddamn wall.
Seriously, you should think about signing out
and hitting the road. - Yeah, maybe you should too.
Oh, that's right, you sent Lena home.
Are you planning on calling in a replacement,
or are you just gonna work till sunrise?
- If I have to.
- Oh, so you get to go the extra mile,
and the rest of us just get accused of being martyrs.
- Robby. - Excuse me.
What's the word? - No subdural, no epidural.
- Diffuse brain swelling with effacement
and compression of the ventricles.
- C-spine? Chest-abdomen-pelvis?
- Uh, left pulmonary contusion, no intra-abdominal hemorrhage.
- Which means I'm off the hook.
I'll send Neurosurgery down.
- If he doesn't need the OR, why Neurosurgery?
- Wait and see. - Let's get busy.
CVP and an art line.
- Orlando. Orlando, squeeze my hand.
[beeping] Open your eyes.
- We already know his GCS is going to be three.
- Hey, Javadi, anti-seizure prophylaxis?
- Keppra, 20 migs per kilo. - Mixing it now.
- Gotta get this brain swelling down, Samira.
How we gonna do that?
Samira? - What?
- We have to lower the intracranial pressure.
- Mannitol. - Not the best.
Can cause diuresis and hypotension.
- Then hypertonic saline.
- 23%. 50 cc's through a central line.
[beeping]
- Still tight as a drum.
- Five minutes since the epi.
- He can have one more EpiPen.
- Sats are borderline, 87.
- How about BiPap? 10 over 5.
- Yes, with in-line nebs.
- All right, Grady, shot number two.
- Might as well throw in some magnesium, 50 per kilo.
- I'm sorry. He's not ventilating.
We should be ready to intubate.
- With an asthma patient?
There's a high risk of cardiac arrest.
- Naomi, has he ever been put on a breathing machine before?
- Never. - Hospitalized?
- No, we could always break him with the Symbicort.
- We're gonna give the current treatment
a few more minutes to help him turn the corner.
[machines beeping]
- I could probably do this myself
now that my cast is off.
- Oh, that's OK.
I don't mind.
- How long have you been a nurse?
- This is my first day.
- You're doing really good.
- Thank you.
- Oh, shit, you OK? - Yeah.
There's water on the floor.
- Sorry! I--I might have spilled.
- Yeah, no worries.
We're gonna have to sort these all by patient
before we scan them.
- Is, uh, Joy still around?
- I heard she left at 6:59.
- Smart girl. - Mm-hmm.
- You know what? Find Ogilvie. He's such an ass-kisser.
He might stay and scan all the charts himself.
- Oh, he, uh, scrubbed in in the OR,
scrubbed in on the ruptured triple-A.
- Oh, the kidney stone that wasn't.
That'll be four hours at least.
So are you still going to Amy's after work?
- Yeah, maybe just for tonight,
after Robby briefs me on all the house stuff.
- Sounds fun.
- [scoffs]
When he asked, it was hard to say no.
- Sure. [sighs]
It's gonna be very weird without him here.
- Yeah.
You think Dr. Al-Hashimi can handle it?
- In a word, no.
- She's smart.
- It takes more than that.
- Yeah, well, at least
it's only three months.
- Yeah, three long months.
Then you need to find a new home.
- [chuckles] Not necessarily.
I mean, if I wanted, I could just check on
Robby's house once or twice a day, you know.
- Why would you do that?
- I don't know. Why not?
[beeping, whirring]
- Hypertonic's in.
- Maintenance LR in the AC.
- Looks like a halo sign.
- Cerebrospinal fluid from a basilar skull fracture.
- The halo sign is neither sensitive nor specific for CSF.
Saline, tap water, and runny noses
all separate from blood.
- Hello, Linda. - Robby.
- Division chief working on a holiday weekend.
- Well, somebody's got to.
Saw the scans. This guy needs an EVD.
- External ventricular drain to take down the pressure.
- Because CPP equals "MAP" minus ICP.
- Cerebral perfusion pressure in the brain
equals mean arterial blood pressure
minus the pressure in the skull.
- ICP less than 22
predicts survival and favorable outcome.
CPP from 60 to 70 reduces morbidity and mortality.
Can somebody assist?
- Dr. Mohan?
- I'm good.
- Samira, you should lend a hand.
- I said I'm good.
- Javadi? - I don't think so.
- Javadi?
As in, daughter of Raymond and Eileen?
I was at your mother's baby shower.
[chuckles] She was a resident.
You were in utero.
I don't know how she got through
motherhood and training.
Feel free to join me.
- Oh, my--my shift was over a while ago.
- OK.
Masks all around. Two sterile gowns.
We brought the surgical towels. Just need some Betadine.
- This is kind of an amazing opportunity.
- I'm exhausted.
- The Chief of Neurosurgery is here.
She's kind of a legend.
- Maybe one of the night residents can do it.
- Is this about the volvulus case from earlier?
'Cause if it is, you made a mistake.
You need to move on.
I do not want to come back here and find that
you've applied for a residency in derm.
Step up to the plate. Do it.
Javadi will assist.
- Excellent.
You know, I think Eileen did her first EVD with me
back when I was a brand-new assistant professor.
[scoffs]
Time flies.
- [raspy breathing]
- How you doing, Grady?
- Still retracting.
- Any improvement? - Not really.
- You feeling tired?
- Do we have Aerogen in the ED? - Just in the unit.
- How fast can you get back?
- Two minutes if I take the stairs.
- Go.
- Uh, Aerogen?
- It has a 5-millimeter mesh
that vibrates over 120,000 times per second.
- Dr. Al-Hashimi?
- You OK?
- Uh, you were telling us about Aerogen.
- Dr. Shen can explain.
- It produces droplets in the 2- to 5-micron range
for medication delivery.
- How's it going? - Just about to start.
- Securing the art line here.
Measure twice, cut once.
We enter 11 centimeters back from the nasion,
3 centimeters lateral.
- Without any direct imaging?
- No, straight shot into the lateral ventricle--
tried and true since 1890.
OK, go ahead with the incision.
- Hey, you worked with Dr. Al-Hashimi at the VA.
- I did.
- For how long?
- During my R2 rotation
and then one again last year.
- OK. Hand drill's all set.
- Maybe you should do this part.
- No, no, there's a safety stop here.
You can't go too deep.
It's not brain surgery.
OK.
Stay perpendicular. - OK.
- Good.
All right, now, four turns
to get through the outer table...
- Yep. - Then half turns
till you penetrate the skull.
- [exhaling slowly]
Three, four.
One...
- Holy smoke!
I thought it was Tom Cruise for a second over here.
Nice job. How's that feel, Digby?
- Pretty good. - I bet.
What do you say we trim up
those gorgeous locks of yours now?
- I don't like having my hair cut.
- I get it, Rapunzel, but you need your ears lowered.
You'll feel better with a fresh summer look
that won't go unnoticed by the ladies.
- Maybe just a trim? - Great.
I'm thinking a pixie cut.
- What? - I'm kidding.
I cut my husband Benji's hair all the time.
Trust me, you're gonna look fabulous.
When's the last time you had a haircut?
- Maybe my daughter's wedding a few years ago.
- Where?
- St. Sebastian,
Our Lady of Mount Carmel Parish.
- Does your daughter know where you are?
- Of course. We all live in Pittsburgh.
In fact, they live in my old house.
- Your daughter lives in your house?
- Yep.
- Where do you live?
- Wherever I want.
- You're gonna pass it 5 to 6 centimeters
from the inner table of the skull, OK?
Centered...
perpendicular...
aiming for the medial canthus.
All yours.
- A-and just keep going?
- You'll feel a pop when you pass
the ependymal lining.
- Art line is calibrated. Good to go.
- Titrate the nicardipine to a MAP of 85, please.
- And if we can get the intracranial pressure
down to 20?
Dr. Mohan?
- I'm sorry.
- MAP of 85, ICP of 20?
- Um, cerebral perfusion pressure 65.
- Which gives him the best shot at survival.
A third of patients like this die.
Half have long-term disability.
We'll know in two weeks if there's a possibility
for a good prognosis.
- Felt a pop.
- Remove the stylet.
OK, let it drain a bit.
And now pinch it shut.
Perfect.
- BP is down, 190 over 88.
Heart rate's 67.
- How are you guys doing?
- Yeah, making some progress.
- You seen Abbot?
- Not since rounds.
- He asked me to see a patient with the night intern.
- [yawning] And you said yes?
- 48-year-old woman, new onset jaundice,
elevated liver enzymes, no history of alcohol use.
- Take your pick--
hepatitis A, B, C, D, or E.
- No risk factors, no fever. - Tylenol?
- Never, and no prescription meds.
- Does she eat polar bear liver?
It can cause vitamin A toxicity.
- No. - Yeah.
- She, uh, doesn't eat meat,
kind of a health nut.
- Well, maybe she's gulping down
cod liver oil to prevent measles.
- No. Vegan, no fish.
Would you, uh, mind laying eyes on her?
- [sighs] Seriously?
- You have a way of figuring out the weird stuff.
- Take the compliment.
- OK, fine.
Five minutes at the bedside-- that's it.
I'm already gonna be here for hours as it is.
- Thank you.
- What am I doing--
- Definitely improving. - Tidal volume's up.
- Wheezes now expiratory only.
- Oh, making some progress.
- You feeling better, baby?
You scared the shit out of me. - Language!
- Does he have a primary-care doctor?
- Not anymore.
- How do you get his prescriptions renewed?
- Neighborhood clinic. We pay cash.
Albuterol's cheap. - Symbicort?
- Without Medicaid, 400 bucks a month.
- Just for a little inhaler?
- Trocar is on the tube. [inhales deeply]
I tunnel underneath the scalp about 5 centimeters
and poke through.
- To prevent infection? - Mm-hmm, exactly.
Now you hold the knuckle steady while I pull it through.
And you can staple the wound shut.
- That looks like something from Home Depot.
- Yeah, big Fourth of July sale.
- The brain pressure is measured by
the height of the fluid column.
We need to calibrate it to zero at the level of the tragus.
- Stopcock's on, ready to attach.
- First troponin's normal,
but you need a second to rule out MI.
- Hey, can you step out for a second?
- I really did do everything I could
to try to make Orlando stay.
- Yeah, I don't doubt it.
I wanted to ask you about
Dr. Al-Hashimi at the VA.
Did you ever notice anything unusual about her behavior?
- Um, like what?
- Lapses in focus, attention?
- No, she was always on top of her game.
But this morning when she was checking labs on Baby Jane Doe,
it was like she zoned out for a few seconds.
Maybe she was just tired.
- [inhales deeply]
[sighs]
- No congestion, nodules,
or cirrhosis.
- Good-looking liver.
- I should not be sick.
I work so hard to stay healthy--
diet, exercise, eight hours of sleep.
- I can't remember the last time I got eight hours.
- Maybe you should try sleepmaxxing.
- Oh, you definitely should.
- Yeah, cold room, white noise, eye shades.
- Kiwis before bedtime, lettuce water, mouth taping.
- Who do you follow for health?
- A few naturopaths and some functional healers.
- Do you--do you buy vitamins from them?
- Oh, no, no, I don't take vitamins.
Food is the best medicine-- kale, blueberries,
kidney beans, turmeric. - Turmeric?
- Uh, how long have you been taking that?
- For a few months. It's an anti-inflammatory.
It detoxes the body, and it can prevent Alzheimer's.
- How much do you take?
- 500 milligram capsules,
but I take five a day.
What?
- With doses that large of turmeric,
there have been cases of liver failure.
- From eating a spice?
- All right, Digby, I think you're good to go.
- Mm-hmm. Would you like to see?
- [sniffles]
I haven't looked like this in a long time.
- Your family won't recognize you.
- Then how will they find me?
They--they won't know what I look like.
They won't know this is me.
- Of course they will.
They know your voice.
They know where you hang out.
They even remember that you used to look like this.
They remember the wedding.
- Did you dance with your daughter
at her wedding?
- I did.
- Then she will always remember you.
- Yeah. - OK.
- Hey, I was just looking for you.
- What's up? - You tell me.
The, uh, asthma patient. - What about him?
- Seemed like you were hesitating
talking about using Aerogen.
I was wondering if you were having second thoughts.
- No. Just thinking.
- About?
- The best treatment plan for the patient.
And I think he's on it.
Anything else? - I don't know.
You tell me. Anything else I need to know?
- I don't think so.
- This is Dr. Robby in the ED.
I'm checking on a patient, Ekins.
- We can take Larson and Stevens off the dry-erase.
- Consider it done.
- He's in the scanner now?
Oh, great.
No, I was just calling to confirm.
Thank you.
Any new information from upstairs?
- Nothing we don't already know.
- Same old story, huh?
- You think we should take up a collection
for Jesse for--for bail money?
- They don't usually set bail
until after you've appeared in front of a judge.
- With the holiday, it's not likely to happen till Monday.
- So he's gonna be locked up all weekend?
- That sucks.
- It does suck.
- Dr. Langdon, Grady's worse-- much worse.
- Need an attending? - Uh, no, we have Shen.
- Sat's down to 83.
- What's happening? - Give us a minute.
- He's tiring out.
Ketamine and rock. It's time to intubate.
- I'll call Volk.
- Ma'am, we have to put a tube
down your son's windpipe
so a machine can breathe for him.
- [crying] Oh, my God.
- Hold on, hold on.
No lung sliding on the right.
- Pneumothorax.
- No need to intubate.
- What's going on?
- He has a collapsed lung.
- There was no history of trauma
that would have caused pneumothorax.
- Glove up, Dr. King.
- In asthma, you can get "air trapping."
When the lungs can't fully exhale,
eventually they overinflate,
causing some of the tiny air sacs to burst.
- How do you fix it?
[rapid beeping]
[air whooshing] - [gasping]
- Like that.
- It's a good thing Dr. Conley was here.
- Yeah. - We should probably try
to find him a Neuro-Critical ICU bed.
We don't want to board a patient like this.
- Mm-hmm. - Hey, Robby.
- Hey, how did the scan go? - Fine.
- It is probably gonna take a little while
to get the results from the radiologist.
- Well, that's not a problem.
Nurse Vivi and I need a little time
to coordinate our schedules over the next few months.
- Really? - Yeah.
I've always wanted to learn
how to ride a motorcycle,
and Duke offered to teach me.
- Well, nobody knows motorcycles like Duke.
- He's giving me the health care worker discount.
- He's quite the gentleman.
Let's get him back to his room.
- How would next Saturday be for you, Vivi?
Uh, maybe we could have some dinner after.
- Dr. Mohan, Lorrie Diaz is here.
She wants to see her husband. She's heading back.
- OK, I'm on my way.
Mrs. Diaz? - Hi.
Did Orlando go up to his room yet?
- No. Um--
- I brought him some dinner from Burgatory.
It's a chicken burger--
no bun, just lettuce.
Figured it would be better than hospital food.
- He's being treated by our top brain-injury specialists.
- Will he wake up?
- We won't know for several weeks.
- And then he could be back to normal?
- Best-case scenario, it would take about a year
before he could be independent at home.
- And the worst case?
- Round-the-clock nursing care for severe disability.
- You let him leave?
- He insisted on leaving to work at his second job.
- You couldn't make him stay?
- He was competent. He knew the risks.
We honored his decision to leave.
- Even if it was a stupid one?
- I tried to stop him.
Offered to get him all the supplies he'd need
to take care of himself at home.
But he left before I could give them to him.
He said he couldn't afford to lose a paycheck.
- Dr. Langdon.
[door closes]
Are you OK?
- Yeah. I'm just kind of, uh...
wondering if I'm really ready to be back here.
- Well, of course you are.
- Ten months is a long time.
I almost killed that kid with an intubation.
Didn't even occur to me to check for pneumothorax.
- There wasn't any trauma to indicate--
- I should have caught it. - OK.
- [sighs]
- You know, I, um...
[chair scraping]
I had a deposition today,
and all the lawyer's questions made me feel like
I was a really, really bad doctor.
We don't always get everything right the first time.
You would have caught the collapsed lung.
And it may have taken a minute, but you would have saved him.
- I'm not sure Robby would agree with you.
He's been riding me all day.
- Well, Robby's leaving for three months.
And, you know, with Robby gone...
I really don't want you to leave either.
That which does not kill me makes me stronger.
- Wow, Friedrich Nietzsche.
- Yeah, Nietzsche, yeah...
not Kelly Clarkson.
- [chuckles]
- Hey, that's a thick one.
- Yeah, Austin Green. Ogilvie's triple-A.
[beeping, whirring]
- Uh, G-R-E-E-N?
- Yeah. Why? What are you doing?
- Checking to see when we'll get Ogilvie
back from the OR.
Oh, shit. - What?
- The guy didn't make it.
He died on the table about 40 minutes ago.
- Then where's Ogilvie?
- Oh, man.
His patient had a CT a year and a half ago
that showed a 4-centimeter triple-A.
- That's too small for surgery.
- He was supposed to come back
every six months for a repeat ultrasound,
but looks like he didn't.
- We would've seen that if the computers were working.
Why wouldn't he tell Ogilvie?
- [sighing] I don't know. Maybe he forgot all about it.
Or Ogilvie didn't ask the right questions.
- Dennis, hey, got a minute?
- Uh, sure. What do you need?
- Teenager with jewelry magnets
stuck to both sides of her nasal septum.
I tried to move them with a plastic curette.
Too much pain, and then there was bleeding.
- Those need to come off before they cause permanent damage.
- Yeah, you think, uh, you could find, like,
a senior or an attending?
We're really trying to get off the clock here.
- They're all busy.
- I already took one for the team.
- Yeah, fine.
- Uh, labs on your yellow lady.
- INR is elevated, 2.2.
- Liver's in trouble but not dead yet.
- Tell her to skip the turmeric.
Admit for monitoring, and follow the LFTs.
- Got it. - Mm-hmm.
- Central 10? - Yeah.
- "Sleepmaxxing"? Really?
- I track the online trends.
- Is that your secret for the tough ones?
- I just think,
what's the stupidest thing this person could have done?
Then assume they did it.
- Well, I mean, she was trying to be healthy.
- Yeah, by taking advice from fools.
- Turmeric is recommended by a lot of doctors.
- Yeah, then ask your doctor for the dose
or check someplace reputable, like the CDC.
Oh, right, I forgot, it's now a medical toxic waste site.
- I mean, she's in pretty bad shape.
If things get worse, she could need a liver transplant.
- Yeah, 'cause she's a big fucking idiot.
- Wow.
- No, I actually appreciate her.
Our job security depends on all these big fucking idiots.
- OK.
- Uh, good night, Perlah, Monica.
Good night, Dr. Robby. - Good night.
- Bye, Emma.
- You could stay to pitch in.
- Mm, Dana told me to go and get some rest
before tomorrow's shift.
- Yeah, you had quite a day.
- Wasn't so bad.
- Why can't I find Duke's results?
- Oh, new patient, no EHR yet.
- I can run over to Radiology, get a printout.
- Thank you, Monica.
- Ready to pick up a few more.
Orlando's all tucked in for now.
- How's he doing? - Numbers are good.
CPP 22.
- OK, so he's got a shot at a decent outcome at least.
- You think he has a chance?
- Oh, I don't know that survival was
the outcome he was hoping for.
- What?
- He told Samira he's got $100,000 in medical debt,
that his life is probably-- - Mrs. Diaz!
How can we help you? - The bathroom?
- Uh, yeah. Perlah can show you the way.
Not a great idea to have a private conversation
about a patient in a public area.
- I know. I know.
- You were about to start yapping--
- But I didn't!
- OK.
And how long have they been in there?
- At least two hours.
- How did it happen? - With my earring.
It was supposed to be, uh, red, white, and blue
to look cool at the fireworks.
- I told her for the nose, one side only,
but she never listens.
- This can be pretty serious.
If we don't get them out quickly,
it can cut off the blood supply
and cause the septum to collapse.
- Like, my nose could be deformed?
Oh, my God, get them off. - Yeah, that's the plan.
- Yeah, she tried already. It hurt like crazy.
- Because they're stuck together
by a very strong magnetic force.
- Yeah. - No, no, no.
- Oh, uh, I'm not gonna use the tips.
I'm gonna flip it around and use the handle.
- It's still gonna hurt.
- Probably not.
Just, uh, hold still.
OK.
[sighs] Voilà.
- Really? - That was amazing.
- I think another half hour,
we can send this dry-erase board back to storage.
- With pleasure.
- Dr. Robinavitch? - Yep.
- Results on your friend.
- Fuck. - Duke?
Are you gonna tell him?
- I want to talk to a surgeon first.
- Uh, Dr. Robby, I have an update on the patient.
- Now is not a great time.
- Oh, I thought you were going home.
- Uh, I was.
Dr. Ogilvie is just sitting
out in the ambulance bay covered in blood.
- Sorry, what-- what's he doing out there?
- Kind of, uh, staring off into space.
I tried to talk to him, but it was like
he couldn't hear me. - Monica,
can you stat page CardioThoracic?
- I'll go check on Ogilvie. - Please.
- Oh.
[sighs]
Hey, Ogilvie.
Ogilvie...
y-you OK, man?
[sighs]
- 99 on 2 liters.
- Scattered end expiratory wheezes.
- He is so much better.
- The steroids should kick in soon.
- So he'll keep improving.
- Um, when can I go home?
- In a day or two.
And we will, uh, discharge you with a Symbicort inhaler.
That should last about a month.
- Hopefully we'll be back on Medicaid by then.
- How'd you lose it?
- They sent a redetermination letter to our old apartment.
It didn't get forwarded.
When I went to pick up his prescription,
pharmacist told me we were no longer covered.
- And you haven't been able to get it back since?
- I've been trying for months.
To get re-enrolled, you need tax returns,
pay stubs.
I cut hair. My income fluctuates.
A lot of my regulars are struggling,
so it's been tough.
- Well, if you run out of Symbicort
before your Medicaid kicks in, you can come back,
and we'll, uh, set you up with another one.
- Oh, is there a patient in here?
'Cause everyone in this room looks extremely healthy to me.
- Dr. Shen and I will be with Grady all night long.
- Yeah. Day shift, we got this.
- We're leaving you in good hands.
- Um...
I was really scared.
Thank you.
- You're very welcome.
- Due to his injury, things have changed.
- I was looking for Dr. Abbot.
- I haven't seen him for a while.
- Excuse me.
[door opens]
- So now, with a long-term disability,
things may be easier.
- "Easier"?
- His condition will qualify him
for Medicare and Medicaid.
So, moving forward, costs should be covered,
including home health care.
- OK.
- Perhaps this isn't the best time--
- I just wanted to reassure you
about future costs.
- Robby.
- Noelle.
- You're still here.
- It's not the best day to try to get out on time.
- Mm.
So I guess this is it for a while.
- Unless you want to come with me.
- No, but thank you,
even if it isn't a legitimate offer.
- What do you mean? - Oh, please.
I know well enough not to get in between
a man and his vision quest.
- "Vision quest."
- That is my nice way of putting it.
- I probably don't want to hear
your not-so-nice way of putting it.
- No, probably not.
I-I hope that this is not, um...
about you running away from me.
I'm a big girl.
You can tell me just to get lost.
- This has nothing to do with you.
- Oh, right.
It's the old, uh, "it's not you, it's me"?
- In this case, it's actually true.
- Excuse me.
- I'll see you next week?
- It's a three-month sabbatical.
- Like I said, I will see you next week.
- My first day here as a med student...
there was a patient.
[sighs]
He was a real nice guy,
came in with belly pain.
I saw a gall stone on the ultrasound,
normal EKG, troponin.
The pain resolved, and he was in the hall
when he had a cardiac arrest.
I couldn't save him.
People die.
And we do the best we can...
but people die.
- You ever get used to it?
- [chuckles] No.
No, you...
you try to accept it.
You try to find balance.
- I don't know if I can take another day like today.
Primary care specialty sounds way better.
Pedes, maybe.
- Yeah, maybe.
I know I'd be bored out of my fucking mind.
Seriously, I like the challenge of undiagnosed illness,
of quick decisions, of life-saving procedures.
And I like being here for people
on the worst days of their lives.
[clears throat]
You know what I think?
- What?
- I think you should go home.
I think you should sleep on it.
And I think you should at least wait
till the morning to decide
if you want to come back.
- I don't really want to...
go back in there and see anybody.
- Yeah.
OK, pull off your gown. I'll take it in.
Shift is over.
Go home.
[indistinct chatter]
- Oh! - [gasps] Oh, God.
- No, I'm--I'm-- - Sorry.
- I'm good. I'm good. I'm good.
- There's a dummy in a wheelchair.
- Uh, yeah, he moves around.
I see I've been replaced.
- Oh, did I take your spot?
- Not really, no. - Are you sure?
- Where the hell have you been?
- I found Ogilvie.
- And?
- And he's going home.
- That's it?
- It's a long story.
- Well, I got nothing but time.
- I need to respect his privacy.
- Where's the fun in that?
- Beep. Beep, beep. [chuckles] - Sorry.
[whirring]
- Um, the shredder jammed.
- Yeah, uh, try putting it in reverse.
[whirring]
- Perfect.
- Just give it a little love tap.
- OK. - Kick it.
[banging]
Jesus Christ.
[laughter]
- Guess Mr. Digby got a room upstairs.
- In your dreams.
- He's not in South 21.
- Yeah, he is.
- There's a new guy in the bed.
- Short hair, clean-shaved?
I'll take care of it.
- Scout film showed obvious pathology,
so we ordered the CT angiogram.
- Textbook ascending aortic aneurysm.
Eight centimeters.
50% one-year mortality.
- So he definitely needs surgery.
- If he wants to live.
- OK, well, he's a friend,
so I will talk to him.
I'll get him admitted to your service.
- Not today. - Why not?
- He needs to see Cardiology and Pulmonary first
to be cleared for the OR.
They can do a stress echo, PFTs.
- He needs to be admitted and evaluated as an inpatient.
- Nothing ever gets done over a holiday weekend.
He can take it easy at home.
- He's a ticking time bomb.
- He's probably been that way for years.
We can get him in early next week
with a specialist to get his testing done.
All goes well, he's on the OR schedule in a week.
- What happens if it ruptures before then?
- Call 911.
Sorry, Robby. Best we can do.
Text me his number. I'll have my office coordinate.
- Fuck! - Hey!
Take a walk. Come on!
[bell dings] - Two for discharge.
- Yeah, please don't ring the bell.
The computers are back up and running.
- Not for these two.
They don't have electronic health records yet.
- Wait, hold up.
This kid had a wrist X-ray ordered.
Ugh, it never happened.
And water-skiing lady's
still waiting on a knee series.
- I canceled the X-rays.
Diagnosed them both with ultrasound.
- Really?
- Yeah.
The, uh, little boy had a simple buckle fracture.
Distal radius. He got a Velcro splint.
And Mrs. Stegman had a small medial meniscus tear.
Knee immobilizer, crutches, and a follow up with ortho.
- Could have used you on the day shift today.
- They don't teach us a lot of musculoskeletal ultrasound.
- I know.
That's why I did electives at Harvard and Highland.
- Are you applying for an ultrasound fellowship here?
- I am, but it is so competitive.
- That's what I hear. - Kind of a long shot.
I only have one publication,
but it's a series of case reports diagnosing
shoulder dislocations with ultrasound only.
If you want to learn some MSK, you can tag along.
I got three more to scan.
- Maybe some other time.
- Cool.
[whirring]
- Hey, don't jam the shredder.
What is that, two charts?
- No, it's my ultrasound fellowship application.
- Hey.
Uh, sorry about your patient.
- Yeah, Orlando's in pretty bad shape.
- Oh, no, I--I was talking about
the triple-A guy you worked on with Ogilvie.
[sighs]
He didn't make it through surgery.
I tried to talk to Robby about it,
but I think he's busy.
- Excuse me.
- [sighing] Oh, shit.
- You think I'm on edge?
First you're shaming Samira, then McKay--
- They both needed to be called out
for unacceptable behavior. - Yeah?
Yeah, well, you do that in private.
Same place you share your thoughts
about a patient's possible suicide.
And slamming stuff? Please.
Sign out all the shit that's bugging you
and get out of here.
- I can't. - Yes, you can.
When either of my kids was acting like this,
I gave them a time-out in their room.
- Whoa, whoa, whoa, you're not my mother.
- Yeah? Well, too bad.
You need one. - No, I had one.
She left. I don't need another one.
What I need is someone who can actually run this place
while I'm gone. - OK, I'm sorry.
I didn't know. - Nobody knows.
Who needs to know? Who gives a fuck?
- I think you need a break.
- That is what the sabbatical is for.
- Then start it now. Walk away.
- I have too much to do.
- Let someone else talk to Duke.
- No, that needs to come from me.
- Why?
- Because I owe him that.
It needs to come from a friend, not a stranger,
otherwise he's gonna bail and drop dead while I'm gone.
- OK, wrap that up and then leave.
- It's not just Duke.
I'm not sure that Al-Hashimi is fit to run this place.
- What's that supposed to mean? - I'm not sure.
I'm trying to figure that out.
Did you know that she wants to have two attendings
on at all times? - No.
- Is that something she's worked out with Gloria?
- I don't know. - I also don't know
if Langdon is going to relapse.
I don't know if Whitaker's gonna be able
to take care of my shit.
I don't know if Javadi's gonna give up on
what she's good at or if Samira's gonna flame out
because of some bullshit with her mother.
- Is there anything else? - Yeah, you.
I don't know about you running around
with a full syringe of Versed in your pocket.
I'm worried about the people that I care about.
- We'll all manage until you come back.
We always do.
- Yeah? What if I don't come back?
[pensive music]
♪ ♪