[indistinct chatter]
- What's up, Ghost Rider? - You good?
- Never better.
- OK, kids, bye-bye time.
Thanks for the trip down memory lane.
Um, where's Evans?
- Uh, I think she's by the family room.
- She is.
- Hey, hey, hey, where are you going?
I'm not gonna scan all this by myself.
- Cruz has a question on my cellulitis.
I'll be right back. - You better.
- Two minutes tops. - Where's Mel?
Where's Donnie?
They should be helping you. - I don't know.
- OK, day shift, listen up.
We're doing really well, but we still got a ways to go.
And nobody's going home until all these paper charts
are digitized, including me.
- And then we're free to celebrate our freedom?
- Exactly.
- Well, can you kick some ass
and get the staff to hurry up
on the EHR home pages?
- Where are Larry and Antoine?
- Antoine's fighting on the phone
with his girlfriend outside.
And Larry's on a cafeteria run.
- Yeah, that tracks.
- We've got five patients in beds waiting to be seen.
How do you want to play this-- man to man or zone?
- The zone.
Have Cruz and Ellis split up the new five.
You take North and Central.
I'll take South and Trauma. - Cool.
Want to switch at 1:00 AM?
- Why?
- Variety is the spice of life.
- I thought that was garlic.
- Oh, sorry.
[sighs] I told you I'd be fast.
OK, let's do this and get out of here.
- What's the hurry?
Got some hay to pitch?
- Ha.
[bell chimes]
Oh, shoot. - What?
- Uh, my ID badge is missing.
- Oh, no. The one you just got?
How'd you lose it?
- I don't know. It must have come off.
- Classic.
Hope you remember your login and password.
- OK. Retrace your steps.
Where'd you have it last?
- Uh, I was with Ogilvie in the Ambulance Bay.
- Not with Colonel Mustard in the library?
- Who's--what?
No.
- The boy has no clue.
[machine dinging]
- Please don't do that.
- Oh, ma'am, I gotta go.
I sit here any longer, I'm gonna get bedsores.
I--I'm supposed to get some CT results.
Any idea how much longer that's gonna be?
- Shouldn't be much longer.
- Where's that Nurse Vivi?
- You don't want any of that.
- No? - No, she's out of your league.
- What league do you think I play in?
- Uh, old timer's night. - [laughs]
Yeah, you're probably right.
But some teams still appreciate a veteran presence.
- Well, don't say I didn't warn you.
You are here for your heart, after all.
- My heart's been broken before.
What's one more time?
- Uh, she's engaged to a jujitsu instructor.
- With a bang, not a whimper, baby.
- [laughs]
- And it's a cool bath a couple times a day
for two days, followed by aloe vera to your skin.
- OK, that's it?
- And sunscreen in your future.
- No, I'm never going outside ever again.
- I wouldn't swear off the sun entirely, you know?
But like most things, moderation.
- Hey, we're getting kind of shorthanded
scanning charts out here.
When you finish, can you come lend a hand?
- Yeah, happy to.
- Thank you.
- And by happy to, I mean there is nothing
I would rather do less.
- They keep you pretty busy.
- Yeah, and today has brought some new challenges.
This is really putting a crimp
in my 4th of July evening plans.
- You're going to see the fireworks?
- Uh, no, I was gonna maybe meet up with this guy,
though that's sounding less appealing
than the three Bs at this point.
- The three Bs?
- Book, bath, and bed.
- College kid with mono and hemorrhagic tonsils,
admit med-surge or observation?
- Uh, observation.
Bleeding stopped with TXA.
She's had steroids, so should be
ready for discharge in the morning.
- Cool.
How was your first shift back?
- Uh, slow start, finding my rhythm.
- [chuckles]
You a little rusty, Rusty James?
Now you won't have Motorcycle Boy to big brother you.
- Is that a "Rumble Fish" reference?
- Sure is.
- And Robby is my big brother in this analogy?
- Bingo.
- Yeah, I wouldn't say he's been
looking out for me exactly.
I think he'd probably prefer
not to see me at all today, actually.
- And you think that's because he's mad at you?
- I think he feels like I let him down, because I did.
- Jesus, with all the martyrs around here,
you'd think this was a passion play.
- What's your take?
- I worked with that man for 10 months
while you were gone.
He's not mad at you.
He's mad at himself for failing you, Rusty James.
- Really?
- [sighs]
Just more White Knight/White noise.
That's how it is.
- Share this video with your friends if you can.
Thank you so much.
Be kind, be safe, be brave.
- What you doing?
- Dr. Robby, sorry.
I was just--
- One of your TikToks? Yeah.
About those, listen, I'm not so sure that--
- No, no, I was just sharing-- - No, I get it.
I just--you know, we do have HIPAA laws here.
We don't let anybody film--
- I would never violate any HIPAA laws, Dr. Robby.
I swear it. - I understand.
Even still, we're getting behind
on scanning patient charts.
So how about no TikTok
on the company clock, Dr. J?
- Dr. Robby, I think you're--
- Out of touch? Probably.
You wouldn't be the first to accuse me of it.
However, when I was in medical school--
- You didn't have cell phones or TikTok
or internet or ICE agents coming in here
and taking away patients and staff.
I get it.
- We did have cell phones, maybe not in the beginning.
Where do you think you're going?
- Uh, home.
- I kind of need you to hang out a little longer
and help digitize some of these analog patient records.
- Normally, I would, truly.
But I gotta get home-- wife, baby, bed.
- OK. Go get some rest.
You sure you're OK to drive home?
- Absolutely.
Just enough in the tank.
- Don't tell anybody I let you go.
- Deal.
Safe travels.
Be sure to send some pictures from the road.
- Fight over at Zazu's Sports Bar.
The two combatants are pulling up soon.
One's a stabbing.
- Ellis, double trauma coming in.
Grab the easy one.
Bring the stabbing to Trauma 2.
We will get the room set up.
- All right. Roger.
- OK, darling, time for this dinosaur to head to extinction.
- Got us through a real jam today.
Can't thank you enough, Monica.
- Nice place to visit.
Wouldn't want to live here anymore.
- Oh, me, neither some days.
- But hey, Virginia Slim,
you've come a long way.
Glad I was wrong about you.
Keep training 'em up right.
- I'll try.
- OK, that's enough mush.
Back to my life of mahjong and margaritas.
Bye, Evans. - Get home safe.
- I will. See ya.
- Bye.
[sighs] She's right.
You are the mama bear glue that holds this place together.
Hey, you OK?
- No.
I'm sad or scared,
or some fucking thing.
I'm worried.
- What's going on?
- Robby. I got a bad feeling.
He's...
it's like I'm never going to see him again after tonight.
- Did he say something?
- Yeah, he said a lot of things.
You should talk to him. He listens to you.
- He's a grown-up.
He just needs to go on a vacation.
- Can't you at least try
to get him to promise to come back in one piece?
- He doesn't like to listen.
- So make him.
- [sighs]
- Fuck it. Check my DMs.
She hit me up.
Sure, baby. I didn't even respond.
[siren wailing] - Scavenger hunt?
- Yeah, something like that.
You need a hand?
- Nope. You do you.
What do we got?
- Barrett Dunkle, 34, decent vitals
given he has Old Glory jammed in his chest.
Satting 91 on 15 liters, BP 132 over 87,
tachy at 112.
- Dr. Abbot's expecting you.
- Whoa, whoa, whoa, whoa, whoa, man!
- What the fuck? - I'll call you back, baby.
- Shit.
I thought I cleared it.
Was it sticking out?
- Sticking out, my ass!
Man, this is on you.
You went wide, and you clipped the shit.
- Bikes shouldn't be parked there.
It was sticking out. Had to be.
- Ain't no fucking way.
Oh, no, you paying for this.
Either you or the city, but you paying for this!
- Seriously? We don't need this hassle.
- I know. I know.
Fuck! How bad is it?
- Not really good.
- Fuck!
- Is that you, you motherfucker?
- Yeah, you better believe it!
I'm gonna take this thing out of my chest
and shove it up your fucking ass!
- You hit me with a fucking Rolling Rock, man.
So you got Iwo Jima'd!
- You fucking cheated, man.
Every detail must be--
- OK, say bye-bye, gentlemen!
You're on different health journeys now.
- I'm going to go see Ahmad.
It's all gonna be on the security video.
- Robby's gonna shit.
[grunting]
OK. [panting]
Hey, a little help?
- All right, he's going straight to Trauma 2.
What is his story?
- Bottle to the face, strong vitals,
12-centimeter facial lac.
Yeah, where do you want us?
- North 4 just got cleaned. - To the North.
- Abbot, single MVA en route. Five away.
- Olive, can you find Robby and Al-Hashimi?
We may need a couple more hands
until we get caught up with these two.
Sir, we are gonna get you more pain meds...
- It hurts.
- But you need to shut your fucking mouth.
- The acronym is SMART,
Single Maintenance and Reliever Therapy.
It's one inhaler that combines an inhaled corticosteroid
with a fast-acting, long-lasting beta agonist.
That's fancy talk for an anti-inflammatory
and a lung muscle relaxer all rolled into one.
- But it's $400. And without Medicaid--
- We can help you look into coverage options.
- Thank you. - Of course.
- Grady should feel worlds better in a few hours.
- Thank you.
- So what are my chances of getting off the table alive?
- Once you're cleared by the heart and lung specialists
next week, chances of death are low, like 1% or 2%.
- And how long would I be in surgery for?
- Between three and five hours.
- Jeez.
- It's long... [clears throat]
Because they have to stop your heart.
You will be on a heart-lung bypass machine,
which will be circulating your blood while they repair
the aneurysm with the graft.
- Well, what's the graft made out of?
- A synthetic fabric called Dacron, super strong.
- OK.
New hoses, new gaskets.
Then what happens after surgery?
- You will be in the hospital for about a week.
No work for eight weeks after that,
no strenuous activity,
no lifting anything over 5 pounds.
- How am I supposed to take a piss?
- Nice.
- [sighs]
And how long till I'm back up to full speed?
- Three months, maybe more like six, given your age.
- And if I don't get the surgery?
- 50% chance of death within 12 months
if the aneurysm ruptures.
- What would I feel if it ruptured?
- Some chest pain, maybe some shortness of breath
for about a minute before you passed out from blood loss.
- And then?
The big fade out?
- Roll the credits.
- [breathes deeply]
Quite the coin flip.
- No coin flip. This has to happen.
But I do worry that you are not gonna make your appointments
or follow your aftercare instructions if I'm not here.
- Sorry, Robby, Abbot asked for me to grab you
for an MVA on route.
- Do what you gotta do, man.
I gotta sit with this for a minute.
- You go ahead and get dressed.
I'll come back.
- [speaking Spanish]
- Monica got an ICU bed upstairs
so we can take Orlando up now.
- We'll prep him for transfer. - Thanks, hon.
We need this room again in a minute.
- [crying]
- All good?
- Uh, totally.
- Uh, totally?
- Look, once more, I feel compelled
to offer some unasked for and probably unwanted advice.
Javadi wasn't making a TikTok video.
She's been posting about Jesse,
trying to find someone who knows where he is.
- Ah.
- And even if she were making one of her videos,
you ever watched one?
- No.
No, my account was suspended
for erotically seditious content.
- Well, they're not what you think.
They're actually kind of cool.
It's like this badass self-care.
- Huh.
- OK, that is it.
I'm going to bury myself in charting
and try to dig my way out.
- Edith Lynch, 46,
right-sided chest pain for an hour.
No cardiac history,
minimal relief from sublingual nitro,
no STEMI on the 12-lead. - Dana?
- South 15.
- Hi, Edith. I'm Dr. Al-Hashimi.
We'll be taking care of you today.
- Absent lung sliding on the right.
- I could have told you that from here.
God bless America.
- Hemodynamically stable.
I'll put in a 20 French, and then right up to the OR.
- Whoa, whoa, whoa! Hold on!
I need surgery?
- Sir, you have a collapsed lung.
We need to put a tube in your chest to see
how much internal bleeding there is.
- Oh, come on, man, just pull it out!
- Nuh-uh. - No.
- OK, everyone knows what to do here, right?
We're gonna take this at a nice slow pace, moving together.
If anyone has an issue, speak up.
There are a lot of moving parts here.
- Are they going up to ICU finally?
- Yes. - Great.
How you doing?
- Is that a trick question, or--
- Not intended to be, no.
- Then not great.
This one got past me.
- Well, listen, you tried to find a viable payment plan.
You tried to keep him here.
You even tried to give him a goodie bag, but he left.
I'm not sure what else you could have done.
- Been more persuasive.
- This was the patient's call-- his life, his mistake.
- What mistake, getting diabetes?
- Not picking a higher spot to jump from.
- History of hyperlipidemia,
an hour of substernal chest pain,
minimal relief with nitro and 4 of MS.
EKG is negative for STEMI.
Heart score is 4, gave 324 milligrams of chewable aspirin,
admit for new onset angina.
- Don't mind me. I'm just passing through.
- Seemed like you wanted an update.
- Well, as long as you feel like you got it covered.
- I do.
Go ahead and repeat the 12-lead.
- Since I'm here, I did want to ask you about something
I observed earlier.
Oh, you gotta be fucking kidding me.
- What?
- Look where these anterior leads are placed.
They're way too low. [sustained beep]
- Holy shit! What's happening?
Mrs. Lynch? V-tach!
- No pulse.
Charge to 200. [machine whirs]
- Charged.
And clear.
[rhythmic beeping] - OK. Normal sinus.
- Strong pulse. Cycle a BP.
- Let's repeat that EKG, please.
Put the leads in the right fucking place.
Who were the medics on this? - Bosco and Otero.
OK, Bosco and Otero.
- See you on Monday.
May your night go smoother than my day.
Happy 4th.
- Heard it's been crazy. They shut down when ICE came.
- Separate events. Get someone else to explain.
I'm going home.
Damn, what is that? That smells good.
- Food from home.
I can't do the cafeteria.
- Oh, you gotta give me that recipe.
I'm going home. - Get home safe.
- Mm-hmm.
[indistinct chatter]
- Hey. - Hey.
- I'm starving. - Of course.
- I will give you $20 for whatever that smell is.
- [chuckles] I'll give you some.
I made too much anyway. - Thank you.
- Just give me a sec. - Yeah.
- How can I help you?
- My granddad just about cut his hand off
with a tug-of-war rope.
- Hi, I--I remember you from earlier.
You're having a family reunion, right?
- Yeah.
- Is your hand actively bleeding?
- Oh, not so bad. Here, take a look.
- Mateo, one to come straight back!
- Oh, my God. - Cover that up, please.
I'll need to get a demographics from you.
- You got them already.
Hansens been in and out of here all day long.
- How did this happen?
- He had the rope wrapped around his hand,
cut through it like a machete.
- Have a seat, sir. I'll take you right back.
- And how would you rate your pain on a scale from 1 to 10?
- Oh, it's not too bad on account of my sugars.
- With his diabetes, his sensation's a little off.
- Yeah.
- After you.
- Thanks.
- Ow. What the fuck?
- Trigeminal nerve is good.
- Shit! You gonna fix me or torture me?
- Ooh, ouch!
- Yeah, I need to call plastics.
- I called a "kiss off the two, off the rail."
Fucker said I didn't call it.
Okay, yes, it was a bit noisy. The fourth is Styx night.
But I called it. I have witnesses.
- Styx, the band?
- Yeah.
- Ah, love Styx.
- I never heard of them.
- You never heard of Styx?
"Mr. Roboto"?
- My Spotify age isn't 62. - [sighs]
"Come Sail Away"? "Lady"? "Babe"?
[groaning]
- Yeah, maybe best if you don't talk.
Looks like there's some sort of foreign body in there.
- Mm-hmm.
Are you OK?
- Yeah, it's just an awkward position.
- Go home. Rest, heat, ice.
- Yeah, no, no, I know.
I'm just waiting for things to slow down.
- You know, express trains don't stop at your station.
You just gotta jump.
- What is that?
Heineken?
Moosehead?
- Oh.
From the glass-lined tanks of Old Latrobe.
- Ah, Rolling Rock.
Nice.
- She's had four of morphine.
How's the pain?
- Down to an 8.
- There it is, lateral STEMI.
OK, call it in.
- The leads were too low to catch it?
- Yeah, it's not the first time it's happened.
You get a male medic who's more concerned about
getting sued or a complaint for undoing a bra.
You see these anterior leads here?
- Code STEMI, South 15.
- Edith, you're having a heart attack
from a blockage in the artery
that brings oxygen to your heart muscle.
If we get you to the-- - Lateral STEMI, V-tach arrest.
Got her back after one shock. She needs the cath lab.
- And serious heart damage. - Oh, my God.
- You're going to be OK. - Hello, I'm Dr. Cruz.
- And I'm Dr. Shen. How are you feeling?
- I'm really scared.
- We've got you. Anything else?
- Uh, like I got kicked in the chest.
- Normal after a shock to the heart.
Family? - Yeah, husband's en route.
- Leave the defib pads on and take her up in a minute.
I'm gonna chaperone a nerve block real quick.
- Go.
- Where's Dr. Al-Hashimi?
- She was just here.
- Hello, everyone. I'm Dr. Shen.
Heard a rumor someone needed a nerve block.
I'm guessing that's you.
- Probably so, although,
you know, I don't have much pain.
I guess it's my diabetes.
- We still need to numb you up to do a proper deep clean.
- You guys do whatever you gotta do.
- Three shots, median, ulnar, and radial.
2 grams of Ancef, 100 milligrams of Gent
for gram-negative coverage.
How'd you do this?
- Oh, a family reunion tug-of-war.
I wrapped the rope around my hand for better grip.
And when we fell down, those bastards just kept pulling.
- Dirty.
- Nah, it's just-- just the way we play.
[laughs]
- Michael, you got a second?
- Uh, not really, no.
- Well, how about showing me a little respect
and finding one?
- Sorry, Caleb.
Are you feeling disrespected?
- Given that you've been actively blowing me off
all day, yeah, maybe a little bit.
But I have a thick skin.
- What can I do for you?
- "Should have found a higher place to jump from."
It's an interesting diagnosis, Doctor.
No pithy retort?
Yeah, I didn't think so.
Uh, I just came to say goodbye.
I'm leaving soon.
I know you are too.
- Yes.
- Keep my number handy, just in case, huh?
- Yes, I promise I will.
Thank you, Caleb.
- We're gonna give you one Diflucan pill to take home.
Take it in three days if your symptoms persist.
- How do I get there?
- Where's that?
- Home.
- Do you know where you live?
- Of course I do. It's not far.
But I don't have a way to get there.
- How'd you get here?
- My--my neighbor Gwen dropped me off,
but she can't drive at night.
- We could call you an Uber or a taxi.
- I don't have any money.
- Excuse me.
Can I help?
- Mrs. Clymer has been discharged,
but has no way home.
- I'm so sorry.
I don't mean to be a burden.
- No burden at all.
Why don't we call you a Lyft?
- What is that?
- It's like a taxi service.
If you put your address in here,
a car will arrive in a few minutes to bring you home.
- Oh. - My treat.
- [laughs]
That's very kind of you, truly.
- Perfect.
OK, Olive, could you take Mrs. Clymer out
to the ambulance bay, where Florian will be
arriving in six minutes in a white Toyota Camry?
- You bet.
- Thank you.
- I could use some good karma.
OK.
Oh, uh, hey.
- Relax, buddy.
It's Advil.
- No, I didn't think you were--
[sighs]
Headache?
- Uh, I tweaked my back a little
lifting that overheated kid.
I guess I should get used to
playing through the pain again, huh?
You look like you got into shape since I saw you last.
Didn't peg you as a gym guy.
- Oh, no.
I'm maybe more of a barn guy. [chuckles]
I'm helping out a friend on the farm, so...
- Nice.
I'm picturing "Babe,"
except instead of Farmer Hoggett, it's you.
And instead of a pig--
- Can you cut the shit?
- Excuse me?
- The sarcasm thing, the--the--the--
the little buddy routine, like--like--like,
you're what, you're the Skipper, I'm Gilligan?
Dude, you're not the Skipper.
- I know I'm not the Skipper. Robby is the Skipper.
- No, Robby is the Professor. Dana's the Skipper.
- OK, somebody's watched a lot of Nick at Nite.
So who am I?
- Play whatever part you like.
Just don't pick mine for me.
- OK.
OK, that's fair.
You got it.
- Thank you.
- You headed home?
- Uh, no, I'm waiting on Robby.
He asked me to house-sit while he's gone.
So I'm waiting for the keys, the alarm code.
- Nice. Nice.
Yeah, I've-- I've seen his place.
You're in for a sweet setup.
- Cool.
I'm sorry if I came across a little strong.
- Don't apologize for standing up for yourself.
It's a healthy habit.
- [sighs]
- You know, I really don't need to see this again.
- No, this is my favorite part.
[laughs]
- My hand's starting to cramp.
We gotta be done soon.
- Oh, you can be done now.
But if you want to the hospital to cover you, last one.
- Hey, Robby. It was an accident, man.
- What are you talking about?
- Your bike.
[sirens wailing]
- Son of a bitch.
Oh, motherfucker!
- Robby, GSW to the head.
- Somebody hit my bike.
- Dude, that sucks.
Is it still rideable?
[man singing "My Country 'Tis of Thee"]
- It better be.
- Elbridge Gerry, 25, stable with good vitals.
- ♪ Of thee I sing ♪
- Was shooting his .22 caliber pistol in the air
with an aluminum pot on his head for protection.
Didn't work.
- He's had about a quart of Seagrams 7
and will probably light up a tox screen
like a Roman candle.
- ♪ We start fucking ♪
- Real wordsmith.
- Entry wound in the frontal scalp,
seems to have tracked down the forehead.
As alert and oriented as you can be
after multiple bong hits.
Got vital satting 98 on room air.
- Sorry, Robby. - Don't you fucking leave.
- I can explain. - I will be right back.
- What's this?
- Trauma 2.
- Low velocity GSW to the head,
seems to have remained extracranial.
- Lucky guy.
- ♪ Gloria, Gloria, here's a dollar! ♪
- After a fireworks explosion resulting
in the loss of two fingers.
- Ooh, that sounds nasty.
- Yeah, that was a sad one.
Parents were deported.
Big sister works a full-time job
and is the sole caregiver.
- Been there, done that.
- Your parents were deported?
- Oh, no. I thought she said departed.
Did either of you guys work on
the Revolutionary War reenactors earlier?
- Why, you didn't think you could pull off a tricorn hat?
- [chuckles] Maybe.
I've always loved history,
and Colonial Williamsburg was my favorite school trip.
And, you know, there's always the Ren Faire,
but that's just once a year.
How often do you think the reenactors get together?
- I don't know. No.
- You should definitely look into that.
- Yeah? - Yeah.
- OK.
[engine revving]
- Deep-throated husky with a touch of bitch.
That's her tune.
- That's what I thought, but you're the expert.
I just needed to make sure.
- I was going through Billings once.
Cop saw my colors, jacked me up,
kept me overnight.
They threw my sweetheart in the impound yard.
They claimed someone backed into it,
but you could see where they took their hammer to it, man.
You gotta be careful out there.
- This is all pretty minor, though, right?
- Yeah, shit, this is just cosmetic.
Bring it in tomorrow, and we'll get Bonnie right.
- Well, this will bend back. This will tighten up.
I can do all that myself. - Jesus, let me do it.
There's no charge. - What?
You don't owe me anything, except
take care of yourself while I'm gone.
- Boy, this record never stops, huh?
- Nah, it's dance till you drop!
- Then what?
- Teach the kids the steps before you do.
- And then what?
- Hope they make it farther than you.
- Hey, Robby, you're coming or going?
- I'm going, pretty soon. What have you got here?
- Lyman Paine, 53, single MVC.
Drove into a telephone pole.
- Passenger space intrusion?
- No, head on.
- Intoxicated?
- No ETOH on his breath.
Either syncope, seizure,
or he just fell asleep at the wheel.
Airbag deployed, unconscious at the scene,
but he's waking up.
- BP 140 over 80,
pulse 120, pulse ox 98,
no obvious injuries.
- Why don't you guys head on in?
I'll meet you in a minute.
Well, hey, buddy, I guess this is it.
Make those appointments next week, you know?
I'll call you from the road to make sure you do.
- Don't do that, man. - What?
- Don't shine me on.
- I'm not.
- Jesus.
I get it.
Hard place to leave, a harder place to stay.
- Yeah.
- Look, I'm not ready to say goodbye yet.
So go do what you gotta do, and I'll get some tools
from the truck and see if I can't make
Bonnie smile again for you.
- OK.
- OK, then.
- Robby, man, I'm so sorry. We've been on for 14 straight.
I thought I cleared it. - It's all right.
- Honestly, I feel terrible.
- No real harm done.
I was bound to nick it up on the road anyway.
First blood drawn, it's a good omen really.
- Thought he'd be more pissed.
- I thought you might get punched.
- Chest and belly look good.
Let me drag Neurosurgery down here to deal with
the C-spine before I go.
- You off? - Yep, an hour ago.
Can't you tell? - How you doing, sir?
- Actually, not too good.
The tingling is getting worse.
It's in both my arms now.
I feel like something's wrong.
- Hey, man. What are we looking at?
- Ran into a telephone pole, airbag deployed.
- Seizure? Stroke?
- Not sure.
Possible C-spine.
CT showed uni-facet dislocation.
- I'm trying not to freak out.
I'm having trouble breathing.
- Squeeze my hand.
Real hard.
Three out of five strength.
- OK.
10 milligrams dexamethasone.
- Dexamethasone? For spinal injury?
- It's compression from a jumped facet
and maybe some ischemia from a kinked vessel.
- What's--what's happening?
- Sir, you have a partial dislocation
of two vertebrae in your neck.
It's putting pressure on your spinal cord.
- How do you fix it?
- We need Neurosurgery to screw a clamp
into both sides of your skull
and then use traction under X-ray guidance
to get everything realigned.
- Like a chiropractic adjustment?
- It's a bit more complicated than that.
- I think I'm having a panic attack,
because I can't even get a shallow breath.
- Or he's losing C3, 4, and 5.
- Uh, page Neurosurgery.
- Garcia went to go get them. - No. Page overhead.
Find Robby if he's still here.
- Any available neurosurgeon to ED Trauma 1, stat!
Any available neurosurgeon to ED Trauma 1, stat!
[liquid trickling]
[knocking on door] - Dr. Robby?
- Uh, yeah?
[toilet flushes] - You're needed in Trauma 1.
- OK.
What patient? - Dr. Langdon's.
It's a neck injury.
- I got the fellow.
They could be down in 15 minutes.
- He's progressing too fast for that.
- What's going on?
- Uni-facet dislocation, C4/C5,
paresthesia and decreased tidal volume.
- Sat's 85.
- We need to prepare for intubation.
- Any delay in reduction almost guarantees
complete spinal cord injury.
- What other options do we have?
- Uh, I saw Neurosurgery do a closed reduction once in ICU.
- Blind? That's crazy risky.
- We gotta do something.
What's that procedure, Dr. Langdon?
- It's just-- it's traction on the neck,
we flex the dislocated side and into slight extension.
- Quadriplegia, if done wrong.
- I'm sorry, what-- did you say quadriplegic?
- It is a possibility, sir.
It's also the same possibility if we do nothing.
- You wanna try?
- I've never seen it done. You have.
- I can't feel my feet.
- Sats 79. 100% non-rebreather?
- He's progressing, Dr. Langdon.
What is your plan?
- Uh, Neuro--
- Fuck Neuro. This is right here, right now.
This guy's gonna be a living head if we do nothing.
- I could paralyze him. - Doctor the fuck up.
[machine beeping]
- [gasping]
- Sir, the partial dislocation of the two vertebrae
in your neck is putting pressure on your spinal cord.
I can try to move the neck bones back into place.
That could help. There's no guarantees.
If we do nothing,
the weakness is definitely going to get worse.
But either way, there's still a chance of paralysis.
- Do it. Please. Please.
- 50 of fentanyl IV.
You need to let us know if the weakness gets worse
or if there's any sudden pain, and we'll stop immediately.
Dr. Cruz, Robby,
hold down his shoulders for countertraction.
OK, I'm gonna pull on your head.
Your job is to try to relax,
breathe so we can overcome the muscle spasm.
[machine beeping]
Flexing to the right.
Any change?
- My legs are starting to tingle.
- Last step.
[bones crack] - Ah!
- I felt something click. - Oh, fuck! Oh, fuck!
- I felt it too. - Sir, talk to us.
What's going on? - Oh.
[panting] I think--
I think... [laughs]
Yeah. I'm starting to breathe easier.
- Any change in your hand or feet?
- Oh.
Oh, this is maybe a little less numb.
- Philadelphia collar is ready.
- Talk to me.
- Langdon just reduced
a uni-facet cervical dislocation.
- What? Without neurosurgery? Don't try this at home, kids.
- He was deteriorating quickly.
- Neuro exam is improving.
- Oh, my God, it's definitely better.
Oh, my God.
- Nice job.
- All right, repeat CT,
then Neurosurgery can take him up for a halo.
Brass balls, buddy.
See? You haven't lost it. - Um, excuse me.
I'm just gonna step outside for a second.
- Langdon, honey, I just got a call from upstairs.
Were you supposed to get a urine screen
and turn it in by 8:00 tonight? - Fuck!
Um...
Oh, no. Uh, ye--yes.
Can you just--can you tell them that I was in a trauma?
I'm going right now.
- Where's he off to?
- No idea.
Did you find your ID badge yet?
- No, I've looked everywhere.
Must have been thrown out on accident.
- They'll issue you a new one.
You just have to fill out a bunch of forms.
[notification chimes] - Oh, great.
What?
- Cow in labor?
- No, I--
I ordered a patient a Lyft.
Now I have a $250 surcharge and a complaint on my account.
- What? - What'd they do?
- It was a sweet old lady.
- Who apparently had some racist
and abusive things to say
right before puking in the back.
- You never know with some people.
- There goes my first paycheck.
- St. Huckleberry.
No good deed.
- I can see why you liked restoring this bike.
You're a fixer.
I fix bikes, but you fix people.
That's pretty damn impressive, man.
- Some people can't be fixed.
- Look, I'm--
I've done plenty of things I'm not proud of.
- Yeah, me too.
- No, bad things--
hurt people on purpose,
hurt myself.
And I did my time, but that doesn't wash away the regret.
I...
wish I'd done things differently.
I think about it every day.
- You know, they say that it's never too late to change.
- Some things can't be changed, like death.
Death can't be changed.
- Hey, I know the surgery is scary.
- I'm not talking about me.
- Yeah, I don't know if I wanna be here anymore.
- I don't know how you stand 12 minutes in there,
let alone 12 hours, 20 years.
- No.
That's the only place I can be.
I have purpose in there. I can be distracted in there.
I don't know that I wanna be...
anywhere anymore.
[exhales]
- So what's the plan?
[distant sirens wailing] - Ride.
- Toward what? - I don't know.
- Away from what?
- Everything.
- Well, that's not riding. That's running.
Is that your final lesson for these kids?
- What's up, Robby?
- Well, if it isn't Medics Bosco and Otero.
- You still on?
- Not for much longer.
I was looking for you two.
- Rita Wolcott, 22.
She was using a dumpster to climb a fire escape
to get to a roof party.
Slipped about 6 feet onto concrete.
Possible tib-fib fracture.
- Oh, can I please tell it?
You're making me sound like an idiot.
My friends and I were just trying to watch the fireworks
from the roof of our building.
But the roof access door and the stairwells stuck,
so we decided to climb the fire escape.
They were supposed to hold the dumpster still while I...
But they didn't.
Then I fell.
- Like I said, 6 feet onto concrete.
- Yeah, because they didn't hold it still.
- Well, it's a good thing she didn't need a 12-lead.
- Why's that?
- 'Cause you guys put one on about a half hour ago wrong
and you missed the STEMI.
- Bullshit.
- 46-year-old woman.
A minute after you left, V-tach.
Repeat EKG showed a massive lateral STEMI.
- No way.
- Leads were so inferior,
you might as well have not put them on at all.
What were you afraid of, her bra?
- What have we got?
- We've got a 22-year-old probable tib-fib fracture
from a 6-foot fall.
Why don't you take her to Central 13?
- Got it. Right this way.
- As I was saying, bad data is shit data.
- Maybe she was diaphoretic and they slid down en route.
- Yeah, she was moving a lot.
- Diaphoretic, my ass. She had big breasts.
You didn't wanna move 'em out of the way
to get under her bra line. - Come on, Robby.
- Women are misdiagnosed for heart attacks all the time.
This is a big reason why.
Shall we put it to a vote?
Hey, ladies in the room, show of hands.
Death with modesty, or life with brief nudity?
Death or life?
Look at that-- turns out women wanna live.
- Got it.
- EKG is an amazing tool if you use it right.
- You could have told us in private.
- I think this was more instructive.
- Agreed.
- Hey, hell of a save your boy made.
On-the-fly reduction
of a uni-facet cervical dislocation--
that's some cowboy shit.
- Yeah, it was. Where is he?
- Ran off for a drug test.
You got your wish. You don't have to say goodbye.
- Hey, thank you for saying all that.
I may have taken a slightly different approach, but--
- I seem to have lost my filter.
- I'm glad.
I could use an honest second opinion on a case.
Do you have five minutes to spare?
- Sure. Why not?
What's the case?
- I have the chart pulled up in 8.
[beep]
I have some experience with this,
but I'd appreciate a fresh perspective.
- [chuckles] After 14 hours,
I don't know how fresh my perspective is,
but I will give you what I got.
- Well, after working with you, Dr. Robinavitch,
I've come to respect your opinion.
- Thank you, Dr. Al-Hashimi.
Likewise.
OK, patient is a 40-year-old female with a history
of seizure disorder for the past 35 years.
She had no perinatal complications
and was in excellent health until age five,
when she had the onset seizure activity
following prolonged illness with viral meningitis.
Her altered mental status from the infec...
Baran, is this you?