- But right now, the average wait time
is six hours, and that's before you see a doctor.
You need to hire more staff
so we can open more inpatient beds.
- Are there rats in the ED? - [screams]
Oh, there goes one.
- Kid brings in his dehydrated mom.
Mom's vomiting is self-induced for the sole purpose
of getting him here after she finds
his death list for classmates.
- I'm ready to get law enforcement involved
whenever you are.
- Any word from David? - Not yet.
- Devastating personal loss can be
very hard to manage on your own.
Would you be willing to speak
to a behavioral health specialist?
- [all shouting] - What do I do?
- 18-year-old woman with dysuria.
She's with her female boss, who's very controlling.
- She doesn't mind. We--we have no secrets.
- And you're thinking? - Red flags for trafficking.
- Who the hell ordered BiPAP? Garcia?
- No. His--his sats were down. I did.
Without running it by me?
- Bella. - Yeah?
- What have you heard about Amber?
[suspenseful music]
- There is absolutely no chance of recovery.
- Amber has died. - No! No!
[sobbing]
- Can you--can you just put him on the phone for a second?
I just want to hear his voice.
There's my guy.
How you doing, buddy?
I would love to hear your--your song.
[waves crashing]
You should go home.
- Oh, that is the last place I want to be.
- Are you sure you shouldn't see your OB?
I checked myself.
Uterus is empty, barely spotting now.
I'm fine.
- [sobbing] - Oh, honey.
I'm so sorry.
- Oh, I shouldn't have bought that fucking stroller.
Oh.
Fuck that fucking stroller.
- Losing a kid is hard on everybody.
That's as hard as it gets.
We do these debriefs
to try to give a sense of closure, meaning,
to difficult cases so that they won't linger.
But trust me, the kids you'll lose will linger.
So what do you do?
I did my residency at Big Charity in New Orleans.
And day one, I got a kid, five-year-old boy,
accidentally shot by his brother
playing with Dad's gun,
worried he was gonna get in trouble
right up until he coded and died.
[exhales sharply]
That night, I asked myself, like,
what do I do with this kid?
Where do I put this feeling?
And I found myself walking all night.
I was walking and walking and walking.
Then I found myself back at the gates
of Big Charity Cemetery, and I'm looking
at all those mausoleums and those crypts
and I'm thinking to myself, OK, that's what I need.
I just need a safe place where I can put these feelings--
- Yo, we got patients throwing punches in chairs.
- Uh, OK, everybody. Let's get back to it.
Just remember, the Employee Assistance Program
is available, as are Kiara and myself,
if anybody needs to talk.
- Where's McKay? - In Central 11
with our UTI accounting assistant
while we keep her boss on ice in North 2.
- Robby, critical case flying in--
possible MDMA overdose, high temp,
en route from PittFest. Five minutes out.
Stay here. Set up for that.
- Ahmad and I got chairs. - Hey, hey.
Is everything all right with Collins?
Something's bothering her. I asked her about it.
She said she doesn't want to talk to me about it.
Oh. Imagine that.
She probably learned it from you.
Seriously? You just gave a speech titled
"How to Literally Bury your Feelings."
Now, if you'll excuse me, I gotta break up a fight.
[indistinct shouting]
- Yo, you need to control your wife, man!
Shut it, man!
[indistinct shouting]
Hey, hey, Olsen!
- Olsen, what the fuck, man? - Took you long enough!
- Calm down. - No.
Don't tell me to calm down.
How hard is it to put a mask on your kid?
- He has allergies, you fucking Fauci zombie.
- What? - Allergies! Fuck you.
[screaming and shouting]
- You fucking bitch! - Hey!
Hey! That's enough!
Jesus almighty, I don't believe what I'm seeing.
Where do you people think you are, huh?
This ain't Philly.
This is a hospital, for Christ's sakes.
What's the matter with you?
You call yourselves adults? Huh?
There are children in here.
You should be ashamed of yourselves.
Olsen, you catch any shrapnel?
- Craziest shit I've seen since I've been here, but I'm good.
- I'm good, seriously. - Jack-offs.
- Ladies, are we finished with the craziness?
- [lisping] This is fucking ridiculous.
All I did was offer to put a mask on her child
who's been coughing for over an hour.
And--and now I'm missing half my goddamn tooth
and talking like this.
- First of all, masks are bullshit.
- Oh, my God. - And B, it's an allergy.
He's allergic to cat dander, like I fucking told you.
My sister brought her two Persians--
- Shut up. Shut up right now, please.
And only answer the questions I ask.
What happened to the tooth? Did you swallow it?
I don't think so.
- I think it's still in my hand.
It sure is.
I hope you both have all your shots.
- What do you mean, like, vaccines?
- Jesus, please don't stir this pot.
Let's take these ladies back
and get them treated, separately.
- Stick with me. - Come on.
Ma'am, it's time to go.
Guess that makes us a team.
I guess it does.
Ma'am, come with Mateo and I--
Mateo and me.
Yes, with us both.
- OK, Earl, let's take a look at you.
Oof, she really tagged you.
- Red's got a left hook like Billy Conn.
- Well, let's get you cleaned up.
Come on, baby.
Excuse me, sir.
You're not allowed back there.
- Unless, what, I start a fight?
Become homeless?
Apparently, that's what it takes.
- I understand your frustration.
I promise you'll be seen
as soon as a provider is available.
- But how can they become available
if new people keep cutting the fucking line?
There's no line.
We see patients by severity of need.
As soon as we have your tests and labs, you will be seen.
- This place is fucking unbelievable.
Runaround after runaround.
Hey. What's up, Erik Estrada?
Still keeping your eye on me?
Always, my friend.
Always.
- Who's Erik Estrada? - Shame on you. "CHiPs."
Know your television history.
- And thank you. - Yeah.
Crazy people.
- If you do get my tooth out, I don't want it
after it's been inside that woman.
- Reattachment wouldn't be possible.
- A type two fracture into the dentin.
Seal with dental cement.
Prescription for Pen VK, soft diet.
Follow up with the dentist in one to three days for a crown.
You handle Spinks while I check on Ali.
You got this.
Don't worry, partner.
Yes.
I totally got this.
How are we doing in here?
- You should write that bitch a script for calcium
because I didn't even hit her that hard.
Too much almond milk in your soy lattes.
That doesn't even make sense.
- You know, most commercial almond and soy milks
are fortified with calcium, so they end up having
a higher percentage of calcium than cows' milk.
Prepped with Betadine and draped.
Very nice.
Let's have a closer look.
Dr. King, can you please grab me
a 10 cc syringe, a 20 gauge needle,
and some sterile saline, please?
- Pluck it out, stitch me up, and send me home.
I've got to get back out there to my kid,
who is still waiting to be seen, by the way.
- Afraid it's a little more complicated than that.
You got yourself a fight bite, which means a couple things.
First, we need to determine
if the bite extended into the joint space.
If it did, you're gonna need IV antibiotics
and a trip to the OR to see a hand surgeon.
- Pinprick and a little burning. - An operation?
- Well, you were just shouting a minute ago about infection,
and with good reason.
While I am sure you are in the clear for rabies and HIV,
human mouths are filthy, some more than others.
How can you tell if it's bad?
Good question. Dr. K?
I'm sorry?
- I am going to inject some sterile saline
into your knuckle joint, which you won't feel
'cause of the anesthetic.
If it comes spraying back out of the bite wound, we'll know.
- Ready? - I guess.
There she blows.
Ah, shit.
Are you serious?
You hear that, you fucking bitch?
I've got to have surgery, thanks to you.
- Good. You assaulted me! - Damn right.
And I'll bet next time, you keep your masks
and opinions to yourself.
You OK?
Yes.
- 3 grams Unasyn IV. Call the OR.
Tell them we have a fight bite that needs to be washed out.
Then go take 20 minutes in the lounge.
I'll come find you if I need you.
- I don't need a break. - Yes, you do.
OK.
Oh, did you want me to tell the surgeons
- to go no masks for surgery? - What?
- Well, those of us who save lives for a living
believe strongly that masks minimize risk
when it comes to spreading disease and infection.
But I--I want to respect your beliefs,
so what do you think?
With or without for surgery? Without?
Um...I want with.
Good call.
- Helicopter's here. Cafeteria send the ice?
- Yeah, everything they got. - Hey.
I hear they're gonna start you
working on the Middle East peace plan.
Not since the Dalai Lama or Gandhi.
- They'd be fucking-A right to.
You should have seen me.
I was inspiring, also terrifying,
and a little bit shaming.
- Holy Trinity of crowd control.
Hey, can we pick it up in here, please?
Overdose is here.
PittFest OD.
- Keely Ralston, brought to the first aid tent
at PittFest with altered mental status and fever.
Temp too high for a field thermometer.
Intubated en route.
- We got to cool this lady down.
- Get some ice packs, head, neck, groin.
- Send off for a rainbow. - On it.
- Heart rate 132, BP 210 over 120.
- Jesus, that's high. - Four of Ativan in the field.
- Pupils are dilated. Definitely MDMA overdose.
Dr. Mohan, how do you want to treat the BP?
- Beta blockers? - No.
Unopposed alpha could kill her.
Four more of Ativan, please.
Seriously?
She might need another 40.
Hypertension and tachycardia from MDMA
is centrally mediated.
Ativan is the drug of choice. [thermometer beeps]
Damn. Core temp, 107.3.
- OK, can we get another hose in here
before she fries her brain, please?
Let's go. Come on. [monitors beeping]
I'll be right back.
Hi. You look lost.
No, it's my assistant
who actually seems to have been misplaced.
I mean, how long does a CT take?
Certainly not this long.
- They can get pretty backed up.
Can I get you a cup of bad coffee?
- Dry sandwich? - No, thank you.
- How about a cold LaCroix from my secret stash in the lounge?
I'm going for one myself. I'm freaking addicted.
- I'm good on drinks. Can you take me to radiology?
- Yeah, right this way. Right this way.
- Piper, while we still have a few minutes,
there are some things I want to say.
Yeah, use protection.
- I know. I'm sorry. - Totally.
- It was a mistake. - Totally.
I'm a part of the street team here.
It's a group of doctors and nurses
who go out into the community and help people
who can't or won't ask for help--
addicts, unhoused, runaways.
And I'll be honest with you, Piper.
I think you need some help.
What are you talking about?
- If you're in trouble, we can help you.
I'm not. OK?
And if we're done here, I think I'd like to go.
- Will you at least take a look at this?
There's a list of resources on the back.
I don't need that.
- I know you don't have a phone,
but if you could just take my number, OK?
You never know.
Where's Laura?
How about taking the pen?
If you ever feel unsafe or in danger, call this number.
It's a national hotline.
There's somebody on the other end 24/7,
a trained professional who can help with anything.
I have all the help I need.
I want to go. Now.
- OK, on my count. One, two, three.
Gentle, gentle, gentle.
Houston, we have splashdown.
- Good luck. See you on the next one.
- Yep. - Temp's down to 107.1.
- How long does she need to stay in the ice, Dr. Santos?
- My PB in the ice is 13 minutes.
- Dr. Santos. - Until her temp is normal.
- Wrong. You pull her out at 102.
Otherwise we could overshoot and cause hypothermia.
- Heart rate 120. Pressure 198 over 116.
- More Ativan? Another four, please.
- Why is she on the ice, Dr. Santos?
- To bring her temp down. - Wow, state the obvious,
yet still don't answer the question.
- The quicker we bring it down, the less of a chance
for permanent damage to the brain,
- liver, or kidneys. - Exactly.
- Was she sweating? - Profusely.
- What if she wasn't, Dr. Santos?
What if she was dry as a bone?
- Then we'd have to think anticholinergic overdose,
not sympathetic.
Very good.
Hey.
I found you scrubs that should fit.
- Oh. [laughs]
Thank you. That's great.
- I appreciate that. - But they come with a catch.
- Mr. Krakozhia is asking to see you.
The guy who peed on me?
- Why me? - I didn't ask.
But maybe you should wait to put these scrubs on
until after you've--
That's a good idea.
Oh, God.
[rat squeaking]
- Oh, man. We got a load of the--
Oh, my God.
Whoa! Hey!
[rat squeaking]
Yeah, I see you.
[rat squeaking]
Your days are numbered, buddy.
- Trauma to ER Two. ETA now.
- That's another four of Ativan.
Rectal temp's down to 105.
- OK, moving in the right direction.
We might get lucky here.
- Double trauma at the back door.
Auto versus pedestrian before hitting a telephone pole.
- You got this? - Yep.
- Dr. Robby, I finished with Dr. Ozeki,
the therapist upstairs.
- Yes, yes, yes. How did that go?
- Well. - Excellent.
Have you heard from David?
No.
Has David seen the therapist?
Do you think that he's still gonna pick you up today?
- I think so. - OK, well--
- Robby, here they come. - OK.
Well, you're medically cleared, so why don't you stay here
for a little while longer in the hopes that he does?
I still would like him to talk to somebody.
Perlah, this is Theresa. She's a friend of mine,
so I expect concierge service, yes?
- VIP treatment. - Thank you.
You're in good hands.
Just let me know if David shows up or if he calls.
- Good boy. Good boy.
Walter Pernell, 52,
walking his dog in the crosswalk,
got struck by a Chevy Impala at low velocity.
Ambulatory on scene, no KO, no neck, chest, or belly pain.
- Good vitals. - Whoa. Major road rash.
- Yeah, the car didn't hit me so much as throw me.
But I slid for a good 10 feet.
Of course, this is the first day
I've worn shorts all effin' year.
- No deformity at the knee or ankle.
Distal pulse is intact.
Four of morphine so far.
- Yeah, feel free to be more generous.
- Don't worry. We will patch you up.
We will get you right. Who's your friend?
Oh, this is Crosby,
who thankfully barked and warned me
so I had half a second to try to move out of the way.
Crosby, you're a hero.
Donahue, you think you could find a Milk-Bone
for our little lifesaver here in the doctor's lounge?
- Absolutely. I'll take good care of him.
- Can't he stay with me? He's a very good boy.
- No doubt. Let's get you settled first.
- You're going to South 20. - Got it.
Is that the driver?
- 28-year-old lady, had her seat belt on.
Clipped the guy with the dog and went
straight into a telephone pole.
Blood's from a scalp lac.
Also complained of chest pain.
Sleepy but arousable.
- What's your name? - Paula.
- Heart rate's a bit tachy. 112. BP's fine.
- Paula, are you in any pain right now?
- [sluggishly] Yeah, I got hurt.
- Witnesses say she was driving erratically before the crash.
No ETOH on her breath. Maybe drugs?
- Core temp's 104.2. - Heart rate 116.
BP 180 over 110.
Better, but still too high.
Another four of Ativan.
That'll make 20.
Good counting.
- Pedestrian in South 20 needs a doctor.
- You got this? - Yep. Keep chilling.
- All hands on deck. You ready? all: Ready.
- OK, here we go. One, two, three.
[groans]
[speaking Spanish]
I heard motor vehicle collision with chest pain
and altered mental status.
- Qué más? - Meet Paula.
Restrained driver versus telephone pole.
Altered before the crash. Good BP, but tachy.
- Second line and run a liter of LR wide open.
- Still tachy at 115. BP's 180 over 72.
Airway's patent.
- Good breath sounds bilaterally.
- Pupils are equal and reactive.
- Paula, do you know what today's date is?
It's, uh...
Sats 94%.
How about the city we're in?
Pittsburgh?
Bruising on the chest.
- [shouts] - Possible sternal fracture.
- Pericardium's clear. - Good. Good.
No marked tenderness.
Nothing in Morrison's pouch.
She's a little tachypneic.
- I don't think she needs intubation.
Might just be concussed.
- I worry about her crumping in the scanner.
- She's protecting her airway. I see lung sliding.
- No pneumo. - With a head injury?
- You guys are supposed to be the airway experts.
Stop fighting. Make a decision.
Call me when she goes to CT.
- Paula, can you raise your right arm for me?
- Good sign. Follows commands.
You want to intubate with a GCS of 13?
- OK. We can hold off and monitor.
- What's your plan? - Pan scan, head to pelvis.
EKG, troponin.
Straight cath urine for UA and tox screen.
- Agreed. [groans] - I'm on it.
- Gotta bend those knees. - I gotta quit showing off.
- Is that what you were doing? - Always.
- It's a ten-day course of doxycycline,
one pill twice a day.
- I'll make sure she takes it on a full stomach.
- I can give you your first dose now, Piper, if you like.
- Get you started. - That'd be great.
- Actually, I need Piper to answer that one.
Sure. That'd be great.
OK.
Hello, everyone.
Looks like we're finishing up here.
I come bearing gifts.
Everything you always wanted to know about STIs
but never wanted to read.
No gross pictures, I promise.
I think we're good.
- You sure? - Mm-hmm.
- Yeah. I learned my lesson.
It won't happen again.
I guess that's it, then.
- Well, if you change your mind,
it comes with a free pen.
- Thank you both so much for your help.
- Yeah. - Thanks.
OK.
Good luck to you both.
Fuck.
That sums it up.
She'll be back.
Only she'll have slipped a little further.
- Sometimes it takes a few visits.
How can I keep her here?
You got anything?
- Maybe Kiara has a social services card to play.
She was by Trauma One last I saw her.
- Brilliant. Brilliant. Thank you.
- That's why I'm here, to be brilliant
and bring peace.
Heart rate's 84.
BP 126 over 78.
Pulse ox, 99 on room air.
Good news, Mr. Pernell.
Your heart, lungs, and belly all look good.
Yeah, just the leg.
- Whoo, this might be a road rash record.
We might have to bust out the tape.
- I'm getting a little worried about Crosby.
Who's Crosby?
- His dog. - My dog.
Where is Crosby?
- He's in the break room. - Your break room, I think.
I'm sure he's fine.
We got a lot of dog lovers around here.
I'm the new owner of a nine-week-old Goldendoodle.
Oh, nice.
Crosby's a terrier.
- [sighs] Great dogs.
Determined, courageous, love to dig.
Who's he named for, Sidney or David?
David.
- Still my Sunday morning soundtrack.
- Ow. Ow. - Oh. Sorry.
Yeah, anyways, great name.
So the knee looks stable.
There's no laxity to suggest a torn ligament.
I think the pain's probably just from the road rash,
but let's get an X-ray just to be sure.
Some more morphine?
- You're a wonderful human being.
- Let's start with LET, no more than 30 cc's.
We're gonna try a topical anesthetic
to numb the raw skin
before we start picking out all the gravel.
- Well, my morning horoscope didn't mention any of this.
- Well, hey, look on the bright side.
Now you can tell people that you got hit by a car.
Not a lot of people can live to say that.
- Yeah, I hope whoever hit me is rich and well insured.
- I'll let him know. OK. Thanks.
Flag on the play.
Positive pregnancy test.
You still want a scan?
- Maybe she's bleeding from an ectopic.
- No, she delivered a healthy baby here
ten days ago.
Normal vaginal delivery, no complications.
Pregnancy tests stay positive for a few weeks.
- So are we good to go? - Good to go.
We'll let the tech know.
Oh, man.
She was seen here this morning by Dr. McKay.
- For what? - Urinary tract infection.
Discharged with oral antibiotics.
- You think it has something to do with the crash?
Yes. No. Maybe.
Ask me again after I've had
the scans, labs, and tox screen.
- [sighs] No.
OK.
So I need to talk to you about something.
- About what? - Do me a favor.
Look at me, and don't turn around
- and just watch-- - [screams] Oh, hell no!
- I told you not to turn around.
- I wish there was a way to keep her,
but there just isn't.
- Well--well, then fuck it.
We'll just say that we need another urine sample,
that the lab left the last one out too long
and couldn't culture it.
OK. Then what?
- I'll give Piper the sample cup
and send her down the hall to the bathroom.
I'll stay with Laura in the room with some bullshit.
You wait for Piper by the bathroom.
To say what exactly?
I don't know.
Just be another voice saying, I see you in danger.
- There are limits to what we can legally do,
but I can try to talk to her.
Thank you.
Hi. It's Dr. McKay again.
Can I come in?
- [sighs] - Sorry.
Yeah.
Well, it was a long shot anyway.
Hey.
I think Piper took a pen.
Yeah.
Temp is 103.2.
Nice. Almost there.
- My God, there are literally hundreds
of different MDMA pills.
And the milligram dosage range is all over the place.
These names--BMW5, Jurassic Park, Red Superman.
[water splashing] [rapid beeping]
Whoa. Why is she seizing?
Febrile seizure?
No, her temp is down.
Maybe she needs more Ativan.
No, she's had 20 already.
And her vitals are stabilizing.
Another four of Ativan.
And prep a gram of Keppra.
- I don't think this is a CNS problem.
She needs saline.
- We don't have her labs back yet.
- At festivals, you dance for hours.
You sweat, you drink gallons of water,
but nobody thinks to replenish their salts.
It's low sodium. Hyponatremia.
She needs 100 cc's of hot saline.
- We don't know her sodium levels.
- Drop 100 cc's of 3% and have it ready.
OK?
- Do it. And prep a gram of Keppra now.
[rapid beeping]
[tense music]
♪ ♪
Start the Keppra, please.
It's not gonna help.
- [phone rings] - Trauma One.
What are you doing?
Got it. Thanks.
It's hyponatremia.
Serum sodium is critical.
Only 112.
Knew it.
- OK, I'll push the other 50 cc's.
- What the hell? - She's seizing.
- You think? How long?
About three minutes.
Why did you not come get me?
Hello? I was--I was across the hall.
I was 30 feet away. What has she had already?
It's hyponatremia.
We pushed 100 cc's of 3% saline.
That did the trick.
- Again, why did you not come get me?
- It was my fault. Yeah, I want--
I wanted to keep going with Ativan and Keppra,
but Dr. Mohan had an excellent idea
to treat for hyponatremia even before her labs came back.
Temp's down to 102.4.
Good call, Dr. Mohan.
Another minute, and we'll de-ice her.
I am going to take that minute to try to instill in Dr. Santos
a very clear understanding of what her role is here
and how she is expected to function.
- Dr. Langdon-- - Dr. Santos--
and I say doctor in such a fashion
to draw attention to the ridiculous fact
that you have enjoyed that title for, what, 90 days?
So yeah, I'm confused.
Is it--is it hubris or ignorance
that makes you think that you know more than other residents
that have two to three years more experience
and have helped thousands more patients
in the emergency department than you have?
Not to mention the over 500 hours
of advanced training
with lectures and simulation labs
with senior faculty instruction.
It doesn't matter!
Stupid or arrogant, you need to realize
that you are a beginner, which means your job
is to shut up, listen, and learn
because so far today, the only thing you have been
successful at is proving repeatedly
that you know nothing.
Dr. Langdon.
Is the patient stable?
Temp's 102.
Just about to take her out of the ice.
- Proceed. Dr. Langdon, a word, please.
[indistinct chatter]
- Look, I know that sounded rough,
- but you only caught the tail. - Stop talking.
- I can give you a list a mile--
- Stop talking. - She was giving unsupervised--
- Knock it off. Shut the fuck up!
[chatter stops]
Where does it say that shaming, belittling, and insulting
are effective teaching tools?
Let me just tell you,
harassment has zero educational value.
You're feeling upset? She's getting under your skin?
Check yourself. Take a break.
I've been watching you ride her.
This kind of behavior will not be tolerated.
I don't want to see it.
- I'm sorry. It won't happen again.
- Where's your other one? Where's Mel?
- She's taking a breather. - Yeah.
Well, maybe go find her, and see if you can
get her back in the game. You are senior leadership here.
Step up and act like it.
Wow. You came prepared.
- Better safe than sorry. [chuckles]
Sorry I took off like that.
I have a thing about rats.
And cows totally freak me out.
- Really? [laughs]
Oh, there's plenty of both where I come from.
They're--you know, they're pretty harmless.
- Let's hope Mr. Krakozhia is now too.
Yeah, no kidding.
OK.
[sniffs]
Is this the guy?
Yes.
Hey, man.
It's Dennis Whitaker.
- I just wanted to say sorry for earlier.
Heard I got you pretty good.
Yeah.
- I kind of go out of my head when I'm off my meds.
Then I guess I piss on people.
- I'm pretty sure the meth doesn't help.
I'm not using anymore.
I take antipsychotics for the schizophrenia
I got from doing meth.
But I've been clean a year.
- Why aren't you taking your meds?
Why don't I take my meds?
Well, Doc, I'm kind of in between houses right now
living in an encampment on Liberty Avenue.
Meds cost money.
I don't have insurance.
- Should I go on? - No. No.
That's fine.
I'm sorry.
Life isn't always easy.
Have you talked to a social worker yet?
- No. - OK.
Do you think you could go grab--
- Kiara? - Kiara in here?
Yeah.
I really am sorry.
It's OK, honestly.
Really, it's OK.
I appreciate the apology.
[door clicks]
This must be Crosby.
[dog whines]
I've heard a lot about you, buddy.
How's my least problematic trainee?
Well, technically, you're all pretty green,
but you're growing on me.
Thank you.
So how you doing?
Um, good.
Better.
Yeah?
- It's--I mean, it's just--
it's the--the little girl and the sister's
too close to home.
The things we do are hard.
Yeah.
- You're sitting here feeling like--
like maybe you're not up to it?
Yeah.
Been there.
We all been there.
Mel, you're a sensitive person.
This--this is a tough place for sensitive people.
But we need them badly.
Now, if you're ready, I need you.
It's a perfect job.
It's practically a zen exercise.
I've got 1,000 pieces of gravel
that need to be plucked out of a 2-foot-long road rash.
- 1,000? - Yeah.
Give or take 100.
South 20.
Make sure you close the door behind you.
- Don't want Crosby getting out. - Yeah.
Thank you. No problem. I'll be right there.
[sighs]
That's a lot of gravel. [chuckles]
- It looks clean to me. You feel that, Earl?
Feel what?
- That's a no. - [laughs]
- All right. Now just apply the Dermabond.
Cool.
Can I ask you something?
That's why I'm here.
Yeah, I was just wondering
what the nurses do after their shifts.
In terms of what?
- You know, do they ever, like, go out together,
like, hang out to decompress after a shift or anything?
Yeah, sometimes.
I mean, most of us are just happy
to get the hell out of here.
Personally, I'm all about a long, long, hot shower,
comfy sweats,
eating some takeout in front of the TV,
ideally watching something that makes me laugh, so...
Yeah, I can see that.
I'm not imagining it in my mind, of course.
I just mean that I can-- I can see the appeal.
I was just asking because--
you know, since we work together,
maybe we could grab a coffee together sometime.
And you could, like, help me get the lay of the land,
so to speak?
You asking him out?
No. What? No. No.
It's just--I'm--I'm new here, so I just thought--
- I--I don't date people in the workplace.
It's nothing personal. Just it's never a good idea.
- No. No, of course not. No. No.
I just--no, it's not a good--no, of course.
I just thought that since you know
how everything operates here and you, like, have everything
so dialed in, that you would be, like, a valuable resource.
But no. No.
I should probably just figure it out on my own.
- Mm-hmm.
No shortcuts here.
- How are they treating you, Earl?
Huh?
I see you wrangled yourself another sandwich.
- I feel like I'm watching a rom-com.
[chuckles]
- Just came by to see if I could take Dr. Javadi
on a reconnaissance through chairs.
Yes.
I mean, sorry, if you think that's--
- Of course. Of course.
I can finish up my man here.
Great.
Are you OK?
I feel ridiculous.
I've spoken, like, two complete sentences
in the last half hour.
And both of them have made me sound
even more imbecilic than the incomplete ones.
And you attribute that to...
- It's like, my parents once took me skiing
for Christmas in Utah, and from the moment
I got off the plane, I could not catch my breath.
No matter how hard I tried, the altitude made me feel,
like, awkward and uncoordinated.
I couldn't concentrate. I couldn't get my bearings.
- Mm-hmm. - And I'm a very good skier,
but I spent the whole vacation just, like,
on my butt, dizzy and panting.
Mateo is like a human Utah.
[laughs]
Oh, honey.
I've worked with a few Utahs.
I wish you many, many Utahs in your life.
Jesse, where are you going?
- Trauma Two. - Stop. Stop. Stop.
Stop. Not back in there.
I'm not even gonna tell you why.
How's she doing?
- Still with some pleuritic pain.
- Oh. Hey, Paula. I'm Dr. Collins.
Your CT shows that you have a broken sternum.
That's your breastbone right here.
Probably from the shoulder belt when you crashed your car.
I crashed my car?
- Mm-hmm, and hit your head.
With a concussion, sometimes you don't remember.
But your head CT doesn't show anything serious.
So I saw in your chart you're a new mom.
How's your baby doing?
- He's good. He's with my mom.
- South 15's open. Oh. Hey, Dr. McKay?
Just get the bed out of 15.
- A patient you saw this morning
came back as an MVC.
Sternal fracture. Slightly concussed.
- Oh, no. Paula, do you remember me?
You look familiar.
- I was your doctor this morning
- for your bladder infection. - Oh, yeah.
Sorry. I'm a little out of it.
Still tachycardic, 115.
BP's 124 over 78.
- There's no bleeding anywhere on the CT.
Chest and abdomen clear apart from the sternal fracture.
- Well, probably still tachy from the fracture pain.
It hurts when I breathe.
Let's try four of morphine.
Paula, we're gonna give you some pain meds.
Let me know if it helps, OK?
Mr. Pernell, you are in luck.
If I had to have gravel meticulously picked out
of my leg, this is the person I'd call,
Dr. Mel King, detail specialist.
- Hello. - Hi.
- I love your dog. - Crosby?
- How is he? - Oh, he's great.
- Here. Something to help see up close.
- Hey, I don't want to be one of those people
who say they need an emotional support animal,
but is it possible he could be with me?
We could tie his leash to the bed.
He wouldn't be in any trouble. I swear.
- What do you think? - I'm happy to go get him.
- Any pain here? - No.
OK.
You go get the dog. You get to work.
I'm gonna get some more gauze from triage.
And just in case, if anybody asks,
just say you need him for anxiety.
OK.
Thanks.
I know you hear me.
You can pretend you don't, but I know you do.
This glass might be bulletproof,
but it ain't soundproof.
Huh?
Hello?
Can you hear me now? Huh?
- Hello! - Whoa. Whoa. Whoa, sir.
Sir, what is the issue?
Oh, same issue.
I've been here all day,
and you people have done nothing to fucking help me.
- We're still waiting on your second troponin.
We can't clear you medically until it comes back.
For instance, if it comes back elevated,
that could indicate a silent heart attack.
And you'd need to be admitted for monitoring
in a cardiology consult.
That's all I'm asking for.
I'm afraid I've had a silent heart attack.
I just want someone who knows something about hearts
to tell me what's happening to me.
You know, unlike most of these losers,
I have insurance, good insurance.
And I pay my taxes, which pays for them
to not have any insurance.
- Sir, you've got about five seconds
to change your whole attitude before security
and the police get involved.
Fuck it.
I'm leaving.
Hey.
Hey!
You are absolutely free to go.
But if you do, you will be leaving AMA,
against medical advice.
This form states that I have advised you to stay
and complete your evaluation, but you are choosing to leave,
understanding and accepting all risks of heart attack,
stroke, disability, and death.
Sounds like a CYA form
in case I drop dead on the curb.
That's exactly what it is.
- I just want to be treated fairly.
- I assure you that is our intention.
We are not back here playing Go Fish.
- We're doing our best to help some very sick people.
You will be seen, OK?
- Robby's gonna love that patient satisfaction score.
Crazy people.
- [rapid beeping] - What's going on?
- Car crash victim Paula just went south.
BP's crashing. 84 over 62.
Much less responsive.
Liter of LR wide open.
- Putting her in a 100% non-rebreather.
Paula, open your eyes.
Paula.
Was it the morphine?
She only got a small dose.
Pulse ox is down to 89.
Set up for intubation.
And, McKay, get Robby in here.
- I'll call ICU and get her bumped
ahead of Joyce, our sickler.
She should get the next bed.
- Between the hyperthermia and the seizure,
she's gonna be out of it for a while.
A similar thing happened to a friend of mine.
- Is that what made you think of hyponatremia?
- Look, I know you value evidence-based medicine.
But sometimes experience counts for something.
- May I ask why you did that? - What?
- Took the blame for a delay in care
which didn't belong to you
and gave me credit for a save that did belong to you?
- You know, I've been on Langdon's shit list all day.
It seemed like he was gonna be more upset about us
not calling him in than glad that we stopped the seizure,
so no reason for him to be pissed at both of us.
- Why have you been on his shit list?
- Well, I think he made it very clear
that he thinks I don't have what it takes to make it here.
- Whether you do or do not, it was completely inappropriate
for him to speak to you that way.
Eh, I've heard worse.
- Well, for what it's worth, he's wrong.
You're very good at this.
Thank you.
That's actually worth a lot.
- I thought the CTs were normal.
- They were. Systolic's down to 70.
Heart rate's up to 130.
100 of ketamine, 100 of rock.
- Could she have delayed bleeding?
It's not the chest.
Pericardium's still clear.
No tamponade, good EF.
Lungs are up.
She feels warm.
We'll check a temp.
Meds are on board.
- Belly's clear. No bleeding here.
- She's loose. - OK. Go for it.
I see cords.
Looks good.
I'm in.
- Connect the bag. - Nice.
- Good breath sounds bilaterally.
Temp is 102.4.
- What? Is this septic shock?
- OK, we need to assume the worst here.
- Code sepsis. Two sets of blood cultures,
lactate, 30 per kilo of LR
and for antibiotics, ceftriaxone?
- No, no, she was just in the hospital.
- Pip-tazo and vanco. - Got it.
- If this is sepsis, where is it coming from?
- What's the source? - Her urinary tract infection.
- She doesn't have one. - She did when I saw her.
It's not a UTI.
We catheterized urine a half an hour ago.
There's no nitrates, zero WBCs.
- Your specimen could have been contaminated this morning.
- Is it pneumonia? - Chest CT negative.
Abdominal CT negative for an infectious source.
- She was altered. Meningitis?
She's postpartum.
- [sighs] Endometritis.
The CT of the uterus shows a thickened endometrium,
but that's normal postpartum.
No retained POCs.
It still could be the source.
We'll do a pelvic after she's stable.
- Mr. Krakozhia, here's my obvious concern.
I write you a script for 30 days' worth of pills.
Then what?
- What do you mean? I'll take them.
- Well, you come back for 30 more, right?
I mean, that's the question.
Even if I could give you your dose
in a once-a-month shot,
you still have to come back when the month is over.
What if he didn't have to?
- Oh, no. He has to.
If he doesn't, he--
well, he pees.
We have a street team here.
Mr. Krakozhia, are you pretty much
in one spot these days?
- Yeah, I'm over on Liberty near the Benedum.
The alley?
I know it well.
- So we could bring the meds to him?
Absolutely.
The once-a-month injection
sounds like the easier option.
We could just put you on our schedule.
- I'd be interested in joining that.
Maybe I can bring out the medicine myself.
That'd be amazing.
We could use all the help we can get.
Thanks, Doc.
- Yeah, purulent drainage from the cervix.
- Got the culture. Oof. - [whistles]
- Looks like we have our source.
The positive urine this morning was contaminated.
Maybe.
Definitely.
Not-so-clean catch specimen.
- This infection's been brewing for a while.
- So the car crash was a coincidence.
Not necessarily.
She was probably already septic as the disease progressed,
dropped her BP, and passed out while driving.
- She wasn't hypotensive when she arrived.
- Adrenaline rush from the car crash
and the sternal fracture raised her BP
- but not for long. - Oh.
No history of fever.
- Bet she was taking Tylenol for the pain.
Let's call ICU for an admit.
Also want gyn to see her.
- She had mild lower abdominal pain
and a positive urine dip.
No fever, no back pain to indicate pyelonephritis.
She was alert, walking, talking.
It just seemed like a simple UTI.
I saw no reason to have her wait eight hours
for a bed for a pelvic exam.
McKay.
Every postpartum patient needs a pelvic exam
to rule out endometritis.
- Wait, you're saying that with 20/20 hindsight.
- Did you ask about Tylenol or ibuprofen use?
Because that can mask a fever.
There was no fever.
- Did you do a careful abdominal exam?
It was a quick chair exam,
and there was only mild tenderness over the bladder.
- Perhaps there was something about the patient
that made you overlook proper treatment.
Like what,
other than the obvious health risk factors?
- Her size doesn't inherently make her unhealthy.
- Are you saying I was biased against the patient
because of her weight?
- I raise it as a possibility, not as an accusation.
Wow.
I mean, I really don't think that's the case here,
but I will look out for it.
Yeah.
You were good with him.
- Do you get a lot of homeless in Pittsburgh?
We call them unhoused.
It's not as bad as Philly or D.C.,
- but it's still pretty bad. - Yeah.
- It really is great that you want to help out.
The street team get cool jackets.
- Yeah? - Come find me end of shift,
and I'll give you more information.
Will do.
- You made it out unscathed this time.
Yeah.
I'm joining the street team.
Even get a jacket, so...
Cool.
Yeah. It is cool.
Very cool.
- Whose pooch? - South 20's.
I'm taking him for a visit.
This is Crosby.
Hello.
I'm going for a smoke.
If anyone asks, he's an emotional--
Support animal. I know.
I got it.
- [gasping] [rat squeaking]
- Whoa! [dog barking]
- Crosby! Hey, hey, heads up.
Crosby. Ow!
[rat squeaking] Drop it. Drop it.
- Ugh! - Whoa.
[indistinct chatter]
[rat squeaking]
[dog growling]
- Got you. Come on.
- Crosby. Crosby, come here, buddy.
Come here. There you go.
- [bones snap] - Yeah.
[people gasping]
- Nice job! - Hey.
- Good work! - There you go.
[applause]
You got a rat, didn't you?
Yeah.
- He does that. - Yeah.
- When did those cops get here? - I don't know.
- Who called them? - I don't know.
- Where's Dana? - Again, I don't know.
- Thank you. - Anytime.
Hard at work?
[both grunt]
[groans]
I'll take my chances.
[groaning]
[dramatic music]
♪ ♪