[The Clarks' "Better Off Without You"]
♪ ♪
- ♪ Oh-oh, oh-oh-oh ♪
♪ You are sultry, dirty ♪
♪ Soft, and hard ♪
♪ You are close to me, and you're so far ♪
[siren wailing]
♪ And I'm thinking of the time we spent together ♪
♪ Now I'll bury this in my backyard ♪
[engine revving]
♪ Sometimes I sit and wonder ♪
♪ If I'll never dial your number ♪
♪ 'Cause I'm having fun looking out for number one ♪
♪ And I'm doing all the things I like to do ♪
♪ I'm having fun 'cause I knew it all along ♪
♪ I'd be better off without you ♪
♪ ♪
- Hey, I need my cast off.
- As soon as you park that outside.
Morning, Doc. - Olsen.
Happy Fourth.
- Excuse me, guys.
- Sorry. [person coughing]
[indistinct chatter]
[device beeps, door clicks]
[indistinct chatter continues]
Hey, how's it going, Dad?
- [sighs] I'm so sleep-deprived.
My house is starting to feel like a CIA black site.
- Have you considered hiring a night nurse?
- You're looking at him. - You got a ripe one coming in
you're gonna have to deal with before everybody out there
starts puking. - Lovely.
Your replacement came in early.
She brought in a full bagel spread.
I'm just saying. - She's not my replacement.
She's just covering as chief while I go
on my little sabbatical. - Three months?
- I'll be back before your daughter
sleeps through the night. - Hey, dude, that's cold.
- Morning. - Good morning.
[elevator dings]
- Good morning, John. - [sighs]
I could have sworn it was still around 4:00 a.m...
- Did you guys have an easy night last night?
The waiting room actually looks manageable.
- I wouldn't call it easy, but not too bad.
I figured we'd have hands and burns down here a bunch,
but so far nobody's blown off any fingers.
- Oh, you know you just jinxed it.
- [chuckles] You guys and your jinxes.
- Please, Jesus, please. - Hail Mary again.
- In the sanctified flesh. - Don't let me die alone.
- Just try to relax, Margaret. - I need a priest.
- Hey, hey, Dr. Robby. - What's the good word, Perlah?
- All your results came back normal, Mrs. Walker.
- I'm dying.
- You're not dying, Mrs. Walker, I promise.
- Jesus is coming for me.
- If He is, He hasn't checked in at registration yet.
- Please don't let me die a sinner.
- Don't worry, Margaret-- we're going to have
the hospital chaplain come and see you in a moment.
- I'm not going to last that long.
- Yes, you will, because we're going to give you a shot
to keep you alive until they get here.
What are you thinking, Dr. Robinavitch?
500 mikes of cyanocobalamin?
- In her condition, I'd push a full 1,000.
- Whoo. You heard the man, Perlah.
- God bless you. God bless all of you.
- Amen to that.
- Hail Mary, full of grace, the Lord is with thee...
- Ooh, nothing like the miracle healing powers
of a good old B12 shot.
How does she hold down a job? - She doesn't.
- She's wearing a waitress uniform.
- Yeah, from a diner that closed 20 years ago.
- [over PA] Tier One Trauma, ETA six minutes.
- And so it begins.
- My husband is still waiting to see a doctor.
- I apologize for the wait,
but here are two doctors just for you.
Mr. Burgess has been complaining
of leg cramps for a day.
Slightly tachy at 110, BP 128 over 75.
Afebrile, good sats.
- I'm Dr. Shen, but I'm going off shift.
Dr. Robinavitch will be one of the doctors looking after you.
- What other medications
are you currently taking, Mr. Burgess?
- I brought his meds.
- Thank you. [dog whines]
- These are his supplements,
mostly all-natural and organic where possible.
And these are his homeopathic prescriptions.
I also have a list of his refrigerated probiotics.
[indistinct chatter]
- Where the hell is everybody?
- Our new attending is torturing
our intern and med students in Trauma One.
She came in early to meet the night shift
and took things over.
- Okay, that takes giant balls of disrespect.
- Giant Balls of Disrespect
was the name of my band in high school.
- [sighs] And my nickname for my ex-husband.
Hey, uh, is this your last shift?
- For a while, yeah. - Oh, I am so jealous.
Hey, I'll pay you a grand if you take my second husband.
- Tempting.
So tell me about this new attending.
- Uh, she's pretty, divorced, one kid.
Can already tell she is a strict rule follower.
I'm probably going to grow to hate her.
- What's her name, again? - Dr. Baran Al-Hashimi.
- Al-Hashimi? What is that?
- Irish? - [chuckles]
- She's some sort of clinical informatics expert.
Once she started talking about AI,
I started thinking about robots and kind of stopped listening.
- Clear. Off the chest, Ogilvie.
Get ready to step up here, Joy.
Ogilvie, off the chest!
- Clear! [alarm blaring]
- Still V-tach, but it looks weird.
- Agreed. - No pulse.
- No effusion, good lung sliding.
- Start compressions, Joy.
- We haven't considered all the Ts.
- I checked for tamponade and tension pneumo.
- What if it's thrombosis?
If it's a pulmonary or cardiac clot, TNK could save him.
- We are sticking with the algorithm for now.
- Algorithm's not working. - Faster and deeper, please.
- Uh, you need a break, Joy? - No, I need an attending.
- I'm right here.
Stop compressions. We're calling it.
[flatline]
Sorry, the patient's dead.
[flatline continues]
All right. Who can tell me what went well?
- We followed the V-tach algorithm.
We checked for reversible causes.
- We limited our rhythm and pulse checks to 10 seconds.
- Excellent.
- Should we have given thrombolytics?
- No, you should have recognized
that the cardiac rhythm on the monitor was polymorphic,
not just V-tach.
It was torsades de pointes.
That's French-- "twisting of the points."
- From prolonged QT, antiarrhythmics,
electrolyte disorders.
- Your patient would have lived
if you had pushed magnesium sulfate.
- Good news is he's an organ donor.
Parts of him are going to get used to make Frisbees
and water bottles and end up as microplastics
in our brains and reproductive organs.
- Thank you for the words of encouragement, boss.
- Dr. Al-Hashimi, Dr. Michael Robinavitch.
Everybody calls me Robby. - Baran, please.
- Welcome to the Pitt. - Yeah, about that--
- Trauma's a minute out.
- Ooh, who wants to treat a real patient?
- Yes, please.
This thing's going to give me nightmares.
- I hope you don't mind me jumping right into things.
I find that a mock code is a great way
to assess the students' capabilities.
- Well, it might have been nice if we'd had a little time
to go over how we do things.
- Did you not get a packet from Dr. Underwood? Gloria?
It outlined the quality-improvement changes
I instituted at the VA.
We're adopting the program
at all of the university hospitals.
You didn't read it? - No, I did. I mean, I will.
I'm going to. I want to.
I thought I had a little bit more time
before you came in today. - We've already distributed
patient passports to everyone at registration.
- What is a patient passport?
- So glad you asked.
Samira? - Dr. Al.
- We worked together at the VA a few years ago.
And now you're an R4. - Yes.
And I'm so excited you're joining us.
Dr. Mel King is here, too.
I think you worked with her as well.
- Incoming! - I did indeed.
- John Doe--dishwasher, penetrating trauma
from a kitchen knife to the right chest.
- Assault or accident? - Unclear.
Initially had a pulse, lost it two blocks away.
[respirator hissing]
- What do we got, party people?
- Dr. Yolanda Garcia, trauma surgery fellow,
meet Dr. Baran Al-Hashimi, new E.D. attending.
She's gonna be covering for me while I'm gone.
- So nice to meet you.
- About time they replaced you, Rabbit-bitch.
- I'm gonna miss you, too, Yolo.
Dr. Garcia has a hard time expressing her feelings.
- Not all of them.
- One, two, three.
Prep for a left thoracotomy. - I'm on it.
- What's up, White Chocolate?
Did you know our farm boy here is a vintage-funk freak?
Unfortunately, he also likes to use
other people's toothbrushes. - It was one time.
They were the same color.
- What's your plan, Samira? - Dr. Mohan, next steps?
- Chest tube to the right.
Stand by with massive transfusion protocol.
- I put two units on the infuser.
- Sterile gloves, 6 1/2.
- Here, we let the fellows
and the residents kind of take charge.
- I'll hold on to them just in case.
- Is the VA even a trauma center?
- Not for medic runs, but they walk in--
falls, major MVCs, GSWs.
- Stab wound's on the right.
Why are we opening the left chest?
- Better access if it's tamponade,
and you can cross-clamp the aorta.
- Javadi, Whitaker, sterile gloves.
- Can I glove up?
- It's best if you watch the first one.
- This guy's dead anyway.
- 10 blade. - 28 French on a long Kelly.
- Javadi, you're on suction,
Whitaker, get ready for internal compressions.
[cell phone chimes]
- Sorry, that's my phone.
- Finochietto retractor.
Whitaker, give me a little room.
- I need to get to his heart.
- I'm in. Hook up the Thora-Seal.
[cell phone chimes]
- You want me to get that for you?
- Not right now.
[hose slurping]
- No tamponade, pretty dry in here.
Heart's empty.
Somebody start cardiac massage, I'll cross-clamp.
- Yeah, I got it.
You do these one-handed,
pushing up against the breastbone with four fingers.
- Very good. - Not much blood to suction.
- Okay, team, I think we need-- - Samira, next steps?
- Keep transfusing.
Open the right chest. - That is correct.
Booties on, kids. There will be blood.
[indistinct chatter]
- Frank?
Langdon.
Frank?
- [exhales deeply]
[indistinct chatter]
- You should be good to go now, hon.
- Thanks, Lupe. - Of course.
Hey, go get 'em.
- Hey, Doc.
It's been a while.
I got a-a bad toothache today.
- We'll take care of that, Louie.
- All right.
[device beeps, door clicks]
- [clears throat]
[chatter continues]
- There's too much blood to suction.
Uh, retracting the lung.
- Try to identify the source. - Could be the right ventricle.
- Or more likely, the hilum.
- Fresh lap pads.
[cell phone chimes]
- Siri, turn on silent mode!
[keypad beeping, locker buzzes]
[keypad beeping]
[locker buzzes]
- [spits]
- Good morning.
- If it was a good morning, I'd still be in bed.
- [chuckles] So what are you doing here?
- Benji's mom is visiting for the holiday.
- She's still alive? - That woman's too mean to die.
Plus, who else is going to get this place
through the Fourth of July weekend?
- Sure as hell ain't going to be me.
- I rest my case. What am I walking into?
- Nothing too bad, yet.
Uh, these are the ones I'd keep an eye on.
[gasps] The prodigal son returns.
Too soon?
- No, I guess not.
You're back. - I took some time.
I'm like an old trail horse-- I always find my way back home.
You look good, kid. How you feeling?
- Uh, yeah, great.
You know, it's been a...
it's been a journey. - I bet.
- Thanks. Robby around?
- Uh, he's in with a trauma.
But if you hurry back, you can catch some of the pass-ons.
They're in North. - Uh, thanks.
- I'll keep an eye on him.
- I think we have a lost little lamb.
Uh, excuse me, hon. Can we help you?
- I'm looking for the charge nurse.
- Oh, well, you found two of 'em.
I'm Lena. This is Dana.
I'm night shift, going home,
but Dana is queen of the day shift.
- Emma Nolan. Nice to meet you both.
Uh, I'm a new grad RN here to shadow.
- Welcome to the Pitt, Emma Nolan.
Here, let me put some of your stuff behind the desk,
and I'll give you a quick tour. - Okay.
- Where you from, sweetheart? - Sault Ste. Marie.
- Oh.
- It's in Upper Michigan, practically Canada.
- My great-grandmother was from up that way--
nice area, a lot of bugs.
How about a cup of coffee?
[hose slurping]
- Can't locate the source.
- Proximal hilum is under the sternum.
- Along with most of the right ventricle.
- You need better exposure. - Convert to a clamshell.
- Exactly. - Trauma shears.
- Would've been nice to let them come up with that plan.
- Heart's going to need double compressions just like this.
[cell phone chimes]
- Squeeze from the apex to the aorta.
[hissing]
- Right ventricle looks good.
- Massive hemorrhage from the hilum.
- Second MTP pack is going, additional four units.
- Hilar injury looks very proximal--
may be pulmonary artery and vein.
- Clamp's on. Nope, no good.
Still bleeding like a stuck pig.
- I can give it a try.
- Dr. Garcia is a very skilled surgeon.
If she can't get it, we need to think of something else.
- Like what?
- Hilar flip.
We're going to rotate the lung 180 degrees,
like putting a kink in the garden hose.
It'll stop the bleeding. - That could possibly work.
- Or he'll die when you rip the entire lung off the hilum.
- Gently, very, very gently, very, very slowly.
[respirator hissing]
- Blood loss is slowing down. - That's a good sign.
- Hilum looks dry.
- Yeah, but the heart feels empty.
- Okay, we fixed the leak. Now let's fill the tank.
[cell phone chimes]
You are very popular today.
- Sorry, I'll turn it off when I can.
- Nine-year-old Kylie Connors--
brought in by her dad's girlfriend, Gina.
Kylie took a tumble on the stairs this morning.
3-centimeter chin lac and a chipped front incisor.
She's got LET on a pressure dressing.
Bleeding pretty good on arrival.
Dermabond should do the trick.
Any questions?
Dr. King?
Mel?
- Oh, um, I didn't say anything.
- Uh, how you feeling, Kylie? - Tired.
- We've been here since 5:30. - Oh, that makes two of us.
But don't worry. We'll patch you up good as new.
And we will get you out of here as soon as we can.
Any questions? - Can you raise your chin?
- No, I'm just her dad's girlfriend,
so I'm new to all this. - No worries. We got you.
Next.
- 26-year-old Liam Sanders-- took a fall from his bicycle.
No LOC, nonfocal neuro,
lower-leg lac with no bony tenderness.
- Were you wearing a helmet, Liam?
- No, I was just riding in my neighborhood.
- You should always wear a helmet.
- Hey, nice of you to join us.
- Hey. - Dr. Langdon!
- Sold to Dr. Langdon.
- Candace O'Grady, 82... [person coughs]
Brought in by her son Richard for intractable vomiting.
- Hardly any hemorrhage on the right.
- Looks like the flip worked. - How's the heart, Whitaker?
- Feels full of blood. First time since we started.
- Hold compressions.
- Quivering bag of worms. - Resume compressions.
- When the heart quivers like that, it's obvious V-fib.
- Okay, internal paddles ready. - Mm-hmm. Charge to...?
- 25 joules. - 50 joules.
50 gets it right the first time.
[paddles whirring] - Charged.
- Okay, Whitaker, when you're ready.
- Clear.
- That's what normal sinus looks like.
- Strong carotid.
- Saline lap pads and up to the OR.
- That's a hell of a way to start the day.
- Unconventional, but a decent outcome.
- Why don't we split up for efficiency?
Residents present to either one of us but not both.
- We can certainly discuss that.
- Were you feeling weak or dizzy?
- [sighs] No.
I-I got up to pee, and I tripped over
a laundry basket that I couldn't see in the dark.
- Did you hit your head?
- Does my chart say that I hit my head?
- No, we just want to be thorough
to make sure you don't miss anything.
- How about we focus on patching me up?
Ah!
- All right, Mr. Williams,
we're going to check an X-ray of your wrist
and try to get you out of here as quickly as possible.
- Great. And let's keep the bullshit extra charges
to a minimum, huh?
My deductible is already a bitch.
- [sighs]
Sure.
[Samira speaking Tamil]
Bye.
My mother is trying to destroy my life.
- Yeah, they seem to take pleasure in that.
- I committed to a partnership-track position
next year at a hospital back in Jersey
so I could be close and support her.
But now she's getting married and selling our house
to go on a year-long cruise around the world.
- Wow. I mean, that's a--
- Pretty fucking stupid idea, if you ask me.
She's known this guy less than a year.
What if he's a player? What if she disappears at sea?
- I mean, what if they're in love?
- Lust is more like it.
- That is even better.
Man, it has been a while,
and I'm solo this weekend.
I need to get laid.
It's a little much before 8:00 a.m., right?
- [scoffs] Yeah.
Or ever.
- How's it going, Esme?
- Oh, just another day in paradise.
[device whirs]
- Heard you're going on a trip.
- Taking a sabbatical. Leave tonight.
- Where you going?
- Um, Head-Smashed-In Buffalo Jump.
- Captain Crunch flying squirrel socks.
What, are we talking in code, or are you having a stroke?
- It's an Aboriginal UNESCO Heritage Site in Alberta.
I've never seen the Badlands.
- What is this, like, uh, some sort of spirit quest?
- Uh, yeah, something like that.
- Look, I, uh-- I guess we should talk.
Got a lot of things I need to-- - At some point, not right now.
Right now I got to hit the head,
and I would like you to go help Donnie out in Triage.
- Triage?
N-no.
No, I already picked up a patient in North 2,
a bicycle fall leg lac, so maybe--
- Pretty sure we can cover for you.
We've been doing it for months.
- Right.
No, and I--and I am-- I am very, uh--
both very sorry and appreciative of that.
I just would hate to think
that this is some kind of a punishment for...
but, uh, yeah. Yeah. No, for sure.
We'll--we'll talk later, before you go.
- Like I said, not right now.
Donnie just passed his NP certification.
He can help if you get in over your head.
Hey, Mel...
can you take over a bike fall leg lac in North 2
for Langdon while he's out in Triage?
- Um, you know, I-I can work in Triage if you want--
- No, I want to keep Langdon out in Triage,
and I want to keep you back here.
You okay with that? - Sure.
- Great. - Absolutely.
- So...
who should I pick up?
- We're about to get the morning rush.
- What do you mean?
- Every morning around this time,
the nursing homes and assisted-living facilities
do their morning bed checks. - Uh-huh.
It looks pretty quiet to me.
- Huh.
- Incoming.
- Oh, like I said.
Come on.
- Ethan Bostick, 79--
found altered this morning at assisted living.
No history of dementia.
Has a POLST. - What's a POLST?
- Physician Orders for Life-Sustaining Treatment--
no CPR, no intubation.
- Then there's-- there's nothing for us to do.
- South 15 is open.
Uh, well, "do not resuscitate" does not mean "do not treat."
He may perk up with fluids, IV antibiotics.
- [speaking Korean]
- What's the good word, Crash?
You save that ventriloquist dummy?
- Yeah. - Really?
- No. - [laughs]
Wait, tell me you're not actually charting
about losing a mannequin. - It's part of the exercise.
Dr. Al-Hashimi asked us to do it.
- Who's his next of kin-- Barbie?
[chuckles]
What's your, uh, take on the new attending?
- Too soon to tell.
You? - [sighs]
She's already bugging me
about being behind on my charting.
Now I know why everyone says
being a second-year resident sucks--because it does.
- I must've slept through the part of med school
where they tell you 90% of your time will be spent typing.
- Which is just one more reason
surgery is a better lifestyle choice.
- Hey, Dr. Shamsi. Dr. Trinity Santos.
- Ah, yes, the ER intern who's interested
in my surgery program. - That's me.
But I'm an R2 now and thinking of double boarding
in surgery and emergency medicine,
which I know would sound ridiculously ambitious
if I didn't have the talent to back it up.
- And the required attitude.
Are you here to see a patient?
- I was. I did.
And now I'm here to learn
why you aren't returning my calls or texts.
- Okay, I'm out.
Nice seeing you again, Dr. Shamsi.
- As soon as I get a little free time,
I will make plans for all of us to do something together.
- What about Tuesday? - I'm working.
- On your birthday?
- I will call you and Dad tomorrow,
and we'll come up with something to do together, I promise.
But right now I actually have
a bunch of night-shift hand-offs.
- [clears throat]
- We have schedules. You have chaos.
You know she's wasting her talents down here.
- Victoria is a big girl. She can make her own decisions.
- She's also a young girl who's still very impressionable.
And you can be very... - "Pressionable"?
[cell phone ringing]
- Yes?
Who?
Oh, for God's sake. I'll be right there.
We need to talk.
- [whispering] How about same time tomorrow?
- Next Tuesday's your birthday?
- No.
Yes. - Your 21st birthday?
- Please don't say anything, okay?
I-I get a little anxious about--
- Dr. Santos, little girl with the chin lac
is getting into a gown.
[whispering] Don't want anyone to know what?
- Nothing.
- Have a good day. - You too.
- [speaking Tagalog]
- [normal voice] Oh.
- Hey, Duke, I'm just calling to remind you
that this is my last shift for a while.
So I need you to come in before 3:00
in case we need to run some tests.
Okay? We had a deal, brother.
Oh. Hello. - Hi.
I know you're crazy busy. - Always.
- But I figured we should really go over a few things
before you're gone. - Sure.
Where would you like to start?
- Well, one little thing that I think
would have a big impact with staff and patients alike
is if we launched a campaign
to eradicate referring to this wonderful department
as the Pitt. - Really?
- I know you think it's silly and petty.
- No, I think it's just kind of endearing,
pretty damn accurate. - I would argue the opposite.
I think subconsciously it affects those who work here.
It also lowers expectations,
which in turn lowers patient-satisfaction scores.
- You have been talking to Gloria.
- Yes, and she agrees with me. - Don't doubt that for a moment.
- You have to see the man over there right now!
- We see people in order of severity, ma'am.
- [speaking Ukrainian]
- I don't know what you're saying.
- I can taste the shit in the back of my throat.
- Actually, the lady's right.
He's going to make all of us sick.
- Yes, please.
[indistinct chatter]
- [coughing]
- All right. [sighs]
We'll get him back.
Tell Dana we're bringing the funk.
- Oh, my God. - Whew!
- So when did your eye start bothering you, Ms. Mathews?
- Sister Grace, please.
I'm only married to God.
- Of course, I'm sorry.
- A few days ago. I thought it was pink eye
or maybe I scratched it while gardening.
- It's a very bad case of conjunctivitis.
We should send a sample to the lab
to direct our treatment.
Look up for me. Thank you.
Okay, I'll put a numbing drop in your eye
and check for a scratch with a special lamp.
And I'll get you to look up for me again.
Thank you.
- Have you ever considered serving God?
- Which one?
- Excuse me?
- My family is Hindu,
so we have, like, 33 different kinds of deities.
- Oh, we have the one.
- Some people only need one, right?
Okay.
[camera shutter clicks]
- Most important rule around here--be smart, be safe.
I can't warn you enough about protecting yourself
and your fellow nurses.
We use the STAMP acronym to assess patients.
You know it?
- Uh, S is for staring or refusal to make eye contact.
- If they're staring, they're scaring.
T? - Tone of voice.
- Often the threat level rises with their voice.
- A is for anxiety.
- You can also think "aggression."
- M is mumbling.
- Which, if you listen closely enough,
is often them saying what they're thinking of doing
as they talk themselves up to it.
And P? - Pacing.
- Good.
We also have a safe word-- "hula hoop."
I guess technically it's two words, but whatever.
If there's a threat, say "hula hoop,"
and we'll all respond. [cell phone ringing]
Yeah?
Lovely.
Okay, I'll be right there with reinforcements.
Duty calls. We're headed for Triage.
[indistinct chatter]
- We're going to get your cast off--
[low humming]
- The antibiotics should clear everything up,
but you should try to stay off it for a few days.
- Uh, I have to work. I'm late as it is.
- Well, um, take breaks and elevate when you can.
Tylenol and Advil for the pain.
If the pain persists or feel like it's getting worse,
come on back.
We'll get you fixed up. - Thanks.
- They said give this to the doctor.
- What the hell is it? - Patient passport.
Lets patients know what they're waiting for
and how long it'll take.
You check off if he needs labs, X-rays, CT.
- None of the above. When did we start this?
- Today, the new attending.
- [scoffs]
What's up with your tooth, Louie?
- It's been going on for a while,
but it got bad last night.
[groans] Lower-left side.
- Okay.
- [groaning in pain] - Oh, yeah.
It could be an infection at the root.
- [groans] - We can drain it, but then...
you're, uh--you're breathing kind of fast.
- [exhales sharply] Yeah, I've been--
well, I've been, uh, walking more,
trying to get in shape.
But sometimes I get a little short of breath.
- Yeah, you need to walk past the liquor store, not into it.
Only shape you're getting in is for a liver transplant.
- I don't need a new liver. Just get rid of this toothache.
- Deep breath.
- [breathes deeply]
- One more.
- Is my heart still ticking? - Like a jackrabbit.
How long you been sitting down? - Oh, just for a few minutes.
Not that long.
- Um, Louie...
There's something I need to tell you.
Last time I saw you, about ten months ago,
I treated you, and I took some of your medicine.
- I'm not sure I follow.
- I have an addiction to benzos,
and I helped myself to some of the Librium I prescribed you
for your withdrawal.
- You stole my pills?
- Yeah.
Yes, um...
I'm sorry. It was, uh...
it was not only wrong and utterly unprofessional,
but it was a betrayal of my Hippocratic Oath,
and it was a fucking crime.
That's where I've been-- rehab and counseling.
- Huh. - I'm sorry.
I-I understand if you'd prefer a different doctor.
- Hey, Doc, we have a situation.
- Excuse me.
What kind of situation?
- Someone left a little baby in the restroom.
[baby crying]
- Okay, let's think
about reversible causes of confusion in the elderly.
- Uh, hypo or hypernatremia, infection, but he's afebrile,
good O2 sats, and urine dip is negative.
- Yeah, great. Joy, anything to add?
- Nah. [alarm blaring]
- V-tach. Can I-- - Yeah.
- No pulse. Should we call for a code blue?
- No CPR, no shock, we honor his POLST and his wishes.
- So what does that leave us?
- Making sure he's comfortable.
- I'll suction.
- Altered mental in the elderly can also be
toxicity from anticholinergics, sedative-hypnotics, opioids.
A-am I missing something?
- Social skills?
- [chuckles] - What?
[blaring continues]
- He looks so peaceful.
- Shouldn't we go find a new patient?
- No, stay here.
[flatline]
- Asystole.
- Quick and painless.
We should all be so lucky.
- I'll try to contact some family.
[flatline stops]
- Yeah, one of the things we like to do here...
When we have the time...
is to take a moment of silence when we lose a patient
to respect their humanity.
He was someone's son, perhaps a father himself,
a brother or a friend.
Oh, uh, make sure your phones are on silent.
Great, great, great. Okay. Uh...
- Is anyone missing a baby?
Did anyone leave their child in the restroom?
- Do you, uh, remember seeing a woman enter with a baby
but leave without one?
- No, sorry.
Might be on the security tapes.
I'll have Ahmad check it out. - Please.
- Yeah.
- Harlow Graham to window one.
Harlow Graham to window one.
Harlow Graham to window one, please.
- Donnie Donahue, nurse practitioner.
This is Emma, new grad nurse.
- Hey. - Nice to meet you.
- What's going on? - Somebody dumped their kid.
- Maybe Mom just stepped out for a smoke or something.
What? I'm being helpful.
Sometimes they just need a little break,
and then they come back.
At least they didn't leave her in a suitcase
at the bus station. - Does that happen?
- If that's a true story, I don't want to know about it.
- It ain't the worst I've seen. - Please, don't tell me.
I'm a new dad, remember? - Okay.
[baby crying]
There you go. I'll get Robby.
- Should I come with? - No, stay here.
Donnie, Jesse, teach her something.
- You know how to check a rectal temp on an infant?
- Uh...
theoretically.
- Mr. Williams, how's the pain?
- Nothing I can't manage
with some Vicodin and a little scotch.
- [chuckles] Well, it's best not to mix the two.
James here is going to take you to get an X-ray of your wrist.
- I'm going to be fine.
- Well, it'll tell us if you need a cast.
- Oh, I doubt it.
I should probably go home, keep some ice on it.
I know you guys always need the beds.
- Well, uh, it'll only take a minute,
and then we'll know for sure.
- Yeah, I-I really don't think it's necessary.
And I have a busy day, but I appreciate your concern.
- I'd really like to observe you for a little bit,
in case you did hit your head.
- My head?
I hit my schnoz on my arm, I think, nothing more.
- You think? You don't remember?
- No.
Or, yes.
I'm going to be fine, really.
But thank you for your concern.
- Okay.
- [shouts in pain]
- How about we take that X-ray just to be safe?
- Yeah. Yeah, okay. - Yeah?
Okay. - Okay, good idea.
- [sighs]
Somebody found a baby? - Yeah.
Not the first time it's happened.
So, about those pills I took--
- Oh, don't worry about it, Doc.
If the pills helped you, great.
I never really liked taking 'em.
[both chuckle]
- I appreciate that, Louie.
That's not really the point, but...
I need to lift up your shirt for a second.
- [groans, sighs]
- How long has your belly been hard like that?
- I don't know.
I figured I could wait another week.
- You need, uh, some lab tests
and a procedure to drain off some of this fluid.
- Yeah, I know the drill.
I've been tapped a few times before.
- Three times in the last six months.
You need to give your liver a break, Louie.
- Yeah, I know.
- I just heard somebody dumped a baby
in the waiting-room bathroom.
How sad is that? - Huh?
- What's up with you today, Mel... ancholia?
- What makes you think there's something up with me?
- You're moping around here all day
like somebody gunned down your favorite K-Pop band.
- I don't really have a favorite K-Pop band.
It's not that I don't like the genre.
It's just kinda-- - Okay, forget K-Pop.
What's going on with you?
You usually ride in here
on your unicorn tossing wildflowers.
- "Unicorn"? - [sighs] Never mind.
Is everything okay with your sister?
- Oh, yeah, she's great.
It's just this...
[stammers]
- Spill, girl.
- Um...
well, a-a couple months ago, I got named in a...
[whispering] Malpractice lawsuit.
And so, um, today is the--the deposition.
- That's it?
Every emergency-medicine doc gets sued sooner or later.
Seriously, don't sweat it. You're still a resident.
We're protected by the hospital.
You could cut somebody's head off and get away with it.
But, you know, like, don't.
You don't want to become known as the one
who put Mel in mel-practice.
- Hey, Santos, our little girl, Kylie, has been
in the West Penn Emergency Department a couple times.
- I'm not saying this is necessarily the case here,
but recent studies have linked bullying behavior
to different personality disorders.
On the other hand, though, I-I am known to be a bit
overly sensitive sometimes--
- Mel. - Yes?
- You're talking to yourself again.
You need something? - Uh, yeah, a good lawyer.
[chuckles] I don't know. I'm kidding.
I'm--
- Yo, Robinavitch, somebody ditched a bundle of joy
in chairs.
- How old? - Couple months maybe.
Donahue's got her in Pedes.
- No one saw who left her? - Apparently not.
- That's so sad. - Tell me about it.
Who throws away a perfectly good baby?
- [laughs]
- Make a lane!
- Ah, sweet baby Jesus, Antoine!
Right to the outdoor shower! - I just drive 'em.
I'm not a wash and detail service.
- Yeah, yeah, God forbid you prove useful.
Ah, good timing, Ms. Emma.
Time for you and me to do the Lord's work. This way.
- Ooh, God, what is that?
- Okay, big breath. - [breathes deeply]
- All right, lungs sound great. Can you lean forward for me?
Uh, did you hit your back when you fell down the stairs?
- No.
- Okay, there's a pretty good bruise here.
- I got knocked down in soccer.
- Oh, no, you broke your wrist last year, too, huh?
- Fell off my skateboard. Got a purple cast.
- Cool color.
- And you were treated at West Penn?
Is that your closest hospital?
- Uh, I guess that would make sense.
I've only been dating her dad a few months.
Uh, he lived in Garfield before the divorce.
- And, uh, what about these? - Soccer.
- Do you wear shin guards?
- My dad ordered them.
- Okay. What does your dad do for work?
- He draws buildings, but he's not an architect.
- He's a draftsman for a firm in Newcastle.
- Okay. Um, Kylie, any chance you can pee?
- Mm, maybe. - Okay.
Well, with the bruise on your back,
we need to check your urine.
- Okay. - Okay.
- Did you eat anything out of the ordinary recently?
- No.
Sorry, but we went through this a bunch.
Don't you people communicate?
You're the third nurse we've told her story to.
- I'm a doctor.
- Richard, would you go to the cafeteria
and get me a large chamomile tea?
What can we get you, my dear?
- I'm fine, thank you.
- Yeah, I'll be right back.
- Please excuse my son.
Ever since my husband died,
he's been a little overprotective.
- I think it's sweet.
You're very lucky to have him. - I am.
- Are you still taking your loperamide and cholestyramine?
- Um, mm, not so much.
- No?
That may be why you're experiencing the abdominal pain
and vomiting.
When did you stop taking your meds?
- Last winter or so.
My neighbor Helen and I bingo in Wintersville.
There's a dispensary next door.
And we got some marijuana.
And I swear it cleared everything up.
A few cookies every few hours...
and no more pain.
- "A few cookies"?
How many are you eating in a day?
- Oh, uh...
I don't know.
Probably a dozen or so, but they're not very big.
- There have been some studies
that show an added dementia risk
with marijuana use in older adults.
- Well, that sucks for old people.
[urine trickling]
- Kylie, there are some questions
that we ask every kid who comes in with an injury.
- Like what?
- Like, sometimes the people that you live with
can get so mad that they hit you or hurt you,
maybe without even meaning to.
Does that ever happen?
- No, not to me.
- Or sometimes kids can get punished
for doing something wrong
with maybe a spanking or a belt.
- I get time-outs.
- How about at school, Kylie?
You know, is anybody being, you know, mean or bullying you?
- No, I have lots of friends.
- [clears throat]
[toilet flushing]
[water running]
- Yo, Whitaker.
- Dr. Langdon.
- You, uh, meet Louie here? - Uh, yeah, yeah, many times.
Good morning, Mr. Cloverfield. - What's up, Doc?
- Where's your new resident badge buddy, buddy?
- Oh, uh, yeah, they--they didn't give me a new one yet.
- Bummer.
You and, uh, your ducklings got time
to tap a six-pack off our friend here?
Louie needs a paracentesis. - Yeah, sure.
It's good to see you again, Louie--
not in this condition, of course.
How you feeling?
- Feeling like I need a drink pretty soon.
- Okay, well, first things first--
we are going to make you more comfortable
by draining some fluid.
- You're gonna take off a big volume,
so start with 60 grams of 25% albumin IV.
You tapped him before? - No.
- That's okay, Doc. I'll talk him through it.
- [chuckles] Okay.
- Sats 99 on room air, normal BP, normal pulse.
- Oh, well hydrated.
- No obvious source of infection.
Could be a benign virus, but can't assume that.
- Is this the abandoned baby? - Mm-hmm.
- How old? - How old do you think she is?
- Month, month and a half? - It's tricky.
Under 28 days is a Safe Haven drop-off, no questions asked.
But over 28 days is a crime, child abandonment.
- How should we assess?
- Under 28 days gets everything, including an LP.
But over 28 days,
you can follow PECARN or Step-by-step
to determine risk of invasive bacterial infection.
- This baby looks great.
- But we know nothing about the birth history.
Did Mom have group B strep, active HSV lesions?
- We should assume the worst. Put in your orders, Dr. Mohan.
- CBC... [sighs]
Blood culture, chem panel,
chest X-ray, UA and culture,
respiratory virus panel.
Check inflammatory markers-- procalcitonin and CRP--
then take it from there.
- That sounds like a plan.
- Dr. Robby, Santos needs you in North 1.
- Okay, I'll be right there.
If you'll excuse me, if you'll excuse me.
- Mind if I join with? - Uh, no, I got this.
- It will help me get a better sense
of how you like to do things by seeing you in action
with the residents.
- Be my guest.
- I will be right back.
Um, nine-year-old Kylie Connors--
took a tumble running up the stairs this morning.
Chin lac and fractured tooth.
Brought in by her dad's girlfriend, Gina.
Supposedly, the dad had to leave early for work.
Kylie has a lot of bruising on her body--
some old, some new.
- Are you concerned about non-accidental trauma?
- Or worse.
Her urine sample shows gross hematuria,
which could be renal injury, or vaginal bleeding from trauma
could have contaminated the specimen.
- Lots to consider. What's your plan?
- Labs, ultrasound, social-work consult,
then decide if this is reportable.
- Mm-hmm.
- Let me know if you can feel this.
- No. Am I supposed to?
- No.
- Your hair's such a pretty color.
- Thank you.
- Reminds me of my mom.
She died when I was nine. - Oh, I'm sorry about that.
- She wore glasses like you, too.
Weird.
What do you like to do when you're not working?
- Um, spend some time with my sister,
read.
- Do you drink coffee?
- Uh, no, I avoid caffeine.
- Me too.
Um...
what about boba?
- I love boba. [chuckles]
- I'd offer you some gum, but it's laced with nicotine.
Trying to quit smoking.
- [sighs] That's good.
- Verdict's still out.
Get in all those nooks and crannies, Mr. Digby.
Your skin will thank you.
We all will.
- Oh, I could stay in here all day.
- It's a miracle what little soap, water, and human decency
can do sometimes.
Don't forget the ears, pal.
Don't want anything growing in there either.
- Okay. Okay.
- What's your story, Emma?
What'd your parents do? Got siblings? Boyfriend?
Ever kill a man in a bar fight?
- Uh...
[indistinct chatter] - [sighs]
So, Mr. Williams,
sometimes a fracture of the scaphoid bone
doesn't show up on day one.
So my advice to be safe is wear a splint for two weeks
and then come back for a repeat X-ray,
and we'll see if it's really there.
- [sighs]
My knee hurts.
- Oh, did you hurt your knee?
- I must have.
What is this?
- That's, um, for your wrist.
- And I need this?
- Well, um, if it's a, uh--
John, can you?
If it's a fracture and we don't immobilize,
the bone might not heal properly.
- [sighs] How long is this gonna take?
- Just a few minutes to fit you.
- Is this place new?
- Mr. Williams, do you know what day it is?
- It's Taco Tuesday.
- Do you know where you are?
- Yeah, I'm in the slowest medical clinic in the West.
- Do you know what year it is?
- How about you just fix my wrist
and you stop with all the questions?
I am not here to be profiled.
- Yeah, of course.
I'll be back, okay?
[inaudible speech]
- All right, Mr. Digby, looking better already.
Certainly smell a little better.
- Do you have any conditioner?
- Let's get you dried off and back inside.
Get him gowned up and put him in South 21,
across from the old nun.
Maybe some of her divine grace will wear off on him.
Who do we have here?
- Evelyn Bostick, 81, with Alzheimer's.
We brought her husband in about 30 minutes ago.
She was supposed to get a ride in,
but they found her wandering in traffic.
- Where are we? - You're at the hospital, dear.
- I'm not sick.
- We brought you to see your husband.
- Oh, no. Is Ethan okay?
- I'll be in to chat with you, Mrs. Bostick.
He died.
What you got, Amboy?
- Allen Billings--had a pallet fall onto his outstretched arm.
Looks like an open dislocation. - Yeah, that's got to hurt.
Don't worry, sir. We got you.
- [breathing heavily]
- How's she doing? - Seems happy enough.
- Yeah. Hi. - Hi.
Just got a quick point-of-care CBC.
- [chuckles]
Is there a problem?
Did I miss something?
Dr. Al? Dr. Al?
[Yvonne Fair's "Say Yeah Yeah"]
- ♪ I've been hurt ♪
♪ But I refuse to cry ♪
♪ I've been hurt, baby ♪
♪ But I refuse to cry ♪
♪ It's so true ♪
♪ You know, you know, you know ♪
♪ You know I can't lie ♪
♪ And I said, yeah, yeah, yeah ♪
- ♪ Yeah, yeah, yeah ♪
- ♪ Yeah, yeah, yeah, baby ♪ - ♪ Yeah, yeah, yeah! ♪
- ♪ Yeah, yeah, yeah ♪
- ♪ I won't cry ♪
♪ Oh, you know I won't cry ♪
♪ I said ♪
♪ I won't cry, baby, baby, baby ♪
♪ You know I won't cry ♪
♪ You know, you know I won't cry, baby ♪
♪ I'm telling you, I won't cry ♪
♪ Oh, I don't lie ♪
♪ Oh, and I refuse to cry ♪
♪ And I said ♪
♪ From time to time ♪
♪ Your friends, they treat you so cold ♪
♪ Your friends, you know they act better, yeah, yeah ♪
♪ When you have that gold ♪
♪ Oh, I won't lie ♪
♪ You know, you know, you know ♪