- 2701! Get the fuck out!
- Is there a MedicAlert bracelet?
- Did you get an ID on him? - Student ID.
Name says Jackson Davis. - That's a start.
Jackson, what's going on? - Title 18!
Title section 508! - Javadi, you're with us.
- We're gonna take good care of you, Mr. Davis.
You're in a safe place. - You're okay.
- Get off! - Trauma One.
- Reasonableness! 2709! - Okay, okay, Jackson.
We're gonna need you to calm down
to get the Taser barbs out of your neck.
- Do you need to jump on that? - Mm-mm.
Covering calls for Dana.
- Stop talking to me.
You can't! Title 2710--
- Hard to assess pupils. - [grunts]
Hard to assess anything. - Yeah, yeah.
Wait till after he's sedated.
- 10 of olanzapine. - No, no.
That'll take 15 minutes to kick in.
Uh, 5 of droperidol puts him down in 5.
- No, you can't give it without knowing his QT.
- Two beats of a rhythm strip before he took off the leads.
- No.
You can't be in here. Get out!
- That looks good. Go with the droperidol.
- Get the fuck out! Get off me!
- Do we take the Taser barbs out?
- 2701. - No.
We got to wait till he calms down first.
- Get off me, man. 2901, get out!
Get out! 2710.
Title 18, section-- 1938.
- Mr. Randall, happy 20th anniversary
and a very happy Fourth of July.
But no sex fireworks for you tonight.
Give everything a chance to heal.
- Don't worry, I will.
Thanks, Doc. Ow.
- We're going right back through here, okay, ma'am?
- Oh, thank you.
- Change the dressing twice a day.
Doggy bag of the ointment and nonstick gauze.
- Cool. I know the drill.
Come back if it starts to ache or stink.
- Exactly. Good luck. Stay safe.
- Oh, shit, it's Daddy, with your daddy.
- Lord, what'd they get up to now?
- Treatin' and streetin'.
- "Pros from Dover."
- I'm sorry, Ms. Graham.
I just saw the ASL note in your chart.
This is Lindsey.
We'll bring you back as soon as possible.
Stay with her.
[indistinct chatter]
All right. Who here needs help?
[indistinct chatter]
You? You need help?
- Oh, no, no, no, ma'am. I've been on these since 1987.
This one here, he got dizzy, fell down.
- Forgot my blood-pressure medication.
I left it back home in Georgia.
- And presto.
We're back, Mr. Digby, with some IV antibiotics.
First we scrub your outsides, then we clean your insides.
What do you need to document in his chart?
- Uh, time started, time completed,
and any adverse reactions.
- What else?
- Um, lot number on the antibiotic vial.
- Excellent. Mr. Digby.
- It's just Digby.
- Digby, why'd you wait so long to come see us?
- I don't like going to doctors.
- Well, that makes two of us.
We all need help from time to time.
Think maybe we could arrange for some ongoing care?
- I just kind of want to get patched up, you know?
- I do know.
But that's today. What's tomorrow?
- Sunday.
- Use the system. That's what it's there for.
Buddy of mine, Dylan, knows all the angles.
He even works the occasional miracle.
You think maybe I could have him stop by?
- I guess, yeah.
- Great.
How about a sandwich? - Yeah.
Yes, please.
- We always offer.
Two most important things-- that they know we're here
and that we'll never stop offering.
- Thanks for covering, Princess.
- Anytime.
- Yo, can I get some help over here?
- Yeah. What's going on, man?
- The crazy kid in there, screaming.
- All right, have a seat. - Yeah, that's him.
Still going nuts.
Probably meth-- fucking animal.
- What's your name, sir? - You don't understand!
- Tony Chinchiolo, campus security.
Yeah, I was at work when this happened,
so I'm gonna need everything documented.
- Okay.
- All right. Heart rate's 89.
Pulse ox 97.
Scalp lac's tiny--
5 millimeters. - Ow.
- Should hold together with Dermabond.
- Kid threw a fucking chair at me.
- Work-related injury gets a full exam.
Jesse here will take you. - Oh, no.
I-I'm gonna stay here till the cops come
so I can give my statement and so I can watch him.
- Yeah.
- Trust me, you do not want him getting out of there.
Ow, fuck.
- Did she say anything? - No more than she said to you.
Nothing going on at home. Nothing at school.
- And you believe her? - There's some flags.
Bruising in various stages of healing.
She's a little withdrawn,
doesn't engage much for girls her age.
But she could just be a little shy...
or scared of being in here.
- Or she's being abused.
- That too.
We'll find out more when Dad shows up.
- Yep. If he shows up.
- I need a hand here!
[object snaps] - There's the first barb out.
All right, Javadi, you're up.
[monitor beeping]
Okay, so you're gonna want to clamp
where the shaft meets the barb.
- Mm-hmm. - Yep.
Stabilize the skin.
- Not so close so as to stick yourself.
I've seen that once or twice.
- Uh, pull up at 90 degrees.
- Harder. Yep.
Harder.
- Oh.
Do we suture those?
- Nope, just a Band-Aid.
- Mel, we need orders. - Right.
- I got a rainbow.
- Uh, CBC...
CMP, UA, blood alcohol, and tox screen.
- All of the above.
- Cap, if this young man's stable,
can he go to Central 10 pronto?
Double trauma at the back door.
- Okay, you heard the boss. Let's get going.
Today is starting to heat up.
[indistinct chatter, telephone ringing]
- Mark Yee, 32-year-old restrained driver,
auto versus motorcycle.
Altered with normal BP, satting 99 on 2 liters.
- We're at the hospital now, Mark.
What's wrong with him? Why isn't he talking?
- His wife, Nancy, front-seat passenger,
declined transport. - I'm fine.
We weren't going all that fast. The motorcycle ran the light.
- I'm Dr. Robby. This is Dr. Al-Hashimi.
- Nice to meet you. - And this is Nurse Dana.
She's our charge nurse.
We need to look over your husband.
- Hello. Let's step over here for a minute, hon.
Let them get to work, okay?
Antoine, Larry, transfer out here.
T-1 will be open in a sec.
- Aye, aye, Cap.
- One, two, three.
[grunts] - Incoming.
- Okay, Joy, you stay with me.
Samira, you stay with Dr. Al-Hashimi.
- Open skull fracture.
Tubed him for agonal respirations.
BP 60 palp initially.
Started a liter of NS, but lost his pulse en route.
- Oh, boy, this doesn't look good.
- One, two, three.
[grunts] Joy, check his pupils.
Somebody hand me a pair of scissors.
- 8 millimeters. Nonreactive.
- AKA blown pupils, fixed and dilated.
Oh. [groans]
- Crushed skull with tons of gray matter extravasation.
At least it was quick.
- No helmet? - Nope, 'cause he took
the PennDOT Motorcycle Safety Course.
- Isn't that what you took, Robby?
- Hold compressions. Yes, but I still wear a helmet.
Is he a donor? - Also nope.
- That is too bad.
Asystole. I think we are done here.
- What's next door? - The guy who hit him.
Joy, you're with me.
- What about a moment of reflection? I thought--
- He'll still be dead when we get back.
- Pulse ox 99. BP 108 over 72.
- EFAST negative.
- Hell of a lot better than the guy next door.
- How's the airway? - Good volume.
Good sats. Gag reflex...
- [gags] - Present.
- Intubate? - Maybe.
Maybe not. - Mr. Yee?
Joy, sternal rub on his chest, like this.
Really hard, please.
Mr. Yee? - [groans]
- Spontaneous eye movement. Responds to pain.
GCS is 10. Borderline for intubation.
- No muscle tone--flaccid paralysis in the left arm.
- Same on the right. - And both legs.
- Add towels to both sides of the collar for more stability.
Let's not make this worse.
- Pan scan with 3D reconstruction of the spine.
- He's quadriplegic?
- If so, it's a low cervical injury.
- Why is that, Joy? - Uh...
- C3, 4, and 5 helps you breathe to stay alive.
- Mr. Montrose...
you can't just be wandering around, talking to patients.
- Well, that's-- that's what I do.
I'm a greeter at Walmart.
I get paid to wander and to talk to folks.
- Well, as a-- as a personal favor to me,
can you at least stay in your general vicinity?
I can get you a wheelchair while we wait for your X-rays,
but it might take a minute.
- [clears throat] My dear, I cannot sit.
My backside is killing me from where I fell on it,
which is an embarrassing admission to make
to such a lovely woman. - [chuckles]
Well, thank you for the compliment,
but there's no need to be embarrassed.
You took a very nasty fall.
- Well, then may I say that one look in your beautiful eyes
and I think I'm falling again.
[both laughing]
- What a charmer.
Just for that, I'm gonna get you a foam donut.
It's the eighth wonder of the world.
- Pretty great laugh you got there, Doc.
- [chuckles]
Oh, God. My witch's cackle?
- Got CT results for Mr. Williams.
- Ah.
Oh, wow.
Okay.
- Okay.
- Ah. Right on time.
Just--just getting full.
Yeah, I'm ready for number five.
- That's impressive. - Uh-huh.
- Yeah, there's more where that came from.
Although, uh, my intake is running low.
- Yeah, well, two more bottles ought to do it.
Then we'll drain your tooth, and we'll get you out of here
before the fireworks tonight. - Oh.
- Okay. Clamped.
Ogilvie, make the change.
- Okay. - Mm-hmm.
- All right. Let her rip.
- Flowing like a river. - [chuckles]
I love me some fireworks.
- Oh, yeah?
- Shit, I-I met Mr. Zambelli...
- Lean forward.
- Many times on the field.
- Who's Mr. Zambelli?
- Son, you don't know fireworks
if you don't know the name Zambelli.
He helped Pittsburgh become
the firework capital of America.
You did know that, didn't you?
- No. - Ah.
Y'all don't know nothing about pyrotechnics.
Stick to doctoring.
- Yes, will do.
- [sighs] I'm sure you have some questions.
I know it's a lot to take in.
- It's a tumor.
It's a brain tumor.
- Well, it's a mass, about 4 centimeters,
in the frontal lobe.
- Is it cancer?
- We can't say for sure right now.
It could be many things--
uh, infection, inflammation,
a benign cyst.
- Is it what made me fall?
- Yeah, possibly.
We'd like to keep you here and treat with dexamethasone,
which is a steroid to take down the swelling.
- Hmm. - And then we'll need
a brain biopsy to know exactly what it is.
- What, you're--you're gonna cut open my head?
- It's just a small hole.
We'll do a-a CT-guided stereotactical biopsy
with a-a blunt, thin needle... - [sighs]
- Which sounds crazy, but it's actually pretty amazing.
I mean, most patients go home the next day.
- I don't know.
What do you think I should do?
- I think this is a pretty good plan.
- Okay. - Yeah?
- BP 95 over 67.
- Seems a little on the low side.
- It is.
Have you ever had low blood pressure in the past?
- No, sir. My blood pressure's always high.
- Hold still, sir. No talking while we do the EKG.
- The Hansens all run high, except for Monty.
He ran low, but he's dead. - That's not helpful.
You want to help, quit playing family pharmacist.
- Pooling meds is how we've always done it.
You put everything in a big pile
in the middle of the table--
- Well, look where that got us now.
- No, I'm gonna jump in here and echo that sharing meds
which haven't been prescribed to you
is actually a real big no-no.
How we doing on remembering
what your brother might've taken?
- We could call back to the house.
- Great idea. Okay.
Whatever little round pill you took, sir,
has caused your heart rate and blood pressure
to drop so low, you're at risk of fainting,
falling, or having a serious injury.
- Oh.
- We need to take him back to the ER
so he can get a liter of fluids,
we can check his blood tests
and monitor his heart rate and blood pressure
till he recovers.
- Pulse ox holding steady at 99.
Good tidal volume.
- How you doing there, Mr. Yee?
- Scanner can take him now.
- I'll check the results from upstairs.
- Why is he so altered? - Could be concussion.
Maybe a small intracranial hemorrhage.
- All will be revealed by the Donut of Truth.
- Need a portable monitor. - Joy, stay with him, please.
See if the radiologist can give us a STAT read.
- How is he?
Did I hear someone say he's paralyzed?
- There are signs of weakness in both arms and legs.
But before we can make any prognosis,
we'll need a full-body scan.
- Head CT will show us any brain injury.
Neck CT will show us any spinal-cord injury.
Chest, abdomen, pelvis will rule out any internal bleeding.
- Oh, my God.
- The scans should only take about 15 minutes.
In the meantime, perhaps you'd let us look you over as well?
- I'm fine. The medics checked me.
I just want to stay with my husband.
- Well, you can't go into the CT with him,
but you can wait just outside if you like.
- Excuse me. - Princess, this is Nancy.
Mrs. Yee is gonna go with her husband to CT.
Will you show her where to go?
- Sure. Come on in. - Thank you.
- So what's the plan now?
Keep observing me in my natural habitat?
No telling what I might do next.
- I think I've got the gist.
How about we each take a lap and meet here
when Mr. Yee is back from CT?
- Splitting up so soon?
- You're free to see other people, Dr. Robinavitch.
I'm looking for cooperation, not commitment.
- [chuckles] [device whirs]
- So you bandaged the burn yourself?
- Oh, no, no, no, no, no, no, no, no--
- Ma'am, you're--you're making it difficult for me
to see under this dressing.
Is that a tablecloth? - Part of a window curtain.
Cleaner than tablecloth.
I'll wait for the doctor. Thank you.
- May I ask how this happened?
- For weeks on end, the kids with their
guchnyy firecrackers, going all day and night.
- Oh, i-is this a firecracker burn?
- No, sweetie, this is from the full samovar
I drop on the floor when the sh--
the firecrackers started going on again.
- I'm sorry. What's a samovar?
- It is a big metal urn for coffee or tea.
They can get super-duper hot,
and I was never allowed to touch ours.
Uh, hello, Mrs. Kovalenko.
My name is Dr. Michael Robinavitch.
Everybody calls me Dr. Robby.
- Robinavitch? Jewish? - You guessed it.
And I see that you are here today for a burn.
Why don't we take a look?
- Oh, not married?
- No, I'm not married.
- [chuckles] Do you attend synagogue?
- Uh, not for a while.
I mean, High Holidays mostly.
- Where?
- Ooh. - [whimpers]
- What did you put on this?
- Where? - On your burn.
Is this honey? - Yes, honey.
Where do you go on holy days?
- Uh, my grandparents, um--
I grew up going to Rodef Shalom.
You?
- Tree of Life.
- They're rebuilding.
- Yes, something new.
Remember, Rebuild, Renew.
That's the slogan.
- I'm sorry, did you say "honey"?
- You think honey's funny?
Works like a charm.
My father kept bees. I know.
- If the honey is medical grade and the burns are not too bad,
honey actually does have some antibacterial
and anti-inflammatory properties.
However, these burns are very deep in some places.
They're going to need debridement.
I'm glad you came in.
- That's what I thought.
I was hoping no, but I figured as much.
- Not to worry.
We are gonna have you patched up and home
in time for dinner and fireworks.
- No.
No more fireworks.
No.
- Okay.
- Anyone here treating Kylie Connors?
- She's my daughter.
She's nine. I'm Benny Connors.
- Mr. Connors, I'm Dr. Santos.
I'm treating Kylie.
- Is she okay? Can I see her?
My--my girlfriend, Gina, says she got a cut on her chin?
- Yeah, I can take you to her.
She has a small laceration on her chin,
but it was easily repaired with medical superglue,
so no stitches necessary. - Okay.
- She chipped a tooth, but it's a baby tooth,
so it won't need dental work.
- All right, well, that's a relief.
- Has Kylie had any previous injuries?
- Uh, yeah.
She, um--she broke her wrist last year.
She was skateboarding.
- Dana, if you could get Dylan to come to North 1,
and Ahmad. - You bet.
- Okay, I got it now. One, two, three.
- Daddy, you came.
- Baby, what's going on, huh?
- My tooth broke, and my chin got cut.
- Oh, no. [smooches]
What happened?
- She was running up the stairs.
- Gina was chasing me. - We were playing.
- As I was saying, Mr. Connors, the laceration is pretty minor.
- On the stairs?
- It was an accident. - Perhaps we can--
- An accident that wouldn't have happened
if you weren't running up the stairs.
Do you understand what I'm saying?
This is the last thing that I need right now,
is her mother finding out that she got hurt
when she's with you. - It was an accident.
And before you get all high and mighty,
I've got questions of my own. - Like what?
- Hey, Mr. Connors.
I'm sorry, I meant to be here when you arrived.
I'm Dylan Easton. I'm with Social Services.
- We have insurance. Thank you.
- Perhaps we can step outside and chat for a second?
I can fill you in on where we are.
Hey, uh, Jesse, do you want to keep Kylie entertained
for a few minutes while I... - Absolutely.
- Borrow her dad?
We'll just head down to the family room.
It's a little quieter there.
- Why do I got to talk to a social worker?
- Anytime a child is injured, we have some standard questions
that we ask parents and caregivers.
- Good. That's fine. Great. Ask me here.
- Well, we noticed some bruising on Kylie's body,
some old, some new, on her back and legs.
Any idea how she got those? - Yeah, soccer.
She plays for a club team.
They're, you know, little girls,
but they play like they're in "The Hunger Games."
- Well, I understand that you and Kylie do
a fair amount of roughhousing.
- What?
I'm sorry. Are you fucking kidding me?
Where are you going with this?
Are you saying that I hurt my daughter?
- Mr. Connors, nobody's saying that--
- Oh, no, no, no, no, no, no, no, no.
Gina! - Mr. Connors--
- Just--just--Gina!
- Sir, take a breath.
- Gina, what did you say to them?
- Nothing. I said that you're a great dad.
- Okay. What else?
- That you guys like to wrestle.
- Jesus Christ. - What?
They wanted to know where all her bruises are from.
- Who the fuck are you to talk about me and my daughter?
- Who the fuck am I? - Yeah, that's what I'm asking.
- Who the fuck am I?
- Hey, big man, take one more fucking step--
- Hey, that's enough. You need to calm down.
- Hey, everybody, back the fuck up!
- Stop! Stop! Stop! Stop!
Kylie's platelets are only 9,000.
- What does that mean? - [sighs]
It's--it's not what we thought.
It's probably ITP.
- What the hell is ITP?
- Something we can treat.
- You feel that? - Mm, no.
- Excellent.
This is looking very good.
- Ah. Tell Mr. Kovalenko.
[laughter]
- Mrs. Kovalenko?
- Yes? Yana, please.
- Yana, you mentioned that you dropped the samovar
when you heard firecrackers.
- Yeah.
I was on my way inside--
October 27, 2018--
to the synagogue when the shooting started.
There was nothing I could do.
I went in...
after the police arrived.
I felt I had to.
I'm better now.
But...
[voice breaking] New Year's Eve, Fourth of July,
when--when kids have their fireworks
and firecrackers, I--
- There is no clock on how long it takes.
- [scoffs]
No clock.
You must be joking.
[knock at door]
- Robby? - Yep.
- Mark Yee is back from CT. - Oh, okay.
Um, Perlah, why don't we go ahead and see if we can put
a nonstick dressing on this?
And I will come back, and we can discuss
aftercare instructions.
- Yeah, you got it, boss.
- Thank you, Doctor.
[door closes]
[indistinct chatter]
- Vitals stable. Pulse ox holding at 99.
- Okay. Heart and lungs look good.
[cell phone rings]
- Dr. Mohan. - Dr. Robby?
- Yeah? [sighs]
- Please make him be okay.
- I can assure you that we are gonna do absolutely--
- Everything you can. I know.
God, this is all my fault.
- Mrs. Yee-- - Oh, he's been so stressed.
So I planned this weekend away at Seven Springs,
but he didn't want to go because of work.
So we fought this whole morning.
And then I...
I said awful things.
Those can't be the last words we say to each other.
Doctor, please.
- Good news. CT looks normal.
No bleeding inside the skull.
C-spine, no fractures seen.
- He didn't break his neck? - Then why is he paralyzed?
- You can have spinal injuries
without radiologic abnormalities.
- Sometimes it doesn't show up on CT, only on MRI.
[cell phone rings] - Dr. Mohan.
Are you sure?
Okay.
Critical potassium level, 1.2.
- Wow.
- Okay. - That's crazy low.
- Uh, extremely low potassium with generalized weakness
and no cervical injury.
We may be looking at--
- Hypokalemic periodic paralysis.
- What is that?
- It's a rare condition where potassium gets shifted
into the cells, causing profound weakness,
just like paralysis.
- Will he get better? - Yes.
Back to normal in a few hours.
- In a f--
- Replete slowly. 10 MEQ of KCl--
- [crying] Thank you so much.
Did you hear that, Mark?
Oh, baby, you're gonna get better.
Oh, baby.
- All right, DD. Hey, come on now, man.
- Oh, how you doing, Duante?
- Fine. - Great.
If you're fine, you go home.
- Really? - Yeah.
- Mm-mm. Hey, tell them.
- Me and my sister were making bracelets,
and I put beads up my nose.
- How many?
- One on each side.
- I got to ask-- why'd you stick them up there?
See how many will fit?
- To shoot them out like rockets.
- Mm.
- But I breathed in,
and they went deeper and now won't come out.
- Did you try anything at home?
- Yeah, I tried blowing in his mouth,
but just got a little snot on my cheek.
- "A" for effort, Dad.
Okay, we need to take a look with a little flashlight.
Okay? - Okay.
- This is what I have to look forward to?
- This and so much more.
Red bead below the inferior turbinate.
- I...
got a blue one.
Afrin, benzocaine, Katz extractor?
- Yep. Dad, looks like we got to go up and get them.
- No way he's sitting still. - Oh, he'll be numbed up.
- You don't know this child.
- Hey, Duante, you like video games?
- Everybody does.
- We have a 3D video game.
- Yeah. - Cool.
- [chuckles]
- That's KCl and saline at 10 MEQ per hour.
- We avoid dextrose because the insulin response
drops the K even more.
- If it's genetic, why didn't it happen when he was a kid?
- It usually starts after the teen years.
- And it can be intermittent.
Sometimes it's triggered by intense exercise or stress.
- We've been married eight years.
We've had fights. He's never collapsed.
- If his thyroid gets overactive,
that brings it on later in life.
- I ordered TSH, T3, T4.
- So now we just wait?
[monitors beeping rapidly]
- Bag him. Starting compressions.
Charge to 200. - What is happening?
- Low potassium can harm electrical activity
in the heart. - Charged.
- Clear. - Clear.
- Resuming compressions.
- So your little girl was ITP? - Go figure.
Nothing like a zebra to kick-start your morning.
- Well, it's better than the alternative.
- True.
- ITP.
So that's, uh, intra--
- Immune thrombocytopenia.
- Used to be called idiopathic thrombocytopenic purpura.
Know what "idiopathic" means?
- That we don't know the exact cause.
- It means the patient is pathetic
and the doctor is an idiot.
- Just checked on baby Jane Doe.
Looking good. Taking formula well.
- We're here to take a statement.
We're looking for a Tony Chinchiolo.
- Yo! Right over here, boys!
Well, officers.
- Heard you had some trouble over at the campus library.
- Shit. Let me just say--
new appreciation for what you guys do every day.
Frickin' junkie jungle, right?
- At the campus library?
- Yeah.
- Thumb and forefinger make a C.
Bottom three fingers make an E for jaw lift.
One breath every five seconds. Come here, try it.
- About two minutes since defibrillation.
- Holding compressions. - Normal sinus.
- Carotid. Strong carotid. Okay, let's try for BP.
- Why don't we check after the shock?
- 2024 ACLS guidelines.
Patients can remain pulseless for a little bit,
even after successful defib.
- He came back with one shock. That's as good as it gets.
- 104 over 68. - Good squeeze. Good EF.
- Spontaneous respirations. Okay, let's lift him up.
- He's breathing on his own-- excellent sign.
- Oh, God.
Can I touch him? - Of course.
- Oh, Mark.
Hey. - [groans softly]
- Oh, shit.
We need a gurney!
Nancy?
Mrs. Yee?
Weak carotid. Shallow breaths.
- Did she vasovagal from stress?
- Can't assume that.
Positive seat belt si-- oh, shit.
Hang two units of O-neg on the rapid infuser.
Somebody call Garcia. Shit.
We really should have insisted on examining her.
- Okay, I got the head.
- Platelets are these tiny things in the blood
that help it clot.
And thrombocytopenia is fancy for "low platelets,"
which explains why your skin bruises so easily.
- And what causes it?
- It's actually her immune system
that's causing the destruction of platelets.
Sometimes it's a triggered response
to, uh, an environmental factor or virus.
- And what's the treatment? What are you giving her?
- We'll be treating her with high-dose steroids
to suppress the immune system and IV immunoglobulin,
which reduces the destruction of the platelets in the spleen.
- Can I go home?
- You're gonna have to stay in the hospital
for about three days
to make sure that the treatment is working.
- Okay. Okay.
So when can she get a room in the hospital?
- That is an excellent question.
I'm going to see if I can make that happen
sooner rather than later,
but it might take a while. - Okay.
- GPS says I should be there by 11:00.
- Do you have any other questions for me, ma'am?
- No. I'm sure I will, but I'll let you go for now.
Thank you, Benny.
- All right. I'll see you when you get here.
- See you soon, baby. I love you.
- Bye, Mom. Love you too.
- There you are.
- And there you are.
- Don't try to charm me. You promised to stay put.
- I was going to come right back.
My backside is killing me.
I need to keep moving, or I get all achy and stiff.
- Well, I got you this foam donut to sit on
while we wait for your X-rays. - Hmm.
Dr. Hazel Eyes, it says here
that it's only supposed to take an hour or two for an X-ray.
- Well, the patient passport holiday edition
would better reflect reality.
It could be double that.
- There's no need for reality.
We romantics...
prefer la reve, the dream.
- We do, do we?
- Oui.
♪ La mer qu'on voit danser ♪
♪ Le long des golfes clairs ♪
♪ A des reflets d'argent, la mer ♪
- [laughs] Right.
- ♪ Des reflets changeants sous la pluie ♪
- Hey, save a dance for me.
- Uh, yeah, okay, I will.
- Dr. McKay? - Yes.
This is Gretchen Williams.
- Actually, it's Lambdin. - Ah.
- You called about my ex-husband, Michael Williams.
- Yeah. Yes, yes. Thank you for coming in.
You were, um, listed as his emergency contact.
- Yeah, I don't know why.
We have been divorced for years.
Is he all right?
- He's--he's going through a lot right now.
Would you like to see him?
- Uh, okay.
Leo, can you zoom in and please hold it a little steadier?
- Okay.
Atorvastatin.
Simvastatin.
Ezetimibe.
Those are all high-cholesterol medications.
Can you go to the right?
Lisinopril.
Losartan. Propranolol.
- Wait, wait, that's it.
Wendy's pile.
Yellowish bottle,
little, round blue pills, just like I said.
- Propranolol? - Bingo, little lady.
- Okay, yeah, well, this makes a lot of sense now.
Um, propranolol is a high-blood-pressure medication.
Those are 20 milligrams each,
and the starting dose is 40 mgs.
How many pills did you take?
- No, ma'am. I-I went just before I came here.
- Dad.
- Um--pill--how many pills did you take?
- Oh, uh, I think four, maybe five.
- That is a lot. Okay.
- Full stomach, mind you.
- Well, um, the good news is, it has a short half-life,
so, um, we're gonna need to keep you
for about four hours to monitor.
But then you'll be able to rejoin
for all the late-afternoon festivities.
- All right. - Whoo!
[monitor beeping rapidly] - Unit 3 and 4 running in.
BP 84 over 56. Heart rate 112.
- Free fluid's much bigger than before.
- She's not turning the corner. OR is holding a room.
- I'll let the husband know.
- Why did you guys wait so long to check her?
- Good vitals in the field. No distress.
She refused to sign in.
- You should have convinced her.
- 20/20 hindsight. She was stable.
- Until she wasn't.
- Next time, I'll use my X-ray vision goggles.
- Let's get her upstairs.
- Got to do an accu-check on my DKA patient.
Thanks for the backup.
- Anytime.
- Now, try and lift your arm, Mark.
- I'm trying. Can't do it.
- But you are getting stronger, and your speech is improving.
- How did I lose so much potassium?
- You didn't lose it. It got shifted into cells.
When it comes back, you'll return to normal.
- Where's Nancy?
- She had an injury to her spleen right about here
with some internal bleeding.
- Oh, God.
- She passed out from blood loss.
We were able to transfuse her, and she's now on her way
to surgery to repair that damage.
- This is my fault.
She was trying to-- [sighs]
She booked a trip for us, for me.
I fought her the whole time. I've been--
[sighs]
Please don't--
oh, my God, please don't let her die.
Please.
- I can assure you that she is in excellent hands.
- Is this how it works?
- How what works?
- You think things are important...
that everything's so important.
And then you end up here and see.
- Yeah, that is how it works.
- No, it's a small hole.
Like the size of a dime, right, Doc?
- Mm-hmm. Yeah, even smaller.
It's a minor enough procedure
that most patients go home the next day.
- And then?
- And then they'll know what it is
and how to treat it.
Isn't that right? - Yeah, exactly.
- I'm sorry that they called you.
I never updated the form, I guess.
- No, no, it's okay. I'm--
You know, they called, and I was just kind of surprised.
[both chuckle]
- Well, you didn't have to come.
- But I did.
- I heard you got married.
Congratulations.
- Thank you.
- I hope he treats you well.
You deserve to be happy.
- [sighs]
I'm really sorry you're going through this, Michael.
- Yeah.
Me too.
But you know me-- I'm a survivor.
- Why don't I-I leave you guys to talk for a few minutes?
I have a patient to check on.
- Sure. - Yeah.
- Mr. Diaz should be improving after 2 liters.
Blood sugar?
- Down from 521 to 436.
- That's good, right?
- Moving in the right direction.
Were you able to get ahold of your mom?
- Yes. She's on her way. She doesn't have a car.
She takes buses, so it takes longer.
I'm sorry. - Don't be.
Current insulin is 0.1 units per kilo per hour.
Next steps?
- Once the glucose is down to 250,
reduce the insulin to 0.05 units per kilo per hour.
- Because you can normalize the blood sugar
before you clear the ketones, and you don't get hypoglycemia.
- But as treatment continues, you'll have to give IV dextrose
to keep the blood glucose in between 150 and 200
while the insulin drip clears the ketones.
- Obviously.
- I'm sorry, what?
- Got it.
- Duante, what are you doing in there, son?
- I'm a rabbit,
grabbing all the carrots before the farmer gets me.
- Keep going.
This is a Katz extractor with a tiny balloon at the end.
What we're gonna do is, we're gonna slip it past the bead,
inflate the balloon, try to pull out the bead.
- Is it painful? - No, he's--he's numbed up.
- Made it to level three.
- And pretty distracted.
- Dad's gonna hold your head still, okay?
- Look up. - Okay.
Now go back, perpendicular,
below the turbinates.
You guys ever hear of John O'Donohue?
- Mm-mm. - No.
- I've been reading him a lot lately.
He's got this book of, um, blessings.
And there's this one about fatherhood.
Really stuck with me. [bead clatters]
Voilà. One red bead.
- Yeah? How's it go?
- The ending goes, "May you be gentle and loving,
"clear and sure.
"May you trust in the unseen Providence
"that has chosen you to be a family.
"May you stand sure on your ground and know
"that every grace you need will unfold before you
like all the mornings of your life."
- Hmm. That's good.
- I'd add, support your woman and pack good snacks.
- That's beautiful.
And it turns out, there's no handbook for fatherhood.
So I will take all the wisdom I can.
[bead clatters] Blue bead out.
- Anything else?
- You tell me. I have my own report to do.
Anything I left out?
- Labs are back on that kid.
- We'll follow up with Mr. Davis.
- Yeah, when Mr. Davis comes off the ceiling.
- Jackson Davis...
tox screen negative for cocaine,
amphetamines, marijuana, PCP, benzos, and opioids.
- So no drugs in his system? - Nope.
- Taser barbs on the back of the victim's neck?
- Yep.
- Changes things, Tony.
- Hey, Louie. - [groans]
- How we doing? - Not so good.
I could really use a drink.
I f-feel a-a little empty.
- Okay, well, empty is what we want.
And it looks like we are there.
- Hey, well, if I can't get a drink, my tooth.
You--you got to do something.
- We're gonna get right to that.
Let's hang some IV antibiotics, 3 grams of Unasyn.
- Excellent.
- He's gonna be right back.
We're gonna numb it up and drain it.
Ten minutes, tops, okay? - Oh.
- Hey, uh, you said you met Mr. Zambelli,
the fireworks guy, on the field.
What field was that?
- Uh, n-no more talking. You got to fix my tooth.
- Yeah, deal.
- [grunts]
- You're Muslim?
- I am.
- Thank you.
- Oh, for what?
- After the shooting, it was the Muslims
that came together for us in support and...
walked with us.
You raised money.
You...
paid for all the funerals.
Anyway...
thank you. [door opens]
- Hello. How's it going in here?
Did I miss all the gross stuff?
- Timed it perfectly. - Excellent.
My job is all about delegation and time management.
- Oh, not for much longer. - That is very true.
- W-why for not longer?
- Because tomorrow I am leaving to go on sabbatical.
- He's leaving us for three months on a motorcycle.
- Motorcycle? You're joking.
Why would you do this? - Why? Why?
Why? Because-- - You're middle-aged man.
Don't be stupid.
- Don't hold back. Tell me how you really feel.
- Forgive me for being blunt, Dr. Robinavitch,
but how old are you, huh--50?
- Ish. - Ish.
50-ish-year-old man on a motorcycle--
very sad.
[laughter]
[indistinct chatter]
- I, um...
I-I-I don't know what to say.
Have you ever heard of ITP?
I never did.
I really appreciate you bringing her here, okay?
- Of course. What do you think I am?
Oh, that's right.
You think I'm some kind of child abuser.
- No, I never said that-- - The fuck you didn't.
In front of all those people, you made it sound like
she might have been getting hurt
while I was watching her, like it was my fault.
- You basically said the same thing about me.
- No, I said that you guys roughhouse--
that's all--because you do.
- You know I would never hurt my daughter.
- Actually, I don't.
I've known you six months. You could be anybody.
- Okay, well, I am sorry for what I said, okay?
I was upset, and I-I was worried.
And I just-- I said something stupid.
And I just-- - You think?
- Will you just fucking let me finish?
- You are finished!
We're finished.
- Well, happy fucking Fourth of July.
- Yeah, happy Independence Day.
[indistinct chatter]
- Excuse me? [grunts]
- Yes? What can I do for you?
- Uh, my wife and I were in an accident.
Um, she's in surgery right now.
Would you mind holding my phone up for me
so I could record a message for her?
- Of course I will.
Happy to.
Oh, good, I have the same one.
I know how this works.
Okay.
Ready?
Go. - [clears throat]
[sighs]
Hi, my love.
[clears throat] So, uh...
I was listening to this couple argue, uh...
and they were yelling.
Both so angry.
And I just wanted you to know, um...
that I was wrong.
I was so wrong, and-- and I'm sorry about all of it.
Uh...
- Hey.
How you doing? - [sighs]
I haven't seen him in, like, four years.
- Oh. I can't imagine.
That must have been-- - So crazy.
You know, things were not good at the end.
He was a really different person.
Huge temper, not like when we first got married.
- I'm so sorry.
- Could that mass have been there for a while
and only recently got worse?
- Yes.
- Could it be responsible for how much he changed?
You know, his-- his moods and tempers?
He was--he was getting into fights with strangers.
- It's possible. [sighs]
- Oh.
Thank you.
Um, unless he's asked you to change it,
would you please leave me as...
the emergency contact?
- Yeah, absolutely.
[door opens]
[sighs]
- Okay, I'm sending Mrs. Kovalenko home
with burn dressing
but not before she turned my sabbatical
into a midlife crisis. - No comment.
- Wound check, two days. - Got it.
- What about Kylie, this little girl?
She gone up yet? - Hopefully soon.
- Hey, we're starting to clear some space around here.
- Yep. [telephone ringing]
PTMC Charge Nurse. Go ahead, Medic Command.
Is this a drill?
Is this a joke?
It's the Fourth of fucking July.
Got it. Thanks.
- What's up? - Westbridge has a Code Black
and is closing to internal disaster.
Central's diverting all their ambulance traffic to us.
- What's the issue? - Comspec didn't say.
- Shit, it could be anything
from a flooding toilet to a power outage.
How long? - Didn't know.
- A couple of doctors probably got the holiday flu,
and they're understaffed.
- [chuckles]
How come? How long? How many?
Mm, mm, mm.
Sounds like a betting grid to me.
We are back.
- Oh, I should have left last night.