1
00:00:11,868 --> 00:00:13,300
There's something seriously
wrong with him.
2
00:00:13,467 --> 00:00:15,667
Ma'am, I can assure you
that your husband is stable.
3
00:00:15,834 --> 00:00:17,100
OK, let me take
a better look at him.
4
00:00:17,267 --> 00:00:18,667
Simon, Simon, Simon!
5
00:00:18,834 --> 00:00:19,868
Oh, he's out!
Get a stretcher.
6
00:00:20,033 --> 00:00:22,167
-Simon, wake up.
-Stay with us, stay with us.
7
00:00:22,334 --> 00:00:25,801
[PA announcement] Code Blue.
8
00:00:25,968 --> 00:00:27,267
Sir, we're gonna put you
on a ventilator to help
9
00:00:27,434 --> 00:00:29,367
you breathe, OK?
-[Dr. Frankel] Stop.
10
00:00:29,534 --> 00:00:31,100
Putting someone on a ventilator
11
00:00:31,267 --> 00:00:32,968
is literally like
blowing up a balloon.
12
00:00:33,133 --> 00:00:34,467
We're gonna blow out
their lungs
13
00:00:34,634 --> 00:00:35,767
and the patient dies.
14
00:00:38,200 --> 00:00:39,467
[screams]
15
00:00:39,634 --> 00:00:44,267
I look down and I'm like,
"Is that a foot?" What the heck
16
00:00:44,434 --> 00:00:45,868
is happening tonight?
17
00:00:46,033 --> 00:00:48,868
[narrator] These are
the "Untold Stories of the ER."
18
00:00:50,100 --> 00:00:51,367
[Dr. Nelson]
The goal is to stay calm.
19
00:01:01,667 --> 00:01:03,000
[nurse Elle] Oh, what you doing?
20
00:01:03,167 --> 00:01:04,767
Oh, looking at cars.
What do you think?
21
00:01:06,000 --> 00:01:07,067
When I started my career,
22
00:01:07,234 --> 00:01:09,167
I worked in level-one
trauma centers.
23
00:01:09,334 --> 00:01:13,901
You see lots of trauma,
lots of accidents.
24
00:01:14,067 --> 00:01:16,167
You don't strike me
as a convertible kind of gal.
25
00:01:16,334 --> 00:01:18,100
I think I can pull it off.
26
00:01:18,267 --> 00:01:20,667
This hospital was smaller.
27
00:01:20,834 --> 00:01:23,200
Bigger hospitals
have like 50 ER beds.
28
00:01:23,367 --> 00:01:25,200
This one had like six.
29
00:01:25,367 --> 00:01:28,968
Don't see as many patients,
but also don't have
30
00:01:29,133 --> 00:01:30,868
the consults
as readily available,
31
00:01:31,033 --> 00:01:33,501
like neurology, cardiology.
32
00:01:36,000 --> 00:01:39,067
Oh no, that is not good.
33
00:01:39,234 --> 00:01:41,901
Typically, when you're working
at a hospital
34
00:01:42,067 --> 00:01:45,267
and you lose power,
there's a backup generator.
35
00:01:45,434 --> 00:01:49,667
However, the generator's only
used for critical systems like
36
00:01:49,834 --> 00:01:53,400
life-support equipment
and emergency lighting.
37
00:01:53,567 --> 00:01:54,767
Oh, it's just a power outage.
38
00:01:54,934 --> 00:01:56,100
I'm sure it'll come back
real quick.
39
00:01:56,267 --> 00:01:57,567
Not tonight.
40
00:01:57,734 --> 00:02:00,467
Did you see that fog out there
and the full moon?
41
00:02:00,634 --> 00:02:02,267
What?
42
00:02:02,434 --> 00:02:04,968
In the ER, you run into a lot
of superstitious people.
43
00:02:05,133 --> 00:02:06,567
"You don't work on a full moon.
44
00:02:06,734 --> 00:02:08,267
You don't work
on Friday the 13th."
45
00:02:09,267 --> 00:02:11,300
Well, full moon and heavy fog.
46
00:02:11,467 --> 00:02:13,000
You know what they say
around here.
47
00:02:13,167 --> 00:02:15,567
Elle, don't rattle the poor
girl on her third shift.
48
00:02:15,734 --> 00:02:16,868
And don't mind her, Natalie.
49
00:02:18,267 --> 00:02:20,367
Superstition doesn't have
any place in the ER.
50
00:02:20,534 --> 00:02:22,767
Just wanted to keep it
scientific, straightforward,
51
00:02:22,934 --> 00:02:25,367
so that our newbie
doesn't spiral.
52
00:02:25,534 --> 00:02:27,067
The goal is to stay calm.
53
00:02:27,234 --> 00:02:29,801
If you have a team that is
rattled, it becomes more
54
00:02:29,968 --> 00:02:32,067
difficult to remember
the things that you need to
55
00:02:32,234 --> 00:02:34,501
remember in order
to save a life.
56
00:02:36,501 --> 00:02:37,667
[panting]
57
00:02:37,834 --> 00:02:38,868
Amber?
58
00:02:40,167 --> 00:02:44,100
What are you doing back here?
I need hands.
59
00:02:45,200 --> 00:02:46,868
-Amber, what happened?
-I can't.
60
00:02:47,033 --> 00:02:49,400
I can't.
I can't catch my breath.
61
00:02:49,567 --> 00:02:52,400
[Dr. Nelson]
She had come in earlier that
day, had a little bit of cough
62
00:02:52,567 --> 00:02:54,701
and cold, had complained
of some shortness of breath.
63
00:02:54,868 --> 00:02:57,167
Everything checked out fine.
She looked great.
64
00:02:57,334 --> 00:03:00,467
Her vitals were stable.
So we discharged her home.
65
00:03:00,634 --> 00:03:02,000
That was it.
She looked great.
66
00:03:02,167 --> 00:03:03,868
When did this start?
67
00:03:04,033 --> 00:03:05,000
Like, 30 minutes ago.
68
00:03:06,167 --> 00:03:07,167
I came straight here.
69
00:03:09,067 --> 00:03:11,868
Amber, Amber!
Let's get her in a room.
70
00:03:12,033 --> 00:03:14,067
Put her in a non-rebreather,
get her on a monitor, IV.
71
00:03:14,234 --> 00:03:15,667
-Let's get some labs.
-No.
72
00:03:15,834 --> 00:03:16,968
Ah!
73
00:03:17,133 --> 00:03:18,167
[nurse Natalie screams]
74
00:03:18,334 --> 00:03:19,868
Oh my God! Did you see that?
75
00:03:30,767 --> 00:03:32,167
[Dr. Frankel] Back
in the early days of COVID,
76
00:03:32,334 --> 00:03:33,968
we were all doing our best.
77
00:03:34,133 --> 00:03:35,100
Hello, Frieda.
78
00:03:36,167 --> 00:03:38,667
Dr. Frankel,
how are you today?
79
00:03:38,834 --> 00:03:40,767
[Dr. Frankel]
Coping in this new strange
world of ours.
80
00:03:43,167 --> 00:03:45,267
It was a difficult time for me,
for my colleagues,
81
00:03:45,434 --> 00:03:46,667
for my family.
82
00:03:46,834 --> 00:03:49,367
You know, COVID was just
running rampant everywhere.
83
00:03:49,534 --> 00:03:50,801
We didn't know
who was gonna hit,
84
00:03:50,968 --> 00:03:52,300
when we were gonna get hit,
85
00:03:52,467 --> 00:03:54,167
and we didn't know
how to treat it.
86
00:03:57,467 --> 00:03:59,100
Hi, Ron, I'm Dr. Frankel.
87
00:03:59,267 --> 00:04:02,267
I understand you were in
recently for a broken leg.
88
00:04:02,434 --> 00:04:04,133
How'd you break your leg?
89
00:04:06,601 --> 00:04:08,167
-[Ron] Sorry.
-[Dr. Frankel] What's going on?
90
00:04:08,334 --> 00:04:10,000
I lost my dog yesterday.
91
00:04:11,467 --> 00:04:12,667
[Dr. Frankel] I'm so sorry.
92
00:04:12,834 --> 00:04:14,167
You want to know
how I broke my leg?
93
00:04:15,701 --> 00:04:18,200
I was walking Murphy
and I tripped over a curb.
94
00:04:19,567 --> 00:04:21,567
I understand you're here
for a fever and shortness
95
00:04:21,734 --> 00:04:24,567
of breath.
-Yeah, and headaches.
96
00:04:24,734 --> 00:04:28,000
Comes and goes,
but mostly comes.
97
00:04:28,167 --> 00:04:31,567
I phoned my daughter and she
heard me wheezy on the phone.
98
00:04:31,734 --> 00:04:32,601
[coughs]
99
00:04:32,767 --> 00:04:33,968
She got concerned.
100
00:04:35,200 --> 00:04:37,567
I mean my son.
I phoned my son.
101
00:04:39,267 --> 00:04:40,901
Ron, your oxygen levels
are pretty low.
102
00:04:41,067 --> 00:04:44,167
-Have you had a COVID test?
-No, I have not.
103
00:04:46,267 --> 00:04:48,300
[sighs]
Boy.
104
00:04:48,467 --> 00:04:50,100
Just what I need right now
is COVID.
105
00:04:50,267 --> 00:04:52,167
[Dr. Frankel] Let's take it
one step at a time.
106
00:04:52,334 --> 00:04:54,067
We have to remember in
the beginning of the pandemic,
107
00:04:54,234 --> 00:04:56,067
there was no
rapid testing, right?
108
00:04:56,234 --> 00:04:57,467
So we would swab the patients.
109
00:04:57,634 --> 00:05:00,767
Results would come back
in anywhere from 24 to 48 hours.
110
00:05:00,934 --> 00:05:03,367
And the way we treated COVID
patients was based
111
00:05:03,534 --> 00:05:05,868
on how they were doing,
their presentation,
112
00:05:06,033 --> 00:05:07,767
and what the X-rays
looked like.
113
00:05:07,934 --> 00:05:08,868
Let's get a chest X-ray,
114
00:05:09,033 --> 00:05:10,100
put him on two liters
nasal cannula.
115
00:05:10,267 --> 00:05:11,634
Absolutely.
116
00:05:11,801 --> 00:05:13,601
[Dr. Frankel]
Didn't look like he was
in too much distress,
117
00:05:13,767 --> 00:05:14,901
but he was short of breath,
118
00:05:15,067 --> 00:05:16,367
and his oxygen levels
were quite low.
119
00:05:16,534 --> 00:05:19,167
Ron also had a cast on
from a recent surgery,
120
00:05:19,334 --> 00:05:22,100
so it required more
extensive workup
121
00:05:22,267 --> 00:05:25,167
because of
the differential diagnosis.
122
00:05:25,334 --> 00:05:26,901
I was really scratching
my head in the beginning.
123
00:05:27,067 --> 00:05:28,367
"Could this be COVID?
124
00:05:28,534 --> 00:05:30,367
"Could this be
a pulmonary embolism?
125
00:05:30,534 --> 00:05:32,667
Could it be pneumonia
with sepsis?"
126
00:05:32,834 --> 00:05:35,367
You know, three big killers
all happening at one time.
127
00:05:35,534 --> 00:05:38,367
[indistinct PA announcement]
128
00:05:39,901 --> 00:05:42,367
Ron, when did your breathing
difficulty start?
129
00:05:44,100 --> 00:05:45,501
The last few days.
130
00:05:46,767 --> 00:05:50,000
Started with a cough mostly
and chills.
131
00:05:52,167 --> 00:05:53,701
I couldn't get warm
in my house.
132
00:05:56,000 --> 00:05:58,667
[Dr. Frankel]
You know, when someone is that
hypoxic, when their oxygen
133
00:05:58,834 --> 00:06:00,801
level is really that low,
you would expect to see
134
00:06:00,968 --> 00:06:03,167
something significant
on an X-ray.
135
00:06:03,334 --> 00:06:04,434
But it wasn't.
136
00:06:04,434 --> 00:06:06,501
You know, there's a mild
ground-glass appearance,
137
00:06:06,667 --> 00:06:09,267
little infiltrates,
but it wasn't anything
138
00:06:09,434 --> 00:06:12,868
too dramatic
to explain his hypoxia.
139
00:06:13,033 --> 00:06:14,167
[Ron] Headaches are
the worst, though.
140
00:06:17,667 --> 00:06:18,901
[Dr. Frankel]
Let's take a look at the oxygen.
141
00:06:23,267 --> 00:06:25,167
The sats are dropping further.
142
00:06:25,334 --> 00:06:28,000
Get a CBC, CMP,
cardiac enzymes.
143
00:06:29,000 --> 00:06:32,167
Get blood cultures,
lactic acid, rule out sepsis.
144
00:06:32,334 --> 00:06:36,601
Get an EKG and a D-dimer
to rule out a PE.
145
00:06:36,767 --> 00:06:38,200
-Right away.
-[Ron] D-dimer?
146
00:06:38,367 --> 00:06:40,300
What the heck is that?
147
00:06:40,467 --> 00:06:42,267
[Dr. Frankel] It's a test that
can pick up blood clots.
148
00:06:42,434 --> 00:06:44,267
It's often a concern in COVID,
149
00:06:44,434 --> 00:06:46,667
but also could be a concern
in leg surgery.
150
00:06:48,100 --> 00:06:49,300
Sounds scary.
151
00:06:49,467 --> 00:06:52,167
After most surgeries,
you're at an increased risk
152
00:06:52,334 --> 00:06:55,667
of developing a blood clot,
specifically in your leg,
153
00:06:55,834 --> 00:06:58,901
which then travels through
your system, through your heart
154
00:06:59,067 --> 00:07:01,467
and straight into your lung,
and causes what's called
155
00:07:01,634 --> 00:07:02,868
the pulmonary embolism.
156
00:07:02,868 --> 00:07:05,968
Massive pulmonary embolism
can kill a person right away.
157
00:07:06,133 --> 00:07:07,567
If the D-dimer is negative,
158
00:07:07,734 --> 00:07:09,501
we essentially can rule out
a blood clot.
159
00:07:11,100 --> 00:07:12,767
[Ron] Can my son visit?
160
00:07:14,000 --> 00:07:15,767
Murphy.
161
00:07:15,934 --> 00:07:17,300
No, not Murphy.
162
00:07:19,167 --> 00:07:21,300
His name is Alan.
That's my son.
163
00:07:21,467 --> 00:07:23,467
-His name's Alan.
-I'm so sorry.
164
00:07:23,634 --> 00:07:25,901
Visitors aren't allowed,
I'm afraid.
165
00:07:26,067 --> 00:07:27,100
I'll be right back.
166
00:07:29,167 --> 00:07:31,467
I'm just gonna draw
some blood.
167
00:07:31,634 --> 00:07:36,000
-You look concerned.
-Happy hypoxia with a caveat.
168
00:07:36,167 --> 00:07:37,367
Caveat?
169
00:07:37,367 --> 00:07:40,000
So one thing that we saw
with COVID, which was unique,
170
00:07:40,167 --> 00:07:44,067
never seen before, was this
concept called happy hypoxic.
171
00:07:44,234 --> 00:07:45,300
Patients came in.
172
00:07:45,467 --> 00:07:47,100
They didn't look like
they were in distress.
173
00:07:47,267 --> 00:07:49,467
Their oxygen levels
were extremely low.
174
00:07:49,634 --> 00:07:53,200
And that was a dead giveaway
that this is what's going on,
175
00:07:53,367 --> 00:07:57,167
that they have COVID.
Ron clearly had happy hypoxia.
176
00:07:57,334 --> 00:07:59,467
However, something else
was going on.
177
00:07:59,634 --> 00:08:01,501
His confusion, his headache.
178
00:08:01,667 --> 00:08:02,801
He's confused.
179
00:08:02,968 --> 00:08:05,167
He just called his son
by his dead dog's name.
180
00:08:05,334 --> 00:08:07,667
Is it possible these are COVID
symptoms we haven't
181
00:08:07,834 --> 00:08:10,100
seen before?
-It's possible.
182
00:08:10,267 --> 00:08:11,567
I think something else
is going on,
183
00:08:11,734 --> 00:08:13,467
and I have absolutely
no idea what it is.
184
00:08:30,501 --> 00:08:31,501
[receptionist] Dr. Carrier.
185
00:08:34,868 --> 00:08:35,868
This is Dr. Carrier.
186
00:08:37,267 --> 00:08:38,868
People call me
Mother Mountain Lion.
187
00:08:39,033 --> 00:08:41,367
I guess that's because
if somebody needs protecting,
188
00:08:41,534 --> 00:08:42,567
that's what comes out.
189
00:08:42,734 --> 00:08:45,567
No, she is 82.
190
00:08:45,734 --> 00:08:47,767
She's fallen four times
this morning.
191
00:08:47,934 --> 00:08:50,367
She cannot get to the bathroom
by herself.
192
00:08:50,534 --> 00:08:52,200
I don't care what
the admission criteria says.
193
00:08:53,467 --> 00:08:54,467
Find me a bed.
194
00:08:55,501 --> 00:08:57,868
I'm not discharging her.
Thank you.
195
00:08:58,033 --> 00:09:00,467
And if it's a patient
or it's one of my staff members,
196
00:09:00,634 --> 00:09:01,567
it's just what I do.
197
00:09:02,868 --> 00:09:05,701
-Unbelievable.
-Good chat?
198
00:09:05,868 --> 00:09:06,901
Delightful.
199
00:09:07,067 --> 00:09:08,367
I just don't take a lot
of nonsense.
200
00:09:08,534 --> 00:09:10,367
Can you come take a look
at bed five?
201
00:09:10,534 --> 00:09:12,467
Had laceration with a beer
bottle, self-inflicted.
202
00:09:13,701 --> 00:09:16,367
-Really?
-And Kyle is suturing.
203
00:09:16,534 --> 00:09:18,701
Oh, I imagine
suturing and lecturing.
204
00:09:18,868 --> 00:09:20,701
-Mm.
-OK.
205
00:09:22,267 --> 00:09:25,367
So every teaching hospital
has one of these residents.
206
00:09:25,534 --> 00:09:28,801
We call them Ready, Shoot, Aim.
207
00:09:28,968 --> 00:09:31,801
The forehead actually has one
of the richest vascular
208
00:09:31,968 --> 00:09:36,167
supplies in the entire body.
-Fantastic, Kyle, keep going.
209
00:09:36,334 --> 00:09:38,300
They're smart,
they're enthusiastic,
210
00:09:38,467 --> 00:09:41,701
but sometimes they like to talk
before thinking things through.
211
00:09:41,868 --> 00:09:44,167
Benny, I'm Dr. Carrier.
212
00:09:44,334 --> 00:09:46,767
What would make you want
to smash a beer bottle
213
00:09:46,934 --> 00:09:48,000
on your head?
214
00:09:49,100 --> 00:09:51,167
For the encore?
Really got the crowd fired up.
215
00:09:52,267 --> 00:09:53,267
I bet it did.
216
00:09:55,167 --> 00:09:56,901
There's a patient's wife
at triage.
217
00:09:57,067 --> 00:09:59,667
She's pushing back hard.
She wants to speak to a doctor.
218
00:09:59,834 --> 00:10:02,100
These days, everyone has done
their research
219
00:10:02,267 --> 00:10:03,367
before they come in.
220
00:10:03,534 --> 00:10:04,834
OK.
221
00:10:04,834 --> 00:10:07,968
We have a new diagnosis we joke
about called cyberchondria.
222
00:10:08,133 --> 00:10:12,601
Dizzy, weak, good vitals,
no chest pain, very anxious.
223
00:10:12,767 --> 00:10:14,467
Seems like he's having
a panic attack.
224
00:10:14,634 --> 00:10:16,567
-OK.
-Call him a solid four.
225
00:10:16,734 --> 00:10:17,934
All right.
226
00:10:20,400 --> 00:10:21,901
And the wife?
227
00:10:22,067 --> 00:10:23,767
Doesn't want to wait.
228
00:10:23,934 --> 00:10:25,200
Of course not.
229
00:10:25,367 --> 00:10:27,367
Triage is one of our most
important jobs
230
00:10:27,534 --> 00:10:28,734
in the emergency department.
231
00:10:28,734 --> 00:10:31,667
These are highly trained nurses
who take vital signs,
232
00:10:31,834 --> 00:10:34,167
but in addition to that,
they look for subtle clues
233
00:10:34,334 --> 00:10:38,167
that can tell us who's really
sick and who can wait safely.
234
00:10:38,334 --> 00:10:40,200
[PA announcement]
Dr. Roberts to the cafeteria.
Dr. Roberts.
235
00:10:40,367 --> 00:10:41,868
Lena.
236
00:10:42,033 --> 00:10:43,367
-This is Dr. Carrier.
-[Lena] Hi.
237
00:10:43,534 --> 00:10:44,601
Hi.
What can we do for you?
238
00:10:44,767 --> 00:10:45,868
I explained
to your triage nurse here
239
00:10:46,033 --> 00:10:47,667
that my husband needs
urgent care.
240
00:10:47,834 --> 00:10:49,901
Sometimes family members
can pull all the oxygen
241
00:10:50,067 --> 00:10:51,100
out of the room.
242
00:10:51,100 --> 00:10:52,267
There's something seriously
wrong with him.
243
00:10:52,434 --> 00:10:53,434
Ma'am, ma'am, ma'am.
244
00:10:53,601 --> 00:10:55,367
I can assure you
that your husband is stable.
245
00:10:55,534 --> 00:10:59,100
[Dr. Carrier]
We know they're upset,
but we need to not lose sight
246
00:10:59,267 --> 00:11:02,200
of who we're really here for,
and that's the patient.
247
00:11:02,367 --> 00:11:05,868
Cardiology discharged him
24 hours ago, clean cath,
248
00:11:06,033 --> 00:11:07,467
but his radial pulse
is irregular,
249
00:11:07,634 --> 00:11:09,167
and that wasn't there yesterday.
250
00:11:09,334 --> 00:11:11,601
He's been bradying down
and diaphoretic ever since.
251
00:11:12,901 --> 00:11:13,968
Are you a doctor?
252
00:11:14,133 --> 00:11:16,100
When I hear language like that,
253
00:11:16,267 --> 00:11:19,501
I realize I'm talking to someone
with medical training.
254
00:11:19,667 --> 00:11:22,767
And then it makes me wonder,
"Why are they so worried?"
255
00:11:22,934 --> 00:11:24,167
I'm a nurse.
256
00:11:24,167 --> 00:11:27,000
If an experienced nurse tells
me something's not right,
257
00:11:27,167 --> 00:11:28,100
I pay attention.
258
00:11:28,267 --> 00:11:29,767
OK, let me take
a better look at him.
259
00:11:32,200 --> 00:11:33,367
-Simon. Oh, he's out.
-[Lena] Simon. Simon?
260
00:11:33,534 --> 00:11:34,868
-Simon.
-Take a deep breath.
261
00:11:35,033 --> 00:11:36,200
-Get a stretcher.
-[Lena] Simon!
262
00:11:36,367 --> 00:11:38,601
-Stay with us.
-Pressure's up, 210 over 120.
263
00:11:38,767 --> 00:11:40,100
I think this is a stroke.
264
00:11:40,267 --> 00:11:41,767
Take it easy.
Take it easy.
265
00:11:41,934 --> 00:11:44,300
Calm down.
We need hands!
266
00:11:44,467 --> 00:11:46,400
Get away!
267
00:11:48,868 --> 00:11:50,567
[Dr. Carrier]
My triage nurse calls me
to the waiting room to deal
268
00:11:50,734 --> 00:11:52,000
with a high-maintenance
family member.
269
00:11:52,167 --> 00:11:54,067
I can assure you
that your husband is stable.
270
00:11:54,234 --> 00:11:55,267
[Dr. Carrier]
The next thing I knew...
271
00:11:55,434 --> 00:11:56,267
Oh, he's out.
272
00:11:56,434 --> 00:11:57,868
Hey, we need a gurney
right now.
273
00:11:58,033 --> 00:11:59,701
Simon, wake up, honey.
Wake up.
274
00:11:59,868 --> 00:12:02,467
We're gonna need an IV,
oxygen, full monitors.
275
00:12:02,634 --> 00:12:05,167
-Get him in a room.
-Simon, wake up.
276
00:12:05,334 --> 00:12:07,667
When somebody loses
consciousness unexpectedly,
277
00:12:07,834 --> 00:12:11,167
we start with the basics.
Airway, breathing, circulation.
278
00:12:11,334 --> 00:12:13,167
And then we start looking
for clues
279
00:12:13,334 --> 00:12:15,200
as to why this
might have happened.
280
00:12:15,367 --> 00:12:17,300
Based on what
the patient's wife had told us,
281
00:12:17,467 --> 00:12:19,100
I'm thinking this could be
a cardiac issue.
282
00:12:19,267 --> 00:12:20,467
Simon.
283
00:12:20,634 --> 00:12:22,667
-What happened?
-You passed out.
284
00:12:22,834 --> 00:12:24,667
-Do you know where you are?
-The hospital.
285
00:12:24,834 --> 00:12:26,067
-[Dr. Carrier] Good, good.
-Vitals are stable.
286
00:12:26,234 --> 00:12:28,167
-[Dr. Carrier] OK.
-Check again, please,
287
00:12:28,334 --> 00:12:29,868
because he wasn't like this
yesterday.
288
00:12:30,033 --> 00:12:32,701
Nurses tend to have a sixth
sense about patients.
289
00:12:32,868 --> 00:12:34,467
I understand that,
but his vitals are stable.
290
00:12:34,634 --> 00:12:35,767
Check again.
291
00:12:35,767 --> 00:12:37,200
[Dr. Carrier] And sometimes
that's a great thing.
292
00:12:37,367 --> 00:12:39,000
But if you get two of them
in the same room
293
00:12:39,167 --> 00:12:40,667
with very
strong personalities...
294
00:12:42,000 --> 00:12:44,167
sometimes you have
to be a referee,
295
00:12:44,334 --> 00:12:45,501
and that's just part of the job.
296
00:12:45,667 --> 00:12:47,267
Lena, you said
that he was cleared
297
00:12:47,434 --> 00:12:49,100
by cardiology yesterday, right?
298
00:12:50,267 --> 00:12:52,267
Rose, let's get an EKG.
We need a 12-lead.
299
00:12:52,434 --> 00:12:53,767
Got it.
300
00:12:53,934 --> 00:12:55,667
[Dr. Kyle] Dr. Carrier?
Dr. Carrier!
301
00:12:56,868 --> 00:12:57,868
You need to come see this.
302
00:12:59,501 --> 00:13:01,167
OK, get that EKG.
I'll be right back.
303
00:13:01,334 --> 00:13:02,234
I've got this.
304
00:13:02,400 --> 00:13:04,367
OK, Simon, I need you
to lean back.
305
00:13:04,534 --> 00:13:06,067
Just stay still.
You're gonna be OK.
306
00:13:08,467 --> 00:13:09,868
Looks like some kind
of allergic reaction,
307
00:13:10,033 --> 00:13:11,767
maybe angioedema.
308
00:13:11,934 --> 00:13:14,767
Should be prepping
steroids, Benadryl.
309
00:13:14,934 --> 00:13:16,567
Wait, how are his vital signs?
310
00:13:16,734 --> 00:13:18,100
Oh, they look better
than he does.
311
00:13:18,267 --> 00:13:20,067
The challenge with young doctors
isn't knowledge,
312
00:13:20,234 --> 00:13:21,868
it's overconfidence.
313
00:13:22,033 --> 00:13:26,067
They tend to see one symptom
and jump right into a diagnosis
314
00:13:26,234 --> 00:13:27,601
without thinking
of anything else.
315
00:13:27,767 --> 00:13:28,868
Well, let's take a look.
316
00:13:33,567 --> 00:13:34,601
Hi.
317
00:13:39,467 --> 00:13:41,000
[screams]
318
00:13:41,167 --> 00:13:43,701
Oh my gosh, look at that!
319
00:13:43,868 --> 00:13:45,501
Oh my gosh.
320
00:13:45,667 --> 00:13:49,100
I have a nurse on staff
who has attributed everything
321
00:13:49,267 --> 00:13:52,667
that's happened for the night
to superstition and fog
322
00:13:52,834 --> 00:13:56,000
and full moons.
And now I have this.
323
00:13:56,167 --> 00:13:58,000
All right, come on.
Here we go.
324
00:13:58,167 --> 00:14:00,367
Sit, sit.
All right.
325
00:14:00,534 --> 00:14:03,167
-What happened?
-I was tying up my boat.
326
00:14:04,667 --> 00:14:08,200
Oh, my head started to hurt.
I got dizzy.
327
00:14:08,367 --> 00:14:09,868
It's the fog.
328
00:14:11,100 --> 00:14:12,667
The fog and the moon,
I'm telling you.
329
00:14:14,100 --> 00:14:15,734
Oh, what happened
to your hand?
330
00:14:18,200 --> 00:14:19,968
All right, let's get
you to a room.
331
00:14:20,133 --> 00:14:22,267
We'll take a closer look
at you.
332
00:14:22,434 --> 00:14:25,400
So he came in, his hand was
hurting, but was also
333
00:14:25,567 --> 00:14:28,567
complaining of
headache and dizziness.
334
00:14:28,734 --> 00:14:30,067
Hey, follow my finger.
335
00:14:30,234 --> 00:14:32,067
My initial thought was,
"Did he fall?
336
00:14:32,234 --> 00:14:33,467
Did he hit his head?"
337
00:14:33,634 --> 00:14:34,601
How'd you get here?
338
00:14:35,567 --> 00:14:36,667
I walked.
339
00:14:36,834 --> 00:14:38,167
I've never seen
anything like it.
340
00:14:38,334 --> 00:14:40,000
Did you fall?
341
00:14:40,167 --> 00:14:42,901
-I don't feel right.
-Pressure's up, 210 over 120.
342
00:14:43,067 --> 00:14:44,901
It's fog.
343
00:14:45,067 --> 00:14:48,300
[Dr. Nelson] He went from
completely alert and oriented
344
00:14:48,467 --> 00:14:50,801
to confused quickly.
345
00:14:53,067 --> 00:14:54,601
[grunts]
346
00:14:54,767 --> 00:14:57,200
Hey, Natalie.
I think this is a stroke.
347
00:14:57,367 --> 00:14:58,501
Get this off.
348
00:14:58,667 --> 00:15:01,801
Get a CBC, CMP, COAGS,
and go ahead and call CT.
349
00:15:01,968 --> 00:15:03,467
-Let them know we're on our way.
-[nurse Natalie] Copy.
350
00:15:03,634 --> 00:15:05,100
Take it easy.
Take it easy.
351
00:15:05,267 --> 00:15:07,667
Calm down.
Calm down.
352
00:15:07,834 --> 00:15:12,868
As his illness progressed,
he became more confused,
353
00:15:13,033 --> 00:15:16,367
more combative, just became
a lot more difficult
354
00:15:16,534 --> 00:15:17,667
to take care of him.
355
00:15:17,834 --> 00:15:19,467
We need hands!
356
00:15:19,634 --> 00:15:20,567
[grunts]
357
00:15:23,501 --> 00:15:24,801
No!
Get away!
358
00:15:26,200 --> 00:15:27,400
Get away!
359
00:15:32,701 --> 00:15:35,767
I understand you're here for
fever and shortness of breath.
360
00:15:35,934 --> 00:15:37,701
Yeah, and headaches.
361
00:15:37,868 --> 00:15:40,501
Comes and goes,
but mostly comes.
362
00:15:40,667 --> 00:15:43,767
[Dr. Frankel]
My patient has profound
hypoxia, and all signs lead
363
00:15:43,934 --> 00:15:46,400
to COVID, but not all the
symptoms are adding up.
364
00:15:47,901 --> 00:15:49,400
All right, how do they look?
365
00:15:49,567 --> 00:15:51,667
EKG indicates mild
sinus tachycardia.
366
00:15:51,834 --> 00:15:52,767
Troponin level?
367
00:15:52,767 --> 00:15:54,801
Normal, and his white blood
cell count
368
00:15:54,968 --> 00:15:56,767
remains unremarkable.
-Lactic acid?
369
00:15:57,868 --> 00:15:59,567
Slightly elevated,
as is his D-dimer.
370
00:15:59,734 --> 00:16:01,801
All right, so we have COVID,
371
00:16:01,968 --> 00:16:04,100
a blood clot from
his positive D-dimer,
372
00:16:04,267 --> 00:16:05,868
possibly from his leg surgery.
373
00:16:06,033 --> 00:16:09,868
He's gonna need a CT scan,
which I was hoping to avoid.
374
00:16:10,033 --> 00:16:11,901
Going to CT when you
don't necessarily have to
375
00:16:12,067 --> 00:16:13,200
is never a great thing.
376
00:16:13,200 --> 00:16:15,400
But in this case, he did have
a positive D-dimer.
377
00:16:15,567 --> 00:16:18,367
He was really hypoxic,
and we wanted to make sure
378
00:16:18,534 --> 00:16:20,801
he didn't have a blood clot
or a pulmonary embolism.
379
00:16:20,968 --> 00:16:23,100
However,
once he leaves the department,
380
00:16:23,267 --> 00:16:25,868
if he does have COVID,
he just increased the chance
381
00:16:26,033 --> 00:16:27,968
of spreading it
everywhere he goes.
382
00:16:28,133 --> 00:16:30,400
We need to get a CAT scan
of his lungs, obviously,
383
00:16:30,567 --> 00:16:31,868
but can we get a CAT scan
of his head?
384
00:16:32,033 --> 00:16:33,801
I'm concerned
about his headaches.
385
00:16:40,167 --> 00:16:42,667
Ground-glass infiltrates.
Nothing too serious, though.
386
00:16:43,968 --> 00:16:46,868
Dr. Ian showed up to weigh in.
Of course.
387
00:16:48,100 --> 00:16:49,767
So what do we have?
388
00:16:49,934 --> 00:16:52,467
[Dr. Frankel]
We often work together to
transition patients from the ER
389
00:16:52,634 --> 00:16:53,868
to the ICU.
390
00:16:54,033 --> 00:16:57,067
He's complaining of headaches,
no mass, no bleed.
391
00:16:57,234 --> 00:16:58,167
[Dr. Ian] Headaches, huh?
392
00:16:58,334 --> 00:17:00,300
[Dr. Frankel]
And some mild confusion.
393
00:17:00,467 --> 00:17:03,868
Ron had all the classic
symptoms of COVID, right?
394
00:17:04,033 --> 00:17:06,767
He was short of breath,
he was hypoxic,
395
00:17:06,934 --> 00:17:09,567
he had ground-glass appearance
on his chest X-ray,
396
00:17:09,734 --> 00:17:11,400
but something else was going on
with Ron.
397
00:17:11,567 --> 00:17:13,367
Ron also had
an excruciating headache
398
00:17:13,534 --> 00:17:14,701
and Ron was very confused.
399
00:17:14,868 --> 00:17:17,267
And those were not
typical presentations
400
00:17:17,434 --> 00:17:18,567
in patients with COVID.
401
00:17:18,734 --> 00:17:21,200
Well, I'm curious to see him
for myself.
402
00:17:21,367 --> 00:17:22,901
Sats have dropped
into the low 70s.
403
00:17:23,067 --> 00:17:24,868
[Dr. Frankel]
Get him a non-rebreather.
I'm right behind you.
404
00:17:25,033 --> 00:17:26,100
Good job.
405
00:17:27,467 --> 00:17:30,000
A non-rebreather mask
is a way of delivering
406
00:17:30,167 --> 00:17:32,767
higher concentration of oxygen
to the patient, right?
407
00:17:32,934 --> 00:17:36,100
So we start off with a nasal
cannula, but then when that's
408
00:17:36,267 --> 00:17:39,167
not enough, that doesn't give
the patient enough oxygen,
409
00:17:39,334 --> 00:17:40,667
then we go to
a non-rebreather mask,
410
00:17:40,834 --> 00:17:44,100
which is the maximum oxygen
that we can give
411
00:17:44,267 --> 00:17:46,467
before going into
higher interventions.
412
00:17:49,601 --> 00:17:51,067
[Ron grunts]
My head hurts.
413
00:17:52,501 --> 00:17:53,567
Where's my dog?
414
00:17:55,567 --> 00:17:56,868
Hello, I'm Dr. Ian.
415
00:17:57,868 --> 00:18:00,400
All right, your oxygen levels
keep dropping, so we're gonna
416
00:18:00,567 --> 00:18:02,567
put you on a ventilator to help
you breathe, OK?
417
00:18:03,667 --> 00:18:05,367
Where am I?
418
00:18:05,534 --> 00:18:08,200
Can I get 20 etomidate
and 100 of sux?
419
00:18:08,367 --> 00:18:09,601
[Dr. Frankel] Stop!
420
00:18:11,701 --> 00:18:13,000
[Dr. Ian] Excuse me?
421
00:18:13,167 --> 00:18:15,000
[Dr. Frankel] So although Ron
needed more oxygen,
422
00:18:15,167 --> 00:18:18,167
I really felt at that time that
if we intubated Ron,
423
00:18:18,334 --> 00:18:19,601
he would certainly die.
424
00:18:19,601 --> 00:18:22,400
And that did cause a lot of
upheaval and a lot of fights.
425
00:18:23,901 --> 00:18:26,501
You saw the scan.
His lungs are totally normal.
426
00:18:26,667 --> 00:18:28,367
We are not intubating
this patient.
427
00:18:28,534 --> 00:18:31,167
Look, his O2 levels are critical
and you know that.
428
00:18:31,334 --> 00:18:34,300
He's in the grips of COVID.
This is a no-brainer, doc.
429
00:18:34,467 --> 00:18:36,601
This one has symptoms
that just don't add up.
430
00:18:37,868 --> 00:18:41,767
Headaches, disorientation,
COVID-adjacent, obviously.
431
00:18:41,934 --> 00:18:44,501
I'm telling you, we are not
intubating this patient.
432
00:18:44,667 --> 00:18:47,367
You know, putting someone on
a ventilator, pumping in all
433
00:18:47,534 --> 00:18:50,601
that oxygen, is literally like
blowing up a balloon.
434
00:18:50,767 --> 00:18:52,767
We'll blow out his lung,
he will die.
435
00:18:52,934 --> 00:18:56,567
He'll die because you refused
to save him.
436
00:18:56,734 --> 00:18:59,100
I'm gonna just check your neck
real quick.
437
00:18:59,267 --> 00:19:02,267
It feels like bubble wrap
and makes a crackling sound
438
00:19:02,434 --> 00:19:04,100
when you touch it.
It was not good.
439
00:19:08,167 --> 00:19:09,267
-[Dr. Kyle] Dr. Carrier?
-EKG.
440
00:19:09,434 --> 00:19:10,901
-Yes?
-Dr. Carrier, you need to come
see this.
441
00:19:16,467 --> 00:19:17,868
Hi.
442
00:19:18,033 --> 00:19:19,901
I'm Dr. Carrier.
I think you've met Kyle.
443
00:19:20,067 --> 00:19:21,234
[Bill] Mm-hmm.
444
00:19:21,400 --> 00:19:24,000
I wasn't sure exactly what was
wrong with this patient.
445
00:19:24,167 --> 00:19:26,467
-How you feeling?
-How do I look?
446
00:19:26,634 --> 00:19:28,267
You look a little swollen.
447
00:19:28,434 --> 00:19:30,467
But I knew one thing,
it was not good.
448
00:19:30,634 --> 00:19:32,267
I'm gonna just check your neck
real quick.
449
00:19:32,434 --> 00:19:33,567
Mm-hmm.
450
00:19:33,567 --> 00:19:37,567
Patients watch our faces.
If we panic, they panic.
451
00:19:37,734 --> 00:19:40,667
It's very important
to learn not to show it.
452
00:19:40,834 --> 00:19:43,767
This case was a masterclass
in not reacting.
453
00:19:43,934 --> 00:19:46,367
Do you want me to prep some
Benadryl, protect that airway?
454
00:19:46,534 --> 00:19:49,601
What didn't make sense is that
the man's neck looked terrible,
455
00:19:49,767 --> 00:19:52,667
but he was not in distress.
His blood pressure was good.
456
00:19:52,834 --> 00:19:54,267
His oxygen levels were good.
457
00:19:54,434 --> 00:19:56,701
He was speaking
without any problems.
458
00:19:56,868 --> 00:19:58,167
Tell me,
459
00:19:58,334 --> 00:20:00,100
does this hurt?
460
00:20:00,267 --> 00:20:02,200
-Is it sore?
-No, not really.
461
00:20:02,367 --> 00:20:04,868
Usually when somebody looks
that strange,
462
00:20:05,033 --> 00:20:07,667
the vital signs
tell the same story.
463
00:20:08,868 --> 00:20:09,868
These were stable.
464
00:20:11,868 --> 00:20:14,167
Kyle, see what you think.
Check his neck.
465
00:20:14,334 --> 00:20:16,467
And the patient
was remarkably calm.
466
00:20:16,634 --> 00:20:19,167
It feels like bubble wrap
and makes a crackling sound
467
00:20:19,334 --> 00:20:21,300
when you touch it.
That's subcutaneous air.
468
00:20:22,868 --> 00:20:25,767
-[sighs] Crepitus?
-Exactly.
469
00:20:25,934 --> 00:20:28,467
Air does not belong
under the skin.
470
00:20:28,634 --> 00:20:31,100
Crepitus tells me that air
is coming from a place
471
00:20:31,267 --> 00:20:32,667
that it shouldn't.
472
00:20:32,834 --> 00:20:34,100
Bill, let me look
a little further.
473
00:20:34,267 --> 00:20:36,767
I'd like to look on this side
of your chest.
474
00:20:36,934 --> 00:20:38,100
-All right.
-All right?
475
00:20:38,267 --> 00:20:40,667
Have you had any recent health
problems, trauma,
476
00:20:40,834 --> 00:20:43,200
falls, anything like that?
-No, not really.
477
00:20:43,367 --> 00:20:44,667
[Dr. Carrier] All right.
Let me just bring your arm
478
00:20:44,834 --> 00:20:46,467
up here so I can see
a little bit better.
479
00:20:47,501 --> 00:20:50,067
Oh, Bill, what is this?
480
00:20:50,234 --> 00:20:53,000
Oh, I had a collapsed lung
a few weeks back.
481
00:20:53,167 --> 00:20:55,567
Oh, and you didn't think
it was worth mentioning?
482
00:20:55,734 --> 00:20:56,834
-[Dr. Carrier] OK.
-Sorry.
483
00:20:56,834 --> 00:21:00,167
The scar looks like
a previous chest tube site.
484
00:21:00,334 --> 00:21:03,100
Now I'm concerned that his lung
may have collapsed again.
485
00:21:03,267 --> 00:21:06,000
Kyle, we need a portable
chest X-ray.
486
00:21:06,167 --> 00:21:07,667
I'd like for you to stay
with him.
487
00:21:07,834 --> 00:21:10,100
Shall I prep
an intubation tray?
488
00:21:10,267 --> 00:21:13,100
No, let's see what the chest
X-ray has to say.
489
00:21:13,267 --> 00:21:14,267
Then we'll see.
490
00:21:14,434 --> 00:21:16,167
I'll be back.
491
00:21:16,334 --> 00:21:19,400
The air itself isn't
the disease, it's the clue.
492
00:21:19,567 --> 00:21:21,901
It's our job to figure out
where it's coming from
493
00:21:22,067 --> 00:21:24,767
and then decide the right
treatment for the patient
494
00:21:24,934 --> 00:21:26,767
so that we don't make him worse.
495
00:21:26,934 --> 00:21:29,200
Simon, I need you
to stay still.
496
00:21:29,367 --> 00:21:31,467
-I can't,
-Something's really wrong.
497
00:21:31,634 --> 00:21:33,067
We're trying to figure
that out.
498
00:21:33,234 --> 00:21:35,801
All right, all right.
How's the EKG coming?
499
00:21:35,968 --> 00:21:37,767
I've tried twice,
he keeps moving.
500
00:21:37,934 --> 00:21:40,701
Simon, can you hear me?
We've got to check your heart.
501
00:21:40,868 --> 00:21:43,000
We need you to hold
as still as you can
502
00:21:43,167 --> 00:21:45,667
so we can get an EKG.
Can you do that?
503
00:21:47,667 --> 00:21:49,901
I've got to check something,
keep me posted,
504
00:21:50,067 --> 00:21:51,868
but we need that EKG stat.
-Got it.
505
00:21:53,868 --> 00:21:58,000
OK, Simon, just stay still
for just a few seconds, OK?
506
00:21:58,167 --> 00:21:59,300
Just a few seconds.
507
00:22:00,767 --> 00:22:02,601
Good job, good job.
508
00:22:04,000 --> 00:22:05,667
[PA announcement]
Pediatrics, dial 22.
509
00:22:08,000 --> 00:22:09,300
[Dr. Carrier] Kyle?
510
00:22:09,467 --> 00:22:11,400
The X-ray was
really impressive.
511
00:22:11,567 --> 00:22:14,701
There was air throughout
the subcutaneous tissues,
512
00:22:14,868 --> 00:22:16,167
in the chest and neck.
513
00:22:16,334 --> 00:22:18,067
It looked like clouds
where there shouldn't have been
514
00:22:18,234 --> 00:22:19,167
anything at all.
515
00:22:19,334 --> 00:22:20,601
The lung was collapsed.
516
00:22:20,767 --> 00:22:23,467
He needed to have
the leak stopped.
517
00:22:23,634 --> 00:22:25,000
-Intubate?
-[Dr. Carrier] No.
518
00:22:25,167 --> 00:22:26,667
But his airway,
Dr. Carrier, we have to --
519
00:22:26,834 --> 00:22:28,300
Hold on, hold on.
520
00:22:28,467 --> 00:22:31,367
If we do that, it could make
him dramatically worse.
521
00:22:31,534 --> 00:22:34,067
He doesn't need an airway.
His vital signs are good.
522
00:22:34,234 --> 00:22:35,601
He needs his leak fixed.
523
00:22:37,100 --> 00:22:39,601
Dr. Carrier, the EKG.
524
00:22:39,767 --> 00:22:42,067
I looked at the EKG
and suddenly everything
525
00:22:42,234 --> 00:22:44,801
makes sense.
He has complete heart block.
526
00:22:45,801 --> 00:22:48,901
Something's not right with
his heart's electrical system.
527
00:22:49,067 --> 00:22:51,667
For Simon,
now the clock is ticking.
528
00:22:51,834 --> 00:22:54,300
The patient with crepitus
has some time.
529
00:22:54,467 --> 00:22:55,767
The other one may not.
530
00:23:01,367 --> 00:23:03,367
Get away!
Get away!
531
00:23:03,534 --> 00:23:06,601
The confusion, the agitation,
that wasn't just him
532
00:23:06,767 --> 00:23:08,400
being scared.
-Get away!
533
00:23:08,567 --> 00:23:10,467
That's what a stroke
can look like.
534
00:23:15,000 --> 00:23:17,501
-OK, we need to get him to CT.
-Yeah.
535
00:23:17,667 --> 00:23:19,868
I need to go check on Amber,
but as soon as you get
536
00:23:20,033 --> 00:23:21,467
the results for the CT,
let me know.
537
00:23:21,634 --> 00:23:22,667
You got it.
538
00:23:22,667 --> 00:23:24,300
If I'm right and we're dealing
with a stroke,
539
00:23:24,467 --> 00:23:25,701
then every minute counts.
540
00:23:25,701 --> 00:23:27,267
[PA announcement] Security,
please report to reception.
541
00:23:29,167 --> 00:23:31,767
But we can't act until
we know for sure.
542
00:23:31,934 --> 00:23:34,200
-Hey, how's she doing?
-She took a turn.
543
00:23:34,367 --> 00:23:36,801
Sats are down.
Breathing's worse, not better.
544
00:23:36,968 --> 00:23:38,267
Pressure's down, too.
545
00:23:38,434 --> 00:23:40,100
-Did you see her labs?
-Yeah, negative.
546
00:23:41,267 --> 00:23:42,467
Fluid bolus?
547
00:23:42,634 --> 00:23:44,868
Ran it, and she got
worse after.
548
00:23:45,033 --> 00:23:46,367
We need to start her on BiPAP.
549
00:23:46,534 --> 00:23:47,767
We need to
support her breathing.
550
00:23:47,934 --> 00:23:49,400
I'll call cardiology.
551
00:23:51,868 --> 00:23:54,767
None of this makes sense
unless it's her heart.
552
00:23:54,934 --> 00:23:56,667
And if it is,
the clock is ticking
553
00:23:56,834 --> 00:23:58,200
and we need a second opinion.
554
00:24:02,767 --> 00:24:04,200
Hey, it's Dr. Nelson.
555
00:24:04,367 --> 00:24:07,767
So I spoke with a cardiologist
at the outside hospital
556
00:24:07,934 --> 00:24:11,801
and we agreed that it is more
than likely acute heart failure.
557
00:24:11,968 --> 00:24:16,000
No echo, no cath lab.
558
00:24:16,167 --> 00:24:18,100
I did a bedside
ultrasound, yes.
559
00:24:18,267 --> 00:24:20,901
But unfortunately,
the intervention,
560
00:24:21,067 --> 00:24:24,200
the studies, the labs
that she would need,
561
00:24:24,367 --> 00:24:26,300
we did not have
at this hospital.
562
00:24:26,467 --> 00:24:28,033
All right, thanks.
563
00:24:30,501 --> 00:24:33,400
Now we have two
critically ill patients,
564
00:24:33,567 --> 00:24:34,901
a new nurse.
565
00:24:35,067 --> 00:24:38,267
We have a power outage.
We have fog.
566
00:24:38,434 --> 00:24:40,667
We can't fly anybody out.
567
00:24:40,834 --> 00:24:43,467
Definitely did not have
the resources that we needed
568
00:24:43,634 --> 00:24:47,167
to manage the acute patients
that we had.
569
00:24:47,334 --> 00:24:49,567
-Hey, any better?
-Barely.
570
00:24:49,734 --> 00:24:52,100
We need to get her
airlifted out of here.
571
00:24:52,267 --> 00:24:54,100
She needs cardiology.
572
00:24:54,267 --> 00:24:57,367
Let's start dobutamine
and prep her for transfer.
573
00:24:57,534 --> 00:25:01,267
Dobutamine is a medicine
that we give when some patients
574
00:25:01,434 --> 00:25:04,601
are in acute heart failure that
helps the heart beat stronger
575
00:25:04,767 --> 00:25:06,100
and it helps to buy us
some time.
576
00:25:07,167 --> 00:25:08,868
-Oh my God!
-You OK?
577
00:25:09,033 --> 00:25:11,067
Yeah, sorry.
CT results.
578
00:25:12,000 --> 00:25:13,067
What do we got?
579
00:25:13,234 --> 00:25:14,300
CT confirmed it.
580
00:25:14,300 --> 00:25:17,367
He had the stroke,
and now the clock is ticking
581
00:25:17,534 --> 00:25:19,267
on both of my patients.
582
00:25:19,434 --> 00:25:21,567
Elle, we need a medevac
helicopter ASAP.
583
00:25:21,734 --> 00:25:24,400
Oh, everything's grounded.
Zero visibility.
584
00:25:24,567 --> 00:25:27,367
Nothing's getting in or out
until this fog lifts.
585
00:25:27,534 --> 00:25:30,100
Oh my gosh, she was right.
The fog and the full moon?
586
00:25:30,267 --> 00:25:32,167
Like what Elle said.
587
00:25:32,334 --> 00:25:36,267
Natalie, it's no jinx,
no ER gods, no superstitions.
588
00:25:36,434 --> 00:25:38,367
People get sick all
the time, OK?
589
00:25:38,534 --> 00:25:40,467
We just need to stay calm,
stay focused.
590
00:25:40,634 --> 00:25:42,367
[whispering] OK.
591
00:25:42,534 --> 00:25:45,200
[radio comms] Inbound motorcycle
versus guardrail, male, 30,
592
00:25:45,367 --> 00:25:47,567
tourniquet in place
on right leg.
593
00:25:47,734 --> 00:25:49,601
Multiple lacerations,
10 minutes out.
594
00:25:52,100 --> 00:25:53,634
[indistinct radio comms]
595
00:25:56,100 --> 00:25:58,000
Let me put this as directly
as I can.
596
00:25:58,167 --> 00:26:00,501
If you intubate my patient,
I promise you,
597
00:26:00,667 --> 00:26:02,667
this will be the last day
you work in this hospital.
598
00:26:12,467 --> 00:26:15,200
Elle, we need a medevac
helicopter ASAP.
599
00:26:15,367 --> 00:26:17,267
Everything's grounded,
zero visibility.
600
00:26:17,434 --> 00:26:20,000
Nothing's getting in or out
until the fog lifts.
601
00:26:20,167 --> 00:26:22,300
[radio comms] Inbound motorcycle
versus guardrail.
602
00:26:22,467 --> 00:26:25,200
Male, 30s, tourniquet in place
on right leg.
603
00:26:25,367 --> 00:26:27,000
Multiple lacerations,
10 minutes out.
604
00:26:30,567 --> 00:26:32,100
-Oh, my God!
-[Elle] Told ya!
605
00:26:34,100 --> 00:26:35,767
[Dr. Nelson]
We need to stay focused,
all right?
606
00:26:35,934 --> 00:26:38,000
The new patient
is minutes away.
607
00:26:38,167 --> 00:26:39,467
This fog still has us grounded.
608
00:26:40,701 --> 00:26:41,734
Status updates?
609
00:26:41,901 --> 00:26:43,167
Dobutamine seems to be keeping
Amber stable.
610
00:26:43,334 --> 00:26:44,501
OK, good.
611
00:26:44,667 --> 00:26:46,267
Terrence has calmed down
quite a bit,
612
00:26:46,434 --> 00:26:48,667
but his pressure is
still really high.
613
00:26:48,834 --> 00:26:50,367
Elle, you stand by
for the new patient.
614
00:26:50,534 --> 00:26:51,634
Copy.
615
00:26:51,634 --> 00:26:53,667
Natalie, you and I,
we'll go check on Terrence.
616
00:26:53,834 --> 00:26:54,767
We'll get neurology
on the screen.
617
00:26:54,934 --> 00:26:56,000
-OK.
-[Dr. Nelson] OK?
618
00:26:56,167 --> 00:26:57,501
We're a small hospital.
619
00:26:57,667 --> 00:27:00,267
I don't have a neurologist
or cardiologist on staff
620
00:27:00,434 --> 00:27:02,601
that can come to the room
and see the patient,
621
00:27:02,767 --> 00:27:06,767
but I do have a neurologist
that we can get on telemedicine.
622
00:27:06,934 --> 00:27:09,100
Hey, Doc.
I have a 62-year-old male here.
623
00:27:09,267 --> 00:27:11,767
Came in, headache, dizziness.
Started having slurred speech.
624
00:27:11,934 --> 00:27:13,167
We got a CT.
625
00:27:13,334 --> 00:27:15,000
It looks like we're dealing
with a hemorrhagic stroke.
626
00:27:17,467 --> 00:27:20,567
Hey, I can't hear you.
You're breaking up.
627
00:27:20,734 --> 00:27:23,701
-Oh, my God.
-It's OK, just a little static.
628
00:27:23,868 --> 00:27:25,400
We'll go ahead and try to work
on getting his pressure down.
629
00:27:25,567 --> 00:27:26,667
We'll get the head
of the bed up.
630
00:27:26,834 --> 00:27:27,968
OK.
631
00:27:27,968 --> 00:27:30,601
His CT head showed bleeding,
so his blood pressure
632
00:27:30,767 --> 00:27:32,567
absolutely cannot stay
that high.
633
00:27:32,734 --> 00:27:34,367
That's non-negotiable.
634
00:27:34,534 --> 00:27:37,167
There's no drug that I can give
for this type of stroke.
635
00:27:37,334 --> 00:27:40,067
We raised the head of the bed
to relieve the pressure.
636
00:27:40,234 --> 00:27:43,000
At this point, whatever we can
do to help decrease
637
00:27:43,167 --> 00:27:44,601
the bleeding, we needed to do.
-OK.
638
00:27:44,767 --> 00:27:46,968
[ambulance siren wailing]
639
00:27:48,400 --> 00:27:49,567
OK, keep an eye
on his blood pressure.
640
00:27:53,868 --> 00:27:55,701
-All right, what'd we get?
-Up and go.
641
00:27:55,868 --> 00:27:57,667
Tourniquet was already on
when we got there.
642
00:27:57,834 --> 00:27:59,000
Must've done it himself.
643
00:27:59,167 --> 00:28:01,868
On my count, one, two, three.
644
00:28:04,167 --> 00:28:05,667
[screams]
645
00:28:05,834 --> 00:28:06,901
Sorry.
646
00:28:07,067 --> 00:28:08,100
[Dr. Nelson] I look down...
647
00:28:10,567 --> 00:28:13,100
What the heck
is happening tonight?
648
00:28:14,100 --> 00:28:16,667
Hey, we got this.
Go take a breath.
649
00:28:16,834 --> 00:28:18,267
Hey, Elle, hang some O-negative.
650
00:28:18,434 --> 00:28:19,667
I'm gonna take a look
at this leg.
651
00:28:21,200 --> 00:28:22,767
OK, tourniquet's doing its job.
652
00:28:22,934 --> 00:28:24,868
Hey, we need to get
an ultrasound, get a FAST exam.
653
00:28:25,033 --> 00:28:26,667
We also need to get
a portable X-ray in here.
654
00:28:26,834 --> 00:28:27,901
All right, blood pressure's
going up.
655
00:28:28,067 --> 00:28:29,100
It's 80 over 70.
656
00:28:29,267 --> 00:28:31,467
OK, hey, get some gauze,
wet it with saline.
657
00:28:31,634 --> 00:28:33,467
Get this on an ice bath.
Do not put it on direct ice.
658
00:28:37,267 --> 00:28:39,300
Dr. Nelson, EMS just called.
659
00:28:39,467 --> 00:28:41,467
SUV rollover,
multiple passengers,
660
00:28:41,634 --> 00:28:42,767
15 minutes out.
661
00:28:42,934 --> 00:28:44,868
[Dr. Nelson] It's unbelievable,
a nightmare.
662
00:28:49,100 --> 00:28:51,200
[Dr. Ian] Twenty of etomidate
and 100 of sux.
663
00:28:51,367 --> 00:28:52,467
[Dr. Frankel] Stop!
664
00:28:54,467 --> 00:28:55,834
[Dr. Ian] Excuse me?
665
00:28:56,000 --> 00:28:58,000
[Dr. Frankel]
At this point, intubation
has become the default
666
00:28:58,167 --> 00:29:01,400
for treatment in patients with
profound hypoxia during COVID,
667
00:29:01,567 --> 00:29:03,400
but I'm standing firm
and saying no.
668
00:29:05,601 --> 00:29:07,567
COVID is not the only thing
going on here.
669
00:29:07,734 --> 00:29:09,167
Listen, if you don't
intubate him,
670
00:29:09,334 --> 00:29:10,968
he'll die and it'll be on you.
671
00:29:13,167 --> 00:29:15,067
[Dr. Frankel]
That's a high-pressure
situation, right?
672
00:29:15,234 --> 00:29:18,367
You're going against what
everyone is telling you to do.
673
00:29:18,534 --> 00:29:19,801
Set up for
a bedside ultrasound.
674
00:29:19,968 --> 00:29:21,267
I want to get a good look
at his heart.
675
00:29:21,434 --> 00:29:22,801
Ron could have died
at any minute
676
00:29:22,968 --> 00:29:24,701
and I had to make
that decision,
677
00:29:26,167 --> 00:29:27,701
to intubate or not intubate.
678
00:29:27,868 --> 00:29:30,367
And if I was wrong,
Ron was gonna die
679
00:29:30,534 --> 00:29:32,400
and I would never live
that moment down.
680
00:29:34,868 --> 00:29:36,868
-Aren't we the rebel today?
-Rebel?
681
00:29:37,033 --> 00:29:38,200
I've been speaking
to my colleagues
682
00:29:38,367 --> 00:29:40,701
around different cities,
and everyone that they intubate,
683
00:29:40,868 --> 00:29:42,367
they're blowing out their lungs
and they're dying.
684
00:29:42,534 --> 00:29:44,667
And it's not just one patient.
685
00:29:44,834 --> 00:29:46,367
The risk of blowing out
his lung is greater
686
00:29:46,534 --> 00:29:48,167
than just leaving it alone.
687
00:29:48,334 --> 00:29:49,501
And besides,
I don't think COVID is
688
00:29:49,667 --> 00:29:51,167
the only thing going on here.
689
00:29:51,334 --> 00:29:52,467
Something else is going on
690
00:29:52,634 --> 00:29:53,767
and I still need
to figure it out.
691
00:30:00,467 --> 00:30:02,267
This heart looks great.
692
00:30:02,434 --> 00:30:03,400
Ron, how you feeling?
693
00:30:04,868 --> 00:30:07,868
Sorry, I can't remember
how I got here.
694
00:30:08,033 --> 00:30:09,267
[Dr. Frankel]
His oxygen is still dire.
695
00:30:09,434 --> 00:30:10,767
We've got to get him up
to the ICU.
696
00:30:10,934 --> 00:30:13,367
Let's get him off
the non-rebreather, get him up
697
00:30:13,534 --> 00:30:16,767
to the ICU for high-flow oxygen,
but no intubation.
698
00:30:16,934 --> 00:30:18,767
You got it?
No intubation.
699
00:30:18,934 --> 00:30:20,000
Understood.
700
00:30:21,868 --> 00:30:23,601
Let me put this as directly
as I can.
701
00:30:23,767 --> 00:30:25,968
When my patient
gets to the ICU,
702
00:30:26,133 --> 00:30:27,267
I want them in high-flow oxygen
only.
703
00:30:27,434 --> 00:30:29,667
I was fighting
uphill battle, really.
704
00:30:29,834 --> 00:30:31,501
No matter what I was telling
people to do,
705
00:30:31,667 --> 00:30:34,267
that I wanted them to do
for my patients,
706
00:30:34,434 --> 00:30:36,601
I felt like I was swimming up
against the tide.
707
00:30:36,767 --> 00:30:39,000
If you intubate my patient,
I promise you,
708
00:30:39,167 --> 00:30:41,300
this will be the last day
you work in this hospital.
709
00:30:47,501 --> 00:30:49,367
Simon, I need you
to stay still.
710
00:30:49,534 --> 00:30:51,467
-We need that EKG stat.
-Dr. Carrier.
711
00:30:51,634 --> 00:30:54,000
For Simon,
now the clock is ticking.
712
00:30:55,167 --> 00:30:57,300
[Simon] What's going on?
What's going on?
713
00:30:57,467 --> 00:30:59,000
-What is it?
-Heart block.
714
00:31:00,367 --> 00:31:02,801
Because heart block
can be intermittent,
715
00:31:02,968 --> 00:31:05,167
it can be easy to miss.
716
00:31:05,334 --> 00:31:08,601
But the patient's symptoms
were concerning.
717
00:31:08,767 --> 00:31:11,901
And fortunately, we got an EKG
just at the right time,
718
00:31:12,067 --> 00:31:13,167
so we were able to see it.
719
00:31:13,334 --> 00:31:15,000
Rose, call cardiology.
720
00:31:15,167 --> 00:31:16,767
-I need him down here yesterday.
-On it.
721
00:31:16,934 --> 00:31:18,868
But time is not
on our side now.
722
00:31:19,033 --> 00:31:21,367
-[Dr. Carrier]
Get the pacer pads on.
-What are you doing?
723
00:31:21,534 --> 00:31:24,467
[Dr. Carrier]
Complete heart block can
deteriorate very rapidly
724
00:31:24,634 --> 00:31:26,000
and without any warning.
725
00:31:26,167 --> 00:31:29,267
That's why I wanted the
pacer pads on him immediately.
726
00:31:29,434 --> 00:31:31,701
If his heart's electrical
system had failed,
727
00:31:31,868 --> 00:31:32,901
we needed to be ready.
728
00:31:33,067 --> 00:31:34,501
Listen, your electrical system
in your heart
729
00:31:34,667 --> 00:31:36,300
is not working properly.
730
00:31:36,467 --> 00:31:38,267
It's causing the pump
to work sometimes
731
00:31:38,434 --> 00:31:40,701
and not work other times.
That's why you feel funny.
732
00:31:40,868 --> 00:31:42,567
-I'm dying?
-[Lena] No, honey.
733
00:31:42,734 --> 00:31:44,167
When your heart's not pumping
effectively,
734
00:31:44,334 --> 00:31:45,767
it's not getting
enough blood to the brain.
735
00:31:45,934 --> 00:31:47,367
That's why you've been
passing out.
736
00:31:47,534 --> 00:31:49,968
The good news is,
we know what's wrong.
737
00:31:50,133 --> 00:31:52,267
-We can get it fixed.
-[nurse Rose] Dr. Carrier?
738
00:31:52,434 --> 00:31:53,467
Yes?
739
00:31:53,634 --> 00:31:54,801
Can I talk to
you for a minute?
740
00:31:54,968 --> 00:31:56,601
-[Dr. Carrier] Sure.
-Cardiology says no.
741
00:31:57,667 --> 00:31:59,300
-Excuse me?
-They looked at his chart.
742
00:31:59,467 --> 00:32:01,000
They don't agree
with his diagnosis.
743
00:32:01,167 --> 00:32:02,501
Let me chat with them.
744
00:32:03,901 --> 00:32:06,200
Yes.
This is Dr. Carrier.
745
00:32:06,367 --> 00:32:08,801
I have a very unstable patient
here--
746
00:32:08,968 --> 00:32:10,868
low blood pressure,
syncopal episodes,
747
00:32:11,033 --> 00:32:13,167
and now we found
third-degree block.
748
00:32:14,801 --> 00:32:16,000
What do you mean
you don't agree?
749
00:32:17,000 --> 00:32:19,667
Look at the EKG.
It is online.
750
00:32:19,834 --> 00:32:20,934
I'll wait.
751
00:32:21,100 --> 00:32:23,467
Complete heart block
is not something we can fix
752
00:32:23,634 --> 00:32:25,467
in an emergency department.
753
00:32:25,634 --> 00:32:28,567
We can stabilize the patient,
and if we have to,
754
00:32:28,734 --> 00:32:32,601
we can pace the heart
from the outside.
755
00:32:32,767 --> 00:32:35,567
Cardiology hadn't seen
the EKG yet.
756
00:32:35,734 --> 00:32:37,968
Yes, that's exactly right.
757
00:32:38,133 --> 00:32:39,467
I need you guys down here
right away.
758
00:32:39,634 --> 00:32:40,767
Thank you.
759
00:32:40,934 --> 00:32:42,133
They're coming down.
760
00:32:43,100 --> 00:32:46,367
We need cardiology to take over
because the definitive
761
00:32:46,534 --> 00:32:48,868
treatment is
a permanent pacemaker.
762
00:32:49,033 --> 00:32:53,267
[PA announcement]
Cardiology, pick up line 12.
Cardiology, line 12.
763
00:32:53,434 --> 00:32:54,901
[Dr. Kyle] We're about
to lose his airway.
764
00:32:55,067 --> 00:32:56,467
That's not
what I'm seeing, Kyle.
765
00:32:56,634 --> 00:32:57,868
What are you seeing?
I don't get it.
766
00:32:58,033 --> 00:33:00,367
Look at the patient.
He's got great sats.
767
00:33:00,534 --> 00:33:03,367
His blood pressure's good.
He's talking in full sentences.
768
00:33:03,534 --> 00:33:05,567
You can't focus
on what scares you.
769
00:33:05,734 --> 00:33:08,267
You have to look
at what's really happening.
770
00:33:08,434 --> 00:33:10,901
He needs a chest tube,
and he needs it right now.
771
00:33:12,000 --> 00:33:13,100
OK.
772
00:33:13,267 --> 00:33:15,300
Kyle's instinct was to intubate
773
00:33:15,467 --> 00:33:17,567
because the neck was enormous,
774
00:33:17,734 --> 00:33:21,267
but the swelling was not
the problem, the air leak was.
775
00:33:21,434 --> 00:33:23,667
[Dr. Kyle] OK, Bill,
we got you all numbed up.
776
00:33:23,834 --> 00:33:25,367
I'm gonna make a small
incision, relieve all that
777
00:33:25,534 --> 00:33:26,968
pressure for you, OK?
-[Bill] OK.
778
00:33:32,667 --> 00:33:35,968
If we had intubated him first,
we would have risked forcing
779
00:33:36,133 --> 00:33:39,901
more air into the chest
and making the situation worse.
780
00:33:45,701 --> 00:33:46,767
Looks like it's in good.
781
00:33:48,167 --> 00:33:49,801
Looks like it's starting
to work a little bit.
782
00:33:53,367 --> 00:33:55,200
What he needed
was to stop the leak
783
00:33:55,367 --> 00:33:56,367
with another chest tube.
784
00:33:56,534 --> 00:33:57,868
[Lena] Somebody help!
785
00:34:00,300 --> 00:34:01,534
Somebody help!
786
00:34:03,367 --> 00:34:06,000
[Dr. Nelson] Three patients,
three different emergencies.
787
00:34:06,167 --> 00:34:09,300
All three needed to be
transferred yesterday.
788
00:34:09,467 --> 00:34:11,400
And then here comes
another accident.
789
00:34:15,100 --> 00:34:16,801
If you intubate my patient,
I promise you,
790
00:34:16,968 --> 00:34:18,501
this will be the last day
you work in this hospital.
791
00:34:18,667 --> 00:34:20,601
I was fighting an uphill battle,
792
00:34:20,767 --> 00:34:23,200
and if I was wrong,
Ron was gonna die.
793
00:34:24,868 --> 00:34:27,501
Under all that gear,
I can tell you're smiling.
794
00:34:27,667 --> 00:34:28,667
What's going on?
795
00:34:28,834 --> 00:34:32,801
Your patient's sats are up,
as in way up.
796
00:34:32,968 --> 00:34:35,567
His heart rate has settled,
and I've been steadily turning
797
00:34:35,734 --> 00:34:36,901
his oxygen down.
798
00:34:36,901 --> 00:34:39,501
His vitals stabilized,
and he's steadily on the rise.
799
00:34:39,667 --> 00:34:41,667
-It's kind of a miracle.
-Sure is.
800
00:34:41,834 --> 00:34:43,767
It's been a rollercoaster.
801
00:34:43,934 --> 00:34:46,234
Really, really
strange rollercoaster.
802
00:34:48,701 --> 00:34:52,467
-Doctor... Dr. Dov.
-I think I got it.
803
00:34:52,634 --> 00:34:54,667
What?
804
00:34:54,834 --> 00:34:58,100
At that moment, I felt like
I finally figured it out,
805
00:34:58,267 --> 00:35:00,167
and I knew what was going on
with Ron.
806
00:35:00,334 --> 00:35:02,000
Ron, I hear
you're feeling better.
807
00:35:02,167 --> 00:35:03,567
Kind of, yeah.
808
00:35:03,734 --> 00:35:05,567
I'm going to ask you
some questions.
809
00:35:05,734 --> 00:35:07,367
Tell me about your dog.
810
00:35:07,534 --> 00:35:09,868
-How did he die?
-[sighs] I honestly don't know.
811
00:35:11,067 --> 00:35:12,701
Murphy.
812
00:35:12,868 --> 00:35:14,767
One moment, he's sleeping
on the couch.
813
00:35:14,934 --> 00:35:17,200
I went to get a sweater,
814
00:35:17,367 --> 00:35:21,667
'cause I was feeling cold
and I came back and he passed.
815
00:35:21,834 --> 00:35:24,067
What was he like
days leading up to his death?
816
00:35:24,234 --> 00:35:28,000
Lethargic, disoriented.
817
00:35:28,167 --> 00:35:29,601
Like you?
818
00:35:29,767 --> 00:35:30,868
Yeah, kind of.
819
00:35:31,033 --> 00:35:32,667
But he always perked up
when we go --
820
00:35:32,834 --> 00:35:35,300
-Outside?
-Yeah, how did you...
821
00:35:35,467 --> 00:35:37,400
I think I know what's causing
your headache, Ron.
822
00:35:37,567 --> 00:35:38,901
You said you were cold
in your house.
823
00:35:39,067 --> 00:35:40,267
Yes, why?
824
00:35:40,434 --> 00:35:42,868
I think the gas furnace
could be the culprit.
825
00:35:43,033 --> 00:35:44,367
Do you have a carbon
monoxide detector?
826
00:35:45,400 --> 00:35:47,968
No, it doesn't work.
Batteries are dead.
827
00:35:48,133 --> 00:35:50,067
[Dr. Frankel]
I think what we're gonna do
is we're gonna call the lab
828
00:35:50,234 --> 00:35:52,767
and get a carboxyhemoglobin
level stat.
829
00:35:52,934 --> 00:35:55,767
At this point,
I have Ron's dog dying,
830
00:35:55,934 --> 00:35:58,467
the gas furnace,
the symptoms getting better.
831
00:35:59,968 --> 00:36:03,100
I knew this was carbon monoxide
poisoning and all I needed was
832
00:36:03,267 --> 00:36:05,467
just to check
a carboxyhemoglobin level.
833
00:36:09,501 --> 00:36:10,501
Bingo.
834
00:36:16,200 --> 00:36:18,100
Blood is saturated
with carbon monoxide.
835
00:36:18,267 --> 00:36:19,467
[Ron sighs]
836
00:36:20,767 --> 00:36:23,367
You're lucky we discovered it
when we did.
837
00:36:23,534 --> 00:36:25,701
Ron, we're gonna have to get
you admitted so we can send
838
00:36:25,868 --> 00:36:27,400
you to the hyperbaric chamber
just to flush out
839
00:36:27,567 --> 00:36:29,300
all that carbon monoxide.
840
00:36:29,467 --> 00:36:32,167
COVID was a scary time,
so you wanted to go in and out
841
00:36:32,334 --> 00:36:33,667
as quickly as you can.
842
00:36:33,834 --> 00:36:39,267
And a lot of people closed
their diagnosis really early on,
843
00:36:39,434 --> 00:36:42,400
thinking that everything that
they saw was COVID-related.
844
00:36:42,567 --> 00:36:44,701
But in reality, there were
other things going on as well.
845
00:36:45,801 --> 00:36:49,000
Congratulations on standing
firm under the onslaught.
846
00:36:49,167 --> 00:36:50,300
You gonna call Dr. Ian?
847
00:36:50,467 --> 00:36:51,801
What, and tell him
"I told you so"?
848
00:36:51,968 --> 00:36:53,267
Absolutely not.
849
00:36:53,434 --> 00:36:55,067
When you're right,
you're right.
850
00:36:55,234 --> 00:36:56,200
Mr. Right?
851
00:36:56,367 --> 00:36:58,667
You must be talking
about Dr. Frankel.
852
00:36:58,834 --> 00:37:00,367
[laughs mockingly]
853
00:37:00,534 --> 00:37:03,868
[Dr. Frankel]
I love being able to solve
the problems for patients
854
00:37:04,033 --> 00:37:05,467
and make their lives better.
855
00:37:05,634 --> 00:37:07,467
I've been doing this
for over 20 years,
856
00:37:07,634 --> 00:37:10,367
and I bounce out of bed
every morning to go to work.
857
00:37:11,868 --> 00:37:14,167
[PA announcement] Code Blue.
858
00:37:16,000 --> 00:37:18,300
[radio comms] Inbound motorcycle
versus guardrail.
859
00:37:18,467 --> 00:37:19,868
[nurse Natalie screams]
860
00:37:20,033 --> 00:37:22,767
Hey, we got this.
Go take a breath.
861
00:37:22,934 --> 00:37:24,667
-All right, what we got?
-Pressure's holding.
862
00:37:24,834 --> 00:37:26,968
-He's steady.
-OK, good.
863
00:37:27,133 --> 00:37:28,868
Now the goal is
to save the foot.
864
00:37:29,033 --> 00:37:30,701
[PA announcement]
Radiology, dial 41.
865
00:37:30,868 --> 00:37:33,367
Three patients,
three different emergencies.
866
00:37:34,567 --> 00:37:38,300
All stable now, but also
all three needed to be
867
00:37:38,467 --> 00:37:40,267
transferred yesterday.
868
00:37:40,434 --> 00:37:41,667
Hey.
869
00:37:41,834 --> 00:37:43,801
Hey, blood pressure's down.
He's calm.
870
00:37:43,968 --> 00:37:45,567
OK, good work.
871
00:37:45,734 --> 00:37:47,767
After one of the darkest nights
of my career...
872
00:37:48,868 --> 00:37:50,000
[nurse Natalie sighs]
873
00:37:50,167 --> 00:37:52,968
...the fog finally lifts.
The lights come back on.
874
00:37:53,133 --> 00:37:54,200
[phone rings]
875
00:37:55,400 --> 00:37:56,467
Dr. Nelson.
876
00:37:57,567 --> 00:37:59,767
Thank God.
Yes.
877
00:37:59,934 --> 00:38:02,000
And we finally get a call
from the transfer center.
878
00:38:02,167 --> 00:38:04,367
Yep, we have three ready to go.
All right.
879
00:38:08,300 --> 00:38:10,601
The medevac helicopters
are on their way.
880
00:38:10,767 --> 00:38:12,267
We are getting
our patients out.
881
00:38:12,434 --> 00:38:15,200
And then here comes rollover,
car accident.
882
00:38:15,367 --> 00:38:17,067
When a car rolls over
going that fast,
883
00:38:17,234 --> 00:38:21,567
you have head trauma,
broken bones, lacerations.
884
00:38:21,734 --> 00:38:26,467
You're getting prepared,
getting in all the proper PPE,
885
00:38:26,634 --> 00:38:29,267
ready to expect a bloody mess.
886
00:38:29,434 --> 00:38:31,467
Hey, I need you guys to triage
as they roll in, OK?
887
00:38:32,868 --> 00:38:34,467
It was like a movie, man.
888
00:38:34,634 --> 00:38:36,601
We just kept
rolling and rolling.
889
00:38:36,767 --> 00:38:38,400
We were very lucky.
890
00:38:38,567 --> 00:38:40,667
Wait, you guys are the family
that rolled over
891
00:38:40,834 --> 00:38:43,667
on the highway?
-Five times.
892
00:38:43,834 --> 00:38:45,801
Doing 60.
Deer jumped out.
893
00:38:45,968 --> 00:38:49,100
-Wow, what were you driving?
-[woman] SUV.
894
00:38:49,267 --> 00:38:51,868
Wow, some fog out there
tonight, huh?
895
00:38:52,033 --> 00:38:54,167
-[sighs] Yeah, sure was.
-[woman] Yeah.
896
00:38:54,334 --> 00:38:57,067
All right, well, let's get
you guys checked out.
897
00:38:57,234 --> 00:38:59,133
-[woman] Thank you.
-[nurse Natalie] I got it.
898
00:39:01,667 --> 00:39:03,000
[Dr. Nelson]
I can't believe my eyes.
899
00:39:03,167 --> 00:39:05,000
Not a scratch on them,
900
00:39:05,167 --> 00:39:06,167
if you can believe that.
901
00:39:09,968 --> 00:39:11,767
-So.
-So.
902
00:39:11,934 --> 00:39:14,267
-Did you notice?
-No fog, no injuries?
903
00:39:15,300 --> 00:39:16,300
Whatever.
904
00:39:19,767 --> 00:39:21,801
You know,
905
00:39:21,968 --> 00:39:23,801
maybe I'm an SUV kind of girl
after all.
906
00:39:33,901 --> 00:39:35,601
[Dr. Carrier]
It looks like it's starting
to work a little bit.
907
00:39:35,767 --> 00:39:36,868
[Lena] Somebody help!
908
00:39:41,601 --> 00:39:42,701
[Dr. Carrier]
Where's cardiology?
909
00:39:42,868 --> 00:39:44,267
[nurse Rose]
They said any minute.
910
00:39:44,434 --> 00:39:46,601
[Dr. Carrier] He's in his 30s.
Turn the machine on.
911
00:39:48,267 --> 00:39:50,100
If he drops again,
we're gonna have to pace him.
912
00:39:50,267 --> 00:39:52,367
OK, it's coming back up.
Oh, good.
913
00:39:53,400 --> 00:39:55,400
This is the EKG,
complete heart block,
914
00:39:55,567 --> 00:39:57,000
multiple syncopal episodes.
915
00:39:57,167 --> 00:39:59,000
He just went into the 30s,
he's back up,
916
00:39:59,167 --> 00:40:00,200
but it's getting worse.
917
00:40:00,367 --> 00:40:01,968
We don't always get
to finish the job.
918
00:40:02,968 --> 00:40:07,000
Sometimes our role is
to recognize the problem,
919
00:40:07,167 --> 00:40:09,367
stabilize the patient,
and buy just enough time
920
00:40:09,534 --> 00:40:11,300
for the next team to take over.
921
00:40:11,467 --> 00:40:13,467
This is our cardiology team.
922
00:40:13,634 --> 00:40:15,567
You're in great hands.
They'll take good care of you.
923
00:40:18,000 --> 00:40:19,968
Sometimes saving a life means
924
00:40:20,133 --> 00:40:21,968
knowing when it's time
to pass the baton.
925
00:40:23,200 --> 00:40:24,634
[indistinct chatter]
926
00:40:27,100 --> 00:40:29,067
-Thank you.
-You're welcome.
927
00:40:29,234 --> 00:40:30,367
And you've got a great partner.
928
00:40:34,000 --> 00:40:35,100
[nurse Rose] He does.
929
00:40:35,267 --> 00:40:36,467
I'm glad Simon had you
with him today.
930
00:40:36,634 --> 00:40:37,567
Thank you.
931
00:40:38,767 --> 00:40:39,901
-Both of you.
-You're welcome.
932
00:40:40,067 --> 00:40:41,767
Thank you.
933
00:40:41,934 --> 00:40:43,567
Medicine is a team sport.
934
00:40:43,734 --> 00:40:46,200
The very best outcomes happen
when everybody does
935
00:40:46,367 --> 00:40:48,367
what's right for the patient.
936
00:40:48,534 --> 00:40:50,868
Luckily, in this case,
that's just what happened,
937
00:40:51,033 --> 00:40:53,367
and this patient got
the life-saving procedure
938
00:40:53,534 --> 00:40:54,834
that he needed.
939
00:40:57,300 --> 00:41:00,267
-Hey, how's he doing?
-Deflated.
940
00:41:00,434 --> 00:41:03,100
-And you?
-Also a little deflated.
941
00:41:03,267 --> 00:41:06,767
And sometimes the job
is giving young doctors
942
00:41:06,934 --> 00:41:08,367
the independence to learn,
943
00:41:09,501 --> 00:41:13,267
but not letting them drive
the bus right into the ditch.
944
00:41:13,434 --> 00:41:14,667
So what'd we learn?
945
00:41:14,834 --> 00:41:16,567
Treat the patient,
not the appearance.
946
00:41:16,734 --> 00:41:18,167
You're starting to get it.
947
00:41:19,467 --> 00:41:20,667
Bam.
948
00:41:22,601 --> 00:41:23,934
OK, what we got next?
949
00:41:26,400 --> 00:41:27,400
-Let's go.
-[nurse] Let's do it.