1 00:00:09,884 --> 00:00:11,928 - Robby. - Yep. 2 00:00:12,012 --> 00:00:14,055 Cellulitis on the dorsum of the foot, 3 00:00:14,139 --> 00:00:16,057 now spreading up the leg. 4 00:00:16,141 --> 00:00:17,267 Hello, I'm Dr. Robby. 5 00:00:17,350 --> 00:00:18,977 Mind if I take a look? 6 00:00:19,060 --> 00:00:21,062 How long do you think this is gonna take? 7 00:00:21,146 --> 00:00:22,647 I took an early lunch break. 8 00:00:23,857 --> 00:00:24,983 I don't know that you're gonna 9 00:00:25,066 --> 00:00:26,860 make it back to work today. 10 00:00:26,943 --> 00:00:28,528 Erythema and warmth halfway up her knee. 11 00:00:28,611 --> 00:00:29,654 When did you see her, Donnie? 12 00:00:29,738 --> 00:00:32,115 He didn't. I did. 13 00:00:32,198 --> 00:00:33,616 - When? - About four hours ago. 14 00:00:33,700 --> 00:00:35,035 Gave her a dose of Keflex, 15 00:00:35,118 --> 00:00:36,578 told her to come back if things got worse. 16 00:00:36,661 --> 00:00:38,538 Things have definitely gotten worse. 17 00:00:38,621 --> 00:00:39,539 Dana, what's open? 18 00:00:39,622 --> 00:00:40,999 Trauma Two. 19 00:00:41,082 --> 00:00:42,500 Jesse, can you get her started in Trauma Two 20 00:00:42,584 --> 00:00:43,793 with some vanco and blood cultures, please? 21 00:00:43,877 --> 00:00:45,253 - Got it, boss. - I'm coming with. 22 00:00:45,336 --> 00:00:47,338 Suit yourself. 23 00:00:47,422 --> 00:00:50,633 Santos, you want in on Trauma Two? 24 00:00:50,717 --> 00:00:53,595 Too much charting, too little time. 25 00:00:53,678 --> 00:00:57,348 62-year-old male presents with chief complaint 26 00:00:57,432 --> 00:00:58,516 of left lower back pain. 27 00:00:58,600 --> 00:00:59,976 - Considered the diagnosis-- - Hey. 28 00:01:00,060 --> 00:01:01,186 Oh, Jesus Christ. 29 00:01:01,269 --> 00:01:02,645 I'm charting. 30 00:01:02,729 --> 00:01:04,147 Sorry. 31 00:01:05,231 --> 00:01:06,733 Did I do something wrong? 32 00:01:06,816 --> 00:01:08,485 Besides interrupting me? Probably. 33 00:01:08,568 --> 00:01:10,111 Then I apologize. 34 00:01:10,195 --> 00:01:13,740 I know that second year of residency can be stressful, 35 00:01:13,823 --> 00:01:16,951 so if there's anything I can do to help you... 36 00:01:17,035 --> 00:01:18,203 like stop talking. 37 00:01:18,286 --> 00:01:20,538 - That's a great idea. - Yeah. 38 00:01:20,622 --> 00:01:24,709 Considered the diagnosis of aortic aneurysm or dissection. 39 00:01:24,793 --> 00:01:26,419 Got a new one for you in 13. 40 00:01:26,503 --> 00:01:29,047 I'm 20 charts behind, and the new attending 41 00:01:29,130 --> 00:01:30,215 is threatening to make me repeat 42 00:01:30,298 --> 00:01:31,341 a year if I can't catch up. 43 00:01:31,424 --> 00:01:32,592 Cry me a river. 44 00:01:32,675 --> 00:01:33,718 Old lady with bad abdominal pain. 45 00:01:33,802 --> 00:01:34,886 Somebody's gotta see her. 46 00:01:34,969 --> 00:01:36,387 Dana, please do me a solid. 47 00:01:36,471 --> 00:01:38,056 Holiday weekend. 48 00:01:38,139 --> 00:01:39,682 Westbridge is down, and our waiting room's on overdrive. 49 00:01:39,766 --> 00:01:41,059 I'm sorry, but your charting's gonna have to wait 50 00:01:41,142 --> 00:01:43,520 until after your shift. 51 00:01:43,603 --> 00:01:44,979 Ogilvie. 52 00:01:45,063 --> 00:01:48,858 Dr. Santos needs you to pick up a new patient in 13. 53 00:01:48,942 --> 00:01:52,737 Y-yes, ma'am. I'm on it. 54 00:01:52,821 --> 00:01:54,030 Chart while you supervise. 55 00:01:54,114 --> 00:01:55,824 Best I can do. 56 00:01:58,952 --> 00:02:01,830 Setting up a GoFundMe, that's what her generation does. 57 00:02:01,913 --> 00:02:03,706 That's how they support each other. 58 00:02:03,790 --> 00:02:04,791 Doctor, tell him. 59 00:02:04,874 --> 00:02:06,376 Your wife's right. 60 00:02:06,459 --> 00:02:08,711 Staying here's gonna cost more than we can afford. 61 00:02:08,795 --> 00:02:10,588 Look, I'm feeling better. 62 00:02:10,672 --> 00:02:12,132 I'll just leave. 63 00:02:12,215 --> 00:02:15,093 Mr. Diaz, even if your blood sugar is back to normal, 64 00:02:15,176 --> 00:02:17,053 we have to continue with the insulin drip 65 00:02:17,137 --> 00:02:18,972 until we clear the ketones from your bloodstream. 66 00:02:19,055 --> 00:02:21,516 Otherwise, you could experience electrolyte disorders, 67 00:02:21,599 --> 00:02:22,851 heart and kidney problems-- 68 00:02:22,934 --> 00:02:26,396 Mi amor, your health is what matters. 69 00:02:26,479 --> 00:02:27,856 I'll make you a deal. 70 00:02:27,939 --> 00:02:29,691 You agree to stay on the insulin drip, 71 00:02:29,774 --> 00:02:31,192 and I'll go find our case manager 72 00:02:31,276 --> 00:02:33,111 to discuss cost-cutting options for your stay. 73 00:02:33,194 --> 00:02:34,487 Deal. 74 00:02:34,571 --> 00:02:36,739 And I'm sitting here making sure he doesn't move. 75 00:02:36,823 --> 00:02:38,867 - You should go look for Ana. - Mm-hmm. 76 00:02:38,950 --> 00:02:39,951 I can find her. 77 00:02:40,034 --> 00:02:41,619 BRB. 78 00:02:43,788 --> 00:02:44,914 Hanging vanco. 79 00:02:44,998 --> 00:02:46,457 What's vanco? 80 00:02:46,541 --> 00:02:48,960 A really strong antibiotic to kill skin germs. 81 00:02:49,043 --> 00:02:51,504 - Need a hand? - No. We got this. 82 00:02:51,588 --> 00:02:53,339 I'll just observe. 83 00:02:53,423 --> 00:02:54,799 Pretend I'm not even here. 84 00:02:54,883 --> 00:02:58,261 Let's send off a CBC, blood cultures, and CMP. 85 00:02:58,344 --> 00:03:01,306 And also a lactic acid, CRP, and calcitonin. 86 00:03:01,389 --> 00:03:03,391 Wait, she's not febrile, not tachycardic. 87 00:03:03,474 --> 00:03:05,018 No evidence of SIRS. 88 00:03:05,101 --> 00:03:06,978 - Yet. - What's SIRS? 89 00:03:07,061 --> 00:03:10,732 Systemic inflammatory response syndrome. 90 00:03:10,815 --> 00:03:11,774 Sorry. 91 00:03:11,858 --> 00:03:13,443 An exaggerated defense response. 92 00:03:13,526 --> 00:03:14,777 A what? 93 00:03:14,861 --> 00:03:16,863 Sometimes the human body can have an overreaction 94 00:03:16,946 --> 00:03:18,781 to an infection, so we're gonna monitor you 95 00:03:18,865 --> 00:03:20,408 to make sure that this does not progress. 96 00:03:23,244 --> 00:03:24,621 It's my boss. 97 00:03:24,704 --> 00:03:26,623 Sorry, I have to take this, or he's gonna fire me. 98 00:03:26,706 --> 00:03:28,708 OK. 99 00:03:28,791 --> 00:03:30,251 Hello. 100 00:03:30,335 --> 00:03:33,880 No, I'm still at the hospital. 101 00:03:33,963 --> 00:03:35,381 Being seen right now. 102 00:03:35,465 --> 00:03:36,674 Ow. 103 00:03:36,758 --> 00:03:39,844 No, they just stuck me with a needle. 104 00:03:39,928 --> 00:03:41,554 I don't know. 105 00:03:41,638 --> 00:03:43,973 You wanna talk to them? 106 00:03:44,057 --> 00:03:47,018 They're kind of busy right now. 107 00:03:47,101 --> 00:03:48,478 I know you are. 108 00:03:48,561 --> 00:03:49,938 Second IV's in. 109 00:03:50,021 --> 00:03:51,648 No, I'm not overreacting. 110 00:03:51,731 --> 00:03:53,983 My body's overreacting. 111 00:03:54,067 --> 00:03:55,985 Please--please don't fire me. 112 00:03:56,069 --> 00:03:57,278 I-- 113 00:03:57,362 --> 00:03:58,738 This is Dr. Michael Robinavitch. 114 00:03:58,821 --> 00:04:00,782 I am the chief of emergency medicine at PTMC. 115 00:04:00,865 --> 00:04:02,742 If you fire her, she will sue you, 116 00:04:02,825 --> 00:04:05,745 and I will testify on her behalf. 117 00:04:05,828 --> 00:04:08,039 OK. 118 00:04:08,122 --> 00:04:09,999 Don't worry about it. We got you. 119 00:04:14,879 --> 00:04:16,756 Do you know how long Jackson's gonna be asleep? 120 00:04:16,839 --> 00:04:20,009 So there's no exact timeline with the sedatives we gave him, 121 00:04:20,093 --> 00:04:21,719 but he should be awake soon. 122 00:04:21,803 --> 00:04:23,388 Have you spoken to your parents yet? 123 00:04:23,471 --> 00:04:25,014 Yeah, they're on their way back from Columbus. 124 00:04:25,098 --> 00:04:27,475 Maybe you should take some time for yourself 125 00:04:27,558 --> 00:04:28,893 before they arrive. 126 00:04:28,977 --> 00:04:30,561 Yeah, cafeteria's right down the hall. 127 00:04:30,645 --> 00:04:31,604 Decent grilled cheese. 128 00:04:31,688 --> 00:04:32,730 Stay away from the tuna. 129 00:04:32,814 --> 00:04:34,774 Thanks, but I'm not hungry. 130 00:04:34,857 --> 00:04:37,485 You know, I just can't believe that a campus security guard 131 00:04:37,568 --> 00:04:38,945 tased my brother. 132 00:04:39,028 --> 00:04:40,446 Aren't they supposed to be helping students 133 00:04:40,530 --> 00:04:42,532 and protect them, not shoot at them? 134 00:04:42,615 --> 00:04:44,242 You have every right to be upset, 135 00:04:44,325 --> 00:04:46,911 and you should absolutely pursue accountability. 136 00:04:46,995 --> 00:04:49,205 But right now, we are taking care of your brother. 137 00:04:49,289 --> 00:04:52,041 And you should really take care of yourself. 138 00:04:52,125 --> 00:04:53,626 I--I have your number. 139 00:04:53,710 --> 00:04:56,004 I'll text you as soon as Jackson's LP results get back 140 00:04:56,087 --> 00:04:58,214 or if he wakes up. 141 00:04:58,298 --> 00:04:59,924 OK. 142 00:05:00,008 --> 00:05:01,259 OK, thank you. 143 00:05:01,342 --> 00:05:02,427 Of course. 144 00:05:02,510 --> 00:05:05,596 - Oh. - OK. 145 00:05:05,680 --> 00:05:07,223 Hypoactive bowel sounds. 146 00:05:07,307 --> 00:05:10,101 Soft, with moderate tenderness in the left lower quadrant. 147 00:05:10,184 --> 00:05:13,354 Mrs. Randolph, do you take Percocet every day? 148 00:05:13,438 --> 00:05:15,273 - No. - Huh. 149 00:05:15,356 --> 00:05:16,733 And what about your water intake, 'cause-- 150 00:05:16,816 --> 00:05:18,276 Pause. 151 00:05:18,359 --> 00:05:20,445 Mrs. Randolph, you said you don't take Percocet every day, 152 00:05:20,528 --> 00:05:22,447 but when was the last time you took some? 153 00:05:22,530 --> 00:05:25,742 Maybe three or four times last week. 154 00:05:25,825 --> 00:05:29,370 Assisted living had a ballroom dance competition, 155 00:05:29,454 --> 00:05:31,581 - and I tweaked my back. - Mm. 156 00:05:31,664 --> 00:05:35,668 Any further questions, Ogilvie? 157 00:05:35,752 --> 00:05:39,380 When was your last bowel movement? 158 00:05:39,464 --> 00:05:41,883 I don't know. Sometime last week. 159 00:05:41,966 --> 00:05:44,886 I've been stopped up for at least five or six days. 160 00:05:44,969 --> 00:05:48,348 Mm-hmm, painkillers can cause constipation. 161 00:05:48,431 --> 00:05:49,640 I know. 162 00:05:49,724 --> 00:05:52,185 That's why they put me on a stool softener, 163 00:05:52,268 --> 00:05:53,519 and then they tried an enema. 164 00:05:53,603 --> 00:05:55,563 - And--and no movements? - Yep. 165 00:05:55,646 --> 00:05:58,858 And then they gave me this horrible drink. 166 00:05:58,941 --> 00:06:00,485 Mag citrate. 167 00:06:00,568 --> 00:06:01,527 Yeah. 168 00:06:01,611 --> 00:06:03,863 Mag citrate. 169 00:06:03,946 --> 00:06:05,156 Made me puke. 170 00:06:05,239 --> 00:06:07,367 All right, what's next, Ogilvie? 171 00:06:07,450 --> 00:06:09,410 Let's get you an X-ray and see how we can help you, 172 00:06:09,494 --> 00:06:10,411 Mrs. Randolph. 173 00:06:10,495 --> 00:06:12,288 - Thank you. - Yeah. 174 00:06:12,372 --> 00:06:14,457 Differential? 175 00:06:14,540 --> 00:06:16,125 Probable stool impaction. 176 00:06:16,209 --> 00:06:17,710 But with her history of cholecystectomy, 177 00:06:17,794 --> 00:06:19,462 it could be small bowel obstruction. 178 00:06:19,545 --> 00:06:20,588 Or worse. 179 00:06:20,671 --> 00:06:22,840 Sigmoid volvulus? 180 00:06:22,924 --> 00:06:25,218 But that's a surgical emergency. 181 00:06:25,301 --> 00:06:26,761 Wouldn't she have tons of pain? 182 00:06:26,844 --> 00:06:30,306 Not always, especially when you're in your 80s. 183 00:06:35,937 --> 00:06:37,480 I am getting concerned. 184 00:06:37,563 --> 00:06:40,066 This is a millimeter past the line. 185 00:06:40,149 --> 00:06:41,442 Or my line was sloppy. 186 00:06:41,526 --> 00:06:42,985 - Any increase in pain? - Oh. 187 00:06:43,069 --> 00:06:45,571 OK, sorry. Let's try four morphine. 188 00:06:45,655 --> 00:06:46,906 White count's only 10,000. 189 00:06:46,989 --> 00:06:48,950 It'd be over 12,000 for SIRS. 190 00:06:49,033 --> 00:06:50,743 There are other criteria. 191 00:06:50,827 --> 00:06:52,203 Still afebrile. 192 00:06:52,286 --> 00:06:53,788 Did you ask about past history of MRSA? 193 00:06:53,871 --> 00:06:55,581 Not specifically, but she's never been hospitalized. 194 00:06:55,665 --> 00:06:57,083 Any evidence of an immunocompromised state? 195 00:06:57,166 --> 00:06:58,334 - No, she's healthy. - Steroid use? 196 00:06:58,418 --> 00:06:59,335 Never. 197 00:06:59,419 --> 00:07:00,878 Maximum heart rate's only 89. 198 00:07:00,962 --> 00:07:02,046 Is that OK? 199 00:07:02,130 --> 00:07:04,132 That's good, very good. 200 00:07:04,215 --> 00:07:05,133 Stay with her. 201 00:07:05,216 --> 00:07:06,717 Monitor her closely. 202 00:07:06,801 --> 00:07:08,553 If there's any change in her condition, come find me. 203 00:07:08,636 --> 00:07:09,762 I mean any change. 204 00:07:12,890 --> 00:07:15,476 Roxie Hamler, 42, home hospice patient 205 00:07:15,560 --> 00:07:17,061 with a history of lung cancer. 206 00:07:17,145 --> 00:07:20,273 New-onset tonic-clonic seizure with right lower leg pain. 207 00:07:20,356 --> 00:07:22,400 She hit it on the coffee table. 208 00:07:24,110 --> 00:07:25,862 Initially nonverbal, now coming around. 209 00:07:25,945 --> 00:07:27,363 That's normal after a seizure. 210 00:07:27,447 --> 00:07:28,948 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 211 00:07:29,031 --> 00:07:30,741 - Nope, we got it. - She hit her head? 212 00:07:30,825 --> 00:07:31,909 No. I was there. 213 00:07:31,993 --> 00:07:33,536 - I caught her. - No IV? 214 00:07:33,619 --> 00:07:34,829 Couldn't get one in. 215 00:07:34,912 --> 00:07:36,330 Gave her four of IM versed for the seizure, 216 00:07:36,414 --> 00:07:37,874 - 25 of fent for the pain. - OK. 217 00:07:37,957 --> 00:07:39,750 - Dana, where to? - Trauma One. 218 00:07:39,834 --> 00:07:41,002 This way. 219 00:07:41,085 --> 00:07:43,337 Haven't seen you guys in a hot minute. 220 00:07:43,421 --> 00:07:45,923 Pickup from SCI Jones Forge. 221 00:07:46,007 --> 00:07:47,425 Was supposed to go to Westbridge but got 222 00:07:47,508 --> 00:07:48,426 diverted to you. 223 00:07:48,509 --> 00:07:49,844 Yeah, you and everybody else. 224 00:07:49,927 --> 00:07:51,387 Princess, I need you pivot to Central 9. 225 00:07:51,471 --> 00:07:52,722 Got it. 226 00:07:52,805 --> 00:07:54,432 Gus Varney, 54, victim of assault 227 00:07:54,515 --> 00:07:55,808 with diffuse blunt trauma. 228 00:07:55,892 --> 00:07:57,810 He's got bruising to the face, the right chest, 229 00:07:57,894 --> 00:07:59,479 10-centimeter laceration to the left arm. 230 00:07:59,562 --> 00:08:01,063 BP's 136 over 84, pulse 102, 231 00:08:01,147 --> 00:08:03,816 good sats, 95 on room air. 232 00:08:03,900 --> 00:08:05,526 How you feeling there, Mr. Varney? 233 00:08:05,610 --> 00:08:07,028 - Fucking hurts. - Where? 234 00:08:07,111 --> 00:08:09,363 - Everywhere. - I am Dr. Robby. 235 00:08:09,447 --> 00:08:10,656 This is Dr. Al-Hashimi. 236 00:08:10,740 --> 00:08:12,116 We'll get you something for the pain. 237 00:08:12,200 --> 00:08:13,659 I've got a progressing cellulitis in Trauma Two. 238 00:08:13,743 --> 00:08:15,286 - Go. I'm good. - Thank you. 239 00:08:15,369 --> 00:08:17,330 Gus, do you know who hurt you? 240 00:08:17,413 --> 00:08:19,999 One of the fine, upstanding citizens of cell block 6. 241 00:08:20,082 --> 00:08:22,919 It's a deep lac through the muscle fascia. 242 00:08:23,002 --> 00:08:24,462 Can we get the cuffs off once he settles? 243 00:08:24,545 --> 00:08:25,630 Not a chance. 244 00:08:25,713 --> 00:08:27,590 Orange jumpsuit. He's cuffed for a reason. 245 00:08:27,673 --> 00:08:29,717 Let's go. 246 00:08:40,102 --> 00:08:43,564 OK, everyone, on my count. 247 00:08:43,648 --> 00:08:45,191 1, 2-- 248 00:08:45,274 --> 00:08:46,734 Hold on. 249 00:08:50,363 --> 00:08:53,866 - Go. - 1, 2, 3. 250 00:08:53,950 --> 00:08:55,368 Mel, E-FAST. 251 00:08:55,451 --> 00:08:56,953 Whitaker, primary assessment. 252 00:08:57,036 --> 00:08:58,246 On it. 253 00:09:03,376 --> 00:09:04,502 Oh, weird bruise. 254 00:09:04,585 --> 00:09:05,795 Did he fall on something? 255 00:09:05,878 --> 00:09:07,296 Footprint, got stomped. 256 00:09:07,380 --> 00:09:09,298 Jesus. 257 00:09:10,591 --> 00:09:12,218 Is it--is that necessary? 258 00:09:12,301 --> 00:09:14,387 Afraid so. 259 00:09:14,470 --> 00:09:17,014 Airway's patent. 260 00:09:17,098 --> 00:09:19,767 Good lung sliding on the left. 261 00:09:19,850 --> 00:09:20,977 Sorry. 262 00:09:21,060 --> 00:09:22,270 Good on the right, too. 263 00:09:22,353 --> 00:09:23,646 How are the lungs? 264 00:09:23,729 --> 00:09:24,772 Good breath sounds. 265 00:09:24,855 --> 00:09:27,525 - No crepitus. - No effusion. 266 00:09:27,608 --> 00:09:30,820 Pulse ox 97, BP 118 over 78, heart rate 112. 267 00:09:30,903 --> 00:09:32,196 Tachycardic from the pain. 268 00:09:32,280 --> 00:09:33,739 Start with four of morphine. Repeat prn. 269 00:09:33,823 --> 00:09:34,740 On it. 270 00:09:34,824 --> 00:09:36,867 OK. Swollen mandible. 271 00:09:36,951 --> 00:09:38,286 Open your mouth for me, Gus. 272 00:09:38,369 --> 00:09:40,121 Little wider. 273 00:09:40,204 --> 00:09:41,372 Can't. 274 00:09:41,455 --> 00:09:42,748 Whitaker, you know the tongue blade exam? 275 00:09:42,832 --> 00:09:44,208 Yeah. 276 00:09:44,292 --> 00:09:45,668 It's a great test for mandible fracture. 277 00:09:45,751 --> 00:09:48,879 Gus, bite down hard on this for me. 278 00:09:51,173 --> 00:09:52,466 Sorry, Gus. 279 00:09:52,550 --> 00:09:54,594 Positive test. 280 00:09:54,677 --> 00:09:56,137 No free fluid in the belly. 281 00:09:56,220 --> 00:09:57,138 Any idea how long this will take? 282 00:09:57,221 --> 00:09:58,514 Too soon to tell. 283 00:09:58,598 --> 00:09:59,599 Whitaker, your assessment? 284 00:09:59,682 --> 00:10:01,017 Fractured left mandible, 285 00:10:01,100 --> 00:10:03,185 multiple rib fractures. 286 00:10:03,269 --> 00:10:04,687 Complex forearm lac. 287 00:10:04,770 --> 00:10:06,689 OK, log roll to the left, then pan scan. 288 00:10:06,772 --> 00:10:08,649 Where were you when Mr. Varney got assaulted? 289 00:10:08,733 --> 00:10:10,234 I just move 'em. I don't get to know 'em. 290 00:10:10,318 --> 00:10:11,986 CT's ready for us. 291 00:10:12,069 --> 00:10:13,821 Cycling the BP. 292 00:10:13,904 --> 00:10:16,490 OK, this redness is now a centimeter over that line, 293 00:10:16,574 --> 00:10:17,992 and this might be a bulla forming. 294 00:10:18,075 --> 00:10:19,285 The vanco takes a little time to work. 295 00:10:19,368 --> 00:10:22,830 Vital signs are still stable, 122 over 78. 296 00:10:22,913 --> 00:10:23,914 I got it. 297 00:10:23,998 --> 00:10:26,917 How are you feeling, Debbie? 298 00:10:27,001 --> 00:10:28,586 I'm feeling a little warm. 299 00:10:28,669 --> 00:10:30,004 That can happen with vanco. 300 00:10:30,087 --> 00:10:31,964 Thanks, man. 301 00:10:32,048 --> 00:10:35,009 Lactic acid 4.2. 302 00:10:35,092 --> 00:10:36,802 - OK. - What's wrong? 303 00:10:36,886 --> 00:10:39,513 That can be a sign of a more serious infection, 304 00:10:39,597 --> 00:10:41,140 but the good news is, we know what to do. 305 00:10:41,223 --> 00:10:44,852 Jesse, 2 liters of LR wide open. 306 00:10:44,935 --> 00:10:46,312 This is severe sepsis. 307 00:10:46,395 --> 00:10:47,938 I know, but at 7:00 AM, it was a simple cellulitis. 308 00:10:48,022 --> 00:10:49,565 Anyone would have given her Keflex. 309 00:10:49,649 --> 00:10:51,567 We could add carbapenem or Zosyn to broaden 310 00:10:51,651 --> 00:10:52,610 our antibiotic coverage. 311 00:10:52,693 --> 00:10:53,778 OK, I got it. 312 00:10:53,861 --> 00:10:55,196 Thanks. 313 00:10:55,279 --> 00:10:58,199 Jesse, 1 gram meropenem, 900 milligrams clinda, 314 00:10:58,282 --> 00:11:00,242 and page Dr. Garcia, please. 315 00:11:00,326 --> 00:11:01,661 What's going on? 316 00:11:01,744 --> 00:11:03,120 We're adding new antibiotics. 317 00:11:03,204 --> 00:11:04,538 It's serious? 318 00:11:04,622 --> 00:11:05,748 We wanna get ahead of it and make sure 319 00:11:05,831 --> 00:11:07,625 it doesn't become serious. 320 00:11:09,293 --> 00:11:10,294 What else can I do? 321 00:11:10,378 --> 00:11:11,462 I think you've done enough. 322 00:11:11,545 --> 00:11:12,672 You can go. 323 00:11:16,425 --> 00:11:17,343 All good in there? 324 00:11:17,426 --> 00:11:18,469 Code sepsis. 325 00:11:18,552 --> 00:11:19,804 Stable for the moment. 326 00:11:19,887 --> 00:11:21,097 How about you? 327 00:11:21,180 --> 00:11:23,474 Perfect vitals, E-FAST negative, off to CT. 328 00:11:23,557 --> 00:11:24,684 Good. 329 00:11:24,767 --> 00:11:26,268 Keep me posted. 330 00:11:26,352 --> 00:11:27,645 Ditto. 331 00:11:31,273 --> 00:11:32,608 How's it going? 332 00:11:32,692 --> 00:11:34,610 Great, if you ignore the hot mess in chairs. 333 00:11:34,694 --> 00:11:36,529 Any update on our little baby Jane Doe? 334 00:11:36,612 --> 00:11:38,531 Security's reviewing the CCTV from last night 335 00:11:38,614 --> 00:11:39,824 and this morning. 336 00:11:42,201 --> 00:11:43,577 You two kiss and make up yet? 337 00:11:43,661 --> 00:11:45,162 I think someone needs to smoke a cigarette. 338 00:11:45,246 --> 00:11:46,580 I'm trying to quit. 339 00:11:46,664 --> 00:11:48,124 Why don't you quit when I'm on my trip? 340 00:11:48,207 --> 00:11:49,375 Everyone's glad to have you back. 341 00:11:49,458 --> 00:11:51,919 - Asshole. - Well, not everyone. 342 00:11:53,421 --> 00:11:55,798 Hey, you want in on this betting board? 343 00:11:55,881 --> 00:11:58,759 Look, all you gotta do is pick why Westbridge went down, 344 00:11:58,843 --> 00:12:00,386 how many of their patients we're gonna get, 345 00:12:00,469 --> 00:12:02,012 and when they'll be back in action. 346 00:12:02,096 --> 00:12:04,765 Hey, already up to $500. 347 00:12:04,849 --> 00:12:07,101 Oh, ah, gotta pass. 348 00:12:07,184 --> 00:12:09,270 Still catching up on rehab bills. 349 00:12:09,353 --> 00:12:11,814 Respect. 350 00:12:13,399 --> 00:12:14,483 All right. 351 00:12:14,567 --> 00:12:16,193 What's the rules on me changing my bet? 352 00:12:16,277 --> 00:12:18,404 Only if you double down. 353 00:12:20,531 --> 00:12:21,907 Sinkhole. 354 00:12:24,577 --> 00:12:27,997 You watch too many movies, man. 355 00:12:28,080 --> 00:12:31,083 Considered the diagnosis of aortic aneurysm 356 00:12:31,167 --> 00:12:33,335 or dissection, but the point-of-care ultrasound was-- 357 00:12:33,419 --> 00:12:35,921 You done want that gridlocked granny? 358 00:12:36,005 --> 00:12:37,840 Ordered an acute abdominal series 359 00:12:37,923 --> 00:12:39,091 to rule out obstruction. 360 00:12:39,175 --> 00:12:40,342 - Still waiting on the X-rays. - Great. 361 00:12:40,426 --> 00:12:41,469 Then you're free to treat our latest 362 00:12:41,552 --> 00:12:42,678 and greatest in South 16. 363 00:12:42,762 --> 00:12:45,473 Oh, come on, D, it's like, every time 364 00:12:45,556 --> 00:12:47,057 I get a moment to chart, I barely get 365 00:12:47,141 --> 00:12:49,769 - a sentence out before I get-- - Interrupted? 366 00:12:49,852 --> 00:12:51,812 Sucks to be you, but trust me, it sucks worse 367 00:12:51,896 --> 00:12:53,731 for the poor gal in 16. 368 00:12:53,814 --> 00:12:56,484 I'm beginning to think you enjoy torturing me. 369 00:12:56,567 --> 00:12:58,611 Perks of the job. 370 00:12:58,694 --> 00:12:59,987 Ogilvie, let's go. 371 00:13:03,616 --> 00:13:06,327 Hold out your hand, Louie. 372 00:13:07,286 --> 00:13:08,913 A little shaky. 373 00:13:08,996 --> 00:13:09,914 No surprise. 374 00:13:09,997 --> 00:13:12,082 I've been here since 4:00 AM. 375 00:13:12,166 --> 00:13:13,459 We can get you something for that. 376 00:13:13,542 --> 00:13:14,794 Or I can take care of it myself 377 00:13:14,877 --> 00:13:16,921 if you cut me loose right now. 378 00:13:17,004 --> 00:13:19,089 Let's get Louie 50 milligrams of Librium. 379 00:13:19,173 --> 00:13:20,716 I'll put in the order. 380 00:13:22,843 --> 00:13:25,596 I will get it from the PDS. 381 00:13:29,141 --> 00:13:31,644 I'm already assigned as Louie's treating physician. 382 00:13:31,727 --> 00:13:34,063 Just makes sense that I put it in. 383 00:13:34,146 --> 00:13:36,232 Yeah. Yeah, yeah. Of course. 384 00:13:41,362 --> 00:13:43,781 Any changes with our septic waitress? 385 00:13:43,864 --> 00:13:44,907 Not yet. 386 00:13:44,990 --> 00:13:45,991 Wait, if you have a second, I-- 387 00:13:46,075 --> 00:13:47,159 I don't. 388 00:13:47,243 --> 00:13:48,577 But the point-of-care ultrasound 389 00:13:48,661 --> 00:13:49,995 was negative for both. 390 00:13:50,079 --> 00:13:52,414 I considered the diagnosis of cauda equina syndrome. 391 00:13:52,498 --> 00:13:55,543 You writing the great American novel? 392 00:13:55,626 --> 00:13:57,503 Charting and supervising. 393 00:13:57,586 --> 00:13:58,546 It's Dana's idea. 394 00:13:58,629 --> 00:14:00,089 Who's the lucky patient? 395 00:14:00,172 --> 00:14:01,966 Unhoused woman with a bad cough. 396 00:14:02,049 --> 00:14:03,759 Ogilvie's all over it. 397 00:14:03,843 --> 00:14:05,135 OK. 398 00:14:05,219 --> 00:14:06,679 Say "eee." 399 00:14:06,762 --> 00:14:08,430 Eee. 400 00:14:08,514 --> 00:14:10,182 OK, deep breath in. 401 00:14:10,266 --> 00:14:12,101 Blow it out real hard. 402 00:14:12,184 --> 00:14:13,853 You haven't heard enough already? 403 00:14:13,936 --> 00:14:17,898 I need to check for wheezing with forced exhalation. 404 00:14:21,151 --> 00:14:23,028 Fucking cough is killing me. 405 00:14:23,112 --> 00:14:24,613 You smoke, Mrs. Yardley? 406 00:14:24,697 --> 00:14:26,824 Yeah, but I haven't been able to 407 00:14:26,907 --> 00:14:28,242 for a couple days 'cause of this cough. 408 00:14:28,325 --> 00:14:30,494 Mm. You ever consider quitting? 409 00:14:30,578 --> 00:14:33,998 You ever considered minding your own business? 410 00:14:37,918 --> 00:14:40,087 Well, the good news is that your test from earlier 411 00:14:40,170 --> 00:14:42,298 came back negative for both COVID and influenza, 412 00:14:42,381 --> 00:14:43,966 but I'm gonna order a chest X-ray 413 00:14:44,049 --> 00:14:45,509 so that we can see what's really going on in those lungs. 414 00:14:45,593 --> 00:14:47,511 You got time to let us do that? 415 00:14:48,804 --> 00:14:51,682 Where the fuck else you think I gotta be? 416 00:14:51,765 --> 00:14:53,475 And we're in. 417 00:14:53,559 --> 00:14:55,144 3 grams Keppra over 10 minutes. 418 00:14:55,227 --> 00:14:56,854 That'll prevent another seizure. 419 00:14:56,937 --> 00:14:57,938 Thank you. 420 00:14:58,022 --> 00:14:59,857 Nobody can ever get an IV in her. 421 00:14:59,940 --> 00:15:01,817 Yeah, midline cath is the way to go 422 00:15:01,901 --> 00:15:03,444 when your veins are shot. 423 00:15:03,527 --> 00:15:08,032 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 424 00:15:08,115 --> 00:15:10,743 - OK. - Cold. 425 00:15:10,826 --> 00:15:14,204 Is it possible to get her a blanket and some socks? 426 00:15:14,288 --> 00:15:15,956 Can do. 427 00:15:16,040 --> 00:15:18,500 When was she diagnosed? 428 00:15:18,584 --> 00:15:20,461 Seven years ago. 429 00:15:20,544 --> 00:15:23,047 Resected a lobe. 430 00:15:23,130 --> 00:15:25,591 Four cycles of platinum chemo gave us a couple good years, 431 00:15:25,674 --> 00:15:28,052 but then it spread to the bones. 432 00:15:28,135 --> 00:15:30,262 Has she had radiation therapy? 433 00:15:30,346 --> 00:15:32,723 Shrunk down the mets, but they're still there. 434 00:15:32,806 --> 00:15:34,683 That's why you're at hospice at home. 435 00:15:34,767 --> 00:15:35,684 Yep. 436 00:15:35,768 --> 00:15:37,728 I'm sorry. 437 00:15:37,811 --> 00:15:39,021 Me too. 438 00:15:39,104 --> 00:15:41,607 Ah. 439 00:15:41,690 --> 00:15:42,733 Sorry. 440 00:15:42,816 --> 00:15:44,276 You have kids? 441 00:15:44,360 --> 00:15:46,737 Yeah, two boys. 442 00:15:46,820 --> 00:15:48,822 15 and 9. 443 00:15:48,906 --> 00:15:50,407 My son's 12. 444 00:15:50,491 --> 00:15:52,618 Goes fast. 445 00:15:52,701 --> 00:15:54,453 Too fast. 446 00:15:54,536 --> 00:15:59,083 Swelling and bruising over the distal tibia. 447 00:15:59,166 --> 00:16:01,710 50 of fentanyl once her systolic's over 100. 448 00:16:01,794 --> 00:16:04,338 What do you usually take for pain? 449 00:16:07,341 --> 00:16:10,469 MS Contin, 30 milligrams twice a day, 450 00:16:10,552 --> 00:16:12,888 oxycodone for breakthrough, and sublingual Actiq 451 00:16:12,972 --> 00:16:16,684 for when it gets really bad. 452 00:16:16,767 --> 00:16:17,851 That's a lot. 453 00:16:17,935 --> 00:16:19,645 You handle her pain meds? 454 00:16:19,728 --> 00:16:20,729 Sometimes. 455 00:16:20,813 --> 00:16:22,606 All the time. 456 00:16:22,690 --> 00:16:25,484 A hospice nurse comes by a few times a week, 457 00:16:25,567 --> 00:16:27,861 but I was alone when she had the seizure. 458 00:16:27,945 --> 00:16:29,822 They told us that it could happen, 459 00:16:29,905 --> 00:16:31,407 but she couldn't breathe. 460 00:16:31,490 --> 00:16:35,869 And I freaked out, and I called 911. 461 00:16:35,953 --> 00:16:38,163 I'm so sorry. 462 00:16:38,247 --> 00:16:40,082 I'm sorry. 463 00:16:40,165 --> 00:16:42,001 I'm sorry. 464 00:16:51,677 --> 00:16:54,763 Due to your family income, you make too much 465 00:16:54,847 --> 00:16:56,640 to be eligible for either PENNIE 466 00:16:56,724 --> 00:16:59,059 or the hospital's "charity care." 467 00:16:59,143 --> 00:17:01,186 But we can't afford health-care premiums. 468 00:17:01,270 --> 00:17:03,981 It's unfortunately very common for people 469 00:17:04,064 --> 00:17:05,274 to fall between the cracks. 470 00:17:05,357 --> 00:17:07,401 It's an imperfect system. 471 00:17:07,484 --> 00:17:09,570 Can PTMC help with the costs in any way? 472 00:17:09,653 --> 00:17:12,031 We can offer financial assistance. 473 00:17:12,114 --> 00:17:13,866 You'd pay the same that Medicare 474 00:17:13,949 --> 00:17:15,492 and Medicaid would pay. 475 00:17:15,576 --> 00:17:16,618 How much is that? 476 00:17:16,702 --> 00:17:20,539 You pay 60%, we cover 40%. 477 00:17:20,622 --> 00:17:21,915 Thank you. 478 00:17:21,999 --> 00:17:23,834 Uh-huh. 479 00:17:25,044 --> 00:17:27,046 Where have you been? 480 00:17:27,129 --> 00:17:29,548 - How are you doing? - I'm sorry, mijita. 481 00:17:29,631 --> 00:17:32,634 You were being thoughtful, and I just blew up. 482 00:17:32,718 --> 00:17:35,554 Well, Ms. Noelle was just telling us that the hospital 483 00:17:35,637 --> 00:17:37,264 is gonna give us a big discount. 484 00:17:37,347 --> 00:17:39,933 We can knock 40% off your final bill. 485 00:17:40,017 --> 00:17:41,894 - That's great. - Mm-hmm. 486 00:17:41,977 --> 00:17:43,771 I stay here for a few days, 487 00:17:43,854 --> 00:17:46,065 my bill could be over $100,000, right? 488 00:17:47,775 --> 00:17:49,443 Yes, unfortunately. 489 00:17:49,526 --> 00:17:51,528 It could end up being lower, 490 00:17:51,612 --> 00:17:53,947 depending on your level of needed care. 491 00:17:54,031 --> 00:17:55,949 Or higher? 492 00:17:56,033 --> 00:17:59,912 So we would still have to pay $60,000? 493 00:17:59,995 --> 00:18:01,455 Which we don't have. 494 00:18:01,538 --> 00:18:03,665 He has to stay here to get better, right? 495 00:18:03,749 --> 00:18:06,043 - Yes. - No. 496 00:18:06,126 --> 00:18:07,294 Excuse me? 497 00:18:07,377 --> 00:18:09,505 I mean, not necessarily. 498 00:18:09,588 --> 00:18:12,174 Couldn't we just admit him to med-surg instead of ICU? 499 00:18:12,257 --> 00:18:14,009 Wouldn't that be a lot cheaper? 500 00:18:14,093 --> 00:18:16,136 Med-surg won't accept him with an insulin drip. 501 00:18:16,220 --> 00:18:17,930 Usually true. 502 00:18:18,013 --> 00:18:21,600 But let me talk to the charge nurse upstairs, and I'll-- 503 00:18:21,683 --> 00:18:22,768 I'll see what she says. 504 00:18:22,851 --> 00:18:24,311 Thank you. 505 00:18:26,313 --> 00:18:28,273 Food poisoning in the hall's asking to leave, 506 00:18:28,357 --> 00:18:30,317 wants to take her kids to the water park. 507 00:18:30,400 --> 00:18:32,861 Those places are cesspools. 508 00:18:32,945 --> 00:18:34,363 Preaching to the choir. 509 00:18:34,446 --> 00:18:35,989 If she's feeling fine on Zofran, she's good to go. 510 00:18:36,073 --> 00:18:37,449 All right. 511 00:18:37,533 --> 00:18:39,368 Louie's in South 15. Meds are coming down. 512 00:18:39,451 --> 00:18:41,370 Another couple hours of monitoring, and he can broom. 513 00:18:41,453 --> 00:18:42,663 Straight to the liquor store. 514 00:18:42,746 --> 00:18:43,789 Don't pass "go." 515 00:18:43,872 --> 00:18:44,790 What about that clamshell case 516 00:18:44,873 --> 00:18:46,250 that went up--anything? 517 00:18:46,333 --> 00:18:48,210 Out of surgery, in recovery, still sedated. 518 00:18:48,293 --> 00:18:50,129 Good. Keep me posted on that. 519 00:18:50,212 --> 00:18:51,547 Will do. 520 00:18:53,757 --> 00:18:55,008 Three times in one day. 521 00:18:55,092 --> 00:18:56,593 To what do we owe the pleasure? 522 00:18:56,677 --> 00:18:58,303 I came down for a consult 523 00:18:58,387 --> 00:19:00,722 and to persuade Ahmad to start a new betting board. 524 00:19:00,806 --> 00:19:02,307 Why, is the Westbridge board full already? 525 00:19:02,391 --> 00:19:04,351 Mm-hmm, was gonna ask him to start one about you 526 00:19:04,434 --> 00:19:06,645 and your midlife crisis trip. 527 00:19:06,728 --> 00:19:08,647 I give it four weeks. 528 00:19:08,730 --> 00:19:11,191 Seven, tops. 529 00:19:11,275 --> 00:19:12,442 Ye of little faith. 530 00:19:12,526 --> 00:19:15,195 Not about faith, just facts. 531 00:19:15,279 --> 00:19:16,488 Facts? 532 00:19:16,572 --> 00:19:18,407 Based on my experience, you're a seven-week-itch 533 00:19:18,490 --> 00:19:19,867 kind of guy. 534 00:19:19,950 --> 00:19:22,077 Hey, Robby, med student's got a pickleball player 535 00:19:22,161 --> 00:19:24,037 in the North Hall with possible Achilles rupture, 536 00:19:24,121 --> 00:19:25,038 asking for your opinion. 537 00:19:25,122 --> 00:19:26,623 Thank you, Perlah. 538 00:19:26,707 --> 00:19:28,792 At least somebody down here has a little faith in me. 539 00:19:31,461 --> 00:19:34,089 You know what Motorcycle Mike's sabbatical is really about? 540 00:19:34,173 --> 00:19:36,967 I never try to guess what's going on in that head of his. 541 00:19:37,050 --> 00:19:40,179 Three months being on the open road by himself. 542 00:19:40,262 --> 00:19:42,347 Man can't stand to be alone for more than a few hours. 543 00:19:42,431 --> 00:19:45,392 He sleeps with the TV on in his bedroom. 544 00:19:45,475 --> 00:19:48,270 I really don't think I needed to know that. 545 00:19:49,730 --> 00:19:52,816 Look, maybe he's looking for something new 546 00:19:52,900 --> 00:19:55,736 or trying to outrun some old ghosts. 547 00:19:55,819 --> 00:19:59,031 Well, I hope he finds what he's looking for. 548 00:19:59,114 --> 00:20:01,200 Man deserves some peace. 549 00:20:01,283 --> 00:20:02,576 Amen. 550 00:20:02,659 --> 00:20:05,245 I considered the diagnosis of cauda equina syndrome, 551 00:20:05,329 --> 00:20:07,080 but the motor and sensory exam 552 00:20:07,164 --> 00:20:09,458 were both intact in the sacral nerve root-- 553 00:20:09,541 --> 00:20:10,792 Our unhoused cougher has pneumonia. 554 00:20:10,876 --> 00:20:13,670 I'm cursed, fucking cursed. 555 00:20:13,754 --> 00:20:15,172 Fuck. 556 00:20:15,255 --> 00:20:16,924 What? 557 00:20:17,007 --> 00:20:19,343 That is a cavitary lesion in the right upper lobe. 558 00:20:19,426 --> 00:20:21,136 Active TB. 559 00:20:21,220 --> 00:20:23,472 What's next? 560 00:20:23,555 --> 00:20:25,057 AFB stain to confirm, 561 00:20:25,140 --> 00:20:27,601 move her to a negative airflow room, start her on meds. 562 00:20:27,684 --> 00:20:29,728 Call infection control and public health. 563 00:20:29,811 --> 00:20:32,022 And now you get to sign in as a patient 564 00:20:32,105 --> 00:20:34,483 and get your blood drawn for a QuantiFERON Gold. 565 00:20:34,566 --> 00:20:36,485 It's too soon to be positive. 566 00:20:36,568 --> 00:20:37,653 Yeah, but you were exposed. 567 00:20:37,736 --> 00:20:39,279 You need a baseline test 568 00:20:39,363 --> 00:20:42,491 and then again in eight weeks to see if you convert. 569 00:20:42,574 --> 00:20:43,825 And if I do? 570 00:20:43,909 --> 00:20:45,953 Then meds every day for three or four months 571 00:20:46,036 --> 00:20:48,830 with regular blood tests to check for toxicity. 572 00:20:48,914 --> 00:20:50,165 - Jesus. - All right. 573 00:20:50,249 --> 00:20:51,667 Let Dana know what's up. 574 00:20:51,750 --> 00:20:54,753 And for the love of God, mask up when you move her. 575 00:21:03,303 --> 00:21:05,430 - Dr. Langdon. - Hey, man. Alex. 576 00:21:05,514 --> 00:21:06,640 Let's take a look. 577 00:21:09,268 --> 00:21:12,145 Ah. 578 00:21:12,229 --> 00:21:13,146 Is it bad? 579 00:21:13,230 --> 00:21:14,690 It's not good. 580 00:21:14,773 --> 00:21:17,317 Sorry, your chart says you were burned with dry ice? 581 00:21:17,401 --> 00:21:19,361 - What happened? - My jack-off brother. 582 00:21:19,444 --> 00:21:20,946 Does he not like you? 583 00:21:21,029 --> 00:21:24,574 I asked him to do it, just not like this exactly. 584 00:21:24,658 --> 00:21:26,159 What? Why? 585 00:21:26,243 --> 00:21:27,828 He was gonna brand me like I branded him. 586 00:21:27,911 --> 00:21:29,663 Branded? Like cattle? 587 00:21:29,746 --> 00:21:32,791 Instead of hot branding, you stick the iron in dry ice, 588 00:21:32,874 --> 00:21:35,752 let it get super cold, and then you put it on your skin. 589 00:21:35,836 --> 00:21:37,587 Cool, huh? 590 00:21:37,671 --> 00:21:38,630 You're stupid. 591 00:21:38,714 --> 00:21:39,881 Let's get some LET on this. 592 00:21:39,965 --> 00:21:41,675 I'll get some snips to debride. 593 00:21:44,177 --> 00:21:45,762 You good? 594 00:21:45,846 --> 00:21:48,098 Yeah. Yeah, good. 595 00:21:48,181 --> 00:21:49,516 You sure? 596 00:21:49,599 --> 00:21:52,602 Doesn't seem like Robby's all that happy I'm back. 597 00:21:52,686 --> 00:21:55,230 Well, he's not going to be here, 598 00:21:55,314 --> 00:21:57,024 and I'm happy you're back. 599 00:21:57,107 --> 00:21:58,984 Thanks. 600 00:22:03,363 --> 00:22:07,492 Head and neck CT is negative, except for mandible fracture. 601 00:22:08,452 --> 00:22:09,745 OK, let's get him off the board. 602 00:22:09,828 --> 00:22:11,038 Roll him, right side up. 603 00:22:11,121 --> 00:22:12,831 Hey, we're gonna need the cuffs off. 604 00:22:15,876 --> 00:22:18,628 Ready. And 1, 2, 3. 605 00:22:18,712 --> 00:22:21,006 Ah, gentle. 606 00:22:21,089 --> 00:22:22,674 Dr. King, how are the chest and belly? 607 00:22:22,758 --> 00:22:25,927 We have three anterior rib fractures 608 00:22:26,011 --> 00:22:27,846 and a small pulmonary contusion. 609 00:22:27,929 --> 00:22:29,097 - Not too bad. - Mm-mm. 610 00:22:29,181 --> 00:22:30,807 When do pulmonary contusions peak? 611 00:22:30,891 --> 00:22:32,225 After a few hours. 612 00:22:32,309 --> 00:22:33,769 And do we always admit for three-rib fractures? 613 00:22:33,852 --> 00:22:35,103 In the elderly, yes, 614 00:22:35,187 --> 00:22:36,897 but not if a patient can manage the pain 615 00:22:36,980 --> 00:22:38,899 and doesn't need supplemental oxygen. 616 00:22:40,192 --> 00:22:41,651 OK, he's really hurting here. 617 00:22:41,735 --> 00:22:43,320 You think you could set us up with a serratus anterior 618 00:22:43,403 --> 00:22:44,529 - field block? - No problem. 619 00:22:44,613 --> 00:22:46,656 Oh, as long as that's OK 620 00:22:46,740 --> 00:22:47,824 with Dr. Al-Hashimi. 621 00:22:47,908 --> 00:22:49,951 If the patient consents. 622 00:22:50,035 --> 00:22:53,830 Mr. Varney, we wanna give you a shot to numb your broken ribs 623 00:22:53,914 --> 00:22:54,998 so you can breathe easier. 624 00:22:55,082 --> 00:22:56,249 Uh-huh. 625 00:22:56,333 --> 00:22:57,918 OK, get Mr. Varney prepped and draped. 626 00:22:58,001 --> 00:22:59,503 Dr. Mohan, you're in charge. 627 00:22:59,586 --> 00:23:01,338 Let's identify the landmarks. 628 00:23:01,421 --> 00:23:02,506 Cuffs. 629 00:23:03,882 --> 00:23:05,467 Yeah, you can just leave them off, man. 630 00:23:05,550 --> 00:23:08,387 He's clearly not moving on his own. 631 00:23:08,470 --> 00:23:09,971 We follow protocol, 632 00:23:10,055 --> 00:23:13,350 for his safety and yours. 633 00:23:15,143 --> 00:23:16,728 Do you need to get that? 634 00:23:16,812 --> 00:23:19,564 Nope. It's my mom. 635 00:23:19,648 --> 00:23:21,817 Ignore it. Just ignore it. 636 00:23:21,900 --> 00:23:23,652 - Amen, sister. - Forearm is numb. 637 00:23:23,735 --> 00:23:24,945 We can irrigate. 638 00:23:25,028 --> 00:23:26,530 If I ignore a problem for long enough, 639 00:23:26,613 --> 00:23:28,156 it just goes away, right? 640 00:23:28,240 --> 00:23:30,409 I wish I could ignore my deposition. 641 00:23:30,492 --> 00:23:32,661 That, you can't ignore. 642 00:23:32,744 --> 00:23:33,912 But you'll be fine. 643 00:23:33,995 --> 00:23:35,455 What's up with you, Whitaker? 644 00:23:35,539 --> 00:23:36,957 Trouble in roomie land? 645 00:23:37,040 --> 00:23:38,500 No, not really. 646 00:23:38,583 --> 00:23:41,795 I think I overstepped with Dr. Langdon earlier. 647 00:23:41,878 --> 00:23:43,046 Oh. 648 00:23:43,130 --> 00:23:45,674 He was trying to prescribe a patient benzos, 649 00:23:45,757 --> 00:23:48,593 and I told Langdon that it'd be better if I did it. 650 00:23:48,677 --> 00:23:50,053 Oof. 651 00:23:50,137 --> 00:23:52,431 Only because I was already the assigned physician. 652 00:23:52,514 --> 00:23:54,266 But yeah, now I feel like an asshole. 653 00:23:54,349 --> 00:23:55,517 Langdon's fine. 654 00:23:55,600 --> 00:23:57,894 He went to rehab, he's working the steps, 655 00:23:57,978 --> 00:24:02,441 and hopefully it's all behind him. 656 00:24:02,524 --> 00:24:04,151 Place the needle in-plane, 657 00:24:04,234 --> 00:24:06,027 superficial to the serratus anterior, 658 00:24:06,111 --> 00:24:08,280 between it and the latissimus dorsi. 659 00:24:08,363 --> 00:24:09,614 Mm-hmm. 660 00:24:09,698 --> 00:24:11,783 You can see the fluid dissect and diffuse-- 661 00:24:11,867 --> 00:24:13,118 Dr. Mohan, we need you. 662 00:24:13,201 --> 00:24:14,744 We've got two more rigs from Westbridge 663 00:24:14,828 --> 00:24:16,955 pulling up right now. 664 00:24:17,038 --> 00:24:18,457 Go. We got this. 665 00:24:18,540 --> 00:24:19,458 Thanks. 666 00:24:19,541 --> 00:24:21,960 How we doing in here? 667 00:24:22,043 --> 00:24:25,589 Spiked a temp to 102, gave Tylenol. 668 00:24:25,672 --> 00:24:27,340 Check out her leg. 669 00:24:27,424 --> 00:24:29,259 That is a definite bulla. 670 00:24:29,342 --> 00:24:30,719 Did surgery come down yet? 671 00:24:30,802 --> 00:24:32,471 - Not yet. - I need surgery? 672 00:24:32,554 --> 00:24:33,555 Page them again. 673 00:24:33,638 --> 00:24:35,348 Surgery would be a last resort. 674 00:24:35,432 --> 00:24:37,684 We would like them to come down and check out your leg 675 00:24:37,767 --> 00:24:40,270 in case we need to remove this infected skin. 676 00:24:40,353 --> 00:24:41,771 I thought it was just a little swelling 677 00:24:41,855 --> 00:24:42,814 'cause I'm on my feet all day. 678 00:24:44,774 --> 00:24:46,610 BP's down to 85 over 40. 679 00:24:46,693 --> 00:24:48,278 - How much LR is in? - Full bolus. 680 00:24:48,361 --> 00:24:49,905 Do another liter and then start Levophed. 681 00:24:49,988 --> 00:24:51,406 Titrate to a MAP of 65. 682 00:24:52,782 --> 00:24:54,242 Can someone please tell me what's going on? 683 00:24:54,326 --> 00:24:55,327 Pulse ox down to 89. 684 00:24:55,410 --> 00:24:56,828 100% non-rebreather. 685 00:24:56,912 --> 00:24:59,873 Sometimes an infection can cause your blood pressure 686 00:24:59,956 --> 00:25:02,792 to drop and lower the amount of oxygen in your blood. 687 00:25:02,876 --> 00:25:03,960 Am I gonna be OK? 688 00:25:04,044 --> 00:25:05,170 We're doing everything that we can 689 00:25:05,253 --> 00:25:06,463 to make sure that you are. 690 00:25:06,546 --> 00:25:07,756 Jesse. 691 00:25:10,175 --> 00:25:11,468 What's up? 692 00:25:11,551 --> 00:25:12,802 Be ready to intubate if you need to. 693 00:25:12,886 --> 00:25:14,304 - You want me to call Langdon? - No. 694 00:25:14,387 --> 00:25:15,889 I will be right back, and you can call surgery 695 00:25:15,972 --> 00:25:17,599 and tell them to get their heads out of their asses 696 00:25:17,682 --> 00:25:19,267 and get down here. 697 00:25:27,817 --> 00:25:29,152 Did you bring Langdon back here? 698 00:25:29,236 --> 00:25:30,904 No, Al-Hashimi did. 699 00:25:30,987 --> 00:25:32,280 You banished him to scut purgatory. 700 00:25:32,364 --> 00:25:33,448 He did everything you would've done 701 00:25:33,532 --> 00:25:35,075 with that cellulitis patient. 702 00:25:35,158 --> 00:25:36,576 If you think he missed something, tell him. 703 00:25:36,660 --> 00:25:38,161 Well, we're probably gonna need to intubate. 704 00:25:38,245 --> 00:25:39,746 We're definitely gonna need an ICU bed. 705 00:25:39,829 --> 00:25:40,997 What happened? 706 00:25:41,081 --> 00:25:43,166 She is in septic shock, on pressors. 707 00:25:43,250 --> 00:25:45,001 Open shoulder dislocation is back. 708 00:25:45,085 --> 00:25:46,795 Westbridge shut down all their ORs, so they told us 709 00:25:46,878 --> 00:25:48,630 - to bring them back here. - You joking? 710 00:25:48,713 --> 00:25:49,631 This ain't the Radisson. 711 00:25:49,714 --> 00:25:50,840 Not my problem. 712 00:25:50,924 --> 00:25:52,384 - Where should we park him? - Grab a wall. 713 00:25:52,467 --> 00:25:53,802 Call Noelle. Call ortho. 714 00:25:53,885 --> 00:25:55,095 Call the OR and tell them we got a patient back 715 00:25:55,178 --> 00:25:56,638 that needs surgery and admission. 716 00:25:56,721 --> 00:25:58,640 Hey, so sorry about this ambulance tour 717 00:25:58,723 --> 00:26:00,642 of Allegheny County, Mr. Billings, 718 00:26:00,725 --> 00:26:02,269 but we got you from here, I promise. 719 00:26:02,352 --> 00:26:03,645 Yeah, I'm starving. 720 00:26:03,728 --> 00:26:05,146 Is there any way I can get something to eat? 721 00:26:05,230 --> 00:26:06,982 Sorry, not before surgery. 722 00:26:07,065 --> 00:26:08,233 Can I have a visitor? 723 00:26:08,316 --> 00:26:09,734 Sure. 724 00:26:09,818 --> 00:26:11,528 Any word from Gloria about what's going on at Westbridge? 725 00:26:11,611 --> 00:26:13,154 Radio silence from the ivory tower. 726 00:26:13,238 --> 00:26:14,823 And the charge nurse over there isn't responding. 727 00:26:14,906 --> 00:26:16,449 Must be bad. 728 00:26:16,533 --> 00:26:17,826 I wonder if it's something that security needs to know about. 729 00:26:17,909 --> 00:26:19,327 I'll keep you posted. 730 00:26:19,411 --> 00:26:21,121 Hey, you're kind of buds with Gloria. 731 00:26:21,204 --> 00:26:22,414 Did she say anything to you about what's 732 00:26:22,497 --> 00:26:24,165 - happening at Westbridge? - No. You? 733 00:26:24,249 --> 00:26:26,710 Nope. How are your patients? 734 00:26:26,793 --> 00:26:29,129 Our prisoner, Gus, has stable injuries, 735 00:26:29,212 --> 00:26:31,339 and our law student in Central 10 is awake, 736 00:26:31,423 --> 00:26:33,550 normal LP, and awaiting a psych consult. 737 00:26:33,633 --> 00:26:34,884 Good. 738 00:26:34,968 --> 00:26:36,553 Quicker we can treat 'em, street 'em, move 'em 739 00:26:36,636 --> 00:26:38,013 up the food chain, the better. 740 00:26:38,096 --> 00:26:40,098 Question. 741 00:26:40,181 --> 00:26:44,352 Why are you treating me like one of your residents? 742 00:26:44,436 --> 00:26:45,562 I'm not. 743 00:26:45,645 --> 00:26:47,355 As the attending, I like to know the status 744 00:26:47,439 --> 00:26:49,107 of all the patients and doctors in the ED 745 00:26:49,190 --> 00:26:51,401 in case I need to jump in quickly. 746 00:26:51,484 --> 00:26:52,402 Makes sense. 747 00:26:52,485 --> 00:26:54,821 Now your turn. 748 00:26:54,904 --> 00:26:56,156 What? 749 00:26:56,239 --> 00:26:58,283 As your fellow attending in our ED, 750 00:26:58,366 --> 00:27:00,076 it only makes sense for me to know the status 751 00:27:00,160 --> 00:27:02,162 of all the patients and all the doctors 752 00:27:02,245 --> 00:27:05,707 in case I need to jump in on a moment's notice. 753 00:27:05,790 --> 00:27:07,250 Touché. 754 00:27:09,961 --> 00:27:12,505 You have a non-displaced fracture, distal tibia. 755 00:27:12,589 --> 00:27:14,674 So if you look at the bone here, it's pretty well aligned. 756 00:27:14,758 --> 00:27:16,051 Sorry. Hi. 757 00:27:16,134 --> 00:27:18,428 Hi, I was in the shower, and I came as soon 758 00:27:18,511 --> 00:27:19,554 as I got Paul's message. 759 00:27:19,638 --> 00:27:21,181 - Lena? - Hi. 760 00:27:21,264 --> 00:27:23,058 What happened? 761 00:27:23,141 --> 00:27:24,517 I had a seizure. 762 00:27:24,601 --> 00:27:26,144 You load her with Keppra? 763 00:27:26,227 --> 00:27:27,520 Yeah. 764 00:27:27,604 --> 00:27:29,522 Yeah, she's back to baseline mental status. 765 00:27:29,606 --> 00:27:31,775 I'm sorry, I'm confused. Aren't you off duty? 766 00:27:31,858 --> 00:27:34,944 - I'm Roxie's death doula. - Oh. 767 00:27:35,028 --> 00:27:36,655 Her--her what? 768 00:27:36,738 --> 00:27:38,657 I help advocate for people like Roxie 769 00:27:38,740 --> 00:27:41,660 to make their transition to death a more peaceful process. 770 00:27:41,743 --> 00:27:44,663 It's like a birth doula but for the end of life. 771 00:27:44,746 --> 00:27:48,291 She's been a real lifesaver for our family. 772 00:27:48,375 --> 00:27:51,127 My husband cracking jokes while I'm dying. 773 00:27:51,211 --> 00:27:52,879 See why I married him? 774 00:27:52,962 --> 00:27:54,714 Whatever you have to say about my condition, 775 00:27:54,798 --> 00:27:56,633 you can share with Lena too. 776 00:27:56,716 --> 00:27:58,593 We were just explaining that Roxie 777 00:27:58,677 --> 00:28:01,763 has a pathological fracture through a metastatic lesion. 778 00:28:01,846 --> 00:28:03,306 Can you fix that? 779 00:28:03,390 --> 00:28:06,142 The bones are well aligned, so she won't need surgery. 780 00:28:06,226 --> 00:28:07,602 The treatment is immobilization 781 00:28:07,686 --> 00:28:08,770 and a long leg boot. 782 00:28:08,853 --> 00:28:10,522 Oh! 783 00:28:10,605 --> 00:28:12,065 Maybe we up her pain meds. 784 00:28:12,148 --> 00:28:13,608 Yeah, sure. 785 00:28:13,692 --> 00:28:14,984 We can do that. 786 00:28:15,068 --> 00:28:17,278 The bones should heal in about six weeks. 787 00:28:17,362 --> 00:28:19,906 If I live that long. 788 00:28:21,825 --> 00:28:22,784 Still numb here? 789 00:28:22,867 --> 00:28:24,369 Yeah, bro. 790 00:28:24,452 --> 00:28:26,705 Great. 791 00:28:26,788 --> 00:28:28,581 You think it's gonna leave a scar? 792 00:28:28,665 --> 00:28:32,627 I don't think it. I know it. 793 00:28:32,711 --> 00:28:34,421 Holy shit. 794 00:28:34,504 --> 00:28:35,964 Fuck are you doing here? 795 00:28:36,047 --> 00:28:36,965 I'm sorry, who are you? 796 00:28:37,048 --> 00:28:38,091 Concerned brother. 797 00:28:38,174 --> 00:28:40,593 That looks not too bad. 798 00:28:40,677 --> 00:28:41,970 You gooning me? 799 00:28:42,053 --> 00:28:43,596 Yeah, it's nasty. 800 00:28:43,680 --> 00:28:45,014 Thanks to you. 801 00:28:45,098 --> 00:28:46,141 You did this? 802 00:28:46,224 --> 00:28:47,600 Oh, yeah. You wanna see the video? 803 00:28:49,811 --> 00:28:51,688 - Yes. - Definitely. 804 00:28:51,771 --> 00:28:53,148 Got you. 805 00:28:54,441 --> 00:28:56,818 All right. All right, get in close. 806 00:28:56,901 --> 00:28:58,486 Brothers unite! 807 00:28:58,570 --> 00:29:00,196 - Ooh! - Ooh! 808 00:29:00,280 --> 00:29:02,031 Dude, why in the world 809 00:29:02,115 --> 00:29:03,658 would you ask to have that done to you? 810 00:29:03,742 --> 00:29:07,328 He was trying to brand me with our family crest. 811 00:29:09,706 --> 00:29:11,833 Your family crest is the Penguins logo? 812 00:29:11,916 --> 00:29:13,626 We were gonna be bonded for life. 813 00:29:13,710 --> 00:29:15,462 You already are, with DNA. 814 00:29:15,545 --> 00:29:16,629 Yeah. 815 00:29:16,713 --> 00:29:18,173 I love you, man. 816 00:29:18,256 --> 00:29:20,008 - I'm real sorry. - It's OK. 817 00:29:20,091 --> 00:29:23,678 Doc said it's gonna take some time, but it'll heal OK. 818 00:29:23,762 --> 00:29:25,221 Awesome. 819 00:29:25,305 --> 00:29:27,015 So maybe we can try again in a couple of months or-- 820 00:29:27,098 --> 00:29:28,516 No. 821 00:29:29,976 --> 00:29:31,644 OK, bag her. 822 00:29:33,688 --> 00:29:35,064 Yellow on the end-tidal. 823 00:29:35,148 --> 00:29:36,816 - Sorry, got backed up. - Sounds a little wet. 824 00:29:36,900 --> 00:29:37,942 Someone asked for a surgical consult? 825 00:29:38,026 --> 00:29:39,194 That's because all the fluid. 826 00:29:39,277 --> 00:29:40,612 TKO the lines for now. 827 00:29:40,695 --> 00:29:42,947 Vent settings 50%, tidal volume 500, AC 12? 828 00:29:43,031 --> 00:29:44,324 Yep, that's perfect. 829 00:29:44,407 --> 00:29:45,658 Surgery here. Hello. 830 00:29:45,742 --> 00:29:47,243 Hey, it's about time. Where's Garcia? 831 00:29:47,327 --> 00:29:49,078 Stuck in the ER. She sent me down. What you got? 832 00:29:49,162 --> 00:29:50,538 Septic shock, respiratory failure, 833 00:29:50,622 --> 00:29:52,207 and possible necrotizing fasciitis. 834 00:29:52,290 --> 00:29:53,958 She needs to go to the OR ASAP. 835 00:29:54,042 --> 00:29:56,211 The infection was isolated to the dorsum of the foot 836 00:29:56,294 --> 00:29:57,837 five hours ago, but now we're almost to the knee 837 00:29:57,921 --> 00:29:59,506 with bullae, crepitus, and edema. 838 00:29:59,589 --> 00:30:01,174 - Yeah. - You seen nec fasc before? 839 00:30:01,257 --> 00:30:02,383 In a textbook. 840 00:30:02,467 --> 00:30:04,594 I was a med student two weeks ago. 841 00:30:06,471 --> 00:30:08,973 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 842 00:30:09,057 --> 00:30:10,642 Go get anybody else from your service down here-- 843 00:30:10,725 --> 00:30:11,935 Shamsi, Miller, Walsh-- 844 00:30:12,018 --> 00:30:13,061 I don't know any of this people, but-- 845 00:30:13,144 --> 00:30:14,437 Don't take this personally. 846 00:30:14,521 --> 00:30:17,482 I just need a fucking grown-up down here. 847 00:30:17,565 --> 00:30:19,442 Nice job on the sub-Qs. 848 00:30:19,526 --> 00:30:21,194 Really took the tension off the wound. 849 00:30:21,277 --> 00:30:22,278 Thanks. 850 00:30:22,362 --> 00:30:23,947 I can help with the skin layer. 851 00:30:24,030 --> 00:30:25,990 Four hands are faster than two. 852 00:30:28,451 --> 00:30:29,786 - Whoa. - Whoa. 853 00:30:29,869 --> 00:30:32,121 That just tore right through the skin. 854 00:30:32,205 --> 00:30:33,456 You may need to take bigger bites 855 00:30:33,540 --> 00:30:35,166 farther away from the wound edges. 856 00:30:35,250 --> 00:30:37,502 Yep. 857 00:30:37,585 --> 00:30:40,880 Skin seems pretty fragile. 858 00:30:45,009 --> 00:30:46,386 Oh. 859 00:30:46,469 --> 00:30:48,054 Yeah, this is not working. 860 00:30:48,137 --> 00:30:50,014 He has the skin strength of an 80-year-old. 861 00:30:50,098 --> 00:30:52,183 Put down Steri-Strips with benzoin, 862 00:30:52,267 --> 00:30:55,478 not across the wound but along each wound edge, both sides. 863 00:30:55,562 --> 00:30:57,021 It'll hold the sutures. 864 00:30:57,105 --> 00:31:00,483 - Yup. - What say you, Dr. Robby? 865 00:31:00,567 --> 00:31:02,443 Great. MacGyver move. 866 00:31:02,527 --> 00:31:05,363 Go for it. 867 00:31:05,446 --> 00:31:09,117 Does a Dr. MacGyver work here? 868 00:31:09,200 --> 00:31:11,619 I don't know. 869 00:31:11,703 --> 00:31:13,580 The patient symptoms are consistent with lumbar 870 00:31:13,663 --> 00:31:17,542 radiculopathy at L4, L5, most likely due to disc herniation. 871 00:31:17,625 --> 00:31:19,043 Coughing patient admitted to isolation 872 00:31:19,127 --> 00:31:21,004 for verified medication administration 873 00:31:21,087 --> 00:31:22,380 and started on RIPE therapy. 874 00:31:22,463 --> 00:31:23,923 Yeah, why do I even bother? 875 00:31:24,007 --> 00:31:24,966 Just fail me now. 876 00:31:25,049 --> 00:31:26,134 OK. 877 00:31:26,217 --> 00:31:27,635 Get in touch with a social worker. 878 00:31:27,719 --> 00:31:29,137 They're gonna wanna do contact tracing 879 00:31:29,220 --> 00:31:30,972 and help her figure out transitional housing 880 00:31:31,055 --> 00:31:32,348 for when she's discharged. 881 00:31:32,432 --> 00:31:33,683 Got it. 882 00:31:33,766 --> 00:31:35,643 And make sure infection control responded. 883 00:31:35,727 --> 00:31:37,103 The people in the waiting room could have been exposed. 884 00:31:37,186 --> 00:31:40,440 They need to be notified and tested. 885 00:31:40,523 --> 00:31:41,691 OK. 886 00:31:41,774 --> 00:31:44,611 Relax. 887 00:31:44,694 --> 00:31:46,863 You can take the mask off. You don't have TB. 888 00:31:46,946 --> 00:31:49,991 At least not yet. 889 00:31:50,074 --> 00:31:52,577 Oh, great. 890 00:31:52,660 --> 00:31:55,496 This is fucked up. 891 00:31:55,580 --> 00:31:57,790 How are you so calm? 892 00:31:57,874 --> 00:31:59,459 Expected job hazard. 893 00:31:59,542 --> 00:32:00,710 You get used to it. 894 00:32:00,793 --> 00:32:02,295 Yeah, no, thanks. 895 00:32:02,378 --> 00:32:04,881 70% of doctors in training at urban hospitals 896 00:32:04,964 --> 00:32:07,216 get exposed to TB and wind up on meds. 897 00:32:07,300 --> 00:32:09,552 - Jesus. - Mm-hmm. 898 00:32:09,636 --> 00:32:11,930 They don't teach you that in med school. 899 00:32:12,013 --> 00:32:14,098 Mrs. Randolph's back. 900 00:32:14,182 --> 00:32:15,975 Pulled up her X-ray. 901 00:32:16,059 --> 00:32:17,143 OK. 902 00:32:17,226 --> 00:32:19,270 No volvulus, no air fluid levels. 903 00:32:19,354 --> 00:32:21,856 What do you think of this? 904 00:32:21,940 --> 00:32:23,942 Fecal material? 905 00:32:24,025 --> 00:32:25,652 A shit ton. 906 00:32:25,735 --> 00:32:27,278 Sorry, had to be said. 907 00:32:27,362 --> 00:32:28,863 So, what, she needs an enema? 908 00:32:28,947 --> 00:32:30,448 No. Tried and failed, remember? 909 00:32:30,531 --> 00:32:31,449 Yeah. 910 00:32:31,532 --> 00:32:33,117 Time to dig in. 911 00:32:33,201 --> 00:32:34,744 How are we gonna do that? 912 00:32:34,827 --> 00:32:38,748 Oh, there is no "we" in disimpaction. 913 00:32:43,711 --> 00:32:45,880 I haven't done one before. 914 00:32:45,964 --> 00:32:48,841 Shouldn't I observe first? 915 00:32:48,925 --> 00:32:51,469 I know just the guy to teach you. 916 00:33:00,728 --> 00:33:03,481 I spoke to the charge nurse in med-surg. 917 00:33:03,564 --> 00:33:04,774 They can take Orlando today. 918 00:33:04,857 --> 00:33:06,567 - Yes! - That's wonderful. 919 00:33:06,651 --> 00:33:08,152 They know he's on an insulin drip? 920 00:33:08,236 --> 00:33:10,697 They know, and they can change to a SQUID protocol. 921 00:33:10,780 --> 00:33:11,698 SQUID? 922 00:33:11,781 --> 00:33:13,449 Sub-Q insulin in DKA. 923 00:33:13,533 --> 00:33:15,159 So no IV drip? 924 00:33:15,243 --> 00:33:17,954 Just shots of short-acting insulin every four hours prn. 925 00:33:18,037 --> 00:33:21,374 The med-surg nurses have time to check a glucose every hour? 926 00:33:21,457 --> 00:33:22,375 They say so. 927 00:33:22,458 --> 00:33:24,419 And five days on med-surge 928 00:33:24,502 --> 00:33:28,172 is gonna cut your hospital bill down by 2/3. 929 00:33:28,256 --> 00:33:30,049 OK. 930 00:33:30,133 --> 00:33:31,926 So what's that gonna cost? 931 00:33:32,010 --> 00:33:33,344 Well, I can't give you an exact amount, 932 00:33:33,428 --> 00:33:35,430 but roughly $35,000. 933 00:33:35,513 --> 00:33:38,558 So after about 40%, I'll still have to pay, 934 00:33:38,641 --> 00:33:40,393 what, like, 20 grand? 935 00:33:40,476 --> 00:33:42,645 The hospital can work out a payment plan. 936 00:33:42,729 --> 00:33:44,355 Orlando, we'll be OK. 937 00:33:44,439 --> 00:33:45,898 We'll figure it out. 938 00:33:45,982 --> 00:33:48,359 I'll take on extra shifts at the coffee shop. 939 00:33:48,443 --> 00:33:51,362 We got you, Dad. 940 00:33:51,446 --> 00:33:54,574 Let's give you some private time with your family. 941 00:33:54,657 --> 00:33:57,076 Thanks. 942 00:33:57,160 --> 00:33:58,703 Sorry. Thank you. 943 00:33:58,786 --> 00:34:00,288 I was worried he might bail. 944 00:34:00,371 --> 00:34:01,539 My pleasure. 945 00:34:01,622 --> 00:34:03,249 The real thanks goes to the newbie here 946 00:34:03,332 --> 00:34:05,001 for thinking outside the box. 947 00:34:07,754 --> 00:34:09,589 Sorry I doubted your med-surg pitch. 948 00:34:09,672 --> 00:34:11,174 Oh, no sweat. 949 00:34:11,257 --> 00:34:13,384 How'd you think of that? 950 00:34:13,468 --> 00:34:16,054 My family had to think of a lot of creative ways 951 00:34:16,137 --> 00:34:19,098 to help my uninsured grandma. 952 00:34:19,182 --> 00:34:20,641 Leukemia. 953 00:34:20,725 --> 00:34:23,978 System doesn't work for you, you gotta work the system. 954 00:34:24,062 --> 00:34:26,230 She survive? 955 00:34:26,314 --> 00:34:28,441 For a while, till she didn't. 956 00:34:28,524 --> 00:34:30,902 She died before my freshman year in college. 957 00:34:30,985 --> 00:34:33,237 Sorry. 958 00:34:33,321 --> 00:34:35,406 Her death taught me a lot. 959 00:34:35,490 --> 00:34:38,367 Mainly that I don't wanna be around people dying. 960 00:34:40,244 --> 00:34:42,830 So they got her, and we can get out of here soon? 961 00:34:42,914 --> 00:34:44,290 Yeah. Oh, I think so. 962 00:34:44,373 --> 00:34:45,708 - I think so, yeah. - OK. 963 00:34:45,792 --> 00:34:48,961 Hi. 964 00:34:49,045 --> 00:34:51,547 Morphine PCA looks ready to go. 965 00:34:51,631 --> 00:34:53,549 This should do the trick. 966 00:34:53,633 --> 00:34:54,967 Do you notice a difference? 967 00:34:55,051 --> 00:34:55,968 Better. 968 00:34:56,052 --> 00:34:58,471 Oh, great. Great. 969 00:34:58,554 --> 00:35:00,223 How does this thing work? 970 00:35:00,306 --> 00:35:02,642 There's a baseline rate of morphine. 971 00:35:02,725 --> 00:35:04,685 And if you're having pain, you can push this button. 972 00:35:04,769 --> 00:35:05,686 You'll get some extra. 973 00:35:05,770 --> 00:35:07,021 And you can push for another dose 974 00:35:07,105 --> 00:35:08,481 every 10 minutes if needed. 975 00:35:08,564 --> 00:35:10,733 Your very own morphine butler. 976 00:35:13,319 --> 00:35:14,403 Amazing. 977 00:35:14,487 --> 00:35:15,947 She can go home with this? 978 00:35:16,030 --> 00:35:17,490 Yeah. 979 00:35:17,573 --> 00:35:19,617 Though you'll need more equipment for the house 980 00:35:19,700 --> 00:35:21,828 now that she can't bear weight on her leg. 981 00:35:21,911 --> 00:35:23,746 OK. Like what? 982 00:35:23,830 --> 00:35:27,917 A wheelchair to go to the bathroom, a shower chair, 983 00:35:28,000 --> 00:35:30,128 wall bars, if you don't already have them. 984 00:35:30,211 --> 00:35:33,256 And a hospital bed could be helpful too. 985 00:35:33,339 --> 00:35:34,590 How do we get all that? 986 00:35:34,674 --> 00:35:36,467 You don't. I do. 987 00:35:36,551 --> 00:35:38,344 I will get everything so that the two of you 988 00:35:38,427 --> 00:35:40,555 can get out of here and back to the kids. 989 00:35:40,638 --> 00:35:42,723 - At home. - Thank you. 990 00:35:49,814 --> 00:35:51,691 Nice of you to join us, Huckleberry. 991 00:35:51,774 --> 00:35:52,984 What do you need? 992 00:35:53,067 --> 00:35:54,819 Some help with a disimpaction. 993 00:35:56,696 --> 00:35:58,656 That is a med student procedure. 994 00:35:58,739 --> 00:36:00,074 Oh, you know the old adage-- 995 00:36:00,158 --> 00:36:02,326 see one, do one, teach one. 996 00:36:02,410 --> 00:36:04,579 Say hello to teaching young Ogilvie here. 997 00:36:04,662 --> 00:36:07,248 -OK. 998 00:36:07,331 --> 00:36:09,375 - Double glove, Ogilvie. - All right. 999 00:36:09,458 --> 00:36:10,877 Mrs. Randolph, we're going to need 1000 00:36:10,960 --> 00:36:13,504 to manually unblock your rectum so that we can 1001 00:36:13,588 --> 00:36:15,006 get your bowels moving again. 1002 00:36:15,089 --> 00:36:16,007 I know. 1003 00:36:16,090 --> 00:36:18,759 Here we go. 1004 00:36:18,843 --> 00:36:21,888 Mrs. Randolph, I would like you to relax 1005 00:36:21,971 --> 00:36:24,807 like you're having a bowel movement. 1006 00:36:24,891 --> 00:36:27,393 Nice and deep. 1007 00:36:27,476 --> 00:36:29,687 OK. 1008 00:36:29,770 --> 00:36:33,900 Curve the finger like an ice cream scoop. 1009 00:36:33,983 --> 00:36:38,529 And bring it out. 1010 00:36:38,613 --> 00:36:40,364 You're up, Ogilvie. 1011 00:36:44,660 --> 00:36:46,787 Some more pressure, Mrs. Randolph. 1012 00:36:46,871 --> 00:36:48,331 I'm ready. 1013 00:36:55,087 --> 00:36:59,133 And here I thought you weren't a quick study. 1014 00:36:59,217 --> 00:37:01,052 Keep going. 1015 00:37:01,135 --> 00:37:03,262 Mrs. Randolph, in order to prevent this 1016 00:37:03,346 --> 00:37:04,680 from happening again, I think you 1017 00:37:04,764 --> 00:37:06,265 need a better stool softener. 1018 00:37:06,349 --> 00:37:07,808 You can try MiraLAX. 1019 00:37:07,892 --> 00:37:10,353 Just a tablespoon with a big glass of water every morning 1020 00:37:10,436 --> 00:37:11,354 should do the trick. 1021 00:37:11,437 --> 00:37:12,563 OK. 1022 00:37:14,857 --> 00:37:15,775 Oh. 1023 00:37:15,858 --> 00:37:17,360 Sorry. 1024 00:37:17,443 --> 00:37:18,527 Passing gas is good. 1025 00:37:18,611 --> 00:37:20,238 Means we're making progress. 1026 00:37:20,321 --> 00:37:21,948 Does that mean that I can-- I can stop? 1027 00:37:22,031 --> 00:37:23,783 No. Nope. Keep going. 1028 00:37:28,829 --> 00:37:31,999 OK, Ogilvie, you-- you might wanna-- 1029 00:37:32,083 --> 00:37:33,793 Oh! 1030 00:37:37,672 --> 00:37:39,173 Much better. 1031 00:37:40,216 --> 00:37:42,134 MAP's holding on Levophed. 1032 00:37:42,218 --> 00:37:44,095 1 mike per kg per minute. 1033 00:37:44,178 --> 00:37:45,304 Do me a favor. 1034 00:37:45,388 --> 00:37:46,514 Give me some 4x4s on some Betadine. 1035 00:37:46,597 --> 00:37:47,807 Sorry, we're getting killed 1036 00:37:47,890 --> 00:37:49,225 with transfers from Westbridge. 1037 00:37:49,308 --> 00:37:51,394 Mesenteric ischemia, perforated bowel. 1038 00:37:51,477 --> 00:37:52,395 Got a hot one here. 1039 00:37:52,478 --> 00:37:53,396 Yeah. 1040 00:37:53,479 --> 00:37:54,522 Possible nec fasc. 1041 00:37:54,605 --> 00:37:55,898 Possible? 1042 00:37:55,982 --> 00:37:57,275 Need CT with contrast to confirm. 1043 00:37:57,358 --> 00:37:58,985 This is spreading like wildfire. 1044 00:37:59,068 --> 00:38:00,361 By the time you get your CT, it's gonna be up to her waist. 1045 00:38:00,444 --> 00:38:01,445 She's gonna need a hemicorporectomy. 1046 00:38:01,529 --> 00:38:02,780 She needs a CT scan. 1047 00:38:02,863 --> 00:38:05,449 How about a stainless steel scan? 1048 00:38:05,533 --> 00:38:07,660 For Christ's sake. Robinavitch! 1049 00:38:07,743 --> 00:38:11,122 Robby, what the fuck are you doing? 1050 00:38:11,205 --> 00:38:12,832 Oh, God, I think I might puke. 1051 00:38:12,915 --> 00:38:15,293 That's called dirty dishwater exudate without purulence. 1052 00:38:15,376 --> 00:38:17,503 There's a gray appearance to the fascia, and in the OR, 1053 00:38:17,586 --> 00:38:19,714 you'll see easy separation in the tissue planes. 1054 00:38:19,797 --> 00:38:21,048 When do you start your sabbatical? 1055 00:38:21,132 --> 00:38:22,800 - Tomorrow. - Not a moment too soon. 1056 00:38:22,883 --> 00:38:24,802 Thanks for coming down. 1057 00:38:28,014 --> 00:38:31,517 I'm catching up on my charting as fast as I can. 1058 00:38:31,600 --> 00:38:34,395 Why don't you give my generative AI app a try? 1059 00:38:34,478 --> 00:38:36,897 It's 30% more efficient, and providers report 1060 00:38:36,981 --> 00:38:38,774 increased job satisfaction. 1061 00:38:38,858 --> 00:38:41,777 And you'll rarely have to stay overtime to complete charts. 1062 00:38:41,861 --> 00:38:43,529 Yeah? 1063 00:38:43,612 --> 00:38:44,822 OK. 1064 00:38:44,905 --> 00:38:46,407 Yeah, I'm usually here at least a couple hours 1065 00:38:46,490 --> 00:38:48,284 after every shift trying to catch up, so... 1066 00:38:48,367 --> 00:38:50,703 Sure, AI will make doctors more efficient, 1067 00:38:50,786 --> 00:38:52,997 but hospitals will expect us to treat more patients 1068 00:38:53,080 --> 00:38:54,999 without any extra pay, of course, 1069 00:38:55,082 --> 00:38:56,792 all the while eliminating staff positions 1070 00:38:56,876 --> 00:38:58,502 for attending and residents. 1071 00:38:58,586 --> 00:39:00,087 Oh, Dr. Robby, I am not an advocate 1072 00:39:00,171 --> 00:39:02,214 for erasing my own profession. 1073 00:39:02,298 --> 00:39:05,718 But I am advocating for getting to spend more time with my son. 1074 00:39:05,801 --> 00:39:08,679 Nothing can replace family. 1075 00:39:08,763 --> 00:39:10,681 What's the status of your septic patient? 1076 00:39:10,765 --> 00:39:13,476 Nec fasc. Surgery's taking her up. 1077 00:39:13,559 --> 00:39:16,020 Think they'll be able to save her leg? 1078 00:39:16,103 --> 00:39:17,980 Right now, I'm just hoping they can save her life. 1079 00:39:18,064 --> 00:39:20,566 Hey, how's Ogilvie doing? 1080 00:39:20,649 --> 00:39:24,403 A little TB exposure, a touch of ass-plosion. 1081 00:39:24,487 --> 00:39:26,530 All in all, pretty good day so far. 1082 00:39:26,614 --> 00:39:27,823 Kaison, you came. 1083 00:39:27,907 --> 00:39:29,367 Hey, ain't no way I was gonna let you 1084 00:39:29,450 --> 00:39:31,285 miss Peter and Aubrey's epic Fourth of July party. 1085 00:39:31,369 --> 00:39:33,496 Come on, now. Hey. 1086 00:39:33,579 --> 00:39:35,164 Brought some brew. 1087 00:39:35,247 --> 00:39:36,540 Oh, you are the man. 1088 00:39:36,624 --> 00:39:38,000 Appreciate the bromance over here, 1089 00:39:38,084 --> 00:39:40,336 but no food 'cause you might go into surgery. 1090 00:39:40,419 --> 00:39:43,005 And no beer 'cause we're a goddamn hospital. 1091 00:39:46,634 --> 00:39:48,761 Starting your sabbatical early? 1092 00:39:48,844 --> 00:39:50,596 I know someone who could really use a drink right now. 1093 00:39:50,679 --> 00:39:51,889 In the hospital? 1094 00:39:51,972 --> 00:39:54,392 As a parting gift. 1095 00:39:58,437 --> 00:39:59,980 How's it looking? 1096 00:40:00,064 --> 00:40:01,232 Good. 1097 00:40:01,315 --> 00:40:03,192 The Steri-Strips did the trick. 1098 00:40:03,275 --> 00:40:04,318 CT's ready. 1099 00:40:04,402 --> 00:40:05,945 We already scanned him. 1100 00:40:06,028 --> 00:40:08,322 Head and neck want thin cuts and a 3D reconstruction 1101 00:40:08,406 --> 00:40:10,324 of the mandible before they decide 1102 00:40:10,408 --> 00:40:11,784 if Mr. Varney needs surgery. 1103 00:40:11,867 --> 00:40:13,702 Have they even come down to examine him in person? 1104 00:40:13,786 --> 00:40:15,287 No, they must be backed up. 1105 00:40:15,371 --> 00:40:19,083 Or there's a July Fourth sale at the BMW dealership. 1106 00:40:19,166 --> 00:40:20,376 Labs are back. 1107 00:40:20,459 --> 00:40:22,211 Albumin's low. Total protein's low. 1108 00:40:22,294 --> 00:40:23,796 He also has megaloblastic anemia. 1109 00:40:23,879 --> 00:40:25,047 - Malnutrition. - Probably. 1110 00:40:25,131 --> 00:40:26,215 Jail cuisine. 1111 00:40:26,298 --> 00:40:27,591 Whitaker, what labs should we add? 1112 00:40:27,675 --> 00:40:29,718 B12, folate, iron levels. 1113 00:40:29,802 --> 00:40:31,220 Good. 1114 00:40:31,303 --> 00:40:32,847 We're gonna run some more tests, Mr. Varney. 1115 00:40:32,930 --> 00:40:34,265 Hang in there. 1116 00:40:38,894 --> 00:40:41,313 I have to pee. 1117 00:40:41,397 --> 00:40:42,773 There's no PureWick here. 1118 00:40:42,857 --> 00:40:44,024 But here you go, hon. 1119 00:40:44,108 --> 00:40:45,985 - I'll help you get on. - No. No. 1120 00:40:46,068 --> 00:40:48,404 No bedpan. I can walk to the bathroom. 1121 00:40:48,487 --> 00:40:50,072 - I just need a little help. - Are you sure? 1122 00:40:50,156 --> 00:40:51,157 I'm here, babe. 1123 00:40:51,240 --> 00:40:52,658 Oh, we got this Mr. Hamler. 1124 00:40:52,741 --> 00:40:55,911 You'll have to bring your IV and portable oxygen. 1125 00:40:55,995 --> 00:40:57,913 Please? 1126 00:40:57,997 --> 00:41:00,332 I'll grab a wheelchair. 1127 00:41:00,416 --> 00:41:02,293 Let's try to sit you up and dangle your legs. 1128 00:41:02,376 --> 00:41:03,836 OK. 1129 00:41:06,547 --> 00:41:09,884 1, 2, 3. 1130 00:41:15,598 --> 00:41:17,224 This is not a good idea. 1131 00:41:17,308 --> 00:41:19,351 I don't think we're gonna need this. 1132 00:41:19,435 --> 00:41:20,978 Hey, Paul, Paul, 1133 00:41:21,061 --> 00:41:23,147 why don't you come grab a cup of coffee with me? 1134 00:41:23,230 --> 00:41:25,107 I'm still zonked from my all-nighter, 1135 00:41:25,191 --> 00:41:28,777 and I wanna go over some delivery instructions with you. 1136 00:41:28,861 --> 00:41:31,447 Sure. 1137 00:41:31,530 --> 00:41:33,324 Rox, you OK? 1138 00:41:33,407 --> 00:41:36,243 - Mm-hmm. - Yeah. It's OK. 1139 00:41:42,958 --> 00:41:44,919 Bedpan it is. 1140 00:41:52,927 --> 00:41:54,720 You lose your pulse ox again, bud? 1141 00:42:00,351 --> 00:42:01,685 Louie. 1142 00:42:01,769 --> 00:42:03,562 Louie! 1143 00:42:03,646 --> 00:42:06,148 He kept pulling off his pulse ox. 1144 00:42:06,232 --> 00:42:07,566 It's on. It's at 71. 1145 00:42:07,650 --> 00:42:09,068 Louie, wake up. 1146 00:42:10,694 --> 00:42:12,404 - I'm not getting a carotid. - I got the airway. 1147 00:42:12,488 --> 00:42:15,574 Hey, Perlah, crash cart, intubation tray, please.