1 00:00:10,761 --> 00:00:13,764 [indistinct chatter] 2 00:00:15,641 --> 00:00:17,059 - You know this guy? - Orlando Diaz. 3 00:00:17,142 --> 00:00:18,769 We were treating him for DKA when he eloped. 4 00:00:18,852 --> 00:00:20,395 - How far did he fall? - 20 feet or so. 5 00:00:20,479 --> 00:00:22,231 - Anyone see him pass out? - No. 6 00:00:22,272 --> 00:00:24,316 They went looking for him after he didn't answer his radio. 7 00:00:24,399 --> 00:00:25,567 - Pupils equal but sluggish. 8 00:00:25,651 --> 00:00:26,944 - He left against medical advice. 9 00:00:26,985 --> 00:00:30,781 - On my count, three, two, one. [grunts] 10 00:00:30,864 --> 00:00:33,116 - Dr. Ellis on the case. Day shift, we got this. 11 00:00:33,158 --> 00:00:35,452 - I'm staying. - Continuity of care. 12 00:00:35,536 --> 00:00:36,870 Dr. Al-Hashimi, why don't you go cover 13 00:00:36,954 --> 00:00:38,121 sign-out rounds with Dr. Abbot? 14 00:00:38,205 --> 00:00:39,456 Shen, you too. - Got it. 15 00:00:39,540 --> 00:00:41,583 - OK, let me know if you need anything. 16 00:00:41,625 --> 00:00:44,127 - Lungs are up bilaterally. - Pelvis is stable. 17 00:00:44,211 --> 00:00:48,006 Right tib-fib hematoma, deformed right forearm. 18 00:00:48,090 --> 00:00:50,008 - Ruptured TM on the left with sero-sanguinous fluid. 19 00:00:50,092 --> 00:00:51,802 - That means basilar skull fracture. 20 00:00:51,885 --> 00:00:53,637 - We've got a diabetic patient, 20-foot fall. 21 00:00:53,679 --> 00:00:55,973 - BP 204 over 98, pulse 56. 22 00:00:56,014 --> 00:00:57,641 - Dr. Mohan, what do those numbers indicate? 23 00:00:57,683 --> 00:00:59,434 - I'm trying to treat the patient. 24 00:00:59,518 --> 00:01:00,727 - It's the Cushing's reflex. 25 00:01:00,811 --> 00:01:02,813 - From increased intracranial pressure. 26 00:01:02,896 --> 00:01:05,147 - Yeah, we need to get him to CT right away. 27 00:01:05,232 --> 00:01:06,817 - No free fluid in the belly. 28 00:01:06,900 --> 00:01:10,153 - Any family to notify? - Wife and three kids. 29 00:01:10,237 --> 00:01:12,281 - Is there a card to sign for Robby? 30 00:01:12,364 --> 00:01:14,324 - No, he said no card, no presents. 31 00:01:14,366 --> 00:01:15,701 - Oh. Was there a cake? 32 00:01:15,784 --> 00:01:17,327 - Oh, he didn't want that either. 33 00:01:17,369 --> 00:01:19,288 - That sucks. I need some cake. 34 00:01:19,329 --> 00:01:21,498 - Patient was injured when they raided a restaurant. 35 00:01:21,539 --> 00:01:23,292 - And they actually arrested the nurse? 36 00:01:23,333 --> 00:01:25,836 - With a takedown and zip ties. - Damn. 37 00:01:25,877 --> 00:01:27,963 - Crus, you, uh, know the computer downtime drill? 38 00:01:28,045 --> 00:01:29,381 - Yeah, no biggie. 39 00:01:29,464 --> 00:01:31,091 I prefer to treat 'em without labs and X-rays. 40 00:01:31,174 --> 00:01:32,593 Welcome back. 41 00:01:32,676 --> 00:01:34,469 - If you do have orders for labs and X-rays, 42 00:01:34,553 --> 00:01:36,513 clipboards go here. 43 00:01:36,597 --> 00:01:39,308 If it's just nursing orders, here. 44 00:01:39,390 --> 00:01:41,101 - Please write neatly, for God's sake. 45 00:01:41,184 --> 00:01:43,645 - Oh, Monica, this is Nazely, new intern. 46 00:01:43,729 --> 00:01:46,565 - I don't need to know that. - So nice to meet you. 47 00:01:47,649 --> 00:01:49,318 - Looks like you and me, Jack. 48 00:01:49,401 --> 00:01:50,735 - Yeah, who's our senior? 49 00:01:50,819 --> 00:01:53,864 - Dr. Henderson. - Excellent. 50 00:01:53,947 --> 00:01:55,741 Night shift's on Crus control. 51 00:01:55,824 --> 00:01:57,868 - You hear ICE brought us a patient? 52 00:01:57,951 --> 00:01:59,703 - Oh, yeah? How'd that go? 53 00:01:59,745 --> 00:02:00,829 - There was some collateral damage. 54 00:02:00,912 --> 00:02:02,331 They arrested Jesse. 55 00:02:02,414 --> 00:02:04,333 - For what? - Assaulting a federal officer. 56 00:02:04,416 --> 00:02:05,876 - Are you fucking kidding me? 57 00:02:05,917 --> 00:02:07,210 - Oh, Dr. Al-Hashimi, 58 00:02:07,294 --> 00:02:09,545 this is Nazely Toomarian-- new intern. 59 00:02:09,588 --> 00:02:12,633 [both speaking Armenian] 60 00:02:16,303 --> 00:02:18,180 - OK, everybody, let's huddle up. 61 00:02:18,263 --> 00:02:19,514 - Before we start, 62 00:02:19,598 --> 00:02:21,099 let me address the elephant in the room. 63 00:02:21,183 --> 00:02:22,893 For those of you who don't know, 64 00:02:22,976 --> 00:02:24,394 Jesse tried to intervene 65 00:02:24,436 --> 00:02:26,188 when a federal agent was handling his patient, 66 00:02:26,271 --> 00:02:28,565 and both he and the patient were taken away by ICE. 67 00:02:28,607 --> 00:02:30,233 - Did he punch the guy? - No. 68 00:02:30,275 --> 00:02:32,653 He put out a hand to stop him, made physical contact. 69 00:02:32,736 --> 00:02:34,237 - [softly] It was a little bit more than that. 70 00:02:34,279 --> 00:02:35,822 - The hospital lawyers are on the case, 71 00:02:35,906 --> 00:02:38,158 and we will brief the staff every 12 hours 72 00:02:38,241 --> 00:02:39,910 at sign-out rounds with an official update. 73 00:02:39,951 --> 00:02:42,412 - In the meantime, don't feed the rumor mill. 74 00:02:42,454 --> 00:02:44,748 - You may have also heard that new grad nurse Emma here 75 00:02:44,790 --> 00:02:47,250 was assaulted by a patient. - I--I'm fine. 76 00:02:47,292 --> 00:02:48,877 - Please don't forget "code hula hoop," 77 00:02:48,960 --> 00:02:50,212 and with risky patients, 78 00:02:50,295 --> 00:02:52,547 always keep a path to the door clear. 79 00:02:52,631 --> 00:02:54,216 - Sounds like one hell of a day. 80 00:02:54,299 --> 00:02:56,051 And we're still dealing with downtime, 81 00:02:56,134 --> 00:02:58,220 so day shift should brief night residents 82 00:02:58,303 --> 00:02:59,262 about the protocol-- [clicking] 83 00:02:59,346 --> 00:03:00,472 [crowd murmuring] - Hey! 84 00:03:00,555 --> 00:03:01,807 - Oh, all right! 85 00:03:01,890 --> 00:03:04,393 [applause] - Oh, thank God. 86 00:03:04,476 --> 00:03:05,769 - Yeah, not so fast. 87 00:03:05,811 --> 00:03:07,604 Every chart from the last five hours 88 00:03:07,688 --> 00:03:09,940 needs to be scanned into the Electronic Health Record 89 00:03:10,023 --> 00:03:12,025 and checked for accuracy... 90 00:03:12,109 --> 00:03:14,194 - Um, whose job is that? - Day shift. 91 00:03:14,277 --> 00:03:16,113 - With a completed and signed T-sheet. 92 00:03:16,196 --> 00:03:17,864 - Are you kidding me? - That's gonna take forever. 93 00:03:17,948 --> 00:03:19,616 - We will set up stations for scanning. 94 00:03:19,658 --> 00:03:21,410 OK, everybody, let's get moving. 95 00:03:21,493 --> 00:03:23,578 - Triage is 20 behind. Gotta help 'em clean up. 96 00:03:23,662 --> 00:03:24,788 I'm skipping rounds. 97 00:03:24,871 --> 00:03:26,623 - Consider yourself lucky. 98 00:03:26,707 --> 00:03:29,251 - Should we join them? - [sighs] 99 00:03:29,334 --> 00:03:30,961 Might as well witness the magic. 100 00:03:31,002 --> 00:03:33,171 It's like changing of the guard at Buckingham Palace. 101 00:03:33,255 --> 00:03:35,090 - Except we're allowed to smile. 102 00:03:35,173 --> 00:03:37,300 - "Smile though your heart is aching." 103 00:03:37,384 --> 00:03:38,468 [machine beeping] 104 00:03:38,510 --> 00:03:39,553 - Plain films, right tib-fib 105 00:03:39,636 --> 00:03:41,471 and right forearm after CT. 106 00:03:41,555 --> 00:03:43,473 - Got the chem-8. Blood sugar's 284. 107 00:03:43,557 --> 00:03:46,143 - That's not too bad. Potassium looks good. 108 00:03:46,184 --> 00:03:48,395 - Mm-hmm. Anion gap's up at 14. 109 00:03:48,478 --> 00:03:49,646 - It was 24 this morning. 110 00:03:49,688 --> 00:03:51,314 He's definitely improving. 111 00:03:51,356 --> 00:03:52,649 - The DKA is resolving. 112 00:03:52,733 --> 00:03:54,317 - So what made him pass out? 113 00:03:54,359 --> 00:03:56,153 - It's hot as hell out there. 114 00:03:56,194 --> 00:03:58,321 He could have been dehydrated from sweating. 115 00:03:58,363 --> 00:04:01,783 Or he could have had an N-STEMI or a posterior CVA. 116 00:04:01,867 --> 00:04:03,326 - Ready to roll. 117 00:04:05,036 --> 00:04:07,664 - I can babysit him at CT. - Thank you. 118 00:04:07,748 --> 00:04:10,041 - I'll stay in case he needs the OR. 119 00:04:11,835 --> 00:04:13,670 - Hey, we're back up. 120 00:04:13,754 --> 00:04:15,672 - It's about time. 121 00:04:15,756 --> 00:04:17,173 - Ooh, Robby. - Yeah. 122 00:04:17,214 --> 00:04:19,341 - I got intel on where ICE has taken Jesse. 123 00:04:19,426 --> 00:04:20,635 - Intel from who? 124 00:04:20,719 --> 00:04:22,512 - Uh, my brother-in-law's a cop. 125 00:04:22,554 --> 00:04:24,848 So he'll be processed at DHS Southside 126 00:04:24,890 --> 00:04:27,350 and then transferred to ICE detention in Clearfield. 127 00:04:27,392 --> 00:04:28,643 - Clearfield? That's two hours away. 128 00:04:28,727 --> 00:04:30,145 - Mm-hmm. 129 00:04:30,228 --> 00:04:32,230 - OK, I'll let the hospital attorneys know. 130 00:04:32,314 --> 00:04:34,191 - How are you doing, Oliver? - Alive and kicking. 131 00:04:34,232 --> 00:04:35,525 - Uh, Mr. Haas. 132 00:04:35,609 --> 00:04:37,861 Pulmonary edema after missed dialysis, 133 00:04:37,903 --> 00:04:40,447 now stable with his son Mason at the bedside. 134 00:04:40,530 --> 00:04:42,032 - Hello. - I'm Dr. Shen. 135 00:04:42,115 --> 00:04:43,283 I'll be back. 136 00:04:43,366 --> 00:04:44,326 - Dialysis tech says 137 00:04:44,409 --> 00:04:46,119 I'm off the machine at 10:42. 138 00:04:46,203 --> 00:04:48,205 - Hit the call light, and I'll come running. 139 00:04:48,288 --> 00:04:50,415 - South 21 next... 140 00:04:52,375 --> 00:04:54,085 Mr. Digby. 141 00:04:54,169 --> 00:04:55,712 - J-just Digby. 142 00:04:55,754 --> 00:04:57,380 - Dr. Mohan's patient. 143 00:04:57,422 --> 00:04:59,549 Forearm cellulitis, admit med-surge. 144 00:04:59,633 --> 00:05:01,176 Awaiting a bed. - I can take him. 145 00:05:01,259 --> 00:05:03,011 - Sold to Dr. Toomarian. 146 00:05:03,094 --> 00:05:05,388 Moving right along. 147 00:05:05,472 --> 00:05:07,224 - Get enough to eat? 148 00:05:07,265 --> 00:05:09,559 We'll be back. 149 00:05:09,601 --> 00:05:12,979 - Lillian Stegman. Tweaked her knee water-skiing. 150 00:05:13,063 --> 00:05:15,023 - Doing a 360 off a 5-foot ramp. 151 00:05:15,106 --> 00:05:16,483 - Ooh, respect. 152 00:05:16,566 --> 00:05:17,818 - X-rays ordered in triage. 153 00:05:17,901 --> 00:05:19,069 - That was hours ago. 154 00:05:19,152 --> 00:05:21,321 - Ma'am, I'm Dr. Crus Henderson. 155 00:05:21,404 --> 00:05:23,573 Let's get you home real fast. 156 00:05:23,615 --> 00:05:25,283 - That would be wonderful. - OK, heading to North. 157 00:05:25,367 --> 00:05:27,035 - Thank you. 158 00:05:27,118 --> 00:05:29,579 - Looks like our first scanning station is almost ready. 159 00:05:29,621 --> 00:05:32,290 Whitaker, Santos, after rounds, this will be your post. 160 00:05:32,374 --> 00:05:34,960 - Seriously? - For...how long? 161 00:05:35,043 --> 00:05:37,087 - Till we mop up this mess. 162 00:05:37,170 --> 00:05:38,755 And away we go. 163 00:05:38,839 --> 00:05:40,924 - All right, now you know everything 164 00:05:41,007 --> 00:05:42,175 there is to know about rounds. 165 00:05:42,259 --> 00:05:43,343 Fascinating, right? 166 00:05:43,426 --> 00:05:45,512 - Uh...yeah. 167 00:05:45,595 --> 00:05:47,806 - Here, I got something better for you. 168 00:05:49,599 --> 00:05:52,394 So, Digby, we're gonna find you some new clothes, 169 00:05:52,477 --> 00:05:54,187 but my friend Emma and I wondered if you'd like 170 00:05:54,271 --> 00:05:56,773 to get cleaned up a bit first. 171 00:05:56,857 --> 00:05:58,567 - I already had a shower. 172 00:05:58,650 --> 00:06:00,151 - I know, and you look good. 173 00:06:00,235 --> 00:06:02,279 But the offer also comes with a shave and a haircut, 174 00:06:02,320 --> 00:06:03,488 if you're interested. 175 00:06:03,572 --> 00:06:04,739 No pressure--like I said, 176 00:06:04,823 --> 00:06:05,991 you already look great. 177 00:06:07,367 --> 00:06:10,287 - Sure, I guess. - Fantastic. 178 00:06:10,370 --> 00:06:12,289 All right, kid, fill that basin with some warm water 179 00:06:12,372 --> 00:06:14,040 and lather him up. 180 00:06:16,960 --> 00:06:19,379 - Hey, stay safe out there. - Back at you in here. 181 00:06:19,462 --> 00:06:21,381 - Hey, Cary. 182 00:06:21,464 --> 00:06:23,466 You were on scene with Orlando, right? 183 00:06:23,550 --> 00:06:25,927 Did you notice anything about his fall? 184 00:06:26,011 --> 00:06:27,429 - Like what? 185 00:06:27,512 --> 00:06:30,599 - Like, um, if there was a break in the railing 186 00:06:30,682 --> 00:06:33,602 or if there were security cameras? 187 00:06:33,685 --> 00:06:35,145 - Too busy working on the guy-- 188 00:06:35,228 --> 00:06:37,647 IV, intubation, backboard, splint. 189 00:06:37,689 --> 00:06:38,815 - Thanks. 190 00:06:38,857 --> 00:06:40,442 - Oh, two names is a start. 191 00:06:40,525 --> 00:06:42,152 Pretty soon, we'll retire the clipboards. 192 00:06:42,235 --> 00:06:43,486 - Baby Jane Doe in Pedes? 193 00:06:43,570 --> 00:06:45,405 - Uh, yeah, abandoned 194 00:06:45,488 --> 00:06:48,158 in the waiting room bathroom at 7:30 a.m. 195 00:06:48,199 --> 00:06:50,619 - Safe haven drop-off? - No, she's too old for that. 196 00:06:50,702 --> 00:06:52,454 At least two months. - I'll take her. 197 00:06:52,537 --> 00:06:54,623 - Awaiting foster placement by CYF. 198 00:06:54,706 --> 00:06:56,957 - What if the mom comes back? - Call the cops. 199 00:06:57,042 --> 00:06:58,376 - Day shift, get to work scanning. 200 00:06:58,460 --> 00:06:59,961 Night shift, the room numbers 201 00:07:00,045 --> 00:07:02,130 on top of the dry-erase board need a doctor. 202 00:07:02,213 --> 00:07:05,008 - Who's in BH-1? - Psych hold, danger to self. 203 00:07:05,091 --> 00:07:06,509 - What's the story? 204 00:07:06,551 --> 00:07:08,345 - Doctors King and Langdon were on the case. 205 00:07:08,428 --> 00:07:10,639 - It's a sad story-- she says her 5-year-old 206 00:07:10,680 --> 00:07:12,515 snuck into the back seat of the car to take a nap. 207 00:07:12,557 --> 00:07:14,184 - Heat stroke. 208 00:07:14,225 --> 00:07:16,519 - Mom was extremely distraught. Walked out into traffic. 209 00:07:16,603 --> 00:07:18,104 - Grady Barnhill, wheezing 210 00:07:18,188 --> 00:07:19,689 and not responding to albuterol. 211 00:07:19,773 --> 00:07:21,608 Pulse ox 87. His mother, Naomi. 212 00:07:21,691 --> 00:07:23,818 - OK, Trauma Two's open. - On our way. 213 00:07:23,860 --> 00:07:26,321 Uh, Mom, history of asthma? - His whole life. 214 00:07:26,404 --> 00:07:28,406 Never this bad. - Barely moving air. 215 00:07:28,490 --> 00:07:31,034 - Using all his accessory muscles. 216 00:07:31,117 --> 00:07:32,534 - Call RT! 217 00:07:32,577 --> 00:07:35,246 Uh, continuous nebs, 20 milligrams an hour. 218 00:07:35,330 --> 00:07:36,748 - We have a home nebulizer. 219 00:07:36,831 --> 00:07:39,668 I've been giving him albuterol every hour. 220 00:07:39,751 --> 00:07:40,752 - Ready? 221 00:07:40,835 --> 00:07:43,713 On my count, one, two, three. 222 00:07:43,755 --> 00:07:45,173 - Does he take any other medications? 223 00:07:45,256 --> 00:07:46,675 - Just the albuterol. 224 00:07:46,758 --> 00:07:48,218 He used to be on montelukast and Symbicort. 225 00:07:48,259 --> 00:07:49,803 - Why did you stop that? 226 00:07:49,886 --> 00:07:51,846 - Because he lost his Medicaid two months ago. 227 00:07:51,930 --> 00:07:53,682 - He's so tight, nothing's getting through. 228 00:07:53,765 --> 00:07:55,225 - Mel, EpiPen. - On it. 229 00:07:55,308 --> 00:07:56,726 - 0.3 milligrams. 230 00:07:56,810 --> 00:07:59,896 - That may open his lungs so the nebs can work. 231 00:07:59,938 --> 00:08:01,898 - All right, Grady, shot in the thigh. 232 00:08:01,982 --> 00:08:04,109 - [grunts] 233 00:08:04,192 --> 00:08:06,903 [beeping] 234 00:08:06,987 --> 00:08:08,738 - Hey. 235 00:08:08,822 --> 00:08:10,240 - Something to scan? 236 00:08:10,281 --> 00:08:11,741 - Critical labs on North Three. 237 00:08:11,825 --> 00:08:13,368 - Oh, it's, uh-- it's not my patient. 238 00:08:13,451 --> 00:08:14,786 - She's about to be. 239 00:08:16,621 --> 00:08:18,873 - I'm, uh-- I'm off the clock, so... 240 00:08:18,957 --> 00:08:21,543 - These were ordered three hours ago from triage, 241 00:08:21,584 --> 00:08:24,004 so, technically, she is a day-shift patient. 242 00:08:24,087 --> 00:08:25,255 Just get the intern started. 243 00:08:25,338 --> 00:08:26,840 I got a meeting upstairs with admin 244 00:08:26,923 --> 00:08:28,842 to get things back on track. 245 00:08:28,925 --> 00:08:30,593 - Sorry. Everyone else is tied up. 246 00:08:30,635 --> 00:08:31,928 - That's OK. 247 00:08:32,011 --> 00:08:33,138 How'd you get stuck on night shift 248 00:08:33,221 --> 00:08:34,304 for your first rotation? 249 00:08:34,389 --> 00:08:35,765 - Just lucky, I guess. 250 00:08:35,849 --> 00:08:37,308 - Yeah, if you like a good horror movie. 251 00:08:37,392 --> 00:08:38,643 - [chuckles] 252 00:08:38,727 --> 00:08:40,602 - Where was med school? - Uh, UC Irvine. 253 00:08:40,687 --> 00:08:42,438 - California, right? - Yep. 254 00:08:42,480 --> 00:08:43,648 - Pittsburgh's a little different. 255 00:08:43,732 --> 00:08:44,899 - Yeah, a lot more humidity. 256 00:08:44,983 --> 00:08:45,942 - Yeah, that'll go away 257 00:08:46,026 --> 00:08:47,902 with your first foot of snow. 258 00:08:47,986 --> 00:08:50,655 Uh, hi, Mrs. Davis. 259 00:08:50,739 --> 00:08:52,741 I am Dr. McKay. This is Doctor... 260 00:08:52,824 --> 00:08:54,951 - Toomarian. - Hello. 261 00:08:55,035 --> 00:08:58,121 - Uh, your labs show a lot of inflammation in your liver. 262 00:08:58,163 --> 00:09:01,458 - Is that why I'm so nauseated? - Definitely, yeah. 263 00:09:01,541 --> 00:09:04,586 Have you, um, noticed a change in your skin coloration? 264 00:09:04,669 --> 00:09:06,629 - I've been using this bronzing cream 265 00:09:06,671 --> 00:09:09,299 so I don't look like a ghost in my bathing suit. 266 00:09:09,340 --> 00:09:11,259 - Do you remember the name of the bronzer? 267 00:09:11,342 --> 00:09:12,802 It could have a chemical that can cause-- 268 00:09:12,844 --> 00:09:14,804 - Oh, no, no, it's 100% natural. 269 00:09:14,888 --> 00:09:18,099 It's DHA from sugar beets. - OK. 270 00:09:18,183 --> 00:09:20,268 - Why would my liver be inflamed? 271 00:09:20,351 --> 00:09:22,228 - Uh, there's a lot of possibilities. 272 00:09:22,312 --> 00:09:24,064 - Are you taking any prescription medications? 273 00:09:24,147 --> 00:09:25,065 - Not a single one. 274 00:09:25,148 --> 00:09:26,649 - Tylenol? - God, no. 275 00:09:26,691 --> 00:09:28,818 - We have to ask everybody about injection drug use. 276 00:09:28,902 --> 00:09:29,986 - Never. 277 00:09:30,028 --> 00:09:31,654 - Raw clams or oysters? 278 00:09:31,696 --> 00:09:33,490 - I'm a vegan. 279 00:09:33,531 --> 00:09:35,658 - One step at a time, OK? 280 00:09:35,742 --> 00:09:36,910 We'll be back. 281 00:09:38,244 --> 00:09:40,121 - Digby, Haas, now on the big board. 282 00:09:40,205 --> 00:09:41,122 - Progress. 283 00:09:41,164 --> 00:09:42,123 - So he's just been waiting 284 00:09:42,165 --> 00:09:43,792 in the hall the whole time? 285 00:09:43,875 --> 00:09:46,753 OK, well, can you maybe get to him next? 286 00:09:48,004 --> 00:09:50,131 Thank you. [sighs] 287 00:09:50,215 --> 00:09:51,800 Duke goes to CT, and they bump him. 288 00:09:51,841 --> 00:09:54,302 - Yeah, he may end up waiting for hours over there. 289 00:09:54,344 --> 00:09:56,805 - Oh, look at that. 7:15 already. 290 00:09:56,888 --> 00:09:58,723 - Just a few more loose ends to tie up. 291 00:09:58,807 --> 00:10:01,976 - You got more loose ends than a macramé wall hanging. 292 00:10:02,060 --> 00:10:04,270 My mom had one. Took up the whole goddamn wall. 293 00:10:04,354 --> 00:10:05,980 Seriously, you should think about signing out 294 00:10:06,064 --> 00:10:07,774 and hitting the road. - Yeah, maybe you should too. 295 00:10:07,857 --> 00:10:09,526 Oh, that's right, you sent Lena home. 296 00:10:09,567 --> 00:10:11,361 Are you planning on calling in a replacement, 297 00:10:11,444 --> 00:10:13,196 or are you just gonna work till sunrise? 298 00:10:13,238 --> 00:10:14,614 - If I have to. 299 00:10:14,697 --> 00:10:16,699 - Oh, so you get to go the extra mile, 300 00:10:16,741 --> 00:10:19,202 and the rest of us just get accused of being martyrs. 301 00:10:19,244 --> 00:10:20,620 - Robby. - Excuse me. 302 00:10:22,580 --> 00:10:24,499 What's the word? - No subdural, no epidural. 303 00:10:24,582 --> 00:10:26,501 - Diffuse brain swelling with effacement 304 00:10:26,584 --> 00:10:28,211 and compression of the ventricles. 305 00:10:28,253 --> 00:10:30,380 - C-spine? Chest-abdomen-pelvis? 306 00:10:30,463 --> 00:10:32,715 - Uh, left pulmonary contusion, no intra-abdominal hemorrhage. 307 00:10:32,757 --> 00:10:33,883 - Which means I'm off the hook. 308 00:10:33,925 --> 00:10:35,343 I'll send Neurosurgery down. 309 00:10:35,426 --> 00:10:37,887 - If he doesn't need the OR, why Neurosurgery? 310 00:10:37,929 --> 00:10:39,264 - Wait and see. - Let's get busy. 311 00:10:39,347 --> 00:10:40,557 CVP and an art line. 312 00:10:40,598 --> 00:10:43,726 - Orlando. Orlando, squeeze my hand. 313 00:10:43,768 --> 00:10:46,062 [beeping] Open your eyes. 314 00:10:46,146 --> 00:10:48,606 - We already know his GCS is going to be three. 315 00:10:48,690 --> 00:10:50,608 - Hey, Javadi, anti-seizure prophylaxis? 316 00:10:50,692 --> 00:10:52,610 - Keppra, 20 migs per kilo. - Mixing it now. 317 00:10:52,694 --> 00:10:54,279 - Gotta get this brain swelling down, Samira. 318 00:10:54,362 --> 00:10:55,488 How we gonna do that? 319 00:10:56,781 --> 00:10:58,241 Samira? - What? 320 00:10:58,324 --> 00:11:01,452 - We have to lower the intracranial pressure. 321 00:11:01,536 --> 00:11:03,204 - Mannitol. - Not the best. 322 00:11:03,288 --> 00:11:04,539 Can cause diuresis and hypotension. 323 00:11:04,622 --> 00:11:05,915 - Then hypertonic saline. 324 00:11:05,957 --> 00:11:08,418 - 23%. 50 cc's through a central line. 325 00:11:08,459 --> 00:11:10,253 [beeping] 326 00:11:10,295 --> 00:11:11,838 - Still tight as a drum. 327 00:11:11,921 --> 00:11:12,922 - Five minutes since the epi. 328 00:11:13,006 --> 00:11:14,340 - He can have one more EpiPen. 329 00:11:14,424 --> 00:11:16,092 - Sats are borderline, 87. 330 00:11:16,134 --> 00:11:17,510 - How about BiPap? 10 over 5. 331 00:11:17,594 --> 00:11:19,679 - Yes, with in-line nebs. 332 00:11:19,762 --> 00:11:21,514 - All right, Grady, shot number two. 333 00:11:21,598 --> 00:11:23,725 - Might as well throw in some magnesium, 50 per kilo. 334 00:11:23,808 --> 00:11:25,059 - I'm sorry. He's not ventilating. 335 00:11:25,143 --> 00:11:26,436 We should be ready to intubate. 336 00:11:26,477 --> 00:11:27,770 - With an asthma patient? 337 00:11:27,854 --> 00:11:29,731 There's a high risk of cardiac arrest. 338 00:11:29,772 --> 00:11:31,941 - Naomi, has he ever been put on a breathing machine before? 339 00:11:32,025 --> 00:11:33,610 - Never. - Hospitalized? 340 00:11:33,693 --> 00:11:35,570 - No, we could always break him with the Symbicort. 341 00:11:35,653 --> 00:11:37,030 - We're gonna give the current treatment 342 00:11:37,113 --> 00:11:39,115 a few more minutes to help him turn the corner. 343 00:11:39,157 --> 00:11:42,243 [machines beeping] 344 00:11:42,327 --> 00:11:44,120 - I could probably do this myself 345 00:11:44,204 --> 00:11:45,580 now that my cast is off. 346 00:11:45,663 --> 00:11:47,457 - Oh, that's OK. 347 00:11:47,540 --> 00:11:49,209 I don't mind. 348 00:11:53,087 --> 00:11:55,006 - How long have you been a nurse? 349 00:11:56,382 --> 00:11:58,092 - This is my first day. 350 00:12:00,762 --> 00:12:02,805 - You're doing really good. 351 00:12:04,724 --> 00:12:06,309 - Thank you. 352 00:12:10,313 --> 00:12:11,981 - Oh, shit, you OK? - Yeah. 353 00:12:12,065 --> 00:12:13,483 There's water on the floor. 354 00:12:13,566 --> 00:12:14,984 - Sorry! I--I might have spilled. 355 00:12:15,068 --> 00:12:16,444 - Yeah, no worries. 356 00:12:16,527 --> 00:12:18,488 We're gonna have to sort these all by patient 357 00:12:18,529 --> 00:12:20,281 before we scan them. 358 00:12:20,323 --> 00:12:22,951 - Is, uh, Joy still around? 359 00:12:23,034 --> 00:12:25,620 - I heard she left at 6:59. 360 00:12:25,703 --> 00:12:27,622 - Smart girl. - Mm-hmm. 361 00:12:27,705 --> 00:12:29,791 - You know what? Find Ogilvie. He's such an ass-kisser. 362 00:12:29,874 --> 00:12:31,459 He might stay and scan all the charts himself. 363 00:12:31,501 --> 00:12:33,628 - Oh, he, uh, scrubbed in in the OR, 364 00:12:33,711 --> 00:12:35,505 scrubbed in on the ruptured triple-A. 365 00:12:35,588 --> 00:12:37,257 - Oh, the kidney stone that wasn't. 366 00:12:37,340 --> 00:12:39,133 That'll be four hours at least. 367 00:12:41,052 --> 00:12:44,389 So are you still going to Amy's after work? 368 00:12:44,472 --> 00:12:46,349 - Yeah, maybe just for tonight, 369 00:12:46,391 --> 00:12:48,768 after Robby briefs me on all the house stuff. 370 00:12:49,811 --> 00:12:51,229 - Sounds fun. 371 00:12:51,312 --> 00:12:52,563 - [scoffs] 372 00:12:52,647 --> 00:12:54,565 When he asked, it was hard to say no. 373 00:12:54,649 --> 00:12:56,234 - Sure. [sighs] 374 00:12:58,236 --> 00:13:00,405 It's gonna be very weird without him here. 375 00:13:00,488 --> 00:13:01,864 - Yeah. 376 00:13:01,906 --> 00:13:04,367 You think Dr. Al-Hashimi can handle it? 377 00:13:04,450 --> 00:13:05,910 - In a word, no. 378 00:13:05,994 --> 00:13:07,370 - She's smart. 379 00:13:07,412 --> 00:13:08,663 - It takes more than that. 380 00:13:08,746 --> 00:13:10,248 - Yeah, well, at least 381 00:13:10,331 --> 00:13:11,666 it's only three months. 382 00:13:11,749 --> 00:13:13,793 - Yeah, three long months. 383 00:13:13,876 --> 00:13:15,545 Then you need to find a new home. 384 00:13:15,586 --> 00:13:17,839 - [chuckles] Not necessarily. 385 00:13:17,880 --> 00:13:19,882 I mean, if I wanted, I could just check on 386 00:13:19,966 --> 00:13:23,011 Robby's house once or twice a day, you know. 387 00:13:23,094 --> 00:13:24,804 - Why would you do that? 388 00:13:26,097 --> 00:13:28,224 - I don't know. Why not? 389 00:13:28,308 --> 00:13:31,227 [beeping, whirring] 390 00:13:31,311 --> 00:13:32,729 - Hypertonic's in. 391 00:13:32,770 --> 00:13:34,856 - Maintenance LR in the AC. 392 00:13:34,939 --> 00:13:36,649 - Looks like a halo sign. 393 00:13:36,733 --> 00:13:39,235 - Cerebrospinal fluid from a basilar skull fracture. 394 00:13:39,277 --> 00:13:43,239 - The halo sign is neither sensitive nor specific for CSF. 395 00:13:43,281 --> 00:13:45,533 Saline, tap water, and runny noses 396 00:13:45,616 --> 00:13:46,743 all separate from blood. 397 00:13:46,784 --> 00:13:48,244 - Hello, Linda. - Robby. 398 00:13:48,286 --> 00:13:50,705 - Division chief working on a holiday weekend. 399 00:13:50,788 --> 00:13:52,790 - Well, somebody's got to. 400 00:13:52,874 --> 00:13:55,585 Saw the scans. This guy needs an EVD. 401 00:13:55,668 --> 00:13:57,920 - External ventricular drain to take down the pressure. 402 00:13:57,962 --> 00:14:01,132 - Because CPP equals "MAP" minus ICP. 403 00:14:01,215 --> 00:14:03,801 - Cerebral perfusion pressure in the brain 404 00:14:03,885 --> 00:14:05,762 equals mean arterial blood pressure 405 00:14:05,803 --> 00:14:07,263 minus the pressure in the skull. 406 00:14:07,305 --> 00:14:08,931 - ICP less than 22 407 00:14:09,015 --> 00:14:11,476 predicts survival and favorable outcome. 408 00:14:11,559 --> 00:14:15,897 CPP from 60 to 70 reduces morbidity and mortality. 409 00:14:15,980 --> 00:14:17,273 Can somebody assist? 410 00:14:17,357 --> 00:14:18,441 - Dr. Mohan? 411 00:14:18,524 --> 00:14:19,692 - I'm good. 412 00:14:20,777 --> 00:14:22,278 - Samira, you should lend a hand. 413 00:14:22,320 --> 00:14:24,030 - I said I'm good. 414 00:14:24,113 --> 00:14:26,908 - Javadi? - I don't think so. 415 00:14:26,991 --> 00:14:28,451 - Javadi? 416 00:14:28,493 --> 00:14:31,871 As in, daughter of Raymond and Eileen? 417 00:14:31,954 --> 00:14:33,873 I was at your mother's baby shower. 418 00:14:33,956 --> 00:14:35,290 [chuckles] She was a resident. 419 00:14:35,333 --> 00:14:36,751 You were in utero. 420 00:14:38,211 --> 00:14:39,295 I don't know how she got through 421 00:14:39,337 --> 00:14:41,089 motherhood and training. 422 00:14:41,172 --> 00:14:42,632 Feel free to join me. 423 00:14:42,715 --> 00:14:44,550 - Oh, my--my shift was over a while ago. 424 00:14:44,634 --> 00:14:45,968 - OK. 425 00:14:46,052 --> 00:14:48,012 Masks all around. Two sterile gowns. 426 00:14:48,096 --> 00:14:50,640 We brought the surgical towels. Just need some Betadine. 427 00:14:50,723 --> 00:14:52,392 - This is kind of an amazing opportunity. 428 00:14:53,518 --> 00:14:54,685 - I'm exhausted. 429 00:14:54,769 --> 00:14:56,646 - The Chief of Neurosurgery is here. 430 00:14:56,729 --> 00:14:58,147 She's kind of a legend. 431 00:14:58,189 --> 00:15:00,149 - Maybe one of the night residents can do it. 432 00:15:00,233 --> 00:15:02,443 - Is this about the volvulus case from earlier? 433 00:15:02,527 --> 00:15:03,986 'Cause if it is, you made a mistake. 434 00:15:04,070 --> 00:15:05,947 You need to move on. 435 00:15:06,030 --> 00:15:07,615 I do not want to come back here and find that 436 00:15:07,698 --> 00:15:10,827 you've applied for a residency in derm. 437 00:15:10,868 --> 00:15:13,496 Step up to the plate. Do it. 438 00:15:13,538 --> 00:15:14,664 Javadi will assist. 439 00:15:14,747 --> 00:15:16,332 - Excellent. 440 00:15:16,416 --> 00:15:18,126 You know, I think Eileen did her first EVD with me 441 00:15:18,209 --> 00:15:20,670 back when I was a brand-new assistant professor. 442 00:15:20,711 --> 00:15:22,004 [scoffs] 443 00:15:22,046 --> 00:15:23,548 Time flies. 444 00:15:25,216 --> 00:15:26,342 - [raspy breathing] 445 00:15:26,426 --> 00:15:27,510 - How you doing, Grady? 446 00:15:27,552 --> 00:15:28,970 - Still retracting. 447 00:15:29,053 --> 00:15:30,680 - Any improvement? - Not really. 448 00:15:30,721 --> 00:15:31,889 - You feeling tired? 449 00:15:33,683 --> 00:15:36,185 - Do we have Aerogen in the ED? - Just in the unit. 450 00:15:36,227 --> 00:15:37,812 - How fast can you get back? 451 00:15:37,895 --> 00:15:38,980 - Two minutes if I take the stairs. 452 00:15:39,063 --> 00:15:40,022 - Go. 453 00:15:40,064 --> 00:15:41,357 - Uh, Aerogen? 454 00:15:41,399 --> 00:15:43,317 - It has a 5-millimeter mesh 455 00:15:43,359 --> 00:15:46,612 that vibrates over 120,000 times per second. 456 00:15:51,742 --> 00:15:53,119 - Dr. Al-Hashimi? 457 00:15:57,415 --> 00:15:58,833 - You OK? 458 00:16:01,252 --> 00:16:03,296 - Uh, you were telling us about Aerogen. 459 00:16:04,422 --> 00:16:05,840 - Dr. Shen can explain. 460 00:16:07,175 --> 00:16:10,052 - It produces droplets in the 2- to 5-micron range 461 00:16:10,136 --> 00:16:12,096 for medication delivery. 462 00:16:19,395 --> 00:16:21,856 - How's it going? - Just about to start. 463 00:16:21,939 --> 00:16:23,065 - Securing the art line here. 464 00:16:23,107 --> 00:16:25,318 Measure twice, cut once. 465 00:16:25,401 --> 00:16:29,071 We enter 11 centimeters back from the nasion, 466 00:16:29,155 --> 00:16:30,740 3 centimeters lateral. 467 00:16:30,781 --> 00:16:32,325 - Without any direct imaging? 468 00:16:32,408 --> 00:16:35,369 - No, straight shot into the lateral ventricle-- 469 00:16:35,453 --> 00:16:38,915 tried and true since 1890. 470 00:16:38,998 --> 00:16:41,334 OK, go ahead with the incision. 471 00:16:42,835 --> 00:16:45,004 - Hey, you worked with Dr. Al-Hashimi at the VA. 472 00:16:45,087 --> 00:16:46,088 - I did. 473 00:16:46,172 --> 00:16:47,590 - For how long? 474 00:16:47,673 --> 00:16:49,592 - During my R2 rotation 475 00:16:49,634 --> 00:16:51,844 and then one again last year. 476 00:16:55,181 --> 00:16:58,267 - OK. Hand drill's all set. 477 00:16:58,351 --> 00:16:59,727 - Maybe you should do this part. 478 00:16:59,810 --> 00:17:01,103 - No, no, there's a safety stop here. 479 00:17:01,145 --> 00:17:02,605 You can't go too deep. 480 00:17:02,647 --> 00:17:04,690 It's not brain surgery. 481 00:17:06,858 --> 00:17:08,109 OK. 482 00:17:11,321 --> 00:17:13,074 Stay perpendicular. - OK. 483 00:17:13,156 --> 00:17:14,992 - Good. 484 00:17:15,076 --> 00:17:16,786 All right, now, four turns 485 00:17:16,827 --> 00:17:17,954 to get through the outer table... 486 00:17:18,037 --> 00:17:19,288 - Yep. - Then half turns 487 00:17:19,329 --> 00:17:20,998 till you penetrate the skull. 488 00:17:24,627 --> 00:17:26,921 - [exhaling slowly] 489 00:17:31,801 --> 00:17:35,388 Three, four. 490 00:17:35,471 --> 00:17:36,722 One... 491 00:17:38,683 --> 00:17:40,309 - Holy smoke! 492 00:17:40,351 --> 00:17:43,729 I thought it was Tom Cruise for a second over here. 493 00:17:43,813 --> 00:17:46,774 Nice job. How's that feel, Digby? 494 00:17:46,857 --> 00:17:48,317 - Pretty good. - I bet. 495 00:17:48,401 --> 00:17:49,652 What do you say we trim up 496 00:17:49,694 --> 00:17:51,529 those gorgeous locks of yours now? 497 00:17:53,114 --> 00:17:55,116 - I don't like having my hair cut. 498 00:17:55,157 --> 00:17:58,452 - I get it, Rapunzel, but you need your ears lowered. 499 00:17:58,536 --> 00:18:00,538 You'll feel better with a fresh summer look 500 00:18:00,621 --> 00:18:02,665 that won't go unnoticed by the ladies. 501 00:18:04,542 --> 00:18:06,836 - Maybe just a trim? - Great. 502 00:18:06,919 --> 00:18:09,046 I'm thinking a pixie cut. 503 00:18:09,130 --> 00:18:10,840 - What? - I'm kidding. 504 00:18:10,923 --> 00:18:12,675 I cut my husband Benji's hair all the time. 505 00:18:12,717 --> 00:18:14,176 Trust me, you're gonna look fabulous. 506 00:18:14,218 --> 00:18:15,886 When's the last time you had a haircut? 507 00:18:17,430 --> 00:18:20,683 - Maybe my daughter's wedding a few years ago. 508 00:18:20,725 --> 00:18:22,018 - Where? 509 00:18:22,059 --> 00:18:23,185 - St. Sebastian, 510 00:18:23,269 --> 00:18:25,187 Our Lady of Mount Carmel Parish. 511 00:18:25,271 --> 00:18:27,857 - Does your daughter know where you are? 512 00:18:27,898 --> 00:18:31,027 - Of course. We all live in Pittsburgh. 513 00:18:31,068 --> 00:18:33,321 In fact, they live in my old house. 514 00:18:35,906 --> 00:18:38,200 - Your daughter lives in your house? 515 00:18:38,242 --> 00:18:40,036 - Yep. 516 00:18:40,119 --> 00:18:42,622 - Where do you live? 517 00:18:42,705 --> 00:18:44,915 - Wherever I want. 518 00:18:46,626 --> 00:18:48,711 - You're gonna pass it 5 to 6 centimeters 519 00:18:48,753 --> 00:18:51,297 from the inner table of the skull, OK? 520 00:18:53,257 --> 00:18:55,343 Centered... 521 00:18:55,426 --> 00:18:57,178 perpendicular... 522 00:18:57,261 --> 00:18:59,096 aiming for the medial canthus. 523 00:19:00,181 --> 00:19:01,766 All yours. 524 00:19:01,849 --> 00:19:03,100 - A-and just keep going? 525 00:19:03,184 --> 00:19:04,560 - You'll feel a pop when you pass 526 00:19:04,644 --> 00:19:07,188 the ependymal lining. 527 00:19:07,271 --> 00:19:08,939 - Art line is calibrated. Good to go. 528 00:19:09,023 --> 00:19:12,902 - Titrate the nicardipine to a MAP of 85, please. 529 00:19:12,943 --> 00:19:14,278 - And if we can get the intracranial pressure 530 00:19:14,362 --> 00:19:16,197 down to 20? 531 00:19:17,615 --> 00:19:18,949 Dr. Mohan? 532 00:19:19,033 --> 00:19:20,409 - I'm sorry. 533 00:19:20,493 --> 00:19:22,745 - MAP of 85, ICP of 20? 534 00:19:22,787 --> 00:19:25,748 - Um, cerebral perfusion pressure 65. 535 00:19:25,790 --> 00:19:28,501 - Which gives him the best shot at survival. 536 00:19:28,584 --> 00:19:30,002 A third of patients like this die. 537 00:19:30,086 --> 00:19:32,588 Half have long-term disability. 538 00:19:32,630 --> 00:19:34,548 We'll know in two weeks if there's a possibility 539 00:19:34,632 --> 00:19:36,884 for a good prognosis. 540 00:19:36,967 --> 00:19:38,094 - Felt a pop. 541 00:19:38,135 --> 00:19:39,804 - Remove the stylet. 542 00:19:42,306 --> 00:19:45,059 OK, let it drain a bit. 543 00:19:46,977 --> 00:19:49,230 And now pinch it shut. 544 00:19:50,690 --> 00:19:51,607 Perfect. 545 00:19:51,691 --> 00:19:53,526 - BP is down, 190 over 88. 546 00:19:53,609 --> 00:19:54,985 Heart rate's 67. 547 00:19:59,031 --> 00:20:00,950 - How are you guys doing? 548 00:20:00,991 --> 00:20:02,827 - Yeah, making some progress. 549 00:20:02,910 --> 00:20:04,161 - You seen Abbot? 550 00:20:04,245 --> 00:20:05,955 - Not since rounds. 551 00:20:06,038 --> 00:20:08,666 - He asked me to see a patient with the night intern. 552 00:20:08,749 --> 00:20:10,292 - [yawning] And you said yes? 553 00:20:10,376 --> 00:20:13,170 - 48-year-old woman, new onset jaundice, 554 00:20:13,254 --> 00:20:16,298 elevated liver enzymes, no history of alcohol use. 555 00:20:16,340 --> 00:20:17,633 - Take your pick-- 556 00:20:17,675 --> 00:20:20,302 hepatitis A, B, C, D, or E. 557 00:20:20,386 --> 00:20:23,180 - No risk factors, no fever. - Tylenol? 558 00:20:23,264 --> 00:20:25,099 - Never, and no prescription meds. 559 00:20:25,182 --> 00:20:27,393 - Does she eat polar bear liver? 560 00:20:28,561 --> 00:20:30,855 It can cause vitamin A toxicity. 561 00:20:31,731 --> 00:20:32,773 - No. - Yeah. 562 00:20:32,815 --> 00:20:33,983 - She, uh, doesn't eat meat, 563 00:20:34,066 --> 00:20:35,651 kind of a health nut. 564 00:20:35,693 --> 00:20:37,069 - Well, maybe she's gulping down 565 00:20:37,153 --> 00:20:38,654 cod liver oil to prevent measles. 566 00:20:38,738 --> 00:20:40,906 - No. Vegan, no fish. 567 00:20:40,990 --> 00:20:42,992 Would you, uh, mind laying eyes on her? 568 00:20:43,033 --> 00:20:44,618 - [sighs] Seriously? 569 00:20:44,660 --> 00:20:46,912 - You have a way of figuring out the weird stuff. 570 00:20:46,996 --> 00:20:48,539 - Take the compliment. 571 00:20:49,874 --> 00:20:51,167 - OK, fine. 572 00:20:51,250 --> 00:20:53,502 Five minutes at the bedside-- that's it. 573 00:20:53,544 --> 00:20:55,463 I'm already gonna be here for hours as it is. 574 00:20:55,546 --> 00:20:57,673 - Thank you. 575 00:20:57,757 --> 00:20:59,341 - What am I doing-- 576 00:21:02,553 --> 00:21:04,847 - Definitely improving. - Tidal volume's up. 577 00:21:04,889 --> 00:21:07,349 - Wheezes now expiratory only. 578 00:21:07,391 --> 00:21:08,893 - Oh, making some progress. 579 00:21:08,976 --> 00:21:11,020 - You feeling better, baby? 580 00:21:11,103 --> 00:21:14,315 You scared the shit out of me. - Language! 581 00:21:14,398 --> 00:21:16,692 - Does he have a primary-care doctor? 582 00:21:16,734 --> 00:21:18,027 - Not anymore. 583 00:21:18,110 --> 00:21:20,654 - How do you get his prescriptions renewed? 584 00:21:20,738 --> 00:21:22,865 - Neighborhood clinic. We pay cash. 585 00:21:22,907 --> 00:21:24,658 Albuterol's cheap. - Symbicort? 586 00:21:24,742 --> 00:21:27,578 - Without Medicaid, 400 bucks a month. 587 00:21:27,661 --> 00:21:29,163 - Just for a little inhaler? 588 00:21:31,248 --> 00:21:33,709 - Trocar is on the tube. [inhales deeply] 589 00:21:33,751 --> 00:21:37,046 I tunnel underneath the scalp about 5 centimeters 590 00:21:37,129 --> 00:21:38,547 and poke through. 591 00:21:38,631 --> 00:21:40,424 - To prevent infection? - Mm-hmm, exactly. 592 00:21:41,884 --> 00:21:44,512 Now you hold the knuckle steady while I pull it through. 593 00:21:47,807 --> 00:21:49,975 And you can staple the wound shut. 594 00:21:51,435 --> 00:21:53,521 - That looks like something from Home Depot. 595 00:21:53,604 --> 00:21:55,356 - Yeah, big Fourth of July sale. 596 00:21:55,439 --> 00:21:56,690 - The brain pressure is measured by 597 00:21:56,774 --> 00:21:58,567 the height of the fluid column. 598 00:21:58,609 --> 00:22:01,070 We need to calibrate it to zero at the level of the tragus. 599 00:22:01,153 --> 00:22:03,113 - Stopcock's on, ready to attach. 600 00:22:03,197 --> 00:22:04,532 - First troponin's normal, 601 00:22:04,615 --> 00:22:06,951 but you need a second to rule out MI. 602 00:22:07,034 --> 00:22:08,869 - Hey, can you step out for a second? 603 00:22:15,000 --> 00:22:16,418 - I really did do everything I could 604 00:22:16,460 --> 00:22:17,962 to try to make Orlando stay. 605 00:22:18,045 --> 00:22:18,963 - Yeah, I don't doubt it. 606 00:22:19,046 --> 00:22:19,964 I wanted to ask you about 607 00:22:20,047 --> 00:22:22,216 Dr. Al-Hashimi at the VA. 608 00:22:22,258 --> 00:22:24,927 Did you ever notice anything unusual about her behavior? 609 00:22:24,969 --> 00:22:26,929 - Um, like what? 610 00:22:26,971 --> 00:22:29,557 - Lapses in focus, attention? 611 00:22:29,598 --> 00:22:32,184 - No, she was always on top of her game. 612 00:22:35,145 --> 00:22:38,774 But this morning when she was checking labs on Baby Jane Doe, 613 00:22:38,816 --> 00:22:41,193 it was like she zoned out for a few seconds. 614 00:22:42,653 --> 00:22:44,488 Maybe she was just tired. 615 00:22:46,448 --> 00:22:49,034 - [inhales deeply] 616 00:22:49,118 --> 00:22:50,578 [sighs] 617 00:22:51,495 --> 00:22:53,747 - No congestion, nodules, 618 00:22:53,831 --> 00:22:55,207 or cirrhosis. 619 00:22:55,291 --> 00:22:56,876 - Good-looking liver. 620 00:22:56,959 --> 00:22:58,752 - I should not be sick. 621 00:22:58,836 --> 00:23:01,380 I work so hard to stay healthy-- 622 00:23:01,463 --> 00:23:04,300 diet, exercise, eight hours of sleep. 623 00:23:04,341 --> 00:23:08,137 - I can't remember the last time I got eight hours. 624 00:23:08,178 --> 00:23:10,139 - Maybe you should try sleepmaxxing. 625 00:23:10,180 --> 00:23:12,016 - Oh, you definitely should. 626 00:23:12,099 --> 00:23:14,977 - Yeah, cold room, white noise, eye shades. 627 00:23:15,019 --> 00:23:18,814 - Kiwis before bedtime, lettuce water, mouth taping. 628 00:23:18,856 --> 00:23:20,482 - Who do you follow for health? 629 00:23:20,524 --> 00:23:22,818 - A few naturopaths and some functional healers. 630 00:23:22,860 --> 00:23:24,778 - Do you--do you buy vitamins from them? 631 00:23:24,862 --> 00:23:26,614 - Oh, no, no, I don't take vitamins. 632 00:23:26,655 --> 00:23:29,366 Food is the best medicine-- kale, blueberries, 633 00:23:29,450 --> 00:23:31,994 kidney beans, turmeric. - Turmeric? 634 00:23:32,036 --> 00:23:33,662 - Uh, how long have you been taking that? 635 00:23:33,746 --> 00:23:36,248 - For a few months. It's an anti-inflammatory. 636 00:23:36,332 --> 00:23:38,792 It detoxes the body, and it can prevent Alzheimer's. 637 00:23:38,876 --> 00:23:40,252 - How much do you take? 638 00:23:40,336 --> 00:23:42,254 - 500 milligram capsules, 639 00:23:42,338 --> 00:23:43,589 but I take five a day. 640 00:23:45,257 --> 00:23:46,800 What? 641 00:23:46,884 --> 00:23:48,636 - With doses that large of turmeric, 642 00:23:48,719 --> 00:23:51,263 there have been cases of liver failure. 643 00:23:51,347 --> 00:23:52,973 - From eating a spice? 644 00:23:53,057 --> 00:23:55,643 - All right, Digby, I think you're good to go. 645 00:23:55,726 --> 00:23:57,811 - Mm-hmm. Would you like to see? 646 00:24:08,155 --> 00:24:09,406 - [sniffles] 647 00:24:10,407 --> 00:24:12,826 I haven't looked like this in a long time. 648 00:24:12,910 --> 00:24:15,329 - Your family won't recognize you. 649 00:24:17,247 --> 00:24:19,333 - Then how will they find me? 650 00:24:19,416 --> 00:24:21,335 They--they won't know what I look like. 651 00:24:21,418 --> 00:24:22,378 They won't know this is me. 652 00:24:22,461 --> 00:24:23,545 - Of course they will. 653 00:24:23,587 --> 00:24:24,755 They know your voice. 654 00:24:24,838 --> 00:24:26,590 They know where you hang out. 655 00:24:26,674 --> 00:24:30,427 They even remember that you used to look like this. 656 00:24:30,511 --> 00:24:32,554 They remember the wedding. 657 00:24:35,474 --> 00:24:37,685 - Did you dance with your daughter 658 00:24:37,768 --> 00:24:39,186 at her wedding? 659 00:24:40,604 --> 00:24:42,731 - I did. 660 00:24:42,773 --> 00:24:45,859 - Then she will always remember you. 661 00:24:48,570 --> 00:24:50,114 - Yeah. - OK. 662 00:24:51,615 --> 00:24:53,158 - Hey, I was just looking for you. 663 00:24:53,242 --> 00:24:54,493 - What's up? - You tell me. 664 00:24:54,576 --> 00:24:56,829 The, uh, asthma patient. - What about him? 665 00:24:56,912 --> 00:24:58,205 - Seemed like you were hesitating 666 00:24:58,288 --> 00:24:59,873 talking about using Aerogen. 667 00:24:59,957 --> 00:25:01,583 I was wondering if you were having second thoughts. 668 00:25:01,625 --> 00:25:03,335 - No. Just thinking. 669 00:25:03,419 --> 00:25:04,586 - About? 670 00:25:04,670 --> 00:25:06,588 - The best treatment plan for the patient. 671 00:25:06,672 --> 00:25:08,716 And I think he's on it. 672 00:25:08,799 --> 00:25:10,217 Anything else? - I don't know. 673 00:25:10,300 --> 00:25:12,761 You tell me. Anything else I need to know? 674 00:25:12,845 --> 00:25:14,179 - I don't think so. 675 00:25:15,806 --> 00:25:17,266 - This is Dr. Robby in the ED. 676 00:25:17,307 --> 00:25:18,934 I'm checking on a patient, Ekins. 677 00:25:19,018 --> 00:25:21,478 - We can take Larson and Stevens off the dry-erase. 678 00:25:21,562 --> 00:25:22,563 - Consider it done. 679 00:25:22,646 --> 00:25:23,772 - He's in the scanner now? 680 00:25:23,814 --> 00:25:25,232 Oh, great. 681 00:25:25,274 --> 00:25:26,275 No, I was just calling to confirm. 682 00:25:26,358 --> 00:25:27,609 Thank you. 683 00:25:27,651 --> 00:25:29,403 Any new information from upstairs? 684 00:25:29,486 --> 00:25:30,821 - Nothing we don't already know. 685 00:25:30,904 --> 00:25:32,489 - Same old story, huh? 686 00:25:32,573 --> 00:25:33,949 - You think we should take up a collection 687 00:25:33,991 --> 00:25:35,743 for Jesse for--for bail money? 688 00:25:35,826 --> 00:25:37,286 - They don't usually set bail 689 00:25:37,369 --> 00:25:39,121 until after you've appeared in front of a judge. 690 00:25:39,163 --> 00:25:40,956 - With the holiday, it's not likely to happen till Monday. 691 00:25:41,040 --> 00:25:43,125 - So he's gonna be locked up all weekend? 692 00:25:43,208 --> 00:25:44,877 - That sucks. 693 00:25:44,960 --> 00:25:46,879 - It does suck. 694 00:25:46,962 --> 00:25:49,923 - Dr. Langdon, Grady's worse-- much worse. 695 00:25:49,965 --> 00:25:52,718 - Need an attending? - Uh, no, we have Shen. 696 00:25:52,801 --> 00:25:54,136 - Sat's down to 83. 697 00:25:54,178 --> 00:25:56,221 - What's happening? - Give us a minute. 698 00:25:56,305 --> 00:25:57,723 - He's tiring out. 699 00:25:57,806 --> 00:25:59,767 Ketamine and rock. It's time to intubate. 700 00:25:59,850 --> 00:26:00,976 - I'll call Volk. 701 00:26:01,018 --> 00:26:02,728 - Ma'am, we have to put a tube 702 00:26:02,811 --> 00:26:03,979 down your son's windpipe 703 00:26:04,021 --> 00:26:05,439 so a machine can breathe for him. 704 00:26:05,522 --> 00:26:06,774 - [crying] Oh, my God. 705 00:26:06,857 --> 00:26:08,317 - Hold on, hold on. 706 00:26:08,358 --> 00:26:09,485 No lung sliding on the right. 707 00:26:09,568 --> 00:26:10,986 - Pneumothorax. 708 00:26:11,070 --> 00:26:13,030 - No need to intubate. 709 00:26:13,113 --> 00:26:14,323 - What's going on? 710 00:26:14,406 --> 00:26:16,325 - He has a collapsed lung. 711 00:26:16,366 --> 00:26:18,202 - There was no history of trauma 712 00:26:18,285 --> 00:26:19,703 that would have caused pneumothorax. 713 00:26:19,787 --> 00:26:21,789 - Glove up, Dr. King. 714 00:26:21,872 --> 00:26:24,124 - In asthma, you can get "air trapping." 715 00:26:24,208 --> 00:26:25,834 When the lungs can't fully exhale, 716 00:26:25,918 --> 00:26:27,211 eventually they overinflate, 717 00:26:27,294 --> 00:26:29,171 causing some of the tiny air sacs to burst. 718 00:26:29,213 --> 00:26:30,339 - How do you fix it? 719 00:26:30,422 --> 00:26:33,467 [rapid beeping] 720 00:26:34,635 --> 00:26:36,220 [air whooshing] - [gasping] 721 00:26:36,303 --> 00:26:37,346 - Like that. 722 00:26:42,935 --> 00:26:45,521 - It's a good thing Dr. Conley was here. 723 00:26:45,562 --> 00:26:46,814 - Yeah. - We should probably try 724 00:26:46,897 --> 00:26:48,357 to find him a Neuro-Critical ICU bed. 725 00:26:48,398 --> 00:26:49,942 We don't want to board a patient like this. 726 00:26:50,025 --> 00:26:51,610 - Mm-hmm. - Hey, Robby. 727 00:26:51,693 --> 00:26:54,196 - Hey, how did the scan go? - Fine. 728 00:26:54,238 --> 00:26:55,656 - It is probably gonna take a little while 729 00:26:55,739 --> 00:26:57,116 to get the results from the radiologist. 730 00:26:57,199 --> 00:26:58,534 - Well, that's not a problem. 731 00:26:58,617 --> 00:27:00,786 Nurse Vivi and I need a little time 732 00:27:00,869 --> 00:27:03,372 to coordinate our schedules over the next few months. 733 00:27:03,413 --> 00:27:04,373 - Really? - Yeah. 734 00:27:04,414 --> 00:27:05,374 I've always wanted to learn 735 00:27:05,415 --> 00:27:06,375 how to ride a motorcycle, 736 00:27:06,458 --> 00:27:07,876 and Duke offered to teach me. 737 00:27:07,960 --> 00:27:10,212 - Well, nobody knows motorcycles like Duke. 738 00:27:10,254 --> 00:27:12,631 - He's giving me the health care worker discount. 739 00:27:12,714 --> 00:27:13,924 - He's quite the gentleman. 740 00:27:14,007 --> 00:27:15,717 Let's get him back to his room. 741 00:27:15,801 --> 00:27:18,554 - How would next Saturday be for you, Vivi? 742 00:27:18,595 --> 00:27:21,890 Uh, maybe we could have some dinner after. 743 00:27:21,932 --> 00:27:23,517 - Dr. Mohan, Lorrie Diaz is here. 744 00:27:23,559 --> 00:27:25,227 She wants to see her husband. She's heading back. 745 00:27:25,310 --> 00:27:26,854 - OK, I'm on my way. 746 00:27:28,981 --> 00:27:30,899 Mrs. Diaz? - Hi. 747 00:27:30,983 --> 00:27:33,777 Did Orlando go up to his room yet? 748 00:27:33,861 --> 00:27:35,279 - No. Um-- 749 00:27:35,362 --> 00:27:37,406 - I brought him some dinner from Burgatory. 750 00:27:37,489 --> 00:27:38,782 It's a chicken burger-- 751 00:27:38,866 --> 00:27:40,409 no bun, just lettuce. 752 00:27:40,492 --> 00:27:43,203 Figured it would be better than hospital food. 753 00:27:46,456 --> 00:27:50,669 - He's being treated by our top brain-injury specialists. 754 00:27:50,752 --> 00:27:52,171 - Will he wake up? 755 00:27:52,254 --> 00:27:54,089 - We won't know for several weeks. 756 00:27:54,131 --> 00:27:56,675 - And then he could be back to normal? 757 00:27:56,758 --> 00:27:59,761 - Best-case scenario, it would take about a year 758 00:27:59,845 --> 00:28:02,431 before he could be independent at home. 759 00:28:02,472 --> 00:28:04,099 - And the worst case? 760 00:28:04,141 --> 00:28:07,644 - Round-the-clock nursing care for severe disability. 761 00:28:11,190 --> 00:28:13,358 - You let him leave? 762 00:28:13,442 --> 00:28:17,321 - He insisted on leaving to work at his second job. 763 00:28:17,404 --> 00:28:19,573 - You couldn't make him stay? 764 00:28:19,656 --> 00:28:22,576 - He was competent. He knew the risks. 765 00:28:22,659 --> 00:28:24,578 We honored his decision to leave. 766 00:28:24,661 --> 00:28:26,330 - Even if it was a stupid one? 767 00:28:26,413 --> 00:28:27,831 - I tried to stop him. 768 00:28:27,915 --> 00:28:29,458 Offered to get him all the supplies he'd need 769 00:28:29,541 --> 00:28:30,959 to take care of himself at home. 770 00:28:31,043 --> 00:28:33,503 But he left before I could give them to him. 771 00:28:33,587 --> 00:28:36,048 He said he couldn't afford to lose a paycheck. 772 00:28:43,555 --> 00:28:45,766 - Dr. Langdon. 773 00:28:45,849 --> 00:28:46,850 [door closes] 774 00:28:48,018 --> 00:28:49,645 Are you OK? 775 00:28:49,728 --> 00:28:52,814 - Yeah. I'm just kind of, uh... 776 00:28:52,856 --> 00:28:55,275 wondering if I'm really ready to be back here. 777 00:28:55,359 --> 00:28:57,569 - Well, of course you are. 778 00:28:57,653 --> 00:28:59,655 - Ten months is a long time. 779 00:28:59,738 --> 00:29:02,950 I almost killed that kid with an intubation. 780 00:29:03,033 --> 00:29:06,245 Didn't even occur to me to check for pneumothorax. 781 00:29:06,328 --> 00:29:07,955 - There wasn't any trauma to indicate-- 782 00:29:08,038 --> 00:29:09,206 - I should have caught it. - OK. 783 00:29:12,000 --> 00:29:13,627 - [sighs] 784 00:29:15,879 --> 00:29:17,172 - You know, I, um... 785 00:29:17,256 --> 00:29:19,007 [chair scraping] 786 00:29:19,091 --> 00:29:21,969 I had a deposition today, 787 00:29:22,010 --> 00:29:25,389 and all the lawyer's questions made me feel like 788 00:29:25,472 --> 00:29:27,808 I was a really, really bad doctor. 789 00:29:30,143 --> 00:29:33,689 We don't always get everything right the first time. 790 00:29:34,773 --> 00:29:37,234 You would have caught the collapsed lung. 791 00:29:37,317 --> 00:29:40,028 And it may have taken a minute, but you would have saved him. 792 00:29:41,238 --> 00:29:43,532 - I'm not sure Robby would agree with you. 793 00:29:43,615 --> 00:29:46,243 He's been riding me all day. 794 00:29:46,326 --> 00:29:48,161 - Well, Robby's leaving for three months. 795 00:29:48,245 --> 00:29:50,998 And, you know, with Robby gone... 796 00:29:51,081 --> 00:29:53,083 I really don't want you to leave either. 797 00:29:56,586 --> 00:29:59,172 That which does not kill me makes me stronger. 798 00:29:59,256 --> 00:30:02,467 - Wow, Friedrich Nietzsche. 799 00:30:02,551 --> 00:30:05,679 - Yeah, Nietzsche, yeah... 800 00:30:05,762 --> 00:30:08,015 not Kelly Clarkson. 801 00:30:08,098 --> 00:30:09,975 - [chuckles] 802 00:30:10,058 --> 00:30:11,977 - Hey, that's a thick one. 803 00:30:12,060 --> 00:30:14,855 - Yeah, Austin Green. Ogilvie's triple-A. 804 00:30:14,938 --> 00:30:17,858 [beeping, whirring] 805 00:30:17,941 --> 00:30:20,444 - Uh, G-R-E-E-N? 806 00:30:20,527 --> 00:30:21,903 - Yeah. Why? What are you doing? 807 00:30:21,945 --> 00:30:23,363 - Checking to see when we'll get Ogilvie 808 00:30:23,447 --> 00:30:25,240 back from the OR. 809 00:30:25,324 --> 00:30:27,284 Oh, shit. - What? 810 00:30:27,367 --> 00:30:29,077 - The guy didn't make it. 811 00:30:29,119 --> 00:30:31,371 He died on the table about 40 minutes ago. 812 00:30:31,455 --> 00:30:33,540 - Then where's Ogilvie? 813 00:30:33,623 --> 00:30:35,459 - Oh, man. 814 00:30:35,542 --> 00:30:38,086 His patient had a CT a year and a half ago 815 00:30:38,170 --> 00:30:40,422 that showed a 4-centimeter triple-A. 816 00:30:40,464 --> 00:30:42,090 - That's too small for surgery. 817 00:30:42,132 --> 00:30:43,425 - He was supposed to come back 818 00:30:43,467 --> 00:30:45,135 every six months for a repeat ultrasound, 819 00:30:45,218 --> 00:30:46,887 but looks like he didn't. 820 00:30:46,928 --> 00:30:49,556 - We would've seen that if the computers were working. 821 00:30:49,639 --> 00:30:51,224 Why wouldn't he tell Ogilvie? 822 00:30:51,308 --> 00:30:53,101 - [sighing] I don't know. Maybe he forgot all about it. 823 00:30:53,143 --> 00:30:55,187 Or Ogilvie didn't ask the right questions. 824 00:30:56,271 --> 00:30:58,231 - Dennis, hey, got a minute? 825 00:30:58,315 --> 00:31:00,776 - Uh, sure. What do you need? 826 00:31:00,817 --> 00:31:02,444 - Teenager with jewelry magnets 827 00:31:02,486 --> 00:31:04,446 stuck to both sides of her nasal septum. 828 00:31:04,488 --> 00:31:06,448 I tried to move them with a plastic curette. 829 00:31:06,490 --> 00:31:08,283 Too much pain, and then there was bleeding. 830 00:31:08,325 --> 00:31:10,577 - Those need to come off before they cause permanent damage. 831 00:31:10,660 --> 00:31:12,120 - Yeah, you think, uh, you could find, like, 832 00:31:12,204 --> 00:31:14,081 a senior or an attending? 833 00:31:14,122 --> 00:31:15,957 We're really trying to get off the clock here. 834 00:31:15,999 --> 00:31:17,167 - They're all busy. 835 00:31:19,836 --> 00:31:21,421 - I already took one for the team. 836 00:31:21,505 --> 00:31:23,340 - Yeah, fine. 837 00:31:23,423 --> 00:31:26,927 - Uh, labs on your yellow lady. 838 00:31:27,010 --> 00:31:29,346 - INR is elevated, 2.2. 839 00:31:29,429 --> 00:31:31,306 - Liver's in trouble but not dead yet. 840 00:31:31,390 --> 00:31:32,933 - Tell her to skip the turmeric. 841 00:31:32,974 --> 00:31:35,102 Admit for monitoring, and follow the LFTs. 842 00:31:35,185 --> 00:31:36,311 - Got it. - Mm-hmm. 843 00:31:36,353 --> 00:31:37,813 - Central 10? - Yeah. 844 00:31:42,192 --> 00:31:44,277 - "Sleepmaxxing"? Really? 845 00:31:44,361 --> 00:31:45,821 - I track the online trends. 846 00:31:45,904 --> 00:31:48,198 - Is that your secret for the tough ones? 847 00:31:48,281 --> 00:31:49,950 - I just think, 848 00:31:49,991 --> 00:31:52,327 what's the stupidest thing this person could have done? 849 00:31:52,369 --> 00:31:53,620 Then assume they did it. 850 00:31:55,038 --> 00:31:57,165 - Well, I mean, she was trying to be healthy. 851 00:31:57,207 --> 00:31:59,501 - Yeah, by taking advice from fools. 852 00:31:59,543 --> 00:32:01,670 - Turmeric is recommended by a lot of doctors. 853 00:32:01,753 --> 00:32:03,672 - Yeah, then ask your doctor for the dose 854 00:32:03,755 --> 00:32:06,299 or check someplace reputable, like the CDC. 855 00:32:06,383 --> 00:32:09,594 Oh, right, I forgot, it's now a medical toxic waste site. 856 00:32:09,678 --> 00:32:12,639 - I mean, she's in pretty bad shape. 857 00:32:12,681 --> 00:32:14,933 If things get worse, she could need a liver transplant. 858 00:32:15,016 --> 00:32:17,102 - Yeah, 'cause she's a big fucking idiot. 859 00:32:18,603 --> 00:32:20,355 - Wow. 860 00:32:20,439 --> 00:32:22,649 - No, I actually appreciate her. 861 00:32:22,691 --> 00:32:25,444 Our job security depends on all these big fucking idiots. 862 00:32:27,821 --> 00:32:29,072 - OK. 863 00:32:31,408 --> 00:32:34,744 - Uh, good night, Perlah, Monica. 864 00:32:34,828 --> 00:32:37,539 Good night, Dr. Robby. - Good night. 865 00:32:37,581 --> 00:32:39,082 - Bye, Emma. 866 00:32:39,166 --> 00:32:40,542 - You could stay to pitch in. 867 00:32:40,625 --> 00:32:42,544 - Mm, Dana told me to go and get some rest 868 00:32:42,586 --> 00:32:43,920 before tomorrow's shift. 869 00:32:44,004 --> 00:32:45,589 - Yeah, you had quite a day. 870 00:32:45,672 --> 00:32:47,048 - Wasn't so bad. 871 00:32:49,009 --> 00:32:50,760 - Why can't I find Duke's results? 872 00:32:50,844 --> 00:32:53,555 - Oh, new patient, no EHR yet. 873 00:32:53,597 --> 00:32:56,349 - I can run over to Radiology, get a printout. 874 00:32:56,433 --> 00:32:57,809 - Thank you, Monica. 875 00:33:00,312 --> 00:33:02,230 - Ready to pick up a few more. 876 00:33:02,314 --> 00:33:03,690 Orlando's all tucked in for now. 877 00:33:03,773 --> 00:33:05,317 - How's he doing? - Numbers are good. 878 00:33:05,400 --> 00:33:07,152 CPP 22. 879 00:33:07,235 --> 00:33:09,738 - OK, so he's got a shot at a decent outcome at least. 880 00:33:09,821 --> 00:33:11,406 - You think he has a chance? 881 00:33:11,448 --> 00:33:13,575 - Oh, I don't know that survival was 882 00:33:13,658 --> 00:33:15,577 the outcome he was hoping for. 883 00:33:15,660 --> 00:33:17,245 - What? 884 00:33:17,287 --> 00:33:19,414 - He told Samira he's got $100,000 in medical debt, 885 00:33:19,498 --> 00:33:21,958 that his life is probably-- - Mrs. Diaz! 886 00:33:24,294 --> 00:33:26,713 How can we help you? - The bathroom? 887 00:33:26,755 --> 00:33:29,424 - Uh, yeah. Perlah can show you the way. 888 00:33:31,176 --> 00:33:33,553 Not a great idea to have a private conversation 889 00:33:33,637 --> 00:33:34,763 about a patient in a public area. 890 00:33:34,846 --> 00:33:36,765 - I know. I know. 891 00:33:36,848 --> 00:33:38,141 - You were about to start yapping-- 892 00:33:38,225 --> 00:33:39,768 - But I didn't! 893 00:33:42,312 --> 00:33:45,148 - OK. 894 00:33:45,232 --> 00:33:47,484 And how long have they been in there? 895 00:33:47,567 --> 00:33:48,944 - At least two hours. 896 00:33:49,027 --> 00:33:51,404 - How did it happen? - With my earring. 897 00:33:51,488 --> 00:33:54,282 It was supposed to be, uh, red, white, and blue 898 00:33:54,366 --> 00:33:56,117 to look cool at the fireworks. 899 00:33:56,159 --> 00:33:57,786 - I told her for the nose, one side only, 900 00:33:57,869 --> 00:33:59,079 but she never listens. 901 00:33:59,162 --> 00:34:00,288 - This can be pretty serious. 902 00:34:00,372 --> 00:34:01,623 If we don't get them out quickly, 903 00:34:01,665 --> 00:34:03,041 it can cut off the blood supply 904 00:34:03,124 --> 00:34:04,960 and cause the septum to collapse. 905 00:34:05,001 --> 00:34:08,588 - Like, my nose could be deformed? 906 00:34:10,799 --> 00:34:13,301 Oh, my God, get them off. - Yeah, that's the plan. 907 00:34:13,385 --> 00:34:15,053 - Yeah, she tried already. It hurt like crazy. 908 00:34:15,136 --> 00:34:16,221 - Because they're stuck together 909 00:34:16,304 --> 00:34:18,306 by a very strong magnetic force. 910 00:34:18,389 --> 00:34:20,266 - Yeah. - No, no, no. 911 00:34:20,350 --> 00:34:21,976 - Oh, uh, I'm not gonna use the tips. 912 00:34:22,060 --> 00:34:25,063 I'm gonna flip it around and use the handle. 913 00:34:25,146 --> 00:34:26,648 - It's still gonna hurt. 914 00:34:26,731 --> 00:34:27,899 - Probably not. 915 00:34:27,983 --> 00:34:29,317 Just, uh, hold still. 916 00:34:31,860 --> 00:34:33,280 OK. 917 00:34:36,533 --> 00:34:38,702 [sighs] Voilà. 918 00:34:38,784 --> 00:34:41,454 - Really? - That was amazing. 919 00:34:41,538 --> 00:34:43,290 - I think another half hour, 920 00:34:43,373 --> 00:34:45,000 we can send this dry-erase board back to storage. 921 00:34:45,041 --> 00:34:46,167 - With pleasure. 922 00:34:46,251 --> 00:34:47,543 - Dr. Robinavitch? - Yep. 923 00:34:47,627 --> 00:34:49,087 - Results on your friend. 924 00:34:53,717 --> 00:34:55,927 - Fuck. - Duke? 925 00:34:59,889 --> 00:35:01,516 Are you gonna tell him? 926 00:35:01,558 --> 00:35:03,143 - I want to talk to a surgeon first. 927 00:35:03,184 --> 00:35:05,186 - Uh, Dr. Robby, I have an update on the patient. 928 00:35:05,228 --> 00:35:06,605 - Now is not a great time. 929 00:35:06,688 --> 00:35:08,023 - Oh, I thought you were going home. 930 00:35:08,064 --> 00:35:09,190 - Uh, I was. 931 00:35:09,274 --> 00:35:10,984 Dr. Ogilvie is just sitting 932 00:35:11,067 --> 00:35:12,694 out in the ambulance bay covered in blood. 933 00:35:12,777 --> 00:35:14,362 - Sorry, what-- what's he doing out there? 934 00:35:14,404 --> 00:35:16,323 - Kind of, uh, staring off into space. 935 00:35:16,364 --> 00:35:17,616 I tried to talk to him, but it was like 936 00:35:17,699 --> 00:35:19,034 he couldn't hear me. - Monica, 937 00:35:19,117 --> 00:35:20,660 can you stat page CardioThoracic? 938 00:35:20,744 --> 00:35:22,912 - I'll go check on Ogilvie. - Please. 939 00:35:25,206 --> 00:35:26,416 - Oh. 940 00:35:35,592 --> 00:35:37,719 [sighs] 941 00:35:37,802 --> 00:35:40,013 Hey, Ogilvie. 942 00:35:42,599 --> 00:35:44,517 Ogilvie... 943 00:35:44,601 --> 00:35:46,436 y-you OK, man? 944 00:35:49,856 --> 00:35:51,399 [sighs] 945 00:35:51,483 --> 00:35:53,568 - 99 on 2 liters. 946 00:35:53,610 --> 00:35:55,904 - Scattered end expiratory wheezes. 947 00:35:55,945 --> 00:35:58,073 - He is so much better. 948 00:35:58,156 --> 00:36:00,116 - The steroids should kick in soon. 949 00:36:00,200 --> 00:36:02,535 - So he'll keep improving. 950 00:36:02,619 --> 00:36:04,871 - Um, when can I go home? 951 00:36:04,954 --> 00:36:06,539 - In a day or two. 952 00:36:06,623 --> 00:36:09,834 And we will, uh, discharge you with a Symbicort inhaler. 953 00:36:09,918 --> 00:36:12,003 That should last about a month. 954 00:36:12,087 --> 00:36:14,547 - Hopefully we'll be back on Medicaid by then. 955 00:36:14,631 --> 00:36:16,591 - How'd you lose it? 956 00:36:16,633 --> 00:36:20,095 - They sent a redetermination letter to our old apartment. 957 00:36:20,136 --> 00:36:22,597 It didn't get forwarded. 958 00:36:22,681 --> 00:36:24,683 When I went to pick up his prescription, 959 00:36:24,766 --> 00:36:28,520 pharmacist told me we were no longer covered. 960 00:36:28,603 --> 00:36:30,772 - And you haven't been able to get it back since? 961 00:36:30,814 --> 00:36:33,108 - I've been trying for months. 962 00:36:33,149 --> 00:36:35,568 To get re-enrolled, you need tax returns, 963 00:36:35,652 --> 00:36:36,945 pay stubs. 964 00:36:37,028 --> 00:36:39,906 I cut hair. My income fluctuates. 965 00:36:39,989 --> 00:36:42,325 A lot of my regulars are struggling, 966 00:36:42,409 --> 00:36:45,453 so it's been tough. 967 00:36:45,537 --> 00:36:47,414 - Well, if you run out of Symbicort 968 00:36:47,497 --> 00:36:49,791 before your Medicaid kicks in, you can come back, 969 00:36:49,833 --> 00:36:52,669 and we'll, uh, set you up with another one. 970 00:36:52,752 --> 00:36:54,671 - Oh, is there a patient in here? 971 00:36:54,754 --> 00:36:57,799 'Cause everyone in this room looks extremely healthy to me. 972 00:36:57,841 --> 00:37:00,260 - Dr. Shen and I will be with Grady all night long. 973 00:37:00,343 --> 00:37:02,178 - Yeah. Day shift, we got this. 974 00:37:02,262 --> 00:37:04,139 - We're leaving you in good hands. 975 00:37:04,222 --> 00:37:05,974 - Um... 976 00:37:06,057 --> 00:37:08,435 I was really scared. 977 00:37:08,518 --> 00:37:09,686 Thank you. 978 00:37:11,354 --> 00:37:13,356 - You're very welcome. 979 00:37:17,235 --> 00:37:19,863 - Due to his injury, things have changed. 980 00:37:21,322 --> 00:37:23,491 - I was looking for Dr. Abbot. 981 00:37:23,575 --> 00:37:26,327 - I haven't seen him for a while. 982 00:37:26,411 --> 00:37:27,704 - Excuse me. 983 00:37:29,414 --> 00:37:30,665 [door opens] 984 00:37:30,707 --> 00:37:32,667 - So now, with a long-term disability, 985 00:37:32,709 --> 00:37:35,336 things may be easier. 986 00:37:35,420 --> 00:37:36,504 - "Easier"? 987 00:37:36,588 --> 00:37:38,006 - His condition will qualify him 988 00:37:38,089 --> 00:37:39,507 for Medicare and Medicaid. 989 00:37:39,591 --> 00:37:42,010 So, moving forward, costs should be covered, 990 00:37:42,093 --> 00:37:43,845 including home health care. 991 00:37:43,887 --> 00:37:45,180 - OK. 992 00:37:45,221 --> 00:37:46,639 - Perhaps this isn't the best time-- 993 00:37:46,723 --> 00:37:48,016 - I just wanted to reassure you 994 00:37:48,057 --> 00:37:49,934 about future costs. 995 00:37:58,109 --> 00:37:59,486 - Robby. 996 00:37:59,527 --> 00:38:01,654 - Noelle. 997 00:38:01,738 --> 00:38:03,239 - You're still here. 998 00:38:03,323 --> 00:38:05,575 - It's not the best day to try to get out on time. 999 00:38:05,658 --> 00:38:07,285 - Mm. 1000 00:38:07,368 --> 00:38:08,703 So I guess this is it for a while. 1001 00:38:08,787 --> 00:38:10,205 - Unless you want to come with me. 1002 00:38:10,288 --> 00:38:12,624 - No, but thank you, 1003 00:38:12,707 --> 00:38:14,667 even if it isn't a legitimate offer. 1004 00:38:14,751 --> 00:38:16,169 - What do you mean? - Oh, please. 1005 00:38:16,252 --> 00:38:18,046 I know well enough not to get in between 1006 00:38:18,087 --> 00:38:20,173 a man and his vision quest. 1007 00:38:21,591 --> 00:38:22,842 - "Vision quest." 1008 00:38:22,926 --> 00:38:26,095 - That is my nice way of putting it. 1009 00:38:27,263 --> 00:38:28,556 - I probably don't want to hear 1010 00:38:28,598 --> 00:38:30,391 your not-so-nice way of putting it. 1011 00:38:30,475 --> 00:38:31,935 - No, probably not. 1012 00:38:33,603 --> 00:38:37,148 I-I hope that this is not, um... 1013 00:38:37,232 --> 00:38:38,525 about you running away from me. 1014 00:38:38,608 --> 00:38:39,734 I'm a big girl. 1015 00:38:39,818 --> 00:38:41,402 You can tell me just to get lost. 1016 00:38:41,486 --> 00:38:43,238 - This has nothing to do with you. 1017 00:38:43,321 --> 00:38:44,572 - Oh, right. 1018 00:38:44,614 --> 00:38:47,367 It's the old, uh, "it's not you, it's me"? 1019 00:38:48,827 --> 00:38:51,037 - In this case, it's actually true. 1020 00:38:57,210 --> 00:38:58,878 - Excuse me. 1021 00:39:04,968 --> 00:39:06,261 - I'll see you next week? 1022 00:39:06,302 --> 00:39:07,595 - It's a three-month sabbatical. 1023 00:39:07,637 --> 00:39:09,639 - Like I said, I will see you next week. 1024 00:39:16,312 --> 00:39:19,524 - My first day here as a med student... 1025 00:39:19,607 --> 00:39:21,234 there was a patient. 1026 00:39:21,317 --> 00:39:22,944 [sighs] 1027 00:39:23,027 --> 00:39:24,737 He was a real nice guy, 1028 00:39:24,821 --> 00:39:27,574 came in with belly pain. 1029 00:39:27,657 --> 00:39:31,202 I saw a gall stone on the ultrasound, 1030 00:39:31,286 --> 00:39:33,371 normal EKG, troponin. 1031 00:39:33,454 --> 00:39:36,749 The pain resolved, and he was in the hall 1032 00:39:36,833 --> 00:39:38,710 when he had a cardiac arrest. 1033 00:39:41,504 --> 00:39:42,881 I couldn't save him. 1034 00:39:44,424 --> 00:39:45,884 People die. 1035 00:39:47,343 --> 00:39:50,805 And we do the best we can... 1036 00:39:50,847 --> 00:39:53,266 but people die. 1037 00:39:54,434 --> 00:39:56,436 - You ever get used to it? 1038 00:39:57,937 --> 00:39:59,564 - [chuckles] No. 1039 00:40:00,940 --> 00:40:03,693 No, you... 1040 00:40:03,776 --> 00:40:05,695 you try to accept it. 1041 00:40:07,697 --> 00:40:09,449 You try to find balance. 1042 00:40:14,871 --> 00:40:17,790 - I don't know if I can take another day like today. 1043 00:40:19,334 --> 00:40:22,629 Primary care specialty sounds way better. 1044 00:40:22,712 --> 00:40:24,422 Pedes, maybe. 1045 00:40:24,505 --> 00:40:26,049 - Yeah, maybe. 1046 00:40:27,550 --> 00:40:30,720 I know I'd be bored out of my fucking mind. 1047 00:40:32,013 --> 00:40:36,017 Seriously, I like the challenge of undiagnosed illness, 1048 00:40:36,059 --> 00:40:41,022 of quick decisions, of life-saving procedures. 1049 00:40:41,064 --> 00:40:43,399 And I like being here for people 1050 00:40:43,483 --> 00:40:45,902 on the worst days of their lives. 1051 00:40:50,740 --> 00:40:52,033 [clears throat] 1052 00:40:54,077 --> 00:40:56,037 You know what I think? 1053 00:40:56,079 --> 00:40:57,705 - What? 1054 00:40:57,789 --> 00:41:00,041 - I think you should go home. 1055 00:41:00,124 --> 00:41:01,501 I think you should sleep on it. 1056 00:41:01,584 --> 00:41:03,002 And I think you should at least wait 1057 00:41:03,086 --> 00:41:04,212 till the morning to decide 1058 00:41:04,295 --> 00:41:05,755 if you want to come back. 1059 00:41:08,758 --> 00:41:11,052 - I don't really want to... 1060 00:41:11,094 --> 00:41:13,680 go back in there and see anybody. 1061 00:41:13,721 --> 00:41:14,931 - Yeah. 1062 00:41:16,432 --> 00:41:18,893 OK, pull off your gown. I'll take it in. 1063 00:41:18,977 --> 00:41:21,396 Shift is over. 1064 00:41:21,437 --> 00:41:22,939 Go home. 1065 00:41:24,899 --> 00:41:27,944 [indistinct chatter] 1066 00:41:35,785 --> 00:41:37,036 - Oh! - [gasps] Oh, God. 1067 00:41:37,120 --> 00:41:38,079 - No, I'm--I'm-- - Sorry. 1068 00:41:38,162 --> 00:41:39,539 - I'm good. I'm good. I'm good. 1069 00:41:39,622 --> 00:41:41,249 - There's a dummy in a wheelchair. 1070 00:41:41,290 --> 00:41:43,209 - Uh, yeah, he moves around. 1071 00:41:46,295 --> 00:41:48,423 I see I've been replaced. 1072 00:41:48,464 --> 00:41:49,924 - Oh, did I take your spot? 1073 00:41:50,008 --> 00:41:51,592 - Not really, no. - Are you sure? 1074 00:41:51,676 --> 00:41:53,094 - Where the hell have you been? 1075 00:41:53,136 --> 00:41:54,721 - I found Ogilvie. 1076 00:41:54,804 --> 00:41:55,972 - And? 1077 00:41:56,055 --> 00:41:58,307 - And he's going home. 1078 00:41:58,391 --> 00:41:59,559 - That's it? 1079 00:41:59,642 --> 00:42:00,893 - It's a long story. 1080 00:42:00,977 --> 00:42:02,311 - Well, I got nothing but time. 1081 00:42:02,395 --> 00:42:04,480 - I need to respect his privacy. 1082 00:42:04,564 --> 00:42:06,107 - Where's the fun in that? 1083 00:42:06,149 --> 00:42:08,151 - Beep. Beep, beep. [chuckles] - Sorry. 1084 00:42:09,402 --> 00:42:11,446 [whirring] 1085 00:42:16,701 --> 00:42:18,077 - Um, the shredder jammed. 1086 00:42:18,161 --> 00:42:21,122 - Yeah, uh, try putting it in reverse. 1087 00:42:21,164 --> 00:42:23,416 [whirring] 1088 00:42:23,499 --> 00:42:24,625 - Perfect. 1089 00:42:24,709 --> 00:42:26,753 - Just give it a little love tap. 1090 00:42:26,836 --> 00:42:28,296 - OK. - Kick it. 1091 00:42:28,379 --> 00:42:29,422 [banging] 1092 00:42:29,505 --> 00:42:31,049 Jesus Christ. 1093 00:42:31,132 --> 00:42:32,967 [laughter] 1094 00:42:33,009 --> 00:42:35,136 - Guess Mr. Digby got a room upstairs. 1095 00:42:35,178 --> 00:42:36,596 - In your dreams. 1096 00:42:36,679 --> 00:42:38,598 - He's not in South 21. 1097 00:42:38,681 --> 00:42:39,974 - Yeah, he is. 1098 00:42:40,058 --> 00:42:42,310 - There's a new guy in the bed. 1099 00:42:42,393 --> 00:42:44,312 - Short hair, clean-shaved? 1100 00:42:44,395 --> 00:42:46,773 I'll take care of it. 1101 00:42:46,856 --> 00:42:48,483 - Scout film showed obvious pathology, 1102 00:42:48,524 --> 00:42:49,984 so we ordered the CT angiogram. 1103 00:42:50,068 --> 00:42:51,652 - Textbook ascending aortic aneurysm. 1104 00:42:51,736 --> 00:42:53,488 Eight centimeters. 1105 00:42:53,571 --> 00:42:55,364 50% one-year mortality. 1106 00:42:55,448 --> 00:42:56,657 - So he definitely needs surgery. 1107 00:42:56,741 --> 00:42:57,658 - If he wants to live. 1108 00:42:57,742 --> 00:42:58,701 - OK, well, he's a friend, 1109 00:42:58,785 --> 00:42:59,994 so I will talk to him. 1110 00:43:00,078 --> 00:43:01,162 I'll get him admitted to your service. 1111 00:43:01,245 --> 00:43:03,331 - Not today. - Why not? 1112 00:43:03,372 --> 00:43:05,166 - He needs to see Cardiology and Pulmonary first 1113 00:43:05,208 --> 00:43:06,375 to be cleared for the OR. 1114 00:43:06,459 --> 00:43:08,336 They can do a stress echo, PFTs. 1115 00:43:08,377 --> 00:43:10,546 - He needs to be admitted and evaluated as an inpatient. 1116 00:43:10,630 --> 00:43:12,215 - Nothing ever gets done over a holiday weekend. 1117 00:43:12,298 --> 00:43:13,341 He can take it easy at home. 1118 00:43:13,382 --> 00:43:14,717 - He's a ticking time bomb. 1119 00:43:14,801 --> 00:43:16,052 - He's probably been that way for years. 1120 00:43:16,135 --> 00:43:17,345 We can get him in early next week 1121 00:43:17,428 --> 00:43:18,971 with a specialist to get his testing done. 1122 00:43:19,055 --> 00:43:20,932 All goes well, he's on the OR schedule in a week. 1123 00:43:21,015 --> 00:43:22,517 - What happens if it ruptures before then? 1124 00:43:22,600 --> 00:43:24,352 - Call 911. 1125 00:43:24,435 --> 00:43:26,020 Sorry, Robby. Best we can do. 1126 00:43:26,104 --> 00:43:28,064 Text me his number. I'll have my office coordinate. 1127 00:43:30,233 --> 00:43:31,818 - Fuck! - Hey! 1128 00:43:31,901 --> 00:43:33,611 Take a walk. Come on! 1129 00:43:37,073 --> 00:43:38,699 [bell dings] - Two for discharge. 1130 00:43:38,741 --> 00:43:40,326 - Yeah, please don't ring the bell. 1131 00:43:40,409 --> 00:43:41,953 The computers are back up and running. 1132 00:43:42,036 --> 00:43:43,496 - Not for these two. 1133 00:43:43,579 --> 00:43:44,872 They don't have electronic health records yet. 1134 00:43:44,956 --> 00:43:46,290 - Wait, hold up. 1135 00:43:46,374 --> 00:43:48,543 This kid had a wrist X-ray ordered. 1136 00:43:48,584 --> 00:43:49,794 Ugh, it never happened. 1137 00:43:49,877 --> 00:43:51,087 And water-skiing lady's 1138 00:43:51,170 --> 00:43:52,421 still waiting on a knee series. 1139 00:43:52,505 --> 00:43:53,714 - I canceled the X-rays. 1140 00:43:53,756 --> 00:43:56,050 Diagnosed them both with ultrasound. 1141 00:43:56,092 --> 00:43:57,260 - Really? 1142 00:43:57,343 --> 00:43:59,053 - Yeah. 1143 00:43:59,095 --> 00:44:01,514 The, uh, little boy had a simple buckle fracture. 1144 00:44:01,597 --> 00:44:04,100 Distal radius. He got a Velcro splint. 1145 00:44:04,183 --> 00:44:06,853 And Mrs. Stegman had a small medial meniscus tear. 1146 00:44:06,936 --> 00:44:09,230 Knee immobilizer, crutches, and a follow up with ortho. 1147 00:44:09,313 --> 00:44:11,566 - Could have used you on the day shift today. 1148 00:44:11,649 --> 00:44:14,026 - They don't teach us a lot of musculoskeletal ultrasound. 1149 00:44:14,110 --> 00:44:15,570 - I know. 1150 00:44:15,611 --> 00:44:18,197 That's why I did electives at Harvard and Highland. 1151 00:44:18,281 --> 00:44:21,033 - Are you applying for an ultrasound fellowship here? 1152 00:44:21,117 --> 00:44:23,828 - I am, but it is so competitive. 1153 00:44:23,911 --> 00:44:26,080 - That's what I hear. - Kind of a long shot. 1154 00:44:26,122 --> 00:44:27,498 I only have one publication, 1155 00:44:27,582 --> 00:44:29,417 but it's a series of case reports diagnosing 1156 00:44:29,458 --> 00:44:31,919 shoulder dislocations with ultrasound only. 1157 00:44:32,003 --> 00:44:33,921 If you want to learn some MSK, you can tag along. 1158 00:44:34,005 --> 00:44:35,423 I got three more to scan. 1159 00:44:35,506 --> 00:44:37,425 - Maybe some other time. 1160 00:44:37,508 --> 00:44:39,886 - Cool. 1161 00:44:39,969 --> 00:44:42,221 [whirring] 1162 00:44:42,305 --> 00:44:44,223 - Hey, don't jam the shredder. 1163 00:44:44,307 --> 00:44:45,766 What is that, two charts? 1164 00:44:45,808 --> 00:44:48,352 - No, it's my ultrasound fellowship application. 1165 00:44:50,146 --> 00:44:51,731 - Hey. 1166 00:44:51,814 --> 00:44:54,734 Uh, sorry about your patient. 1167 00:44:54,817 --> 00:44:57,737 - Yeah, Orlando's in pretty bad shape. 1168 00:44:57,820 --> 00:44:59,614 - Oh, no, I--I was talking about 1169 00:44:59,697 --> 00:45:03,284 the triple-A guy you worked on with Ogilvie. 1170 00:45:03,367 --> 00:45:04,493 [sighs] 1171 00:45:05,912 --> 00:45:08,456 He didn't make it through surgery. 1172 00:45:08,539 --> 00:45:09,999 I tried to talk to Robby about it, 1173 00:45:10,082 --> 00:45:12,001 but I think he's busy. 1174 00:45:12,084 --> 00:45:13,753 - Excuse me. 1175 00:45:16,047 --> 00:45:17,924 - [sighing] Oh, shit. 1176 00:45:22,094 --> 00:45:23,554 - You think I'm on edge? 1177 00:45:23,638 --> 00:45:25,306 First you're shaming Samira, then McKay-- 1178 00:45:25,389 --> 00:45:26,641 - They both needed to be called out 1179 00:45:26,724 --> 00:45:27,975 for unacceptable behavior. - Yeah? 1180 00:45:28,059 --> 00:45:29,310 Yeah, well, you do that in private. 1181 00:45:29,352 --> 00:45:30,728 Same place you share your thoughts 1182 00:45:30,811 --> 00:45:31,938 about a patient's possible suicide. 1183 00:45:32,021 --> 00:45:33,397 And slamming stuff? Please. 1184 00:45:33,481 --> 00:45:34,607 Sign out all the shit that's bugging you 1185 00:45:34,690 --> 00:45:35,775 and get out of here. 1186 00:45:35,858 --> 00:45:37,610 - I can't. - Yes, you can. 1187 00:45:37,652 --> 00:45:38,945 When either of my kids was acting like this, 1188 00:45:39,028 --> 00:45:40,404 I gave them a time-out in their room. 1189 00:45:40,488 --> 00:45:41,572 - Whoa, whoa, whoa, you're not my mother. 1190 00:45:41,656 --> 00:45:42,782 - Yeah? Well, too bad. 1191 00:45:42,865 --> 00:45:43,991 You need one. - No, I had one. 1192 00:45:44,033 --> 00:45:45,660 She left. I don't need another one. 1193 00:45:45,743 --> 00:45:46,994 What I need is someone who can actually run this place 1194 00:45:47,078 --> 00:45:48,955 while I'm gone. - OK, I'm sorry. 1195 00:45:49,038 --> 00:45:50,289 I didn't know. - Nobody knows. 1196 00:45:50,373 --> 00:45:52,583 Who needs to know? Who gives a fuck? 1197 00:45:52,667 --> 00:45:53,918 - I think you need a break. 1198 00:45:54,001 --> 00:45:55,503 - That is what the sabbatical is for. 1199 00:45:55,544 --> 00:45:57,004 - Then start it now. Walk away. 1200 00:45:57,088 --> 00:45:58,297 - I have too much to do. 1201 00:45:58,381 --> 00:46:00,007 - Let someone else talk to Duke. 1202 00:46:00,049 --> 00:46:01,717 - No, that needs to come from me. 1203 00:46:01,801 --> 00:46:03,052 - Why? 1204 00:46:03,135 --> 00:46:04,679 - Because I owe him that. 1205 00:46:04,720 --> 00:46:06,514 It needs to come from a friend, not a stranger, 1206 00:46:06,555 --> 00:46:08,516 otherwise he's gonna bail and drop dead while I'm gone. 1207 00:46:08,599 --> 00:46:11,394 - OK, wrap that up and then leave. 1208 00:46:11,477 --> 00:46:13,020 - It's not just Duke. 1209 00:46:13,104 --> 00:46:14,814 I'm not sure that Al-Hashimi is fit to run this place. 1210 00:46:14,855 --> 00:46:16,023 - What's that supposed to mean? - I'm not sure. 1211 00:46:16,065 --> 00:46:17,650 I'm trying to figure that out. 1212 00:46:17,692 --> 00:46:18,859 Did you know that she wants to have two attendings 1213 00:46:18,943 --> 00:46:20,528 on at all times? - No. 1214 00:46:20,569 --> 00:46:22,029 - Is that something she's worked out with Gloria? 1215 00:46:22,071 --> 00:46:23,531 - I don't know. - I also don't know 1216 00:46:23,614 --> 00:46:24,865 if Langdon is going to relapse. 1217 00:46:24,949 --> 00:46:25,866 I don't know if Whitaker's gonna be able 1218 00:46:25,950 --> 00:46:27,285 to take care of my shit. 1219 00:46:27,368 --> 00:46:28,869 I don't know if Javadi's gonna give up on 1220 00:46:28,911 --> 00:46:30,705 what she's good at or if Samira's gonna flame out 1221 00:46:30,788 --> 00:46:32,164 because of some bullshit with her mother. 1222 00:46:32,248 --> 00:46:34,542 - Is there anything else? - Yeah, you. 1223 00:46:34,625 --> 00:46:36,794 I don't know about you running around 1224 00:46:36,877 --> 00:46:38,546 with a full syringe of Versed in your pocket. 1225 00:46:38,629 --> 00:46:40,965 I'm worried about the people that I care about. 1226 00:46:41,048 --> 00:46:43,384 - We'll all manage until you come back. 1227 00:46:43,426 --> 00:46:44,552 We always do. 1228 00:46:44,593 --> 00:46:46,429 - Yeah? What if I don't come back? 1229 00:46:57,064 --> 00:46:59,942 [pensive music] 1230 00:47:00,026 --> 00:47:07,074 ♪ ♪