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