1 00:00:15,599 --> 00:00:17,308 Next time, maybe inform the department chair 2 00:00:17,309 --> 00:00:18,351 before the shit hits the fan. 3 00:00:18,352 --> 00:00:20,019 I was on my way to tell you. 4 00:00:20,020 --> 00:00:21,354 Make sure you get everything you need. 5 00:00:21,355 --> 00:00:22,438 OK, let's do this. 6 00:00:22,439 --> 00:00:24,023 IT called me up because 7 00:00:24,024 --> 00:00:26,359 I've trained in cyberattack prevention and response. 8 00:00:26,360 --> 00:00:27,652 Then you can tell everybody what to do. 9 00:00:27,653 --> 00:00:29,028 No, thank you. 10 00:00:29,029 --> 00:00:30,279 Best if it comes from the department chair. 11 00:00:30,280 --> 00:00:31,281 Oh, you think? 12 00:00:33,784 --> 00:00:36,035 All right, everybody, circle up. 13 00:00:36,036 --> 00:00:37,286 What the fuck? 14 00:00:37,287 --> 00:00:39,247 We may have had a cyberattack. 15 00:00:39,248 --> 00:00:41,500 No, we shut down to prevent a cyberattack. 16 00:00:43,252 --> 00:00:45,336 OK, everybody, settle down. Listen up. 17 00:00:45,337 --> 00:00:46,712 As you can see, we're doing a little 18 00:00:46,713 --> 00:00:49,215 redecorating in the central work area. 19 00:00:49,216 --> 00:00:52,093 Our hospital computers are at risk for a cyberattack, 20 00:00:52,094 --> 00:00:54,095 so we are going old school, analog. 21 00:00:54,096 --> 00:00:55,513 - For how long? - Great question. 22 00:00:55,514 --> 00:00:57,557 Our IT department has shut everything down 23 00:00:57,558 --> 00:00:59,892 to give them time to bolster our cyber defenses. 24 00:00:59,893 --> 00:01:01,811 I believe the question was, for how long? 25 00:01:01,812 --> 00:01:03,104 Uh, hard to say. 26 00:01:03,105 --> 00:01:04,397 Could be up to 24 hours. 27 00:01:04,398 --> 00:01:06,023 Jesus Christ. 28 00:01:06,024 --> 00:01:07,650 So first order of business, 29 00:01:07,651 --> 00:01:09,610 we need to replicate the electronic patient boards 30 00:01:09,611 --> 00:01:10,945 on these dry-erase boards. 31 00:01:10,946 --> 00:01:12,029 So please, somebody tell me 32 00:01:12,030 --> 00:01:13,155 they got a photo of the boards. 33 00:01:13,156 --> 00:01:14,156 Uh, yeah, yeah, yeah. 34 00:01:14,157 --> 00:01:15,658 Right here. OK. 35 00:01:15,659 --> 00:01:16,702 Oh, uh... 36 00:01:18,870 --> 00:01:21,080 It's a little blurry. 37 00:01:21,081 --> 00:01:23,708 No, more than a little blurry. 38 00:01:23,709 --> 00:01:26,502 - Sorry. - Oh, my God. 39 00:01:26,503 --> 00:01:28,254 - I remember. - Great. 40 00:01:28,255 --> 00:01:30,214 If everybody else can remember their patient names 41 00:01:30,215 --> 00:01:31,591 and their room numbers, that would be awesome. 42 00:01:31,592 --> 00:01:33,593 No, I mean I can remember all of it. 43 00:01:33,594 --> 00:01:34,719 All of what? 44 00:01:34,720 --> 00:01:36,929 Names, doctors, room numbers. 45 00:01:36,930 --> 00:01:39,348 I kind of have a photographic memory. 46 00:01:39,349 --> 00:01:41,475 Seriously? The whole board? 47 00:01:41,476 --> 00:01:43,853 Central 12, Harlow Graham, headache, 48 00:01:43,854 --> 00:01:46,606 - abdominal pain, ASL only. - Oh, shit. 49 00:01:46,607 --> 00:01:48,524 I have an interpreter waiting for me. 50 00:01:48,525 --> 00:01:50,651 - Go. - OK, for patient privacy, 51 00:01:50,652 --> 00:01:52,361 all chief complaints will be abbreviated. 52 00:01:52,362 --> 00:01:53,696 So HA for headache, 53 00:01:53,697 --> 00:01:55,656 AP for abdominal pain, and so forth. 54 00:01:55,657 --> 00:01:58,909 Central 10, Jackson Davis, new-onset psychosis. 55 00:01:58,910 --> 00:02:00,369 Javadi, psych admission. 56 00:02:00,370 --> 00:02:02,371 Greek letter psi for psych. 57 00:02:02,372 --> 00:02:04,624 Pedes is Baby Jane Doe, fever, Dr. Mohan, 58 00:02:04,625 --> 00:02:06,167 awaiting admission orders. 59 00:02:06,168 --> 00:02:07,877 Nurses need to convert to a zone defense-- 60 00:02:07,878 --> 00:02:08,919 north, central, south, trauma. 61 00:02:08,920 --> 00:02:10,087 Where's Dana? 62 00:02:10,088 --> 00:02:11,756 In with a sexual assault case. 63 00:02:11,757 --> 00:02:13,341 She can't leave until the exam is finished. 64 00:02:13,342 --> 00:02:14,634 Yeah, it could be a while. 65 00:02:14,635 --> 00:02:16,052 Princess has charge nurse experience. 66 00:02:16,053 --> 00:02:17,511 - Not really. - That's a great idea. 67 00:02:17,512 --> 00:02:18,763 Princess it is. 68 00:02:18,764 --> 00:02:19,764 You can make the nursing assignments. 69 00:02:19,765 --> 00:02:21,098 - Next. - Central 9, 70 00:02:21,099 --> 00:02:23,059 Roxie Hamler, end-stage lung cancer. 71 00:02:23,060 --> 00:02:24,435 Sorry, do we have to stand here while 72 00:02:24,436 --> 00:02:25,645 - she recites the whole board? - No. 73 00:02:25,646 --> 00:02:26,896 In fact, go check on your patients 74 00:02:26,897 --> 00:02:28,397 and then please come back here. 75 00:02:28,398 --> 00:02:29,940 Thank you. 76 00:02:29,941 --> 00:02:31,693 How many hours a day are you on your laptop? 77 00:02:34,738 --> 00:02:36,072 At least eight hours. 78 00:02:36,073 --> 00:02:37,490 I work from home. 79 00:02:37,491 --> 00:02:39,368 And are you at a desk all day? 80 00:02:41,244 --> 00:02:42,578 No, no. 81 00:02:42,579 --> 00:02:44,038 I will either sit on the sofa, 82 00:02:44,039 --> 00:02:46,290 or sometimes I'll be in bed, 83 00:02:46,291 --> 00:02:48,459 kind of sitting up with the computer on my lap, 84 00:02:48,460 --> 00:02:50,002 that kind of thing. 85 00:02:50,003 --> 00:02:52,630 So you're always looking down at the screen? 86 00:02:52,631 --> 00:02:54,256 - Yeah. - OK. 87 00:02:54,257 --> 00:02:56,677 I'm going to check the muscles in your neck. 88 00:03:03,392 --> 00:03:04,475 - Ooh! - Ooh! 89 00:03:04,476 --> 00:03:06,686 Ow, that hurts. 90 00:03:06,687 --> 00:03:09,397 All right. Well, I think we can help. 91 00:03:09,398 --> 00:03:11,565 Come on over. 92 00:03:11,566 --> 00:03:13,109 OK, gather up. 93 00:03:13,110 --> 00:03:15,319 Listen up, everybody. This is our chart rack. 94 00:03:15,320 --> 00:03:17,279 So as you can see, each slot and clipboard 95 00:03:17,280 --> 00:03:18,406 has a room number on it. 96 00:03:18,407 --> 00:03:19,824 When you pick up a new patient, 97 00:03:19,825 --> 00:03:22,201 you grab a fresh chart from the T-system. 98 00:03:22,202 --> 00:03:25,204 Pick your chart by chief complaint. 99 00:03:25,205 --> 00:03:27,415 Use the cartoon to find it. 100 00:03:27,416 --> 00:03:29,166 Why are there two bodies? 101 00:03:29,167 --> 00:03:31,168 Trauma on the left, medical on the right. 102 00:03:31,169 --> 00:03:32,545 So head injury, you go left. 103 00:03:32,546 --> 00:03:34,088 Headache, go right. 104 00:03:34,089 --> 00:03:35,631 Are those fish swimming in seaweed? 105 00:03:35,632 --> 00:03:36,716 No. 106 00:03:36,717 --> 00:03:38,050 That is bees and grass. 107 00:03:38,051 --> 00:03:39,301 That's the section for insect bites, 108 00:03:39,302 --> 00:03:40,845 skin rash, allergies. 109 00:03:40,846 --> 00:03:42,430 OK, let's say, for example, 110 00:03:42,431 --> 00:03:44,557 Dr. Al-Hashimi has a new patient with belly pain. 111 00:03:44,558 --> 00:03:47,184 For the history, circle the positives, 112 00:03:47,185 --> 00:03:49,145 like vomiting and diarrhea. 113 00:03:49,146 --> 00:03:51,772 Backslash the negative, such as recent travel, 114 00:03:51,773 --> 00:03:53,357 sick contacts, fever. 115 00:03:53,358 --> 00:03:57,278 For physical exam, checkmark normals on the left, 116 00:03:57,279 --> 00:03:59,530 and circle any abnormal findings on the right. 117 00:03:59,531 --> 00:04:00,614 Questions? 118 00:04:00,615 --> 00:04:01,824 Is your generative AI program 119 00:04:01,825 --> 00:04:02,743 still gonna be working? 120 00:04:04,202 --> 00:04:05,494 Not for a while. 121 00:04:05,495 --> 00:04:07,204 And ditch your SpectraLink phones. 122 00:04:07,205 --> 00:04:08,749 Those are voice over internet. 123 00:04:11,835 --> 00:04:13,043 PTMC Emergency. 124 00:04:13,044 --> 00:04:14,587 Go ahead, Medic Command. 125 00:04:14,588 --> 00:04:15,755 That is how we will hear about incoming runs. 126 00:04:15,756 --> 00:04:17,214 Thanks. 127 00:04:17,215 --> 00:04:18,924 Two minutes out with abdominal pain and fever. 128 00:04:18,925 --> 00:04:20,384 OK, has everybody got that so far? 129 00:04:20,385 --> 00:04:21,969 How do we write orders? 130 00:04:21,970 --> 00:04:23,596 Physician order form in triplicate. 131 00:04:23,597 --> 00:04:26,390 Labs, X-rays, IV fluid, medication. 132 00:04:26,391 --> 00:04:27,808 Will the labs still be able to run blood tests? 133 00:04:27,809 --> 00:04:29,185 Yes. 134 00:04:29,186 --> 00:04:30,603 Are the CT scanners still working? 135 00:04:30,604 --> 00:04:31,937 Yes, but the results will come back 136 00:04:31,938 --> 00:04:34,231 on paper from the radiologist. 137 00:04:34,232 --> 00:04:35,733 This is the dark ages. 138 00:04:35,734 --> 00:04:37,943 So if you have orders with labs or X-rays, 139 00:04:37,944 --> 00:04:39,487 they go into the clerk file here. 140 00:04:39,488 --> 00:04:40,780 They will sign them off. 141 00:04:40,781 --> 00:04:42,239 They will add a downtime slip on them, 142 00:04:42,240 --> 00:04:43,532 make sure they go to the correct department. 143 00:04:43,533 --> 00:04:45,075 I'm sorry, who are the clerks? 144 00:04:45,076 --> 00:04:46,368 - You're looking at them. - At your service. 145 00:04:46,369 --> 00:04:47,661 Larry and Antoine are filling in 146 00:04:47,662 --> 00:04:49,205 - until more help arrives. - We got this. 147 00:04:49,206 --> 00:04:51,290 After the clerk orders, chart gets moved 148 00:04:51,291 --> 00:04:53,042 to the nursing order rack here for IVs, 149 00:04:53,043 --> 00:04:54,794 medications, procedures. 150 00:04:54,795 --> 00:04:57,004 Medications are locked up in the PDS. 151 00:04:57,005 --> 00:04:59,799 The PDS is getting unlocked by a clinical pharmacist, 152 00:04:59,800 --> 00:05:01,383 - Dr. Megan Nordt. - We've got your back. 153 00:05:01,384 --> 00:05:02,384 This is a lot. 154 00:05:02,385 --> 00:05:04,345 Any questions? Yes. 155 00:05:04,346 --> 00:05:05,638 Uh, no. 156 00:05:05,639 --> 00:05:07,181 What's up with the third rack? 157 00:05:07,182 --> 00:05:08,724 When your patient is ready to be discharged, 158 00:05:08,725 --> 00:05:09,975 chart goes here. 159 00:05:09,976 --> 00:05:11,227 This lets everybody know 160 00:05:11,228 --> 00:05:12,478 we're about to have an open bed. 161 00:05:12,479 --> 00:05:14,271 Or that your tuna melt is up. 162 00:05:14,272 --> 00:05:15,524 Jesse? 163 00:05:16,817 --> 00:05:18,859 - What is that? - What is that? 164 00:05:18,860 --> 00:05:20,653 That is a fax machine. 165 00:05:20,654 --> 00:05:22,112 They still make those? 166 00:05:22,113 --> 00:05:23,948 This is our lifeline to labs and X-rays. 167 00:05:23,949 --> 00:05:25,825 When the results come back, they will fax to us, 168 00:05:25,826 --> 00:05:27,535 and the clerks will put them on the charts. 169 00:05:27,536 --> 00:05:28,869 - Yes? - If you say so. 170 00:05:28,870 --> 00:05:30,621 Incoming. 171 00:05:30,622 --> 00:05:33,874 OK, Dr. McKay, Dr. Whitaker, Ogilvie, you're with me. 172 00:05:33,875 --> 00:05:36,628 The rest of you, build your clipboards. 173 00:05:39,005 --> 00:05:41,715 Howard Knox, 52, abdominal pain and fever. 174 00:05:41,716 --> 00:05:44,385 152 over 90, tachy at 120. 175 00:05:44,386 --> 00:05:46,136 - Couldn't get an IV. - I wonder why. 176 00:05:46,137 --> 00:05:47,721 Hello, sir. My name is Dr. Robby. 177 00:05:47,722 --> 00:05:50,140 - Howard. - This is a teaching hospital. 178 00:05:50,141 --> 00:05:52,268 I'll be supervising Doctors McKay and Dr. Whitaker 179 00:05:52,269 --> 00:05:53,519 - and student Dr. Ogilvie. - Hey. 180 00:05:53,520 --> 00:05:54,687 - Hello. - How are you feeling? 181 00:05:54,688 --> 00:05:56,105 - Not so great. - OK. 182 00:05:56,106 --> 00:05:57,606 - Princess, what's free? - Trauma 1. 183 00:05:57,607 --> 00:05:58,942 Perlah? 184 00:06:01,403 --> 00:06:05,030 All right, orders for Mylanta and bupivacaine, Central 12. 185 00:06:05,031 --> 00:06:06,407 Wrong spot, Dr. Santos. 186 00:06:06,408 --> 00:06:08,326 And you need a sticker. 187 00:06:10,078 --> 00:06:11,412 Put it in the nursing orders rack. 188 00:06:11,413 --> 00:06:12,913 And meet me over at PDS. 189 00:06:12,914 --> 00:06:14,498 How much does this suck? 190 00:06:14,499 --> 00:06:16,208 I didn't think today could get any worse. 191 00:06:16,209 --> 00:06:18,335 This is how we rolled when I was a resident. 192 00:06:18,336 --> 00:06:19,920 Was that in the 1900s? 193 00:06:19,921 --> 00:06:22,214 Yeah, when charts were written by candlelight. 194 00:06:22,215 --> 00:06:24,049 Hey, today will be an adventure. 195 00:06:24,050 --> 00:06:26,261 Think of it like "Back to the Future." 196 00:06:28,889 --> 00:06:30,931 Or possibly "Titanic." 197 00:06:30,932 --> 00:06:32,808 Here is your antacid. 198 00:06:32,809 --> 00:06:34,184 Cheers. 199 00:06:34,185 --> 00:06:35,936 And I marked the trigger point 200 00:06:35,937 --> 00:06:37,479 that is bringing out your headache, 201 00:06:37,480 --> 00:06:39,231 and a shot of local anesthetic in that area 202 00:06:39,232 --> 00:06:41,192 could really help. 203 00:06:42,444 --> 00:06:43,527 Yeah, let's do it. 204 00:06:43,528 --> 00:06:44,738 All right. 205 00:06:45,947 --> 00:06:48,741 You are going to feel a little pinprick 206 00:06:48,742 --> 00:06:50,327 and some burning. 207 00:06:55,999 --> 00:06:57,958 OK. 208 00:06:57,959 --> 00:06:59,960 Oh, ow, ow, that really hurts. 209 00:06:59,961 --> 00:07:04,465 Temp 101.4, tachy at 128, pulse ox 92 on 2 liters. 210 00:07:04,466 --> 00:07:05,841 When did the pain start? 211 00:07:05,842 --> 00:07:07,384 It's been on and off for about a week. 212 00:07:07,385 --> 00:07:09,178 - And where do you feel it? - All over. 213 00:07:09,179 --> 00:07:11,722 It started on the left, and now there's some on the right. 214 00:07:11,723 --> 00:07:12,932 How about that fever? 215 00:07:12,933 --> 00:07:14,266 Since last night. 216 00:07:14,267 --> 00:07:15,643 I was burning up. 217 00:07:15,644 --> 00:07:17,478 Then I had chills pretty bad. 218 00:07:17,479 --> 00:07:18,479 I can't find a vein here. 219 00:07:18,480 --> 00:07:19,521 We'll try for a midline. 220 00:07:19,522 --> 00:07:21,273 Let us know if this hurts. 221 00:07:21,274 --> 00:07:22,650 - Ah, ah. - Sorry. 222 00:07:22,651 --> 00:07:24,526 - And on this side? - Yeah, yeah! 223 00:07:24,527 --> 00:07:25,653 Sorry, sir. 224 00:07:25,654 --> 00:07:26,737 Guarding with no rigidity. 225 00:07:26,738 --> 00:07:28,906 For pain, 100 of fent IM? 226 00:07:28,907 --> 00:07:30,240 Plan, Dr. Whitaker? 227 00:07:30,241 --> 00:07:32,952 Blood cultures, lactate, Zosyn. 228 00:07:32,953 --> 00:07:35,454 We're gonna need a CT to figure out what's going on. 229 00:07:35,455 --> 00:07:36,872 Ah-ah. 230 00:07:36,873 --> 00:07:38,916 - Yeah, it's not gonna work. - Yep. 231 00:07:38,917 --> 00:07:40,250 Write neatly. Penmanship counts. 232 00:07:40,251 --> 00:07:41,585 Howard, for the scan, we're gonna have 233 00:07:41,586 --> 00:07:42,670 to lay you flat on your back. 234 00:07:42,671 --> 00:07:43,921 Can you do that? 235 00:07:43,922 --> 00:07:45,172 I could ten years ago, 236 00:07:45,173 --> 00:07:46,757 but now it's too hard to breathe. 237 00:07:46,758 --> 00:07:48,467 If we can't lay you flat, 238 00:07:48,468 --> 00:07:49,969 then we're gonna have to put a tube in your windpipe 239 00:07:49,970 --> 00:07:51,470 to help you breathe-- are you OK with that? 240 00:07:51,471 --> 00:07:52,972 Intubation with rapid sequence induction? 241 00:07:52,973 --> 00:07:54,306 No, we can't lay him down. 242 00:07:54,307 --> 00:07:55,474 The tube will go in your nose 243 00:07:55,475 --> 00:07:56,600 while you're awake, sir. 244 00:07:56,601 --> 00:07:57,643 - Well... - Right. 245 00:07:57,644 --> 00:07:58,936 Does it hurt? 246 00:07:58,937 --> 00:08:00,104 You'll be numbed up completely. 247 00:08:00,105 --> 00:08:01,522 You won't feel any discomfort. 248 00:08:01,523 --> 00:08:04,400 Do you happen to know your weight? 249 00:08:04,401 --> 00:08:06,068 A little over 400. 250 00:08:06,069 --> 00:08:07,403 When was the last time you checked? 251 00:08:07,404 --> 00:08:08,904 It's been a while. 252 00:08:08,905 --> 00:08:11,365 Is it possible that you might be over 450? 253 00:08:11,366 --> 00:08:13,325 Possibly. 254 00:08:13,326 --> 00:08:15,619 Perlah, let's call for the Hoyer. 255 00:08:15,620 --> 00:08:18,622 So we're gonna place the tube and get you ready for the scan. 256 00:08:18,623 --> 00:08:20,290 Is this something serious? 257 00:08:20,291 --> 00:08:22,084 Well, it's hard to tell without a CT. 258 00:08:22,085 --> 00:08:23,794 You could just need antibiotics, 259 00:08:23,795 --> 00:08:25,587 or you could require an operation. 260 00:08:25,588 --> 00:08:26,880 If surgery is necessary, 261 00:08:26,881 --> 00:08:28,215 then your weight could make things 262 00:08:28,216 --> 00:08:29,633 - a little bit more complicated. - I know. 263 00:08:29,634 --> 00:08:31,218 - I'm sorry. - Not to worry. 264 00:08:31,219 --> 00:08:32,636 We're gonna take very good care of you. 265 00:08:32,637 --> 00:08:33,929 Team. 266 00:08:33,930 --> 00:08:35,055 OK. 267 00:08:35,056 --> 00:08:36,557 Pain medication for you, OK? 268 00:08:36,558 --> 00:08:38,434 Let's try for a midline, 269 00:08:38,435 --> 00:08:40,310 basilic vein with ultrasound guidance. 270 00:08:40,311 --> 00:08:41,770 Can ultrasound check for an appy? 271 00:08:41,771 --> 00:08:43,647 He's a little too large for an ultrasound. 272 00:08:43,648 --> 00:08:46,066 Plus, our CT can only handle 450 pounds. 273 00:08:46,067 --> 00:08:48,528 And so if he's over that, we send him to the zoo? 274 00:08:49,571 --> 00:08:50,905 He's right there. 275 00:08:53,241 --> 00:08:56,285 I--I heard that there's a large animal CT at the zoo. 276 00:08:56,286 --> 00:08:58,287 Presby's CT can handle 650. 277 00:08:58,288 --> 00:09:00,497 Yeah, if Presby's still up and running. 278 00:09:00,498 --> 00:09:01,999 Wh... 279 00:09:02,000 --> 00:09:04,001 That--that's not a jinx. It's-- 280 00:09:04,002 --> 00:09:06,628 Have any of you ever done an awake naso-tracheal? 281 00:09:06,629 --> 00:09:07,921 OK. 282 00:09:07,922 --> 00:09:09,006 Perlah, can you also ask 283 00:09:09,007 --> 00:09:10,174 Dr. Al-Hashimi to come in? 284 00:09:10,175 --> 00:09:11,258 I'm gonna need an assist. 285 00:09:11,259 --> 00:09:12,634 Yep. You got it. 286 00:09:12,635 --> 00:09:14,596 Ah, sorry. Signed. 287 00:09:15,764 --> 00:09:19,016 Hall bed F, George Francis, shortness of breath, 288 00:09:19,017 --> 00:09:21,477 Dr. Mohan, awaiting D-dimer. 289 00:09:21,478 --> 00:09:23,103 Wow. She's still going? 290 00:09:23,104 --> 00:09:25,230 Yeah. Remarkable, really. 291 00:09:25,231 --> 00:09:26,815 Dr. Al, Robby's asking for you. 292 00:09:26,816 --> 00:09:28,025 Uh, OK. 293 00:09:28,026 --> 00:09:29,777 In Trauma if you need me, Princess. 294 00:09:29,778 --> 00:09:30,904 Got it. 295 00:09:32,530 --> 00:09:34,114 Who's supposed to run the downtime slips 296 00:09:34,115 --> 00:09:35,324 to X-ray and lab? 297 00:09:35,325 --> 00:09:37,826 Uh, the charge nurse? 298 00:09:37,827 --> 00:09:39,620 Don't look at me. 299 00:09:39,621 --> 00:09:40,997 My plate's full! 300 00:09:43,041 --> 00:09:45,709 Uh, parents of Roxie Hamler? 301 00:09:45,710 --> 00:09:46,960 Central 9. 302 00:09:46,961 --> 00:09:48,253 Oh, I got it, Donnie. 303 00:09:48,254 --> 00:09:49,546 Hi, I'm Victoria Javadi, 304 00:09:49,547 --> 00:09:51,006 one of the student doctors here. 305 00:09:51,007 --> 00:09:52,549 I've been assisting with Roxie's care. 306 00:09:52,550 --> 00:09:53,926 Oh, thank you so much. 307 00:09:53,927 --> 00:09:56,136 - I'm Lloyd. - Cora. 308 00:09:56,137 --> 00:09:57,262 It's nice to meet you. 309 00:09:57,263 --> 00:09:58,430 She broke her leg? 310 00:09:58,431 --> 00:09:59,765 Um, yeah. 311 00:09:59,766 --> 00:10:01,517 There's a fracture down by the ankle. 312 00:10:01,518 --> 00:10:04,061 She's in a boot now, so there's not quite so much pain. 313 00:10:04,062 --> 00:10:06,356 But I'll take you. She's just in 9. 314 00:10:11,820 --> 00:10:13,237 The hospital Wi-Fi isn't working. 315 00:10:13,238 --> 00:10:14,613 Oh, it'll be down for a while. 316 00:10:14,614 --> 00:10:16,448 Sorry. 317 00:10:16,449 --> 00:10:18,951 Mom broke her leg, Grandpa. 318 00:10:18,952 --> 00:10:21,078 We heard. 319 00:10:21,079 --> 00:10:22,705 How are you, honey? 320 00:10:24,958 --> 00:10:27,376 You've got this, kiddo. 321 00:10:27,377 --> 00:10:29,670 Yeah. 322 00:10:29,671 --> 00:10:31,755 How long will she stay in the ER? 323 00:10:31,756 --> 00:10:35,384 Oh, until a bed opens up upstairs. 324 00:10:35,385 --> 00:10:36,928 Could be a while. 325 00:10:42,225 --> 00:10:43,976 You know, it's getting pretty crowded in here. 326 00:10:43,977 --> 00:10:45,727 Maybe we should take Tucker and Shane out for ice cream. 327 00:10:45,728 --> 00:10:49,189 - Yes, please. - No, no. I'm OK. 328 00:10:49,190 --> 00:10:52,359 Maybe your mom would like some time to rest. 329 00:10:52,360 --> 00:10:54,487 Yeah. Go. 330 00:10:56,197 --> 00:10:58,615 Can she have ice cream? 331 00:10:58,616 --> 00:11:01,827 She can have anything she wants. 332 00:11:01,828 --> 00:11:04,788 Come on, let's go. 333 00:11:04,789 --> 00:11:06,624 Bye, Mom. 334 00:11:08,334 --> 00:11:10,545 Ice cream, ice cream. 335 00:11:13,840 --> 00:11:15,215 Yep. 336 00:11:15,216 --> 00:11:17,217 Listen up. 337 00:11:17,218 --> 00:11:18,719 This is Oxymetazoline. 338 00:11:18,720 --> 00:11:19,637 This will open up the passage. 339 00:11:20,889 --> 00:11:22,347 What medication do you take? 340 00:11:22,348 --> 00:11:25,142 Uh, Lisinopril and Metformin. 341 00:11:25,143 --> 00:11:27,060 Ozempic? Wegovy? 342 00:11:27,061 --> 00:11:28,979 No. Kind of expensive. 343 00:11:28,980 --> 00:11:30,939 I'm going to squirt some numbing gel in your nose. 344 00:11:30,940 --> 00:11:34,443 If it drips back in your throat, that's OK. 345 00:11:34,444 --> 00:11:36,737 Here, in case you need it. 346 00:11:36,738 --> 00:11:38,572 Do you smoke? 347 00:11:38,573 --> 00:11:39,865 Alcohol? 348 00:11:39,866 --> 00:11:41,950 - Never. - Do you exercise? 349 00:11:41,951 --> 00:11:44,411 Moving from the bedroom to the kitchen. 350 00:11:44,412 --> 00:11:45,913 No, I'd walk more, 351 00:11:45,914 --> 00:11:48,540 but I need a bench to rest on every block. 352 00:11:48,541 --> 00:11:50,042 What about water aerobics? 353 00:11:50,043 --> 00:11:52,336 Let's focus on helping Mr. Knox. 354 00:11:52,337 --> 00:11:53,754 Agreed. 355 00:11:53,755 --> 00:11:55,756 It took me 25 years to get this way. 356 00:11:55,757 --> 00:11:58,383 Car crash, burn unit, 357 00:11:58,384 --> 00:12:01,178 four leg surgeries over ten years. 358 00:12:01,179 --> 00:12:03,388 Laid me up so much, I lost my job. 359 00:12:03,389 --> 00:12:05,057 I need to numb the back of your tongue. 360 00:12:05,058 --> 00:12:06,892 This is gonna taste pretty bad. 361 00:12:06,893 --> 00:12:08,310 Is there anyone you'd like us to call? 362 00:12:08,311 --> 00:12:09,478 No. 363 00:12:09,479 --> 00:12:11,021 Any family? 364 00:12:11,022 --> 00:12:13,607 Mm. My parents passed. 365 00:12:13,608 --> 00:12:14,816 I'm single. 366 00:12:14,817 --> 00:12:15,817 Go figure. 367 00:12:15,818 --> 00:12:17,027 Siblings? 368 00:12:17,028 --> 00:12:19,029 Sister in Arizona. 369 00:12:19,030 --> 00:12:21,448 We don't talk much. 370 00:12:21,449 --> 00:12:23,325 Now that we've numbed up the back of your tongue, 371 00:12:23,326 --> 00:12:26,870 we can anesthetize a bit deeper. 372 00:12:26,871 --> 00:12:27,871 Um, sorry to interrupt. 373 00:12:27,872 --> 00:12:28,872 I have a middle-aged woman 374 00:12:28,873 --> 00:12:30,540 with sudden onset blindness. 375 00:12:30,541 --> 00:12:31,917 - I can go. - OK. 376 00:12:31,918 --> 00:12:33,168 Will you see if Abbot's still around? 377 00:12:33,169 --> 00:12:34,169 - Yeah. - Thank you. 378 00:12:34,170 --> 00:12:35,796 What's your sister's name? 379 00:12:35,797 --> 00:12:37,506 Lauren Milford. 380 00:12:37,507 --> 00:12:39,007 Where in Arizona? 381 00:12:39,008 --> 00:12:40,634 Flagstaff, I think. 382 00:12:40,635 --> 00:12:41,843 Just gonna go over your tongue 383 00:12:41,844 --> 00:12:43,053 and numb your vocal cords. 384 00:12:43,054 --> 00:12:46,431 Ah... 385 00:12:46,432 --> 00:12:47,599 How many fingers? 386 00:12:47,600 --> 00:12:49,810 I don't see any fingers. 387 00:12:49,811 --> 00:12:51,770 And now? 388 00:12:51,771 --> 00:12:54,314 I can see a little bit of light. 389 00:12:54,315 --> 00:12:56,066 Um, Brooke, you've met Dr. King. 390 00:12:56,067 --> 00:12:57,567 This is Dr. Al-Hashimi. 391 00:12:57,568 --> 00:12:58,902 - Nice to meet you. - And her wife, Wendy. 392 00:12:58,903 --> 00:13:00,195 - Hello. - Hello. 393 00:13:00,196 --> 00:13:01,947 OK if we discuss your symptoms? 394 00:13:01,948 --> 00:13:04,157 As long as I can correct you if you get anything wrong. 395 00:13:04,158 --> 00:13:05,951 Trust me, she will. 396 00:13:05,952 --> 00:13:09,037 One hour of sudden, painless vision loss in the left eye. 397 00:13:09,038 --> 00:13:10,872 No history of hypercoagulable state 398 00:13:10,873 --> 00:13:12,249 or vascular disease. 399 00:13:12,250 --> 00:13:13,792 Could you look straight ahead, please? 400 00:13:13,793 --> 00:13:16,253 Could be a central retinal artery occlusion. 401 00:13:16,254 --> 00:13:17,713 In English, please? 402 00:13:17,714 --> 00:13:19,881 A little blood clot can block the artery 403 00:13:19,882 --> 00:13:22,467 at the back of the eye and decrease your vision. 404 00:13:22,468 --> 00:13:24,094 Sometimes it's called an eye stroke. 405 00:13:24,095 --> 00:13:25,095 Stroke? 406 00:13:25,096 --> 00:13:26,513 Like she could be paralyzed? 407 00:13:26,514 --> 00:13:28,056 No, this would be limited to the eye. 408 00:13:28,057 --> 00:13:29,474 Is it permanent? 409 00:13:29,475 --> 00:13:31,852 First, we have to make the diagnosis. 410 00:13:31,853 --> 00:13:33,061 Retinal exam? 411 00:13:33,062 --> 00:13:34,104 Hard to get a good look. 412 00:13:34,105 --> 00:13:35,689 We need the FOP. 413 00:13:35,690 --> 00:13:37,358 The what? 414 00:13:39,736 --> 00:13:41,486 Oh, Princess. 415 00:13:41,487 --> 00:13:43,447 We need patient stickers on each of these order sheets, 416 00:13:43,448 --> 00:13:45,574 or the pharmacy won't know who to give meds to. 417 00:13:45,575 --> 00:13:46,992 We're on it. 418 00:13:46,993 --> 00:13:49,161 Princess, smartphone fundoscope? 419 00:13:49,162 --> 00:13:50,537 Equipment corridor, eye cart. 420 00:13:50,538 --> 00:13:53,665 - Thanks. - You seem a little confused. 421 00:13:53,666 --> 00:13:55,459 How do I figure out which new patient to pick up? 422 00:13:55,460 --> 00:13:56,793 Top of the board. 423 00:13:56,794 --> 00:13:58,003 They're listed in the order they arrive. 424 00:13:58,004 --> 00:13:59,254 You erase the first one, then put 425 00:13:59,255 --> 00:14:00,714 your initials in the MD box. 426 00:14:00,715 --> 00:14:02,341 OK. Thanks. 427 00:14:02,342 --> 00:14:03,717 - Caleb. - Michael. 428 00:14:03,718 --> 00:14:05,552 Are you managing this chaos OK? 429 00:14:05,553 --> 00:14:08,180 Well, it's all pretty easy when you're a short-timer. 430 00:14:08,181 --> 00:14:10,725 Any more comatose patients for me to have a chat with? 431 00:14:12,518 --> 00:14:13,852 I'm kidding. 432 00:14:13,853 --> 00:14:15,437 OK. 433 00:14:15,438 --> 00:14:17,105 Victoria, this is Nicole Steadman. 434 00:14:17,106 --> 00:14:18,315 I run the parent support group 435 00:14:18,316 --> 00:14:19,775 for the psychiatric service. 436 00:14:19,776 --> 00:14:21,568 Yeah. Nicole's daughter was diagnosed 437 00:14:21,569 --> 00:14:23,320 sophomore year in college. 438 00:14:23,321 --> 00:14:26,448 You think Jackson's parents might have a chat with her? 439 00:14:26,449 --> 00:14:28,367 We can certainly ask. 440 00:14:28,368 --> 00:14:30,035 Now we can see the whole retina 441 00:14:30,036 --> 00:14:31,454 without dilating the pupil. 442 00:14:32,663 --> 00:14:34,289 You're looking in the wrong eye. 443 00:14:34,290 --> 00:14:36,541 Oh, we start with the good eye for comparison. 444 00:14:36,542 --> 00:14:38,627 Oh. 445 00:14:38,628 --> 00:14:39,711 Retina looks great. 446 00:14:39,712 --> 00:14:40,879 Now for the bad eye? 447 00:14:40,880 --> 00:14:42,131 Eyes wide open. 448 00:14:44,592 --> 00:14:45,967 How's it look? 449 00:14:45,968 --> 00:14:47,552 Extremely pale, no blood flow. 450 00:14:47,553 --> 00:14:49,679 Digital massage, 10 seconds on, 5 seconds off. 451 00:14:49,680 --> 00:14:53,059 Order non-contrast head CT. 452 00:14:54,685 --> 00:14:56,812 Come in. 453 00:14:56,813 --> 00:14:57,979 Hi. 454 00:14:57,980 --> 00:14:59,398 Heard your patient took off. 455 00:14:59,399 --> 00:15:00,941 She's taking a little break. 456 00:15:00,942 --> 00:15:03,318 How long are you gonna wait? 457 00:15:03,319 --> 00:15:05,195 You know about the cyber shutdown thing? 458 00:15:05,196 --> 00:15:06,738 Yeah. 459 00:15:06,739 --> 00:15:08,198 Wish I could help, but I gotta stay here 460 00:15:08,199 --> 00:15:09,616 till all the evidence is collected, so... 461 00:15:09,617 --> 00:15:11,243 It's a hot mess out there. 462 00:15:11,244 --> 00:15:12,537 This whole day is. 463 00:15:13,704 --> 00:15:16,248 Sorry. I was just leaving. 464 00:15:16,249 --> 00:15:18,417 You OK? 465 00:15:18,418 --> 00:15:19,876 I'm good. 466 00:15:19,877 --> 00:15:21,628 I'm glad to hear it. 467 00:15:21,629 --> 00:15:22,671 You get something to eat? 468 00:15:22,672 --> 00:15:25,549 No. 469 00:15:25,550 --> 00:15:27,676 Let's keep going. 470 00:15:27,677 --> 00:15:29,010 OK. 471 00:15:29,011 --> 00:15:30,054 Yeah. 472 00:15:40,523 --> 00:15:43,024 Why don't we keep one in the ER? 473 00:15:43,025 --> 00:15:46,695 Because our intubated patients are usually sedated. 474 00:15:46,696 --> 00:15:48,196 Right. 475 00:15:48,197 --> 00:15:49,823 Maybe you could ease up 476 00:15:49,824 --> 00:15:51,409 with your comments about his weight. 477 00:15:52,869 --> 00:15:54,828 I was just wondering how he got so big 478 00:15:54,829 --> 00:15:56,496 and how we could help. 479 00:15:56,497 --> 00:15:58,206 We can help by finding out what's wrong with him 480 00:15:58,207 --> 00:15:59,249 and treating him with respect. 481 00:15:59,250 --> 00:16:00,250 How's your belly now? 482 00:16:00,251 --> 00:16:01,585 Second pain shot helped. 483 00:16:01,586 --> 00:16:03,462 OK. There's more if you need it. 484 00:16:03,463 --> 00:16:04,713 Diminished bowel sounds. 485 00:16:04,714 --> 00:16:06,047 VidaTalk from the ICU. 486 00:16:06,048 --> 00:16:07,632 Great. 487 00:16:07,633 --> 00:16:08,925 Howard, we need to open up that passageway now 488 00:16:08,926 --> 00:16:10,177 so we can pass the tube. 489 00:16:10,178 --> 00:16:11,761 I'm gonna start with my pinky. 490 00:16:11,762 --> 00:16:13,180 Slowly, over a few minutes, I'm gonna go deeper, 491 00:16:13,181 --> 00:16:14,639 all the way to the back of my knuckle. 492 00:16:14,640 --> 00:16:16,349 Once the tube's through your vocal cords, 493 00:16:16,350 --> 00:16:17,851 you won't be able to talk. 494 00:16:17,852 --> 00:16:19,603 But this is a communication device. 495 00:16:19,604 --> 00:16:22,272 Swipe through the screen for anything you want to say. 496 00:16:22,273 --> 00:16:24,774 Hit the icon, and it talks to us. 497 00:16:24,775 --> 00:16:27,027 I would like some pain medicine. 498 00:16:27,028 --> 00:16:28,862 My pain is a nine. 499 00:16:28,863 --> 00:16:30,448 Can I get it to order a pizza? 500 00:16:32,909 --> 00:16:34,743 There's cell service in the ambulance bay. 501 00:16:34,744 --> 00:16:37,287 I found his sister's new number, left a voicemail. 502 00:16:37,288 --> 00:16:38,538 OK, I'm gonna start. 503 00:16:38,539 --> 00:16:39,748 You ready? 504 00:16:39,749 --> 00:16:41,208 Not really. 505 00:16:41,209 --> 00:16:42,209 Go ahead. 506 00:16:42,210 --> 00:16:43,585 Robby, over here. 507 00:16:43,586 --> 00:16:45,796 Here we go. Head back. 508 00:16:47,256 --> 00:16:48,548 You thinking it's surgical? 509 00:16:48,549 --> 00:16:50,008 I'm hoping for a non-perfed appy. 510 00:16:50,009 --> 00:16:51,593 - Can you do it with a scope? - Possibly, 511 00:16:51,594 --> 00:16:53,261 but he could be treated with antibiotics alone. 512 00:16:53,262 --> 00:16:55,263 And if he needs surgery? 513 00:16:55,264 --> 00:16:58,266 With his size, an emergency open laparotomy, 514 00:16:58,267 --> 00:17:00,393 death rate's close to 50%. 515 00:17:00,394 --> 00:17:01,978 OK, one step at a time. 516 00:17:01,979 --> 00:17:04,564 Let's keep trying his sister every 15 minutes. 517 00:17:04,565 --> 00:17:05,900 She'll get it. 518 00:17:09,820 --> 00:17:12,989 Half the downtime slips are blank. 519 00:17:12,990 --> 00:17:15,075 What are you talking about? 520 00:17:15,076 --> 00:17:17,244 Here and here. 521 00:17:17,245 --> 00:17:19,329 Larry, are you using a felt tip pen? 522 00:17:19,330 --> 00:17:21,623 Maybe. 523 00:17:21,624 --> 00:17:24,918 It's not going through for the copies. 524 00:17:24,919 --> 00:17:26,711 Ballpoint pen only. 525 00:17:26,712 --> 00:17:28,047 OK. 526 00:17:30,508 --> 00:17:31,883 Digby still MIA? 527 00:17:31,884 --> 00:17:33,093 Is that the homeless guy? 528 00:17:33,094 --> 00:17:34,845 We need the bed if he eloped. 529 00:17:36,264 --> 00:17:38,181 - What do you need? - An attending. 530 00:17:38,182 --> 00:17:40,016 - Or a senior resident? - Nope, I'm good. 531 00:17:40,017 --> 00:17:42,227 - Dr. Al-Hashimi, can I present? - Yes. 532 00:17:42,228 --> 00:17:44,813 32-year-old deaf woman with myofascial headache. 533 00:17:44,814 --> 00:17:47,107 Ibuprofen caused gastritis and epigastric pain, 534 00:17:47,108 --> 00:17:49,317 and she vasovagalled, but now pain-free 535 00:17:49,318 --> 00:17:51,361 after Mylanta and a trigger point injection. 536 00:17:51,362 --> 00:17:52,571 Excellent. That can take care of the pain 537 00:17:52,572 --> 00:17:54,239 - for several months. - Yeah. 538 00:17:54,240 --> 00:17:56,575 It shouldn't recur if she keeps her screen at eye level. 539 00:17:56,576 --> 00:17:57,951 There was a delay 540 00:17:57,952 --> 00:17:59,536 in getting an ASL interpreter. 541 00:17:59,537 --> 00:18:01,204 And I almost gave up and ordered 542 00:18:01,205 --> 00:18:03,373 an unnecessary brain and abdominal CT. 543 00:18:03,374 --> 00:18:04,624 Good thing you didn't. 544 00:18:04,625 --> 00:18:07,294 Dr. Al-Hashimi, for you. 545 00:18:07,295 --> 00:18:08,670 Nice job on the trigger point. 546 00:18:08,671 --> 00:18:09,879 Yeah, I know. 547 00:18:09,880 --> 00:18:11,631 How's the T-system going? 548 00:18:11,632 --> 00:18:13,717 - Quick and easy. - Yeah. 549 00:18:13,718 --> 00:18:15,969 On these MDMs, don't just circle your diagnosis. 550 00:18:15,970 --> 00:18:17,762 Also put a backslash through all the ones 551 00:18:17,763 --> 00:18:18,805 that you've ruled out. 552 00:18:18,806 --> 00:18:19,848 No problem. 553 00:18:19,849 --> 00:18:21,516 Thank you very much. 554 00:18:21,517 --> 00:18:23,518 Princess, bump Central 13 to the front of the CT line. 555 00:18:23,519 --> 00:18:24,686 What do you got? 556 00:18:24,687 --> 00:18:26,062 Sudden onset blindness patient 557 00:18:26,063 --> 00:18:27,606 has central retinal artery occlusion. 558 00:18:27,607 --> 00:18:29,274 I just spoke to an ophthalmologist 559 00:18:29,275 --> 00:18:30,859 at the VA, principal investigator 560 00:18:30,860 --> 00:18:32,527 for thrombolytics in cases like this. 561 00:18:32,528 --> 00:18:33,987 Not exactly standard of care. 562 00:18:33,988 --> 00:18:35,030 Kind of risky. 563 00:18:35,031 --> 00:18:36,656 We'll do informed consent. 564 00:18:36,657 --> 00:18:38,199 It's our best shot at saving some of her vision. 565 00:18:38,200 --> 00:18:39,993 Your patient, your call. 566 00:18:39,994 --> 00:18:41,912 I'm not gonna be around long enough for any complications. 567 00:18:44,915 --> 00:18:48,585 I'll be taking two swabs from the vagina, 568 00:18:48,586 --> 00:18:50,546 two swabs from the cervix. 569 00:18:53,966 --> 00:18:56,843 Let me know if you feel any discomfort. 570 00:18:56,844 --> 00:18:58,887 OK. 571 00:18:58,888 --> 00:19:03,058 Each swab gets labeled-- first vaginal, second vaginal. 572 00:19:03,059 --> 00:19:05,352 Smear a slide with both, and let it air dry. 573 00:19:05,353 --> 00:19:06,561 Same for the cervix? 574 00:19:06,562 --> 00:19:07,562 Yeah. 575 00:19:07,563 --> 00:19:08,856 No slide needed. 576 00:19:10,524 --> 00:19:12,734 How you doing, Ilana? 577 00:19:12,735 --> 00:19:14,778 Hanging in there. 578 00:19:14,779 --> 00:19:16,279 OK. 579 00:19:16,280 --> 00:19:17,698 Almost done. 580 00:19:20,493 --> 00:19:23,286 All these samples go in the vaginal contact envelope. 581 00:19:23,287 --> 00:19:24,704 - I can help with that. - No. 582 00:19:24,705 --> 00:19:26,414 It's gotta be me. 583 00:19:26,415 --> 00:19:29,793 I'm gonna pull this out. 584 00:19:29,794 --> 00:19:31,586 OK. 585 00:19:31,587 --> 00:19:32,671 All good here. 586 00:19:32,672 --> 00:19:34,048 Legs can come down. 587 00:19:37,885 --> 00:19:39,844 Are we done? 588 00:19:39,845 --> 00:19:41,179 One last thing. 589 00:19:41,180 --> 00:19:43,598 Four more swabs inside your mouth. 590 00:19:43,599 --> 00:19:45,308 Didn't you do that already? 591 00:19:45,309 --> 00:19:48,311 This one's different-- inside your cheek for your DNA, 592 00:19:48,312 --> 00:19:49,897 not for his. 593 00:19:52,608 --> 00:19:58,071 So it could be bipolar or schizophrenia? 594 00:19:58,072 --> 00:20:00,365 Those are the two most likely possibilities. 595 00:20:00,366 --> 00:20:01,908 How do they know which it is? 596 00:20:01,909 --> 00:20:04,077 Based on response to medicine, 597 00:20:04,078 --> 00:20:06,663 but also with therapy and observation on the ward. 598 00:20:06,664 --> 00:20:10,042 They'll monitor his mood and interactions with others. 599 00:20:12,002 --> 00:20:14,838 Is there a blood test or a brain scan 600 00:20:14,839 --> 00:20:15,880 that will tell us for sure? 601 00:20:15,881 --> 00:20:17,841 Unfortunately not. 602 00:20:17,842 --> 00:20:20,802 When properly medicated, people with bipolar disorder 603 00:20:20,803 --> 00:20:23,513 can have successful careers. 604 00:20:23,514 --> 00:20:25,432 So we hope for bipolar? 605 00:20:25,433 --> 00:20:27,434 You can hope for your son's happiness. 606 00:20:27,435 --> 00:20:30,061 With early treatment, 20% of people 607 00:20:30,062 --> 00:20:32,814 with schizophrenia have a complete recovery. 608 00:20:32,815 --> 00:20:34,733 So 80% don't? 609 00:20:34,734 --> 00:20:36,944 This is a new version of Jackson. 610 00:20:39,739 --> 00:20:40,905 How old was your daughter? 611 00:20:40,906 --> 00:20:42,824 20. 612 00:20:42,825 --> 00:20:46,244 Studying architecture at Georgetown. 613 00:20:46,245 --> 00:20:47,954 Schizophrenia. 614 00:20:47,955 --> 00:20:50,165 I'm sorry. 615 00:20:50,166 --> 00:20:51,833 Oh, she's good. 616 00:20:51,834 --> 00:20:56,713 Living at home, working as a cashier at Giant Eagle. 617 00:20:56,714 --> 00:20:59,174 Employee of the Month. 618 00:20:59,175 --> 00:21:01,384 We still have struggles, 619 00:21:01,385 --> 00:21:04,346 but there's also laughter and love. 620 00:21:11,604 --> 00:21:13,104 Good to go. 621 00:21:13,105 --> 00:21:14,105 How'd that feel? 622 00:21:14,106 --> 00:21:15,648 Very weird. 623 00:21:15,649 --> 00:21:17,734 There's no pain. Just weird. 624 00:21:17,735 --> 00:21:20,028 OK, the next step is, we're gonna take this tube 625 00:21:20,029 --> 00:21:22,030 and pass it through your nose, 626 00:21:22,031 --> 00:21:24,532 stopping at the back of your tongue. 627 00:21:24,533 --> 00:21:26,409 Best not to talk for that. 628 00:21:26,410 --> 00:21:30,038 Tube's soaking in warm water to make it more flexible. 629 00:21:30,039 --> 00:21:32,749 Do you wanna try it? 630 00:21:32,750 --> 00:21:34,626 What day and time is it? 631 00:21:34,627 --> 00:21:37,003 4th of July, 2:31 p.m. 632 00:21:37,004 --> 00:21:38,922 When is my tube coming out? 633 00:21:38,923 --> 00:21:41,800 We have to put it in first. 634 00:21:41,801 --> 00:21:42,801 I know. 635 00:21:42,802 --> 00:21:44,427 Just practicing. 636 00:21:44,428 --> 00:21:47,806 Sounds like you're an expert already. 637 00:21:47,807 --> 00:21:50,850 Before I can't talk, 638 00:21:50,851 --> 00:21:53,603 I just wanna say 639 00:21:53,604 --> 00:21:57,065 thank you for everything. 640 00:21:57,066 --> 00:21:59,109 You're very welcome. 641 00:22:04,907 --> 00:22:06,283 Here we go. 642 00:22:10,955 --> 00:22:12,413 STI prevention. 643 00:22:12,414 --> 00:22:14,040 One shot treats gonorrhea, 644 00:22:14,041 --> 00:22:16,417 then pills for chlamydia and trichomonas. 645 00:22:16,418 --> 00:22:17,961 Thank you. 646 00:22:17,962 --> 00:22:19,754 We also have morning-after contraception. 647 00:22:19,755 --> 00:22:20,839 She has an IUD. 648 00:22:20,840 --> 00:22:23,383 Over 99% effective, not 100%. 649 00:22:23,384 --> 00:22:24,926 We still offer. 650 00:22:24,927 --> 00:22:26,511 I'll pass. 651 00:22:26,512 --> 00:22:29,973 For HIV, we got PEP, Post-Exposure Prophylaxis. 652 00:22:29,974 --> 00:22:31,474 28 days. 653 00:22:31,475 --> 00:22:34,727 The sooner you start, the more effective. 654 00:22:34,728 --> 00:22:36,479 Emma, I'm pretty sure they could use 655 00:22:36,480 --> 00:22:39,649 an extra set of hands out there. 656 00:22:39,650 --> 00:22:42,110 It's nice to meet you, Ilana. 657 00:22:42,111 --> 00:22:43,528 You're a very brave woman. 658 00:22:43,529 --> 00:22:44,572 Yeah. 659 00:22:51,704 --> 00:22:53,204 She's a good nurse. 660 00:22:53,205 --> 00:22:57,709 She's still learning, but she will be. 661 00:22:57,710 --> 00:22:59,669 After this, we're done? 662 00:22:59,670 --> 00:23:01,255 Yeah. 663 00:23:04,508 --> 00:23:06,719 I'm glad you were here today. 664 00:23:11,181 --> 00:23:13,850 Me too. 665 00:23:13,851 --> 00:23:16,936 We have a decision to make. 666 00:23:16,937 --> 00:23:18,938 Studies have shown that some vision 667 00:23:18,939 --> 00:23:21,733 can be restored with a clot-busting medication. 668 00:23:21,734 --> 00:23:23,151 So give it. 669 00:23:23,152 --> 00:23:25,320 But there are possible risks. 670 00:23:25,321 --> 00:23:29,908 For eye stroke, only 17% get better without any treatment. 671 00:23:29,909 --> 00:23:31,910 - Only 17%? - Yes. 672 00:23:31,911 --> 00:23:36,247 But with the medicine, another 20% can improve. 673 00:23:36,248 --> 00:23:38,750 But there can be complications. 674 00:23:38,751 --> 00:23:42,378 2% of patients who receive the medication get worse, 675 00:23:42,379 --> 00:23:47,176 and 1% have severe disability or death. 676 00:23:52,765 --> 00:23:56,310 Honey, this one has to be your call. 677 00:23:57,561 --> 00:24:00,855 No, it's our call. 678 00:24:00,856 --> 00:24:02,732 What would you do without me? 679 00:24:02,733 --> 00:24:04,860 I'd figure out how to get by. 680 00:24:06,820 --> 00:24:09,822 And I'd probably cry for two years solid. 681 00:24:09,823 --> 00:24:12,242 Two years? That's all? 682 00:24:13,494 --> 00:24:14,953 I want the medication. 683 00:24:14,954 --> 00:24:16,830 OK. 684 00:24:20,376 --> 00:24:22,377 OK, we need your full name to make a chart. 685 00:24:22,378 --> 00:24:26,130 Jackie Liddell. 686 00:24:26,131 --> 00:24:27,173 And you are? 687 00:24:27,174 --> 00:24:28,591 Her friend Jaquie. 688 00:24:28,592 --> 00:24:30,510 - You have the same name? - No, no. 689 00:24:30,511 --> 00:24:32,720 She's Jackie with a C-K. I'm Jaquie with a Q. 690 00:24:32,721 --> 00:24:34,514 You can call me CK. 691 00:24:34,515 --> 00:24:35,598 Oh. 692 00:24:35,599 --> 00:24:36,933 Best not to talk, CK, OK? 693 00:24:36,934 --> 00:24:38,434 - Just chill. - Chill? 694 00:24:38,435 --> 00:24:41,771 - Q, I bit off half my tongue! - What? 695 00:24:41,772 --> 00:24:43,606 She said, I bit off half my tongue. 696 00:24:43,607 --> 00:24:44,983 You can understand that? 697 00:24:44,984 --> 00:24:46,651 Oh, you should hear her when she's had 698 00:24:46,652 --> 00:24:48,569 two pitchers of margaritas, fucked up and slurring. 699 00:24:48,570 --> 00:24:51,114 Ooh, you are such an idiot! 700 00:24:51,115 --> 00:24:52,740 Princess, what's open? 701 00:24:52,741 --> 00:24:54,492 South 15's clean. 702 00:24:54,493 --> 00:24:56,035 Deep tongue laceration. 703 00:24:56,036 --> 00:24:58,746 I can jump on this. 704 00:24:58,747 --> 00:25:01,708 Robby and Al-Hashimi are both with critical patients. 705 00:25:01,709 --> 00:25:03,042 Hello. 706 00:25:03,043 --> 00:25:04,293 I'm Dr. Langdon. 707 00:25:04,294 --> 00:25:06,046 I'll be supervising your care. 708 00:25:08,090 --> 00:25:10,676 Jesus, CK, your doctor's fucking hot. 709 00:25:13,595 --> 00:25:16,014 Tube's at 14 centimeters, just above the airway. 710 00:25:16,015 --> 00:25:18,391 OK, Howard, I'm going to start. 711 00:25:18,392 --> 00:25:22,562 If you want me to stop, you just put your hand up, OK? 712 00:25:22,563 --> 00:25:25,149 Blue mark tells me I'm in the tube. 713 00:25:28,569 --> 00:25:30,737 Looks like he cleared it. 714 00:25:30,738 --> 00:25:33,322 If he inhales, we should see chords. 715 00:25:33,323 --> 00:25:35,617 OK, deep breath for me, Howard. 716 00:25:38,412 --> 00:25:40,872 - OK. - Beautiful. 717 00:25:40,873 --> 00:25:42,498 Chords are sensitive, so we spray lidocaine 718 00:25:42,499 --> 00:25:44,959 - in the scope. - OK. 719 00:25:44,960 --> 00:25:48,504 1 cc going in now. 720 00:25:48,505 --> 00:25:51,215 And we'll just give that a second to work. 721 00:25:51,216 --> 00:25:52,634 How you doing, Howard? 722 00:25:54,011 --> 00:25:55,845 Once the tube's in, you'll have to breathe 723 00:25:55,846 --> 00:25:57,180 through your nose. 724 00:25:57,181 --> 00:25:58,598 OK, Howard, hold still. 725 00:25:58,599 --> 00:26:02,101 I am now going in past your vocal cords 726 00:26:02,102 --> 00:26:04,605 until we see the carina. 727 00:26:06,231 --> 00:26:07,857 Ogilvie. 728 00:26:07,858 --> 00:26:09,108 Uh, there. 729 00:26:09,109 --> 00:26:10,234 Right and left mainstem. 730 00:26:10,235 --> 00:26:12,988 And the tube slides in. 731 00:26:16,867 --> 00:26:20,120 And then the scope comes out. 732 00:26:21,955 --> 00:26:23,539 Great. 733 00:26:23,540 --> 00:26:24,874 OK, inflate the balloon. 734 00:26:24,875 --> 00:26:26,292 Deep breath through your nose. 735 00:26:26,293 --> 00:26:27,502 Amazing. 736 00:26:27,503 --> 00:26:29,629 You good? 737 00:26:29,630 --> 00:26:31,255 Great end-tidal waveform. 738 00:26:31,256 --> 00:26:32,507 Does he need a vent? 739 00:26:32,508 --> 00:26:33,716 He's breathing on his own, 740 00:26:33,717 --> 00:26:35,134 but a little CPAP wouldn't hurt. 741 00:26:35,135 --> 00:26:37,345 Starting at 5, titrate to 10. 742 00:26:37,346 --> 00:26:39,347 OK, that went really well, Howard. 743 00:26:39,348 --> 00:26:41,058 Now we're going to check your weight. 744 00:26:43,018 --> 00:26:44,644 So the nurse examiner is supposed 745 00:26:44,645 --> 00:26:46,521 to lock up the rape kit in this fridge, 746 00:26:46,522 --> 00:26:49,690 where it stays until it gets turned over to law enforcement. 747 00:26:49,691 --> 00:26:52,401 It's called preserving the chain of evidence. 748 00:26:52,402 --> 00:26:54,695 Are you fucking kidding me? 749 00:26:54,696 --> 00:26:56,572 Is there a problem? 750 00:26:56,573 --> 00:26:58,866 Jesus Christ. 751 00:26:58,867 --> 00:27:01,953 Police are supposed to pick up the rape kits within 72 hours. 752 00:27:01,954 --> 00:27:04,956 This one I did two weeks ago. 753 00:27:04,957 --> 00:27:06,375 God damn it. 754 00:27:08,627 --> 00:27:10,878 So how exactly did this happen? 755 00:27:10,879 --> 00:27:13,756 We were in between pubs taking a selfie. 756 00:27:13,757 --> 00:27:14,841 Very nice. 757 00:27:14,842 --> 00:27:17,301 Until she jerked her head up. 758 00:27:17,302 --> 00:27:18,761 Ooh. 759 00:27:18,762 --> 00:27:20,096 Ouch. 760 00:27:20,097 --> 00:27:21,764 OK, topical epi did the trick. 761 00:27:21,765 --> 00:27:23,182 - No more bleeding. - Sweet. 762 00:27:23,183 --> 00:27:24,559 I can go home now? 763 00:27:24,560 --> 00:27:26,435 I don't think so. 764 00:27:26,436 --> 00:27:28,020 It looks like the Grand Canyon across the back of your tongue. 765 00:27:28,021 --> 00:27:30,022 We need to put in some stitches. 766 00:27:30,023 --> 00:27:31,023 I don't want stitches. 767 00:27:31,024 --> 00:27:33,109 Oh. Listen to the doctor. 768 00:27:33,110 --> 00:27:34,861 Don't tell me what to do. 769 00:27:34,862 --> 00:27:36,362 This is all your fault. 770 00:27:36,363 --> 00:27:38,406 - No, it's not. - Uh, yes, it is. 771 00:27:38,407 --> 00:27:40,074 - Uh, Princess. - No, it's not. 772 00:27:40,075 --> 00:27:41,659 Princess, hey, why don't you show Q 773 00:27:41,660 --> 00:27:43,452 where she can wait while we patch up her friend? 774 00:27:43,453 --> 00:27:44,954 Of course. 775 00:27:44,955 --> 00:27:47,165 OK, this is a numbing shot for the tip. 776 00:27:47,166 --> 00:27:48,166 The tip? 777 00:27:48,167 --> 00:27:50,084 That's not where I bit it. 778 00:27:50,085 --> 00:27:51,503 One step at a time. 779 00:27:58,719 --> 00:28:01,095 That's 20 migs of TNK. 780 00:28:01,096 --> 00:28:04,140 In at 14:39. 781 00:28:04,141 --> 00:28:06,434 Feeling anything? 782 00:28:06,435 --> 00:28:07,560 Not yet. 783 00:28:07,561 --> 00:28:10,479 Could take an hour or two. 784 00:28:10,480 --> 00:28:11,939 We're going to move you to another room 785 00:28:11,940 --> 00:28:13,816 for better monitoring. 786 00:28:13,817 --> 00:28:15,360 Dr. King. 787 00:28:18,197 --> 00:28:21,616 I'd like you to stay with her. 788 00:28:21,617 --> 00:28:22,950 Why? 789 00:28:22,951 --> 00:28:24,577 In case there are complications. 790 00:28:24,578 --> 00:28:26,329 You'll be there to respond quickly 791 00:28:26,330 --> 00:28:29,248 to a blown pupil, a seizure, altered mental status. 792 00:28:29,249 --> 00:28:31,292 Or I could catch up on my charts. 793 00:28:31,293 --> 00:28:33,211 And my deposition's coming up. 794 00:28:33,212 --> 00:28:35,713 Think of this as a great way to steal some quiet time 795 00:28:35,714 --> 00:28:37,006 and get mentally prepared. 796 00:28:37,007 --> 00:28:39,218 Jesse, Mel's with you. 797 00:28:41,011 --> 00:28:43,012 Oh, excuse me, Dr. Mohan. 798 00:28:43,013 --> 00:28:44,138 Excuse me. 799 00:28:44,139 --> 00:28:45,139 Dr. Mohan. 800 00:28:45,140 --> 00:28:46,557 Uh, in a minute, George. 801 00:28:46,558 --> 00:28:47,642 I've got this. 802 00:28:47,643 --> 00:28:48,851 Thank you. 803 00:28:48,852 --> 00:28:51,187 Oh, uh, I, um-- 804 00:28:51,188 --> 00:28:53,356 D-dimer is back normal. 805 00:28:53,357 --> 00:28:54,357 Oh. 806 00:28:54,358 --> 00:28:55,691 I'm ready to go. 807 00:28:55,692 --> 00:28:57,568 Are you feeling better? 808 00:28:57,569 --> 00:29:01,240 I--I really wasn't short of breath this time. 809 00:29:02,407 --> 00:29:04,034 Then why'd you come in? 810 00:29:05,619 --> 00:29:07,662 When I found out about the blood clot in my leg, 811 00:29:07,663 --> 00:29:10,581 I just kept thinking it's gonna go to my lung and kill me. 812 00:29:10,582 --> 00:29:13,751 We've talked before about how the Eliquis would prevent that. 813 00:29:13,752 --> 00:29:16,462 I know. 814 00:29:16,463 --> 00:29:18,839 Well, I finally took your advice. 815 00:29:18,840 --> 00:29:21,300 I got out of the house, and I joined 816 00:29:21,301 --> 00:29:23,219 the Frick Park Lawn Bowling Club. 817 00:29:23,220 --> 00:29:24,512 Wonderful. 818 00:29:24,513 --> 00:29:25,638 Yeah. 819 00:29:25,639 --> 00:29:27,473 I mean, you're right, you know? 820 00:29:27,474 --> 00:29:29,434 We all need a community. 821 00:29:33,480 --> 00:29:34,939 You're gonna do what? 822 00:29:34,940 --> 00:29:36,607 In order to fix your tongue, 823 00:29:36,608 --> 00:29:39,151 we need to move it forward to access the laceration. 824 00:29:39,152 --> 00:29:40,778 You're just gonna feel some pulling, OK? 825 00:29:40,779 --> 00:29:44,156 I guess so. 826 00:29:44,157 --> 00:29:46,867 Go for it. 827 00:29:46,868 --> 00:29:48,244 What size suture is that? 828 00:29:48,245 --> 00:29:52,039 O-silk, the biggest one we got. 829 00:29:52,040 --> 00:29:54,918 As soon as I cut the needle, you're on traction, Joy. 830 00:30:03,719 --> 00:30:05,261 Oh. 831 00:30:05,262 --> 00:30:07,471 That is pretty deep. 832 00:30:07,472 --> 00:30:09,056 And now we can numb up the cut. 833 00:30:09,057 --> 00:30:10,391 It's best to start with-- 834 00:30:10,392 --> 00:30:11,809 Proximal side first so she doesn't 835 00:30:11,810 --> 00:30:15,021 feel the distal injection. 836 00:30:15,022 --> 00:30:16,022 Give it ten minutes. 837 00:30:16,023 --> 00:30:17,524 I'll be back for the repair. 838 00:30:21,737 --> 00:30:23,654 I got a rape kit sitting here for two weeks 839 00:30:23,655 --> 00:30:26,157 that was supposed to be picked up within 72 hours. 840 00:30:26,158 --> 00:30:27,199 I don't care! 841 00:30:27,200 --> 00:30:29,243 Get someone over here now! No. 842 00:30:29,244 --> 00:30:30,745 You expect us to treat your officers 843 00:30:30,746 --> 00:30:32,371 as soon as they come in, 844 00:30:32,372 --> 00:30:34,206 you get a detective to pick these kits up ASAP. 845 00:30:34,207 --> 00:30:35,207 I gotta go. 846 00:30:35,208 --> 00:30:36,792 - Dana-- - Hey, Dana. 847 00:30:36,793 --> 00:30:37,960 South 19 got their head CT before we went down. 848 00:30:37,961 --> 00:30:39,295 No results yet. 849 00:30:39,296 --> 00:30:40,463 All right, I'll send a reminder. 850 00:30:40,464 --> 00:30:41,464 - Hey, Dana. - Dana. 851 00:30:41,465 --> 00:30:42,841 Hang on. 852 00:30:43,884 --> 00:30:45,634 What's up? 853 00:30:45,635 --> 00:30:47,595 We put in an order for more pain meds for Roxie. 854 00:30:47,596 --> 00:30:49,680 All right, so put it in the nursing racks. 855 00:30:49,681 --> 00:30:52,308 Oh, I did, a long time ago. 856 00:30:52,309 --> 00:30:54,185 All right. I'll bump it to the front. 857 00:30:54,186 --> 00:30:55,728 Thank you. 858 00:30:55,729 --> 00:30:57,438 Uh, what's that noise? 859 00:30:57,439 --> 00:30:58,522 UFO landed. 860 00:30:58,523 --> 00:30:59,523 Aliens are invading. 861 00:30:59,524 --> 00:31:01,025 Hey, Dana. 862 00:31:01,026 --> 00:31:02,902 Chem 7's not back on Trauma 2 yet. 863 00:31:02,903 --> 00:31:05,196 Let me see the chart. 864 00:31:05,197 --> 00:31:06,739 Oh, Jesus. 865 00:31:06,740 --> 00:31:08,282 I bet your Chem 7 rec went to Radiology. 866 00:31:08,283 --> 00:31:10,117 Larry, Antoine. 867 00:31:10,118 --> 00:31:12,620 You put labs and chest X-ray on the same downtime form. 868 00:31:12,621 --> 00:31:14,914 You need two slips--one for labs, one for radiology. 869 00:31:14,915 --> 00:31:16,582 - Got it. - Won't happen again. 870 00:31:16,583 --> 00:31:17,708 I'll run it down myself. 871 00:31:17,709 --> 00:31:19,418 Use the iStat at bedside. 872 00:31:19,419 --> 00:31:20,836 They won't take him to CT without a creatinine. 873 00:31:20,837 --> 00:31:22,046 Oh, perfect. 874 00:31:22,047 --> 00:31:23,172 Nice to have you back. 875 00:31:23,173 --> 00:31:24,465 Thrilled to be here. 876 00:31:24,466 --> 00:31:25,591 You trying to text? 877 00:31:25,592 --> 00:31:27,134 I am just composing. 878 00:31:27,135 --> 00:31:28,677 I'm gonna send it from the bay. 879 00:31:28,678 --> 00:31:30,930 My mechanic friend, Duke, never showed up. 880 00:31:30,931 --> 00:31:32,473 I thought he was coming in this morning. 881 00:31:32,474 --> 00:31:33,682 That was the plan. 882 00:31:33,683 --> 00:31:35,976 I guess he got busy. 883 00:31:35,977 --> 00:31:37,186 What if he's a no-show? 884 00:31:37,187 --> 00:31:38,813 Tell me what he needs. 885 00:31:38,814 --> 00:31:39,897 I'll pass it on to the night shift. 886 00:31:39,898 --> 00:31:40,816 That won't be necessary. 887 00:31:43,652 --> 00:31:45,486 Oh, Princess. 888 00:31:45,487 --> 00:31:46,570 Ask and you shall receive. 889 00:31:46,571 --> 00:31:47,696 Normal head CT. 890 00:31:47,697 --> 00:31:50,074 Thanks. I'll get him discharged. 891 00:31:50,075 --> 00:31:51,909 How's your day going? 892 00:31:51,910 --> 00:31:54,412 I think I'm getting writer's cramp. 893 00:31:54,413 --> 00:31:55,746 You with the big guy? 894 00:31:55,747 --> 00:31:57,998 Yeah. It's sad. 895 00:31:57,999 --> 00:32:01,837 Bad car accident, multiple operations, tons of stress. 896 00:32:03,922 --> 00:32:05,798 Lidocaine shot to a sensitive area. 897 00:32:05,799 --> 00:32:07,550 I got a binge-drinking party girl with a tongue lac. 898 00:32:07,551 --> 00:32:08,884 Mm. 899 00:32:08,885 --> 00:32:10,136 Sounds like she needs some help. 900 00:32:10,137 --> 00:32:12,847 In more ways than one. 901 00:32:12,848 --> 00:32:16,559 How's, uh--how's your first shift back going? 902 00:32:16,560 --> 00:32:18,769 One day at a time. 903 00:32:18,770 --> 00:32:20,354 First year sober is the hardest. 904 00:32:20,355 --> 00:32:21,605 That's what they keep telling me. 905 00:32:21,606 --> 00:32:24,192 I'm nine years and counting. 906 00:32:26,653 --> 00:32:28,237 Oh. 907 00:32:28,238 --> 00:32:31,782 Special delivery for my guy. 908 00:32:31,783 --> 00:32:33,742 If you, um--if you need anything, call me. 909 00:32:33,743 --> 00:32:35,328 Thanks. 910 00:32:41,334 --> 00:32:42,960 Where are you going? 911 00:32:42,961 --> 00:32:44,336 Blisters in North 3. 912 00:32:44,337 --> 00:32:45,838 That's where I'm going. 913 00:32:45,839 --> 00:32:47,715 Did you sign up for the patient? 914 00:32:47,716 --> 00:32:49,508 I pulled the chart from the rack. 915 00:32:49,509 --> 00:32:51,260 You're supposed to sign up on the dry-erase board. 916 00:32:51,261 --> 00:32:53,137 You're supposed to have a clipboard for the patient. 917 00:32:53,138 --> 00:32:54,930 I thought the nurses had that. 918 00:32:54,931 --> 00:32:56,557 Whatever. 919 00:32:56,558 --> 00:32:57,683 Hi. 920 00:32:57,684 --> 00:32:59,101 I'm Student Doctor Ogilvie. 921 00:32:59,102 --> 00:33:01,312 And this is--wow. 922 00:33:01,313 --> 00:33:02,771 That is some rash. 923 00:33:02,772 --> 00:33:05,649 - Yeah. Tell me about it. - Student Doctor Javadi. 924 00:33:05,650 --> 00:33:07,860 - When did this start? - Last night. 925 00:33:07,861 --> 00:33:09,403 And have you been on any hikes recently 926 00:33:09,404 --> 00:33:10,529 around poison ivy? 927 00:33:10,530 --> 00:33:12,448 Nope. Haven't left the house. 928 00:33:12,449 --> 00:33:15,451 What about new medications, lotions, soaps, 929 00:33:15,452 --> 00:33:16,452 detergents, even? 930 00:33:16,453 --> 00:33:17,745 I don't take medicine. 931 00:33:17,746 --> 00:33:19,413 Nothing new with all that other stuff. 932 00:33:19,414 --> 00:33:20,498 Uh-huh. And where did this start? 933 00:33:20,499 --> 00:33:21,916 Everywhere, all at once. 934 00:33:21,917 --> 00:33:25,252 Just a lot of pain, really itchy. 935 00:33:25,253 --> 00:33:26,962 What is it? 936 00:33:26,963 --> 00:33:28,464 I'm not sure yet. 937 00:33:28,465 --> 00:33:31,217 Um, be back in a second. 938 00:33:31,218 --> 00:33:32,761 Can't--will you-- 939 00:33:37,015 --> 00:33:39,058 What are you thinking? 940 00:33:39,059 --> 00:33:40,142 I have no idea. 941 00:33:40,143 --> 00:33:41,311 Agreed. 942 00:33:43,188 --> 00:33:44,772 Bullous pemphigoid? 943 00:33:44,773 --> 00:33:46,482 Autoimmune severe pruritis? 944 00:33:46,483 --> 00:33:48,108 Yeah, but not as deadly as pemphigus vulgaris. 945 00:33:48,109 --> 00:33:50,110 Untreated, the death rate is over 90%. 946 00:33:50,111 --> 00:33:51,529 We need to check for pustules, 947 00:33:51,530 --> 00:33:52,655 mucous membrane involvement-- 948 00:33:52,656 --> 00:33:54,032 And the Nikolsky sign. 949 00:33:56,535 --> 00:33:57,911 Here you go. 950 00:33:59,412 --> 00:34:00,496 What? 951 00:34:00,497 --> 00:34:02,040 For your progress note. 952 00:34:03,416 --> 00:34:06,418 Did I hear we're making progress? 953 00:34:06,419 --> 00:34:08,712 Oh, um, it's just what we call it 954 00:34:08,713 --> 00:34:11,800 when we write down things to describe a clinical course. 955 00:34:13,343 --> 00:34:14,302 Any changes? 956 00:34:15,387 --> 00:34:16,679 Not so far. 957 00:34:16,680 --> 00:34:19,056 It's time for the next neuro check. 958 00:34:19,057 --> 00:34:21,350 Excuse me, Dr. King, do you have a minute? 959 00:34:21,351 --> 00:34:22,935 Um, no. 960 00:34:22,936 --> 00:34:24,728 I'm observing a patient right now. 961 00:34:24,729 --> 00:34:27,065 60 seconds tops. 962 00:34:28,483 --> 00:34:29,858 I'll check pupils. 963 00:34:29,859 --> 00:34:31,403 We're good here. 964 00:34:37,033 --> 00:34:38,993 Hey. 965 00:34:38,994 --> 00:34:41,328 I just finished my deposition. 966 00:34:41,329 --> 00:34:43,789 Oh, should I go up now? 967 00:34:43,790 --> 00:34:45,499 Yeah. Just wait until you get a call. 968 00:34:45,500 --> 00:34:46,875 OK. 969 00:34:46,876 --> 00:34:48,335 Well, I'd ask how it went, 970 00:34:48,336 --> 00:34:50,379 but we're not supposed to discuss the case. 971 00:34:50,380 --> 00:34:51,880 This isn't a discussion. 972 00:34:51,881 --> 00:34:55,134 It's a monologue, so shut up and listen. 973 00:34:55,135 --> 00:34:57,344 The malpractice case is frivolous. 974 00:34:57,345 --> 00:34:58,887 The mother of the measles kid claims 975 00:34:58,888 --> 00:35:00,306 we caused intellectual decline 976 00:35:00,307 --> 00:35:02,391 by performing a spinal tap. 977 00:35:02,392 --> 00:35:05,603 But the tap was perfect with no complications. 978 00:35:05,604 --> 00:35:07,354 Her son presented with altered mental status 979 00:35:07,355 --> 00:35:10,816 due to low oxygen from measles pneumonia. 980 00:35:10,817 --> 00:35:13,277 Any change in intellect was due to hypoxic brain injury. 981 00:35:13,278 --> 00:35:16,947 It had nothing to do with your spinal tap. 982 00:35:16,948 --> 00:35:18,657 End of monologue. 983 00:35:18,658 --> 00:35:21,410 We never discussed the case. 984 00:35:21,411 --> 00:35:23,746 I gotta get some sleep. 985 00:35:23,747 --> 00:35:27,000 Thanks, I guess. 986 00:35:28,668 --> 00:35:30,961 OK, are you ready to lay down? 987 00:35:30,962 --> 00:35:31,962 I got your head. 988 00:35:31,963 --> 00:35:33,172 Nice and slow. 989 00:35:33,173 --> 00:35:35,300 One, two, three. 990 00:35:36,718 --> 00:35:37,718 OK. 991 00:35:37,719 --> 00:35:38,803 How's that feel? 992 00:35:41,723 --> 00:35:42,849 Lifting up now. 993 00:35:52,859 --> 00:35:54,486 Keep going. 994 00:35:57,113 --> 00:36:00,367 And... that ought to do it right about there. 995 00:36:02,118 --> 00:36:03,952 215? 996 00:36:03,953 --> 00:36:05,872 Oh, that's in kilos. 997 00:36:08,208 --> 00:36:09,793 OK, team. 998 00:36:15,423 --> 00:36:17,174 It's not that much over 450. 999 00:36:17,175 --> 00:36:19,968 No, we can't risk breaking our CT on a holiday weekend. 1000 00:36:19,969 --> 00:36:22,096 Would the medics take him while he's intubated? 1001 00:36:22,097 --> 00:36:24,473 If I go along for the ride, I could still get a nap in 1002 00:36:24,474 --> 00:36:26,017 before my night shift. 1003 00:36:30,021 --> 00:36:32,981 474. 1004 00:36:32,982 --> 00:36:34,858 Our CT can't handle your weight, 1005 00:36:34,859 --> 00:36:38,237 but we're gonna take you over to Presbyterian Hospital. 1006 00:36:38,238 --> 00:36:40,155 Road trip. 1007 00:36:40,156 --> 00:36:42,450 I'll keep you company the whole time. 1008 00:36:44,994 --> 00:36:47,079 Sorry for all this trouble. 1009 00:36:47,080 --> 00:36:48,288 It's OK. 1010 00:36:48,289 --> 00:36:49,708 This is what we do. 1011 00:36:55,213 --> 00:36:56,797 So sub Q starts deep. 1012 00:36:56,798 --> 00:36:57,923 You want to bury the knot. 1013 00:36:57,924 --> 00:36:59,466 Yeah, I've done these before. 1014 00:36:59,467 --> 00:37:01,760 Joy, how do we cut the ends? 1015 00:37:01,761 --> 00:37:03,303 Short. Slide to the knot. 1016 00:37:03,304 --> 00:37:04,304 Turn 45 degrees. 1017 00:37:04,305 --> 00:37:06,432 Excellent. 1018 00:37:06,433 --> 00:37:08,267 Um, Dr. Langdon, we have a case. 1019 00:37:08,268 --> 00:37:09,268 It'll have to wait. 1020 00:37:09,269 --> 00:37:10,394 It could be urgent. 1021 00:37:10,395 --> 00:37:14,231 Find Robby or Al-Hashimi. 1022 00:37:14,232 --> 00:37:16,567 This girl is wasted. 1023 00:37:16,568 --> 00:37:18,610 Drunk as a skunk. 1024 00:37:18,611 --> 00:37:20,362 Should we check her blood alcohol level? 1025 00:37:20,363 --> 00:37:21,989 No, it won't change what we do. 1026 00:37:21,990 --> 00:37:23,574 She can go home when she has a steady gait. 1027 00:37:23,575 --> 00:37:25,743 I already sent one off. 1028 00:37:25,744 --> 00:37:28,412 Joy, do you want to guess her blood alcohol? 1029 00:37:28,413 --> 00:37:29,913 Why would I want to do that? 1030 00:37:29,914 --> 00:37:31,958 I don't know. 'Cause it's fun. 1031 00:37:37,964 --> 00:37:39,631 When will you have a bed? 1032 00:37:39,632 --> 00:37:41,467 I'm not sure she needs a bed. 1033 00:37:41,468 --> 00:37:43,260 She's a febrile infant. 1034 00:37:43,261 --> 00:37:45,220 Who is clearly over a month old and looks amazing. 1035 00:37:45,221 --> 00:37:47,181 Every marker is normal. She has a cold virus. 1036 00:37:47,182 --> 00:37:48,932 Infants with rhinovirus can still have 1037 00:37:48,933 --> 00:37:50,350 a serious bacterial infection. 1038 00:37:50,351 --> 00:37:51,852 Not this one. 1039 00:37:51,853 --> 00:37:53,479 We send kids like this home all the time. 1040 00:37:53,480 --> 00:37:56,441 Except this one doesn't have a home or a parent. 1041 00:37:57,817 --> 00:37:59,359 All right. 1042 00:37:59,360 --> 00:38:01,111 I can't put a kid with a virus in the nursery, 1043 00:38:01,112 --> 00:38:03,363 and I can't waste a private room on a healthy baby. 1044 00:38:03,364 --> 00:38:04,782 Then what do you propose? 1045 00:38:04,783 --> 00:38:06,742 CYF can place her in emergency foster care 1046 00:38:06,743 --> 00:38:08,285 by tomorrow morning. 1047 00:38:08,286 --> 00:38:10,496 You want to leave her down here overnight? 1048 00:38:10,497 --> 00:38:12,873 Seems to be the standard of care these days. 1049 00:38:12,874 --> 00:38:14,208 Have your attending give me a call. 1050 00:38:14,209 --> 00:38:15,250 Will do. 1051 00:38:15,251 --> 00:38:16,585 I can't believe this. 1052 00:38:16,586 --> 00:38:18,378 Let CYF know it's very urgent. 1053 00:38:18,379 --> 00:38:19,880 Got it. 1054 00:38:19,881 --> 00:38:22,424 This is turning into quite the day. 1055 00:38:22,425 --> 00:38:24,343 You know, I've been thinking 1056 00:38:24,344 --> 00:38:25,886 about applying for a fellowship. 1057 00:38:25,887 --> 00:38:27,846 I thought you had a job lined up in New Jersey. 1058 00:38:27,847 --> 00:38:29,973 I did, to be close to my mom. 1059 00:38:29,974 --> 00:38:33,519 But she sold her house to travel the world 1060 00:38:33,520 --> 00:38:35,521 with her new boyfriend. 1061 00:38:35,522 --> 00:38:37,356 So what's the point of New Jersey? 1062 00:38:37,357 --> 00:38:38,774 Yeah, good question. 1063 00:38:38,775 --> 00:38:40,400 Which fellowship? 1064 00:38:40,401 --> 00:38:44,112 I've narrowed it down to ultrasound, toxicology, 1065 00:38:44,113 --> 00:38:47,366 and sports medicine. 1066 00:38:47,367 --> 00:38:48,742 Those are very disparate fields 1067 00:38:48,743 --> 00:38:50,244 leading to very different careers. 1068 00:38:50,245 --> 00:38:51,411 I know. 1069 00:38:51,412 --> 00:38:53,497 I'm a little undecided. 1070 00:38:53,498 --> 00:38:55,123 Do you have research experience? 1071 00:38:55,124 --> 00:38:57,709 I was a part of a study on racial disparities 1072 00:38:57,710 --> 00:38:59,586 in health care until the White House 1073 00:38:59,587 --> 00:39:01,129 cut the funding last year. 1074 00:39:01,130 --> 00:39:03,549 Yeah. You are not alone. 1075 00:39:03,550 --> 00:39:06,468 Have you considered a geriatrics fellowship? 1076 00:39:06,469 --> 00:39:08,387 I have not. 1077 00:39:08,388 --> 00:39:10,514 I've seen your skills with the elderly, 1078 00:39:10,515 --> 00:39:12,641 and there are a lot of openings. 1079 00:39:12,642 --> 00:39:14,476 It might be your best shot. 1080 00:39:14,477 --> 00:39:17,312 Think about it. 1081 00:39:17,313 --> 00:39:18,313 Last stitch. 1082 00:39:18,314 --> 00:39:19,398 You want me to cut? 1083 00:39:19,399 --> 00:39:20,859 I got it. 1084 00:39:22,569 --> 00:39:23,902 It looks good. 1085 00:39:23,903 --> 00:39:25,988 OK. Let's pull the traction suture. 1086 00:39:25,989 --> 00:39:27,365 With pleasure. 1087 00:39:29,325 --> 00:39:31,451 OK, Jackie. 1088 00:39:31,452 --> 00:39:32,870 - Jackie. - Stop it. 1089 00:39:32,871 --> 00:39:33,871 Stop. 1090 00:39:33,872 --> 00:39:35,163 All done. 1091 00:39:35,164 --> 00:39:36,748 All done with what? 1092 00:39:36,749 --> 00:39:38,417 Sewing up your tongue. 1093 00:39:38,418 --> 00:39:40,127 What happened to my tongue? 1094 00:39:40,128 --> 00:39:41,336 You bit it. 1095 00:39:41,337 --> 00:39:42,337 Ha. 1096 00:39:42,338 --> 00:39:44,006 No, I didn't. 1097 00:39:44,007 --> 00:39:45,841 That is called a blackout. 1098 00:39:45,842 --> 00:39:47,676 How much did you drink? 1099 00:39:47,677 --> 00:39:49,928 A couple Bloody Marys. 1100 00:39:49,929 --> 00:39:51,138 Only a couple? 1101 00:39:51,139 --> 00:39:53,307 I don't know. Maybe more. 1102 00:39:53,308 --> 00:39:56,018 It's a holiday, a pub crawl. 1103 00:39:56,019 --> 00:39:58,729 Do you usually have a couple cocktails every day? 1104 00:39:58,730 --> 00:39:59,980 Only on weekends. 1105 00:39:59,981 --> 00:40:01,315 How about during the week? 1106 00:40:01,316 --> 00:40:02,733 Nothing much. 1107 00:40:02,734 --> 00:40:07,738 Just wine with dinner or a few beers. 1108 00:40:07,739 --> 00:40:10,908 Maybe we should recommend rehab? 1109 00:40:10,909 --> 00:40:11,992 Yeah. 1110 00:40:11,993 --> 00:40:13,411 We could try. 1111 00:40:17,999 --> 00:40:20,459 Ready to roll. 1112 00:40:20,460 --> 00:40:22,085 How are you feeling? 1113 00:40:22,086 --> 00:40:23,462 My pain is a two. 1114 00:40:23,463 --> 00:40:25,047 We got meds if you need them. 1115 00:40:25,048 --> 00:40:26,590 Scan will be quicker than the ride to Presby. 1116 00:40:26,591 --> 00:40:27,966 We'll keep trying to reach your sister. 1117 00:40:27,967 --> 00:40:29,593 - You guys are the best. - See you later. 1118 00:40:29,594 --> 00:40:31,386 Can I put a new patient in T1? 1119 00:40:31,387 --> 00:40:33,764 Uh, no, I kind of want to leave one trauma room open. 1120 00:40:33,765 --> 00:40:37,392 Why don't you double up the north if you have to? 1121 00:40:37,393 --> 00:40:40,312 Mr. Digby? 1122 00:40:40,313 --> 00:40:42,189 - It's just Digby. - Right. 1123 00:40:42,190 --> 00:40:44,733 We've been looking all over. Where you been? 1124 00:40:44,734 --> 00:40:46,276 With Louie. 1125 00:40:46,277 --> 00:40:47,778 You've been in there for an hour? 1126 00:40:47,779 --> 00:40:49,821 He was my friend. 1127 00:40:49,822 --> 00:40:51,740 - I had a lot to say. - Hmm. 1128 00:40:51,741 --> 00:40:54,035 Well, let's get you back to your bed. 1129 00:40:56,120 --> 00:40:57,996 Louie got his wings. 1130 00:40:57,997 --> 00:40:59,915 - Dr. Robby. - Dr. Robby. 1131 00:40:59,916 --> 00:41:01,500 We picked up a patient together. 1132 00:41:01,501 --> 00:41:02,918 Teamwork! 1133 00:41:02,919 --> 00:41:04,461 It's a concerning bullous rash. 1134 00:41:04,462 --> 00:41:06,046 We might need a biopsy for pemphigus vulgaris. 1135 00:41:06,047 --> 00:41:07,506 It's phytophotodermatitis. 1136 00:41:07,507 --> 00:41:09,257 - What? - I asked. 1137 00:41:09,258 --> 00:41:11,385 He was making three gallons of margaritas for a party, 1138 00:41:11,386 --> 00:41:13,637 squeezing fresh limes out in the sun. 1139 00:41:13,638 --> 00:41:15,055 Let's go take a peek. 1140 00:41:15,056 --> 00:41:16,891 I don't need to see it again. 1141 00:41:19,435 --> 00:41:20,894 How's it going out there? 1142 00:41:20,895 --> 00:41:22,479 Standing room only. 1143 00:41:22,480 --> 00:41:23,897 If I call the fire department, will they clear 1144 00:41:23,898 --> 00:41:25,190 - that waiting room? - I wish. 1145 00:41:25,191 --> 00:41:26,316 What's up? 1146 00:41:26,317 --> 00:41:28,360 12 patients need med refills. 1147 00:41:28,361 --> 00:41:29,945 Shouldn't they see their doctors? 1148 00:41:29,946 --> 00:41:31,697 With the Medicaid cuts, we are their doctor. 1149 00:41:31,698 --> 00:41:33,407 No, I can't e-prescribe to their pharmacies. 1150 00:41:33,408 --> 00:41:35,117 So get out your pen. Go old school. 1151 00:41:35,118 --> 00:41:37,452 Dana, on what? 1152 00:41:37,453 --> 00:41:39,913 Nordt, you got the security pads? 1153 00:41:39,914 --> 00:41:41,206 Sure do. 1154 00:41:41,207 --> 00:41:43,000 Just need a patient sticker. 1155 00:41:43,001 --> 00:41:45,377 - Any other questions? - Yeah. 1156 00:41:45,378 --> 00:41:47,755 What would have happened if you weren't here today? 1157 00:41:48,965 --> 00:41:50,799 You'd all be curled up in the fetal position, 1158 00:41:50,800 --> 00:41:53,135 crying like babies. 1159 00:41:53,136 --> 00:41:54,761 Were you wearing flip-flops? 1160 00:41:54,762 --> 00:41:56,096 I was. 1161 00:41:56,097 --> 00:41:58,015 - What is it? - Phytophotodermatitis. 1162 00:41:58,016 --> 00:42:00,225 Otherwise known as margarita burn. 1163 00:42:00,226 --> 00:42:01,768 For some people, limes plus sunshine 1164 00:42:01,769 --> 00:42:03,103 can cause a horrible rash. 1165 00:42:03,104 --> 00:42:05,230 This is all because of limes? 1166 00:42:05,231 --> 00:42:08,066 Have you ever squeezed limes outside in the sun before? 1167 00:42:08,067 --> 00:42:09,735 I don't think so. 1168 00:42:09,736 --> 00:42:12,195 You will feel better after a day of steroid pills. 1169 00:42:12,196 --> 00:42:14,114 But once these heal, you gotta wear sunscreen. 1170 00:42:14,115 --> 00:42:16,241 Because these blisters can turn into dark scars 1171 00:42:16,242 --> 00:42:17,410 and stay a while if you don't. 1172 00:42:19,120 --> 00:42:22,456 I'll be right back with your aftercare instructions. 1173 00:42:22,457 --> 00:42:24,416 - Hey, Robby. - Yep. 1174 00:42:24,417 --> 00:42:26,585 My, uh-- my hospice patient Roxie 1175 00:42:26,586 --> 00:42:28,503 is still in a ton of pain. 1176 00:42:28,504 --> 00:42:29,796 Where are we with the morphine? 1177 00:42:29,797 --> 00:42:31,757 10 milligrams an hour. 1178 00:42:31,758 --> 00:42:34,301 OK, you can bolus another 2 and go up to 12. 1179 00:42:34,302 --> 00:42:35,677 I will let Princess know. 1180 00:42:35,678 --> 00:42:37,054 12 an hour is a lot. 1181 00:42:37,055 --> 00:42:38,513 Yeah, on top of the MS Contin, 1182 00:42:38,514 --> 00:42:41,475 she could stop breathing. 1183 00:42:41,476 --> 00:42:44,811 Are you familiar with the doctrine of double effect? 1184 00:42:44,812 --> 00:42:46,897 - Not really. - No. 1185 00:42:46,898 --> 00:42:49,399 It is an ethical principle in palliative care. 1186 00:42:49,400 --> 00:42:51,109 We treat pain. 1187 00:42:51,110 --> 00:42:53,070 And if, in doing so, there's a negative side effect, 1188 00:42:53,071 --> 00:42:54,696 we accept it. 1189 00:42:54,697 --> 00:42:57,532 Even if the negative side effect is death? 1190 00:42:57,533 --> 00:43:00,161 In some cases, that could be the best outcome. 1191 00:43:06,000 --> 00:43:07,459 Maybe the nurse has it. 1192 00:43:07,460 --> 00:43:10,170 Emma. Emma, where does-- 1193 00:43:10,171 --> 00:43:11,922 Maybe the fax ran out of paper? 1194 00:43:11,923 --> 00:43:14,633 No, there is enough paper. I don't know what's wrong. 1195 00:43:14,634 --> 00:43:16,134 - Could be in another room. - We should call IT. 1196 00:43:16,135 --> 00:43:18,136 You want me to check every room? 1197 00:43:18,137 --> 00:43:19,721 How are we gonna get through this mess? 1198 00:43:19,722 --> 00:43:22,682 I was about to ask you. 1199 00:43:22,683 --> 00:43:24,226 Ask the pharmacist. 1200 00:43:24,227 --> 00:43:25,811 She can't leave the PDS. 1201 00:43:25,812 --> 00:43:27,522 Nothing's getting done here.