1 00:00:15,599 --> 00:00:17,226 Next time, maybe inform the department chair 2 00:00:17,309 --> 00:00:18,268 before the shit hits the fan. 3 00:00:18,352 --> 00:00:19,937 I was on my way to tell you. 4 00:00:20,020 --> 00:00:21,271 Make sure you get everything you need. 5 00:00:21,355 --> 00:00:22,356 OK, let's do this. 6 00:00:22,439 --> 00:00:23,941 IT called me up because 7 00:00:24,024 --> 00:00:26,276 I've trained in cyberattack prevention and response. 8 00:00:26,360 --> 00:00:27,569 Then you can tell everybody what to do. 9 00:00:27,653 --> 00:00:28,946 No, thank you. 10 00:00:29,029 --> 00:00:30,197 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 --> 00:00:35,953 All right, everybody, circle up. 13 00:00:36,036 --> 00:00:37,204 What the fuck? 14 00:00:37,287 --> 00:00:39,164 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 --> 00:00:45,254 OK, everybody, settle down. Listen up. 17 00:00:45,337 --> 00:00:46,630 As you can see, we're doing a little 18 00:00:46,713 --> 00:00:49,132 redecorating in the central work area. 19 00:00:49,216 --> 00:00:52,010 Our hospital computers are at risk for a cyberattack, 20 00:00:52,094 --> 00:00:54,012 so we are going old school, analog. 21 00:00:54,096 --> 00:00:55,430 - For how long? - Great question. 22 00:00:55,514 --> 00:00:57,474 Our IT department has shut everything down 23 00:00:57,558 --> 00:00:59,810 to give them time to bolster our cyber defenses. 24 00:00:59,893 --> 00:01:01,728 I believe the question was, for how long? 25 00:01:01,812 --> 00:01:03,021 Uh, hard to say. 26 00:01:03,105 --> 00:01:04,314 Could be up to 24 hours. 27 00:01:04,398 --> 00:01:05,941 Jesus Christ. 28 00:01:06,024 --> 00:01:07,568 So first order of business, 29 00:01:07,651 --> 00:01:09,528 we need to replicate the electronic patient boards 30 00:01:09,611 --> 00:01:10,862 on these dry-erase boards. 31 00:01:10,946 --> 00:01:11,947 So please, somebody tell me 32 00:01:12,030 --> 00:01:13,073 they got a photo of the boards. 33 00:01:13,156 --> 00:01:14,074 Uh, yeah, yeah, yeah. 34 00:01:14,157 --> 00:01:15,576 Right here. OK. 35 00:01:15,659 --> 00:01:16,702 Oh, uh... 36 00:01:18,870 --> 00:01:20,998 It's a little blurry. 37 00:01:21,081 --> 00:01:23,625 No, more than a little blurry. 38 00:01:23,709 --> 00:01:26,420 - Sorry. - Oh, my God. 39 00:01:26,503 --> 00:01:28,171 - I remember. - Great. 40 00:01:28,255 --> 00:01:30,132 If everybody else can remember their patient names 41 00:01:30,215 --> 00:01:31,508 and their room numbers, that would be awesome. 42 00:01:31,592 --> 00:01:33,510 No, I mean I can remember all of it. 43 00:01:33,594 --> 00:01:34,636 All of what? 44 00:01:34,720 --> 00:01:36,847 Names, doctors, room numbers. 45 00:01:36,930 --> 00:01:39,266 I kind of have a photographic memory. 46 00:01:39,349 --> 00:01:41,393 Seriously? The whole board? 47 00:01:41,476 --> 00:01:43,770 Central 12, Harlow Graham, headache, 48 00:01:43,854 --> 00:01:46,523 - abdominal pain, ASL only. - Oh, shit. 49 00:01:46,607 --> 00:01:48,442 I have an interpreter waiting for me. 50 00:01:48,525 --> 00:01:50,569 - Go. - OK, for patient privacy, 51 00:01:50,652 --> 00:01:52,279 all chief complaints will be abbreviated. 52 00:01:52,362 --> 00:01:53,614 So HA for headache, 53 00:01:53,697 --> 00:01:55,574 AP for abdominal pain, and so forth. 54 00:01:55,657 --> 00:01:58,827 Central 10, Jackson Davis, new-onset psychosis. 55 00:01:58,910 --> 00:02:00,287 Javadi, psych admission. 56 00:02:00,370 --> 00:02:02,289 Greek letter psi for psych. 57 00:02:02,372 --> 00:02:04,541 Pedes is Baby Jane Doe, fever, Dr. Mohan, 58 00:02:04,625 --> 00:02:06,084 awaiting admission orders. 59 00:02:06,168 --> 00:02:07,794 Nurses need to convert to a zone defense-- 60 00:02:07,878 --> 00:02:08,837 north, central, south, trauma. 61 00:02:08,920 --> 00:02:10,005 Where's Dana? 62 00:02:10,088 --> 00:02:11,673 In with a sexual assault case. 63 00:02:11,757 --> 00:02:13,258 She can't leave until the exam is finished. 64 00:02:13,342 --> 00:02:14,551 Yeah, it could be a while. 65 00:02:14,635 --> 00:02:15,969 Princess has charge nurse experience. 66 00:02:16,053 --> 00:02:17,429 - Not really. - That's a great idea. 67 00:02:17,512 --> 00:02:18,680 Princess it is. 68 00:02:18,764 --> 00:02:19,681 You can make the nursing assignments. 69 00:02:19,765 --> 00:02:21,016 - Next. - Central 9, 70 00:02:21,099 --> 00:02:22,976 Roxie Hamler, end-stage lung cancer. 71 00:02:23,060 --> 00:02:24,353 Sorry, do we have to stand here while 72 00:02:24,436 --> 00:02:25,562 - she recites the whole board? - No. 73 00:02:25,646 --> 00:02:26,813 In fact, go check on your patients 74 00:02:26,897 --> 00:02:28,315 and then please come back here. 75 00:02:28,398 --> 00:02:29,858 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 --> 00:02:35,989 At least eight hours. 78 00:02:36,073 --> 00:02:37,407 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 --> 00:02:42,496 No, no. 81 00:02:42,579 --> 00:02:43,955 I will either sit on the sofa, 82 00:02:44,039 --> 00:02:46,208 or sometimes I'll be in bed, 83 00:02:46,291 --> 00:02:48,377 kind of sitting up with the computer on my lap, 84 00:02:48,460 --> 00:02:49,920 that kind of thing. 85 00:02:50,003 --> 00:02:52,547 So you're always looking down at the screen? 86 00:02:52,631 --> 00:02:54,174 - 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 --> 00:03:04,393 - Ooh! - Ooh! 89 00:03:04,476 --> 00:03:06,603 Ow, that hurts. 90 00:03:06,687 --> 00:03:09,314 All right. Well, I think we can help. 91 00:03:09,398 --> 00:03:11,483 Come on over. 92 00:03:11,566 --> 00:03:13,026 OK, gather up. 93 00:03:13,110 --> 00:03:15,237 Listen up, everybody. This is our chart rack. 94 00:03:15,320 --> 00:03:17,197 So as you can see, each slot and clipboard 95 00:03:17,280 --> 00:03:18,323 has a room number on it. 96 00:03:18,407 --> 00:03:19,741 When you pick up a new patient, 97 00:03:19,825 --> 00:03:22,119 you grab a fresh chart from the T-system. 98 00:03:22,202 --> 00:03:25,122 Pick your chart by chief complaint. 99 00:03:25,205 --> 00:03:27,332 Use the cartoon to find it. 100 00:03:27,416 --> 00:03:29,084 Why are there two bodies? 101 00:03:29,167 --> 00:03:31,086 Trauma on the left, medical on the right. 102 00:03:31,169 --> 00:03:32,462 So head injury, you go left. 103 00:03:32,546 --> 00:03:34,005 Headache, go right. 104 00:03:34,089 --> 00:03:35,549 Are those fish swimming in seaweed? 105 00:03:35,632 --> 00:03:36,633 No. 106 00:03:36,717 --> 00:03:37,968 That is bees and grass. 107 00:03:38,051 --> 00:03:39,219 That's the section for insect bites, 108 00:03:39,302 --> 00:03:40,762 skin rash, allergies. 109 00:03:40,846 --> 00:03:42,347 OK, let's say, for example, 110 00:03:42,431 --> 00:03:44,474 Dr. Al-Hashimi has a new patient with belly pain. 111 00:03:44,558 --> 00:03:47,102 For the history, circle the positives, 112 00:03:47,185 --> 00:03:49,062 like vomiting and diarrhea. 113 00:03:49,146 --> 00:03:51,690 Backslash the negative, such as recent travel, 114 00:03:51,773 --> 00:03:53,275 sick contacts, fever. 115 00:03:53,358 --> 00:03:57,195 For physical exam, checkmark normals on the left, 116 00:03:57,279 --> 00:03:59,448 and circle any abnormal findings on the right. 117 00:03:59,531 --> 00:04:00,532 Questions? 118 00:04:00,615 --> 00:04:01,742 Is your generative AI program 119 00:04:01,825 --> 00:04:02,743 still gonna be working? 120 00:04:04,202 --> 00:04:05,412 Not for a while. 121 00:04:05,495 --> 00:04:07,122 And ditch your SpectraLink phones. 122 00:04:07,205 --> 00:04:08,749 Those are voice over internet. 123 00:04:11,835 --> 00:04:12,961 PTMC Emergency. 124 00:04:13,044 --> 00:04:14,504 Go ahead, Medic Command. 125 00:04:14,588 --> 00:04:15,672 That is how we will hear about incoming runs. 126 00:04:15,756 --> 00:04:17,132 Thanks. 127 00:04:17,215 --> 00:04:18,842 Two minutes out with abdominal pain and fever. 128 00:04:18,925 --> 00:04:20,302 OK, has everybody got that so far? 129 00:04:20,385 --> 00:04:21,887 How do we write orders? 130 00:04:21,970 --> 00:04:23,513 Physician order form in triplicate. 131 00:04:23,597 --> 00:04:26,308 Labs, X-rays, IV fluid, medication. 132 00:04:26,391 --> 00:04:27,726 Will the labs still be able to run blood tests? 133 00:04:27,809 --> 00:04:29,102 Yes. 134 00:04:29,186 --> 00:04:30,520 Are the CT scanners still working? 135 00:04:30,604 --> 00:04:31,855 Yes, but the results will come back 136 00:04:31,938 --> 00:04:34,149 on paper from the radiologist. 137 00:04:34,232 --> 00:04:35,650 This is the dark ages. 138 00:04:35,734 --> 00:04:37,861 So if you have orders with labs or X-rays, 139 00:04:37,944 --> 00:04:39,404 they go into the clerk file here. 140 00:04:39,488 --> 00:04:40,697 They will sign them off. 141 00:04:40,781 --> 00:04:42,157 They will add a downtime slip on them, 142 00:04:42,240 --> 00:04:43,450 make sure they go to the correct department. 143 00:04:43,533 --> 00:04:44,993 I'm sorry, who are the clerks? 144 00:04:45,076 --> 00:04:46,286 - You're looking at them. - At your service. 145 00:04:46,369 --> 00:04:47,579 Larry and Antoine are filling in 146 00:04:47,662 --> 00:04:49,122 - until more help arrives. - We got this. 147 00:04:49,206 --> 00:04:51,208 After the clerk orders, chart gets moved 148 00:04:51,291 --> 00:04:52,959 to the nursing order rack here for IVs, 149 00:04:53,043 --> 00:04:54,711 medications, procedures. 150 00:04:54,795 --> 00:04:56,922 Medications are locked up in the PDS. 151 00:04:57,005 --> 00:04:59,716 The PDS is getting unlocked by a clinical pharmacist, 152 00:04:59,800 --> 00:05:01,301 - Dr. Megan Nordt. - We've got your back. 153 00:05:01,384 --> 00:05:02,302 This is a lot. 154 00:05:02,385 --> 00:05:04,262 Any questions? Yes. 155 00:05:04,346 --> 00:05:05,555 Uh, no. 156 00:05:05,639 --> 00:05:07,098 What's up with the third rack? 157 00:05:07,182 --> 00:05:08,642 When your patient is ready to be discharged, 158 00:05:08,725 --> 00:05:09,893 chart goes here. 159 00:05:09,976 --> 00:05:11,144 This lets everybody know 160 00:05:11,228 --> 00:05:12,395 we're about to have an open bed. 161 00:05:12,479 --> 00:05:14,189 Or that your tuna melt is up. 162 00:05:14,272 --> 00:05:15,524 Jesse? 163 00:05:16,817 --> 00:05:18,777 - What is that? - What is that? 164 00:05:18,860 --> 00:05:20,570 That is a fax machine. 165 00:05:20,654 --> 00:05:22,030 They still make those? 166 00:05:22,113 --> 00:05:23,865 This is our lifeline to labs and X-rays. 167 00:05:23,949 --> 00:05:25,742 When the results come back, they will fax to us, 168 00:05:25,826 --> 00:05:27,452 and the clerks will put them on the charts. 169 00:05:27,536 --> 00:05:28,787 - Yes? - If you say so. 170 00:05:28,870 --> 00:05:30,539 Incoming. 171 00:05:30,622 --> 00:05:33,792 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 --> 00:05:41,633 Howard Knox, 52, abdominal pain and fever. 174 00:05:41,716 --> 00:05:44,302 152 over 90, tachy at 120. 175 00:05:44,386 --> 00:05:46,054 - Couldn't get an IV. - I wonder why. 176 00:05:46,137 --> 00:05:47,639 Hello, sir. My name is Dr. Robby. 177 00:05:47,722 --> 00:05:50,058 - Howard. - This is a teaching hospital. 178 00:05:50,141 --> 00:05:52,185 I'll be supervising Doctors McKay and Dr. Whitaker 179 00:05:52,269 --> 00:05:53,436 - and student Dr. Ogilvie. - Hey. 180 00:05:53,520 --> 00:05:54,604 - Hello. - How are you feeling? 181 00:05:54,688 --> 00:05:56,022 - Not so great. - OK. 182 00:05:56,106 --> 00:05:57,524 - Princess, what's free? - Trauma 1. 183 00:05:57,607 --> 00:05:58,942 Perlah? 184 00:06:01,403 --> 00:06:04,948 All right, orders for Mylanta and bupivacaine, Central 12. 185 00:06:05,031 --> 00:06:06,324 Wrong spot, Dr. Santos. 186 00:06:06,408 --> 00:06:08,326 And you need a sticker. 187 00:06:10,078 --> 00:06:11,329 Put it in the nursing orders rack. 188 00:06:11,413 --> 00:06:12,831 And meet me over at PDS. 189 00:06:12,914 --> 00:06:14,416 How much does this suck? 190 00:06:14,499 --> 00:06:16,126 I didn't think today could get any worse. 191 00:06:16,209 --> 00:06:18,253 This is how we rolled when I was a resident. 192 00:06:18,336 --> 00:06:19,838 Was that in the 1900s? 193 00:06:19,921 --> 00:06:22,132 Yeah, when charts were written by candlelight. 194 00:06:22,215 --> 00:06:23,967 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 --> 00:06:30,849 Or possibly "Titanic." 197 00:06:30,932 --> 00:06:32,726 Here is your antacid. 198 00:06:32,809 --> 00:06:34,102 Cheers. 199 00:06:34,185 --> 00:06:35,854 And I marked the trigger point 200 00:06:35,937 --> 00:06:37,397 that is bringing out your headache, 201 00:06:37,480 --> 00:06:39,149 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 --> 00:06:43,445 Yeah, let's do it. 204 00:06:43,528 --> 00:06:44,738 All right. 205 00:06:45,947 --> 00:06:48,658 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 --> 00:06:57,876 OK. 208 00:06:57,959 --> 00:06:59,878 Oh, ow, ow, that really hurts. 209 00:06:59,961 --> 00:07:04,382 Temp 101.4, tachy at 128, pulse ox 92 on 2 liters. 210 00:07:04,466 --> 00:07:05,759 When did the pain start? 211 00:07:05,842 --> 00:07:07,302 It's been on and off for about a week. 212 00:07:07,385 --> 00:07:09,095 - And where do you feel it? - All over. 213 00:07:09,179 --> 00:07:11,640 It started on the left, and now there's some on the right. 214 00:07:11,723 --> 00:07:12,849 How about that fever? 215 00:07:12,933 --> 00:07:14,184 Since last night. 216 00:07:14,267 --> 00:07:15,560 I was burning up. 217 00:07:15,644 --> 00:07:17,395 Then I had chills pretty bad. 218 00:07:17,479 --> 00:07:18,396 I can't find a vein here. 219 00:07:18,480 --> 00:07:19,439 We'll try for a midline. 220 00:07:19,522 --> 00:07:21,191 Let us know if this hurts. 221 00:07:21,274 --> 00:07:22,567 - Ah, ah. - Sorry. 222 00:07:22,651 --> 00:07:24,444 - And on this side? - Yeah, yeah! 223 00:07:24,527 --> 00:07:25,570 Sorry, sir. 224 00:07:25,654 --> 00:07:26,655 Guarding with no rigidity. 225 00:07:26,738 --> 00:07:28,823 For pain, 100 of fent IM? 226 00:07:28,907 --> 00:07:30,158 Plan, Dr. Whitaker? 227 00:07:30,241 --> 00:07:32,869 Blood cultures, lactate, Zosyn. 228 00:07:32,953 --> 00:07:35,372 We're gonna need a CT to figure out what's going on. 229 00:07:35,455 --> 00:07:36,790 Ah-ah. 230 00:07:36,873 --> 00:07:38,833 - Yeah, it's not gonna work. - Yep. 231 00:07:38,917 --> 00:07:40,168 Write neatly. Penmanship counts. 232 00:07:40,251 --> 00:07:41,503 Howard, for the scan, we're gonna have 233 00:07:41,586 --> 00:07:42,587 to lay you flat on your back. 234 00:07:42,671 --> 00:07:43,838 Can you do that? 235 00:07:43,922 --> 00:07:45,090 I could ten years ago, 236 00:07:45,173 --> 00:07:46,675 but now it's too hard to breathe. 237 00:07:46,758 --> 00:07:48,385 If we can't lay you flat, 238 00:07:48,468 --> 00:07:49,886 then we're gonna have to put a tube in your windpipe 239 00:07:49,970 --> 00:07:51,388 to help you breathe-- are you OK with that? 240 00:07:51,471 --> 00:07:52,889 Intubation with rapid sequence induction? 241 00:07:52,973 --> 00:07:54,224 No, we can't lay him down. 242 00:07:54,307 --> 00:07:55,392 The tube will go in your nose 243 00:07:55,475 --> 00:07:56,518 while you're awake, sir. 244 00:07:56,601 --> 00:07:57,560 - Well... - Right. 245 00:07:57,644 --> 00:07:58,853 Does it hurt? 246 00:07:58,937 --> 00:08:00,021 You'll be numbed up completely. 247 00:08:00,105 --> 00:08:01,439 You won't feel any discomfort. 248 00:08:01,523 --> 00:08:04,317 Do you happen to know your weight? 249 00:08:04,401 --> 00:08:05,986 A little over 400. 250 00:08:06,069 --> 00:08:07,320 When was the last time you checked? 251 00:08:07,404 --> 00:08:08,822 It's been a while. 252 00:08:08,905 --> 00:08:11,282 Is it possible that you might be over 450? 253 00:08:11,366 --> 00:08:13,243 Possibly. 254 00:08:13,326 --> 00:08:15,537 Perlah, let's call for the Hoyer. 255 00:08:15,620 --> 00:08:18,540 So we're gonna place the tube and get you ready for the scan. 256 00:08:18,623 --> 00:08:20,208 Is this something serious? 257 00:08:20,291 --> 00:08:22,002 Well, it's hard to tell without a CT. 258 00:08:22,085 --> 00:08:23,712 You could just need antibiotics, 259 00:08:23,795 --> 00:08:25,505 or you could require an operation. 260 00:08:25,588 --> 00:08:26,798 If surgery is necessary, 261 00:08:26,881 --> 00:08:28,133 then your weight could make things 262 00:08:28,216 --> 00:08:29,551 - a little bit more complicated. - I know. 263 00:08:29,634 --> 00:08:31,136 - I'm sorry. - Not to worry. 264 00:08:31,219 --> 00:08:32,554 We're gonna take very good care of you. 265 00:08:32,637 --> 00:08:33,847 Team. 266 00:08:33,930 --> 00:08:34,973 OK. 267 00:08:35,056 --> 00:08:36,474 Pain medication for you, OK? 268 00:08:36,558 --> 00:08:38,351 Let's try for a midline, 269 00:08:38,435 --> 00:08:40,228 basilic vein with ultrasound guidance. 270 00:08:40,311 --> 00:08:41,688 Can ultrasound check for an appy? 271 00:08:41,771 --> 00:08:43,565 He's a little too large for an ultrasound. 272 00:08:43,648 --> 00:08:45,984 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 --> 00:08:56,202 I--I heard that there's a large animal CT at the zoo. 276 00:08:56,286 --> 00:08:58,204 Presby's CT can handle 650. 277 00:08:58,288 --> 00:09:00,415 Yeah, if Presby's still up and running. 278 00:09:00,498 --> 00:09:01,916 Wh... 279 00:09:02,000 --> 00:09:03,918 That--that's not a jinx. It's-- 280 00:09:04,002 --> 00:09:06,546 Have any of you ever done an awake naso-tracheal? 281 00:09:06,629 --> 00:09:07,839 OK. 282 00:09:07,922 --> 00:09:08,923 Perlah, can you also ask 283 00:09:09,007 --> 00:09:10,091 Dr. Al-Hashimi to come in? 284 00:09:10,175 --> 00:09:11,176 I'm gonna need an assist. 285 00:09:11,259 --> 00:09:12,552 Yep. You got it. 286 00:09:12,635 --> 00:09:14,596 Ah, sorry. Signed. 287 00:09:15,764 --> 00:09:18,933 Hall bed F, George Francis, shortness of breath, 288 00:09:19,017 --> 00:09:21,394 Dr. Mohan, awaiting D-dimer. 289 00:09:21,478 --> 00:09:23,021 Wow. She's still going? 290 00:09:23,104 --> 00:09:25,148 Yeah. Remarkable, really. 291 00:09:25,231 --> 00:09:26,733 Dr. Al, Robby's asking for you. 292 00:09:26,816 --> 00:09:27,942 Uh, OK. 293 00:09:28,026 --> 00:09:29,694 In Trauma if you need me, Princess. 294 00:09:29,778 --> 00:09:30,904 Got it. 295 00:09:32,530 --> 00:09:34,032 Who's supposed to run the downtime slips 296 00:09:34,115 --> 00:09:35,241 to X-ray and lab? 297 00:09:35,325 --> 00:09:37,744 Uh, the charge nurse? 298 00:09:37,827 --> 00:09:39,537 Don't look at me. 299 00:09:39,621 --> 00:09:40,997 My plate's full! 300 00:09:43,041 --> 00:09:45,627 Uh, parents of Roxie Hamler? 301 00:09:45,710 --> 00:09:46,878 Central 9. 302 00:09:46,961 --> 00:09:48,171 Oh, I got it, Donnie. 303 00:09:48,254 --> 00:09:49,464 Hi, I'm Victoria Javadi, 304 00:09:49,547 --> 00:09:50,924 one of the student doctors here. 305 00:09:51,007 --> 00:09:52,467 I've been assisting with Roxie's care. 306 00:09:52,550 --> 00:09:53,843 Oh, thank you so much. 307 00:09:53,927 --> 00:09:56,054 - I'm Lloyd. - Cora. 308 00:09:56,137 --> 00:09:57,180 It's nice to meet you. 309 00:09:57,263 --> 00:09:58,348 She broke her leg? 310 00:09:58,431 --> 00:09:59,682 Um, yeah. 311 00:09:59,766 --> 00:10:01,434 There's a fracture down by the ankle. 312 00:10:01,518 --> 00:10:03,978 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 --> 00:10:13,154 The hospital Wi-Fi isn't working. 315 00:10:13,238 --> 00:10:14,531 Oh, it'll be down for a while. 316 00:10:14,614 --> 00:10:16,366 Sorry. 317 00:10:16,449 --> 00:10:18,868 Mom broke her leg, Grandpa. 318 00:10:18,952 --> 00:10:20,995 We heard. 319 00:10:21,079 --> 00:10:22,705 How are you, honey? 320 00:10:24,958 --> 00:10:27,293 You've got this, kiddo. 321 00:10:27,377 --> 00:10:29,587 Yeah. 322 00:10:29,671 --> 00:10:31,673 How long will she stay in the ER? 323 00:10:31,756 --> 00:10:35,301 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 --> 00:10:43,893 You know, it's getting pretty crowded in here. 326 00:10:43,977 --> 00:10:45,645 Maybe we should take Tucker and Shane out for ice cream. 327 00:10:45,728 --> 00:10:49,107 - Yes, please. - No, no. I'm OK. 328 00:10:49,190 --> 00:10:52,277 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 --> 00:10:58,533 Can she have ice cream? 331 00:10:58,616 --> 00:11:01,744 She can have anything she wants. 332 00:11:01,828 --> 00:11:04,706 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 --> 00:11:15,133 Yep. 336 00:11:15,216 --> 00:11:17,135 Listen up. 337 00:11:17,218 --> 00:11:18,636 This is Oxymetazoline. 338 00:11:18,720 --> 00:11:19,637 This will open up the passage. 339 00:11:20,889 --> 00:11:22,265 What medication do you take? 340 00:11:22,348 --> 00:11:25,059 Uh, Lisinopril and Metformin. 341 00:11:25,143 --> 00:11:26,978 Ozempic? Wegovy? 342 00:11:27,061 --> 00:11:28,897 No. Kind of expensive. 343 00:11:28,980 --> 00:11:30,857 I'm going to squirt some numbing gel in your nose. 344 00:11:30,940 --> 00:11:34,360 If it drips back in your throat, that's OK. 345 00:11:34,444 --> 00:11:36,654 Here, in case you need it. 346 00:11:36,738 --> 00:11:38,489 Do you smoke? 347 00:11:38,573 --> 00:11:39,782 Alcohol? 348 00:11:39,866 --> 00:11:41,868 - Never. - Do you exercise? 349 00:11:41,951 --> 00:11:44,329 Moving from the bedroom to the kitchen. 350 00:11:44,412 --> 00:11:45,830 No, I'd walk more, 351 00:11:45,914 --> 00:11:48,458 but I need a bench to rest on every block. 352 00:11:48,541 --> 00:11:49,959 What about water aerobics? 353 00:11:50,043 --> 00:11:52,253 Let's focus on helping Mr. Knox. 354 00:11:52,337 --> 00:11:53,671 Agreed. 355 00:11:53,755 --> 00:11:55,673 It took me 25 years to get this way. 356 00:11:55,757 --> 00:11:58,301 Car crash, burn unit, 357 00:11:58,384 --> 00:12:01,095 four leg surgeries over ten years. 358 00:12:01,179 --> 00:12:03,306 Laid me up so much, I lost my job. 359 00:12:03,389 --> 00:12:04,974 I need to numb the back of your tongue. 360 00:12:05,058 --> 00:12:06,809 This is gonna taste pretty bad. 361 00:12:06,893 --> 00:12:08,228 Is there anyone you'd like us to call? 362 00:12:08,311 --> 00:12:09,395 No. 363 00:12:09,479 --> 00:12:10,939 Any family? 364 00:12:11,022 --> 00:12:13,524 Mm. My parents passed. 365 00:12:13,608 --> 00:12:14,734 I'm single. 366 00:12:14,817 --> 00:12:15,735 Go figure. 367 00:12:15,818 --> 00:12:16,945 Siblings? 368 00:12:17,028 --> 00:12:18,947 Sister in Arizona. 369 00:12:19,030 --> 00:12:21,366 We don't talk much. 370 00:12:21,449 --> 00:12:23,243 Now that we've numbed up the back of your tongue, 371 00:12:23,326 --> 00:12:26,788 we can anesthetize a bit deeper. 372 00:12:26,871 --> 00:12:27,789 Um, sorry to interrupt. 373 00:12:27,872 --> 00:12:28,790 I have a middle-aged woman 374 00:12:28,873 --> 00:12:30,458 with sudden onset blindness. 375 00:12:30,541 --> 00:12:31,834 - I can go. - OK. 376 00:12:31,918 --> 00:12:33,086 Will you see if Abbot's still around? 377 00:12:33,169 --> 00:12:34,087 - Yeah. - Thank you. 378 00:12:34,170 --> 00:12:35,713 What's your sister's name? 379 00:12:35,797 --> 00:12:37,423 Lauren Milford. 380 00:12:37,507 --> 00:12:38,925 Where in Arizona? 381 00:12:39,008 --> 00:12:40,551 Flagstaff, I think. 382 00:12:40,635 --> 00:12:41,761 Just gonna go over your tongue 383 00:12:41,844 --> 00:12:42,971 and numb your vocal cords. 384 00:12:43,054 --> 00:12:43,972 Ah. 385 00:12:44,055 --> 00:12:46,349 Ah... 386 00:12:46,432 --> 00:12:47,517 How many fingers? 387 00:12:47,600 --> 00:12:49,727 I don't see any fingers. 388 00:12:49,811 --> 00:12:51,688 And now? 389 00:12:51,771 --> 00:12:54,232 I can see a little bit of light. 390 00:12:54,315 --> 00:12:55,984 Um, Brooke, you've met Dr. King. 391 00:12:56,067 --> 00:12:57,485 This is Dr. Al-Hashimi. 392 00:12:57,568 --> 00:12:58,820 - Nice to meet you. - And her wife, Wendy. 393 00:12:58,903 --> 00:13:00,113 - Hello. - Hello. 394 00:13:00,196 --> 00:13:01,864 OK if we discuss your symptoms? 395 00:13:01,948 --> 00:13:04,075 As long as I can correct you if you get anything wrong. 396 00:13:04,158 --> 00:13:05,868 Trust me, she will. 397 00:13:05,952 --> 00:13:08,955 One hour of sudden, painless vision loss in the left eye. 398 00:13:09,038 --> 00:13:10,790 No history of hypercoagulable state 399 00:13:10,873 --> 00:13:12,166 or vascular disease. 400 00:13:12,250 --> 00:13:13,710 Could you look straight ahead, please? 401 00:13:13,793 --> 00:13:16,170 Could be a central retinal artery occlusion. 402 00:13:16,254 --> 00:13:17,630 In English, please? 403 00:13:17,714 --> 00:13:19,799 A little blood clot can block the artery 404 00:13:19,882 --> 00:13:22,385 at the back of the eye and decrease your vision. 405 00:13:22,468 --> 00:13:24,012 Sometimes it's called an eye stroke. 406 00:13:24,095 --> 00:13:25,013 Stroke? 407 00:13:25,096 --> 00:13:26,431 Like she could be paralyzed? 408 00:13:26,514 --> 00:13:27,974 No, this would be limited to the eye. 409 00:13:28,057 --> 00:13:29,392 Is it permanent? 410 00:13:29,475 --> 00:13:31,769 First, we have to make the diagnosis. 411 00:13:31,853 --> 00:13:32,979 Retinal exam? 412 00:13:33,062 --> 00:13:34,022 Hard to get a good look. 413 00:13:34,105 --> 00:13:35,606 We need the FOP. 414 00:13:35,690 --> 00:13:37,358 The what? 415 00:13:39,736 --> 00:13:41,404 Oh, Princess. 416 00:13:41,487 --> 00:13:43,364 We need patient stickers on each of these order sheets, 417 00:13:43,448 --> 00:13:45,491 or the pharmacy won't know who to give meds to. 418 00:13:45,575 --> 00:13:46,909 We're on it. 419 00:13:46,993 --> 00:13:49,078 Princess, smartphone fundoscope? 420 00:13:49,162 --> 00:13:50,455 Equipment corridor, eye cart. 421 00:13:50,538 --> 00:13:53,583 - Thanks. - You seem a little confused. 422 00:13:53,666 --> 00:13:55,376 How do I figure out which new patient to pick up? 423 00:13:55,460 --> 00:13:56,711 Top of the board. 424 00:13:56,794 --> 00:13:57,920 They're listed in the order they arrive. 425 00:13:58,004 --> 00:13:59,172 You erase the first one, then put 426 00:13:59,255 --> 00:14:00,631 your initials in the MD box. 427 00:14:00,715 --> 00:14:02,258 OK. Thanks. 428 00:14:02,342 --> 00:14:03,634 - Caleb. - Michael. 429 00:14:03,718 --> 00:14:05,470 Are you managing this chaos OK? 430 00:14:05,553 --> 00:14:08,097 Well, it's all pretty easy when you're a short-timer. 431 00:14:08,181 --> 00:14:10,725 Any more comatose patients for me to have a chat with? 432 00:14:12,518 --> 00:14:13,770 I'm kidding. 433 00:14:13,853 --> 00:14:15,355 OK. 434 00:14:15,438 --> 00:14:17,023 Victoria, this is Nicole Steadman. 435 00:14:17,106 --> 00:14:18,232 I run the parent support group 436 00:14:18,316 --> 00:14:19,692 for the psychiatric service. 437 00:14:19,776 --> 00:14:21,486 Yeah. Nicole's daughter was diagnosed 438 00:14:21,569 --> 00:14:23,237 sophomore year in college. 439 00:14:23,321 --> 00:14:26,366 You think Jackson's parents might have a chat with her? 440 00:14:26,449 --> 00:14:28,284 We can certainly ask. 441 00:14:28,368 --> 00:14:29,952 Now we can see the whole retina 442 00:14:30,036 --> 00:14:31,454 without dilating the pupil. 443 00:14:32,663 --> 00:14:34,207 You're looking in the wrong eye. 444 00:14:34,290 --> 00:14:36,459 Oh, we start with the good eye for comparison. 445 00:14:36,542 --> 00:14:38,544 Oh. 446 00:14:38,628 --> 00:14:39,629 Retina looks great. 447 00:14:39,712 --> 00:14:40,797 Now for the bad eye? 448 00:14:40,880 --> 00:14:42,131 Eyes wide open. 449 00:14:44,592 --> 00:14:45,885 How's it look? 450 00:14:45,968 --> 00:14:47,470 Extremely pale, no blood flow. 451 00:14:47,553 --> 00:14:49,597 Digital massage, 10 seconds on, 5 seconds off. 452 00:14:49,680 --> 00:14:53,059 Order non-contrast head CT. 453 00:14:54,685 --> 00:14:56,729 Come in. 454 00:14:56,813 --> 00:14:57,897 Hi. 455 00:14:57,980 --> 00:14:59,315 Heard your patient took off. 456 00:14:59,399 --> 00:15:00,858 She's taking a little break. 457 00:15:00,942 --> 00:15:03,236 How long are you gonna wait? 458 00:15:03,319 --> 00:15:05,113 You know about the cyber shutdown thing? 459 00:15:05,196 --> 00:15:06,656 Yeah. 460 00:15:06,739 --> 00:15:08,116 Wish I could help, but I gotta stay here 461 00:15:08,199 --> 00:15:09,534 till all the evidence is collected, so... 462 00:15:09,617 --> 00:15:11,160 It's a hot mess out there. 463 00:15:11,244 --> 00:15:12,537 This whole day is. 464 00:15:13,704 --> 00:15:16,165 Sorry. I was just leaving. 465 00:15:16,249 --> 00:15:18,334 You OK? 466 00:15:18,418 --> 00:15:19,794 I'm good. 467 00:15:19,877 --> 00:15:21,546 I'm glad to hear it. 468 00:15:21,629 --> 00:15:22,588 You get something to eat? 469 00:15:22,672 --> 00:15:25,466 No. 470 00:15:25,550 --> 00:15:27,593 Let's keep going. 471 00:15:27,677 --> 00:15:28,928 OK. 472 00:15:29,011 --> 00:15:30,054 Yeah. 473 00:15:40,523 --> 00:15:42,942 Why don't we keep one in the ER? 474 00:15:43,025 --> 00:15:46,612 Because our intubated patients are usually sedated. 475 00:15:46,696 --> 00:15:48,114 Right. 476 00:15:48,197 --> 00:15:49,740 Maybe you could ease up 477 00:15:49,824 --> 00:15:51,409 with your comments about his weight. 478 00:15:52,869 --> 00:15:54,745 I was just wondering how he got so big 479 00:15:54,829 --> 00:15:56,414 and how we could help. 480 00:15:56,497 --> 00:15:58,124 We can help by finding out what's wrong with him 481 00:15:58,207 --> 00:15:59,167 and treating him with respect. 482 00:15:59,250 --> 00:16:00,168 How's your belly now? 483 00:16:00,251 --> 00:16:01,502 Second pain shot helped. 484 00:16:01,586 --> 00:16:03,379 OK. There's more if you need it. 485 00:16:03,463 --> 00:16:04,630 Diminished bowel sounds. 486 00:16:04,714 --> 00:16:05,965 VidaTalk from the ICU. 487 00:16:06,048 --> 00:16:07,550 Great. 488 00:16:07,633 --> 00:16:08,843 Howard, we need to open up that passageway now 489 00:16:08,926 --> 00:16:10,094 so we can pass the tube. 490 00:16:10,178 --> 00:16:11,679 I'm gonna start with my pinky. 491 00:16:11,762 --> 00:16:13,097 Slowly, over a few minutes, I'm gonna go deeper, 492 00:16:13,181 --> 00:16:14,557 all the way to the back of my knuckle. 493 00:16:14,640 --> 00:16:16,267 Once the tube's through your vocal cords, 494 00:16:16,350 --> 00:16:17,768 you won't be able to talk. 495 00:16:17,852 --> 00:16:19,520 But this is a communication device. 496 00:16:19,604 --> 00:16:22,190 Swipe through the screen for anything you want to say. 497 00:16:22,273 --> 00:16:24,692 Hit the icon, and it talks to us. 498 00:16:24,775 --> 00:16:26,944 I would like some pain medicine. 499 00:16:27,028 --> 00:16:28,779 My pain is a nine. 500 00:16:28,863 --> 00:16:30,448 Can I get it to order a pizza? 501 00:16:32,909 --> 00:16:34,660 There's cell service in the ambulance bay. 502 00:16:34,744 --> 00:16:37,205 I found his sister's new number, left a voicemail. 503 00:16:37,288 --> 00:16:38,456 OK, I'm gonna start. 504 00:16:38,539 --> 00:16:39,665 You ready? 505 00:16:39,749 --> 00:16:41,125 Not really. 506 00:16:41,209 --> 00:16:42,126 Go ahead. 507 00:16:42,210 --> 00:16:43,503 Robby, over here. 508 00:16:43,586 --> 00:16:45,796 Here we go. Head back. 509 00:16:47,256 --> 00:16:48,466 You thinking it's surgical? 510 00:16:48,549 --> 00:16:49,926 I'm hoping for a non-perfed appy. 511 00:16:50,009 --> 00:16:51,511 - Can you do it with a scope? - Possibly, 512 00:16:51,594 --> 00:16:53,179 but he could be treated with antibiotics alone. 513 00:16:53,262 --> 00:16:55,181 And if he needs surgery? 514 00:16:55,264 --> 00:16:58,184 With his size, an emergency open laparotomy, 515 00:16:58,267 --> 00:17:00,311 death rate's close to 50%. 516 00:17:00,394 --> 00:17:01,896 OK, one step at a time. 517 00:17:01,979 --> 00:17:04,482 Let's keep trying his sister every 15 minutes. 518 00:17:04,565 --> 00:17:05,900 She'll get it. 519 00:17:09,820 --> 00:17:12,907 Half the downtime slips are blank. 520 00:17:12,990 --> 00:17:14,992 What are you talking about? 521 00:17:15,076 --> 00:17:17,161 Here and here. 522 00:17:17,245 --> 00:17:19,247 Larry, are you using a felt tip pen? 523 00:17:19,330 --> 00:17:21,541 Maybe. 524 00:17:21,624 --> 00:17:24,835 It's not going through for the copies. 525 00:17:24,919 --> 00:17:26,629 Ballpoint pen only. 526 00:17:26,712 --> 00:17:28,047 OK. 527 00:17:30,508 --> 00:17:31,801 Digby still MIA? 528 00:17:31,884 --> 00:17:33,010 Is that the homeless guy? 529 00:17:33,094 --> 00:17:34,845 We need the bed if he eloped. 530 00:17:36,264 --> 00:17:38,099 - What do you need? - An attending. 531 00:17:38,182 --> 00:17:39,934 - Or a senior resident? - Nope, I'm good. 532 00:17:40,017 --> 00:17:42,144 - Dr. Al-Hashimi, can I present? - Yes. 533 00:17:42,228 --> 00:17:44,730 32-year-old deaf woman with myofascial headache. 534 00:17:44,814 --> 00:17:47,024 Ibuprofen caused gastritis and epigastric pain, 535 00:17:47,108 --> 00:17:49,235 and she vasovagalled, but now pain-free 536 00:17:49,318 --> 00:17:51,279 after Mylanta and a trigger point injection. 537 00:17:51,362 --> 00:17:52,488 Excellent. That can take care of the pain 538 00:17:52,572 --> 00:17:54,156 - for several months. - Yeah. 539 00:17:54,240 --> 00:17:56,492 It shouldn't recur if she keeps her screen at eye level. 540 00:17:56,576 --> 00:17:57,868 There was a delay 541 00:17:57,952 --> 00:17:59,453 in getting an ASL interpreter. 542 00:17:59,537 --> 00:18:01,122 And I almost gave up and ordered 543 00:18:01,205 --> 00:18:03,291 an unnecessary brain and abdominal CT. 544 00:18:03,374 --> 00:18:04,542 Good thing you didn't. 545 00:18:04,625 --> 00:18:07,211 Dr. Al-Hashimi, for you. 546 00:18:07,295 --> 00:18:08,588 Nice job on the trigger point. 547 00:18:08,671 --> 00:18:09,797 Yeah, I know. 548 00:18:09,880 --> 00:18:11,549 How's the T-system going? 549 00:18:11,632 --> 00:18:13,634 - Quick and easy. - Yeah. 550 00:18:13,718 --> 00:18:15,886 On these MDMs, don't just circle your diagnosis. 551 00:18:15,970 --> 00:18:17,680 Also put a backslash through all the ones 552 00:18:17,763 --> 00:18:18,723 that you've ruled out. 553 00:18:18,806 --> 00:18:19,765 No problem. 554 00:18:19,849 --> 00:18:21,434 Thank you very much. 555 00:18:21,517 --> 00:18:23,436 Princess, bump Central 13 to the front of the CT line. 556 00:18:23,519 --> 00:18:24,604 What do you got? 557 00:18:24,687 --> 00:18:25,980 Sudden onset blindness patient 558 00:18:26,063 --> 00:18:27,523 has central retinal artery occlusion. 559 00:18:27,607 --> 00:18:29,191 I just spoke to an ophthalmologist 560 00:18:29,275 --> 00:18:30,776 at the VA, principal investigator 561 00:18:30,860 --> 00:18:32,445 for thrombolytics in cases like this. 562 00:18:32,528 --> 00:18:33,904 Not exactly standard of care. 563 00:18:33,988 --> 00:18:34,947 Kind of risky. 564 00:18:35,031 --> 00:18:36,574 We'll do informed consent. 565 00:18:36,657 --> 00:18:38,117 It's our best shot at saving some of her vision. 566 00:18:38,200 --> 00:18:39,910 Your patient, your call. 567 00:18:39,994 --> 00:18:41,912 I'm not gonna be around long enough for any complications. 568 00:18:44,915 --> 00:18:48,502 I'll be taking two swabs from the vagina, 569 00:18:48,586 --> 00:18:50,546 two swabs from the cervix. 570 00:18:53,966 --> 00:18:56,761 Let me know if you feel any discomfort. 571 00:18:56,844 --> 00:18:58,804 OK. 572 00:18:58,888 --> 00:19:02,975 Each swab gets labeled-- first vaginal, second vaginal. 573 00:19:03,059 --> 00:19:05,269 Smear a slide with both, and let it air dry. 574 00:19:05,353 --> 00:19:06,479 Same for the cervix? 575 00:19:06,562 --> 00:19:07,480 Yeah. 576 00:19:07,563 --> 00:19:08,856 No slide needed. 577 00:19:10,524 --> 00:19:12,652 How you doing, Ilana? 578 00:19:12,735 --> 00:19:14,695 Hanging in there. 579 00:19:14,779 --> 00:19:16,197 OK. 580 00:19:16,280 --> 00:19:17,698 Almost done. 581 00:19:20,493 --> 00:19:23,204 All these samples go in the vaginal contact envelope. 582 00:19:23,287 --> 00:19:24,622 - I can help with that. - No. 583 00:19:24,705 --> 00:19:26,332 It's gotta be me. 584 00:19:26,415 --> 00:19:29,710 I'm gonna pull this out. 585 00:19:29,794 --> 00:19:31,504 OK. 586 00:19:31,587 --> 00:19:32,588 All good here. 587 00:19:32,672 --> 00:19:34,048 Legs can come down. 588 00:19:37,885 --> 00:19:39,762 Are we done? 589 00:19:39,845 --> 00:19:41,097 One last thing. 590 00:19:41,180 --> 00:19:43,516 Four more swabs inside your mouth. 591 00:19:43,599 --> 00:19:45,226 Didn't you do that already? 592 00:19:45,309 --> 00:19:48,229 This one's different-- inside your cheek for your DNA, 593 00:19:48,312 --> 00:19:49,897 not for his. 594 00:19:52,608 --> 00:19:57,988 So it could be bipolar or schizophrenia? 595 00:19:58,072 --> 00:20:00,282 Those are the two most likely possibilities. 596 00:20:00,366 --> 00:20:01,826 How do they know which it is? 597 00:20:01,909 --> 00:20:03,994 Based on response to medicine, 598 00:20:04,078 --> 00:20:06,580 but also with therapy and observation on the ward. 599 00:20:06,664 --> 00:20:10,042 They'll monitor his mood and interactions with others. 600 00:20:12,002 --> 00:20:14,755 Is there a blood test or a brain scan 601 00:20:14,839 --> 00:20:15,798 that will tell us for sure? 602 00:20:15,881 --> 00:20:17,758 Unfortunately not. 603 00:20:17,842 --> 00:20:20,720 When properly medicated, people with bipolar disorder 604 00:20:20,803 --> 00:20:23,431 can have successful careers. 605 00:20:23,514 --> 00:20:25,349 So we hope for bipolar? 606 00:20:25,433 --> 00:20:27,351 You can hope for your son's happiness. 607 00:20:27,435 --> 00:20:29,979 With early treatment, 20% of people 608 00:20:30,062 --> 00:20:32,732 with schizophrenia have a complete recovery. 609 00:20:32,815 --> 00:20:34,650 So 80% don't? 610 00:20:34,734 --> 00:20:36,944 This is a new version of Jackson. 611 00:20:39,739 --> 00:20:40,823 How old was your daughter? 612 00:20:40,906 --> 00:20:42,742 20. 613 00:20:42,825 --> 00:20:46,162 Studying architecture at Georgetown. 614 00:20:46,245 --> 00:20:47,872 Schizophrenia. 615 00:20:47,955 --> 00:20:50,082 I'm sorry. 616 00:20:50,166 --> 00:20:51,751 Oh, she's good. 617 00:20:51,834 --> 00:20:56,630 Living at home, working as a cashier at Giant Eagle. 618 00:20:56,714 --> 00:20:59,091 Employee of the Month. 619 00:20:59,175 --> 00:21:01,302 We still have struggles, 620 00:21:01,385 --> 00:21:04,346 but there's also laughter and love. 621 00:21:11,604 --> 00:21:13,022 Good to go. 622 00:21:13,105 --> 00:21:14,023 How'd that feel? 623 00:21:14,106 --> 00:21:15,566 Very weird. 624 00:21:15,649 --> 00:21:17,651 There's no pain. Just weird. 625 00:21:17,735 --> 00:21:19,945 OK, the next step is, we're gonna take this tube 626 00:21:20,029 --> 00:21:21,947 and pass it through your nose, 627 00:21:22,031 --> 00:21:24,450 stopping at the back of your tongue. 628 00:21:24,533 --> 00:21:26,327 Best not to talk for that. 629 00:21:26,410 --> 00:21:29,955 Tube's soaking in warm water to make it more flexible. 630 00:21:30,039 --> 00:21:32,666 Do you wanna try it? 631 00:21:32,750 --> 00:21:34,543 What day and time is it? 632 00:21:34,627 --> 00:21:36,921 4th of July, 2:31 p.m. 633 00:21:37,004 --> 00:21:38,839 When is my tube coming out? 634 00:21:38,923 --> 00:21:41,717 We have to put it in first. 635 00:21:41,801 --> 00:21:42,718 I know. 636 00:21:42,802 --> 00:21:44,345 Just practicing. 637 00:21:44,428 --> 00:21:47,723 Sounds like you're an expert already. 638 00:21:47,807 --> 00:21:50,768 Before I can't talk, 639 00:21:50,851 --> 00:21:53,521 I just wanna say 640 00:21:53,604 --> 00:21:56,982 thank you for everything. 641 00:21:57,066 --> 00:21:59,109 You're very welcome. 642 00:22:04,907 --> 00:22:06,283 Here we go. 643 00:22:10,955 --> 00:22:12,331 STI prevention. 644 00:22:12,414 --> 00:22:13,958 One shot treats gonorrhea, 645 00:22:14,041 --> 00:22:16,335 then pills for chlamydia and trichomonas. 646 00:22:16,418 --> 00:22:17,878 Thank you. 647 00:22:17,962 --> 00:22:19,672 We also have morning-after contraception. 648 00:22:19,755 --> 00:22:20,756 She has an IUD. 649 00:22:20,840 --> 00:22:23,300 Over 99% effective, not 100%. 650 00:22:23,384 --> 00:22:24,844 We still offer. 651 00:22:24,927 --> 00:22:26,428 I'll pass. 652 00:22:26,512 --> 00:22:29,890 For HIV, we got PEP, Post-Exposure Prophylaxis. 653 00:22:29,974 --> 00:22:31,392 28 days. 654 00:22:31,475 --> 00:22:34,645 The sooner you start, the more effective. 655 00:22:34,728 --> 00:22:36,397 Emma, I'm pretty sure they could use 656 00:22:36,480 --> 00:22:39,567 an extra set of hands out there. 657 00:22:39,650 --> 00:22:42,027 It's nice to meet you, Ilana. 658 00:22:42,111 --> 00:22:43,445 You're a very brave woman. 659 00:22:43,529 --> 00:22:44,572 Yeah. 660 00:22:51,704 --> 00:22:53,122 She's a good nurse. 661 00:22:53,205 --> 00:22:57,626 She's still learning, but she will be. 662 00:22:57,710 --> 00:22:59,587 After this, we're done? 663 00:22:59,670 --> 00:23:01,255 Yeah. 664 00:23:04,508 --> 00:23:06,719 I'm glad you were here today. 665 00:23:11,181 --> 00:23:13,767 Me too. 666 00:23:13,851 --> 00:23:16,854 We have a decision to make. 667 00:23:16,937 --> 00:23:18,856 Studies have shown that some vision 668 00:23:18,939 --> 00:23:21,650 can be restored with a clot-busting medication. 669 00:23:21,734 --> 00:23:23,068 So give it. 670 00:23:23,152 --> 00:23:25,237 But there are possible risks. 671 00:23:25,321 --> 00:23:29,825 For eye stroke, only 17% get better without any treatment. 672 00:23:29,909 --> 00:23:31,827 - Only 17%? - Yes. 673 00:23:31,911 --> 00:23:36,165 But with the medicine, another 20% can improve. 674 00:23:36,248 --> 00:23:38,667 But there can be complications. 675 00:23:38,751 --> 00:23:42,296 2% of patients who receive the medication get worse, 676 00:23:42,379 --> 00:23:47,176 and 1% have severe disability or death. 677 00:23:52,765 --> 00:23:56,310 Honey, this one has to be your call. 678 00:23:57,561 --> 00:24:00,773 No, it's our call. 679 00:24:00,856 --> 00:24:02,650 What would you do without me? 680 00:24:02,733 --> 00:24:04,860 I'd figure out how to get by. 681 00:24:06,820 --> 00:24:09,740 And I'd probably cry for two years solid. 682 00:24:09,823 --> 00:24:12,242 Two years? That's all? 683 00:24:13,494 --> 00:24:14,870 I want the medication. 684 00:24:14,954 --> 00:24:16,830 OK. 685 00:24:20,376 --> 00:24:22,294 OK, we need your full name to make a chart. 686 00:24:22,378 --> 00:24:24,380 Jackie Liddell. 687 00:24:24,463 --> 00:24:26,048 Jackie Liddell. 688 00:24:26,131 --> 00:24:27,091 And you are? 689 00:24:27,174 --> 00:24:28,509 Her friend Jaquie. 690 00:24:28,592 --> 00:24:30,427 - You have the same name? - No, no. 691 00:24:30,511 --> 00:24:32,638 She's Jackie with a C-K. I'm Jaquie with a Q. 692 00:24:32,721 --> 00:24:34,431 You can call me CK. 693 00:24:34,515 --> 00:24:35,516 Oh. 694 00:24:35,599 --> 00:24:36,850 Best not to talk, CK, OK? 695 00:24:36,934 --> 00:24:38,352 - Just chill. - Chill? 696 00:24:38,435 --> 00:24:41,689 - Q, I bit off half my tongue! - What? 697 00:24:41,772 --> 00:24:43,524 She said, I bit off half my tongue. 698 00:24:43,607 --> 00:24:44,900 You can understand that? 699 00:24:44,984 --> 00:24:46,568 Oh, you should hear her when she's had 700 00:24:46,652 --> 00:24:48,487 two pitchers of margaritas, fucked up and slurring. 701 00:24:48,570 --> 00:24:51,031 Ooh, you are such an idiot! 702 00:24:51,115 --> 00:24:52,658 Princess, what's open? 703 00:24:52,741 --> 00:24:54,410 South 15's clean. 704 00:24:54,493 --> 00:24:55,953 Deep tongue laceration. 705 00:24:56,036 --> 00:24:58,664 I can jump on this. 706 00:24:58,747 --> 00:25:01,625 Robby and Al-Hashimi are both with critical patients. 707 00:25:01,709 --> 00:25:02,960 Hello. 708 00:25:03,043 --> 00:25:04,211 I'm Dr. Langdon. 709 00:25:04,294 --> 00:25:06,046 I'll be supervising your care. 710 00:25:08,090 --> 00:25:10,676 Jesus, CK, your doctor's fucking hot. 711 00:25:13,595 --> 00:25:15,931 Tube's at 14 centimeters, just above the airway. 712 00:25:16,015 --> 00:25:18,308 OK, Howard, I'm going to start. 713 00:25:18,392 --> 00:25:22,479 If you want me to stop, you just put your hand up, OK? 714 00:25:22,563 --> 00:25:25,149 Blue mark tells me I'm in the tube. 715 00:25:28,569 --> 00:25:30,654 Looks like he cleared it. 716 00:25:30,738 --> 00:25:33,240 If he inhales, we should see chords. 717 00:25:33,323 --> 00:25:35,617 OK, deep breath for me, Howard. 718 00:25:38,412 --> 00:25:40,789 - OK. - Beautiful. 719 00:25:40,873 --> 00:25:42,416 Chords are sensitive, so we spray lidocaine 720 00:25:42,499 --> 00:25:44,877 - in the scope. - OK. 721 00:25:44,960 --> 00:25:48,422 1 cc going in now. 722 00:25:48,505 --> 00:25:51,133 And we'll just give that a second to work. 723 00:25:51,216 --> 00:25:52,634 How you doing, Howard? 724 00:25:54,011 --> 00:25:55,763 Once the tube's in, you'll have to breathe 725 00:25:55,846 --> 00:25:57,097 through your nose. 726 00:25:57,181 --> 00:25:58,515 OK, Howard, hold still. 727 00:25:58,599 --> 00:26:02,019 I am now going in past your vocal cords 728 00:26:02,102 --> 00:26:04,605 until we see the carina. 729 00:26:06,231 --> 00:26:07,775 Ogilvie. 730 00:26:07,858 --> 00:26:09,026 Uh, there. 731 00:26:09,109 --> 00:26:10,152 Right and left mainstem. 732 00:26:10,235 --> 00:26:12,988 And the tube slides in. 733 00:26:16,867 --> 00:26:20,120 And then the scope comes out. 734 00:26:21,955 --> 00:26:23,457 Great. 735 00:26:23,540 --> 00:26:24,792 OK, inflate the balloon. 736 00:26:24,875 --> 00:26:26,210 Deep breath through your nose. 737 00:26:26,293 --> 00:26:27,419 Amazing. 738 00:26:27,503 --> 00:26:29,546 You good? 739 00:26:29,630 --> 00:26:31,173 Great end-tidal waveform. 740 00:26:31,256 --> 00:26:32,424 Does he need a vent? 741 00:26:32,508 --> 00:26:33,634 He's breathing on his own, 742 00:26:33,717 --> 00:26:35,052 but a little CPAP wouldn't hurt. 743 00:26:35,135 --> 00:26:37,262 Starting at 5, titrate to 10. 744 00:26:37,346 --> 00:26:39,264 OK, that went really well, Howard. 745 00:26:39,348 --> 00:26:41,058 Now we're going to check your weight. 746 00:26:43,018 --> 00:26:44,561 So the nurse examiner is supposed 747 00:26:44,645 --> 00:26:46,438 to lock up the rape kit in this fridge, 748 00:26:46,522 --> 00:26:49,608 where it stays until it gets turned over to law enforcement. 749 00:26:49,691 --> 00:26:52,319 It's called preserving the chain of evidence. 750 00:26:52,402 --> 00:26:54,613 Are you fucking kidding me? 751 00:26:54,696 --> 00:26:56,490 Is there a problem? 752 00:26:56,573 --> 00:26:58,784 Jesus Christ. 753 00:26:58,867 --> 00:27:01,870 Police are supposed to pick up the rape kits within 72 hours. 754 00:27:01,954 --> 00:27:04,873 This one I did two weeks ago. 755 00:27:04,957 --> 00:27:06,375 God damn it. 756 00:27:08,627 --> 00:27:10,796 So how exactly did this happen? 757 00:27:10,879 --> 00:27:13,674 We were in between pubs taking a selfie. 758 00:27:13,757 --> 00:27:14,758 Very nice. 759 00:27:14,842 --> 00:27:17,219 Until she jerked her head up. 760 00:27:17,302 --> 00:27:18,679 Ooh. 761 00:27:18,762 --> 00:27:20,013 Ouch. 762 00:27:20,097 --> 00:27:21,682 OK, topical epi did the trick. 763 00:27:21,765 --> 00:27:23,100 - No more bleeding. - Sweet. 764 00:27:23,183 --> 00:27:24,476 I can go home now? 765 00:27:24,560 --> 00:27:26,353 I don't think so. 766 00:27:26,436 --> 00:27:27,938 It looks like the Grand Canyon across the back of your tongue. 767 00:27:28,021 --> 00:27:29,940 We need to put in some stitches. 768 00:27:30,023 --> 00:27:30,941 I don't want stitches. 769 00:27:31,024 --> 00:27:33,026 Oh. Listen to the doctor. 770 00:27:33,110 --> 00:27:34,778 Don't tell me what to do. 771 00:27:34,862 --> 00:27:36,280 This is all your fault. 772 00:27:36,363 --> 00:27:38,323 - No, it's not. - Uh, yes, it is. 773 00:27:38,407 --> 00:27:39,992 - Uh, Princess. - No, it's not. 774 00:27:40,075 --> 00:27:41,577 Princess, hey, why don't you show Q 775 00:27:41,660 --> 00:27:43,370 where she can wait while we patch up her friend? 776 00:27:43,453 --> 00:27:44,872 Of course. 777 00:27:44,955 --> 00:27:47,082 OK, this is a numbing shot for the tip. 778 00:27:47,166 --> 00:27:48,083 The tip? 779 00:27:48,167 --> 00:27:50,002 That's not where I bit it. 780 00:27:50,085 --> 00:27:51,503 One step at a time. 781 00:27:58,719 --> 00:28:01,013 That's 20 migs of TNK. 782 00:28:01,096 --> 00:28:04,057 In at 14:39. 783 00:28:04,141 --> 00:28:06,351 Feeling anything? 784 00:28:06,435 --> 00:28:07,477 Not yet. 785 00:28:07,561 --> 00:28:10,397 Could take an hour or two. 786 00:28:10,480 --> 00:28:11,857 We're going to move you to another room 787 00:28:11,940 --> 00:28:13,734 for better monitoring. 788 00:28:13,817 --> 00:28:15,360 Dr. King. 789 00:28:18,197 --> 00:28:21,533 I'd like you to stay with her. 790 00:28:21,617 --> 00:28:22,868 Why? 791 00:28:22,951 --> 00:28:24,494 In case there are complications. 792 00:28:24,578 --> 00:28:26,246 You'll be there to respond quickly 793 00:28:26,330 --> 00:28:29,166 to a blown pupil, a seizure, altered mental status. 794 00:28:29,249 --> 00:28:31,210 Or I could catch up on my charts. 795 00:28:31,293 --> 00:28:33,128 And my deposition's coming up. 796 00:28:33,212 --> 00:28:35,631 Think of this as a great way to steal some quiet time 797 00:28:35,714 --> 00:28:36,924 and get mentally prepared. 798 00:28:37,007 --> 00:28:39,218 Jesse, Mel's with you. 799 00:28:41,011 --> 00:28:42,930 Oh, excuse me, Dr. Mohan. 800 00:28:43,013 --> 00:28:44,056 Excuse me. 801 00:28:44,139 --> 00:28:45,057 Dr. Mohan. 802 00:28:45,140 --> 00:28:46,475 Uh, in a minute, George. 803 00:28:46,558 --> 00:28:47,559 I've got this. 804 00:28:47,643 --> 00:28:48,769 Thank you. 805 00:28:48,852 --> 00:28:51,104 Oh, uh, I, um-- 806 00:28:51,188 --> 00:28:53,273 D-dimer is back normal. 807 00:28:53,357 --> 00:28:54,274 Oh. 808 00:28:54,358 --> 00:28:55,609 I'm ready to go. 809 00:28:55,692 --> 00:28:57,486 Are you feeling better? 810 00:28:57,569 --> 00:29:01,240 I--I really wasn't short of breath this time. 811 00:29:02,407 --> 00:29:04,034 Then why'd you come in? 812 00:29:05,619 --> 00:29:07,579 When I found out about the blood clot in my leg, 813 00:29:07,663 --> 00:29:10,499 I just kept thinking it's gonna go to my lung and kill me. 814 00:29:10,582 --> 00:29:13,669 We've talked before about how the Eliquis would prevent that. 815 00:29:13,752 --> 00:29:16,380 I know. 816 00:29:16,463 --> 00:29:18,757 Well, I finally took your advice. 817 00:29:18,840 --> 00:29:21,218 I got out of the house, and I joined 818 00:29:21,301 --> 00:29:23,136 the Frick Park Lawn Bowling Club. 819 00:29:23,220 --> 00:29:24,429 Wonderful. 820 00:29:24,513 --> 00:29:25,555 Yeah. 821 00:29:25,639 --> 00:29:27,391 I mean, you're right, you know? 822 00:29:27,474 --> 00:29:29,434 We all need a community. 823 00:29:33,480 --> 00:29:34,856 You're gonna do what? 824 00:29:34,940 --> 00:29:36,525 In order to fix your tongue, 825 00:29:36,608 --> 00:29:39,069 we need to move it forward to access the laceration. 826 00:29:39,152 --> 00:29:40,696 You're just gonna feel some pulling, OK? 827 00:29:40,779 --> 00:29:44,074 I guess so. 828 00:29:44,157 --> 00:29:46,785 Go for it. 829 00:29:46,868 --> 00:29:48,161 What size suture is that? 830 00:29:48,245 --> 00:29:51,957 O-silk, the biggest one we got. 831 00:29:52,040 --> 00:29:54,918 As soon as I cut the needle, you're on traction, Joy. 832 00:30:03,719 --> 00:30:05,178 Oh. 833 00:30:05,262 --> 00:30:07,389 That is pretty deep. 834 00:30:07,472 --> 00:30:08,974 And now we can numb up the cut. 835 00:30:09,057 --> 00:30:10,309 It's best to start with-- 836 00:30:10,392 --> 00:30:11,727 Proximal side first so she doesn't 837 00:30:11,810 --> 00:30:14,938 feel the distal injection. 838 00:30:15,022 --> 00:30:15,939 Give it ten minutes. 839 00:30:16,023 --> 00:30:17,524 I'll be back for the repair. 840 00:30:21,737 --> 00:30:23,572 I got a rape kit sitting here for two weeks 841 00:30:23,655 --> 00:30:26,074 that was supposed to be picked up within 72 hours. 842 00:30:26,158 --> 00:30:27,117 I don't care! 843 00:30:27,200 --> 00:30:29,161 Get someone over here now! No. 844 00:30:29,244 --> 00:30:30,662 You expect us to treat your officers 845 00:30:30,746 --> 00:30:32,289 as soon as they come in, 846 00:30:32,372 --> 00:30:34,124 you get a detective to pick these kits up ASAP. 847 00:30:34,207 --> 00:30:35,125 I gotta go. 848 00:30:35,208 --> 00:30:36,710 - Dana-- - Hey, Dana. 849 00:30:36,793 --> 00:30:37,878 South 19 got their head CT before we went down. 850 00:30:37,961 --> 00:30:39,212 No results yet. 851 00:30:39,296 --> 00:30:40,380 All right, I'll send a reminder. 852 00:30:40,464 --> 00:30:41,381 - Hey, Dana. - Dana. 853 00:30:41,465 --> 00:30:42,841 Hang on. 854 00:30:43,884 --> 00:30:45,552 What's up? 855 00:30:45,635 --> 00:30:47,512 We put in an order for more pain meds for Roxie. 856 00:30:47,596 --> 00:30:49,598 All right, so put it in the nursing racks. 857 00:30:49,681 --> 00:30:52,225 Oh, I did, a long time ago. 858 00:30:52,309 --> 00:30:54,102 All right. I'll bump it to the front. 859 00:30:54,186 --> 00:30:55,645 Thank you. 860 00:30:55,729 --> 00:30:57,356 Uh, what's that noise? 861 00:30:57,439 --> 00:30:58,440 UFO landed. 862 00:30:58,523 --> 00:30:59,441 Aliens are invading. 863 00:30:59,524 --> 00:31:00,942 Hey, Dana. 864 00:31:01,026 --> 00:31:02,819 Chem 7's not back on Trauma 2 yet. 865 00:31:02,903 --> 00:31:05,113 Let me see the chart. 866 00:31:05,197 --> 00:31:06,656 Oh, Jesus. 867 00:31:06,740 --> 00:31:08,200 I bet your Chem 7 rec went to Radiology. 868 00:31:08,283 --> 00:31:10,035 Larry, Antoine. 869 00:31:10,118 --> 00:31:12,537 You put labs and chest X-ray on the same downtime form. 870 00:31:12,621 --> 00:31:14,831 You need two slips--one for labs, one for radiology. 871 00:31:14,915 --> 00:31:16,500 - Got it. - Won't happen again. 872 00:31:16,583 --> 00:31:17,626 I'll run it down myself. 873 00:31:17,709 --> 00:31:19,336 Use the iStat at bedside. 874 00:31:19,419 --> 00:31:20,754 They won't take him to CT without a creatinine. 875 00:31:20,837 --> 00:31:21,963 Oh, perfect. 876 00:31:22,047 --> 00:31:23,090 Nice to have you back. 877 00:31:23,173 --> 00:31:24,383 Thrilled to be here. 878 00:31:24,466 --> 00:31:25,509 You trying to text? 879 00:31:25,592 --> 00:31:27,052 I am just composing. 880 00:31:27,135 --> 00:31:28,595 I'm gonna send it from the bay. 881 00:31:28,678 --> 00:31:30,847 My mechanic friend, Duke, never showed up. 882 00:31:30,931 --> 00:31:32,391 I thought he was coming in this morning. 883 00:31:32,474 --> 00:31:33,600 That was the plan. 884 00:31:33,683 --> 00:31:35,894 I guess he got busy. 885 00:31:35,977 --> 00:31:37,104 What if he's a no-show? 886 00:31:37,187 --> 00:31:38,730 Tell me what he needs. 887 00:31:38,814 --> 00:31:39,815 I'll pass it on to the night shift. 888 00:31:39,898 --> 00:31:40,816 That won't be necessary. 889 00:31:43,652 --> 00:31:45,404 Oh, Princess. 890 00:31:45,487 --> 00:31:46,488 Ask and you shall receive. 891 00:31:46,571 --> 00:31:47,614 Normal head CT. 892 00:31:47,697 --> 00:31:49,991 Thanks. I'll get him discharged. 893 00:31:50,075 --> 00:31:51,827 How's your day going? 894 00:31:51,910 --> 00:31:54,329 I think I'm getting writer's cramp. 895 00:31:54,413 --> 00:31:55,664 You with the big guy? 896 00:31:55,747 --> 00:31:57,916 Yeah. It's sad. 897 00:31:57,999 --> 00:32:01,837 Bad car accident, multiple operations, tons of stress. 898 00:32:03,922 --> 00:32:05,715 Lidocaine shot to a sensitive area. 899 00:32:05,799 --> 00:32:07,467 I got a binge-drinking party girl with a tongue lac. 900 00:32:07,551 --> 00:32:08,802 Mm. 901 00:32:08,885 --> 00:32:10,053 Sounds like she needs some help. 902 00:32:10,137 --> 00:32:12,764 In more ways than one. 903 00:32:12,848 --> 00:32:16,476 How's, uh--how's your first shift back going? 904 00:32:16,560 --> 00:32:18,687 One day at a time. 905 00:32:18,770 --> 00:32:20,272 First year sober is the hardest. 906 00:32:20,355 --> 00:32:21,523 That's what they keep telling me. 907 00:32:21,606 --> 00:32:24,192 I'm nine years and counting. 908 00:32:26,653 --> 00:32:28,155 Oh. 909 00:32:28,238 --> 00:32:31,700 Special delivery for my guy. 910 00:32:31,783 --> 00:32:33,660 If you, um--if you need anything, call me. 911 00:32:33,743 --> 00:32:35,328 Thanks. 912 00:32:41,334 --> 00:32:42,878 Where are you going? 913 00:32:42,961 --> 00:32:44,254 Blisters in North 3. 914 00:32:44,337 --> 00:32:45,755 That's where I'm going. 915 00:32:45,839 --> 00:32:47,632 Did you sign up for the patient? 916 00:32:47,716 --> 00:32:49,426 I pulled the chart from the rack. 917 00:32:49,509 --> 00:32:51,178 You're supposed to sign up on the dry-erase board. 918 00:32:51,261 --> 00:32:53,054 You're supposed to have a clipboard for the patient. 919 00:32:53,138 --> 00:32:54,848 I thought the nurses had that. 920 00:32:54,931 --> 00:32:56,475 Whatever. 921 00:32:56,558 --> 00:32:57,601 Hi. 922 00:32:57,684 --> 00:32:59,019 I'm Student Doctor Ogilvie. 923 00:32:59,102 --> 00:33:01,229 And this is--wow. 924 00:33:01,313 --> 00:33:02,689 That is some rash. 925 00:33:02,772 --> 00:33:05,567 - Yeah. Tell me about it. - Student Doctor Javadi. 926 00:33:05,650 --> 00:33:07,777 - When did this start? - Last night. 927 00:33:07,861 --> 00:33:09,321 And have you been on any hikes recently 928 00:33:09,404 --> 00:33:10,447 around poison ivy? 929 00:33:10,530 --> 00:33:12,365 Nope. Haven't left the house. 930 00:33:12,449 --> 00:33:15,368 What about new medications, lotions, soaps, 931 00:33:15,452 --> 00:33:16,369 detergents, even? 932 00:33:16,453 --> 00:33:17,662 I don't take medicine. 933 00:33:17,746 --> 00:33:19,331 Nothing new with all that other stuff. 934 00:33:19,414 --> 00:33:20,415 Uh-huh. And where did this start? 935 00:33:20,499 --> 00:33:21,833 Everywhere, all at once. 936 00:33:21,917 --> 00:33:25,170 Just a lot of pain, really itchy. 937 00:33:25,253 --> 00:33:26,880 What is it? 938 00:33:26,963 --> 00:33:28,381 I'm not sure yet. 939 00:33:28,465 --> 00:33:31,134 Um, be back in a second. 940 00:33:31,218 --> 00:33:32,761 Can't--will you-- 941 00:33:37,015 --> 00:33:38,975 What are you thinking? 942 00:33:39,059 --> 00:33:40,060 I have no idea. 943 00:33:40,143 --> 00:33:41,311 Agreed. 944 00:33:43,188 --> 00:33:44,689 Bullous pemphigoid? 945 00:33:44,773 --> 00:33:46,399 Autoimmune severe pruritis? 946 00:33:46,483 --> 00:33:48,026 Yeah, but not as deadly as pemphigus vulgaris. 947 00:33:48,109 --> 00:33:50,028 Untreated, the death rate is over 90%. 948 00:33:50,111 --> 00:33:51,446 We need to check for pustules, 949 00:33:51,530 --> 00:33:52,572 mucous membrane involvement-- 950 00:33:52,656 --> 00:33:54,032 And the Nikolsky sign. 951 00:33:56,535 --> 00:33:57,911 Here you go. 952 00:33:59,412 --> 00:34:00,413 What? 953 00:34:00,497 --> 00:34:02,040 For your progress note. 954 00:34:03,416 --> 00:34:06,336 Did I hear we're making progress? 955 00:34:06,419 --> 00:34:08,630 Oh, um, it's just what we call it 956 00:34:08,713 --> 00:34:11,800 when we write down things to describe a clinical course. 957 00:34:13,343 --> 00:34:14,302 Any changes? 958 00:34:15,387 --> 00:34:16,596 Not so far. 959 00:34:16,680 --> 00:34:18,974 It's time for the next neuro check. 960 00:34:19,057 --> 00:34:21,268 Excuse me, Dr. King, do you have a minute? 961 00:34:21,351 --> 00:34:22,852 Um, no. 962 00:34:22,936 --> 00:34:24,646 I'm observing a patient right now. 963 00:34:24,729 --> 00:34:27,065 60 seconds tops. 964 00:34:28,483 --> 00:34:29,776 I'll check pupils. 965 00:34:29,859 --> 00:34:31,403 We're good here. 966 00:34:37,033 --> 00:34:38,910 Hey. 967 00:34:38,994 --> 00:34:41,246 I just finished my deposition. 968 00:34:41,329 --> 00:34:43,707 Oh, should I go up now? 969 00:34:43,790 --> 00:34:45,417 Yeah. Just wait until you get a call. 970 00:34:45,500 --> 00:34:46,793 OK. 971 00:34:46,876 --> 00:34:48,253 Well, I'd ask how it went, 972 00:34:48,336 --> 00:34:50,297 but we're not supposed to discuss the case. 973 00:34:50,380 --> 00:34:51,798 This isn't a discussion. 974 00:34:51,881 --> 00:34:55,051 It's a monologue, so shut up and listen. 975 00:34:55,135 --> 00:34:57,262 The malpractice case is frivolous. 976 00:34:57,345 --> 00:34:58,805 The mother of the measles kid claims 977 00:34:58,888 --> 00:35:00,223 we caused intellectual decline 978 00:35:00,307 --> 00:35:02,309 by performing a spinal tap. 979 00:35:02,392 --> 00:35:05,520 But the tap was perfect with no complications. 980 00:35:05,604 --> 00:35:07,272 Her son presented with altered mental status 981 00:35:07,355 --> 00:35:10,734 due to low oxygen from measles pneumonia. 982 00:35:10,817 --> 00:35:13,194 Any change in intellect was due to hypoxic brain injury. 983 00:35:13,278 --> 00:35:16,865 It had nothing to do with your spinal tap. 984 00:35:16,948 --> 00:35:18,575 End of monologue. 985 00:35:18,658 --> 00:35:21,328 We never discussed the case. 986 00:35:21,411 --> 00:35:23,663 I gotta get some sleep. 987 00:35:23,747 --> 00:35:27,000 Thanks, I guess. 988 00:35:28,668 --> 00:35:30,879 OK, are you ready to lay down? 989 00:35:30,962 --> 00:35:31,880 I got your head. 990 00:35:31,963 --> 00:35:33,089 Nice and slow. 991 00:35:33,173 --> 00:35:35,300 One, two, three. 992 00:35:36,718 --> 00:35:37,636 OK. 993 00:35:37,719 --> 00:35:38,803 How's that feel? 994 00:35:41,723 --> 00:35:42,849 Lifting up now. 995 00:35:52,859 --> 00:35:54,486 Keep going. 996 00:35:57,113 --> 00:36:00,367 And... that ought to do it right about there. 997 00:36:02,118 --> 00:36:03,870 215? 998 00:36:03,953 --> 00:36:05,872 Oh, that's in kilos. 999 00:36:08,208 --> 00:36:09,793 OK, team. 1000 00:36:15,423 --> 00:36:17,092 It's not that much over 450. 1001 00:36:17,175 --> 00:36:19,886 No, we can't risk breaking our CT on a holiday weekend. 1002 00:36:19,969 --> 00:36:22,013 Would the medics take him while he's intubated? 1003 00:36:22,097 --> 00:36:24,391 If I go along for the ride, I could still get a nap in 1004 00:36:24,474 --> 00:36:26,017 before my night shift. 1005 00:36:30,021 --> 00:36:32,899 474. 1006 00:36:32,982 --> 00:36:34,776 Our CT can't handle your weight, 1007 00:36:34,859 --> 00:36:38,154 but we're gonna take you over to Presbyterian Hospital. 1008 00:36:38,238 --> 00:36:40,073 Road trip. 1009 00:36:40,156 --> 00:36:42,450 I'll keep you company the whole time. 1010 00:36:44,994 --> 00:36:46,996 Sorry for all this trouble. 1011 00:36:47,080 --> 00:36:48,206 It's OK. 1012 00:36:48,289 --> 00:36:49,708 This is what we do. 1013 00:36:55,213 --> 00:36:56,715 So sub Q starts deep. 1014 00:36:56,798 --> 00:36:57,841 You want to bury the knot. 1015 00:36:57,924 --> 00:36:59,384 Yeah, I've done these before. 1016 00:36:59,467 --> 00:37:01,678 Joy, how do we cut the ends? 1017 00:37:01,761 --> 00:37:03,221 Short. Slide to the knot. 1018 00:37:03,304 --> 00:37:04,222 Turn 45 degrees. 1019 00:37:04,305 --> 00:37:06,349 Excellent. 1020 00:37:06,433 --> 00:37:08,184 Um, Dr. Langdon, we have a case. 1021 00:37:08,268 --> 00:37:09,185 It'll have to wait. 1022 00:37:09,269 --> 00:37:10,311 It could be urgent. 1023 00:37:10,395 --> 00:37:14,149 Find Robby or Al-Hashimi. 1024 00:37:14,232 --> 00:37:16,484 This girl is wasted. 1025 00:37:16,568 --> 00:37:18,528 Drunk as a skunk. 1026 00:37:18,611 --> 00:37:20,280 Should we check her blood alcohol level? 1027 00:37:20,363 --> 00:37:21,906 No, it won't change what we do. 1028 00:37:21,990 --> 00:37:23,491 She can go home when she has a steady gait. 1029 00:37:23,575 --> 00:37:25,660 I already sent one off. 1030 00:37:25,744 --> 00:37:28,329 Joy, do you want to guess her blood alcohol? 1031 00:37:28,413 --> 00:37:29,831 Why would I want to do that? 1032 00:37:29,914 --> 00:37:31,958 I don't know. 'Cause it's fun. 1033 00:37:37,964 --> 00:37:39,549 When will you have a bed? 1034 00:37:39,632 --> 00:37:41,384 I'm not sure she needs a bed. 1035 00:37:41,468 --> 00:37:43,178 She's a febrile infant. 1036 00:37:43,261 --> 00:37:45,138 Who is clearly over a month old and looks amazing. 1037 00:37:45,221 --> 00:37:47,098 Every marker is normal. She has a cold virus. 1038 00:37:47,182 --> 00:37:48,850 Infants with rhinovirus can still have 1039 00:37:48,933 --> 00:37:50,268 a serious bacterial infection. 1040 00:37:50,351 --> 00:37:51,770 Not this one. 1041 00:37:51,853 --> 00:37:53,396 We send kids like this home all the time. 1042 00:37:53,480 --> 00:37:56,441 Except this one doesn't have a home or a parent. 1043 00:37:57,817 --> 00:37:59,277 All right. 1044 00:37:59,360 --> 00:38:01,029 I can't put a kid with a virus in the nursery, 1045 00:38:01,112 --> 00:38:03,281 and I can't waste a private room on a healthy baby. 1046 00:38:03,364 --> 00:38:04,699 Then what do you propose? 1047 00:38:04,783 --> 00:38:06,659 CYF can place her in emergency foster care 1048 00:38:06,743 --> 00:38:08,203 by tomorrow morning. 1049 00:38:08,286 --> 00:38:10,413 You want to leave her down here overnight? 1050 00:38:10,497 --> 00:38:12,791 Seems to be the standard of care these days. 1051 00:38:12,874 --> 00:38:14,125 Have your attending give me a call. 1052 00:38:14,209 --> 00:38:15,168 Will do. 1053 00:38:15,251 --> 00:38:16,503 I can't believe this. 1054 00:38:16,586 --> 00:38:18,296 Let CYF know it's very urgent. 1055 00:38:18,379 --> 00:38:19,798 Got it. 1056 00:38:19,881 --> 00:38:22,342 This is turning into quite the day. 1057 00:38:22,425 --> 00:38:24,260 You know, I've been thinking 1058 00:38:24,344 --> 00:38:25,804 about applying for a fellowship. 1059 00:38:25,887 --> 00:38:27,764 I thought you had a job lined up in New Jersey. 1060 00:38:27,847 --> 00:38:29,891 I did, to be close to my mom. 1061 00:38:29,974 --> 00:38:33,436 But she sold her house to travel the world 1062 00:38:33,520 --> 00:38:35,438 with her new boyfriend. 1063 00:38:35,522 --> 00:38:37,273 So what's the point of New Jersey? 1064 00:38:37,357 --> 00:38:38,691 Yeah, good question. 1065 00:38:38,775 --> 00:38:40,318 Which fellowship? 1066 00:38:40,401 --> 00:38:44,030 I've narrowed it down to ultrasound, toxicology, 1067 00:38:44,113 --> 00:38:47,283 and sports medicine. 1068 00:38:47,367 --> 00:38:48,660 Those are very disparate fields 1069 00:38:48,743 --> 00:38:50,161 leading to very different careers. 1070 00:38:50,245 --> 00:38:51,329 I know. 1071 00:38:51,412 --> 00:38:53,414 I'm a little undecided. 1072 00:38:53,498 --> 00:38:55,041 Do you have research experience? 1073 00:38:55,124 --> 00:38:57,627 I was a part of a study on racial disparities 1074 00:38:57,710 --> 00:38:59,504 in health care until the White House 1075 00:38:59,587 --> 00:39:01,047 cut the funding last year. 1076 00:39:01,130 --> 00:39:03,466 Yeah. You are not alone. 1077 00:39:03,550 --> 00:39:06,386 Have you considered a geriatrics fellowship? 1078 00:39:06,469 --> 00:39:08,304 I have not. 1079 00:39:08,388 --> 00:39:10,431 I've seen your skills with the elderly, 1080 00:39:10,515 --> 00:39:12,559 and there are a lot of openings. 1081 00:39:12,642 --> 00:39:14,394 It might be your best shot. 1082 00:39:14,477 --> 00:39:17,230 Think about it. 1083 00:39:17,313 --> 00:39:18,231 Last stitch. 1084 00:39:18,314 --> 00:39:19,315 You want me to cut? 1085 00:39:19,399 --> 00:39:20,859 I got it. 1086 00:39:22,569 --> 00:39:23,820 It looks good. 1087 00:39:23,903 --> 00:39:25,905 OK. Let's pull the traction suture. 1088 00:39:25,989 --> 00:39:27,365 With pleasure. 1089 00:39:29,325 --> 00:39:31,369 OK, Jackie. 1090 00:39:31,452 --> 00:39:32,787 - Jackie. - Stop it. 1091 00:39:32,871 --> 00:39:33,788 Stop. 1092 00:39:33,872 --> 00:39:35,081 All done. 1093 00:39:35,164 --> 00:39:36,666 All done with what? 1094 00:39:36,749 --> 00:39:38,334 Sewing up your tongue. 1095 00:39:38,418 --> 00:39:40,044 What happened to my tongue? 1096 00:39:40,128 --> 00:39:41,254 You bit it. 1097 00:39:41,337 --> 00:39:42,255 Ha. 1098 00:39:42,338 --> 00:39:43,923 No, I didn't. 1099 00:39:44,007 --> 00:39:45,758 That is called a blackout. 1100 00:39:45,842 --> 00:39:47,594 How much did you drink? 1101 00:39:47,677 --> 00:39:49,846 A couple Bloody Marys. 1102 00:39:49,929 --> 00:39:51,055 Only a couple? 1103 00:39:51,139 --> 00:39:53,224 I don't know. Maybe more. 1104 00:39:53,308 --> 00:39:55,935 It's a holiday, a pub crawl. 1105 00:39:56,019 --> 00:39:58,646 Do you usually have a couple cocktails every day? 1106 00:39:58,730 --> 00:39:59,898 Only on weekends. 1107 00:39:59,981 --> 00:40:01,232 How about during the week? 1108 00:40:01,316 --> 00:40:02,650 Nothing much. 1109 00:40:02,734 --> 00:40:07,655 Just wine with dinner or a few beers. 1110 00:40:07,739 --> 00:40:10,825 Maybe we should recommend rehab? 1111 00:40:10,909 --> 00:40:11,910 Yeah. 1112 00:40:11,993 --> 00:40:13,411 We could try. 1113 00:40:17,999 --> 00:40:20,376 Ready to roll. 1114 00:40:20,460 --> 00:40:22,003 How are you feeling? 1115 00:40:22,086 --> 00:40:23,379 My pain is a two. 1116 00:40:23,463 --> 00:40:24,964 We got meds if you need them. 1117 00:40:25,048 --> 00:40:26,507 Scan will be quicker than the ride to Presby. 1118 00:40:26,591 --> 00:40:27,884 We'll keep trying to reach your sister. 1119 00:40:27,967 --> 00:40:29,510 - You guys are the best. - See you later. 1120 00:40:29,594 --> 00:40:31,304 Can I put a new patient in T1? 1121 00:40:31,387 --> 00:40:33,681 Uh, no, I kind of want to leave one trauma room open. 1122 00:40:33,765 --> 00:40:37,310 Why don't you double up the north if you have to? 1123 00:40:37,393 --> 00:40:40,229 Mr. Digby? 1124 00:40:40,313 --> 00:40:42,106 - It's just Digby. - Right. 1125 00:40:42,190 --> 00:40:44,651 We've been looking all over. Where you been? 1126 00:40:44,734 --> 00:40:46,194 With Louie. 1127 00:40:46,277 --> 00:40:47,695 You've been in there for an hour? 1128 00:40:47,779 --> 00:40:49,739 He was my friend. 1129 00:40:49,822 --> 00:40:51,658 - I had a lot to say. - Hmm. 1130 00:40:51,741 --> 00:40:54,035 Well, let's get you back to your bed. 1131 00:40:56,120 --> 00:40:57,914 Louie got his wings. 1132 00:40:57,997 --> 00:40:59,832 - Dr. Robby. - Dr. Robby. 1133 00:40:59,916 --> 00:41:01,417 We picked up a patient together. 1134 00:41:01,501 --> 00:41:02,835 Teamwork! 1135 00:41:02,919 --> 00:41:04,379 It's a concerning bullous rash. 1136 00:41:04,462 --> 00:41:05,964 We might need a biopsy for pemphigus vulgaris. 1137 00:41:06,047 --> 00:41:07,423 It's phytophotodermatitis. 1138 00:41:07,507 --> 00:41:09,175 - What? - I asked. 1139 00:41:09,258 --> 00:41:11,302 He was making three gallons of margaritas for a party, 1140 00:41:11,386 --> 00:41:13,554 squeezing fresh limes out in the sun. 1141 00:41:13,638 --> 00:41:14,973 Let's go take a peek. 1142 00:41:15,056 --> 00:41:16,891 I don't need to see it again. 1143 00:41:19,435 --> 00:41:20,812 How's it going out there? 1144 00:41:20,895 --> 00:41:22,397 Standing room only. 1145 00:41:22,480 --> 00:41:23,815 If I call the fire department, will they clear 1146 00:41:23,898 --> 00:41:25,108 - that waiting room? - I wish. 1147 00:41:25,191 --> 00:41:26,234 What's up? 1148 00:41:26,317 --> 00:41:28,277 12 patients need med refills. 1149 00:41:28,361 --> 00:41:29,862 Shouldn't they see their doctors? 1150 00:41:29,946 --> 00:41:31,614 With the Medicaid cuts, we are their doctor. 1151 00:41:31,698 --> 00:41:33,324 No, I can't e-prescribe to their pharmacies. 1152 00:41:33,408 --> 00:41:35,034 So get out your pen. Go old school. 1153 00:41:35,118 --> 00:41:37,370 Dana, on what? 1154 00:41:37,453 --> 00:41:39,831 Nordt, you got the security pads? 1155 00:41:39,914 --> 00:41:41,124 Sure do. 1156 00:41:41,207 --> 00:41:42,917 Just need a patient sticker. 1157 00:41:43,001 --> 00:41:45,294 - Any other questions? - Yeah. 1158 00:41:45,378 --> 00:41:47,755 What would have happened if you weren't here today? 1159 00:41:48,965 --> 00:41:50,717 You'd all be curled up in the fetal position, 1160 00:41:50,800 --> 00:41:53,052 crying like babies. 1161 00:41:53,136 --> 00:41:54,679 Were you wearing flip-flops? 1162 00:41:54,762 --> 00:41:56,014 I was. 1163 00:41:56,097 --> 00:41:57,932 - What is it? - Phytophotodermatitis. 1164 00:41:58,016 --> 00:42:00,143 Otherwise known as margarita burn. 1165 00:42:00,226 --> 00:42:01,686 For some people, limes plus sunshine 1166 00:42:01,769 --> 00:42:03,021 can cause a horrible rash. 1167 00:42:03,104 --> 00:42:05,148 This is all because of limes? 1168 00:42:05,231 --> 00:42:07,984 Have you ever squeezed limes outside in the sun before? 1169 00:42:08,067 --> 00:42:09,652 I don't think so. 1170 00:42:09,736 --> 00:42:12,113 You will feel better after a day of steroid pills. 1171 00:42:12,196 --> 00:42:14,032 But once these heal, you gotta wear sunscreen. 1172 00:42:14,115 --> 00:42:16,159 Because these blisters can turn into dark scars 1173 00:42:16,242 --> 00:42:17,410 and stay a while if you don't. 1174 00:42:19,120 --> 00:42:22,373 I'll be right back with your aftercare instructions. 1175 00:42:22,457 --> 00:42:24,333 - Hey, Robby. - Yep. 1176 00:42:24,417 --> 00:42:26,502 My, uh-- my hospice patient Roxie 1177 00:42:26,586 --> 00:42:28,421 is still in a ton of pain. 1178 00:42:28,504 --> 00:42:29,714 Where are we with the morphine? 1179 00:42:29,797 --> 00:42:31,674 10 milligrams an hour. 1180 00:42:31,758 --> 00:42:34,218 OK, you can bolus another 2 and go up to 12. 1181 00:42:34,302 --> 00:42:35,595 I will let Princess know. 1182 00:42:35,678 --> 00:42:36,971 12 an hour is a lot. 1183 00:42:37,055 --> 00:42:38,431 Yeah, on top of the MS Contin, 1184 00:42:38,514 --> 00:42:41,392 she could stop breathing. 1185 00:42:41,476 --> 00:42:44,729 Are you familiar with the doctrine of double effect? 1186 00:42:44,812 --> 00:42:46,814 - Not really. - No. 1187 00:42:46,898 --> 00:42:49,317 It is an ethical principle in palliative care. 1188 00:42:49,400 --> 00:42:51,027 We treat pain. 1189 00:42:51,110 --> 00:42:52,987 And if, in doing so, there's a negative side effect, 1190 00:42:53,071 --> 00:42:54,614 we accept it. 1191 00:42:54,697 --> 00:42:57,450 Even if the negative side effect is death? 1192 00:42:57,533 --> 00:43:00,161 In some cases, that could be the best outcome. 1193 00:43:06,000 --> 00:43:07,376 Maybe the nurse has it. 1194 00:43:07,460 --> 00:43:10,088 Emma. Emma, where does-- 1195 00:43:10,171 --> 00:43:11,839 Maybe the fax ran out of paper? 1196 00:43:11,923 --> 00:43:14,550 No, there is enough paper. I don't know what's wrong. 1197 00:43:14,634 --> 00:43:16,052 - Could be in another room. - We should call IT. 1198 00:43:16,135 --> 00:43:18,054 You want me to check every room? 1199 00:43:18,137 --> 00:43:19,639 How are we gonna get through this mess? 1200 00:43:19,722 --> 00:43:22,600 I was about to ask you. 1201 00:43:22,683 --> 00:43:24,143 Ask the pharmacist. 1202 00:43:24,227 --> 00:43:25,728 She can't leave the PDS. 1203 00:43:25,812 --> 00:43:27,522 Nothing's getting done here.