Huh?
Hey!
Donnie, thank you. I'm sorry.
We'll get another nurse to replace Jesse.
Do we even know where these ICE assholes took him?
No, but the hospital attorneys are all over it.
I know you got child duty-- what's going on?
It's a code Hula Hoop, Central 14.
Move, move, move, move, move, move, move, move.
What the hell happened?
He attacked Emma, so I gave him a shot to settle him down.
Are you all right?
Let's see.
- How did he get a bloody nose? - He slipped.
- Can I see? - He had her in a headlock.
- Uh, where's Ogilvy? - Upstairs.
They let him scrub in on that kidney stone turned triple-A.
Oh, great, on the one day med students
might actually be useful in the ED.
Oh, uh, present company excluded.
You're doing great.
Sure.
Hey, uh, can I get a selfie with you?
With me?
Yeah, you're kind of a legend among med students.
Really?
They call you Phantom of the Pitt,
on account of you secretly living
in the hospital for months.
What? It wasn't months.
Still waiting on labs...
X-rays, meds.
PTMC. Go ahead, Medic Command.
Where are all the nurses?
There was a code Hula Hoop in Central 14.
- Oh, no. - What's that?
Hospital worker assault.
- Who? - The new nurse Emma.
- Is she okay? - I don't know.
I think so.
Smoke 'em if you got 'em. This place is going tits up.
Okay, are we all good in here?
Oh, yeah, boss, we got this.
Are you sure you're all right?
- Uh, I think so. - Okay, good. Come.
So what exactly happened?
He grabbed Emma. He threw her up against a wall.
- I ran in and gave him a shot. - Right.
And did he slip before or after the shot?
Before.
Yeah, he had me in a headlock.
I didn't see what happened.
- What did you give him? - 4 milligrams of Versed.
- Who wrote the order? - I had it in my pocket.
I was on my way to waste it when shit went sideways.
What?
Okay, so now he's altered
from alcohol, Versed, and a head trauma.
Now he's gonna need a head CT to rule out
intracranial bleeding and a fracture.
Would you rather it be Emma with a head injury or worse?
Don't worry about it. We got this.
No, there's no we here.
You need to pass this patient off and report him.
Fine. Emma, you're done with this bastard.
- I'll handle him now. - No, no,
this is my emergency department,
and I'm telling you to pass it off.
These are my nurses, and I choose
what cases they work, and if you think for one minute
I'm putting anyone else from my staff at risk
with that asshole, you better give your fucking head a shake.
Come on. Come on.
- MVA coming in. - Okay, I'll be right there.
Thank you.
Did I kill my son?
No, he's not dead.
He's recovering in pediatric ICU.
We'll be back to check on you again shortly, Ms. Azurmendi.
Um, has her husband arrived yet?
Yeah, but he went straight upstairs.
Really?
He may have just wanted to see his child first.
Let's not jump to conclusions.
- Dr. Robby, can I have a word? - Shoot.
In private.
People are gonna start to talk.
- Thank you. - Mm-hmm.
What is this about?
I'm going to recommend this ED have two attendings on shift
at all times moving forward.
This department is clearly too much
for one person to handle.
It's not healthy for you or the patients,
and I'm very concerned
by what I've witnessed today with some of the staff.
What is going on with Langdon and Santos?
I saw them having it out like it was fight night.
Dr. Langdon hasn't even been here for ten months,
and you told me this morning
there was nothing to worry about with Dr. Santos.
There isn't. There isn't. Santos and Langdon have beef
because she's the one who turned him in for taking meds.
I'm sorry, what?
Santos is responsible
for revealing Langdon's benzo addiction.
Was he stealing drugs from this ED?
This ED is the best of the best,
and I would put it up against any emergency department
in the country.
And it is going to be yours to fuck up,
so don't fuck it up.
You're not supposed to smoke out here.
Really?
Seems to be working for me so far.
How old are you, kid?
I'm 21...
On Tuesday.
Jesus, some kind of idiot savant.
We no longer use that term.
It's derogatory.
- You bruise-easy Millennials. - Actually, I'm Gen Z.
Even worse.
I was stripping at Purgatory to put myself through school
when I was your age.
Snowflake.
Hey, Amy?
Yeah, I'm getting off later than I thought.
Um, I'll give you a call when I get a better idea of--
I need help!
- I got to go. - He can't breathe.
I got the airway. You take the pulse.
Yeah.
- Oh, shit. - Oh, my God.
Okay, trying jaw thrust.
- Radial's weak and thready. - What's his name?
My dad--uh, Oliver.
Hey, Oliver, can you open your eyes for me?
Okay, here we go.
Okay, one, two, three.
Drive-in with severe respiratory distress.
Left-sided dialysis shunt, probable renal failure
and fluid overload.
Have respiratory set up BiPAP.
When was his last dialysis?
It was supposed to be yesterday morning.
I'm gonna need a nitro drip ASAP.
- You got this? - Yeah.
Is that the guy who attacked Emma?
Is he going to CT?
Yeah, Ms. Emma here needs an H&P.
Uh, Cassie, can you give Emma here a workup?
Start a chart.
- Victim of assault. - Really?
- I'm fine. - He was choking you.
- He had me by the head mostly. - You're a patient now.
Full examine in South 18, McKay.
She also needs to make a statement to the police.
Is that really necessary?
- Yeah. - Absolutely.
Don't worry. I'll be there with you.
Come on, let's get you a spot.
Well, your guy just bumped my guy for CT.
- Now he's my guy? - Duke's gonna chew me
a new one 'cause he's been sitting here forever,
and I'm never gonna get out of here.
- Tell it to someone who cares. - You know what?
You should care, because if you gave that guy
a serious injury with force inflicted from a sedative
you are not licensed to prescribe--
Anyone else uses force to stop an assault,
they're a hero, but a nurse does it, and we're punished.
You just happened to have a vial of Versed in your pocket?
It was extra from the medics. Good timing, I guess.
When we waste a controlled substance,
we need a witness to sign off.
I was on my way to when I spotted that asshole
attacking a girl.
Anything else, Nancy Drew?
- Where you going? - Taking a pee.
Do I need your permission to do that, too, now?
Fuck! Fuck! Fuck! Fuck!
Should we intubate?
Uh, best to avoid that if possible.
Pressure support and afterload reduction
buys us time for dialysis.
BiPAP starting at 10 over 5.
Good hard squeeze, good lung sliding,
- but there's a ton of B lines. - Pulmonary edema.
Which is best treated by what, Dr. Javadi?
- Uh, nitrates. - Dose?
BP 198 over 132.
Pulse 120.
- Pulse ox only 85. - Good BP.
Let's start at 400 mikes per minute for 2 to 5 minutes.
I was asking Dr. Javadi.
Don't you always start low with nitro, then titrate up?
In flash pulmonary edema, we do the opposite.
What he really needs is dialysis to get the fluid off.
- What's his dialysis schedule? - Monday, Wednesday, Friday.
He missed yesterday 'cause of a wedding.
We tried to go to the center this morning.
It's usually open on Saturday,
but I think they closed for the Fourth.
- Where do you live? - Uh, Brookville.
That's, like, an hour and a half away.
Yes, ma'am.
I tried Pine Ridge Hospital in Ford City,
but I didn't know they shut down.
Yeah, they sure did.
All right, sister.
How can I help uncluster this clusterfuck?
PTMC emergency, what do you got?
You ready to finish our conversation?
We talked, okay? Now I got an ED to run.
Please.
Okay.
Talk to me.
- Tired of this shit. - Okay.
That's the second time that Emma was attacked
- by a patient today. - Okay.
ICE took one of my nurses,
and these cyber-assholes have thrown us back into 1999.
Well, I'm worried about you. You are not yourself today.
That makes two of us, then.
Do you have something you want to say?
Go ahead. I can take it.
All right, then yeah.
Sometimes it's like you're just tempting death
'cause you don't give a shit anymore.
So this is about the motorcycle?
It's not just about the motorcycle.
It's about the whole damn thing.
Robby, you're actually telling people
that you're going to a place called Smash My Head In.
Close, not quite. That's not--
Robby, your buddy Duke is insisting on leaving,
and that MVA is here.
Okay, I'll be right there.
- What's open? - Uh, South 15.
78-year-old woman,
very low speed auto versus pedestrian
with ground-level fall.
Bruising on her left hip. No head trauma.
Her husband, Eddie, came along.
Hi. How do you do, sir? I'm Dr. Robby. Come with us.
We're gonna get you set up right over here.
Sorry.
We'll get you something for the pain shortly.
Thank you.
Do you have any medical problems, Frida?
Uh, high blood pressure, low thyroid, um, AFib.
Any chest pain, shortness of breath?
- No. - Front-row seat, sir.
So, um, what happened?
Well, she walked into the car.
You hit me.
No, I didn't hit you. You hit the car.
You backed up right into me.
I wasn't even moving.
Well, you're both in very good hands now.
Yes?
Before we get you in a gown, we'd like to check your hip.
Of course.
I am sorry.
We had a whole bunch of craziness come in,
and you got bumped down a patient or two for CT.
But take comfort in knowing
it was for some pretty nasty stuff.
How am I supposed to find comfort in that
or anything you've told me since I got here,
- for that matter? - I don't know.
But everything is supposed to come with a lesson, right?
Oh, this is more of your Zen motorcycle bullshit.
Maybe.
No, no, the truth is, I'm just stalling
'cause it's gonna be a while longer.
Oh, hey, look, I appreciate the effort,
but you guys are obviously jammed up.
I'll just come back when it's not our nation's birthday.
You're already here.
It's not gonna be that much longer, I promise.
Just stay and get your CT.
I will do it all when you get back
- and this place is less crazy. - This place is always crazy.
I don't know when I'm gonna get back.
Can you just sit the fuck down and wait a little bit longer?
It won't kill you, but leaving might.
Okay.
No problem.
Thank you.
That's a nasty bruise.
Do you take aspirin or any blood thinners?
Uh, Eliquis for my AFib.
Any tenderness here?
No, not really.
- Here? - Oh, yeah, that hurts.
All right, 4 of, uh, morphine and Zofran.
- What about up here? - Not really.
All right, so let's start with labs and plain film.
No, CT abdomen pelvis.
We'll get a better view of the hip and check for bleeding.
The Eliquis is concerning.
Uh, you think she broke her hip?
If it's broken, you broke it.
Usually for a broken hip,
the leg is shortened and rotates out,
but we'll just wait for CT results.
Mr. Cohen...
I know that you were checked on scene,
but I was wondering if I could do
a quick examination of you.
Oh, no, I'm fine. I was in the car.
Just unofficially.
Okay.
Deep breath for me.
Good. Again.
Great. Thanks, Eddie.
Next thing--would you mind taking your shoes off?
Uh...
what for?
Just being safe.
My back's not what it used to be.
Let me help you.
I, uh, could use a pedicure.
You and me both.
Dr. King, what do you think about doing a Romberg test?
What is that?
It's a general evaluation of balance.
Um, can you stand up, sir?
Yep.
How are you doing, Oliver?
Sats are not coming up.
Pressure's holding on 400 of nitro.
- Let's up the BiPAP to 20 on 10. - We could try phlebotomy.
Decrease the fluid burden on the lungs.
Old school, but might buy time.
Hemoglobin is only 9.2.
He's anemic from renal failure.
Then he can't afford more blood loss.
We need to intubate. We're losing this war.
Intubation's not a trivial matter
for immunosuppressed patients.
So we just drop a bunch of red tops?
No, we do the collection on the floor
- as if he's giving blood. - Like medieval bloodletting.
Essentially, and that is something
you should step out for, Mason.
- Casey, thank you. - Got a good vein for a 16.
One donor bag, 500 cc's.
No more.
Okay, let it out.
Same again. Deep breath in.
Great. All done.
- How's she doing? - Pulse ox 100%, normal exam.
- No evidence of injury. - Great.
I got way worse from my older brothers.
I bet.
All right, I'll go, uh, write up her chart.
How about we call it a day?
My shift isn't over.
This was a shift and a half for anyone today, believe me.
If it's all right with you, I'd rather stay.
I'm not a quitter.
Okay, Ms. Emma, good for you.
But stick close to Donnie for the rest of the day, would you?
Sure.
And you also need to make a statement to the police.
If we don't stand up for ourselves, no one else will.
We're here to help, not to be punching bags.
Thank you for saving me.
I got you, girl.
- Something wrong? - That depends.
Are you a four-month-old with severe diaper rash?
No, I'm Dorion Cole,
and I'm pretty sure that I broke my collarbone.
Okay, we can help with that. I'll be back.
Wait, wait. Are you serious?
Can I at least get something for my pain?
- Sure. Sit tight. - This place sucks.
Tell me about it. Try working here.
Boy, you're really working hard
to boost those patient satisfaction scores.
The chart for Central 7
doesn't match the patient that's in there.
Hang in there. We're almost over this.
I was over this six hours ago.
Chairs is looking like Mullaney's on St. Paddy's Day.
They're gonna break through the doors like zombies...
- Incoming. - If we don't start moving
more of the meat back there.
Dante Casella, 34.
Blunt trauma from a fireworks explosion in a storage unit.
A and O, good vitals,
large scalp laceration and bruising to the chest.
No meds or allergies.
Partial or full thickness burns?
No burns. The blast launched him
into a rolled-down garage door frame.
- Am I fucking dying here? - I'm Dr. Robby.
- This is Dr. Santos. - What? I can't hear you.
Try the other side.
I'm Dr. Santos.
- Can you hear me? - Yeah, yeah.
Dante. Lot of ringing.
Hey, McKay, Joy, you're with us.
One, two, three.
I need, like, four doctors?
Oh, shit, I knew it was bad.
This is a teaching hospital.
You get all the extra help you need.
Airway and breathing intact.
Good lung sliding bilaterally.
Tender over the sternum-- possible fracture.
That's your breastbone.
- No ectopy on monitor. - No pericardial effusion.
- The heart looks good. - 130 over 85.
Pulse 108, sats 98 on 2 liters.
Good enough for 50 of fent.
He soaked through his head dressing.
Let's take a peek.
Normally, we don't deal with scalp lacs
on the primary survey,
only if there's active bleeding.
With blast injuries,
the pressure wave can transmit energy
through the body and cause internal damage
even without any external visible signs,
especially with organs that are air filled.
- How are we looking, Dr. Santos? - E-FAST negative.
No free fluid in the belly.
- Fuck me. - What--what is it?
It's a pretty big flap. Checking for bleeding source.
- Is that through the galea? - It is, indeed.
- Crack my head open or what? - Don't worry.
Your skull is intact. It's just a, uh, very deep cut.
Ugh.
Okay, we got a couple arterioles that need control.
- Figure-of-eight sutures? - Dr. Santos for 800.
What are Raney clips, Alex?
- Quicker than sutures. - Ding, ding, ding, ding.
Okay, clamp those bleeders, call for CT.
I'll be next door, and Duke's CT line keeps growing.
500 cc's out.
How you doing, Oliver?
Making some progress in here.
Can't tell if it was the phlebotomy
or if the nitro finally kicked in.
Oh, could have been both.
Potassium's high. 6.5.
Be expected with the missed dialysis
and the added heat stress.
- He needs, uh-- - Dr. Javadi.
Uh, he needs insulin and glucose
to shift the potassium intracellular.
Exactly. Uh, 10 units, amp of D-50.
Start with 5 milligrams of nebulized albuterol.
It'll shift some potassium and help his breathing.
He's at risk for arrhythmias.
Mm, no peaked T waves, no QRS widening.
Insulin puts him at risk for hypoglycemia.
And you tie up nurses with frequent Accu-Cheks.
Dr. Al-Hashimi's right.
The nebs will hold him over until dialysis gets here.
- You got this? - Mm-hmm.
- All good in here? - Yep.
Uh, I'm gonna go give this guy's kid an update.
He's probably freaking out.
- Come find me if you need me. - Uh, yep.
Um, hey.
Where'd you learn that shoe trick?
Oh, I did a clerkship at NJMS senior care.
One of the attendings always said you can learn a lot
about your patients just by looking at their feet.
Bravo, ladies.
Now on to the next lucky customers.
Probably gonna have to stay late
to catch up on all these patients.
Night-shift reinforcements will be here soon.
We're supposed to be speeding up in the 11th hour,
not slowing down.
They don't call it the final sprint for nothing.
Chop-chop.
Is that the, uh, mom of the heatstroke?
Yeah.
Do you believe it was just an accident?
Does it matter?
As a doctor, no.
But as a mom...
Sometimes I can't tell if motherhood has made me
more understanding or more judgmental.
Dana, got a couple visitors.
Uh, my--my brother. There was an explosion.
Hi. My mom was in a car accident.
Uh, okay, Monica, can you help these fine folks
- find their loved ones? - Yeah.
And, Princess, what are you still doing here?
Don't you got some crazy luau pig roast barbecue thing
- to get to? - It's lechón, but, yes, I do.
- I'm gonna sneak out in a few. - Okay, yeah, yeah.
Go have some fun for both of us, all right?
- Don't stay too late. - Okay.
Hello, Ms. Stevens.
I'm Dr. McKay.
- How you feeling? - Stupid...
and really, really sore.
Yeah, we'll, uh, get you something for your pain, okay?
Your last patient left her blanket.
Oh.
Uh, yeah.
I...
yeah, I'll take it.
Thanks, Esme.
Um, I'll be right back, yeah?
Fuck!
- You good? - Yeah, yeah.
I'm just--I'm looking for something to put this in.
A, uh--a patient left it.
She died, the, uh, cancer mom with the two kids.
Sounds like a tough one.
Yeah, that one sucked.
Seeing those two young boys say goodbye to their mother
was brutal.
Just makes you want to cry.
You should cry. You'll feel better.
I wish I could.
No, I don't even remember the last time I cried.
I'm not even sure I can anymore.
Is that what this place does to you?
We get pretty good at shutting down our feelings.
Yeah, I'm a little scared
I've shut them off for so long,
I don't know how to turn them back on again.
I just wish I could cry again, you know?
You want a hug?
God, no.
Your mom is stable,
but she's still waiting on the imaging of her hip.
We'll know more soon.
You can wait with your dad in the meantime.
I've told him a million times
he shouldn't be driving anymore.
May I ask what their home situation is like right now?
I don't know, they live over in Squirrel Hill.
Same house I grew up in, just the two of them.
We noticed your father
exhibiting signs of an unsteady gait,
along with other balance and mobility issues.
He sees an internist, neurologist,
cardiologist, gastroenterologist.
He's got a whole team of "ologists."
Both my parents used to be in pretty great shape,
but lately, it's like they can barely get up the stairs.
Half their house isn't accessible to them.
Have you looked into assisted living options?
Yes, but they refuse to even talk about it with me.
Mr. Cohen, you have a visitor.
- Care Bear. - Dad.
- You feeling okay? - No, I'm feeling dumb.
Carrie, this is Dr. King,
who will be assisting with your mother's care.
I was just explaining that the treatment
depends on the injuries,
but there are complicating factors.
We are required to report impairments
that might affect driving,
and you will likely have to take another driver's test
to keep your license.
What's that got to do with Frida?
Well, if the hip injury is serious
and you're also, uh, limited,
then it could mean
an "unsafe to return home" recommendation for your wife.
You'd be looking at a temporary move
to some form of assisted living and rehabilitation
for Frida's care.
How temporary?
Best case, three to six months,
but she may never return to the functionality she had
prior to the injury and recovery.
- Okay, well, kill me now. - See what I'm dealing with?
Dad, you need to find somewhere to live that is safer
and healthier for both of you.
You--you know, the new communities are not anything
like the old, scary nursing homes.
They're really nice, and you get your own apartment.
And, um, you know, my sister actually lives in one.
She just loves it.
When the dog dies, we can talk.
What if you fall?
What if you have a heart attack or a stroke,
and there's no one there to help you?
- You worry too much. - How can I not?
Look what happened today.
Okay, we're gonna leave you two alone.
We'll come back with Mrs. Cohen.
Hey, Robby, our scalp victim is back from CT.
- They're prepping him now. - Shit.
Uh, okay. I'm coming.
Um...
- Is your friend doing okay? - He's on my flight risk radar.
Oh, and Dana put McKay on the guy who attacked the new nurse.
- Is she okay? - Physically, yes.
I heard you had a little chat with Langdon earlier.
Yeah, water under the bridge.
You have to figure out a way of working with him
- now that he's back. - Or until he relapses.
You're becoming a very good doctor.
Don't let old conflicts get in the way.
Speaking of which, I want you and everybody else
to see the trauma counselor while I'm gone, yes?
- Yes. - And I asked Whitaker
to house-sit for me while I'm gone.
I figured that would distract
from the whole farmer's widow thing.
- Wait, what? - Bring in the mail,
water the plants--cool?
- Cool. Yeah. Fine. - That looks good.
You can start the repair after this one.
Feeling any pain, sir?
Uh, no pain, just wet.
- You already numbed him up? - I did.
1% with epi.
- CT back yet? - No, not yet.
I watched the slices come up.
Isolated sternal fracture. Everything else looked normal.
Could send him home, but given the mechanism,
should probably watch him overnight.
I agree with Dr. Garcia.
I agree with Dr. Garcia, too.
Three-layer closure-- galea, sub-Q, skin staples.
Enjoy the fireworks.
And hey, if I don't see you before you leave,
don't forget to buy me a souvenir,
like a custom elk-bone-carved hunting blade.
Nothing less for my favorite butcher.
Aww, you're gonna make a great ex-husband
one day, Robinavitch.
Hospital's got a defense attorney looking for Jesse.
Probably took him to an ICE detention center.
Said we shouldn't hold our breath, though.
Whatever happened to "we the people," huh?
Anything back on that drunk son of a bitch
- that attacked Emma? - Not yet.
- Christ's sake. - I'm making a run now.
- I'll ask. - Yeah.
That's the guy who attacked Emma?
- Mm-hmm. - That's intense.
How you doing?
Peachy.
Oh, that's me.
Hey, you did what you had to do with that guy.
- Everything's gonna be fine. - From your lips.
Box of class B launch tubes to the van.
Next second, kaboom!
I get launched 10, 15 feet across the garage,
right up into the lift track.
Hit something hard.
Uh, I don't really remember the rest.
Oh, just my brother screaming, help, help!
I'm lying there thinking, oh, he must be dying.
I guess it was me he was screaming about.
Your brother is in the family room.
He's waiting to see you, and he is alive and well.
Oops.
"Oops"?
What--what's oops mean?
- Hello? - It's nothing to worry about.
We never say "oops" in front of a patient.
All right, try again.
- You sure? - Mm-hmm.
Okay.
Better. Keep going.
You might want to leave the fireworks
to the professionals.
We are professionals.
Got our official PDA consumer license a few years back.
Gunpowder's in my blood, man.
Nothing like that...
Ain't no fighting it.
Amor fati.
More like memento mori.
Tomato, tom-ah-to.
Am I, like, the only one
who didn't study Latin for med school?
- Yep. - Yes.
And finished.
Nicely done.
- Can I see my brother now? - Yep.
Oh, motherfucker.
- Chest pain? - Only when I move.
That would be the fracture in your sternum,
which we will give you another 4 of morphine for that.
Thank you.
And try no laughing or sneezing
for the next four weeks.
Mr. Haas, we're gonna switch you over
to a high-flow nasal oxygen instead of the BiPAP
and see how you do.
This looks promising.
Repeat potassium is at 6.1 with the albuterol.
Feeling a...
a little better.
Don't you ever tell your mother about how fast you drove here.
I thought you were gonna die.
Any longer, and he might have, so good job.
Boy just got his permit last week.
Felt like I was living
in one of those "Fast and the Furious" movies.
I can't believe Pine Ridge closed.
When did that happen?
I read about it a few months ago.
Medicare spending cuts.
Are there any other emergency rooms in the area?
Nope.
It's gonna be a long way to drive
for folks out where we live.
Mr. Haas, you'll need to stay here a few hours.
Get you tuned up.
Yeah. I know the drill.
Hey, you know, Mason, if you're hungry,
we've got a pretty good cafeteria.
Don't lie to him.
We have a cafeteria.
I'm just gonna stay here with my dad.
Yeah, sure.
Thank you for saving him.
Are you still thinking rural emergency medicine
when you're done here?
Um, not thinking, doing.
God, I hope there are still some hospitals left
- for you to work at. - Yeah.
Oh!
So the march of the walking dead night shift begins.
First one in, Mateo. You get a gold star.
What happened in here?
I left you guys with a layup this morning.
Don't ask.
Speaking of layups, what up, Dr. J?
Oh, right.
That was, um, some sort of basketball player, wasn't it?
Shame on you.
Only the greatest Sixer to ever play the game.
Week one of year four of med school.
You'll be ordering me around before you know it.
Gonna join the dark side when you graduate?
The emergency department?
The night shift, baby. It's wild.
Um...
I haven't even decided what residency I'm applying for yet.
You'll figure it out. Got lots of time.
Tell that to my parents.
Dana, results are back on your guy.
Give me those.
I-I choked her?
No, I would never do something like that.
But you did.
Can you, uh--sorry, can you excuse me for a minute?
- Jesus Christ, Dana. - Read.
What's he saying, anyway?
He's in a bit of shock.
Claims he doesn't remember anything.
Says he was on the golf course getting boozy,
maybe a little too boozy.
Things get hazy, next thing you know, he's on the floor
and everyone's screaming at him.
How convenient.
Maybe it's better for both of you
that he doesn't remember what happened.
Let me know when you're ready to take my statement.
All right, well, the good news is,
your CT was negative for skull fracture
or intracranial hemorrhage.
You mean that's good news for you and that blonde nurse lady.
But your lab results were positive for alcohol
and cocaine.
Okay, you got me.
I did a couple of birdie bumps on the turn,
but we were just having fun on the golf course.
Look, when alcohol is mixed with cocaine,
your liver produces a metabolite
called cocaethylene.
What does that have to do with me
allegedly doing what you said?
It's a psychoactive molecule
more toxic and potent than cocaine.
And it can lead to confusion, paranoia, aggression,
and even psychosis.
What happens now?
We're gonna monitor you for a few hours,
especially given your likely concussion.
And you'll need to give a statement
to the police outside in the meantime.
Oh, you lucky this was just a poke.
Spared the muscle.
See? It could have been worse.
No shit, Sherman.
The triangular bayonets they created back then
were designed to leave wounds
that are nearly impossible to stitch.
Those bayonets had never met me.
- Oh, wow. - What?
It's all good. We got it covered.
No, are you guys from the Fort Pitt Museum?
- Yeah. You familiar? - Yeah.
I love you guys.
My mom would take me to the fort
every time we'd come down to visit family as a kid.
We've been volunteering there as living historians
- for over 20 years. - I probably saw you then.
Man, I can't wait to tell my parents about this.
Getting stabbed must have been scary.
Yeah, well, Poindexter here stumbled over his boots
and nearly impaled me.
Wouldn't have mattered if you weren't out of formation.
You're in good hands.
This guy could have saved a lot of lives
with his sutures back in 1776.
- I was not out of formation. - You were out of formation.
Hi, again.
Good news, Mrs. Cohen.
Your imaging results show no hip fracture
and no internal bleeding.
But you do have a small hairline fracture
of the superior pubic ramus.
Well, that doesn't sound good.
Well, if you're gonna have a fracture,
it's the best one to have.
Do I need to stay in the hospital?
Not necessarily.
Your recovery should be
pretty straightforward if we can control your pain.
But you need to take it easy and stay off your feet
for six to eight weeks.
How can she go home if she can't walk?
Oh, she can bear weight and walk with some help.
And we'll get you a walker and schedule physical therapy.
- So--so we can go home. - Yes.
Dad, you can't take care of Mom all by yourself.
Oh, we'll manage.
You guys, you need to be realistic.
I don't want strangers hanging around in the house.
It's not strangers. It's helpers.
Mm-mm, no. No, thanks.
- Mm-mm. - Doctors, please.
I am worried about your ability
to get the assistance you need, Mrs. Cohen.
It may be time to think about some of those
alternative living options we mentioned.
I can take care of her.
Dad, are you gonna be able to get her into the bathroom
onto the toilet in the middle of the night?
Are you gonna help her change her clothes in the morning?
- Are you gonna-- - We're--we're fine.
Dad, please just try it.
You don't have to sell the house right away.
Just see if you like it.
- You could move in with us. - No, I can't.
I have work. I have the kids. I can't.
No. No. No.
No. Okay? Just no.
Carrie, could I speak with you outside for a minute?
It's like that every time.
It's tough to find the balance
between respecting your loved ones' needs for agency
and doing what's best for their safety.
I was wondering if you had your parents' medication lists
- with you or on your phone. - Yeah.
I'd like to take a quick look at it, if that's okay.
Yeah.
My man, how you doing?
Like you better roll in
a bar cart and a happy hour buffet
if I'm gonna be stuck in this place much longer.
This place is a traffic jam.
We're trying to merge you in, I promise.
That's no traffic jam.
That's a 20-car pileup.
The sooner you get out, the sooner I get out,
so you know I'm not bullshitting you.
Why are you jonesing so hard to get out
and start your ride tonight?
I've got a schedule.
I've got places to go. I've got people to see.
I just have to get going.
You're worried if you don't leave tonight,
you won't leave at all.
Look, I get it.
I can feel it in the air here. This place is like quicksand.
Right.
Dr. Robby?
Uh, Dante, the fireworks guy-- something's wrong.
Okay, shit.
Um, do not go anywhere. You are next up.
I'm gonna deliver you myself.
I'm starting to feel like a hostage in this place.
How do you think I feel?
- What's going on? - Fucking chest hurts.
Systolic's down to 78.
- Blood loss from scalp lac? - Uh, that's highly unlikely.
- Dr. Santos? - Good breath sounds.
But neck veins are up. Checking the heart now.
Okay, 500-cc bolus, 100% non-rebreather please.
Okay, pericardial effusion, RV collapse--it's tamponade.
Yeah, let's prep for a pericardiocentesis.
What's going on? Is he gonna be okay?
- You said he was fine. - CT scan was normal.
Things change.
Dante, there is a collection of blood around your heart.
- We need to drain it. - Oh, fuck.
Okay, 0.5 per kilo ketamine, please.
Won't that drop his pressure even more?
We don't have a choice.
We cannot do this on a moving target.
Dante, Jesus fucking Christ. It's my baby brother.
- Hey, Perlah? - Sir, I'm so sorry,
but you can't be in here right now.
What's wrong with him? Hey, Dante. Dante.
- Hey, just hear me-- - Okay. I'm so sorry.
You can't be in there right now, okay?
- We have to stabilize. - They said he was fine.
Yeah. Okay. There's been a complication.
I just need you to take a couple deep breaths
- and try to stay calm. - Please. Please.
Okay, just breathe with me. In. Okay, out.
Look at me. Breathe in.
Out.
Very good. In, out.
Okay, stay calm, okay? We got this.
I can't leave you pendejos alone.
- Tamponade with shock. - From what?
Uh, I'm guessing a small tear
in the right atrium from the sternal fracture.
If it was ventricular,
he would have crashed in the field.
I'll call cardiothoracic. See if they have an OR.
Systolic's down to 64.
Okay, have you ever done an apical approach?
- Nope. - No time like the present.
- Go lateral to my probe. - Why not subcostal?
This is a shorter distance. There are fewer structures.
If you can see fluid, there's nothing
between the probe and the pericardial.
There? There. the needle's in the effusion.
- Mm-hmm. Draw back. - Good blood return.
Okay, sometimes it only takes 20 cc's
to let that heart fill again.
- Carotid pulse much stronger. - Thanks. Be right up.
They'll have a room ready in five.
All right, that is 40 cc's out.
Blood pressure's up. 90 systolic.
Okay, now we're gonna place the J wire,
and we're gonna leave the catheter in
with a three-way stopcock.
Still bleeding from the heart.
He can live with a little blood loss
but not with a pressure bag squeezing his heart
so it can't beat.
Good thing we didn't send him home.
Nice save, Robby. You too, Trinity.
- Is that an actual compliment? - Sometimes you guys get lucky.
Got a couple of bad ones.
- How old is he? - 84.
Meclizine for vertigo.
Anticholinergic effects can cause drowsiness.
It's PRN, so maybe he doesn't take it all the time.
He's also been prescribed methocarbamol,
another anticholinergic.
Could definitely impair driving.
And metoclopramide for his stomach.
That could cause gait problems.
Exactly.
- Dr. Robby, may we present? - Yeah, what do you got?
Hey, you should probably get started
crossing your T's and dotting your I's
- for night shift handoff - Right.
Well, vaya con Dios,
or whatever the bikers are saying these days.
Our elderly couple, Frida and Ed...
We're anxious about their ability to recover at home
or to remain at home in general.
But a number of Mr. Cohen's medications
are on the Beers List,
and they may be contributing to his deteriorating health.
- "May be"? - We can't be certain.
But none of them are critical meds.
We could have him stop them right now,
follow up with his PCP,
see how he's doing in a few weeks.
Run it by the family.
Sometimes just affirming a patient's...
independence, autonomy can do a world of good.
Um, hey, Dr. Mohan.
I heard a rumor that you were looking for an elective.
Consider geriatrics.
It's as much of an art as a science.
There's usually an opening, and you seem to have
a predisposition to the pace.
Hey, have you seen Dana?
I think she went out for a smoke,
lucky girl.
You ever gonna tell me what really happened in there?
In where?
You could lose your nursing license.
Let me guess--that vial of Versed in your pocket,
you drew that up for Doug Driscoll
in case he ever came back,
and now you've just been carrying it around ever since.
I did exactly what I needed to,
and now there's a young nurse who gets to go home
in one piece because of me.
McKay can sign the Versed order for me if you won't.
I will sign the order!
I will sign an extra order
so you can have one when I'm gone.
That's hardly the point.
It's not exactly like I'm against nurse safety.
I'm trying to advocate for your caution,
because you're the person who's supposed to be here
keeping this running while I'm gone,
not roaming the halls like a vigilante
with a loaded syringe and a vendetta!
It's always "do as I say,
not as I do" with you, isn't it?
What is wrong with you today?
Samira missed a triple-A. Mel and Ellis had a deposition.
McKay's treating people in the park. Fucking Langdon--
At some point, you and Langdon
- got to work this out. - I don't want him here!
He made a mistake, and he paid for it.
Did he? Did he go to jail?
Because I let him get away with a crime.
- So what does that make me? - Human!
Are you angry at him, or are you angry at you?
- Somebody could have died. - Oh, it's the ED.
- Somebody's always dying. - Go ahead and make jokes.
Make jokes instead of acknowledging that--
- Langdon didn't kill anybody. - That we know of.
And he saved a lot of lives that we do know of.
Our kids disappoint us sometimes.
Langdon is not a kid.
No, but he's your guy,
and you're taking it personally.
Langdon fucked up, and you think
that makes you look bad,
but it's on him.
How am I supposed to leave this place
when it's a shit show?
First you can't stay. Now you can't go.
What is it, Robinavitch?
No, I'm going.
I just thought I could leave it a little better when I did.
Oh, don't be such a martyr.
This place is always teetering on the brink of disaster,
with or without you.
We do it every night, every day off.
This place is bigger than one person.
It survived without Adamson, it survived without me,
and it'll survive without you.
My meds are making me worse?
Not worse, but they may be impacting
your balance and mobility.
Why would his doctors prescribe drugs
that could harm him?
Oh, it's not any one medication.
It's the combination that could be impairing
his daily functioning.
We have a case manager
that will put together a robust plan
that I think will make everyone happy,
while allowing you to stay at home.
There's regular physical therapy,
an at-home nurse that visits a few times a week, and, um...
oh, even personal shoppers to help with groceries.
This sounds expensive.
Actually, Medicare covers most of it,
with some assistance from the Area Agency on Aging.
You know, every old person knows what it is to be young,
but no young person can know what it is to be old.
Thank you for listening.
You guys are still coming with me
to visit a few assisted living places
just in case it's ever time.
Well, maybe.
Hey. You, uh--you doing all right?
Never better. Thanks. Bye.
God, you're really just gonna
keep standing there, aren't you?
Yeah. What's going on?
It was literally my first day of being a doctor,
and Langdon gaslit me
and made me question my skills over and over.
And it's taken me a long time to feel like I belong here,
and now he's back.
And I don't even care that he was an addict.
I care that he was a fucking asshole.
And it's like no one here even remembers any of this.
And everyone here talks about community and family,
all while they throw you under the bus, and I--
Robby is the only attending
who actually sees through the bullshit,
but now he's leaving for some grand ego-death spirit quest,
and Robo-Doc over there shoots me in the proverbial dick.
Well, Garcia's here.
- She likes you, right? - She doesn't like me.
She likes getting laid.
I'm her stress relief squeeze toy--or was.
You know, she and Langdon would make a great couple.
Yeah. That's dark.
I'm sorry.
Yeah? Why do you care?
Well, 'cause we're friends, I thought--I think.
Are we? Because on top of all of that,
you're the one who's being super shady
about moving out on me.
Moving out?
Yeah, I heard you're gonna go squat
at Robby's sad bachelor pad.
Honestly, I thought that was your idea to get me
- to move out of the apartment. - No, no.
I wanted him to give you some fatherly advice
about going all Farmers Only,
not giving you the keys to his fucking house.
Oh, my God.
No, I know it was none of my business.
No, it's not that. It's...
you actually like living with me, don't you?
What are you talking about?
You leave your dirty clothes everywhere.
You eat all of my avocados as soon as they ripen.
You keep pausing the TV to ask the dumbest questions.
No, I'm going back to the avocado thing,
because I've never seen someone consume so many.
It's disgusting--
Just say it, and I won't move out, okay?
I'm not gonna be doing much at Robby's.
I'm gonna be taking in his mail.
I'm gonna be watering his plants.
Say what?
Admit that you like having me as your roommate.
You are such a fuckle-berry. Have fun with Robby's plants.
You have no idea how much joy that just brought me.
Hey.
How much longer until I get these things off and go home?
Oh...
You assaulted a nurse.
Yeah--you said it was the cocaethylene thing
that made me go crazy.
Well, if you're drunk and you kill someone,
you still kill someone.
So after we clear you in a few hours,
you're gonna take a ride with the uniformed officer outside,
who's gonna take you in for processing.
No. No, no, no, this cannot be happening.
No, since you golf and can buy cocaine,
I assume you can post bail after your arraignment.
You're gonna ruin my fucking life!
But it being our nation's big, beautiful birthday,
that hearing may take longer than usual.
So I'd cancel any grand plans you have for the Fourth.
You know, I...
I can leave you with these.
Rehab? Fuck off.
I'm suing this whole hospital and you for personal injury.
Well, good luck convincing a jury of that one.
- Oh, fuck this whole place... - Asshole.
And fuck all of you!
No, not you, Officer. Fuck!
Make sure discharge charts are bundled and placed
in the "to be scanned" bin with nursing notes,
order sheets, lab, and X-ray results.
Day shift needs completed T sheets
on every patient and to write on the board
what tests are pending so nothing falls
through the cracks while we wait to come back online.
Westbridge and Good Dominion
have settled their cyber dispute.
- They paid the ransom? - Yeah.
Our IT department is confident in our defenses,
so they will be rebooting everything soon...
- slowly but surely. - Okay.
So when everything comes back on,
all the residents have to do
is scan all the completed paper charts
and digitize them into the patient's EHRs before they go?
I'm never getting out of this place.
This means you're clear for takeoff.
Nothing here we can't handle with night shift coming in.
Yeah, right. Free to go.
Uh, hey, I told you I would get you up there,
and I promise I'm not leaving until you're back
and sent packing.
Robby, buddy, you got me to come in,
got me to take my tests.
You don't got to babysit me. That's why I have a nurse.
- What's your name, sweetheart? - Nurse Vivi, sir.
That's what I have the lovely Nurse Vivi here for.
This will not take very long.
Where have I heard that before?
Hey.
So, uh, this is it, huh?
Uh, yeah.
Don't let the place burn down.
You know...
in a previous life, I had a lot of friends who liked to see
how close the edge was...
as if it was a challenge they were called to meet.
Trouble is, they all inevitably found it.
Okay.
I'm just picking up
on a weird vibe from you today is all.
Yeah, well, it's been a weird day.
- You leaving? - Uh, yeah.
My shift is over, and I ain't getting paid to be here.
Quite literally the opposite, in fact.
Well, I don't know if you noticed,
but we're sort of, uh, in disaster mode here still.
We put in the extra time if we're needed.
You know 62% of ED docs report suffering from burnout?
- Painfully aware. - Mm.
So maybe all you lunatics need to learn
how to set some boundaries, like me.
Well, see you tomorrow, Doc.
Good luck in there. Sorry about the mess.
"Mess"?
Yup.
- Incoming. - Head trauma.
Unwitnessed fall from the warehouse catwalk
where he works as a security guard.
Oh, my God.
Orlando.
He left five hours ago.