The Pitt 1x11

1. {\an8}Boop-bee-doop. Boop-bee-doop.

2. {\an8}Boop-bee-doop.

3. {\an8}Hey!

4. {\an8}- Not now, Myrna. - Aw.

5. Woman in labor. 10 minutes out.

6. What are you still doing here?

7. I have one hour left on my shift.

8. If I get home before 6:00, Benji will know something's up.

9. Pretty sure the black eye is going to give you away.

10. Well, sadly, it's not the first time

11. I've gone home with a war wound from a patient.

12. Hey, Doc.

13. You got a sandwich?

14. You know what, Earl? I can do you one better.

15. I'm going to order Tagari's pizza.

16. I think we could all use a morale boost around here.

17. No sandwich?

18. You could fold it in half, New York style,

19. - just like a sandwich. - Better not be pineapple--

20. No pineapple, I promise. Not this time, okay?

21. We good?

22. I say this with all the love and respect in my heart.

23. I honestly do.

24. - Get the hell out of here. - You need me.

25. The CT came back normal.

26. Nasal bone just has a hairline fracture.

27. I'm fine. Don't worry about me. I don't like it.

28. You sound like me. That's not a good thing.

29. - Just let me finish my day. - Okay.

30. I'm not going to argue with you.

31. Yeah, all that knowledge and still learning.

32. - It really is impressive. - Yes.

33. Well, can you at least keep a cold pack on it?

34. No promises.

35. I've had so much coffee, I've got to pee again.

36. Walk with me--I also need to fill you in on something.

37. - What? - So Langdon is gone.

38. - Gone? Where? - Home.

39. I will handle his caseload. It won't fall on anybody else.

40. And Dr. Ellis usually comes in early.

41. I get punched in the face, and he goes home early?

42. Nope. It's not like that. Trust me.

43. You do not want to be Langdon right now.

44. And I need a favor.

45. I need you to run a pharmacy audit on Langdon

46. for the last three days.

47. I need a list of all the patients he's treated

48. and all the medications he's prescribed.

49. - Do I want to know why? - No, you do not.

50. You sure you're still good to stay?

51. Yeah. Are you?

52. Honestly, I'm beginning to have my doubts.

53. You ever feel like God's trying to tell you something?

54. We stopped talking a long time ago.

55. {\an8}2-0-2-2-8.

56. {\an8}Yeah. 20 boxes ought to be enough.

57. {\an8}10 cheese, 10 pepperoni.

58. {\an8}God, no. No pineapple. No.

59. Okay. Thank you very much.

60. Can I have a word?

61. With us?

62. With Dr. Santos.

63. Sure.

64. Let me just wrap this up.

65. Okay.

66. {\an8}I told you she was Filipina.

67. So the situation we discussed earlier has been handled.

68. I sent Dr. Langdon home.

69. Well, I wanted to make a big impression on my--

70. - Save it. - Okay.

71. We're now down a senior resident, so it's all hands on deck.

72. - Got it? - Got it.

73. And I trust you have not mentioned this to anybody else.

74. No. No, I don't know anyone.

75. Good.

76. Let's keep it that way.

77. Dr. Garcia?

78. This is Trinity Santos, ED intern, day one.

79. I need to talk to you about something.

80. So at your earliest convenience would be great.

81. Thanks.

82. Oh, and there's pizza coming, if you want to--

83. Yeah.

84. Dr. Robby!

85. Theresa, did you hear from David?

86. No, but he posted this on his Instagram 10 minutes ago.

87. "All I ever wanted was to fit in and be loved,

88. "but they mocked me and forced me into an existence

89. "of loneliness and pain.

90. It didn't need to be this way." Wow.

91. They did this. They did this.

92. I think he's talking about the girls on the list.

93. But the police said it's not enough for a BOLA.

94. BOLO. It means "Be On The Lookout."

95. Yeah, well, police are gone.

96. I heard Langdon left.

97. Theresa, why don't you take a deep breath and go have a seat in the waiting room?

98. I will come and find you.

99. We will finish this conversation, I promise.

100. Yes, Langdon left.

101. I will be covering for him.

102. There are two hours left in this shift.

103. And if you need to go, I will call somebody to come in early.

104. Why would I want to go home?

105. You tell me.

106. Okay.

107. I'm only going to say this once.

108. I had a miscarriage.

109. Oh, Heather, I'm so sorry.

110. I'm fine. And, no, I don't want to go home,

111. and, no, I don't want to talk about it.

112. I was trying on my own with IVF.

113. I...

114. I don't know what to say.

115. I'm ready to get back to work.

116. - Okay. - Okay.

117. Hey, we need a doctor here!

118. Natalie Malone, 35-year-old G3P2,

119. 39-week pregnancy, in active labor after a SROM.

120. I'm fine, really. It's not my first time.

121. All right, let's get her into Trauma Two for a quick check,

122. and then we'll send her up to Labor and Delivery.

123. Got it.

124. - I'm Dr. Heather Collins. - Nice to meet you.

125. Justin should be here any minute. He was right behind me.

126. Any problems with the pregnancy?

127. Well, third time's a charm.

128. Justin's pretty nervous, though. This is his first time.

129. BP's 112 over 72, heart rate 84.

130. Dr. Collins, can I join?

131. Sure.

132. Okay, when did the contractions start?

133. Yesterday.

134. Really?

135. Well, my last two labors were very long,

136. so I decided to wait it out this time.

137. But then my water broke.

138. Natalie, I'm here. Sorry, I got a little lost.

139. - Contraction! - Curtain.

140. Don't push. Just breathe.

141. Check her, Dr. King.

142. Okay, good.

143. I see hair.

144. Baby's hair.

145. Natalie, you're crowning.

146. You were right. I waited too long.

147. I thought I had more time.

148. It's okay. It's okay. Just breathe.

149. All right, we can try and rush you

150. upstairs to OB, but at the rate you're moving,

151. you may end up having this baby in the elevator.

152. So what's my other option?

153. We deliver your baby here.

154. Grab a BOA kit and get a baby warmer in here.

155. Call L and D, and tell them this baby is coming now!

156. We're 20 behind in triage.

157. Mateo, treat 'em and street 'em.

158. See how many you can dispo.

159. I hear we're down a senior resident.

160. - How can I help? - Oh, yeah? What senior?

161. Langdon had to go home early to deal with something.

162. Robby's covering.

163. You can follow Mateo to Chairs.

164. That's where we could really use you.

165. Chairs is about to be my bitch.

166. So, D...

167. is this all about the fight?

168. What fight?

169. Robby and Langdon got into it at the lockers.

170. - Shit was flying. - Literal shit.

171. That's enough from you two. Not another word.

172. {\an8}Keep it up!

173. You'll both be working the holidays!

174. What have we got?

175. 39 weeks, crowning after a SROM.

176. Hi, Mom. I'm the attending.

177. I'm Dr. Robinavitch.

178. I'm Natalie, but I'm not the mom.

179. What's happening?

180. You got here just in time.

181. We're the dads. Natalie's my best friend and surrogate.

182. We both teach fourth grade and even share a classroom.

183. Same room, same womb.

184. We've been urging her to stop saying that.

185. I've got the prenatal bag,

186. and let me pull up the birthing playlist on my phone.

187. It's time.

188. Fuck Beyoncé. Fuck her.

189. I can take this.

190. No.

191. I got it.

192. Go, Dr. Collins.

193. Okay, Natalie.

194. Good chance we'll deliver on the next contraction.

195. Bulb suction is ready.

196. Right. Head is out!

197. Nice. Take a break. Catch your breath before the next one.

198. All right.

199. I'm going to need another big push from you.

200. You got this.

201. Three, two...

202. Who do we have in here?

203. Ivan Pugliesi, 55, has experienced

204. a day of abdominal cramps, vomiting, and diarrhea.

205. Afebrile, tachy at 124, BP 192 over 100.

206. I'm Dr. Mohan.

207. I'm Student Doctor Whitaker.

208. Nice to meet you guys.

209. I would have called my own doctor, but I'm from New York.

210. You two kids ever been out there?

211. Oh, I've never been to New York.

212. Coming to Pittsburgh was my first time leaving Nebraska.

213. - How long are you in town? - Just till Monday.

214. My daughter's getting married. She's my baby and the only girl.

215. - Congratulations. - Yeah, thanks.

216. You know, they say you're not supposed to have a favorite kid, but--

217. I'm an only child, so I was born the favorite.

218. Whitaker?

219. Oh, youngest of four.

220. I'm just happy when my parents remember my name.

221. No, I meant, do you have any questions for the patient?

222. Hey, can I just get something for the pain, you think?

223. As soon as we're done with this assessment.

224. We just want to do our due diligence.

225. Any intestinal disease in your past?

226. Ulcers, gallstones?

227. General stomach ailments? Surgeries?

228. No. No, nothing.

229. Good bowel sounds.

230. Thank you.

231. Abdomen's soft.

232. Nothing focal.

233. Anything else bothering you?

234. You know, my back is killing me.

235. Four-hour car ride will do it.

236. I mean, the last time I tweaked it,

237. I think they gave me...

238. they gave me morphine, and that worked pretty good.

239. - Do you smoke? - No.

240. - Drink alcohol? - Once, twice a month.

241. I'm not a big drinker.

242. Any recreational drugs, either pills or by injection?

243. Tranquilizers, hallucinogens, painkillers?

244. All of the above.

245. Yeah. I'm kidding.

246. No, no drugs, never.

247. And what do you spend your time doing?

248. I'm an actuary. It's risk management, stats.

249. It's pretty much a desk job.

250. I pulled Zofran for the nausea.

251. Start with 4, repeat PRN.

252. What, and that's it?

253. For now, we're going to start with some blood tests.

254. We'll be back soon and check in on you.

255. All right. Fine.

256. What do you think we should be looking at?

257. A big differential of pretty serious stuff to rule out.

258. So what's your plan?

259. Besides Zofran, CBC, CMP,

260. IV fluids, morphine, maybe CT.

261. Good on labs and IV fluids, but no morphine.

262. Treat his symptoms with Clonidine and muscle relaxants.

263. What if he's--

264. Look, I really can't lose another patient today.

265. Remember how I said you get good at spotting the fakers?

266. Yeah.

267. He's exhibiting every sign of opiate withdrawal.

268. Eyes dilated, tearing,

269. skin has piloerection and goosebumps.

270. Hypertension, tachycardia.

271. Agitation, restlessness, perspiration.

272. He's checking every box.

273. Right, but he said he doesn't take drugs and seldom drinks alcohol, so...

274. That's exactly what he would want you to believe

275. if he was drug-seeking.

276. Wow. You're good.

277. Thanks.

278. I am.

279. So how do we treat him?

280. By getting him to admit his opiate usage.

281. - Right. How do we do that? - By being smarter than the patient.

282. Got it.

283. Another big one.

284. You said that the last two times.

285. Shoulder dystocia.

286. The head's pulling back.

287. That's called the turtle sign.

288. Hey, Donahue, can you call an L and D nurse

289. and ask her to bring down a fetal monitor, please?

290. What's going on?

291. Baby's shoulder might be a little stuck on your pelvic bone.

292. It's nothing for you to worry about.

293. We'll just try something different on the next push.

294. Ready?

295. Why don't we all take a deep breath, huh?

296. Everybody.

297. One more time. Dads too. And in.

298. If you want him for Halloween, just say it.

299. I want him for Halloween and everything until then.

300. - Give me Thanksgiving. - Fine.

301. You can celebrate bringing smallpox to wipe out the Native Americans.

302. You know, I'm the one who's hurt.

303. A little sympathy wouldn't kill you.

304. You broke your ankle doing something stupid with our son.

305. I need surgery.

306. He wasn't wearing a helmet, Chad.

307. What if he had fallen and hit his head?

308. - He didn't. - No, but he could have.

309. Do you know what it's like to watch a child die?

310. Oh, here we go.

311. You know how many kids come in here

312. who are messed up because of one stupid parental mistake?

313. You know I would never let anything happen to our son.

314. Then act like it.

315. Be a grown-up.

316. You're his father, not his friend.

317. Yeah, and you're his mother, not my wife.

318. - Do you think-- - Chad!

319. - Oh, my God! - Hey, babe.

320. Where's Harrison?

321. Staff lounge.

322. - Is he okay? - He's fine.

323. I'm going to go check on Harrison.

324. I'm pretty sure being in the same room

325. with her violates the restraining order, so...

326. I'll go.

327. I can take him home.

328. Actually, Chloe, since it'll be hard for me to get around after my surgery,

329. Harrison is going to stay with Cassie for a little while.

330. - Right. - No.

331. I'm here.

332. I can help take care of him while you're recovering.

333. - Absolutely not. - Babe, I don't mind.

334. I do.

335. Yeah, sure, if you don't mind-- just till I'm back on my feet.

336. - Wait. Hold on! - Dr. McKay, sorry to interrupt!

337. We're moving Central 6 to Trauma One. We need you.

338. We are not done here.

339. ICU boarder, 48-year-old cirrhotic,

340. here for hematemesis.

341. Intubated overnight and after one unit pBRCs and FFP

342. - was supposedly stable. - Not anymore. Weak carotid.

343. Javadi? I need you on suction.

344. Why is she bleeding all of a sudden?

345. Most likely, bleeding is from the esophageal varices.

346. With cirrhosis, you get enlarged veins under pressure

347. at the entry of the stomach.

348. Varicose veins, and they can burst.

349. What does that mean?

350. The cirrhosis from hepatitis B caused a vein to burst

351. where the esophagus meets the stomach, and that's where the blood is coming from.

352. In through the nose...

353. Mel, I'll have you help with the McRoberts maneuver.

354. - Of course. - Hey, Natalie...

355. we're going to lift your knees up to your chest now.

356. Doing great.

357. Justin, is this the worst you've ever seen me?

358. This is the most I've ever seen of you.

359. You're beautiful.

360. All right, a little suprapubic pressure here.

361. We got you.

362. You're going to feel me pressing on your bladder.

363. Two minutes since head delivery.

364. Fetal heart rate looks good-- normal variability.

365. You're doing great, Nat.

366. Feel free to step in and take over.

367. - Another one's coming! - Give me a big push!

368. Okay, Natalie. Here we go. You got this.

369. - You're almost there. - Keep going.

370. - We love you. - Go, Team Natalie.

371. Late decel.

372. Okay, can you call Dr. Ingram and tell him to come down here, please, from the NICU?

373. What's happening?

374. The baby's heart rate has slowed, which could be a sign of distress.

375. - So what do we do? - We deliver this baby.

376. We got this.

377. Eusebio, can you page the OR

378. and tell them to prep for a possible crash C-section?

379. BP's only 82 over 46.

380. Hey, Mom, you're going to be okay.

381. Rapid infuser, massive transfusion protocol,

382. octreotide bolus and drip,

383. 80 pantoprazole and ceftriaxone.

384. Perlah, get Robby in here.

385. Hey, Peggy. Where's Robby?

386. Thank you.

387. Robby, MTP from bleeding varices in Trauma One.

388. A little burning from the local.

389. Oh, fuck! That hurts.

390. If I can get my hand inside, under the baby's head,

391. I can release that lower arm.

392. Three minutes since head delivery.

393. - Dr. Robby. - Yeah.

394. My hands are a little tied up at the moment.

395. I'll need the Minnesota box. Who's in there?

396. - Dr. McKay. - Tell her to go ahead and get set up.

397. She knows what to do. I'll be there as soon as I can.

398. - Yeah. - I'm Dr. Myers with Obstetrics.

399. - Nice to meet you. - And who's the father?

400. We are.

401. - And who's the mother? - We are.

402. Roger that.

403. OR is prepped and ready. Do we need to go up?

404. Not if I can rotate this posterior shoulder.

405. - All right, there's the elbow. - Make sure it's flexed.

406. It's flexed. Good call.

407. We're getting closer. Just stay with me, okay?

408. - I'm trying. - Okay.

409. I've got control of the hand and forearm.

410. That hurts!

411. Rotating posterior shoulder up and out!

412. Fuck!

413. - Perfect. - You're right there.

414. Give me one good push.

415. Yeah, yeah, yeah, yeah.

416. Good! Hey!

417. We got a baby boy!

418. I've got a stubborn set of twins upstairs. Admit her to postpartum.

419. Congratulations, everyone.

420. Good job.

421. - He's pretty quiet. - Sometimes it takes them a minute.

422. Put the baby on a pulse ox and a heart monitor.

423. Hey, Amy, swap out with me.

424. Mel, dry and stimulate vigorously.

425. - On it. - Very vigorously.

426. Shouldn't he be crying by now?

427. - Heart rate is 95. - Too slow.

428. Dr. Collins, BVM.

429. Tiny volumes, once per second.

430. - This kid needs oxygen. - Come on, baby.

431. Come on, let's breathe.

432. - Suction ready? - Ready. Dr. Ingram?

433. I'm opening the intubation tray.

434. - Yep. - One minute apgar is three.

435. Isn't apgar supposed to be nine or ten?

436. - What does that mean? - Come on, baby.

437. Breath, baby, breathe.

438. - There we go! - We got him back.

439. That's good, right?

440. That is very good, very good.

441. - Okay, you got this? - Yeah, go.

442. Looking much better.

443. Hemorrhagic shock from varices.

444. Failed medical therapy.

445. Suction stopped working.

446. Because your canister is full.

447. - I'm on it. - Oh, my God.

448. - Someone please take her out. - Mom!

449. Thank you very much.

450. By the way, that is not how you raise patient-satisfaction scores.

451. Okay, Dr. McKay, do you want to explain to Javadi here

452. - all about the Minnesota? - Yeah.

453. So best way to stop the bleeding is direct pressure.

454. First balloon goes in the stomach as an anchor.

455. Second runs the length of the esophagus for direct pressure on the varices.

456. First, we want to inflate the balloon under water like a bicycle inner tube

457. - to check for any air leaks. - Yeah.

458. - Javadi, stopcock in the ports. - Use that 50-cc syringe.

459. - Suction's good and running. - I got it.

460. What did you give me?

461. Because I feel worse.

462. I told you that I got better last time with morphine.

463. I have a morphine-like drug called BUPE.

464. Works the same way and faster, goes right under your tongue.

465. If this doesn't work, we'll switch to morphine.

466. But let's try this first, okay?

467. I just want the pain to stop.

468. Open up.

469. Lift your tongue.

470. Leave it there and let it dissolve.

471. We'll be back in ten minutes.

472. Just so I'm clear, our plan is lying to patients?

473. I didn't lie.

474. BUPE is a morphine-like drug, binds to the same receptor.

475. He said he isn't an addict,

476. so why give him an opiate agonist to treat his withdrawal symptoms?

477. Because I don't believe him. And I know this will work.

478. Then once he feels better,

479. we can get him to admit to his addiction and treat him long-term.

480. If you say so.

481. First do no harm.

482. Then do what's best for the patient.

483. Here you go, hon.

484. Langdon called the main line.

485. - You got to be kidding me. - Princess answered.

486. Told him you were busy. Just wanted you to know.

487. Okay, noted. Thank you.

488. - Can you see anything? - I don't have to.

489. You just have to push the tongue out of the way

490. in order to pass the tube.

491. Okay.

492. Here we go.

493. Heart rate's 124. BP's still only 84 over 42.

494. Bleeding is still brisk.

495. Get another unit on that infuser, please.

496. - How far did you go? - 50 centimeters.

497. Dr. Robby?

498. Did you say 50 centimeters? Yes, that's plenty.

499. Inflate the gastric balloon.

500. Start with 50, and then we'll check the placement

501. in the stomach with an X-ray.

502. Apgar is now ten.

503. Go on.

504. - Yeah? - Yeah.

505. Okay, little one.

506. Okay.

507. All right, support his head right away.

508. - All right, come here. - Right there.

509. There you go.

510. You're a natural.

511. Whenever you're ready.

512. We're gonna take him now.

513. Okay.

514. Already miss your dad.

515. - I'll be up soon. - Okay.

516. Can I put my legs down now?

517. As soon as your placenta's out.

518. Breathe. Good, good.

519. Here it comes.

520. Oh, wow.

521. - What? - That is a lot of blood.

522. Starting a second line. Spike a liter of saline.

523. - On it. - What's going on?

524. This happens sometimes.

525. We have to help the uterus clamp back down.

526. Starting uterine massage. 40 of oxytocin in the back.

527. 800 mikes of sublingual misoprostol and 1,000 of TXA.

528. 2 units from the blood bank, just in case.

529. Call OB and get Robby!

530. - Why is Dana still here? - She refuses to leave.

531. That's perfect placement.

532. She wants to finish her shift.

533. Of course she does.

534. I've never met a charge nurse who wasn't a stubborn bitch.

535. McKay.

536. In an adorable way, of course.

537. I honestly don't know what we'd do without her.

538. The mouth is filling up again. It's like a fountain.

539. Dr. Robby, we need you in Trauma Two.

540. Yeah, okay, I'll be right there.

541. She's still bleeding higher up in the esophagus.

542. Natalie. Keep your eyes open.

543. We got it.

544. - Perlah? - Yeah.

545. She's not bleeding in her stomach.

546. We have to inflate the second balloon up in the esophagus.

547. - Dr. Robby, we need you! - Yes! Fuck!

548. I'm coming, I'm coming. Fucking Langdon.

549. This port is in the esophagus.

550. With a ton of blood.

551. Mystery solved.

552. Pump up the esophageal balloon to 30 millimeters mercury.

553. That's an insufflator and a manometer?

554. Yep, just like a fancy bike pump.

555. We are at 30, and shut the stopcock.

556. Barely any blood coming from the esophageal port.

557. The balloon stopped the bleeding. Tomorrow GI can cauterize the veins.

558. That was awesome.

559. I learned from the best.

560. - Is she going to be okay? - We are doing everything that we can.

561. Massive PPH on MTP and all uterotonics.

562. Any rupture? Any inversion? Any retained products?

563. Checked for all. None present.

564. - This is all my fault. - Second unit's going up.

565. Still tachy at 130. Systolic's only 84.

566. Let's try carboprost, 0.25 milligrams IM.

567. And get a Bakri balloon from Central.

568. You could talk to her. Get in there.

569. Tell her some of your favorite memories with her. That'll help.

570. - Thanks for coming down. - You said there was pizza.

571. Do you remember that thing I was worried about?

572. My foot is fine, but I'll let you make it up to me with a cocktail.

573. - No, about Langdon. - What about him?

574. Unfortunately, I was right, and he's been dismissed.

575. - What do you mean "dismissed"? - Dr. Robby sent him home.

576. Why?

577. You know, it's probably best if we don't talk about it anymore.

578. But if you could just keep a lid

579. on what I mentioned earlier, that would be really great.

580. You called me down to talk about it, but you don't want to talk about it?

581. - What is going on? - He's been stealing meds.

582. Stop. I don't want to talk about this.

583. - You just said-- - I said stop.

584. I don't want any part of this.

585. You're trouble.

586. Fuck.

587. - Bakri's here. Need a fresh saline bag. - On it.

588. Third and fourth units are coming up.

589. - FFP is also infusing. - Keep going.

590. Keep talking to her. More memories. It'll help.

591. There was the time that we got that glass table

592. off of Craigslist, and we went to go pick it up,

593. and they mugged us, and they stole it back from us?

594. - Estimated blood loss? - About two liters, maybe three.

595. What's she had?

596. Oxytocin drip, TXA, carboprost,

597. massive transfusion protocol.

598. - Spike the saline. - Balloon is past the cervix.

599. - How much should we put in? - Up to 500.

600. If that doesn't work, she'll need a hysterectomy.

601. - "Hysterectomy"? - This is going to work.

602. Come on, keep talking. More memories.

603. It's good for her, and it's good for all of us.

604. And the time we binged "Game of Thrones"

605. two months before the finale because of FOMO.

606. Natalie! Hey, Natalie!

607. Natalie! Stay with us!

608. How are you feeling, Mr. Pugliesi?

609. Oh, I'm feeling a lot better. Nausea's gone.

610. What about your stomachaches? Muscle cramps?

611. I mean, I'd say I'm 75% better.

612. Blood pressure and heart rate are back to normal.

613. Incredible.

614. You sound surprised.

615. Oh, no, I'm just relieved for you, so...

616. Good news is you can have another dose.

617. That should get you back to 100%.

618. Tongue up.

619. I think we did it.

620. No more blood loss.

621. Thanks for your help.

622. I'll tell OR to stand down.

623. Nice save, Dr. Robinavitch, Dr. Collins.

624. Pulse ox 99.

625. BP 102 over 68.

626. She doesn't need the mask.

627. Thank you for being my best friend in the whole world.

628. We're family.

629. How long does this thing need to stay in me?

630. 12 to 24 hours. We'll take it out tomorrow.

631. We're going to admit you to the ICU for overnight monitoring.

632. Thanks, Dr. Robby.

633. Thank you, Dr. Collins.

634. Excuse me.

635. BP's 98 over 70.

636. Heart rate's 104.

637. So what happens next?

638. Once she's stabilized, the GI specialist

639. can do an endoscopy to try to cauterize the bleeders.

640. Or they might put in a shunt to take pressure off the bleeding veins.

641. And she'll go to the top of the transplant list for a new liver.

642. "The top of the list"? It's that serious?

643. It is, yeah, but...

644. Once she gets her new liver,

645. she should be able to return to normal life.

646. Okay.

647. I guess I always knew that this day would come, but...

648. somewhere in the back of my mind, I hoped that maybe it wouldn't.

649. It's a lot for someone your age to handle.

650. Is there anybody we can call or...

651. Oh, no.

652. No, it's just us.

653. It's been that way for a long time.

654. I'm sorry. That's really hard.

655. Yeah, it's good she has you.

656. Yeah, I'm the same age that she was when she first got hep B.

657. I know it's hard to believe when you look at her,

658. but she was a wild child

659. and an intravenous drug user.

660. But she got clean the day that she found out

661. she was pregnant with me, and she has been ever since.

662. She sounds like a good mom.

663. She's the best.

664. Are you close with your mom?

665. Sure, yeah.

666. Like, proximity-wise?

667. It's just not the first word that comes to mind.

668. It's complicated.

669. - Usually is, right? - Yeah.

670. I mean, my mom hasn't been perfect.

671. I mean, sometimes I really hated her.

672. But I always loved her,

673. and I knew that she loved me.

674. Yeah, it's a long road ahead.

675. But it's a marathon, not a sprint.

676. All you can do is take it day by day.

677. We have a great social worker here, Kiara Alfaro,

678. if you want to talk to her.

679. Maybe a little bit later.

680. I think I just want to be with my mom right now.

681. Yeah. Of course.

682. Yeah.

683. I know.

684. Dude, you got to stop calling me, okay?

685. Yeah, okay.

686. I'll tell him. I'll...

687. Whenever I see him next.

688. Okay.

689. Guess who that was.

690. God.

691. No. I told you. He never calls.

692. Well, Langdon's desperate to get ahold of you.

693. You don't say.

694. God damn it.

695. Hey, Jake.

696. Hey, man. How's it going?

697. Everything okay with the passes and the tickets?

698. Yeah, yeah, it's all good.

699. Want to say hi?

700. Hey, Jake. Long time no see.

701. How's the festival?

702. It's really cool.

703. I mean, there's tons of people, and there's a lot of cool stuff going on.

704. Good. I'm glad you're having a good time.

705. How's your friend?

706. Oh, she actually wanted to thank you personally.

707. Hi, Dr. Robinavitch!

708. Just Robby.

709. Robby, I'm Leah, Jake's friend.

710. - Girlfriend. - Stop!

711. You said you weren't going to embarrass me.

712. I know you were supposed to be here with Jake,

713. so thank you so much for letting me use your tickets.

714. - We're having a blast. - You're more than welcome.

715. All right, well, we got to get out of here,

716. but thanks again for the tickets, man.

717. Thank you! Nice meeting you!

718. You too.

719. Can I get you anything?

720. No.

721. I didn't even know that you were trying.

722. I really didn't tell anyone.

723. It's not like it's the first time, but...

724. It's probably the last.

725. Why do you say that?

726. Do you know how much IVF costs?

727. I should have gone into reproduction endocrinology.

728. Oh, those fertility doctors are making a killing.

729. Even if my insurance would pay for more rounds

730. or I could pay out of pocket, I...

731. I'm...

732. I'm not sure I could go through this again.

733. Maybe it's just not meant to be.

734. I've never known you to give up on anything.

735. Except maybe me.

736. Unbelievable.

737. I had it coming.

738. Do you want me to go find Kiara? Do you want--

739. No. No, look, I know you mean well, but I just...

740. I just want to be left alone.

741. Go home.

742. You sure?

743. Absolutely.

744. There's only an hour left in the shift.

745. It's not like we're going to get ahead of it.

746. We never do. Maybe we never can.

747. So, yeah, go home.

748. Turn off your phone. Turn off the TV.

749. Pour a glass of wine. Have a bath.

750. Go to bed.

751. And if you need anything...

752. Thank you.

753. I got...

754. I got pregnant a few years ago.

755. I wasn't ready to be a mom then.

756. I wasn't even sure about the relationship.

757. I never told him.

758. I was afraid.

759. I was afraid of...

760. All of it.

761. But, mostly, I was afraid he'd hate me

762. for being selfish.

763. {\an8}Not selfish.

764. {\an8}Heather...

765. {\an8}not selfish.

766. Do you think he'd forgive me if he knew?

767. Yes.

768. And, more importantly,

769. I know he would want you to forgive yourself.

770. The mom had nine babies on her back.

771. That's a big family.

772. Opossums are marsupials, so they have a pouch like a kangaroo.

773. - You're smart. - Thanks.

774. I read a lot when I was your age, too.

775. Hey, Victoria, do you want to show Harrison

776. - how an ultrasound works? - Sure, yeah.

777. You want to see inside your guts?

778. - Always. - Okay.

779. Bye, Mom.

780. See you in a sec.

781. This definitely violates the restraining order.

782. I tried to warn you.

783. Chad was severely injured.

784. I wish.

785. Look, whatever's going on between you and Chad,

786. it's not really my business, okay?

787. He's yours. Believe me.

788. But mind your place with my son.

789. Harrison loves living with us.

790. An 11-year-old needs stability.

791. I've been Harrison's mother for 11 years, okay?

792. I made him.

793. And I've made a lot of mistakes in my life,

794. but I am a damn good mom.

795. Look, Cassie, it's really about what's best for Harrison.

796. Chloe, Harrison wants to live with me.

797. I don't believe that.

798. That's because at your age, your prefrontal cortex

799. hasn't really even fully formed.

800. I'll be 25 next month.

801. Congratulations. You can rent a car.

802. If you really care what's best for Harrison,

803. - you will back the fuck off. - But--

804. And if I ever, so help me God,

805. see you in that shirt again...

806. Let's just say you will have wished you hadn't, okay?

807. And he still hasn't admitted to any opiate use?

808. No, but, again, he exhibited every symptom,

809. and now he's 100% better.

810. And it feels like it was just a few hours ago

811. I was asking you why didn't you consult me first

812. and specifically telling you never to do that again.

813. But instead, you went behind my back and--

814. - I did it again. - You did it again, for fuck's sake.

815. Is anybody honest about anything anymore?

816. Or are we all just bullshitting our way through life?

817. - It's just a case of-- - That was rhetorical.

818. - Why didn't you come and find me? - You were a little busy.

819. Really?

820. Do better, Dr. Mohan.

821. Yes, sir.

822. Using BUPE was unconventional,

823. and while it wasn't dangerous, it could be subject for scrutiny,

824. which I really don't need any more of right now from Gloria.

825. I expect a level of this from medical students.

826. I expect more from an R3.

827. You know what? Just give 'em to Cindy, have her hold 'em,

828. and then you don't got to think about it.

829. Because I'm your father, that's why.

830. Listen, the doctors are back. I got to go.

831. I'll talk to you later.

832. Yes, I love you.

833. Bye.

834. - How you feeling, Mr. Pugliesi? - Oh, so much better. Thank you.

835. You guys think that I could have a little bit more of that medicine,

836. just for the few days that I'm out here?

837. I just want to be able to walk my daughter down the aisle without shitting myself.

838. The medication we gave you wasn't morphine.

839. It was something called buprenorphine, or BUPE.

840. Yeah, no, she said that.

841. I mean, whatever you call it, Doc, it worked great.

842. It's a medicine specifically targeted to treat opioid withdrawal.

843. That's why it worked.

844. Wait, I don't understand.

845. All indicators are that you have been using opioids.

846. That would include pain medication like hydrocodone, oxycodone.

847. I told them I don't do drugs.

848. Wow.

849. - You lied to me. - I didn't lie.

850. I said I was giving you a morphine-like drug

851. that got rid of your cravings.

852. Well, you know what? This is bullshit.

853. I mean, you know, I could sue all of you. You hear me?

854. I'm not some junkie on the street.

855. Look, look, I got a family. I got a job. I make good money.

856. You know, I return my shopping carts. I pay my taxes.

857. That sound like a drug addict to you?

858. Yes, because anybody can be an addict. You are proof of that.

859. These pills that you were taking, they're not helping you with your pain.

860. They are keeping you stuck in it.

861. A lot of really good people struggle with addiction.

862. It is a brain disease.

863. But social environment and personal choice

864. - are also factors. - I don't have a problem.

865. The good news is that the brain is highly dynamic, as is the environment.

866. But you need to stop now before the damage is irreparable.

867. No, screw this hospital, okay?

868. - And screw you. - Hey.

869. Doctor Mohan-- Doctor Mohan will advise you

870. on our proposed action plan.

871. You can either choose to follow it or not. That is entirely up to you.

872. I wish you luck, Mr. Pugliesi.

873. We're giving you a seven-day supply of a drug called Suboxone.

874. - We can set you up with a medic-- - Fuck off. I'm not interested.

875. My father passed away when I was young.

876. I don't know if I'll ever get married,

877. but if I do, it'll be without him walking me down the aisle.

878. I'm glad your daughter has you there on her wedding day.

879. I hope she gets to have you there for all of her other big days to come, too.

880. Dr. Mohan.

881. I don't always know the exact right thing to say,

882. but I am sorry about your dad.

883. It was a long time ago, but thank you.

884. Dr. Robby.

885. I've been waiting in the lobby for almost an hour.

886. - You said you'd be right there. - Theresa, oh, I am so sorry.

887. We are a little understaffed, and, truthfully, my head has been

888. in a million different places-- can you forgive me?

889. I'm here now. Please. What's going on?

890. The psychologist spoke to me about becoming a petitioner

891. to place David on a involuntary psychiatric hold.

892. - Yes. - But can that be anonymous?

893. No.

894. To call a 302 in the state of Pennsylvania,

895. the petitioner needs to admit to having witnessed

896. the concerning behavior,

897. and you need a physician and a social worker to sign off,

898. which both Kiara and I can do.

899. What if I'm wrong?

900. Then you apologize.

901. And we will help you explain

902. that this came from concern for his safety.

903. What if you're right?

904. But if I become a petitioner, what am I doing to my son?

905. You are trying to get him the help

906. that it sounds like he needs.

907. David lost his father. That would affect anyone.

908. But we are failing young men,

909. because we don't teach them how to express their emotions.

910. We just tell them to man up, and then we let them

911. get their lessons in manhood from toxic podcasts.

912. And these young men then feel isolated from themselves and society,

913. and they find community and comfort in all the wrong places.

914. David needs help.

915. We don't want to fail him, too.

916. You have kids?

917. I sort of have a stepson, yeah.

918. His mom and I dated for a while, but Jake and I have a great relationship.

919. - Jake's lucky. - Oh, I think I'm the lucky one there.

920. I'm going to check in with the psychologist

921. and tell her I want to become a petitioner.

922. Great, and then come find me,

923. and I will sign off on that paperwork.

924. Knock, knock.

925. To what do I owe this pleasure?

926. I found these.

927. You must have dropped them. Got to be more careful.

928. You don't want these ending up in the wrong hands.

929. You can keep 'em.

930. You ever think about quitting?

931. I'm not a quitter.

932. Oh, I know you're a happy drunk today.

933. But one day, when your liver fails--

934. and believe me, it will fail--

935. you won't be so happy.

936. It's not a nice way to go.

937. I'm digging my own grave.

938. Let me.

939. I don't have to give you the shovel.

940. Have you seen Dr. Langdon?

941. He left for the day.

942. He didn't say goodbye. That's...

943. I really wanted to tell him about this delivery.

944. It was really cool.

945. I mean, the dads were so happy, and...

946. Great stuff.

947. Dr. Robby?

948. I just wanted to apologize for what happened with Langdon.

949. Apology accepted.

950. If I hadn't said anything, he would still be--

951. Nobody's fault but Langdon's. Now, if you'll excuse me--

952. Well, it doesn't feel that way.

953. Some people might have turned a blind eye, but you didn't.

954. It took a strong moral compass to do what you did--

955. on your first day, nonetheless.

956. I just wonder if--

957. You did the right thing, Dr. Santos.

958. Thanks, Dr. Robinavitch.

959. Have you seen Dana?

960. Yeah, she was headed to the ambulance bay.

961. Keep your distance. I'm already in a bad mood.

962. - I'm just getting some air. - Yeah, right.

963. You're a terrible liar.

964. Hope you're better at security.

965. Hey, now you're just being mean.

966. You realize that this is the second person to accuse you of that today.

967. - You starting to see a pattern? - No.

968. But I am starting to see why Gloria's unhappy

969. with your patient-satisfaction scores.

970. You need something, or you just here to ruin one of the few things

971. that still brings me a little joy in life?

972. I sent Collins home.

973. You don't want to work with anybody today.

974. You must be in a mood.

975. She's had a rough day.

976. It's going around.

977. You should leave, too.

978. Yeah.

979. You're good.

980. You're not that good.

981. You know I was born at this hospital?

982. I even volunteered here in high school.

983. I've been punched, kicked, spit at, pissed on, had feces thrown at me.

984. I talked to Gloria.

985. I told her, listen, we got to do something to beef up security.

986. - This can't happen again. - It will.

987. It will.

988. Maybe not to me, but to somebody.

989. World's changed. People are angry.

990. Our tempers are shorter.

991. And we're still just trying to help.

992. You do help.

993. You do make a difference.

994. One asshole doesn't get to change that.

995. I think I'm done.

996. Yeah.

997. I know that one.

998. And I don't blame you.

999. I...

1000. I don't know. I don't know.

1001. Maybe what I want and what the patients need isn't what's best for you anymore.

1002. Yeah.

1003. I just honestly don't know what I'm going to do without you.

1004. You'll figure it out.

1005. You always do.

1006. You're a good man, Robinavitch.

1007. Don't let this place take that from you.

1008. Okay?

1009. God.

1010. Yeah?

1011. Code triage.

1012. Multiple GSWs.

1013. There's an active shooter at Pittfest.

1014. Jake and his girlfriend are there.