The Pitt 1x14

1. Prep to intubate.

2. Ketamine and Roc on board.

3. Chest tube is in. Hook me up.

4. Yellow zone, we are running out of everything.

5. Only change bandages that are completely bled through.

6. Yo.

7. Overheard a nurse say the shooter's here.

8. Holy shit.

9. Oh, my God.

10. Sorry.

11. He's handcuffed, but he's in a room.

12. He gets a room while the rest of us

13. are stacked up like firewood.

14. Sorry to interrupt.

15. Anything you could tell us about the shooter?

16. Is he here? - Where'd you hear that?

17. Nurses be talking.

18. I don't know anything about that.

19. Yeah, let's keep the rumor mill in check.

20. The cops will alert us when they know something.

21. Uh, Dawn, how are you doing? Do you need anything?

22. I'm better. Kind of hungry, though.

23. Well, we can discontinue your IV,

24. give you a sandwich so your sugar doesn't tank,

25. and then you can go home. - Thanks.

26. But my phone died at PittFest, so I wasn't getting

27. any alerts from my glucose monitor.

28. What about me?

29. Can I go home?

30. Since you OD'd, we need to keep you here

31. for a couple more hours, make sure

32. you don't need any more Narcan.

33. How's your pain doing, Buster?

34. I mean, my arm still hurts pretty bad.

35. Hey, can I get a sandwich, too?

36. Uh, we can up your pain meds,

37. but you're on the list for the OR,

38. so we need to keep you NPO.

39. Meaning?

40. Nothing more to eat.

41. We'll keep you hydrated with IV fluids.

42. Can I at least get a blanket? It's so cold in here.

43. Yeah, uh—

44. All the blankets are in Pedes—

45. the morgue.

46. Rock Paper Scissors?

47. Shit.

48. Dawn, I can charge your phone for you.

49. Thank you.

50. Fucking circus.

51. - Robby here? - No. Check trauma rooms.

52. 500 cc's from the chest tube already.

53. We're out of O-neg again.

54. Hang the cell saver for autotransfusion.

55. - This is weird. - What?

56. Shot in the chest, but nothing

57. out of the thoracostomy tube.

58. You got through the pleura okay?

59. Yeah, I definitely felt the lung with my finger.

60. I lost the radial pulse. I got a femoral.

61. This guy's bleeding out.

62. Probably tore through the spleen.

63. How?

64. Okay, nipples to navel is no man's land.

65. If he got shot while exhaling, the bullet possibly

66. passed below the diaphragm.

67. Start a second IO, transfuse two units O-positive.

68. Where's Robby?

69. Let's find him and call Walsh.

70. This guy needs the next OR immediately.

71. - Dana! - Yeah?

72. Have you seen Robby?

73. I was about to ask you the same thing.

74. McKay! - Yeah?

75. You seen Robby?

76. Uh, no, not in Pink.

77. I was at the festival

78. with my husband and my daughter.

79. My husband is in a wheelchair from MS.

80. I did my best to protect him.

81. A bullet went through my arm and through his head.

82. The medics declared him dead.

83. What about your daughter?

84. What's her name?

85. Morgan.

86. Some family members are meeting in the cafeteria.

87. I can see if she's there.

88. How do you deal with all this death and carnage?

89. I don't—

90. I don't know.

91. Any more Pleur-evacs in Pink?

92. - Maybe. - What do you need?

93. - A couple units of blood. - Good luck.

94. Princess.

95. Whoa. Jeez.

96. Sh'ma Yisra'eil...

97. Dr. Robby?

98. - Adonai. - Dr. Robby, you okay?

99. Eloheinu.

100. Adonai echad.

101. Barukh sheim

102. k'vod malhkuto.

103. You have to go. You have to go.

104. They need you out there.

105. We need you out there.

106. Okay, come on, give me your hand.

107. I can't.

108. You have to...

109. Because if you don't, we're fucked.

110. Okay.

111. See you out there, Captain.

112. Once your phone is charged and able to monitor

113. your blood sugar, we'll let you go.

114. Thank you.

115. Any update on the guy who did this?

116. Nothing yet.

117. I'm kind of glad I was out of it when the shit went down.

118. You OD'd. You could have died.

119. You okay, Huckleberry? - Yeah.

120. You sure?

121. I know it's tough in there with all the bodies.

122. - Yeah. - Can I get help

123. with a pressure dressing here? - Yeah, I'm on it.

124. 2 grams of Ancef primed for your leg guy.

125. With pleasure.

126. You okay, Dr. Robby?

127. Do you need something to eat or drink?

128. No, no. I'm good. Thank you. Thank you.

129. Uh, Esme, your team's doing a great job

130. staying on top of all this.

131. Um, I need another four of morphine here.

132. Yeah, coming right up.

133. Uh, yeah, that's two.

134. Tourniquet's down on MCI-9, looks dry.

135. Good job, Whitaker, Donahue.

136. Dr. King, keep it up.

137. All right, maintenance fluids at 125 an hour for all NPOs.

138. - Heard. - Turn them down.

139. Well, it looks like you have everyone tucked in,

140. Huckleberry. - Yeah.

141. We're getting there. - Well, I'm going to leave you

142. in charge of the boring Yellow stuff.

143. Where are you going?

144. Get in on the Red Zone action.

145. Robby, are you okay?

146. Right.

147. Well, I got some good news.

148. County Public Health is sending out a truckload

149. of supplies from Magee-Womens and Mercy.

150. Gloria, are we gonna have to call in more blood donors?

151. - Already done. - Donated.

152. I-I don't—

153. my blood, needles—

154. Choppers are coming

155. from blood banks in Erie and Youngstown.

156. - Oh, thank God. - I appreciate the way

157. you've handled logistics today. - Wait, hold on.

158. W-what does she mean, more blood donors?

159. You didn't use unscreened blood donations, did you?

160. We did what we had to do

161. to save as many people as we could.

162. You're killing me, Robinavitch.

163. And for the love of God, can you tell me

164. that you didn't know about a-a shooter's hit list,

165. and then you let him go this morning?

166. He didn't do it.

167. - Police confirmation? - No.

168. Then this nightmare—

169. Jesus, Gloria!

170. The police are still looking.

171. Why don't you go back to your micro-managerial

172. ivory tower and let us get the fuck back to work?

173. Robby, get some air, brother.

174. Check on triage.

175. Dr. Abbot, I got your carotid bypass guy up to the OR.

176. Vascular surgery says to give you mad props.

177. Okay.

178. You think he told Jake his girlfriend died?

179. - Yeah. - Fuck.

180. Hey. Hey.

181. Oh.

182. - How's it going out here? - Good.

183. 12 minutes since the last pink or red.

184. I think it's quieting.

185. - Jesus! - What?

186. - Don't say that. - Come on.

187. Don't tell me you believe in that superstitious shit.

188. It's like saying "Macbeth" in the theater.

189. Yeah, and you call yourself a person of science.

190. Watch out!

191. Hands up!

192. Any weapons?

193. Everyone stand back!

194. No—no weapons.

195. All clear!

196. - Are you okay, sir? - Yeah, I'm good.

197. Guy in the back needs help.

198. Sorry about the parking job.

199. Getting a little woozy.

200. Okay, what happened?

201. I found him in the festival parking lot.

202. Gave him Narcan from my kit, but he didn't respond.

203. Might be benzos—I don't know. - You a medical worker?

204. Navy corpsman.

205. I'm okay.

206. Your leg does not look okay.

207. I got shot through and through.

208. I stayed to help as long as I could.

209. Bullets flying everywhere. It was a fucking nightmare.

210. Hey, Ellis. How's the passenger?

211. No sign of trauma, but he's pretty cyanotic.

212. Needs oxygen. Let's move him in.

213. Grabbing a gurney.

214. Any headache, neck pain,

215. chest pain, belly pain?

216. Sir!

217. No, I'm good.

218. I'm gonna get a wheelchair. Do not try to walk.

219. Must have missed the bone because I could—

220. Whoa, whoa, whoa, whoa! Cancel the wheelchair.

221. Bring a gurney. - Gurney!

222. Any new customers for the OR?

223. - Yes. - Yeah.

224. This one looked like chest, but it was intra-abdominal.

225. Nipples to navel is no man's land.

226. Am I the only one who missed that day

227. in medical school?

228. I need high-flow O2, maybe BiPAP for this guy.

229. Trauma rooms open? - No, still getting cleaned.

230. South 15 is avail. - Okay, South 15 it is.

231. Find out if the ICU is ready for her.

232. All right, get me a tech and an RT,

233. and we'll take him up. - Yeah, I'm on it.

234. Hey, McKay.

235. There's someone from Allegheny County Courthouse

236. on the line. - Not now!

237. I'm in. Bag her.

238. Dr. McKay, you have a visitor.

239. I said not now!

240. Jesus Christ.

241. Sorry, Dad. Hey.

242. Thank you so much for coming in to pick up Harrison.

243. Are you okay?

244. Ah, I mean, relatively speaking,

245. I'm fan-fucking-tastic. - Good.

246. Hey, Dr. Abbot, can you keep an eye on this one?

247. Stable after 1 unit pRBCs. - No problem.

248. Ellis, get him started. Holler if you need me.

249. Copy.

250. Dana, hypotensive and altered.

251. Untreated GSW to the thigh.

252. Perfect timing.

253. Trauma One's open, but be careful.

254. Floor's probably still wet.

255. - Mohan, you're on this. - Okay.

256. Dr. Abbot, you need anything?

257. Check with Ellis in South 15.

258. - What do we got? - What do we got?

259. Pulse ox is low, 85 on room air.

260. 100% non-rebreather mask.

261. This guy needs a major workup.

262. Everyone in Yellow is stable.

263. Okay. Uh, check in with Robby.

264. - Holy shit. - See where he can use

265. another set of hands.

266. Okay, great. Thanks.

267. Trauma One, I know that guy.

268. His sister's in the cafeteria.

269. Her husband was shot and killed today.

270. Oh, sweet Jesus.

271. Do you think I can bring the lady in

272. to see her brother?

273. Uh, Robby,

274. lady in the cafeteria, dead husband,

275. brother in Trauma One, can we bring her back?

276. It seems like it's slowing down around here—go ahead.

277. Um, I have a patient in Central 9.

278. She was shot trying to protect her husband, who, um, died.

279. But her daughter is in the cafeteria.

280. I don't think I can spare any doctors right now.

281. In fact, why don't you go cover triage until Shen

282. and Ellis get back there? - Okay.

283. Give me her name. I'll find her.

284. Oh, thank you so much.

285. Um, her name is Morgan. Her mom is Trish Gregory.

286. Okay if we bring her up here, too?

287. Sure. Why not?

288. Pulse ox is still 85 on high-flow oxygen.

289. BP is borderline.

290. Dr. Santos, differential diagnosis of cyanosis?

291. Hypoxia, low oxygen from lung disease—

292. pneumonia, PE, asthma.

293. Good breath sounds, no crackles, no wheezing.

294. Pulmonary problems should improve with O2.

295. What else? - Heart disease, heart failure.

296. - No B line. - Right to left shunt?

297. That's usually in congenital heart disease.

298. PDA, Tetralogy of Fallot.

299. Cardiac ECHO looks good.

300. Normal ejection fraction, no valvular disease.

301. Hmm, what else could it be?

302. Okay, is Dr. Ellis running this resuscitation, or are you?

303. Because last time I checked, you're not supposed to be here.

304. We both are.

305. The senior resident's job is to teach.

306. What else, Dr. Santos?

307. Hemoglobinopathies?

308. Excellent.

309. Blood is chocolate brown.

310. Santos?

311. Methemoglobinemia?

312. Bingo.

313. Put him on BiPAP.

314. Send off a blood gas. Order methylene blue.

315. Etiology?

316. Drugs, toxins.

317. Smart money is poppers, amyl nitrates,

318. and partied a little too hard at PittFest.

319. Mm-hmm.

320. Langdon, got a sec?

321. Yep.

322. Keep me posted.

323. - Can I do the intubation? - Not necessary yet.

324. But his pulse ox is low. He's altered.

325. All the oxygen in the world won't fix that.

326. His methemoglobin level is sky-high.

327. Nothing but methylene blue will help.

328. I'll run the blood gas up to the lab,

329. see if they've caught up with all the traumas yet.

330. First day?

331. Yeah.

332. What's the beef with Langdon?

333. Um—

334. Are you good here?

335. Yeah, methemoglobinemia, ordered methylene blue.

336. Perfect.

337. Keep it up.

338. Will do.

339. And here he is.

340. - Hey. - Grandpa!

341. How's my favorite grandchild?

342. I'm your only grandchild.

343. Chadwick Harrison Ashcroft III.

344. Please don't call me that.

345. Douchebag name for a douchebag guy.

346. - Dad! - Are you ready?

347. 'Cause Grandma is making your favorite—

348. carbonara.

349. Thanks for taking him, Dad.

350. Will you save some pasta for me?

351. Okay.

352. Tapping in.

353. - Thanks, brother. - Yeah.

354. EFAST normal.

355. No abdominal hemorrhage, no tamponade.

356. Pulse ox borderline, 89% on 15 liters.

357. BP's only 95 over 58.

358. Vinny Rivera— is he here?

359. I'm not sure, man.

360. I'm so sleepy.

361. Were you tired right after you got shot?

362. Uh, no.

363. I helped move 20, 30 people.

364. What's causing his oxygen levels to tank?

365. Up the oxygen.

366. 15's as high as it goes.

367. Gauge only goes to 15. Keep cranking.

368. You can get to 50.

369. Brian?

370. Vinny got shot.

371. I sent him with the first car I saw.

372. Is he okay?

373. You fight, Brian, okay?

374. You fight like the stubborn bastard you are.

375. I tried, Whit.

376. I tried.

377. - Oh, no, thanks. - It's not coffee.

378. It's bourbon.

379. That was a joke.

380. Robby did everything he could to save your girlfriend.

381. If he couldn't save her, nobody could.

382. Wait, wait, wait. What do you mean, neutralized?

383. Means he's dead.

384. Wait. I thought the kid in BH-2 was the shooter.

385. What's going on?

386. SWAT found the shooter.

387. Self-inflicted gunshot to the head.

388. He had a duffel bag full of ammo.

389. He was in some bushes down by the river

390. with his AR-15.

391. Do we know why he did it?

392. Does it matter?

393. Are we expecting any more victims?

394. SWAT cleared the festival grounds.

395. Probably no more coming our way.

396. What you've done down here...

397. all the lives you've saved...

398. there aren't adequate words.

399. Thank you.

400. We need to prep to open back up to the public.

401. Walk-ins only.

402. No traumas until we get word from surgery

403. that a few ORs have cleared.

404. That could be hours.

405. Blood Bank, pick up line two.

406. Blood Bank, pick up line two.

407. Everybody seems to know exactly what to do.

408. Is this kind of thing normal? - Thankfully, no.

409. But preparing for the worst and hoping for the best,

410. that's what we do.

411. Hey, is Dr. King still outside?

412. Yep.

413. We don't need a doctor covering triage.

414. We can bring her back in. - Yeah.

415. And, everybody else, let's process

416. these remaining patients

417. so my day shift can finally go home.

418. On it, Cap.

419. Ah, you hear that?

420. - Hear what? - It's quiet.

421. It's over.

422. Oh, son of a—

423. Hey, yo, yo, we're closed.

424. We're way over capacity. Take them to West Penn.

425. Kid in extremis. You were the closest EDAP.

426. 13-year-old hypoxic and hypertensive.

427. He looks pale and tachypneic.

428. Flynn Edwards, home alone with his little sister.

429. Cough, fever, rash, altered.

430. Tachy at 150, BP 80 over 55, breathing at 36,

431. and satting low 80s on the face mask.

432. Hi.

433. What's your name? - Georgia.

434. Hi, Georgia. I'm Mel.

435. Oh, yeah. That's scary.

436. Yep.

437. Georgia, where are your parents?

438. At the movies.

439. - Did you try calling them? - I texted.

440. Can you give us their numbers?

441. Do you remember what happened before you called 911?

442. Flynn was talking weird.

443. Okay.

444. Um, and then after he was talking weird?

445. He got super sleepy,

446. and then I couldn't wake him up.

447. Um, this is Princess.

448. I have to go help your brother now.

449. But Princess is going to get you a snack.

450. I already brushed my teeth.

451. Then maybe just a glass of water?

452. My count, one, two, three.

453. Flynn, open your eyes, buddy.

454. Start a second line. 2 liters of Ringer's wide open.

455. 100% non-rebreather.

456. Crackles bilaterally.

457. Temp 101, O2 sat only up to 82.

458. Shit.

459. It's code sepsis.

460. Blood cultures, labs,

461. portable chest, gram of ceftriaxone.

462. Dr. King, what are you thinking?

463. Uh, well, rash, altered with sepsis—

464. could be meningococcus, Strep pneumo,

465. something viral like disseminated HSV, encephalitis?

466. BP's 82 over 49.

467. Sat up to 87.

468. What about the rash?

469. It's more prominent on the lower body,

470. not much on the face.

471. There's no vesicles.

472. It doesn't look like chicken pox or typical Lyme rash.

473. Agreed.

474. Do you know what this is?

475. Nope.

476. Resuscitate first, diagnose later.

477. We're moving patients from the Yellow Zone

478. into real rooms along the South and Central Corridors.

479. Till now, all these patients have just been numbers to us.

480. Time to ask them their names.

481. So we scan their wristbands

482. and put them into the big board.

483. Yeah, and then Dana and I will assign rooms

484. based on medical priority.

485. Ortho extremity wounds go get X-rays.

486. Dr. McKay, can you finish up whatever it is you're doing

487. and come meet me in BH-2?

488. Uh, yeah, sure.

489. I told you he didn't do it.

490. I know.

491. But you said yourself his threats were serious.

492. At least now we're nipping it in the bud.

493. You think this is that easy?

494. Think again.

495. He's on 100% oxygen.

496. His pulse ox is still only 88.

497. - How's it going upstairs? - Regular spa day at the OR.

498. 42 ex-laps and thoracotomies. - Impressive.

499. What do you got?

500. GSW through and through the thigh,

501. not arterial, now hypotensive and hypoxic.

502. - Sounds like blood loss. - No.

503. Hemoglobin times 2 is stable.

504. Vena cava is plump—it would be flat with hemorrhage.

505. It's actually a little too plump.

506. Let me see the phased array probe.

507. Any history of heart disease?

508. Not sure, but he's a strong guy.

509. Got shot, strapped a T-shirt and a belt around his thigh

510. and ran around helping people for a few hours.

511. Holy shit.

512. Check out the four chamber apical view.

513. Dilated right atrium and right ventricle.

514. Right-sided strain with bowing of the septum.

515. Sounds like a PE.

516. He throw a clot from having the tourniquet on?

517. Way too soon for a DVT.

518. Okay, let's get him in left lateral decubitus.

519. One, two.

520. Trendelenburg ASAP.

521. What for?

522. Intracardiac air embolism.

523. All that running around introduced air

524. into the femoral vein right up to the heart.

525. Now it's blocking blood flow to the lungs.

526. Need a CT to confirm.

527. They're still backed up with other patients.

528. Well, maybe the cath lab can take them.

529. They have fluoro.

530. I'll go check. - Yeah, good luck with that.

531. I need a central line kit

532. and a 5 French pigtail catheter.

533. I got it.

534. He doesn't have a collapsed lung.

535. - Yeah? - So what are you going to do?

536. I'm not gonna do anything. You are.

537. Thank you, Casey.

538. Hey, David. How you doing?

539. Hi, David.

540. I didn't shoot anybody.

541. I wouldn't do that.

542. I know.

543. Did you make a list of girls you wanted to hurt?

544. - Where's my mom? - Did you make a list?

545. I want to go home.

546. You're gonna get to go home.

547. But, first, we have to keep you here

548. for a mandatory 72-hour hold.

549. What? Why? I didn't do anything.

550. I know you're upset.

551. We're only doing what we think is in your best interest.

552. No, fuck you! You don't know me!

553. You don't know anything about me!

554. Look, I know it's a lot to process, but—

555. No, no!

556. I want to see my mom.

557. Where is she? Is she out there?

558. - I— - Mom!

559. Mom!

560. This is not helping your case, David.

561. Mom! Mom!

562. This is not helping your case—

563. Oh, fuck you!

564. Let's go outside.

565. I just want to see my mom, please!

566. Please, I just want to see my mom.

567. Mom! Mom!

568. BP's 92 over 60 after 2 liters.

569. Still tachy.

570. Sats are way down at 84 on the non-rebreather.

571. Flynn, open your eyes.

572. How you doing, bud?

573. He's still having trouble breathing.

574. He's more lethargic than before.

575. Let's give him a third liter and prep for intubation.

576. Can we do that without parental consent?

577. We wait, he dies.

578. Tech is here for a portable chest.

579. Dr. King, what are your intubation meds?

580. - Etomidate and Roc. - Great.

581. Gather up everything you need. What size tube?

582. Age divided by 4 plus 3

583. would be 6.5 cuffed.

584. Let's do it.

585. And find his parents. - Okay.

586. Prep these.

587. What time you start today?

588. 7:00 a.m.

589. Thanks.

590. Can I get one of those? I'm starving.

591. No can do.

592. But I'm hungry.

593. We can't give you any food in case you need surgery.

594. You might aspirate.

595. You need to work on your bedside manner.

596. Mm, asshole reporter.

597. - ABG back on the blue man? - Not yet.

598. Should we just give him the methylene blue?

599. Mm, pulse ox holding at 85.

600. We can wait a little.

601. Dr. Santos...

602. how do we evaluate methemoglobinemia

603. and determine a treatment plan?

604. Um...

605. Tired?

606. Yeah.

607. Feet hurt?

608. Brain feeling like mush?

609. Absolutely.

610. That patient doesn't give a shit.

611. He needs you.

612. Methemoglobinemia.

613. Let's go.

614. Robby?

615. Hey, Janey.

616. Where's Jake?

617. I got here as fast as I could,

618. but there were street closures—

619. He's okay. He's okay.

620. He had some minor injuries

621. that are going to need to be treated, but he's okay.

622. He's gonna go home tonight. - Oh, thank God.

623. Um...

624. Leah didn't make it.

625. She's dead?

626. Oh, my God.

627. He, um, is kind of blaming me for not saving her.

628. Robby, he's just a kid.

629. So was she.

630. Don't do that to yourself.

631. Hey, look at me.

632. Jake loves you, okay?

633. Where is he? - Hey, Dana.

634. You remember Janey?

635. - Of course. - Thank you for calling me.

636. Mind taking her to go find Jake?

637. Yeah, no problem. Come on.

638. Tube's in.

639. Good color change.

640. Nicely done.

641. Present.

642. Uh, we have a septic 13-year-old with pneumonia.

643. I just intubated, and ceftriaxone is on board.

644. Patchy consolidation, maybe some nodules.

645. It could be viral pneumonia

646. with or without bacterial superinfection.

647. Kid's got a weird rash, too.

648. Oh, and it's maculopapular on the legs.

649. Pretty faded on the neck and chest.

650. Starting to desquamate.

651. You ever seen anything like this before?

652. - Nope. - Me neither.

653. Well, that just goes to show you how old I am.

654. This looks like measles.

655. - "Measles"? - Holy shit.

656. Any travel history?

657. He wasn't able to talk before we intubated.

658. Measles is super contagious.

659. It's not contagious if it's resolving.

660. We need more history.

661. Where are the parents? - Oh, they're at the movies.

662. I'm sure their phone's off.

663. But he came in with his little sister.

664. We can talk to her.

665. - What theater? - I don't know.

666. Shen, try every theater.

667. There's got to be over a dozen in Pittsburgh.

668. Start with the ones closest to where they live.

669. We need to find those parents. And call Public Health.

670. Tell them we might have a measles outbreak.

671. We get blood gas results back?

672. I just got them.

673. Methemoglobin level of 42%,

674. enough for cyanosis and lethargy.

675. Ooh, party on, Wayne.

676. Okay, let's go ahead and start methylene blue.

677. Uh, 1 mg per kg, slow IV push over five minutes.

678. On it.

679. Gonna need somebody to stand bedside,

680. push it with a syringe. - Santos, tag, you're it.

681. How long until his cyanosis resolves?

682. Five minutes, bright spark.

683. Oh, you two definitely got beef.

684. Hi, Georgia.

685. Um, this is Dr. Robby.

686. He's gonna ask you some questions so we can help Flynn.

687. Is that okay?

688. Hi, Georgia.

689. Can you tell me

690. when your brother first got sick?

691. A week ago.

692. I was already getting better.

693. You were sick, too?

694. Fever, rash like Flynn?

695. Has your family traveled anywhere recently

696. on an airplane or to another state?

697. Orlando for a dance competition

698. a couple of weeks ago.

699. And where on your body did the rash start?

700. On my face.

701. Then it went down to my legs.

702. Okay.

703. Thank you, Georgia.

704. - Is Flynn gonna be okay? - Oh, well, yeah.

705. We're gonna do everything we can to help him.

706. The story is consistent with measles.

707. Plenty of opportunity for exposure in Orlando

708. with all the international travelers.

709. Isolation?

710. No, 'cause you're only infectious

711. for four days after the rash starts,

712. so we're past that point.

713. But the altered mental status,

714. he's in the right time frame for ADEM.

715. ADEM?

716. Acute Disseminated Encephalomyelitis,

717. post-infection immune response.

718. - So a head CT and an LP? - Afraid so.

719. It has a 20% death rate.

720. - Dr. King, this is Morgan. - Trish Gregory's daughter.

721. Is my mom okay? - Oh, yeah, um, she's fine.

722. Uh, Dr. Robby, do you mind if I show Morgan to her mom?

723. No, go ahead. I'm going to send Flynn for a head CT

724. and get Shen to prep the LP.

725. What about the parents?

726. I think he's still trying to find them.

727. - I can help. Go. We got this. - Thanks, Lupe.

728. Um, just this way.

729. So she's gonna need surgery, but she's...

730. - Take a seat. - What?

731. Why?

732. Adrenaline crash after a big event.

733. A juice box? Thanks.

734. What happened here today, it's not normal.

735. But you—

736. You were a rock star, Victoria.

737. He knows my name.

738. Got the IJ.

739. Okay, back to business as usual, thank God.

740. Guidewire and introducer. - What the hell are you doing?

741. Dr. Mohan is about to pull air from the right atrium

742. and right ventricle. - With what?

743. - 5 French pigtail catheter. - Inside his heart?

744. Multiple side-holes gives you a better shot

745. at sucking out all the air.

746. Dr. Abbot showed me a case report from South Korea.

747. What the actual fuck?

748. I just talked to cardiology. They want a CT scan.

749. If it's showing air, then you need to dive him

750. in the hyperbaric chamber. - He'll be dead by then.

751. Not if you kill him first

752. with this banana-pants procedure.

753. We don't have time to wait for your fancy-pants machine.

754. If we don't get the air out of his heart, he'll die.

755. This is not the standard of care.

756. Oh, fuck standard of care.

757. If we want to save him, we go in now.

758. Maybe I should—

759. Thread in the pigtail?

760. Excellent idea, Dr. Mohan.

761. Go down to 24 centimeters,

762. and then we'll confirm with X-ray.

763. Good.

764. Think I'll stick around in case you need

765. another set of hands to resuscitate

766. your patient when he crashes.

767. Oh, my God. You're bleeding. What—

768. Are you okay? - Mom, I'm fine.

769. You got to get me out of here.

770. Well, they— they just want to help you.

771. We all do. - I don't need help.

772. I just want to go, okay? - David...

773. you haven't called me back or texted me all day.

774. Mom.

775. You didn't go to school.

776. I saw the Instagram post you made.

777. And I found the list about all the girls.

778. You went through my stuff?

779. - I love you. - No, Mom, Mom.

780. - And I don't— - Those are my things.

781. Can I just say that we all have scary thoughts?

782. It does not make you a bad person.

783. And—and dealing with those feelings can be hard.

784. Talking to somebody can really help somebody about that.

785. Oh, my God. Just shut up.

786. I'm not gonna fucking talk to anyone, okay?

787. You can't make me.

788. David, I signed a petition.

789. What the fuck?

790. What, you signed some paper to get me locked up?

791. I signed a petition to get you help.

792. This is fucking bullshit.

793. Seeing all those people come in here today...

794. all those hurt people and the death and the blood...

795. I was so afraid

796. of you being that sad and angry.

797. I cannot bear to lose you.

798. I would never do something like that.

799. There's nothing wrong with me. It's me, Mom.

800. You know I'd never hurt someone like that.

801. Please, don't— don't do this to me.

802. Why are you doing this?

803. All we're asking is that you speak with a professional.

804. It's important to talk to somebody

805. about how you're feeling.

806. You think you might be open to that?

807. Fuck you.

808. Fuck all of you.

809. Can you just get out?

810. Get out!

811. Hey, Perlah, can you take Theresa

812. to go find a cup of tea? - Yeah, of course.

813. Jesus.

814. What now?

815. Well, I suggested a better way,

816. but you had him taken down by the police, handcuffed,

817. and dragged in here.

818. You made this fucking mess. You're gonna have to fix it.

819. Pigtail's in the right atrium, good position.

820. Aspirate, see what you get.

821. Pulling back blood from the heart...

822. Along with some air.

823. How about that?

824. BP's still only 85 systolic.

825. No improvement.

826. Advance slowly into the right ventricle.

827. - How do I know when I'm— - PVCs.

828. That's how you know. Aspirate again.

829. Run of three.

830. More blood and air coming out.

831. - Run of five. - Non-sustained V tach.

832. Charge to 200 for when he deteriorates.

833. Mainly blood now.

834. Pull the pigtail back to the RA.

835. - Step aside. - Pull the pigtail, Dr. Mohan.

836. - Step aside! - You got this.

837. Normal sinus rhythm, 92.

838. Pulse ox is improving. BP's 112 over 84.

839. Not too shabby, huh, Dr. Walsh?

840. I think we can admit him to General Surgery now.

841. Hell, no.

842. - He's a gunshot victim. - Admit him to the cardiac ICU.

843. We'll consult from there.

844. Well, you can admit him yourself,

845. with Cardiology consulting.

846. I thought you liked flying the plane.

847. Not when it's gonna crash.

848. Solid work.

849. That was your save, not mine.

850. Take the win, Dr. Mohan.

851. Thanks.

852. Besides, it was a little too risky for me to do myself.

853. - What? - Suture.

854. Whoa, this is so cool.

855. Blue plus blue equals pink.

856. Can you tell us your name?

857. Max.

858. Max, can you tell us what you took?

859. Sleep.

860. Yeah, he might need a second dose of methylene blue

861. if his methemoglobin level stays above 30.

862. This definitely wasn't poppers.

863. He would have had to have sniffed, like, a gallon of it.

864. So what caused the overdose?

865. Got to wait for him to wake up

866. so we can get more answers.

867. Trish...

868. I have a special visitor for you.

869. Mom, are you okay?

870. Yeah, I'm fine.

871. Okay. I was so scared.

872. - I know. - And Dad.

873. - You okay? - Mm-hmm.

874. Just—my patient hasn't seen her daughter,

875. and it won't— it won't happen again.

876. Never apologize for feeling something for your patients.

877. Today was chaos.

878. You were awesome.

879. I'm really glad you're with us, Dr. King.

880. Robby, Flynn's parents are here, the measles kid.

881. You should go home.

882. How did Flynn get measles?

883. Uh, from his sister. Hi. I'm Dr. Robby.

884. Georgia is fine. She's in our staff room.

885. She's the one who actually called 911

886. and probably saved her brother's life.

887. Georgia was sick, but she got better on her own quickly.

888. Yeah, many people get better on their own, like Georgia.

889. However, as many as 1 in 20 kids that get measles

890. get pneumonia, like your son.

891. Are your children vaccinated against measles?

892. No.

893. The MMR vaccine is perfectly safe.

894. Measles is not.

895. We're concerned about inflammation

896. and possible damage to Flynn's brain and spinal cord.

897. The measles got to his brain?

898. Well, his head CT was normal, but the only way

899. to find out if he's okay is to perform a lumbar puncture.

900. A spinal tap?

901. I've read about kids who've been paralyzed

902. from a spinal tap.

903. There is zero risk of paralysis.

904. What about bleeding or infection?

905. It's a perfectly safe procedure—we do it every day.

906. We need spinal fluid to see

907. if Flynn has acute disseminated encephalomyelitis.

908. And if he does?

909. We treat with high-dose steroids to decrease the risk

910. of blindness, deafness, intellectual disability,

911. even death.

912. He could die from this?

913. Yes, the death rate from ADEM is high—1 in 5.

914. Do the spinal tap.

915. No!

916. Can't you just give him steroids

917. without the spinal tap? - If there's no ADEM,

918. the steroids could suppress his immune system,

919. making it harder to fight off the pneumonia.

920. But it says here that—

921. Can you put your damn phone away?

922. Your son is critically ill.

923. The longer that we wait,

924. the higher the risk of permanent brain damage.

925. What is not clear here?

926. Hillary, he has a tube down his throat.

927. He can't breathe on his own.

928. They're not poking holes in my son's spine!

929. Wow.

930. Okay.

931. Let's just wait and see if he gets better.

932. Dr. King, could you please take

933. Flynn's parents to see their daughter?

934. No problem.

935. They are going to see their daughter.

936. Fucking Dr. Google bullshit.

937. They want medical treatment,

938. but they don't want medical advice.

939. What the actual fuck are we doing?

940. Yeah, I know, and we'll keep trying.

941. Hey, you okay, boss? - Yes.

942. Hey, Whitaker.

943. You got a minute? - Yeah, yeah.

944. I just wanted to say thank you

945. for earlier when I was, um...

946. Oh, your brief moment of silent reflection?

947. Yeah. You didn't mention that to anybody?

948. - No, no. God, no. No. - I don't know what that was.

949. I was just— felt like I was drowning.

950. What was that you were reciting?

951. It's called the Shema prayer.

952. It's a declaration of faith in God.

953. I lived with my grandmother when I was little,

954. and she and I used to recite it every morning.

955. "Even youths grow tired and weary,

956. "and young men stumble and fall.

957. "But those who hold hope in the Lord

958. "will renew their strength

959. and soar on wings like eagles."

960. It's Isaiah 40.

961. I was an undergrad theology major.

962. I don't know why I said that.

963. I don't know if I actually believe in God,

964. especially on days like today.

965. A wise man once told me that you learn to live with it,

966. learn to accept it,

967. and find balance if you can.

968. I hope we all do.

969. Only one pink left.

970. The rest all went up.

971. Hey.

972. You guys need any help with new patients, or...

973. No, no, no. We're good.

974. It's quick and easy stuff. Go home.

975. - Yeah? - Yeah.

976. - Hey, you got a second? - Yeah.

977. What is up with Robby?

978. He's been better.

979. I'm really worried about him.

980. I've never seen him like this. Have you?

981. No.

982. How about you, slugger?

983. Been better.

984. - Preach. - Yeah.

985. Sorry to interrupt.

986. Oh, uh, if you guys are looking for Officer Stefano,

987. he went up to surgery about an hour ago.

988. We're looking for Dr. Cassie McKay.

989. Uh, yeah, that's me.

990. We were alerted about your ankle monitor

991. being tampered with.

992. County probation called to check in earlier,

993. but you never responded.

994. Yeah, it was—it was beeping and giving an error message.

995. And we were in the middle of a mass casualty from PittFest.

996. Did you tamper with your ankle monitor?

997. Yeah, I, um—I might have—

998. I might have drilled a hole in it.

999. Officers, look around. She was saving lives.

1000. Put your hands behind your head.

1001. Whoa!

1002. Whoa, whoa, whoa, hang on a second.

1003. - Are you joking? - Officers, wait a second.

1004. You're under arrest.

1005. Great.