The Pitt 1x3

1. - Oh, shit. - What?

2. I think I just broke some ribs.

3. It means you're doing it right.

4. Third amp of epi is on board.

5. Oh, come on.

6. Call me if there's a resurrection.

7. - Hey, Perlah. - Doctor?

8. Your kids have any pets?

9. - Ugh, my house is like a zoo. - You have a dog?

10. Ugh, no dogs, no cats. I followed my mother's rule.

11. No pets that can't be buried at sea.

12. I'm not sure I follow.

13. You ever try to flush a guinea pig?

14. Try explaining that to your plumber.

15. Good to know.

16. Hey, what's up with your asthma guy?

17. Responding to albuterol.

18. One more neb, and we'll discharge on prednisone.

19. How's it going out in Chairs?

20. Oh, it's fine, I guess.

21. - Dr. McKay seems nice. - Cassie?

22. Oh, yeah, she's great.

23. - She been here long? - A little while. Why?

24. I'm just curious.

25. Do you know what she did before she came here?

26. What she did? What do you mean, like, school?

27. Oh, like school, work, personal life.

28. I'm just trying to get to know her better.

29. Um, yeah, I don't-- I don't know.

30. I don't know that much about her.

31. She has a son. I know that.

32. She's a pretty private person.

33. - Anything else? - No, sorry, I'm good.

34. Thank you.

35. Hey, where are we at with opening up some beds?

36. Our Nepali lady with the crushed foot,

37. Minu, she still in line for the OR?

38. Yeah, she got bumped by your Le Fort

39. three fracture, Ben Kemper.

40. - He just went up. - Mm.

41. Still waiting for them to take

42. the electrocution fasciotomy.

43. What about our OD in Central 7?

44. Robby wants a few more tests. He's stable and on a vent.

45. Is he a candidate for organ donation?

46. Not sure.

47. Then why is Robby keeping him here?

48. I don't know.

49. Maybe he sees something we don't.

50. Or maybe he's hoping for something that isn't there.

51. What's there is an 18-year-old kid

52. - named Nick Bradley. - Yeah, is he though?

53. I don't mean to be a dick, but--

54. You just can't help it?

55. No, as sad as it is, that kid is gone.

56. and if we get him upstairs to the ICU,

57. we can use that bed to actually help somebody.

58. Robby is helping somebody.

59. He's helping two people, in fact.

60. They're in there right now praying over their dead son.

61. They just haven't let their hearts accept it yet.

62. Jesus, 9:00, you're already bumming me out.

63. OK, let's see.

64. Who's up next at the deli of death?

65. Weak and dizzy. No, thanks.

66. Flank pain. Need a UA first.

67. And buttock abscess.

68. Great teaching case for a student.

69. Don't make me tell Robby you're cherry picking.

70. I'll take projectile vomiting in North 5 for 200, Alex.

71. What do you think the chances are it's a demonic possession?

72. About the same as you going a whole hour

73. without saying something stupid.

74. For Christ's sakes, go already.

75. You're like having a kid I never wanted.

76. How are you feeling? Any pain, Minu?

77. No pain, but I'm thirsty.

78. Oh, nothing to drink before your surgery,

79. but we can get you some lemon swabs.

80. Thank you.

81. Excuse me?

82. When are you due?

83. You can always tell.

84. Congratulations.

85. Thanks.

86. How long before we might expect to see some improvement?

87. It could be hours. It could be days.

88. It could be never.

89. I don't expect anything for a little while.

90. Why don't you guys go get a cup of coffee

91. in the cafeteria, maybe something to eat?

92. I'll have a nurse call you if anything changes

93. - while you're out. - Thank you.

94. We appreciate that.

95. - I'm not leaving. - Suit yourself.

96. I'm gonna get a cup of coffee.

97. I got to call Sarah and the kids.

98. Cafeteria?

99. Straight down that hallway,

100. through the corridor, and to the right.

101. Thanks, and I'm-- I'm sorry

102. if my sister comes across a little strident.

103. It's OK. This isn't easy.

104. The parents of teen overdose, Lily and John Bradley,

105. are asking about the tests you told them about.

106. - OK, I'll be right there. - What about the rats?

107. What about them?

108. - Have they been caught? - I have no idea.

109. - Well, find out. - Not sure that's my job.

110. You're in charge of the ER. The rats are in the ER.

111. That makes you in charge of the rats,

112. and I have a strict rule about vermin in the workplace.

113. Good to know.

114. Could I get your eyes on a sickle cell crisis in South 20?

115. Headed that way right now.

116. ICU is insisting they still don't have rooms available.

117. Bullshit. Esme recon'd for me.

118. Send our electrocution, Victor Hunt, up there

119. until the OR is ready please. Thank you.

120. - Third epi on board? - Three minutes ago.

121. How long has he been going at it?

122. 10 minutes in here, possibly 30 minutes of prior downtime.

123. Don't suppose you'd let me try a pericardiocentesis?

124. - For what? - For practice.

125. - In case it's tamponade. - None seen on ultrasound.

126. - This is a teaching hospital. - It's not a cadaver lab.

127. What do you call this?

128. - Do you need a break? - I'm fine.

129. You don't look fine.

130. Hold compressions.

131. Still no rhythm.

132. OK, Whitaker, I think that's enough.

133. It's been four minutes since the last epi.

134. One more minute, please.

135. Help me, please help! Somebody help!

136. - Please, my friend needs help. - What happened?

137. - My friend. - Hey, where is she?

138. My friend, she's in my car.

139. - She won't wake up. - OK.

140. OK, Mateo, gurney!

141. - What's her name? - Jenna.

142. Come on, Jenna.

143. Wake up for me, baby.

144. Pupils pinpoint. I need--

145. - Narcan. - Yeah.

146. Hold her head back, Javadi. OK.

147. Not responding to Narcan. We might need to intubate.

148. Find a room and open a crash cart.

149. I can't find a carotid pulse.

150. Five minutes since the last epi.

151. OK, that's it.

152. Hold compressions.

153. Welcome back. She's OK.

154. He took his wife out for dinner last night,

155. for her birthday.

156. OK, why doesn't everybody take a minute?

157. Go check on your other patients.

158. We'll meet back here to debrief with Kiara.

159. - Bed four. - Where the hell am I?

160. Pittsburgh Trauma Medical Center.

161. Why?

162. Your friend couldn't wake you.

163. I'm right here, Jenna.

164. Came to with one spray of Narcan.

165. - What'd you take, Jenna? - Nothing.

166. You had to have taken something to cause this.

167. No, I was just up late studying,

168. and I just couldn't fall asleep.

169. So you took something to help you sleep?

170. We need to know in order to treat you properly, OK?

171. - Do you know what she took? - No.

172. This could be a sign of something really serious,

173. and we're gonna have to do a lot of tests that you--

174. OK, I took, like, half a Xanax.

175. That's not nothing.

176. It's OK. OK?

177. - Have you taken Xanax before? - First time.

178. OK.

179. Take a deep breath for me.

180. Come on, man. You heard Dr. Robby.

181. Let's take a break. Grab a coffee.

182. No, I'm fine, thank you.

183. Did you know him?

184. No, I didn't. Did you?

185. I just met him.

186. He was my first patient to die.

187. I'm sorry.

188. - Are you OK? - Mm-hmm, yeah.

189. - You sure? - Yeah. Just I--

190. I just remember the first time that--

191. on occasion, I have an emotional response to death.

192. It's--

193. Got to be kind of tough for a doctor.

194. At times, it can be.

195. At least I'm not a pathologist.

196. I was joking. I--

197. Oh.

198. I have nothing against pathologists.

199. Yeah, no.

200. New radiodensity in the right middle lobe.

201. Is it pneumonia?

202. Possibly, or just changes from vaso-occlusion

203. of the sickle cells.

204. It's called acute chest syndrome.

205. We're gonna cover you with antibiotics

206. just to be on the safe side.

207. We've been through this before.

208. Third generation cephalosporin and a macrolide.

209. Perfect. You're in good hands.

210. - Can I do a chest tube? - Which patient?

211. Any.

212. I've just never done a chest tube before.

213. Are you really asking me to reserve

214. any incoming injury requiring a chest tube for you?

215. Not all of them.

216. I'd be more than happy just doing one,

217. but, hey, if you wanted to give me more,

218. I'd be fine with that, too, but that's up to you.

219. I'm down for anything.

220. Confidence and ambition are great attributes,

221. especially when paired with respect and humility.

222. OK, what else? What else went well?

223. We checked for reversible causes

224. of cardiac arrest on ultrasound.

225. OK, good.

226. Does anybody have anything that they wish had gone differently?

227. In the hall, he should have been on a cardiac monitor.

228. We would have caught the arrest right away.

229. That's true,

230. but there was no indication for monitoring.

231. And we now know that his abdominal pain

232. was not from his gallstones but from unstable angina

233. due to coronary artery disease.

234. Then we should have admitted to cardiology.

235. Mm, we did an EKG. We did a troponin.

236. He had a HEART score of three.

237. Who can tell me what that means?

238. 1% chance of an adverse cardiac event

239. in the next 30 days.

240. Standard of care is to discharge

241. with outpatient follow-up.

242. He was your patient, Dr. Whitaker.

243. Would you like to say something before

244. we all take a brief moment of silent reflection?

245. Um...

246. He liked Kentucky bourbon.

247. OK, good.

248. Me too.

249. - Anything else? - I don't know.

250. I just met him.

251. No, he seemed nice.

252. He was married.

253. Um, that's it. That's all I got. I--

254. Mm.

255. I spoke with his wife. She's on her way here.

256. If anyone needs to talk about this some more,

257. I'm available.

258. For now, let's harness some good thoughts

259. here for Mr. Milton.

260. OK, that's it.

261. Let's go save some lives.

262. Hey, Whitaker.

263. How are you feeling on this?

264. I mean, not good. I was just talking to him.

265. Now he's dead.

266. That's the hardest way to lose a patient.

267. It always hurts.

268. Especially when it's your fault.

269. This was not your fault. This was nobody's fault.

270. No doctor on the planet could have caught this.

271. Listen, it sucks,

272. but today, today was this guy's day to leave this mortal coil.

273. 150,000 people die every day in the world,

274. and you got one of them, but you learn to live with it,

275. and you learn to accept it as much as your own mortality

276. and find balance if you can.

277. You've found balance?

278. No, not even close.

279. But, you know, you keep trying, which is all you can do.

280. You're doing great, Whitaker.

281. - Just, you know, hang in there. - Yeah, thanks.

282. OK.

283. - I'm just gonna go. - Yeah.

284. But, you know, our social worker, Kiara,

285. is here if you want to talk.

286. OK, yeah.

287. OK.

288. You're gonna recover, OK?

289. Good luck.

290. Wait, what happens now?

291. We monitor her heart and breathing

292. for the next few hours to make sure

293. she doesn't need more Narcan.

294. - That's it? - Yeah.

295. You should text your friends.

296. Hell, you should text your whole college.

297. Tell anyone who will listen

298. to not take pills without a real prescription

299. unless they want to end up here.

300. Seriously, fentanyl is everywhere.

301. It's in everything on the street these days.

302. How long would I monitor her pupils for?

303. You know what, actually, I should go to the bathroom.

304. Are you OK on your own till I get back?

305. Absolutely. Take your time.

306. OK, great. Thanks.

307. Sometimes I come on too strong.

308. Excuse me?

309. It's a defense mechanism against insecurity.

310. - You're kidding, right? - Yeah.

311. But I am sorry if I hurt your feelings.

312. I really-- I want us to get along.

313. I want us to be friends.

314. And if I'm really being honest,

315. I want your mother to write me

316. a kickass recommendation letter.

317. You're going into general surgery.

318. I might. I'm keeping my options open.

319. You want me to pimp out my mother

320. for something you might do?

321. OK, well, when you put it like that, it sounds dirty,

322. and a little hot, but yes.

323. In full disclosure, so we can be friends.

324. - Friends? - You've heard of the concept?

325. Buddies, compatriots, confidants, pals.

326. - They even made a show about it. - Yeah.

327. Boom. Come on.

328. Don't leave me hanging, Crash. Pound that shit.

329. I can call you that now that we're friends, right?

330. - OK. - We'll work on that.

331. So for the apnea test, we keep him on 100% oxygen,

332. but the ventilator won't be giving him breaths.

333. - For how long? - For 10 minutes.

334. We'll monitor his carbon dioxide levels,

335. and if they come back way too high,

336. then we'll know that his brain stem

337. - is not telling him to breathe. - And that means?

338. That would mean that there's no brain function

339. at the most fundamental level.

340. Princess will monitor him, and I will come back as soon

341. as we know the test results.

342. - OK. - Yeah.

343. OK.

344. I hate this fucking hospital.

345. This is Hank.

346. - What happened? - Nothing.

347. We were just framing, and then my buddy Joey comes in.

348. He says, "A guy walks into a bar with a nail in his head,"

349. and then he points his fucking nail gun at my head.

350. So what would you do?

351. So I freaked out, and then in the ensuing melee,

352. - he fucking shoots me. - Melee?

353. Yeah, you know, like a scuffle, like a donnybrook.

354. What, you think because I work construction,

355. not a hospital, I don't have a fucking vocabulary?

356. Tier one trauma now.

357. - No, sir, I-- - Whoa.

358. Definitely intracardiac.

359. And I got to tell you, this fucking hurts.

360. Let's just try and relax and dial down the F bombs.

361. - We have children in here. - You want me to stop swearing?

362. Take the fucking nail out of my heart.

363. And, please, something for the pain!

364. Stabilize the nail.

365. Hank, we need to cut your shirt off.

366. Fuck that.

367. You cut the shirt, you're gonna buy me a new one.

368. You can have your pick out of our lost and found.

369. Whew, how did this happen?

370. Framing nail incident with deep penetration

371. - of the left chest. - The fuck does it look like?

372. Hank, do you take medicine every day?

373. Any allergies to medication?

374. No. Can you give me something for the fucking pain already?

375. Is this a hospital or a vet clinic?

376. Very soon, Hank. Very soon.

377. I bet you say that to the beagles too.

378. Pulse 120. BP 100 over 65.

379. Two milligrams of morphine.

380. Liver GSW is in recovery. He's good as new.

381. Whoa, that looks intracardiac.

382. - Nailed it. - Whoa, you got jokes now.

383. No jokes, just pushing your pain meds, buddy.

384. Small pericardial effusion, but no evidence of tamponade.

385. - Not yet. - Somebody talk to me.

386. Do I need a priest here?

387. He's tachycardic with borderline BP.

388. He could decompensate.

389. Standby with two units whole blood.

390. Garcia here. Stat cardiac case.

391. Am I dying here and nobody's telling me?

392. Hank, there is blood collecting

393. in the sac around your heart.

394. You need surgery before your heart stops

395. from the pressure around it.

396. Just pull the fucking nail out!

397. That would definitely kill you.

398. I want a second opinion. Where's my fucking phone?

399. I can Uber to Presby and find a real hospital.

400. OR can take him in 10 minutes.

401. Mind if we intubate him first?

402. The sooner the better for all of us.

403. Great. 120 of sux, 100 of ketamine.

404. - Javadi, you're up for this one. - Really?

405. Now. Let's go. Move.

406. Code STEMI, ETA five minutes.

407. Code STEMI, ETA five minutes.

408. I can start the STEMI with Mel.

409. - Sounds good. - This place sucks.

410. I will destroy you on Yelp.

411. Nobody's ever coming to this shithole again.

412. I swear to God.

413. From your mouth to God's ear.

414. Kiara? Hi. I'm Dr. Melissa King.

415. - Everyone calls me Mel. - Yes, we met.

416. Right, um, I wanted to ask you

417. about Tyler, the little boy who ate the marijuana gummy.

418. He's been admitted to pediatrics for observation.

419. - And his parents? - They're upstairs with him.

420. CYF is going to follow up with a home visit just to be safe,

421. but no police were involved. Don't worry.

422. No one is taking their child away from them.

423. Good. That's a relief.

424. Yeah, the parents, on the other hand,

425. may need couples counseling after this,

426. but I think little Tyler's going to be fine.

427. - STEMI with me, Mel. - Right behind you.

428. - Dana, what's open? - Trauma two.

429. All right, keep it that way.

430. Our target door to balloon time for STEMIs is 51 minutes.

431. Ambitious.

432. But doable, as you're about to find out.

433. Let's go.

434. Good view of the glottis.

435. Eyes off the screen.

436. Now look down the mouth and insert

437. the tube around the bend.

438. You stole my med student from triage?

439. - How's she doing over here? - She's doing pretty good.

440. Now look back at the screen.

441. And advance through the cords.

442. Good. Good job.

443. Thanks.

444. Pressure's down. 72/38.

445. Effusion has grown, now with the RV collapse.

446. Pericardiocentesis?

447. Let's get another unit on that infuser.

448. Prep for thoracotomy. Coming through.

449. We should get back to triage.

450. You don't want to stay for this?

451. There are like 30 patients still waiting

452. - to be assessed out there. - OK.

453. - Did someone say thoracotomy? - Crashing from tamponade.

454. Dr. Garcia, do you think I--

455. Trauma Surgery gets left sided thoracotomies.

456. ED gets the right if we need to extend.

457. Glove up, girl. You're on suction.

458. Let's advance that ET tube to the right main stem please.

459. Ten blade.

460. Metz.

461. Dr. Santos, how do we cut through the intercostals?

462. Through the superior rib to avoid the neurovascular bundle.

463. - That is correct. - Finochietto retractor.

464. Full suction.

465. And get rid of this nail before I get poked.

466. On it.

467. Nail's intact in one piece.

468. Toothed forceps. Opening the pericardium.

469. This is so fucking cool.

470. Dr. Santos, you and this patient

471. share a common vocabulary.

472. Yeah, I swear a lot. I know. I'm sorry.

473. They say it's a sign of intelligence.

474. I think it shows a lack of self-control.

475. But what the fuck do I know?

476. Single puncture wound to the left ventricle.

477. We've got a finger on it.

478. First unit is in. Pressure's up.

479. Heart is filling well.

480. Throw in a horizontal mattress, and we're out of here.

481. - Stop the bleed while I sew. - STEMI's arrived.

482. You got this?

483. Just wrapping him up for OR delivery.

484. 2-0 Prolene on a tapered needle.

485. Mr. Ed Gellin is 52 years young

486. with a history of hypertension and hyperlipidemia.

487. 20 minutes of substernal chest pain.

488. 10 out of 10 with dyspnea and diaphoresis.

489. BP is 152 over 95.

490. Currently chewing 324 mgs of baby aspirin.

491. OK.

492. Blood's drawn. Second IV started.

493. BP stable.

494. Seven millimeters ST elevation...

495. - One nitro spray, sublingual. - In the anterior leads.

496. Those are sometimes called tombstones.

497. - Open up, sir. - Tombstones?

498. Lift your tongue.

499. Mr. Gellin, you're having

500. a very big heart attack right now.

501. Major artery that carries oxygen to your heart

502. - is almost totally blocked. - That doesn't sound too good.

503. No, it's not very good.

504. We're gonna send you up to the cath lab.

505. A cardiologist is gonna unblock that with a balloon

506. and leave it open with a stent.

507. But I'm still having a heart attack?

508. If everything goes as planned,

509. it'll be like you never had a heart attack.

510. We're gonna put a catheter in this artery right here.

511. We're gonna shave the hair with a clipper.

512. Long as you stop short of a Brazilian.

513. It's an option we offer. Costs a little bit more.

514. A lot of people's insurance won't cover it.

515. Don't make me laugh.

516. - It hurts. - Deal.

517. Anybody we can call?

518. - My wife. - Already have her number.

519. OK, we'll call her. You hang in there.

520. I'll be right back.

521. I think they finished the apnea test on Nick.

522. - Can you check the results? - Not just yet.

523. The blood test needs to go to the lab.

524. It takes a few minutes to run the test.

525. I'll come find you in the room as soon as it's done.

526. Horizontal mattress in place with excellent hemostasis.

527. Cut here.

528. Moist, sterile towel. And away we go.

529. I spoke to cardiothoracic. They can meet you in the OR.

530. Good job.

531. Coming through.

532. Well done. Well done.

533. - Good luck, Mr. Gellin. - Thank you so much.

534. You're very welcome.

535. Two saves. Totally awesome.

536. I just held a beating human heart in my hands.

537. We should celebrate.

538. We should clean these rooms

539. and bring some more patients back.

540. - Sounds like a plan. - No rest for the wicked.

541. - Code STEMI was fast. - Time is myocardium.

542. And our statistics for door to balloon time

543. get reviewed, critiqued, and published online.

544. Door to balloon time?

545. That's the time from when they hit our door

546. to when the angioplasty balloon gets inflated in the cath lab.

547. We keep it to under 51 minutes, we can reverse a heart attack

548. and save a life.

549. Kind of wish Mr. Milton had a STEMI.

550. Thank you for letting me go the distance on him.

551. I really thought we'd get him back, you know?

552. Yeah, well, you know, even though

553. you do everything right, you don't always

554. get what you hope for.

555. My parents both had sickle cell trait,

556. and I was screened as a newborn with the hemoglobin FS pattern.

557. - Did you take penicillin? - Mm-hmm, until I was five.

558. Then the vaccines kicked in.

559. She has her entire medical history on her phone.

560. It's extremely long.

561. Dr. Mohan, do you have a minute?

562. Yep. Excuse me.

563. Is there a problem over there?

564. No, her pain is well controlled.

565. You understand that's my polite way of asking

566. why are you spending so much time with one patient?

567. You're an R3.

568. As an R3, you should be seeing at least two patients an hour.

569. I have two, Joyce and Mr. Wallace,

570. - our Good Samaritan. - Who's comatose and stable.

571. You should have four by now.

572. I have the highest patient satisfaction of anyone.

573. I don't doubt it,

574. but we just had this conversation

575. a couple of hours ago.

576. I know people call me Slow-Mo.

577. You don't have to confirm or deny.

578. It used to hurt my feelings a lot, but I can't help it.

579. I work at the speed I'm comfortable at.

580. Because you're afraid of making a mistake?

581. I'm always afraid of making a mistake.

582. - Aren't you? - Yeah, of course I am.

583. But you know what I mean.

584. You make a mistake once, and somebody dies,

585. and you feel so badly about it,

586. you'll never let it happen again--

587. How is that wrong?

588. Because you waste time and money

589. on unnecessary tests.

590. You keep sick patients waiting too long.

591. You miss out on cases you could be learning from.

592. You shortchange your own education.

593. I'm not saying this to be a hard-ass.

594. I'm saying this because I know you could do this,

595. but you need to do it at a level

596. - I also know you're capable of. - And what if I'm not?

597. Then you should look into a specialty

598. that better suits you.

599. Have you thought about psychiatry?

600. I don't want to go into psychiatry.

601. I want to be here.

602. Being here means

603. no matter how good you are or how hard you try,

604. you're gonna make another mistake,

605. and someone else might even die.

606. That's called being an emergency medicine doctor.

607. And if you can't accept that,

608. then maybe this isn't the place for you.

609. - I can accept that. - You sure?

610. - Yes. - OK, good.

611. Go save some lives.

612. Clear some beds while you're at it.

613. I would fancy a spot of tea at some point.

614. You want some tea, darling? I'll get you some tea.

615. - Oh, thank you, sweetheart. - Is Dr. Robby available?

616. He's with a patient. Can I help?

617. - My father's starting to move. - OK, I'll let him know.

618. - Thanks. - Yeah.

619. Is it good or bad?

620. If there's no spontaneous breathing,

621. then carbon dioxide levels rise above 60.

622. So 82 definitely means that Nick's brainstem

623. is not triggering him to breathe.

624. Well, how can you fix that?

625. We can't. I'm sorry.

626. But with rest and time...

627. This is not something that heals on its own.

628. There's got to be something else that we can do.

629. Nick is our only child.

630. - Is that test 100% accurate? - It is.

631. Isn't there anything else?

632. We can do an imaging test called

633. - a cerebral perfusion study. - Then let's do it.

634. But you have to understand that will be the last test

635. that we would do.

636. If it comes back that there's no blood flow to Nick's brain,

637. it would confirm beyond a shadow of a doubt

638. that there's been brain death,

639. which would mean that he's gone.

640. Then we wait and see.

641. Call Nuclear Medicine. See how soon they can take him.

642. You got it.

643. I'll be back in a few minutes.

644. Thank you.

645. Hey, Mr. Spencer in Central 9 tried to pull out his ET tube

646. - and is now in soft restraints. - No surprise there.

647. We need to up the propofol.

648. And the sister of the dead MVC vet in the viewing room

649. - just arrived in Chairs. - Can you, um--

650. - Park her in the family room? - Please.

651. No problem, I'll have Perlah and Princess prep the body

652. as best they can for viewing.

653. Any progress in there?

654. No.

655. Can you also keep an extra eye on Whitaker today?

656. Oh, I'm already on it.

657. I know he lost his first patient.

658. Yeah, I just don't want it to throw him off his game.

659. - You think this kid has game? - Not sure yet.

660. I want to give him a chance to find out.

661. Copy that.

662. - Hey, fruitcake. - Myrna.

663. What brings you in here today, anyway?

664. - I murdered my husband. - Ah.

665. How did you do it this time?

666. I put him through a meat grinder.

667. Best just to grab one and jump back in.

668. Yeah, right.

669. Mr. Fulton in Central 14 just needs a shot of Mylanta

670. for his GERD, and to avoid eating foods

671. with the words "flaming hot" in their title

672. for at least a few days.

673. - OK, thanks. - Central 14.

674. Yeah.

675. Could I get some Mylanta for Mr. Fulton in Central 14?

676. It'll be a while.

677. If you want it fast, go check out the employee

678. - first aid cabinet. - Where is that?

679. In the lounge. I'll show you.

680. - How's it going? - Not so great.

681. - I lost a patient. - So I heard.

682. I also heard it wasn't your fault.

683. Doesn't make it feel any better.

684. Yeah, it doesn't. I'm sorry.

685. Unfortunately, it comes with the job.

686. If it's any consolation, I just got scolded for going too slow.

687. If you hear someone talking about a Slow-Mo, that's me.

688. Guaranteed you're going faster than me.

689. I like to say it gets easier. Some days it does.

690. I'm sure the rest of your shift will be better.

691. - Shake it first. - Mm-hmm.

692. Oh, but make sure the lid is...

693. Screwed down tight.

694. - OK. - Oh.

695. Everyone seems to get along like family.

696. You see a family, I see every man for himself.

697. Actually, that's not entirely true.

698. There is some family here.

699. Javadi's mom is a surgeon upstairs.

700. - Really? - Yeah.

701. - Oh, that must be so nice. - Are you kidding?

702. I don't know about your mom,

703. but I would not want mine working within 100 miles of me.

704. - No way. - My mother passed.

705. She had a very aggressive, malignant pheochromocytoma,

706. - so... - Sorry.

707. Unfortunately, my mother is gonna live forever.

708. No, she was definitely dead. Like, I'm still shaking.

709. No, she was, like, dead. Like dead-dead.

710. I mean, I think her heart stopped.

711. No, she was, like, literally dead.

712. - Think she was dead? - Who?

713. Who she was just talking about.

714. Oh.

715. In case you didn't realize, I use sarcasm

716. and comedy as a shield. Or so I've been told.

717. Thank you for opening up to me.

718. - Mel, right? - Yes.

719. Well, it was nice talking to you, Mel.

720. It was nice talking to you too.

721. You know, I really hope we can be fri--

722. friends.

723. Is there anything I can assist you with, Dr. Robby?

724. I think we're best on our own right now, thank you.

725. He keeps trying to pull away.

726. We're giving him some more sedation.

727. Why is he so agitated?

728. He could have some awareness of the tube in his throat

729. or that he's in a strange place,

730. or it could be lack of oxygen to his brain.

731. - Does he need more oxygen? - He's on 100%.

732. That's as high as it goes.

733. That is his blood pressure dropping.

734. Oh, is that even fixable?

735. Normally, yes, with IV fluids,

736. but we now know that that will just fill up his lungs,

737. drop his oxygen even more.

738. Well, isn't there something else we can do?

739. We can place a long, large IV catheter in his jugular vein

740. down into his heart and administer Levophed,

741. which is a very powerful medicine

742. to constrict his arteries, raise his blood pressure.

743. But that could cause other organ damage, organ failure.

744. I'm really sorry, but each new step is even more invasive,

745. could cause more suffering with minimal benefit.

746. Uh, hi.

747. Dr. Robby said he'd be back in a few minutes.

748. Yeah, he's with a patient, but I'll let him know.

749. My son is dead, isn't he?

750. I'm not a doctor, Mr. Bradley,

751. but I do believe in God, and I am praying for your boy

752. with every beat of my heart.

753. Thought she'd taken Xanax, but it was actually fent.

754. - Thank you. - Yeah.

755. Oh, one second. Yeah?

756. - She was legitimately dead? - Yeah, like, 100%.

757. - Mr. Bradley? - Vince?

758. No, my dad's gonna freak out.

759. No, I know. I know.

760. I just needed to sleep. I thought I was.

761. Where did you get the fucking drugs?

762. - Who are you? - Did you give them to my son?

763. Did you give my son drugs?

764. Mr. Bradley, you can't come in here.

765. - Mr. Bradley, please. - Who is this?

766. - Tell me the fucking truth. - Security!

767. It's Nick's dad.

768. - Did you drug my son? - Where the hell's security?

769. Your son gave me the drugs, asshole.

770. - Ask him. - He's dead.

771. And you are a fucking liar!

772. You killed my son! You killed my fucking son!

773. Hey, there's no scrubs in here.

774. Yeah, you have to put your old ones in before

775. it'll give you a new pair.

776. What?

777. Forgive me, Mr. Milton.

778. Hey, you missed the best action of the day.

779. I heard. What happened?

780. Father of the brain-dead son

781. goes after another patient he thinks gave his son

782. - the drugs that killed him. - Jesus.

783. - How do you deal with that? - No fucking idea.

784. Whoa, what happened here? Did we have an accident?

785. Do you think I'm wearing this by choice?

786. Was it number one or number two?

787. I just got some stuff spilled on me.

788. Was it a bodily fluid, and was it yours?

789. No and no.

790. Oh, is it from when you killed that guy?

791. I did not--

792. that guy had a massive MI in his sleep.

793. Relax, Huckleberry, I'm just fucking with you.

794. Truth is, you're not a real doctor until

795. you've lost at least one patient.

796. You got off easy. It wasn't your fault.

797. Not all of us can take comfort in saying that.

798. But try not to kill anybody else.

799. - What am I looking at? - Mr. Bill Philbin, 46.

800. He tripped while walking his dog.

801. He saw a squirrel. And it's my wife's dog.

802. Damn thing doesn't even like me.

803. Clearly. Where's the dog now?

804. Hopefully in a kill shelter.

805. Come on, baby.

806. Oh, yes.

807. I'm sorry.

808. I just want to understand how this could happen to our son.

809. I can't stop wondering, why Nick and not her?

810. I can't help it.

811. I think it would be helpful for you

812. to speak with our department social worker.

813. Would you two be open to that?

814. - None of this is fair. - No.

815. - No, it's not. - But he's still breathing.

816. The ventilator is breathing for him.

817. Brain death is the same as death.

818. What about that last test that we're waiting for?

819. I can almost guarantee it'll stay the same.

820. I'm so sorry.

821. I wish I could have done more to save your son.

822. Our social worker, Kiara, is here to help you

823. with anything you might need. She's amazing.

824. I'm gonna go find her and have her come see you.

825. Go back to the dorm,

826. and within a couple of minutes...

827. Get dad sorted out?

828. I think so.

829. He and his wife are dealing with a lot right now.

830. No shit. That's a tough one.

831. Yeah. Do you know where Kiara is?

832. Not offhand, but I can page her.

833. No, it's OK. I'll find her.

834. I got to hit the restroom anyway.

835. I'll tell her you're looking for her if she comes this way.

836. - Thank you. - Yep.

837. Now I got to pee.

838. Kevin, take Myrna to pee.

839. Ask Dana what's open, four of morphine,

840. - and order an X-ray, OK? - Copy.

841. Hey, closed injury, forklift versus foot.

842. - Forklift won. - Got it.

843. Hey, any news on our incel kid, David?

844. Uh, I don't think we've heard from him yet,

845. and I don't know that you should refer to him that way.

846. Well, he did have a list of girls' names he wanted to hurt.

847. They could be at risk. Are the cops looking for him?

848. - Not sure we're there yet. - OK.

849. I trust your judgment,

850. and I'm the last person who wants to involve

851. the police in anything,

852. but you don't want to be wrong about this one.

853. I know. I know.

854. So what's the issue?

855. Maybe I don't want to ruin this kid's life.

856. Well, you don't want him ruining

857. anyone else's life either.

858. Look, I've personally been on the wrong side

859. of someone who hates women.

860. It's not a safe place to be.

861. OK?

862. - Any luck reaching David? - Not yet.

863. Did you try calling the school?

864. He didn't show up for class.

865. Any idea where he might have gone?

866. Friends, relatives.

867. We don't have any family in state.

868. And David, he doesn't associate with anyone.

869. Theresa, do you think that David

870. would try to hurt any of the girls that are on that list?

871. No.

872. Do you remember some of the names on that list?

873. Not really.

874. Maybe you could try.

875. How's she doing?

876. She's worried sick about her son.

877. What are you going to do?

878. I thought he would come back after mom called him.

879. Hey, what are the ethics about me reaching out

880. to him under the guise

881. of a medical emergency with mom?

882. If he's a danger to himself or others,

883. I'd argue you have a professional responsibility

884. to do whatever is necessary.

885. Right. OK.

886. Hey, can you come talk to the parents of the OD'd kid

887. that we brought in earlier?

888. 18-year-old brain-dead from a fentanyl overdose.

889. - Oh, jeez. - Yeah, only child.

890. And I just think that the parents

891. could use a little help processing

892. what they're going through.

893. What about donation? Is he a candidate?

894. If the transplant counselor could get him there,

895. but I think we're a ways away from calling them in.

896. - I'll see what I can do. - Thank you.

897. They're in Central 7.

898. I would introduce you, but I really have to pee.

899. - No worries. - Thank you.

900. What the hell?

901. I just saw one of those rats.

902. And you thought you'd start an IV?

903. It's not funny.

904. You're not the one who's gonna have nightmares.

905. I forgot about your phobia with rats.

906. It is not a phobia. Nobody likes rats.

907. Some people keep them as pets.

908. If you are purposely keeping a rat in your house,

909. that is not a pet.

910. That is a sign of an underlying mental health problem.

911. OK, if it makes you feel any better,

912. just think of them as cute little Disney mice

913. with a pituitary condition.

914. Mm-hmm, joke all you want,

915. but if one of those disgusting things bites a patient

916. and we get a case of hantavirus,

917. guess who's gonna have to answer for that one, Chief.

918. Point taken.

919. What was the name of that cop you were talking to earlier?

920. What cop?

921. The good-looking one that you were talking to earlier.

922. - How would I know? - It seemed like you guys had--

923. - Stay in your own lane. - What?

924. I'm not even asking like that.

925. I really did want to talk to him about something.

926. Uh-huh.

927. Hey, did the exterminator come yet?

928. Yeah. Right. Sometimes you can be so cute.

929. Anything like that has to go through facilities.

930. - They said they'd handle it. - What does that mean?

931. It means nothing's gonna happen until next week

932. at the earliest unless we get a patient in here

933. with a service cat.

934. Oh, don't forget, you still have the sister

935. of Abbot's deceased veteran waiting for you.

936. Oh, shit, yes, yes, yes. I'll be there.

937. - I'll be there. - Yeah, go.

938. Hey, I've been looking all over for you.

939. We need a cardiovert unstable AFib in North 1.

940. - OK, just give me a sec. - Systolic's 90.

941. Fuck me.

942. 35-year-old architect working on a deadline,

943. vaping nicotine all night. Palpitations this morning.

944. AFib at 147. Mr. Quinn, this is Dr. Robby.

945. Hello, sir. How are you feeling?

946. Like crap.

947. When did your palpitations start?

948. A little while ago.

949. We interrogated his smartwatch.

950. His heart rate has only been up for 92 minutes.

951. You understand we need to shock

952. - your heart back to normal? - Is it gonna hurt?

953. - You'll be sedated. - So it's really gonna hurt.

954. Mel, 75 of propofol, slow IV push.

955. How much did you vape last night?

956. - A couple of pods. - You vape every day?

957. I do, but not that much.

958. - You want to cut back? - I've tried.

959. It's just really fucking hard.

960. How much nicotine is in a pod?

961. - Anybody know? - No idea.

962. 40 milligrams, same as a pack of cigarettes.

963. Wow, two packs in one night.

964. Mel, what's the safe window for cardioversion?

965. - 12 hours. - What happens after that?

966. Increased risk of embolic stroke

967. from left atrial blood clot.

968. Which he does not have.

969. Mr. Quinn. Mr. Quinn.

970. OK, he's out.

971. Sync cardioversion at 200 joules.

972. - Charged. - Clear.

973. - Bingo. - Sinus rhythm.

974. Cycle BP.

975. We'll monitor for a few hours.

976. Yeah, let's get addiction services on the case too.

977. He's gonna need a daily patch

978. and nicotine gum for breakthrough cravings.

979. This one's a bitch to kick.

980. Hey, the sister of Abbot--

981. Shit, yes. Shit, yes, yes.

982. Go get 'em, tiger.

983. Are you Mr. Orser's sister?

984. - Fiona. - Hi, Fiona.

985. I'm Dr. Robinavitch.

986. Everybody calls me Dr. Robby.

987. Have a seat, please, and I will tell you

988. everything that's happened.

989. Are you looking for something in particular?

990. Anything with a very low potential for mortality.

991. Mm-mm. You're not playing that game.

992. Only thing I'm playing is let's keep the patients alive.

993. Uh-huh, well, now we're playing face your fears.

994. That sounds like a terrible game.

995. What up there scares you the most?

996. - All of it. - Pick the worst.

997. South 20.

998. 82-year-old woman, low back pain.

999. I mean, that's potential leaking AAA,

1000. cauda equina syndrome, spinal epidural abscess.

1001. That could go wrong in so many ways.

1002. Not today, amigo.

1003. We're gonna work this lady up like a race car.

1004. What does that mean?

1005. It means you're on the pit crew now.

1006. Come on.

1007. Are you ready to go inside?

1008. No, not really.

1009. I'll be with you.

1010. You can decide when you want to leave.

1011. You're so cold.

1012. I'm sorry.

1013. I'm sorry I wasn't here with you.

1014. But I'm here now.

1015. Wherever you are.

1016. I don't know what the world is without you.

1017. I really can't look at this letter.

1018. Would it be too much to ask you to read it to me?

1019. Oh, I'm sorry.

1020. That's an inappropriate request.

1021. No, not at all, not at all.

1022. I'd be honored by the request.

1023. "To the family of Raymond Orser,

1024. "my name is Dr. Jack Abbot.

1025. "I am the emergency department physician who treated Raymond.

1026. "I, like Ray, am also a veteran.

1027. "And though I never met Raymond before today,

1028. "I served with men like him.

1029. "So I can only imagine what an outstanding person

1030. he must have been."

1031. "I'm sorry I could not save Ray's life.

1032. "We worked on him for several hours,

1033. "but his injuries were too severe,

1034. "even for someone as tough and battle-tested as Raymond.

1035. "Please take some comfort in knowing he did not suffer.

1036. "You have my heartfelt condolences.

1037. Jack Abbot."

1038. - Thank you. - You're very welcome.

1039. Again, I'm very, very sorry for your loss.

1040. Where do you think you're going, Myrna?

1041. Oh, none of your business, fruitcake.

1042. Actually, everything that happens in this department

1043. is my business. And you know what?

1044. I put up with a lot around here.

1045. I take very good care of you,

1046. so you can call me Dr. Robinavitch,

1047. or you can call me Dr. Robby,

1048. or you can use my first name of Michael,

1049. but I do not appreciate you calling me fruitcake.

1050. Oh, did I hurt your feelings, cocksucker?

1051. That said, it has a certain whimsical quality

1052. to it that I can probably learn to live with.

1053. Whatever you say, fruitcake.

1054. Excuse me, Doctor, my father is starting to struggle again.

1055. OK.

1056. Don't you know those things will kill you?

1057. I'm not that lucky.

1058. Ow!

1059. What the fuck?

1060. Hey, they're stealing our rig!

1061. Did you leave the keys in it?

1062. Always, in case somebody needs to move it.

1063. Yeah, you probably shouldn't have done that.

1064. Why don't you come on inside, Ziggler?

1065. - We'll look you over. - I'm fine.

1066. Fuck that.

1067. God, can you believe that shit?

1068. It happens.

1069. What can you do to make him more comfortable?

1070. We can take the tube out.

1071. But he needs that to breathe.

1072. If we extubate, we would keep him on oxygen for comfort.

1073. We would decrease his sedation.

1074. He might regain consciousness. He could recognize you.

1075. Maybe even speak.

1076. Well, I don't want to do anything to jeopardize

1077. - him getting better. - That's just the point, Helen.

1078. He's never getting better.

1079. - You don't know that. - I do know that, OK?

1080. He knows that.

1081. And Dad probably even knows it.

1082. It's time to let him go.

1083. I'm sorry if you've had your fill of Dad,

1084. but I haven't, and I am not giving up on him.

1085. Even if it's hurting him?

1086. I'm sorry, but if there was anything I could do

1087. to heal your father, I would do it.

1088. But the most humane thing that I can do for him

1089. is to allow him a painless, peaceful passing,

1090. and that requires removing the breathing tube.

1091. How long will it take once the tube's out?

1092. From minutes to hours,

1093. but we would ensure that he'd be in no physical discomfort.

1094. OK.