The Pitt 1x4

1. What the hell is going on out there?

2. - Somebody stole the rig. - Again?

3. Hey, where do you guys think you're going?

4. We'll be back in two minutes max.

5. Antoine is going to show us his new motorcycle.

6. Great. We always need organ donors.

7. Yeah, someone stole your rig.

8. Yeah, you weren't watching the screens?

9. How'd you miss it? - Oh, I saw it pull out.

10. But I figured you were in it. Why'd you leave the keys in it?

11. - It's protocol. - No, it's not.

12. That's what I said.

13. Yes, it is.

14. And I—who steals a fucking ambulance at 10:00 a.m.?

15. Easy—junkies, meth heads,

16. thinking they just stole the candy store.

17. Or a psych patient kicked loose last night.

18. Y'all don't know. That thing is getting

19. stripped, chopped, and shipped.

20. That's a pro job. - Shut the fuck up.

21. Maybe another driver took it. Did you call your dispatch?

22. Of course we called our dispatch.

23. Did you call the cops? - I can,

24. but there are two having breakfast in the cafeteria.

25. Help yourself.

26. Hey.

27. I'm good. Thanks.

28. Protocol.

29. Come on.

30. I'd put $20 on the psych patient.

31. Oh, I'll take that action.

32. Hey, do we have crutches?

33. Yeah, ortho locker just restocked.

34. Okay, great.

35. Can you bring back Sherry Davis next?

36. Sterno mom with the hand burn?

37. - Mm-hmm. - She split.

38. Shit. When?

39. I gave the kids two breakfasts each

40. off the boarders' cart, and they left.

41. In school probably?

42. Did she say anything about coming back for wound care?

43. Not to me.

44. Fuck.

45. I need rooms cleared and cleaned,

46. so I'm shuffling the deck.

47. Yeah, but why are you moving him into Pedes?

48. I'm just about to extubate him.

49. There's no kids in there at the moment.

50. The family can have some privacy.

51. There's nice pictures on the wall.

52. What's the problem?

53. There's no problem.

54. Mrs. Smith does not need a cardiac monitor.

55. She can get her Vanco in the hall.

56. We've got one tele-bed available.

57. Let's give it to Otis before someone else snags it.

58. - Yep. - Leave the family

59. in Central 7 alone until nuclear medicine

60. is ready to take the kid.

61. There's no sense in moving them twice.

62. Aye-aye, Cap.

63. Hey, Robby.

64. You're going to extubate? - Yes.

65. Good. You shouldn't have intubated.

66. Yeah, I remember you saying that,

67. just like it was this morning.

68. You want me to do it?

69. No, why?

70. Adamson.

71. - Jesus! - Okay.

72. There's something moving in there!

73. - Ma'am, hold still. - Get it out!

74. I can't help you if you keep moving your head.

75. Get it fucking out!

76. I can feel it!

77. Arthropod in the EAC.

78. Oh, my God.

79. I better get in there.

80. Yeah.

81. How long will he live without the oxygen?

82. It's difficult to say.

83. Once the tube comes out, it could be anywhere

84. from 30 minutes to several hours.

85. When I extubate, we're gonna suction the back of his throat.

86. We're going to give him some glycopyrrolate drops,

87. which will cut down on his secretions.

88. He'll get morphine for any pain.

89. And we'll give him some oxygen in his nose

90. as a comfort measure.

91. Jesus.

92. I don't—I don't think that I can go through with this.

93. I mean, this— this is happening?

94. Like, now? Like—like, today?

95. We—we just decided that Dad is gonna

96. die in this room,

97. in a room with cartoon forest animals all over it?

98. If you think about it, it's kind of perfect.

99. Our—our dad worked on "Mister Rogers' Neighborhood"

100. the whole time that we were growing up.

101. Oh, no kidding. That's very cool.

102. "Mister Rogers," the television program?

103. - That's right. - Here in Pittsburgh?

104. At WQED on Fifth Ave for 33 years.

105. Dad worked with Jack Guest, the art director.

106. So he helped, um,

107. paint and build all those sets.

108. I don't think that I can do this.

109. Okay.

110. Just to be clear, your father is dying,

111. and you're choosing to allow that to occur naturally,

112. rather than subject him to a torturous amount

113. of procedures, which would only delay the inevitable.

114. I just thought that it would be different.

115. And I thought that there'd—

116. we'd have more time.

117. Is your family religious?

118. Oh.

119. God, no.

120. No God.

121. I had a teacher, mentor,

122. who told me about a Hawaiian ritual

123. called ho'oponopono,

124. or "the four things that matter most."

125. It's basically just a few key things

126. that we can say when we're saying goodbye

127. to a loved one that can really help

128. at the early stages of loss.

129. What are they?

130. They're gonna sound really simple,

131. but I swear I've seen them work.

132. Okay.

133. I love you.

134. Thank you.

135. I forgive you.

136. Please forgive me.

137. That's—that's it?

138. Yep.

139. Told you it was simple.

140. Okay.

141. Mr. Spencer, I'm gonna take this tube out

142. of your throat now.

143. What I want you to do is to take a very deep breath.

144. Breathe in.

145. And now blow it out.

146. There we go.

147. Okay.

148. Okay.

149. I'm gonna give you some oxygen in your nose.

150. A couple drops under your tongue.

151. You okay?

152. Tired.

153. You can rest.

154. Close your eyes if you want.

155. Your children are here.

156. Uh, Dad, you just— you just rest, okay?

157. We're right here.

158. I'm right here.

159. Come find me.

160. Okay, take a deep breath for me.

161. Jesus, everybody's going to this concert tonight.

162. I wonder if there's any decent passes left.

163. Another deep breath.

164. Oh, my God, Jenna.

165. You're never gonna believe who DM'd me.

166. I fucking told you this would happen.

167. I'm sure Jenna is happy you're here to support her,

168. but perhaps you could wait outside until we finished.

169. Excuse me?

170. Excuse me, I'm in the middle of an examination.

171. Yeah, and I'm gonna stay with my friend for as long

172. as she needs me.

173. I'm the one who brought her here.

174. Gold star for you.

175. Hey. It's fine. I'm fine.

176. - Are you sure? - Yeah.

177. Thank you.

178. I wanted her to leave.

179. How are you doing?

180. I called Nick's dad an asshole

181. and told him to go ask his son.

182. Why would I say that?

183. Uh, why don't you tell me about school?

184. What are you studying?

185. What?

186. Do you do any sports?

187. Are you into any extracurricular activities?

188. I don't—

189. I don't know why you're asking me that.

190. Well, it's important that you focus on the good things

191. in your life right now.

192. How?

193. A boy—a very sweet boy

194. that I barely even knew is dead.

195. And I just fucking made it worse.

196. You just need to—

197. And his father thinks I killed him,

198. and you're asking me if I play sports?

199. Jenna, Jenna, I can tell how upset you are right now.

200. I see how painful this is.

201. We don't even do drugs.

202. We were studying. I mean, how does that happen?

203. I can't imagine how hard this must be for you.

204. I just really want to go home.

205. Well, your vitals are excellent.

206. When your parents arrive, they can take you.

207. Thank you.

208. We're here if you need anything.

209. Oh, well, that went south.

210. A couple of observations?

211. Please.

212. How thin is your skin?

213. - Rhino. - Good.

214. Distraction is a terrible strategy.

215. When a patient says, "I'm hurting,"

216. we don't respond, "What's your major?"

217. Oh, I wasn't trying to diminish—

218. Additionally, "I" statements work better

219. than "you" statements.

220. "I can see how painful this is" acknowledges

221. the reality of the situation and invites

222. further examination.

223. "You need to move on" has the opposite effect.

224. Understood, but in my personal experience—

225. Your personal experience isn't germane here.

226. Germane?

227. Relevant, pertinent, appropriate.

228. Well, I respectfully disagree.

229. My life gives me a perspective that's—

230. Are you aware you have an aggressive energy, Trinity?

231. Even this conversation feels confrontational.

232. We bring our education to the job, not our baggage.

233. Got it.

234. Thank you. Will do.

235. Good news or bad news first?

236. What's the good news?

237. Ear canal is numb.

238. Simple flush with saline will fix the problem.

239. What's the bad news?

240. You've got a dead bug in your ear.

241. A cockroach.

242. We were in here for maybe 35, 40 minutes, tops.

243. I go outside, it's gone.

244. Seriously, there's nothing on the radio?

245. Not yet. The keys were inside?

246. Yes, I leave them in there in case somebody needs to move it.

247. You're not supposed to leave the keys.

248. That's what I said.

249. You take the keys so nobody steals it.

250. So what the fuck is security for?

251. Oh, I'm about to show you.

252. - Oh, yeah? - Hey, guys,

253. can we congregate somewhere else?

254. Give a little room. We got a new guest checking in.

255. Guys, Ahmad, we got to keep this area clear.

256. Everybody, please. - Hey, 5 bucks on "Chop Shop."

257. Wendell Stone, 52, chief rigger from Pitfest.

258. Isolated trauma— - Get Cecil and Tony.

259. To the left chest—

260. Tell them to bring their guys.

261. When a speaker tower came down on him.

262. Looks like multiple rib fractures.

263. Pulse 110, BP 130 over 85—

264. They gotta go back over everything.

265. Decent sats at 96.

266. 50 of fent in the field. - Got it?

267. How we doing, Mr. Stone?

268. Mr. Stone was my dad.

269. Just Stone.

270. Damn.

271. They woke the Kraken.

272. When's he due for his next round?

273. 40 minutes ago.

274. Perfect.

275. Mr. Driscoll?

276. Mr. Doug Driscoll?

277. About fucking time.

278. See you later, suckers.

279. Excuse me. - Sorry.

280. "Jiya" Yi Chen?

281. I have some Tylenol for "Jiya" Yi Chen.

282. Yes, please.

283. Over here.

284. Jia Yi.

285. Jia Yi Chen. Here you go.

286. How much longer until we can see the doctor?

287. Uh, we have to wait for a bed to open up.

288. Might be a little while.

289. Pretty popular today.

290. The medicine should help.

291. Four of morphine.

292. No abdominal tenderness.

293. - What have we got? - What have we got?

294. Jinx, you owe me a Coke.

295. - Isolated chest trauma with— - Stop.

296. I want to hear from Dr. Santos.

297. Isolated chest trauma with obvious flail chest.

298. No hemopneumo on POCUS.

299. Good sats and vitals.

300. Excellent presentation.

301. Sir, I'm Dr. Garcia from Surgery.

302. I need surgery?

303. Not necessarily.

304. No blood in the belly on FAST.

305. You got this?

306. Abdomen is benign.

307. CT chest, abdomen, pelvis with contrast,

308. which I trust way more than your ultrasound skills.

309. And more morphine, for God's sake.

310. No, no, no, no. Don't knock me out.

311. I gotta stay on top of the crew doing the put in.

312. - The what? - The festival.

313. We'll block all the nerves going to the broken ribs.

314. Roll to the right.

315. You'll be awake and pain-free.

316. Yeah, that's what I'm talking about.

317. That's a ton of intercostal blocks.

318. Nope, one shot.

319. Serratus anterior blocks down to T-9.

320. You kids and your crazy regional blocks.

321. Dr. Santos, call me with the CT results.

322. Extension 1121.

323. Gabe's the same age that I was

324. when we made our first layout.

325. You remember that, Dad?

326. The—the two level track in the basement

327. of the Clovis house?

328. - O. - That's right.

329. Yeah, it was an O gauge.

330. It limited the cars we could use, but...

331. That layout was a beauty.

332. Hmm.

333. Doctor, does that sound he's making

334. mean it could be any minute?

335. No, no.

336. It just means that he's having trouble

337. handling his secretions.

338. Mr. Spencer, this should help.

339. I'm also going to give you a scopolamine patch

340. behind your ear.

341. That will cut down on his secretions

342. for the next 24 hours.

343. Do you think he has 24 hours?

344. There's really no way to know.

345. Let's give another two of morphine.

346. Repeat PRN.

347. We're going to give him something

348. to keep him comfortable.

349. Doctor, what were those four things again?

350. I love you. Thank you.

351. I forgive you. Please forgive me.

352. That's easy.

353. I love you, Dad.

354. I've loved every minute we've gotten to spend together.

355. Thank you.

356. You're the best dad a boy could have wanted.

357. You—you never missed a game.

358. You always made time for me to play catch

359. or to build models or—

360. When you helped me with my homework...

361. Or when we would wake up

362. before everybody else—

363. And make sandwiches.

364. Be right back.

365. They spotted it.

366. East on 376.

367. Ho, ho!

368. Oh, let's go.

369. It is on now.

370. $15 on crash, another $5 on junkies.

371. Give me $8 on catch with another—

372. Uh-uh-uh.

373. Multiples of 5 only.

374. I'm not touching your stripper bills.

375. Yo, what's that shit?

376. Hey!

377. Wanna keep it down?

378. This is a hospital, not Rivers Casino.

379. Keep talking. I'ma find Robby.

380. Mm-hmm.

381. I'm alive!

382. Psych wanted to transition him to oral meds.

383. There's an order for an olanzapine tablet at 9:30 a.m.

384. Yeah, that's on us.

385. I've been with criticals all morning.

386. He needs to go upstairs to behavioral health.

387. We're too busy down here to dispense

388. psych meds on a schedule.

389. Understood.

390. What options are we left with?

391. Either we let him tire himself out,

392. or we go in and stick him.

393. I'm worried he's gonna hurt himself.

394. He's in partial soft restraints.

395. What we really need is a Pavulon blow dart.

396. Hold it.

397. You caught me!

398. And I was almost over the wall.

399. Go easy on me, warden.

400. I need an order for an agitated psych patient.

401. Been here for days.

402. Methamphetamine induced psychosis.

403. The Kraken?

404. We really shouldn't call him that.

405. How about a B-52? - No, no, no.

406. That would take way too long, tie up the staff.

407. QTC? - Normal.

408. Five of midazolam, five of Haldol, and Mister—

409. Krakozhia.

410. - You're joking. - No.

411. Mr. Krakozhia will be out like a light in under a minute.

412. It hardly seems as offensive

413. to call him Kraken if his name is actually—

414. - Irritable five-month-old. - Clearly.

415. I'll be right there.

416. Um, I need more coffee.

417. You doing okay, Cap?

418. Yeah, why?

419. Can't have you going over the wall.

420. Tomas Cordera, Mr. Tomas Cordera,

421. please come to the window.

422. I have your insurance card.

423. Tomas Cordera.

424. Yes? - Cordera.

425. It's actually Tasha Cordera, and "Ms."

426. Okay.

427. Do you want to come on back?

428. Go through those doors.

429. You cut your arm?

430. - Yes. - Okay.

431. No problem.

432. Hi.

433. I'm Dr. McKay.

434. This is Victoria Javadi, student doctor.

435. Hello. Tasha.

436. Hi.

437. Sorry for the long wait, Tasha.

438. Do you mind if I take a quick peek?

439. - Yeah. - Okay.

440. All right.

441. Not too bad.

442. Definitely gonna need a few stitches, though.

443. Why don't you come on back?

444. And we'll get you patched up, okay?

445. All right.

446. Okay.

447. How big is the pneumothorax?

448. Got it. Thanks.

449. What's a pneumothorax?

450. Uh, just a little air leaking

451. from the big bruise in your lung.

452. Oh.

453. Getting short of breath here.

454. Pain?

455. No, all that's gone.

456. Good. The block worked.

457. Sats are down to 85 on 5 liters.

458. His lung contusions need some help.

459. Start BiPAP, 10 over 5.

460. That'll open up the bruised parts of your lung.

461. Thanks.

462. Good news is, you don't need surgery,

463. but I'll let Dr. Garcia know about the CT.

464. Oh. She likes you.

465. I met her two hours ago.

466. Must have made a strong first impression.

467. Any fever, vomiting, or cough?

468. None of that.

469. Good feedings?

470. Was she full term at birth?

471. Normal delivery.

472. Childhood vaccines?

473. Um, yeah, two months and four months.

474. To get an accurate temperature—

475. What's your differential diagnosis?

476. Gotta rule out the worst first.

477. We need to check with a rectal thermometer.

478. Is that really necessary?

479. It's really important.

480. Ooh, I know.

481. I know.

482. We gotta rule out any serious bacterial infection,

483. sepsis, pneumonia,

484. pyelo, appendicitis, meningitis.

485. You think she has meningitis?

486. No, we're just discussing hypothetical possibilities.

487. Temp 99.2.

488. Making meningitis extremely unlikely.

489. Heart rate 164, sats 99.

490. This is Dr. Robby, our senior physician.

491. Hi, nice to meet you.

492. Hi, hi.

493. Afebrile, alert, good vitals.

494. Doctors Mohan and King were

495. just about to start their physical.

496. Why don't you go check on our students, and I'll handle this?

497. Mm-hmm.

498. Oh.

499. So why are you sticking me again?

500. You came in an hour after the chest pain.

501. If it's a heart attack, it can take

502. more time for the heart damage to show up in the blood—

503. put your finger on that—

504. even with the normal EKG.

505. That's why we repeat the test.

506. Lift your arm up.

507. Thank you.

508. All right, let's get you back to the waiting room.

509. - What? No. - Yeah.

510. No, all I've been doing is waiting.

511. I'm supposed to see a doctor now.

512. Soon.

513. I'll let you know.

514. This is a fucking joke.

515. Yeah, it's good to laugh.

516. Laughing our way to being a third world country.

517. Remind you of home?

518. Okay, I know we're not supposed

519. to pick favorites here.

520. I'ma keep my eye on you.

521. Yeah.

522. You do that.

523. Oh, yeah.

524. So, Tasha, it was a decanter?

525. A beautiful Baccarat carafe.

526. I was, uh, showing a colleague how to polish it,

527. and the neck broke with my arm still inside—

528. - Mm. - So not my finest.

529. Did it shatter?

530. No, no, it cracked cleanly in two.

531. But as a reflex, I jerked my arm back,

532. and that's what did it.

533. Reflexes, I have regretted a few of my own.

534. Good. Now inject to other side.

535. Single layer, straight edges,

536. about as straightforward as it gets.

537. Oh, good. That's a relief.

538. What's going on?

539. Hypoxic to 78.

540. BP's crashing.

541. Systolic's 82.

542. Pulse is thready.

543. I should intubate.

544. Does he need a massive transfusion protocol?

545. No. Absent breath sounds on the left,

546. tracheal deviation to the right.

547. 14 gauge angiocath now.

548. Put him on a non-rebreather.

549. What are you doing?

550. Tension pneumothorax from the BiPAP's positive pressure.

551. You hear that?

552. Who the hell ordered BiPAP? Garcia?

553. No, his—his sats were down.

554. I did.

555. You did?

556. Without running it by me?

557. Can I put in a chest tube?

558. He doesn't need a chest tube.

559. He needs a pigtail catheter.

560. And I'll be doing it.

561. Sats and pressure both coming up.

562. Draw up 75 of ketamine.

563. Why is she still crying?

564. Fontanelle soft and flat.

565. Pupils equal and reactive, tracking across midline.

566. Dr. Mohan, keep it focused, please.

567. Mucous membranes nice and moist.

568. Hard to hear over the crying, but lungs are clear.

569. Heart rate's tachy but normal.

570. Soft abdomen, no obvious signs of tenderness.

571. - So basically a normal exam. - Then what's wrong?

572. Give us a little time to finish our exam.

573. Yeah, I know. I know.

574. What am I looking for, Dr. King?

575. Uh, cellulitis?

576. Edema from nephrotic syndrome?

577. - Diagnosis made. - What is it?

578. Hair tourniquet.

579. Mother's wet hair can wrap around the toe multiple times.

580. When it dries, it tightens and cuts off circulation.

581. My hair?

582. I—I showered before nursing her.

583. Easy to miss, Mom.

584. But we caught it early, so there won't be

585. any permanent damage to the toe.

586. Treatment, Dr. Mohan?

587. Uh, it's too tight for scissors.

588. Do we have Nair? - We do indeed.

589. Nair? Like from the drugstore?

590. 10 minutes, should dissolve it right off

591. and stop the crying.

592. Hey, you're okay.

593. What's up?

594. We're gonna give the wild one a shot.

595. Have the order, meds on the way,

596. but we need bodies.

597. I call the head.

598. I got kicked last time. - Right arm.

599. - Left arm. - Right leg.

600. - Need one more. - Uh, two more.

601. I'm just here to observe and speak with the patient

602. once he's under control. - Oh.

603. Hey, Robby!

604. Can—can you help us with Mr. Krakozhia?

605. - No. - Coward!

606. Whitaker— just the man we need.

607. Come over here, please.

608. Whoa, what did I miss?

609. A little drama from a tension pneumo.

610. You could have called me.

611. - We got it under control. - Good.

612. And Dr. Santos learned what can happen

613. when you put a patient with a small pneumothorax

614. on BiPAP. - Ah.

615. Thumb scalpel.

616. He was hypoxic. I thought it would help.

617. But you didn't discuss it with me,

618. and he almost died. Dilator.

619. You need to run every order by a senior resident or attending.

620. That's why it's a four-year program.

621. Now, when you do this procedure,

622. you want to make sure to never, ever lose this guidewire.

623. That gets sucked in the chest, you're screwed.

624. Now, ready for the pigtail.

625. What the hell are you doing?

626. Pneumo is tiny. It'll resolve spontaneously.

627. Yeah, it was tiny until the patient went on BiPAP.

628. Are you fucking kidding me?

629. Guidewire out.

630. His sats were down.

631. I—I gave the order.

632. Without clearing it with me.

633. Honest mistake from the rookie.

634. That's how we learn.

635. If she knew everything, she'd be your attending,

636. not an intern.

637. That is very true.

638. Besides, it could have happened on its own

639. without the BiPAP.

640. Wow. Beautiful moment.

641. A lot of love in the room.

642. If you'll excuse me.

643. Nice save.

644. It's Wheeler.

645. Dr. Abbot said to come back at 6:30,

646. and he'd still be here, but we overslept.

647. I forgot to charge my phone.

648. I'm really sorry.

649. Okay, let's see.

650. Wheeler, Kristin?

651. It—it's Kristi, and—

652. and I'm her mom.

653. Dr. Abbot went off duty at 7:00,

654. but that's no problem.

655. We'll get you back.

656. Have a seat until we call your name.

657. - Okay. - Thank you.

658. - Thank you so much. - You're welcome.

659. Next.

660. - How you guys doing? - Good, thanks.

661. We missed our appointment, but otherwise, we're fine.

662. Oh, no.

663. Have you been here long?

664. I've been here about four hours.

665. Oh.

666. We were here two nights ago.

667. We waited seven hours.

668. Hmm.

669. It's all bullshit.

670. Can't believe somebody hasn't died out here.

671. How we doing?

672. No change.

673. I—I've been doing all the talking.

674. Do you want to...

675. say some things?

676. What is there to say?

677. I'm sad.

678. I'm angry.

679. I don't want him to go.

680. There's so much that I wish were different.

681. It's not fair.

682. Tell him.

683. I am telling him.

684. I'm telling both of you.

685. It's not fair.

686. I wanted what you had.

687. I love you, Dad.

688. And I'm thankful for everything you did to provide for us.

689. But you weren't the dad I wanted, because I didn't—

690. I didn't play baseball or build models or fish.

691. My friends' dads all had grown-up jobs.

692. They didn't tell silly jokes or talk in character voices

693. or make up stories.

694. I was embarrassed, and I—

695. I didn't want my friends to meet you.

696. - Helen. - It's true.

697. I'm ashamed to admit it, but it's true.

698. I left for college, and I—

699. I stayed away.

700. I could have gone fishing.

701. I should have gone fishing.

702. And I'm—I'm curious now.

703. And I forgive you, Dad, for not being the man

704. that I wanted you to be.

705. But I am—

706. I am so grateful that you weren't.

707. The world needed you to be exactly as you are.

708. It got—it got serious, and—

709. and it turned ugly.

710. And you and your friends built

711. the Neighborhood of Make-Believe.

712. What an incredible gift.

713. Oh, Daddy.

714. I am so sorry.

715. Please, please forgive me.

716. Come find me when it's time.

717. No news chopper coverage.

718. No eye in the sky.

719. Not even a damn drone.

720. No mystery here.

721. The cop said east on 376.

722. They're headed to Swissvale.

723. I have a cousin in Swissvale.

724. Says it's crazy.

725. Fellas, they are not going to Swissvale.

726. They're crossing the line. Canada, baby.

727. That's the other way, genius. See, I'm taking all your money.

728. - No, you're not. - You're taking his money.

729. You think so?

730. I'm breaking up this sewing circle.

731. Antoine, you're supposed to be in triage.

732. Dennison needs a knee immobilizer and crutches.

733. Go on.

734. Paolo, take postural vitals on Thorpe in North 5,

735. and a repeat potassium draw on Fontaine in South 18.

736. Larry, you're coming with me.

737. Okay, we have a quorum.

738. Meds finally here? - Yep.

739. Guy's got some energy. - Let's do this.

740. Donahue, right leg. Larry, left leg.

741. Kim, right arm.

742. I call left arm. Perlah takes the head.

743. And our young man here will inject. Clear?

744. - Yeah. - Pulse ox?

745. - Right here. - Good luck.

746. IM injection to the mid-anterior left thigh.

747. Everybody ready?

748. Yo, Whitaker.

749. You play any ball?

750. What, football?

751. No, dodgeball.

752. Of course football.

753. Yeah, some peewee.

754. You know, I was actually a pretty good kicker.

755. Not helpful.

756. Look, Larry and I are gonna block for you.

757. Come in right behind us.

758. When we split and go for his legs,

759. you go right up the middle.

760. End zone, baby. - Okay, yeah.

761. Got it. - Okay.

762. You ready?

763. One, two, three.

764. Okay, Mr. Krakozhia, we're here to help you.

765. We're here to help you— oh, God!

766. What do I do? Ahh!

767. Shit.

768. Ahh!

769. Oh.

770. That's it.

771. Congrats, kid.

772. You just earned your yellow wings.

773. Okay, midazolam will take him down in a minute.

774. We'll monitor him for 20.

775. After that, the Haldol will have kicked in.

776. Yeah, he's settling down now.

777. Do I really need to be here for 20 minutes?

778. Why? You got a date?

779. - I mean, I'm covered in— - I'm kidding.

780. Thanks for your help.

781. Go get cleaned up.

782. Okay. Thanks, everyone. Good work.

783. I know I don't need to say it, but let's try

784. to stay on top of Mr. Krakozhia's med schedule.

785. - Ugh. - Sorry.

786. Yeah, thanks.

787. Can I help you get new scrubs?

788. Oh, no, it's good. I'm gonna...

789. Uh, thank you for the offer, though.

790. So, Tasha, you work in a restaurant?

791. No, take it in two bites.

792. - Okay. - Rotate your wrist.

793. Follow the curve of the needle.

794. Exit at 90 degrees, same distance from the wound.

795. Good.

796. Yes, I'm the sommelier at Altius.

797. Oh, Altius is supposed to be amazing.

798. Sorry. What—what is it you do?

799. I'm the sommelier, the wine steward.

800. Ah.

801. We have the best cellar in the city.

802. I don't mind bragging.

803. Ah, it sounds like a great gig.

804. Do you have to go to school for that?

805. Oh, my. Yeah.

806. Yeah, I have a degree.

807. - Mm, cool. - Okay.

808. How's that?

809. Really good.

810. First tie is a surgeon's knot.

811. Wrap the suture twice.

812. Grab the short end.

813. Pull with just enough tension.

814. Bring the wound edges together.

815. Not too tight or she'll have railroad tracks.

816. So, Tasha, what's your favorite wine you've ever tasted—

817. or most expensive?

818. Same answer for both—

819. a 2011 Domaine de la Romanée-Conti.

820. Three more instrument ties.

821. Great.

822. Square knots, single wrap around the needle driver.

823. Is that French?

824. As French as it gets,

825. a burgundy. - Ah.

826. And how much does that cost?

827. I sold that bottle for $18,000.

828. Not here.

829. That was in New York.

830. Are you kidding?

831. 18 grand for a bottle of wine?

832. I mean, was it really that good?

833. Life changing.

834. And I know something about life changing.

835. Maybe one day.

836. I'm still not old enough to drink—legally.

837. That's a little scary.

838. And I'm about 18 grand short and a friend of Bill's,

839. so I'll have to take your word for it too.

840. My only extravagance these days is moisturizer.

841. I hear you.

842. Jenna, I have some people here to see you.

843. - Jenna, oh. - Oh, my God.

844. Hi.

845. Oh, my God. I'm glad you're okay.

846. I'm so sorry.

847. I have no idea how this happened, I swear.

848. Is she, um—

849. Yes, she's cleared medically. You may take her home.

850. Here's some discharge instructions,

851. but no more pills unless they're

852. from a doctor or pharmacy.

853. Yeah. I won't.

854. We're giving you some fentanyl test strips.

855. These work on pills and liquids.

856. And this is a Narcan spray.

857. Please, just keep it in your purse just in case

858. if you're at a party, and someone's out of it.

859. Yeah, thank you.

860. You realize how lucky you are?

861. Yes?

862. Yeah, I—I do.

863. Mr. and Mrs. Bradley, I just spoke to nuclear medicine,

864. and they are ready to take Nick

865. for the cerebral perfusion study test in a few minutes.

866. Can we stay with him?

867. Absolutely.

868. The test itself involves radiation imaging,

869. so you'll have to wait just outside the door.

870. But Dave will take you down.

871. I'll show you where you can be.

872. He'll also bring you back here.

873. The results take about an hour or so,

874. and I'll come find you when I get them.

875. And we'll take it from there.

876. Thank you, Doctor.

877. Okay.

878. So sorry to keep you waiting.

879. I'm Dr. Heather Collins.

880. You must be Kristi and Lynette Wheeler?

881. - Yes. - Yes.

882. We were supposed to see Dr. Abbot.

883. Yes, Dr. Abbot is an amazing physician,

884. but even he needs sleep occasionally.

885. I guess I just got tired.

886. And I forgot to charge my phone,

887. and we overslept. - Mm.

888. I use an old-fashioned alarm clock since med school.

889. Never fails.

890. That's what I have at home.

891. I just forgot to bring it.

892. Okay.

893. I see we're doing a medication abortion today, correct?

894. Yep.

895. Well, since I didn't initially assess you,

896. do you mind if I ask a few questions?

897. Get up to speed?

898. No.

899. Thanks.

900. Is this your first pregnancy?

901. Yes.

902. And you're 17?

903. When did your last menstrual cycle start?

904. Um, I'm not exactly sure.

905. End of June—

906. 23rd maybe?

907. Any allergies to medication?

908. No.

909. Any surgeries in the past?

910. No.

911. I need to do another quick ultrasound

912. to make sure everything is okay for the medication.

913. Do you want to put on a gown

914. to make sure you don't get gel all over your clothes?

915. Okay.

916. I'll be right back.

917. Thank you.

918. Joyce, our sickler, is doing well

919. on the exchange transfusion.

920. Awaiting a telemetry bed.

921. Quinn, the midnight vaper,

922. is still in sinus after cardioversion.

923. Uh, four hours of cardiac monitoring starting now,

924. and you can discharge him.

925. Our Good Samaritan's hanging in,

926. stable vitals and neuro checks.

927. Yeah, I want to get a repeat head CT in an hour,

928. rule out any increased bleeding.

929. And Mr. Gold was stool positive for campylobacter,

930. has gone home on azithromycin.

931. Well, I hope he loads up on water and electrolytes.

932. The guy filled up half a dozen bedpans.

933. Must be a record.

934. Without sounding like a broken record,

935. everything okay with you?

936. That's your third cup before 11:00.

937. Yeah, I'm not sleeping great.

938. It's fucking with me a little bit.

939. But I've got four days off next week.

940. I think I'm gonna get out of Dodge and head for the hills.

941. I wish you would. What'd Shakespeare say—

942. "Physician, heal thyself"?

943. What? Have you been talking to Collins?

944. Not Shakespeare.

945. Luke, the disciple,

946. who probably heard it from Paul the Apostle.

947. But what do I know? I'm Jewish.

948. It's not my book.

949. Shakespeare had nothing to do with it, though.

950. Yeah.

951. Maybe a little time off would be good.

952. Oh. You have everything?

953. Yeah, I think so.

954. Is that—

955. Yeah.

956. Let's go, sweetheart.

957. Wait. Um, Mr. Bradley?

958. I just wanted to apologize for the way I spoke to you.

959. Please wait. Please.

960. There's no excuse.

961. I was gonna ask a nurse to give you this,

962. but it's my number and email.

963. If I can ever be of any help in any way, please.

964. I don't know who you are.

965. - Oh. - Oh.

966. I'm sorry. I'm Jenna.

967. I met Nick at orientation, and he was really sweet.

968. We were in the same econ class,

969. and we had this really big test coming up.

970. So some of us made this kind of study group.

971. And we'd stay up way too late drinking coffee

972. and then have a really hard time falling asleep.

973. And one girl said

974. she knew how to get Xanax,

975. but was too afraid to go pick it up.

976. Nick was just being nice when he said he'd do it.

977. I am so sorry.

978. I really hope he pulls through this.

979. I'm praying he pulls through this.

980. He will.

981. Uh, yeah.

982. Thank you.

983. You should go.

984. I'm sure your parents want to take you home.

985. All right. Come on.

986. Sorry about earlier.

987. I think I still have a lot to learn.

988. You do.

989. Looks good.

990. Nice job, Doc.

991. Thank you for the trust.

992. Now keep it clean and dry,

993. and we'll see you for a wound check in two days.

994. You did great. I didn't feel a thing.

995. Sutures out in a week, but come back sooner

996. for any redness, fever, or drainage.

997. Okay? - Okay.

998. Thank you.

999. Um, I couldn't help but notice.

1000. There's a misgendering error on your chart.

1001. I'm really sorry about that.

1002. I've gone ahead and fixed it here

1003. and on your insurance data file,

1004. but it shouldn't happen again.

1005. Wow.

1006. I am...

1007. Thank you.

1008. Truly.

1009. Thank you both.

1010. Yeah, of course.

1011. That was cool.

1012. Didn't think to check that.

1013. Good catch.

1014. Oh, any other medications?

1015. The only medicine is Tylenol, and she has no allergies.

1016. Hi, I'm Dr. Mohan.

1017. Hello. Nice to meet you.

1018. Oh, let me catch her up.

1019. Jia Yi is a 12-year-old with six weeks

1020. of constant pain in the suprapubic area.

1021. There's no fever, no dysuria,

1022. no nausea, vomiting, diarrhea,

1023. no vaginal discharge.

1024. And the urine pregnancy test is negative.

1025. A—a pregnancy test?

1026. Of course it's negative.

1027. She has a stomachache.

1028. Tell me a little bit more about your pain.

1029. Can you give me a number from 1 to 10, 10 being the worst?

1030. It was like a two the first few weeks.

1031. Then it went up to a five.

1032. Now it's worse, like a seven.

1033. And when was your last menstrual period?

1034. - Haven't had it. - This month?

1035. No, never.

1036. A few of my friends got theirs. I'm still waiting.

1037. She's only 12.

1038. Okay. We'll be back for an exam.

1039. Why don't you change into a gown open in the back?

1040. It's weird.

1041. I mean, no period,

1042. but she has early secondary sexual characteristics—

1043. you know, breast development, widening hips.

1044. Yeah, it's primary amenorrhea.

1045. What are you thinking?

1046. Could be a pituitary dysfunction or...

1047. Okay, how are we doing?

1048. Are we moving anybody out of here?

1049. We're trying. Asthma cleared after two nebs,

1050. went home with steroids and albuterol.

1051. I like that. Who else?

1052. Uh...

1053. Hire scabs that don't know zip ties from airline cable?

1054. Fuck around and find out.

1055. Come Monday, that promoter is gonna have

1056. my lawyer's shoe so far up his ass,

1057. he's gonna be flossing with the laces.

1058. How are we doing in here?

1059. Vitals are perfect.

1060. Satting 98 on 4 liters.

1061. Nice.

1062. So I can go back to work now?

1063. With six rib fractures, a bruised lung,

1064. and a catheter in your chest?

1065. Not the best idea.

1066. But I do respect the work ethic.

1067. Ritchie, get Cecil on FaceTime again.

1068. I need to see this shit myself.

1069. Do me a favor.

1070. Call Dr. Gregorian in thoracic

1071. and see if he'll take Stone as a personal favor to me,

1072. and make sure he knows he doesn't need

1073. any real babysitting. He's stable.

1074. We just need a bed. - Copy that.

1075. Projectile vomiting is better with ondansetron.

1076. Labs normal, awaiting a PO challenge.

1077. What about Minu, the fall lady?

1078. Antibiotics on board, pain free,

1079. on the OR schedule at 3:00 p.m.

1080. We parked her in the hall for a few hours.

1081. Okay, good.

1082. A little jelly on the belly.

1083. Sorry.

1084. It's cold.

1085. And just to be sure, you're not being

1086. treated for any blood clots, taking any anticoagulants?

1087. No, I don't take any medicines.

1088. Is everything okay?

1089. Yeah.

1090. There it is. There it is.

1091. Chopper 7, I knew you wouldn't let me down.

1092. Here we go.

1093. Wait, where is it?

1094. Well, it sure as shit ain't Swissvale.

1095. - Hmm. - They're out in Monroeville—

1096. - Mm-hmm. - Trailing PPD.

1097. What are they doing out there?

1098. They're driving till the wheels fall off.

1099. And it's almost outside our catch.

1100. I got $10 that say they don't make it to the county line.

1101. They coming back. - I don't know.

1102. Yeah, yeah, yeah, yeah, I'll take that.

1103. They're Westmoreland's problem now.

1104. - Mm. - Yep.

1105. Uh-oh. - It's on the news?

1106. Yes, ma'am.

1107. Where are they?

1108. They're headed east toward Monroeville.

1109. Let me see.

1110. Give me $20 on junkies, caught, outside our zone.

1111. Well, damn.

1112. All right.

1113. - Soft, non-tender. - Okay.

1114. Jia Yi, we're going to check below the waist.

1115. You'll be all covered up. Would you like Dad to stay?

1116. Yes, please. Don't go.

1117. Okay, I'm here. I'm here.

1118. All right, knees up, but keep your feet on the bed.

1119. And let the knees flop apart.

1120. We're just gonna take a quick look.

1121. You'll feel me touch your upper leg

1122. so we can see where you pee.

1123. Any pain?

1124. No, it's okay.

1125. Okay.

1126. You can put your legs back down.

1127. You did great, and we know how we can help you.

1128. Thank you.

1129. Dad, can we step out for a minute?

1130. Yay. Good job.

1131. What's—what's wrong with her?

1132. Her mother died of colon cancer.

1133. Is it—

1134. No, that has nothing to do with this.

1135. Do you know what a hymen is?

1136. I—not really.

1137. When the baby is developing in the womb,

1138. there's a membrane called the hymen

1139. which blocks the vaginal passage.

1140. Before birth, most of it goes away,

1141. but sometimes it doesn't.

1142. - Is that dangerous? - No, not at all.

1143. The good news is that your daughter

1144. has an imperforate hymen totally blocking the vagina.

1145. We saw what looks to be about three months of

1146. violaceous menstrual blood bulging from behind it.

1147. Oh, my God.

1148. It's totally curable and an easy fix.

1149. Your daughter needs minor surgery

1150. best done under anesthesia

1151. in an operating room by a gynecologist.

1152. Then she'll be okay?

1153. Yes, totally back to normal.

1154. Thank you.

1155. We, uh—

1156. we lost Jia Yi's mother when Jia Yi was six.

1157. And I do my best to fill her place.

1158. But as she gets older...

1159. Her mother would have known what to do.

1160. I'm sure you do great. She's going to be fine.

1161. Thank you.

1162. We should let her know.

1163. I'll do the talking this time.

1164. Housekeeping is turning over South 20.

1165. Damn, we're good.

1166. What's it like when I'm not here?

1167. I hate to break it to you,

1168. but I run a tight ship with or without you.

1169. More fun with me, though, right?

1170. Jokes are better. - Always.

1171. But your tell is the hairier it gets,

1172. the funnier you get, and you are on fire today.

1173. Dr. Robby, it's time.

1174. Hey.

1175. Is he still with us?

1176. Those are called agonal respirations.

1177. Close to the end.

1178. He said our mother's name a few minutes ago.

1179. Marge.

1180. Did he?

1181. Like she was here in the room with us.

1182. And—and then he smiled and just closed his eyes.

1183. How are you both holding up?

1184. I'm exhausted.

1185. Yeah, I—I—

1186. I think I'm doing okay.

1187. Oh, Jereme, I am so glad that you are here.

1188. Same.

1189. I—I couldn't go through this by myself.

1190. You don't have to.

1191. Sara and I are here.

1192. I know. Thank you.

1193. I need you.

1194. It's good that your families live close.

1195. This becomes a primary relationship now.

1196. You're the last witnesses to each other's lives.

1197. You hold the memories.

1198. Scary thought, the way my memory's going.

1199. I just had the craziest idea.

1200. You know what we should think about doing?

1201. Why don't we take the boat out, like, this weekend?

1202. Oh, no.

1203. Bactrim twice a day, warm soaks,

1204. and we'll see you here again in two days for a wound check.

1205. Do you have any questions? - Oh, hey, hey, hey, hey!

1206. Hey, I need a gurney in here!

1207. Now!

1208. Gurney! 675 Now!

1209. Gurney!