The Pitt 1x6

1. There is no way this is happening.

2. Not now, not ever.

3. Mom, stop!

4. This is what you had in mind

5. for your fun weekend with your aunt?

6. - All right. Can we— - I was trying to help her.

7. No, what would have been helpful is telling me

8. that my daughter is pregnant!

9. Instead, I find out from a confused teenage boy!

10. - Jackson told you? - Yeah, he did.

11. Whoa, whoa, everything OK in here?

12. This is Mrs. Wheeler, Kristi's mother.

13. Lynette is Kristi's aunt.

14. She doesn't want to have this baby.

15. This has nothing to do with you!

16. - OK, maybe we just take— - Mom, I called Aunt Lynn, OK?

17. I don't want to be a teen mom.

18. Well, then maybe you should have thought of that

19. before you started having sex.

20. OK, emotions are running high.

21. I think a private conversation

22. between mother and daughter is in order.

23. Lynette, let's you and I step out.

24. I'll buy you a cup of coffee.

25. The crashed ambulance thieves are en route.

26. ETA, 10 minutes. Trauma 2's all yours.

27. Great.

28. They better be meth-head junkies

29. 'cause Abby wants a Birkin for her birthday.

30. What's she gonna do with a Birkin?

31. Hopefully forgive me for getting

32. the kids a goldendoodle.

33. You want to be a good husband?

34. Send her on a vacation

35. without you or the kids or a damn puppy.

36. Are you mean to everyone or just me?

37. Just you.

38. Hey, what's the status

39. of the head CT on Joseph Marino?

40. Uh, still waiting on results.

41. He's postictal and sleeping in North 2.

42. - No more seizure activity. - Good.

43. Let me know as soon as those CT results get back.

44. Yeah, of course.

45. How's, uh, Travis, our tonsillectomy patient?

46. Oh, I, uh, just dropped him off at surgery.

47. - He's doing well. - Good work.

48. - You kept him from bleeding out. - Oh, no, come on.

49. That was all you and Dr. Robby.

50. I mean, I could never have done

51. what you guys did with that airway.

52. Not yet. That's why you're here.

53. But you stayed with him the whole time.

54. He would have died at most other hospitals.

55. Yeah. Yeah, no, I guess you're right.

56. Yeah, I usually am.

57. I'm sorry about all of this.

58. I didn't think that Eloise would find out.

59. Yeah, well, she did.

60. Kristi should make her own decisions.

61. Unfortunately, she's still considered a minor.

62. Why don't you take a seat?

63. And we'll come find you if there's an update.

64. - What do you need, Robby? - Escaping.

65. Go, go.

66. - Dr. Robinavitch. - Gloria.

67. This is Dr. Tracy Morris,

68. regional manager of ECQ America.

69. The contract management group.

70. - It's a pleasure to meet you. - Likewise.

71. But if you'll excuse me, I'm a little slammed,

72. as per usual.

73. We were upstairs with the executive team

74. going over a proposal.

75. - A proposal? - Mm-hmm.

76. We're interested in having

77. your emergency department join us.

78. The 500 or so ERs you have aren't enough?

79. What can I say? Business is good.

80. Yeah, for who?

81. - Everyone benefits. - Do they, though?

82. Your contract management's corporate mandate

83. is profits for shareholders above everything else, yes?

84. - Robby. - Dah-dah-dah.

85. Your hospital's board was very impressed

86. with ECQ's metrics on patient satisfaction,

87. throughput time, and billing collections.

88. Does your proposal include the part

89. where you cut the pay for all my doctors?

90. Maybe I can find an incentive for you.

91. How does regional medical director sound?

92. Lighter workload, better benefits, stock options.

93. Did you go to business school or medical school?

94. Both.

95. We look forward to your decision.

96. Of course.

97. Hopefully we'll get a chance to work together soon,

98. Dr. Robinavitch.

99. I can't believe you're seriously considering this.

100. Bottom line is, our current numbers aren't good,

101. and theirs are.

102. Just because their dashboard is pretty

103. doesn't mean it's good for patients.

104. If you want to keep this ED, improve metrics.

105. There's a lot of OFI.

106. Opportunities for improvement.

107. Well, you could have just said that.

108. I need you to care about patient-satisfaction scores.

109. I would love nothing more.

110. But right now the average wait time is six hours,

111. and that's before you see a doctor.

112. You need to hire more staff

113. so we can open more inpatient beds.

114. Are you prepared to do that?

115. I need you to improve scores with the resources we have,

116. or we will explore what ECQ has to offer.

117. This is bullshit. You know this is bullshit.

118. And if you don't, then we are all in trouble.

119. - Maybe you need some time off. - Hey, we got a ladder fall.

120. A couple of minutes out. Yeah.

121. Mint?

122. Who would have guessed frat boys?

123. Collins.

124. Damn it. I knew they were gonna crash.

125. Then why didn't you bet crash?

126. I didn't want anybody to get hurt.

127. - It's bad karma, man. - So who won?

128. Oh, Doc Collins hit the full parlay—

129. in our zone, crash, and frat boys.

130. That's uncanny, bordering on spooky.

131. And the rich just get richer.

132. You need to practice more gratitude.

133. I'd be a lot more grateful if my paycheck was bigger.

134. That part.

135. Any luck finding Ginger's daughter?

136. She was supposed to be right back to take her mom home.

137. I just tried her cell again. Still no answer.

138. Let me try the cafeteria one more time.

139. What do we tell her?

140. No, don't tell her anything yet.

141. Oh, boy.

142. Um, you should consult with Kiara

143. just in case this goes south.

144. - What do we have? - 45-year-old Silas Dunn.

145. Fell off an 8-foot ladder.

146. Right chest hit the carpeted floor.

147. No LOC. Good vitals. No meds, no allergies.

148. I'm Dr. Santos. How are you doing?

149. Fine. My wife called 911.

150. These guys said this was all necessary, but I-I can walk.

151. We're gonna keep it on until we get you all checked out, OK?

152. What are you thinking?

153. What made him fall could have been cardiac or neuro.

154. - Any headache? - I was a little dizzy.

155. He needs a head CT. EKG and troponin.

156. - Exactly. - On my count.

157. One, two, three.

158. I was installing a lighting fixture—

159. Dr. Santos on E-fast, please.

160. I'm Dr. Garcia. Can you spell "world"?

161. W-O-R-L-D.

162. Start with D, spell it backwards.

163. Oof. D-L-R-O-W?

164. Excellent. Your brain is fine.

165. Pulse 92. BP 132 over 78.

166. - Sat 98. - No pericardial effusion.

167. - Ow. - Oh. Tender?

168. - Yeah. - OK, ribs 7 and 8, MCL.

169. You probably cracked a rib or two.

170. Check for lung sliding. That could be a pneumo.

171. Ah, I was gonna paint the living room next.

172. My wife has a whole list of things

173. she wants us to get done.

174. I'm afraid the only home renovations

175. you're gonna be doing in the next couple weeks

176. are the kind you watch on TV.

177. Can you tell my wife that?

178. Lungs are up.

179. What's your sign?

180. - Scorpio. - Spicy.

181. And I'm focused on our patient.

182. Um, belly's clear.

183. Dr. Garcia.

184. Shit. Be right there.

185. Wish I could stay.

186. Post-op hemorrhage.

187. You're in good hands.

188. Tier One Trauma, ETA now. Trauma Tier One—

189. OK, call me if anything changes.

190. Stolen ambulance versus tree.

191. PPD maintaining custody of suspects.

192. This one doesn't meet criteria.

193. Zac Dawson, 21, restrained front-seat passenger,

194. was ambulatory on scene.

195. Lacerations to the anterior thigh from broken glass.

196. Otherwise no injuries. Good vitals.

197. - You hurting anywhere, Zac? - Where's Miles?

198. Miles Hernandez, 18, unrestrained driver

199. of the stolen ambulance.

200. Right chest, left leg injuries.

201. Short of breath. Sat 91.

202. Tachy 120s. BP 105 over 70.

203. - Can I go with him? - Is this your friend?

204. He's my pledge.

205. We're gonna find a room for you.

206. - Let us take care of Miles, OK? - I'm Dr. Collins.

207. Can you talk?

208. Breath sounds bilateral but lots of stridors.

209. Set up for intubation. We got to fix this fast.

210. Posterior hip dislocation. Good pedal pulse.

211. We need induction meds, ketamine and rock.

212. Ho, ho, ho, look at this clavicle.

213. Depressed centrally. Sternoclavicular dislocation.

214. It's compressing his trachea.

215. Let's reduce it, see if it helps his breathing.

216. All right, stabilize the leg.

217. One, two, three.

218. Four of morphine.

219. Draw a rainbow, type and screen.

220. Heart rate's 125.

221. Langdon, get on the airway. Collins, E-fast.

222. No blood in the oropharynx.

223. Clavicle is dislocated posteriorly.

224. Chlorhexidine swab.

225. 10 of lido with epi. Time is of the essence.

226. BP's 108 over 74.

227. All right, Miles, your collarbone

228. is pushing against your windpipe.

229. We're gonna pull it back up.

230. I'm going to inject an anesthetic.

231. You're gonna feel a pinprick and a big burn.

232. All right, towel clip.

233. All right, go deep.

234. You want to get a really good grip

235. on both sides of that bone.

236. Got it. All right, Miles.

237. It's gonna hurt for a second. You ready?

238. Oh, motherfucker!

239. - Ooh. - Screaming is good.

240. Who are you torturing now?

241. Reduced a sternoclavicular dislocation.

242. - How's your breathing? - Better.

243. What happened to your post-op hemorrhage?

244. Panicky intern.

245. False alarm.

246. - Who is she? - Right?

247. This is Dr. Garcia. We're gonna get your leg straightened out.

248. After we do a CT.

249. OK, looks like you got it from here.

250. You know you guys were on the news?

251. You stole an ambulance. What were you thinking?

252. It wasn't my idea.

253. Does he look like a meth head to you?

254. Seriously, what is wrong with you?

255. This was a terrible idea.

256. OK, Chanel, all set.

257. How bad does it look?

258. I'm gonna be honest with you.

259. It doesn't look great.

260. Thankfully, there's no signs of infection.

261. I'm such an idiot.

262. And now I'm having a panic attack.

263. Excuse me, Dr. Mohan—

264. I'll be right back.

265. I've only been in with her for a few minutes.

266. I didn't say anything. What's the case?

267. Chanel Sutton, 22,

268. complications from silicone butt injections.

269. So call the clinic that did it.

270. She found the guy on TikTok.

271. He did the injections in his living room.

272. She thinks it was maybe silicone caulk from Home Depot.

273. Jesus.

274. Really?

275. Kids today.

276. She is tachycardic and tachypneic.

277. I think it's a panic attack.

278. But if a piece of silicone hit a vein,

279. she could have a pulmonary embolism.

280. - We should scan her. - Good.

281. How's Joyce, our sickle cell patient doing?

282. Holding up.

283. She's intubated and waiting on an ICU bed.

284. Good. Keep it up.

285. Will do.

286. Team rounds. CWA. Team rounds. CWA.

287. Come join us when you're finished.

288. As soon as I put in a few orders.

289. - I'm so sorry. - Hi, how's she doing?

290. Better. Faster. Still need ten more of her.

291. Never thought I'd see the day

292. where you'd wish for more Samiras.

293. You can blame Gloria for that.

294. If I don't get patient satisfaction scores up

295. around here, they're bringing in

296. an outside management company to run things.

297. - Mother of God. Really? - Yep.

298. Holy hell.

299. Any word back on Nick Bradley's

300. - cerebral perfusion test? - Still waiting on results.

301. What about ipecac mom, Theresa Saunders?

302. On fluids. Should be good to go soon.

303. See, we do have patients that appreciate you.

304. You're done with triage for the day.

305. I'm sorry. Did I do something wrong?

306. Because I know I said too much to the unhoused mom.

307. No, don't— don't worry about it.

308. It's cool.

309. One of us just covers the waiting room

310. and triage for the first few hours,

311. try to thin the herd out there.

312. We're back here for the rest of the shift now.

313. OK, great.

314. Hey, do you think they're gonna give us lunch?

315. It's past 12:00, and I'm starving.

316. Oh, you can pack a bunch of these for your next shift

317. or grab a sandwich from the patient bin.

318. There's no time for breaks around here.

319. Thanks.

320. Wardrobe change?

321. Oh, I caught a gusher.

322. Helped save his life.

323. - How's triage? - It was good.

324. I-I'm back with you guys now.

325. Cool. So you're feeling OK?

326. Yeah, I'm feeling fine. I slipped hours ago.

327. I'm great.

328. Ready to go.

329. Let me guess.

330. You got these ones from the lost and found.

331. The scrub dispenser was out of my size.

332. Well, it's a good look, Huckleberry.

333. Show off those ankles.

334. Aren't board rounds at 2:00?

335. These aren't board rounds.

336. I just want to remind you all of a few things, OK?

337. So we do a great job coming up with the right diagnosis

338. and treatment plan for our patients,

339. but there are still some... opportunities for improvement.

340. - Not this bullshit again. - First off...

341. always sit down at the bedside of a stable patient.

342. It will make you a better doctor.

343. Second, if there's a discharge to be done,

344. do it before you pick up a new patient.

345. The patients are very aware of the time

346. that they spend with us, so please

347. don't keep them here any longer than they need to be.

348. They complain about the wait.

349. I get it, but for the sake of efficiency

350. and running smoothly on our end and opening up beds

351. and opening up rooms, let's discharge

352. before we start with somebody new, OK?

353. Thank you. Lastly, in your medical records,

354. make sure that your decision-making and your notes

355. reflect not just the diagnosis but all the thought

356. that you put into ruling out all the critical illnesses

357. - in the differential. - More work?

358. I do enough charting as it is.

359. The hospital won't admit this,

360. but it's less about charting and more about profit.

361. OK? Good.

362. That's it. Goodbye.

363. Go.

364. Are our pregnant teen and mom still talking?

365. Yeah.

366. No more yelling from that room?

367. - Not that I've heard. - Good, maybe it's working.

368. Either that, or they killed each other.

369. I'm good with either one at this point.

370. And you wonder why your patient

371. satisfaction scores are in the toilet.

372. Always appreciate your support.

373. I need to check on my Nepali patient.

374. She likes me.

375. Everybody likes you when they're on morphine.

376. All right, I think we'll follow up with Gillian Dupree,

377. the four-year-old we saw in triage with the fever.

378. - OK. - Yeah.

379. Dr. Javadi.

380. Um, sorry. What—what are you doing here?

381. Oh, I'm down to see a consult—

382. young man with a hot appy.

383. - Are you a med student? - Oh, yes, ma'am.

384. This is a great case for the students.

385. Can they come with?

386. I'd be happy to do a little bedside teaching.

387. - Oh, we have a four-year-old— - Oh, yeah, I would love that.

388. Do you mind if I join?

389. Maybe I can learn something new.

390. - Sure. - Great.

391. I just— I don't need anyone else

392. associating me with my mom.

393. I know, but I just can't say no to a hot appy.

394. These are student doctors.

395. - Mind if I do a little teaching? - Go for it.

396. Now, everyone knows McBurney's point.

397. But who can tell me the name of this sign?

398. Tim, raise your right leg, please.

399. - Oh! - Psoas sign.

400. Causing friction of the psoas muscle

401. over the inflamed appendix.

402. Excellent.

403. Now, back in the day, appendicitis meant

404. you went straight to the OR.

405. Who can tell me about the CODA study?

406. Uh, well, it's from a 2020 "New England Journal" trial

407. comparing surgery to antibiotics, you know?

408. It, um—it showed that without an appendicolith,

409. there was a 75% success rate in the antibiotic-only group.

410. Exactly.

411. Honey, we discussed the study at home, right?

412. "Honey"?

413. Wait. She's your mom?

414. It's—it's Victoria...

415. or Javadi, Dr. Shamsi.

416. Uh, hello?

417. Oh, yeah, I'll be right there.

418. Mrs. Grant now has chest pain.

419. If you'll excuse us.

420. Oh, yeah, go. Patients come first.

421. - Who's Mrs. Grant? - Nobody. I made her up.

422. Sorry.

423. You just had that look on your face

424. my son gives me when I give his basketball team

425. pointers from the sideline.

426. I'm sorry.

427. No, I think renovations

428. should be treated like dental care.

429. Leave it to the professionals.

430. They're the only ones that should be climbing on ladders.

431. Um, is my family here yet?

432. I'm not sure. We'll check. How was the CT?

433. Head and neck normal, but tech found

434. a small hemothorax on the right.

435. - What's that? - It's a little bleeding

436. around the lung where you broke a rib.

437. He's also been more short of breath

438. - since after the scan. - Is that from the pain?

439. Silas?

440. Hey, Silas, wake up.

441. Lost the radial pulse.

442. Thready carotid. His BP'S crashing.

443. I think he might need a chest tube.

444. Check another hemocue.

445. Get type specific from the blood bank.

446. BP 72 over 44.

447. Pulse ox 89.

448. He just dropped his BP and sats.

449. Put him on 100% nonrebreather.

450. - Call for two units. - Already done.

451. Normal head CT. Small hemothorax on the right.

452. Which has now turned into a huge collection of blood.

453. Prep for a chest tube. 20 French.

454. I would love to do the chest tube.

455. You got it. I'll guide you.

456. Sats are low. Should we intubate?

457. Not until after the chest tube's in.

458. We wouldn't want to cause a tension pneumo.

459. She won't make that mistake again.

460. Ten blade to Dr. Santos.

461. There's a lot of breast tissue.

462. Focus on the chest tube.

463. Fifth intercostal space,

464. - anterior axillary line. - Perfect.

465. Long Kelly next.

466. - Fuck! - Oh, my God. Are you OK?

467. Oh, that's got to hurt.

468. - Leave it! - OK, but—

469. - OK, I'm stepping in. - No, you're not gloved.

470. I got this.

471. - I-I— - On my own.

472. Glove up. You're sewing this in.

473. - We're good. No need to hover. - OK.

474. I'll be next door if you need me.

475. - Sats and BP look perfect. - Mm-hmm.

476. - We ready to go in here? - We're getting there.

477. - You good? - Absolutely.

478. You start feeling lightheaded, just speak up, OK?

479. Yeah.

480. OK, you're gonna pretend you're a pirate

481. with your foot on a keg of rum.

482. - Are you serious? - Yep.

483. This is the Captain Morgan technique for hip reduction.

484. Who's Captain Morgan?

485. The guy on the rum bottle?

486. I'll stabilize the pelvis.

487. OK, you're gonna step up here.

488. Actually, let me just—sorry.

489. Yeah, and you are gonna put your right leg behind his knee.

490. - Like this? - Yeah.

491. And you are gonna use your leg as a hinge

492. to put anterior force on his femur.

493. Physics.

494. Push down on the lower leg with your left hand.

495. You got this. Put your back into it.

496. The hip is a big joint with lots of muscle stabilizing it.

497. OK.

498. - Whoa! - Oh, shit.

499. I mean, shoot.

500. And that is what a hip reduction feels like.

501. Nicely done.

502. Thank you.

503. I hear you have an 85-year-old patient

504. who may have been abandoned by her primary caregiver.

505. Well, maybe. I-I hope not.

506. I don't really know what to do. We can't find the daughter.

507. And I'm really worried about the mom—

508. Slow down. We'll figure this out.

509. What do you think happened?

510. Um, well, Ginger has schizophrenia, and she fell.

511. And the daughter was already so overwhelmed, I mean...

512. maybe she ran.

513. I don't want to say this is elder neglect, but—

514. Don't jump to the worst case yet.

515. I'll see if I can get ahold of any other family members.

516. You know, I-I told the daughter—

517. I told her to take a break,

518. you know, to prioritize herself.

519. And I-I just—I didn't think

520. that she was gonna dump her mom, so—

521. This isn't your fault.

522. We're seeing more cases like this

523. as Baby Boomers age.

524. It's really tough on their families.

525. Thanks.

526. Dr. Robby, Nick Riley's

527. cerebral perfusion study is back.

528. No blood flow past the brain stem.

529. OK.

530. Let me know when the transplant people from CORE arrive.

531. Will do.

532. - Any news? - There is.

533. Why don't we step outside?

534. Mm.

535. Let's go this way.

536. So I have the results of Nick's cerebral perfusion scan.

537. Unfortunately, it shows that there's no blood flow

538. to Nick's brain.

539. Uh, what am I looking at?

540. It might help you if I showed you.

541. This is a healthy brain.

542. See the black?

543. That's blood flowing to the cerebrum.

544. When there's no blood flow...

545. It's white.

546. Yes.

547. He's brain-dead.

548. I am so very sorry.

549. I prayed. I had hoped...

550. We all did.

551. So he's not—

552. he's not coming back?

553. No.

554. The apnea test and now the perfusion scan prove that.

555. What happens now?

556. He's hooked up to all those machines...

557. Take some time.

558. Try to process this news.

559. A family support specialist will come in very soon

560. and help you through the next steps.

561. Thank you.

562. - Are you OK? - Yeah.

563. I just had to show the parents of the OD'd teen

564. the perfusion scan results.

565. How'd it go?

566. Oh, it never gets easier.

567. Is that Dr. Robby?

568. You owe me a dance.

569. Looks like an opportunity

570. to boost your patient satisfaction.

571. Well, I am a little rusty,

572. but let's give it a go, shall we?

573. Mm-hmm.

574. - Ready? - Mm-hmm.

575. Whoo!

576. Xeroform first, then two cut 4x4s.

577. Kim will show you how to do it right.

578. I absolutely will.

579. Thanks.

580. Only 500 out.

581. He won't need the OR.

582. You, follow me.

583. I totally fucked up.

584. Tell me something I don't know.

585. You're confident. That's good.

586. But there's a fine line between confidence and cockiness.

587. Should I draw your blood?

588. You already did.

589. Yeah, I-I mean for the HIV and hepatitis panels.

590. I can do Silas', too.

591. No, I'll have Dana do it after the wound repair.

592. C-can I suture for you?

593. Hell, no. I'll do it myself.

594. You can assist.

595. Set me up a chux, suture tray, betadine,

596. irrigation saline, syringe on splash guard,

597. and 5-0 prolene.

598. 1% lido with epi, 5 CC syringe, 27-gauge needle.

599. Mom and Kristi still talking in there?

600. Mm-hmm.

601. I'm giving them as much time as I can.

602. Within reason.

603. Do you think Mom will consent

604. to Kristi terminating the pregnancy?

605. A woman should only have a child if she wants to.

606. Well, if you'd just gone with Abbot's measurements,

607. they would have been discharged an hour ago.

608. Are you serious?

609. I need a doctor in triage ASAP.

610. - What's up? - I have a teen

611. with severe scrotal pain.

612. I need to rule out torsion.

613. Pull four of intranasal Versed.

614. - I got this. - Be my guest.

615. Hi.

616. Look at this beautiful Black queen.

617. - Are you our doctor? - Thank you.

618. Uh, yes, I'm Dr. Heather Collins.

619. And I take it this is Dillon?

620. Mm-hmm. And I'm his mother, Tina.

621. It's nice to meet you both.

622. Dillon, when did the pain start?

623. It started, like, an hour ago.

624. Did you get kicked or hit with a ball or anything?

625. No, it—it just came out of nowhere.

626. Oh, God.

627. OK.

628. I need to do an ultrasound to make sure

629. your testicle didn't twist on itself

630. and cut off the blood supply.

631. Is that all right with you?

632. Can I get, like, a dude doctor?

633. Come on, Dillon.

634. This is the doctor you want. I promise you.

635. OK, fine. It really fucking hurts.

636. - Language, baby. - Thanks.

637. - I'm sorry. It really does. - OK.

638. We're going to squirt some medicine up your nose.

639. It'll help you relax and help take away some of the pain.

640. Then do it.

641. OK, Dr. Collins says it'll help.

642. I know, Mom. I heard her. My ears are fine.

643. It's my junk that's killing me. Please.

644. - OK, sorry, baby. - Come on, bro.

645. Hold still.

646. All good, Beto?

647. All good, Doctor.

648. That'll be us one day.

649. You sooner than me, of course.

650. Shit. Thanks.

651. I was one crack pipe away from winning the whole thing.

652. So Collins won, huh?

653. You guys ever find out why those kids stole the rig?

654. Uh, undeveloped prefrontal cortex.

655. Idiots gonna do prison time now.

656. Dr. Langdon, I have Joseph Marino's CT results.

657. Our seizure patient.

658. How's Garcia?

659. Uh, she's fine. She's getting her labs drawn.

660. I'll go visit her in a minute, start a chart on her.

661. What happened to your old bud?

662. Oh, long story.

663. Let's take a look.

664. You see what I'm seeing?

665. Neurocysticercosis.

666. Be gentle with this one.

667. Patients don't usually handle this diagnosis very well.

668. Got it.

669. There is no blood flow here at all.

670. Is that dangerous?

671. If it goes untreated for more than six hours,

672. he could lose a testicle.

673. I could—

674. I could lose my balls?

675. One testicle.

676. And we're going to try and prevent that.

677. What the hell were you doing, Dillon?

678. I'm taking that lock off your door.

679. It's difficult to know

680. what causes a torsion, unfortunately.

681. Dillon, hey,

682. it's really important that I try and fix this now.

683. OK.

684. And I see we're gonna have a new prescription sent to—

685. To the pharmacy.

686. And, uh, it's just one pill every morning.

687. OK, up next, nausea and vomiting in North 4.

688. Oh. Ah, ah, ah, ah.

689. Forearm X-rays are back

690. on Mr. Ofori in the south corridor.

691. You can discharge with a volar splint.

692. Notify ortho. ADF.

693. Always discharge first. Got it.

694. Four-year-old with a fever.

695. Your medical decision-making says otitis media.

696. Yeah, she had an ear infection.

697. Did you also consider and rule out

698. meningitis, mastoiditis, malignant otitis externa?

699. I did.

700. Then you should document your cognitive work in the MDM.

701. You want me to pad my chart?

702. No, I want you to show your work.

703. Billing is a side effect of that.

704. Did anyone listen to what I said earlier?

705. Most of the time, the torsion is to the inside,

706. so we rotate outward by opening the book.

707. The testicle might have twisted the other way.

708. Uh, let's go back 180

709. and then try another 180 to the inside.

710. That's good.

711. That feels good.

712. - I think I'm OK now. - It's fixed?

713. For the time being.

714. We need to admit to Urology.

715. He'll need minor surgery to tack it down

716. and prevent it from happening again.

717. Thank you.

718. Dillon, say thank you.

719. Thank you.

720. I'll call Urology and see about the wait.

721. - Thanks. - Thank you, too.

722. Any other questions I can answer for you?

723. Yes, can you please let me know

724. how we can sign up for you to be our doctor?

725. I specialize in emergency medicine,

726. so I only work at this hospital and not in primary care.

727. Damn.

728. Please let me know when you get your own office

729. because you have been wonderful.

730. And you have a great relationship with your son.

731. He is my heart in human form.

732. Oh.

733. Do you have any?

734. Uh... Not yet, but, uh...

735. hopefully soon.

736. Hey, I've been in triage.

737. What's the update on incel kid's mom?

738. Please don't refer to her that way.

739. Theresa is rehydrated,

740. and her electrolytes have been replaced.

741. I'm gonna let her know that she can be discharged.

742. Did she hear from her son who ran off?

743. I have no idea.

744. I'm ready to get law enforcement involved

745. whenever you are.

746. If he's not here, he could be out there hurting somebody.

747. I'm not ready to ruin a kid's life over a thought crime.

748. We just need to make sure that he's not—

749. OK. OK. OK, I get it.

750. I heard you loud and clear when you brought this up before.

751. I will speak to Theresa.

752. I will see if she's talked to her son.

753. Fine.

754. We should admit her.

755. She's recovered.

756. She's good physically, but she made herself sick

757. to get her son here.

758. She's clearly not coping,

759. and she needs professional help.

760. Neurocysticercosis, a parasite in your brain.

761. I thought I just had a migraine, but I have...

762. bugs in my head?

763. Well, not exactly.

764. You had larva from a pork tapeworm

765. that made multiple cysts, but they're all dead now.

766. A worm?

767. In my fucking head? Are you kidding me?

768. No, no, you don't have a worm in your head.

769. You just said that I have—

770. I said you had a worm in your head,

771. but it's dead and long gone.

772. What we're seeing on the CT is scarring

773. around those dead cysts.

774. - Like dead worm eggs? - Larvae.

775. Is my brain like Swiss cheese? Am I dying?

776. - No, no, you're not dying. - Joseph, you're gonna be OK.

777. The—the cysts are tiny, and they're calcified over.

778. There'll be no further damage.

779. - Can you fix it? - Unfortunately, no.

780. The—the little calcified spots will stay there.

781. So there's gonna be a worm graveyard in my brain forever?

782. Yeah, but they're resting in peace.

783. Hi, Theresa. Any word from David?

784. Not yet.

785. It's still important that we talk to him,

786. so keep trying.

787. In the meantime, you are cleared to go home.

788. But I had a thought.

789. I'm concerned that you took so much ipecac.

790. I don't want you to do that again.

791. Oh, I won't.

792. How have things been at home lately?

793. Different.

794. One of us is always sad since my husband died.

795. Would you be willing to speak

796. to a behavioral health specialist?

797. I don't need that.

798. Did you talk to anybody after your husband passed?

799. Friends, family.

800. Anybody professionally?

801. Therapist, clergy, social worker?

802. Devastating personal loss can be very hard

803. to manage on your own.

804. It's OK to need help.

805. It might even improve your communication with David.

806. - OK. - Great.

807. I phoned in a favor with behavioral health.

808. They can get you in to see a psychologist at 1:30.

809. Today?

810. Mm-hmm, in an hour.

811. - O-OK. - Great.

812. Oh, hey. I was just coming to check on you two.

813. - Are—are you leaving? - Yes, we're going home.

814. Were you able to come to a decision?

815. Kristi is gonna stay in school until she's due.

816. Is that what you want?

817. Morning sickness.

818. I hate this.

819. OK.

820. Let me get you some anti-nausea medicine.

821. It'll help you feel better.

822. And you've got a long drive ahead of you.

823. OK, fine.

824. I never did meds, but sure.

825. Dr. Santos?

826. Susan and Alana Dunn—

827. here for an update on Silas Dunn, your ladder fall.

828. - Thanks, Mateo. - Yeah.

829. Is it serious?

830. He broke a few ribs on his right side

831. from the fall, which caused some bleeding around the lungs.

832. So he has a drainage catheter in his chest.

833. And with the trauma,

834. his oxygen levels were really low,

835. so he needed a breathing tube in his windpipe.

836. Good Lord.

837. Could he die?

838. His condition is serious, but it's—it's stable now.

839. Would you like to go see him?

840. He won't be able to talk with the breathing tube in, but—

841. Yeah. Where is he?

842. No, we'll wait in the waiting room.

843. - But, Mom— - Alana, please.

844. Just let the doctors do what they need to do for your dad.

845. We will find you with any updates.

846. Thanks.

847. Doing OK, kid?

848. Oh, yeah, I was just checking something.

849. I should get back to work.

850. Anything I can do to help, I'm available.

851. Thank you.

852. It's just that I have, um—

853. I have a dependent patient

854. whose daughter might have ditched her.

855. You don't always get to see the best side of people.

856. I guess it just kind of makes me sad.

857. It is sad.

858. But you can't dwell on it. That'll tear you apart.

859. Look, you've taken some time to step away.

860. That's good.

861. Don't forget, your patient needs you.

862. - She still here? - Yes. I've—

863. Mm, I've kind of been avoiding her.

864. I don't really know what to tell her about her daughter.

865. Well, you don't have to have all the answers.

866. Sometimes just asking how someone's doing is enough.

867. You got this.

868. Come on.

869. Will Miles be able to walk again?

870. Yes, he will recover.

871. None of this was supposed to happen.

872. You want to share how it was supposed to go?

873. 'Cause you stole an ambulance.

874. He did.

875. That was dumb.

876. Haven't you ever done anything stupid?

877. No, not really.

878. We were gonna drive it and bring it back to campus.

879. I wanted the guys to see Miles, think he was cool.

880. He has a hard time. He doesn't really fit in.

881. That's actually kind of sweet.

882. Some cops started chasing us.

883. Miles freaked out.

884. I'm pretty sure you saw the rest.

885. It was just supposed to be a joke.

886. Now we're going to jail.

887. My mom's gonna kill me.

888. Emma, no offense, but I can't exactly say

889. I'm happy to see you.

890. It comes with the territory.

891. Is there anything more you can tell me about the parents?

892. Lily and John Bradley.

893. Middle class, college educated, Catholic.

894. - How's their demeanor? - About what you'd expect.

895. Nick was their only child.

896. Got it.

897. I'm ready.

898. You?

899. Never.

900. John, Lily,

901. uh, I want to introduce you to Emma Isaacs.

902. She's a family support specialist

903. that works with me and families in the emergency room.

904. She's here to answer any questions that you have

905. and to keep you informed.

906. Hi, Mr. and Mrs. Bradley.

907. Oh, uh, John and Lily, please.

908. OK. I'll let you talk.

909. Doctor, can you stay?

910. Please.

911. Sure.

912. I'm happy to be here.

913. Emma is really the expert, though.

914. I understand your son is in here and not doing well.

915. Can you tell me what Dr. Robby has told you

916. about Nick's unfortunate situation?

917. There's no blood going to Nick's brain.

918. He's—he's brain-dead.

919. So...

920. he's dead.

921. I'm so sorry for your loss.

922. He was a wonderful son.

923. He was the quietest baby.

924. He slept—slept through the night.

925. It was perfect.

926. Um, if any one of his friends had a problem,

927. he was there to listen, to—

928. to lend a helping hand.

929. He...

930. he would have been a great man.

931. Oh, I can't believe this is happening.

932. I know how difficult this must be for you.

933. Can you tell us what happens now?

934. Yes.

935. I can walk you through all the next steps.

936. How are you—

937. If you ask me how I'm doing, I swear I'll punch you.

938. Did I miss something?

939. I just didn't get to do my chest tube.

940. He did.

941. There's a little more to it than that—

942. Not another word,

943. unless you want your tongue stapled.

944. All right, fuck it.

945. I dropped a scalpel,

946. and it stuck into Garcia's foot.

947. Oh, that's bad.

948. It might actually be worse than fainting, so—

949. Well, at least I didn't kill anyone.

950. - Day's only half over. - You killed a patient?

951. Not really.

952. You kind of did.

953. I'm sorry. You did.

954. It—it wasn't fully Huckleberry's fault.

955. It was a fluke.

956. He caught some gomer with a sneaky bad ticker.

957. His name was Bennet.

958. Oh, great, you can get his name tattooed on your chest.

959. At least I'm not the only fuck-up here.

960. I got nosebleed.

961. So long, fellow losers.

962. I'll reach out to a funeral director

963. and get the paperwork started on arrangements.

964. - What's the name of your church? - Um, St. Mary's.

965. - Great. Thank you. - Mm-hmm.

966. Do you have any other questions?

967. Uh...

968. No.

969. I think we should talk about something else

970. that is very important.

971. Your son's driver's license indicated

972. that he wanted to be an organ and tissue donor upon death.

973. That means he's given his permission for that—

974. No, no, I—

975. I don't want to talk about that.

976. No, he was too young to make that kind of decision.

977. I can understand why you would think that,

978. but he was 18.

979. No!

980. You didn't know him!

981. He is still my son!

982. Sorry.

983. They need more time.

984. 850 bucks.

985. I'll Zelle you the rest.

986. PayPal is also fine.

987. Winning. It never gets old.

988. Hey, I'm serious about that vacation for your wife.

989. - What about me? - What about you?

990. Your wife has two kids under four.

991. Abby works her ass off every day.

992. I'm a doctor.

993. They're all clueless.

994. What, is this— is this a female thing?

995. You should go, now. Go.

996. Beat it. Go ahead, go.

997. So what are you gonna buy with all that hard-earned cash?

998. I have had this bookmarked for months.

999. Oh, James Bond makes strollers now.

1000. Convertible is the way to go.

1001. - Ah, I'm gonna buy it. - You should.

1002. You and baby absolutely deserve it.

1003. Yeah, we do, right?

1004. Yeah, it's good to be excited.

1005. Just ran into a totally lost Uber Eats driver.

1006. - Where do I put these? - I got this. Thank you.

1007. Poor guy.

1008. Not everyone's cut out for the home-reno life.

1009. Um, I'll—I'll be right back.

1010. - Dr. Robby? - What's up?

1011. Silas's chest tube output has slowed down after 650 CCs.

1012. - Good. - But on re-exam,

1013. I noticed some breast enlargement,

1014. bilateral and symmetrical with no palpable masses.

1015. What's in the differential diagnosis

1016. for male gynecomastia?

1017. Definitely alcoholism.

1018. But then there's pituitary and gonadal tumors

1019. or pathology.

1020. So what do you want to check?

1021. LFTs for alcohol abuse, and for the rest,

1022. hormonal levels— estrogen, testosterone,

1023. Prolactin, hCG, progesterone.

1024. Good. Go.

1025. Ugh!

1026. Oh, the things I would do for pastrami.

1027. - Is there a turkey and cheese? - Uh, yeah.

1028. - Oh, what is all this? - Lunch. Primanti's.

1029. It appears that we have at least one grateful patient.

1030. Hope is alive.

1031. - Who do we have to thank? - I don't know.

1032. I think there's a card— bottom of the bag.

1033. Mmm. My God, that's so good.

1034. Enjoy your lunch.

1035. What was that?

1036. I don't know.

1037. - Aww. - What?

1038. It's from Shelby Adamson, Dr. Adamson's sister.

1039. She sends something every year.

1040. - He doesn't like her? - It's not about her.

1041. It's about him.

1042. Dr. Adamson was Robby's mentor, and he—

1043. he died during COVID, so...

1044. Mr. Randolph in Central 10 can be moved to a chair.

1045. Done.

1046. Hey, if you're hungry,

1047. there's Primanti's in the staff lounge.

1048. Sorry.

1049. Uh, daily reminder to call my sister.

1050. You were saying?

1051. There's free lunch in the lounge.

1052. Do you need to take care of that?

1053. I do. I just, um—I want to check on a patient first,

1054. but thank you...

1055. Jesse.

1056. - Jesse. Jesse. - Yeah.

1057. Hello, Mrs. Kitajima. How are you feeling?

1058. Ginger, please.

1059. I'm getting tired.

1060. I want to go home.

1061. Where's my daughter?

1062. Um, I'm sorry, but I don't know.

1063. But we're doing everything we can to find her.

1064. Can I do something for you while we wait?

1065. I wouldn't mind a snack.

1066. I can have someone bring you a sandwich.

1067. Wonderful.

1068. Feel free to bring that Dr. Robby back around, too.

1069. OK, yeah, I just— I have to make a quick call.

1070. Um, can you get Mrs. Kitajima a sandwich from the bin?

1071. Yeah, you got it.

1072. Hi, Becca.

1073. Mel!

1074. - Uh, how was lunch? - It was good.

1075. We had paninis and watermelon salad.

1076. That sounds delicious.

1077. Are you coming to get me?

1078. Um, yeah, remember,

1079. I'm coming, uh, to pick you up after my shift.

1080. Have you found a boyfriend yet?

1081. - Uh, no. - Hurry up.

1082. You have to find somebody to kiss.

1083. - You're right. I do. - Yeah.

1084. I got to get on that right away.

1085. Yeah.

1086. Hey. Is everything all right?

1087. Yeah. Yeah.

1088. - Where's Kristi? - She's using the bathroom.

1089. Hey, Kristi, it's Dr. Collins here.

1090. Is everything all right in there?

1091. - No, I want the pills! - Absolutely not.

1092. Eloise, why don't you find a place to sit, and I will—

1093. You're gonna what, give my daughter

1094. - the abortion I've forbidden? - Hey.

1095. What's going on? Kristi's texting.

1096. - Is she OK? - You can't be back here.

1097. - She's begging us for help. - Lynette, I got this. Come on.

1098. You are treating Kristi like Mom treated you.

1099. Oh, fuck you!

1100. Hey, let's take it down a notch.

1101. This is none of your business!

1102. I am not abandoning Kristi.

1103. Just get the fuck out of here!

1104. - Fuck you. - Hey, ladies, that's enough.

1105. - She is my daughter. - Just step away.

1106. - Give her a chance. - She's mine!

1107. That's enough!