The Pitt 1x8

1. 16 is open.

2. How come nobody's been—

3. my bad, it's taken.

4. Sorry.

5. Mr. Louie was found unresponsive

6. and on the sidewalk next to Fine Wine and Good Spirits.

7. Decent vitals, no head trauma.

8. Didn't we just discharge him a couple hours ago?

9. Yeah. Stone-cold sober at 7:00 a.m.

10. Oh, God.

11. Don't light any matches.

12. Hey, Doc, how you doing?

13. Not as good as you, Louie.

14. Hey, you know it, Doc.

15. How much did you have to drink, Louie?

16. Uh, just a couple of shots of vodka.

17. So like a half-gallon?

18. Oh, hell no.

19. Just—just a quart.

20. If you overexaggerate with your question,

21. you usually get a truthful answer.

22. Learned from the best.

23. Uh, he's got Librium from this morning.

24. That's what I prescribed him.

25. All right, Louie, let's scoot it on over.

26. You want to guess the blood alcohol level?

27. Why would I want to do that?

28. I don't know, because it's fun?

29. You prescribed 20 Librium.

30. There's only 10 left.

31. See you next time.

32. Uh, shouldn't we be concerned about an overdose?

33. Oh, no.

34. Vodka is Louie's drug of choice.

35. Quickest way to kill the shakes.

36. Oh, true that.

37. Where did the other 10 pills go?

38. I don't know.

39. Maybe, uh, lost, stolen.

40. Maybe he sold them to buy the vodka.

41. What'd you do with the other pills, Louie?

42. In my pocket.

43. I didn't need them.

44. Come on, give it a rest.

45. Is everything OK with Collins?

46. She seems fine to me, unlike our patient board.

47. How's the Kraken?

48. Sleeping like a baby.

49. What's the story with beds upstairs?

50. A ladder fall took the last ICU bed.

51. One tele bed's open, no med-surge, no pedes.

52. So which one of our 21 boarders

53. is going to win the lottery?

54. CHF exacerbation's been with us for two days.

55. Sounds like a winner.

56. The rest will receive our lovely

57. consolation prize package.

58. Tell them what they won, Dana. - Stop.

59. It's another 24 hours of bright lights,

60. screaming trauma patients, hard gurneys,

61. and sleep deprivation,

62. all while you wait for a bed upstairs.

63. Hey, uh, Nandi,

64. the influencer in Central Eight,

65. still waiting for psych?

66. Nope. She's a keeper.

67. Her mercury levels are sky high

68. from that face cream.

69. I ordered chelation TID,

70. 10 per kilo of DMSO.

71. I'll make sure it comes up from pharmacy.

72. Great pickup.

73. Hey. You OK?

74. Excuse me.

75. I'm sorry, Dr. Robinavitch?

76. - Yes, that is me. - Father McGill.

77. Here to see John and Lily Bradley.

78. Oh, yes. Thank you for coming.

79. No problem.

80. I will take you to the family room.

81. Dana, I need some help.

82. What's up?

83. I've been trying to check the nursing notes on Louie

84. from 7:00 a.m. this morning.

85. Uh, Langdon ordered lorazepam, but I don't think it was given.

86. Yeah, lorazepam ordered, dispensed,

87. and then returned unused to the PDS per Dr. Langdon,

88. as patient's tremor had resolved.

89. Is that unusual?

90. No, it happens all the time.

91. You think that could be the vial I couldn't open

92. on our seizure patient?

93. Possibly.

94. Can we check the other vials in the PDS?

95. Make sure they're OK?

96. - If you really want to. - I do.

97. All right, come on.

98. Dysuria in North Two's been waiting a long time.

99. I'll take it.

100. Oh, Dr. King.

101. Rita!

102. We were so worried.

103. Oh, I'm so sorry.

104. My phone was on silent.

105. I missed 10 calls from the hospital.

106. Is my mom OK?

107. Oh, yeah, she's fine.

108. Uh, I went to move my car,

109. and it was so peaceful and quiet when I parked

110. in the garage, I dozed off.

111. I'm just really glad you're back.

112. Oh, your mom is going to be so happy.

113. She's—she's waiting in the hall.

114. OK.

115. So if I order lorazepam for Louie,

116. the log shows me we have five vials left.

117. Take one out, and now we have four left.

118. But if I click that I want to return one unused,

119. you put it back, and the computer count

120. goes back up to five.

121. Yeah.

122. Same lot numbers.

123. Everything looks good.

124. No way of knowing which vial

125. was returned by Dr. Langdon.

126. Yeah, I guess.

127. Thanks. - Yeah.

128. Old man coming in with a heart rate of 30.

129. Sounds like pacemaker failure.

130. Could be a good case.

131. Putting an amputation in 15.

132. Ooh, that one sounds even better.

133. Yeah.

134. Rocco DeJulio.

135. Amputation of the fourth fingertip

136. at the base of the nail, bone exposed.

137. Uh, how'd this happen?

138. I, uh—I crushed it under an air conditioning unit

139. we were installing.

140. We'll numb up your finger.

141. One shot will help with the pain.

142. Amazing.

143. Digital block,

144. three ccs of marcaine.

145. Pulse 110, BP 135 over 88 in triage.

146. Any drug allergies, sir?

147. Uh-uh.

148. Two grams of Cefazolin?

149. Uh-huh.

150. Oh, wow.

151. Go with the block.

152. Are you ready?

153. Mm-hmm.

154. Pinprick and some burning.

155. Uh, where's the missing piece of skin?

156. It's, um, under a thousand-pound unit.

157. It's flat as a pancake.

158. Well, then we have nothing to reattach.

159. Plan, Dr. McKay?

160. Bone rongeur, V-Y flap.

161. - Exactly. - Awesome.

162. I picked the right case.

163. Can somebody translate?

164. To close the wound,

165. we're going to trim down the bone,

166. then use a plastic surgery trick so the skin

167. will cover everything.

168. OK.

169. Your finger is going to be a little shorter.

170. No nail.

171. Great.

172. 10% off manicures.

173. Looks like they found you guys a new rig.

174. Nah, we Ubered.

175. Willie Alexander, 81, near syncope

176. from the Memory Day Center.

177. They said he's more altered than usual.

178. Pulse is 30, BP's 80 over 40.

179. No change with a mig of atropine.

180. He's got a pacer in his chest, but there's no capture.

181. How are you feeling, Mr. Alexander?

182. Call me Willie.

183. I'm fine, I'm fine.

184. Any chest pain?

185. No, ma'am.

186. Do you take beta blockers?

187. I take walks every day.

188. Only med is Namenda.

189. On my count.

190. One, two, three.

191. Pacemaker patient with dementia.

192. Heart rate of 30.

193. A little altered with a systolic of 80.

194. What's your plan, Dr. Langdon?

195. Second mig of atropine now.

196. Push dose epi, 0.1 milligram.

197. Portable chest.

198. 31 on the monitor.

199. Dr. Javadi, what do you think of that heart rate?

200. Uh, it's not beta blockers, so junctional escape rhythm?

201. Exactly—common with

202. a non-functioning pacemaker.

203. Etiology, Dr. Mohan?

204. Dead battery or lead failure?

205. Indeed.

206. Good squeeze, even if it is slow.

207. Atropine and epi on board.

208. What's next, Dr. Langdon?

209. We can try percutaneous pacing,

210. but eventually, he'll need transvenous.

211. Agreed.

212. Systolic's up to 95 with epi.

213. It's too low.

214. Let's start a drip.

215. Two mikes per minute. Check the mental status.

216. Um, he knows his name.

217. Sir, do you know what year it is?

218. Um, it's 20-something.

219. Uh—

220. Do you know where you are?

221. It looks like a hospital to me.

222. Pittsburgh Trauma Medical Center.

223. Yep.

224. Yep, I know this place.

225. It's Dr. Adamson's place.

226. Where's he at?

227. He working today?

228. Are you feeling any pain?

229. No, that shot worked great.

230. OK.

231. Just like this.

232. Uh, how far down?

233. Just so the sub-Q will cover.

234. You'll need to take a few days off work, sir.

235. Good. More time to study.

236. Oh, yeah?

237. For what?

238. Uh, master's degree.

239. Psychology. - Oh, no kidding.

240. Yeah. HVAC's just my day job.

241. I went to trade school because I couldn't afford college.

242. Now I can.

243. Good on the rongeur.

244. Marking the surgical borders.

245. Two incisions.

246. Advance the triangle to cover the tip.

247. Until the V becomes a Y?

248. Exactly.

249. I guess you're the boss here?

250. Something like that.

251. You're very good at teaching.

252. Seriously.

253. You step back, and with a few words,

254. you impart wisdom.

255. If you say so.

256. Do you mind if I ask what you do when you don't work?

257. Sleep.

258. Now a blunt dissect to undermine the tissue.

259. What do you think, Dr. Javadi?

260. Third degree.

261. Complete heart block. - Because?

262. AV dissociation.

263. No relationship between the P waves

264. and the QRS complexes.

265. Clear.

266. Heart rate is 30.

267. His low BP is going to make him a lot more confused.

268. Could cause a heart attack or a stroke if we don't fix it.

269. Oh.

270. Well, mystery solved.

271. The wires aren't even touching.

272. They're totally disconnected.

273. Shit happens.

274. Heart rate still in low 30s.

275. No change with atropine.

276. Pacing pads are on.

277. We can try.

278. Willie, your pacemaker isn't working.

279. Well, you better fix it.

280. We're going to try to pace your heart from the outside.

281. You might feel it in your chest.

282. Let's start at 10 milliamps, rate of 60.

283. Pacer on.

284. I'm twitching.

285. No capture.

286. Increase to 20 milliamps.

287. Now it's more like a shock.

288. Still no capture.

289. Up to 30.

290. Whoa!

291. Y'all trying to electrocute me? - Pacer off.

292. Can't tolerate it. - Get rid of this shit!

293. Dr. Langdon?

294. One of versed.

295. Can we set up for transvenous?

296. I was set up before you got here.

297. Versed's on board.

298. Willie, we need to float a temporary pacemaker

299. from your neck into your heart.

300. Why is that?

301. Because your heart rate is only 30.

302. Then, uh, hit me with, uh, a shot of atropine.

303. You've already had three.

304. Wait, are you a doctor?

305. He's out.

306. Ginger, what do you think about having some help at home?

307. I think Rita could use a little break

308. every now and then.

309. We can't afford it.

310. Oh, um, Kiara told me about DHS senior phone line.

311. It's part of AAA, the Area Agency on Aging.

312. They make referrals for in-home services.

313. Uh, what's that going to cost?

314. Medicare will cover short-term home care,

315. at least 10 hours a week.

316. Ginger, have you ever been to a senior center?

317. I went once.

318. Nothing but old people.

319. AAA also has senior companions

320. for a few hours a day.

321. And if Rita needs to be away at lunchtime,

322. the OPTIONS program can deliver a meal.

323. Uh, is everything all right?

324. Yeah.

325. Did I say something that upset you?

326. No, it's all good.

327. This is—

328. This is way more than I expected, so...

329. Bam.

330. Internal jugular accessed.

331. Pulse ox 99 on five liters.

332. Systolic's 95 on epi.

333. That's good enough to perfuse the brain.

334. Guidewire.

335. You doing OK under there, Willie?

336. I guess.

337. So this is just like a triple lumen?

338. Except you need a big seven French introducer

339. to fit the pacing wire.

340. I could use some air.

341. Is that any better?

342. What y'all doing?

343. We're putting a temporary wire into an external pacemaker

344. until you can have surgery to repair the one in your chest.

345. Heart rate's still 31.

346. Bradycardia.

347. Are you a doctor, Willie?

348. Yeah, right.

349. No mention of any medical career in his past records.

350. Just mild dementia.

351. "Are you a doctor?"

352. That's a good one.

353. OK, last one.

354. How's it look?

355. Perfect.

356. Uh, Xeroform and tube gauze?

357. Mm-hmm.

358. What's up, party people?

359. Uh, V-Y flap.

360. Nicely done. Can I borrow Dr. Santos?

361. As long as Dr. McKay can finish the dressing.

362. Sure.

363. I can't stop thinking about your foot.

364. Uh, you know what I mean.

365. I'm—I'm sorry, but— - I know. Move on.

366. I already did. - OK.

367. There's a high-maintenance surgery clinic patient

368. down here— as in total pain in the ass.

369. I could use your help distracting her.

370. So we're—we're good?

371. Every hero needs a sidekick.

372. I need to find a tube gauze cage.

373. I'll be right back.

374. You'll need to elevate, antibiotics three times a day

375. for a week, a couple of painkiller tablets,

376. but try to get by on Tylenol and ibuprofen.

377. Are you OK?

378. Is today a bad day?

379. Drowning victim.

380. ETA three minutes.

381. Sorry, I got to go.

382. 20 centimeters clears the cordis.

383. Pacing box rate of 80, five milliamps.

384. Confirmed.

385. On ventricular setting.

386. Passing to 30, just outside the heart.

387. Why do we inflate the balloon now?

388. So it'll float into the right ventricle.

389. Exactly. And we're looking for?

390. An injury pattern, since it's below the AV node.

391. Looking good.

392. Check the pulse.

393. Strong radial. Really strong.

394. Man, I feel like I just woke up.

395. Nice work, Dr. Langdon.

396. Systolic's up to 130.

397. How do you feel?

398. Feel like a million bucks.

399. Widened QRS on the scope.

400. Willie, did you used to work at this hospital?

401. Hell, no.

402. I just brought the mail.

403. Can we steal Javadi?

404. Absolutely.

405. Time to shine, Crash.

406. Do you have time to write the procedure note?

407. No problem.

408. I'll be at Central if you need me.

409. Oh, jeez.

410. I still need to tell Nandi about her mercury level.

411. The average emergency doctor gets pulled from task A

412. to task B every three to five minutes.

413. Remind me again why we picked this specialty?

414. Because we all have ADHD,

415. and anything else would be boring as hell.

416. Another ICU admission.

417. I'll call to confirm.

418. Dr. Collins, do you think that we might be able to—

419. Drowning victim here.

420. Not right now.

421. Amber Phillips, six years old.

422. Found at the bottom of a home pool with an unknown downtime.

423. Asystole on the monitor.

424. Intubated with a cuffed 4.5, 22-gauge left AC,

425. 0.25 epi three minutes ago.

426. One, two, three.

427. OK.

428. Whitaker, take over compressions.

429. Any family coming in? - Grandma and little sister.

430. Fast and deep.

431. Ready?

432. Yeah.

433. Go.

434. She's really cold.

435. OK.

436. Get a core temp.

437. Good breath sounds bilaterally.

438. Should we use the Lucas?

439. No, she's way too small for that.

440. - Rectal temp only 85. - What do you think, Mel?

441. Uh, she's cold. Moderate hypothermia.

442. We need to get her up to 90 if we have any chance

443. of restarting her heart.

444. 250 ccs heated saline.

445. Set up the Arctic Sun.

446. Continuous core temp monitoring,

447. and prep another epi 0.25.

448. Yep.

449. Preemptive orders done. Let's go.

450. I just—I don't understand why you need me.

451. Crohn's disease status post colectomy 10 years ago,

452. now with severe abdominal pain.

453. Could be perforation, fistula, obstruction.

454. Great teaching case.

455. Someone give me something for the pain!

456. Good afternoon, Ms. Walker.

457. I'm Dr. Garcia from surgery.

458. This is Dr. Santos and Javadi.

459. It looks like you're in a lot of pain.

460. No shit!

461. We ordered you some morphine.

462. Did you read my chart?

463. I'm allergic to morphine!

464. I'll puke my guts out.

465. That's a side effect, not an allergy.

466. Oh, give me some Dilaudid.

467. OK.

468. One milligram Dilaudid.

469. I'll grab it from the PDS.

470. One is never enough.

471. I need two, sometimes four.

472. Got it.

473. Pertinent history, Javadi?

474. Um, have you had any fever or vomiting?

475. Shut up with your questions!

476. Ma'am, we can't help you if we don't know your—

477. If you want to help me, get me my doctor.

478. Dr. Shamsi.

479. 10 years, no one knows me better.

480. I don't want to talk to anybody else.

481. I'm very sorry, but she's in surgery right now.

482. - How long? - Unknown.

483. But ma'am, right here we have

484. Dr. Shamsi's daughter, Victoria.

485. She's the next best thing.

486. Time for another epi.

487. Dr. Robby?

488. I'll be right back.

489. Uh, my wife and I decided.

490. We're on board with organ donation.

491. Oh, I'm really glad to hear it.

492. Uh, the church supports their decision.

493. The OPO is sending an ambulance.

494. I'll be staying with the family.

495. How's it going in there?

496. Oh, not good. Not good.

497. - Robby. - Yeah?

498. For the little girl in Trauma One,

499. this is grandmother Frances and sister Bella.

500. Hi, I'm Dr. Robinavitch.

501. How is she?

502. Um—

503. Bella, would you like to color?

504. Maybe get a snack?

505. Yes, please.

506. My name is Kiara.

507. Let's find you some crayons.

508. I like to draw.

509. Let's do it.

510. Come on.

511. They are still doing CPR.

512. Can I please see her?

513. Yes, of course.

514. Got Grandma coming in.

515. You can sit right by the bedside.

516. Ready to switch?

517. Go.

518. Here you go, ma'am.

519. You can hold her hand.

520. She wasn't breathing,

521. so the medics put a tube in her throat.

522. She's so cold.

523. We're warming her up.

524. That way, she'll have a better chance

525. to respond to the medicines.

526. They moved a bench next to the pool fence

527. so they could go over,

528. because their soccer ball went in the water.

529. Amber couldn't make it out of the deep end.

530. The gate was locked.

531. I was vacuuming.

532. I didn't hear them.

533. My mercury level is 94?

534. That's high enough to cause all your symptoms—

535. insomnia, tremors, imbalance, psychosis.

536. From a stupid face cream?

537. We're going to start chelation therapy.

538. It's a medication that binds with the mercury

539. and helps your body excrete it.

540. And then I'll be back to normal?

541. I don't know.

542. Are any of us normal?

543. Where's my phone?

544. They locked it away with all your valuables.

545. I—I need my phone.

546. OK.

547. But when you post, you have to tell everyone

548. not to use the cream. - Definitely.

549. Can I borrow your phone?

550. Just the camera.

551. I was wearing a wig when I left my apartment

552. and I had a wig when I came in, right?

553. Not when you came in.

554. Oh my God.

555. I look like shit.

556. - How is he doing? - Stable.

557. Scheduled for a new pacer tomorrow with cardiology.

558. - Great. - Robby.

559. Parents of T1.

560. This is Dr. Robby.

561. Where's Amber? Is she OK?

562. What have you heard?

563. That she got pulled from the pool.

564. She wasn't breathing,

565. so we're doing that for her now.

566. And we're trying to get her heart started again.

567. Wait, her heart stopped?

568. I have to be with her.

569. Of course.

570. There are a lot of people in here

571. right now trying to help her.

572. We understand.

573. Amber.

574. Oh my God, Amber!

575. I'm here. I love you.

576. I love you so much.

577. Gina, I am so sorry.

578. Where's Bella?

579. She's with our social worker.

580. Oh, I should be with her.

581. I'll go with you, Mom.

582. I'll be right back.

583. OK. Come on. She's just down the hall.

584. Hang on. We got it. - Oh.

585. Rhythm check.

586. Hold compressions.

587. Asystole.

588. Resume compressions.

589. Three minutes since the last epi.

590. Push another.

591. Did you shock the heart?

592. Uh, no.

593. Why didn't you shock the heart?

594. We've got to save her. You've got to shock the heart.

595. Heart rhythm right now is flatlining.

596. That's not treatable with a shock.

597. We're trying to get the rhythm to change to something

598. we can shock by warming her up.

599. OK. So we've got to warm up.

600. You've got to get some more blankets in here or something.

601. We are giving her warm IV fluids,

602. and you can feel these blue pads.

603. They have warm water running through them

604. like a hot tub.

605. Are you sure you're doing everything?

606. Yes, we are.

607. Amber, honey, I'm here.

608. It's going to be OK.

609. I promise you, everything's going to be OK.

610. I can't take much longer!

611. I've got Dr. Shamsi on speakerphone from the OR.

612. Eileen, how soon can you get here?

613. I'm finishing a lap chole.

614. Shouldn't be long.

615. Your daughter is here.

616. Hi, honey.

617. Minimal relief with two of Dilaudid.

618. She needs four.

619. That's what I've been telling them!

620. We're titrating.

621. We didn't want her to stop breathing.

622. - Is Dr. Garcia with you? - Right here.

623. How's the exam?

624. Rigidity with guarding.

625. Sounds like peritonitis.

626. Two sets of blood cultures and 3.375 of Zosyn.

627. Make sure she's next in line for a CT scan.

628. Bump everyone else.

629. Do you understand? Victoria?

630. - Got it. - See you soon.

631. Thank you, Eileen.

632. Ready for some more Dilaudid?

633. God, yes.

634. Victoria will make sure all of Dr. Shamsi's

635. orders are followed.

636. Call if you need us.

637. Yeah.

638. Great move bringing in Javadi.

639. Is this patient payback for dropping the scalpel?

640. Look at the bright side— if she goes to the OR for perf,

641. you can scrub in.

642. I'll coach you.

643. You'll make a brilliant first impression on Dr. Shamsi.

644. - Really? You'd do that? - Mm-hmm.

645. Thanks.

646. I, um—I have something unusual to ask.

647. OK.

648. I've been on two cases with Langdon,

649. and there have been irregularities

650. with benzos— Lorazepam with a seizure,

651. Librium with an alcoholic.

652. And?

653. And I'm concerned.

654. Concerned about what?

655. That he could be stealing.

656. Whoa, whoa, whoa.

657. I insult the shit out of Langdon,

658. but he's a great doctor.

659. I've never seen him impaired.

660. What do I do?

661. You've been here for, what, seven hours?

662. Just do your job.

663. Kind of a weird vibe out here.

664. Yeah, pediatric drowning will do that.

665. Glad I didn't end up in there.

666. Yeah, you and me both.

667. Uh, what's with the scarf?

668. Oh, it's from the lost and found,

669. for my patient in Central Eight.

670. Cool.

671. I'm off to North Two.

672. Dysuria.

673. What happened to two visitors a patient?

674. It's the fentanyl overdose.

675. There's going to be an honor walk.

676. He's an organ donor.

677. Well, see you later.

678. See you.

679. Myrna?

680. Myrna!

681. Oh, no. No, not today.

682. Myrna!

683. What the fuck?

684. What do you think you're doing?

685. I—I was just checking on you, ma'am.

686. You can't even take a nap in this hellhole.

687. Fuck off!

688. Sorry.

689. Hi, I'm Dr. McKay.

690. Uh, Piper.

691. Laura.

692. And you guys are?

693. She's my boss.

694. Oh, what kind of work?

695. I'm an accountant, and she's my assistant.

696. Oh, cool.

697. Um, Piper, are you OK with your boss being here while we talk?

698. Yeah, I'm—I'm good.

699. Are you sure?

700. I'm going to be asking you some pretty personal questions.

701. She doesn't mind.

702. We—we have no secrets.

703. OK.

704. So burning with urination.

705. Mm-hmm.

706. When did that start?

707. About two days ago.

708. Why don't we let Piper answer the questions?

709. I'm sorry, it's just, we've been waiting so long.

710. About two days ago.

711. Any blood in the urine?

712. I don't think so.

713. No, she would have definitely noticed that.

714. OK.

715. I'm going to get you a gown and I'll be right back, OK?

716. OK.

717. Any change with the extra Dilaudid?

718. Not really.

719. The pain is still there.

720. Sorry. Sorry.

721. Just to review, no fever, no vomiting,

722. no diarrhea, no constipation.

723. Correct.

724. When exactly did the pain start?

725. 10:15 this morning, all of a sudden.

726. That's very strange.

727. I agree.

728. Will you tell me everything you did this morning?

729. Took a shower.

730. I had breakfast, some coffee, toast with jam.

731. Yard work.

732. Moved some firewood.

733. Did the pain start before or after the firewood?

734. A little bit after.

735. I might have got a splinter in my foot.

736. I wasn't wearing socks.

737. Other one.

738. Two small puncture wounds, one millimeter apart.

739. Two splinters?

740. Whoa.

741. What?

742. There's a dead black widow spider in your shoe.

743. You're shitting me.

744. Red hourglass marking.

745. We need IV diazepam. Start with five.

746. Might need 10.

747. What does a spider bite have to do with my Crohn's disease?

748. Oh, nothing.

749. Um, black widow venom can cause muscle spasms in the belly.

750. People have had surgery thinking it was appendicitis.

751. Hi, Dolores.

752. Why didn't you get her to CT yet?

753. I—I don't think she needs it.

754. The abdomen is rigid. She's perfed.

755. Maybe not.

756. What are you giving?

757. - Diazepam. - I didn't order that.

758. I did.

759. She has a rigid abdomen

760. but no other GI signs or symptoms.

761. It didn't make any sense.

762. There's a black widow spider and a bite mark on the foot.

763. The venom is causing spasm of the abdominal wall musculature.

764. Whatever you guys gave me, it's working.

765. Possibly.

766. No, definitely.

767. I'm much better.

768. Take a deep breath.

769. Good, good.

770. Are you from Pittsburgh?

771. Uh, two hours north.

772. Like, Mill Village.

773. OK.

774. You have any family you want to call?

775. I don't have a phone.

776. She can use mine if she needs to.

777. OK.

778. Lay down.

779. I've, uh, never heard of Mill Village.

780. Yeah, nobody has.

781. Population 400.

782. Wow, that's small.

783. Tell me about it.

784. After high school, I had to get out of there.

785. Mm.

786. Well, you're lucky you found a job.

787. Any pain around here?

788. Mm-hmm, a little.

789. OK.

790. Sit up for me.

791. All right.

792. You gave us a urine specimen?

793. Hours ago, in the waiting room.

794. OK.

795. Well, I'll find the results,

796. and then you might need a pelvic exam.

797. Is that really necessary?

798. It could be.

799. If there's no bladder infection,

800. it's important to check.

801. OK.

802. And if we do a pelvic, Laura,

803. we'll have you step outside for a minute.

804. I'd prefer to stay with her, for support.

805. Piper, do you want some privacy?

806. No, it's cool.

807. She—she can stay.

808. OK.

809. All right.

810. I'll be back.

811. Core temp is 88.

812. Is—is that good?

813. It's up from 85 on her arrival,

814. so we're headed in the right direction.

815. You hear that, Amber?

816. It's better.

817. You're getting better.

818. I need to step out for a second.

819. You're in good hands.

820. Come find me when it's over 90.

821. Parents are going to need the family room.

822. It's available now.

823. Last rites for Nick.

824. Just one of those days.

825. Yeah.

826. Anyone else dying?

827. Not at the moment.

828. What the hell is that?

829. You asked for better patient satisfaction scores.

830. What do you want, man?

831. Oh, jeez.

832. Excuse me, Dr. Robby.

833. This is Eli, son of Willie Alexander.

834. - Hey, nice to meet you. - Likewise.

835. How's he doing? - He's doing better.

836. He's going to need to stay with us,

837. though, for a new pacemaker.

838. He got a new one at Presby

839. about, uh, a year ago.

840. They said it'd be good for 10 years.

841. Yes, but the wires separated from the box.

842. It happens sometimes.

843. Can he have a visitor?

844. Of course. Right this way.

845. Hey, Eli, what did your dad do for a living?

846. Uh, postal worker, 40 years.

847. Did he ever do any volunteer work at the hospital?

848. No.

849. But when he was a kid, he was a medic

850. for the Freedom House Ambulance Service.

851. That's incredible.

852. Uh, I will be in as soon as I can.

853. Thank you.

854. That guy's a legend.

855. I know.

856. Sorry, can I get your help with something?

857. Yeah.

858. Um, 18-year-old woman with dysuria,

859. moved here two months ago from rural Pennsylvania.

860. She's with her female boss,

861. who's very controlling and answers questions for her

862. and won't leave her side for anything, even a pelvic exam.

863. And you're thinking?

864. - Red flags for trafficking. - Sounds like it.

865. I need to take a sexual history

866. and do a pelvic in private.

867. She's not going to talk unless we separate them.

868. That we can do. Come on.

869. That looks like ST elevation.

870. That could be bad.

871. Oh, no.

872. That's just because we're pacing your right ventricle.

873. Willie, I'm impressed.

874. After all these years, you still remember

875. your medical training.

876. He couldn't tell you what he had for breakfast.

877. It's all right.

878. I remember what's important.

879. Like the Freedom House.

880. What's that?

881. A damn shame.

882. That's your history.

883. Dad, they're busy.

884. Back in the '60s, no 911,

885. no ambulances.

886. All we had was police paddy wagons

887. that took you to the hospital, if you were lucky.

888. Then this doc from Pitt, Dr. Safar,

889. he got some money and trained us up.

890. Well, you must have been a good student.

891. Hell, no.

892. I was a knucklehead.

893. Smoked a lot of weed, dropped out of high school.

894. But Freedom House trained me up.

895. Saved my life.

896. What are you doing there, Willie?

897. Nothing.

898. You're moving your old pacemaker.

899. Diagnosis made.

900. What?

901. Twiddler's syndrome.

902. Spinning that thing around caused the wires to break off.

903. Oh, Dad.

904. - I didn't mean to. - It's OK.

905. We'll put the new one in a little deeper.

906. Won't happen again.

907. Some of your tests are concerning for a kidney stone.

908. Wouldn't that give more pain?

909. Not always.

910. If it's a urine infection with a stone,

911. you'll need to stay in the hospital

912. for some IV antibiotics.

913. What do we have to do?

914. A CT scan of your kidneys.

915. How long is that going to take?

916. - They can do it right now. - Great.

917. Let's go. - I'm—I'm sorry.

918. There's radiation.

919. You won't be able to stay with her.

920. But we'll be back as soon as the scan is done.

921. You're good with this, right?

922. Yeah, I'll be fine.

923. We'll see you in a minute.

924. So Laura's an accountant?

925. - Uh-huh. - Oh.

926. How'd you get the job?

927. - Online ad. - Yeah.

928. Zoom interview.

929. You must be good at math.

930. Not really.

931. So what do you do for work?

932. I answer the phones, I make appointments, I—

933. I bring deposits to the bank.

934. You work with spreadsheets?

935. She hasn't taught me that yet.

936. This is where you do the CT?

937. Uh, no.

938. We wanted to give you some privacy for your pelvic exam.

939. Laura's going to be so pissed.

940. Why would she be mad?

941. Piper, do you have any concerns

942. you want to talk about?

943. No, just the pain when I pee.

944. Anything you need to tell us about your job or your boss?

945. No.

946. No, it's all really great.

947. OK.

948. Temp is up to 91.

949. She's so much warmer.

950. Is it working?

951. Can you shock the heart now?

952. 91 is warm enough for her heart to respond.

953. Hold compressions.

954. Asystole.

955. Resuming compressions.

956. Got the potassium level back.

957. 12.2.

958. No one has ever survived a cardiac arrest

959. with a potassium over 11.

960. There is absolutely no chance of recovery.

961. I am so sorry.

962. Amber has died.

963. No.

964. No, no, no, no, no, no, no.

965. It's not happening.

966. No, no, no!

967. No! No!

968. I'm sorry.

969. I am so—

970. Before we stop, do you think her sister

971. would like a chance to say goodbye?

972. No.

973. Uh, Bella shouldn't see her like this.

974. OK.

975. You can stay in here for as long as you like.

976. Shh.

977. It's OK. It's OK.

978. We are going to stop now.

979. Resuscitation efforts discontinued at 14:51.

980. Oh, sweetheart, I'm sorry.

981. OK, that's it.

982. We're done.

983. Let me get the gurney up.

984. Is everything OK?

985. Yeah.

986. There's no infection

987. in your uterus or ovaries.

988. OK, that's—that's good.

989. But your urine test was positive for chlamydia.

990. Shit.

991. It's a sexually transmitted infection.

992. Any idea how that happened?

993. Yeah, my cheating

994. piece of shit ex-boyfriend back home.

995. But we broke up before I moved.

996. You need antibiotics twice a day for 10 days.

997. That'll clear it up.

998. And he'll need treatment too.

999. If I don't tell him, is there a chance

1000. his dick will fall off?

1001. If you don't tell him, a public health nurse will.

1002. You should also test for HIV, syphilis,

1003. gonorrhea, and hepatitis.

1004. OK.

1005. Any other sexual partners

1006. in the last few months?

1007. Not really.

1008. Use condoms?

1009. Most of the time.

1010. It's important to use them all the time.

1011. Yeah, but if I forget,

1012. you can just give me a shot, right?

1013. Not for some infections.

1014. This is serious.

1015. Birth control?

1016. Norplant.

1017. It's good for five years.

1018. Piper, we have a question that we ask everyone.

1019. Sometimes people are pressured

1020. to have sex when they don't want to.

1021. Does that ever happen to you?

1022. No, never.

1023. And when you signed in, you put down Laura

1024. as your emergency contact.

1025. Yeah.

1026. You have the same address as Laura?

1027. Yeah.

1028. She's letting me use her guest room

1029. until I can save up for a place of my own.

1030. OK.

1031. Why don't we have you lie down again?

1032. What for?

1033. Uh, ultrasound.

1034. We're going to check your kidneys.

1035. You got bumped from CT by a couple of emergency cases.

1036. Bella, Dr. King and Dr. Collins are here.

1037. Hi.

1038. I'm coloring.

1039. You're a very good artist.

1040. Thanks.

1041. Um, Bella?

1042. Yeah?

1043. What have you heard about Amber?

1044. She's really sick, but the doctor and the nurse

1045. is trying to make her better.

1046. That must make you sad.

1047. You know, I have a sister too,

1048. and I don't like it when she's sick.

1049. She saved me.

1050. She did?

1051. I fell in the pool.

1052. She helped me get out, but then she couldn't get out.

1053. I'm making her a card.

1054. Freedom House took us in and trained us for 300 hours.

1055. They turned out the very first medics

1056. in the United States.

1057. We started IVs, defibrillated,

1058. intubated in the field.

1059. They were the heroes of Hill District,

1060. a bunch of young Black dudes saving lives every day.

1061. Why'd you quit?

1062. I didn't.

1063. The city saw how successful it was

1064. and took over the program.

1065. Trained new medics.

1066. All white.

1067. Everything that Willie and his friends did

1068. set the EMS standard for the entire country.

1069. Their program created the 911 system.

1070. It wasn't just us.

1071. We had the best teachers.

1072. Dr. Safar invented CPR.

1073. Dr. Adamson, med student when I arrived.

1074. But I'm telling you, boy, that guy could teach

1075. like there was no tomorrow.

1076. You ever hear him give a lecture?

1077. Many times.

1078. Every time I saved a patient,

1079. it was like he was standing right here,

1080. whispering in my ear,

1081. telling me what to do.

1082. Me too.

1083. Yeah.

1084. Where is he working now?

1085. Dr. Adamson died a few years ago, during COVID.

1086. Oh.

1087. Hard to believe.

1088. He was so young, so full of life.

1089. A force of nature.

1090. Yes, he was.

1091. We're back.

1092. I should be out there for the honor walk.

1093. Right.

1094. Hey, Mrs. Phillips.

1095. Your son would like to speak with you.

1096. Oh.

1097. Dr. King can stay here.

1098. Bella, I'll be right back.

1099. I finished my card.

1100. Oh.

1101. It's beautiful.

1102. I love it. - Thanks.

1103. Can I see Amber now?

1104. Um, not quite yet.

1105. What is that?

1106. Oh, uh, it's from the gift shop.

1107. For Amber?

1108. For you and for Amber.

1109. Um, but you get to name it.

1110. I think her name will be Bear.

1111. Bear.

1112. All right.

1113. Um, since you can't see Amber right now,

1114. but I bet you got a lot of things to tell her,

1115. Bear is going to help.

1116. How?

1117. Well, um, if you tell Bear

1118. everything you want to tell Amber,

1119. then I'll take Bear and sit her on Amber's pillow,

1120. and then she'll tell her everything you said.

1121. What do you think of that plan?

1122. - I like it. - Yeah?

1123. OK.

1124. Do you want to give it a try?

1125. There you go.

1126. Hi, Amber.

1127. It's me, Bella.

1128. Thank you for saving me.

1129. When you come home, I promise

1130. I won't touch your toys without asking.

1131. And I'll try not to fight, because you're my best friend

1132. in the whole entire world.

1133. I love you.

1134. Amber is going to be so happy with that.

1135. Hey.

1136. Uh, how long have you been working here?

1137. 32 years.

1138. All in the ER?

1139. Yeah.

1140. Oh, man.

1141. How do you do it?

1142. I like taking care of everyone,

1143. especially the ones who fall through the cracks.

1144. They got nowhere else to go.

1145. Well, you deserve a medal.

1146. Yeah, I'd settle for a raise.

1147. Thank you for everything.

1148. Uh...

1149. I wish they could do the surgery here.

1150. Surgical teams are flying in from all over the country

1151. to meet Nick at the Center for Organ Recovery.

1152. We have a car and driver waiting

1153. so John and Lily can follow right behind the ambulance.

1154. Thank you.

1155. So we won't be seeing you again?

1156. If it's all right, I think a lot of us here

1157. would like to attend Nick's funeral.

1158. Yeah, of course.

1159. Thank you. - > 00:44:50,604 Thank you.