The Pitt 2x15

1. Baran, is this you?

2. It began after a bad case of viral meningitis

3. when I was five.

4. They tried every anti-seizure medication,

5. but I still had episodes every few months or so.

6. No one's ever noticed before.

7. They just think I'm thoughtful.

8. Are you driving?

9. I couldn't until laser ablation

10. to my left temporal lobe 12 years ago.

11. Between that and the Keppra, I've been seizure-free,

12. cleared by Neurology to drive and to work as an attending.

13. How long, uh, between the seizure

14. you had today and the last one?

15. It's been well over a year.

16. But I had two today.

17. I don't know why.

18. It could be sleep deprivation, new job stress.

19. I—I haven't had to deal with Peds cases

20. since Afghanistan.

21. What are your options now?

22. Um...

23. up my Keppra or maybe try

24. one of the newer anti-seizure meds.

25. But if that doesn't work, I'm left with two choices—

26. um, a temporal lobectomy, which could impair my speech,

27. or get a neuromodulation device,

28. which can sense and stop the seizures

29. almost immediately.

30. You need to disclose this.

31. I know. I have a plan.

32. Hey, Robby, Dana's looking for you.

33. She's in Peds.

34. Yeah, OK, I'll be right there.

35. Sounds like you're needed in Peds,

36. and I have patients to see.

37. Robby, pregnant woman with severe headache

38. on her way in by ambulance.

39. Find Abbot or a night shift resident.

40. Need you to turn out your pockets.

41. OK. Show me your hands.

42. Come here often?

43. What's going on?

44. Oh, sorry—false alarm.

45. We thought she spiked a fever, but it was the wrong chart

46. from our analog hell.

47. You know anybody who might consider kinship adoption?

48. Doctors and nurses qualify.

49. Don't look at me.

50. Hey, can your staff keep an eye on Dr. Al-Hashimi

51. until she leaves?

52. Why?

53. Uh, because I think she's tired,

54. and I don't want her to make any mistakes.

55. Oh, great advice. Maybe you should take it.

56. Yeah.

57. I'm gonna go get some fresh air.

58. Grab some for me while you're out there.

59. Your lungs wouldn't know what to do with it.

60. Screw you!

61. In front of the baby? Nice.

62. Yeah.

63. We are the night crawlers.

64. We deal with the weirdest and the wildest because...

65. We are the weirdest and the wildest of them all.

66. That is right, and tonight,

67. they are really gonna be crawling.

68. Now go get some!

69. Hooah!

70. Sorry to wake you.

71. I—I was thinking.

72. Doubt PTX.

73. You're supposed to be leaving.

74. I am.

75. You know, this spirit quest of yours

76. has a lot of people up in arms around here.

77. Everyone's gonna be fine without me,

78. and it's hardly a spirit quest.

79. Whatever it is, it seems you've given people

80. the impression you might not be coming back.

81. Well, who knows

82. what the future has in store for any of us?

83. Yeah, saying shit like that right there

84. isn't helping.

85. People are worried about you.

86. Dr. Abbot, the patient in South 21,

87. Digby, he's missing again.

88. Sounds like a day shift problem.

89. Not if he was handed off already.

90. Best I can do under the circumstances.

91. Thank you.

92. Hey, don't leave before I get back, yeah?

93. Hell, I feel like I live here now.

94. Your friend fixing your bike?

95. Ambulance clipped it

96. while it was just parked here today.

97. Jesus Christ.

98. That's a sign if I've ever seen one.

99. Yeah, here's the thing— when people worry about you,

100. it makes me think that I should be worried about you,

101. and I don't like worrying about things.

102. Ooh. Now you're a shrink?

103. No, I'm trying to be your friend.

104. You got—you got Dana convinced

105. that you're gonna hurt yourself.

106. - Dana's got her own issues. - That sounds like projection.

107. Are you seriously trying to have this fucking

108. conversation with me right now, man?

109. I—I'm not the one

110. who spends his free time getting shot at.

111. Hooah!

112. Hey, Dr. Robby, this is Judith Lastrade—

113. 36 weeks pregnant with two days of headache,

114. now a 10 out of 10 with blurred vision.

115. BP 174/120, heart rate 92.

116. No relief with fentanyl. - Judith, I'm Dr. Abbot.

117. Any weakness in your arms or legs?

118. No, no. Is this a stroke?

119. We need to check for everything.

120. Pitting edema with severe preeclampsia.

121. Where are you doing your prenatal care?

122. Nowhere.

123. It's a wild pregnancy.

124. I want a free birth.

125. This 81-year-old nun presents with red, itchy eyes

126. with secretions for the past two days.

127. Patient complains of no URI symptoms,

128. no contact with any chemical... - Hey.

129. Agents, no known exposures—

130. Want half a Monster?

131. Oh, no, thanks.

132. I—I don't really want to stay awake

133. any longer than I have to.

134. Yeah, I hear you.

135. Did you find your ID badge?

136. Uh, no.

137. You any closer to deciding what's next for you?

138. Uh, yeah, I'm seriously considering law school.

139. What? What are you talking about?

140. You're gonna be a great doctor.

141. I mean, no offense, but look what this place does to you.

142. Langdon's an addict.

143. Is a person with a substance use disorder.

144. McKay was on house arrest.

145. Dana's a time bomb.

146. Santos is one of the angriest people

147. you are ever going to meet.

148. Sarcastic, yes. Cynical, definitely.

149. I don't know if she's, you know—

150. Mel?

151. Samira has no life.

152. Abbot's an adrenaline junkie who gets shot at for fun.

153. Robby's got, like, PTSD or something way fucking worse.

154. OK, well, I—I mean,

155. I'd hate to know what you think about me.

156. I don't know, I just—

157. the more time I spend here,

158. the more I realize the importance

159. of my mental health.

160. Mm.

161. For patients and for us.

162. And this is...

163. Yeah.

164. Well, you know,

165. maybe that's what you should focus on.

166. - What? - Mental health.

167. Clearly, you have a passion for it, right?

168. I mean, that's—that's great.

169. I don't know if I'd call it a passion.

170. I would call it, like, a...

171. Oh, my God.

172. You might be right.

173. Oh, you're a genius, Whitaker.

174. Oh, OK.

175. CTG is on.

176. - CTG? - Cardiotocography.

177. Measures the baby's heart rate and checks for contractions.

178. Fetal heart rate 128.

179. Normal range, Nazely?

180. 110 to 160.

181. So the baby's OK?

182. Right now, yes.

183. 128 is reassuring.

184. BP's 170/119.

185. 6 grams of magnesium running in.

186. Your next move, Crus?

187. 20 of labetalol, IV push over two minutes.

188. Uh, what's happening?

189. Uh, you have a condition called preeclampsia.

190. And how did it happen?

191. Uh, nobody really knows, actually.

192. It affects about 10% of the pregnancies.

193. High blood pressure, headaches,

194. protein in the urine, and swollen ankles.

195. OK, well, it's a wild pregnancy,

196. so that means no medical care.

197. Then why are you here?

198. I just need to get rid of this headache.

199. Well, if we don't lower your blood pressure

200. and treat with magnesium, there can be problems.

201. Like what?

202. Seizures, bleeding,

203. even death, for you and the baby.

204. Oh, my God.

205. Robby, your VIP's ready to go.

206. OK, I'll be right there.

207. You good? - Yeah, I'm good.

208. I got it. With my eyes closed.

209. But I won't. Maybe one eye.

210. Hey—

211. Hey, Becca. How you feeling?

212. I'm better. Thanks.

213. Where are you?

214. I'm at Adam's house.

215. Can I call you later? We're watching a movie.

216. Oh, sure. I just—I thought

217. you were gonna see the fireworks.

218. Nope, we decided to watch "Elf" instead.

219. Ah.

220. Of course you did. - OK.

221. I'll call you tomorrow! - Tomorrow? Wait.

222. Uh, are—are you spending the night?

223. Um, uh, yes.

224. His parents invited me.

225. They—they need to ask me that.

226. Are—are you staying here too?

227. No, they—they needed to ask if it was OK if you stayed.

228. Why?

229. Be—because, uh, it's polite.

230. It's the right— it's the right thing to do.

231. Um, I need to talk to them.

232. Um, they're not here. They're at a barbecue.

233. OK, um, can you have them call me

234. as soon as they get home?

235. - Yes. - Can you promise?

236. I promise. OK, bye, Mel!

237. Bye. Have fun—

238. Thanks for fixing my bike.

239. Well, you keep me running, I'll keep her going.

240. You know, the Cree don't have a word for goodbye.

241. You know a lot of Cree?

242. A bit.

243. I got around, man.

244. I don't doubt it.

245. Look, I'll come back for all this other shit...

246. Great.

247. If you promise to come back

248. and let me take the Bonnie for a ride.

249. Uh, I don't know.

250. I've seen you ride, old man.

251. Fuck you.

252. I mean it.

253. We got a deal?

254. I'll think about it.

255. This looks like an ambush.

256. We got a slight hiccup in chairs.

257. ICE is back?

258. No, we got a dead body.

259. - Somebody died out there? - Yeah.

260. Poor devil checked in at 5:00 this morning.

261. He was a DNR.

262. - What was his chief complaint? - Hemorrhoids

263. and constipation. - No shit.

264. Hence the constipation.

265. Throw me a slow one, I'm gonna hit it.

266. Tell the night shift. I'm saying that's when he died.

267. We all in agreement on that?

268. To the grave.

269. Just like poor Jasper.

270. You're on fire.

271. Just getting my second wind.

272. How's the headache?

273. Still a 10.

274. More fentanyl?

275. - Yep. - BP's good. Another 50.

276. Hey, Abbot.

277. Attending and resident are stuck in the OR.

278. Oh, you're the next best thing.

279. Better, some would say.

280. Mm.

281. - What do you got? - This is Judith.

282. G1, P0 with no prenatal care.

283. Preeclampsia with severe hypertension.

284. Hi, Judith. Nurse Garvin from OB.

285. Some jelly on the belly.

286. Gonna take a quick look with ultrasound.

287. No, no, no. Ultrasound can harm the baby.

288. - Not true. - Not doing the ultrasound

289. could end up harming you and the baby.

290. OK.

291. Just do it as fast as you can.

292. Why no prenatal care, Judith?

293. I wanted a free birth—

294. no doctors, no hospital, no medicine.

295. Mm. You have a midwife?

296. A birth doula?

297. No, I don't need one.

298. Women have been having children on their own

299. for thousands of years.

300. Yeah, with an infant mortality rate

301. of 30% for most of those thousands of years.

302. - Femur length 7 centimeters. - 37 weeks.

303. They'll probably induce.

304. What? No.

305. No, no, no, no. Absolutely not.

306. At 37 weeks,

307. the cure for preeclampsia is to deliver the baby.

308. We need to get you upstairs so the OB doctors

309. can induce labor to save you and your baby.

310. No. No, no, no, no. Mm-mm.

311. Yep, that's definitely Jasper.

312. He was alive and kicking

313. when my shift ended this morning.

314. This is definitely a day shift patient.

315. Now he's not a patient.

316. He's a DB that we gotta deal with.

317. Is this dude dead?

318. Nope.

319. All right, Mr. Reed, time to take you back

320. and get you checked out, OK?

321. - He sure looks dead. - Are you a doctor?

322. - No, but he— - Has hypernarcolepsy.

323. It's no joke. - Mm-hmm.

324. Excuse me.

325. Oh, sometimes I hate nights.

326. - Yep. - Oof.

327. Wow.

328. Crazy how muggy it still is out here.

329. You, uh—you seen Robby?

330. Uh, not for a bit.

331. You catch up on your charts

332. from the beginning of the shift?

333. Yeah.

334. What are you still doing here?

335. Uh, just gonna...

336. You staying for the fireworks?

337. Yeah.

338. I was supposed to see them with Becca,

339. but she is at her boyfriend Adam's

340. family's house instead.

341. Your sister seems like she's, uh, pretty put-together.

342. Yeah.

343. Uh, a lot more than I realized.

344. How was your day?

345. I've had better.

346. You?

347. Yeah.

348. But then again, I've had a lot worse.

349. Hell, I did a closed cervical reduction, like, an hour ago.

350. Oh, I heard. That must have been so intense.

351. My hands are still shaking.

352. Hey, um, do you think you could teach me

353. how to do that sometime?

354. Uh, yeah.

355. - Yeah? - Yeah, sure. I mean,

356. I hope you never have to use it.

357. I could have paralyzed that guy.

358. Yeah, but you didn't.

359. No, I didn't.

360. Thank you...

361. by the way, for...

362. talking me down earlier.

363. I'm sorry I snapped.

364. It's OK.

365. Dr. Mohan, you ever heard of kinship fostering?

366. It's where a nurse or doctor can

367. become an emergency foster— - Oh, no.

368. I don't need any kids.

369. I need to find a job first.

370. Candice O'Grady is an 82-year-old female

371. brought in by her son for intractable vomiting.

372. No fever, no chills, no abdominal pain, no rash.

373. Beep.

374. Oh, I've already got one I can barely keep up with.

375. What about Sleeping Beauty over here?

376. She's already babysitting Whitaker.

377. Well, if you know anyone who'd like to help us out

378. with Baby Jane Doe, have them call the main desk.

379. Sure thing.

380. I'd take her myself, but Benji'd kill me.

381. BP's 164/114.

382. Another 40 of labetalol.

383. Mag bolus is in.

384. Now infusing 2 grams an hour.

385. Labs are coming back.

386. Hemoglobin 7.5, platelets 40.

387. LFTs are sky high.

388. - HELLP syndrome. - Hemolytic anemia,

389. elevated liver enzymes, and low platelets.

390. They're cleaning a room.

391. We can bring her up in ten minutes.

392. How you doing, Judith?

393. I—I—

394. Oh, she's seizing.

395. Oh, shit.

396. 10 of IV diazepam. Have another 10 ready.

397. With all the movement, we can't get a fetal heartbeat.

398. Putting on 15 liters by mask. Should we intubate?

399. Hold intubation. Let's try to break this.

400. We don't want to mask seizures with paralysis

401. unless we have to.

402. OK, um...

403. Crus, CTG isn't reading.

404. Check with ultrasound. - On it.

405. Nazely, what's the diagnosis?

406. Um, with the seizure, now it's eclampsia.

407. - Fetal heart rate is about 90. - Way too low.

408. Mom's sats are going down.

409. Time to tube her?

410. Set up for it, but wait.

411. Another 10 of diazepam.

412. Push 4 grams of Keppra.

413. History of hypertension

414. presents to the emergency department

415. with a chief complaint of dizziness

416. after inadvertently ingesting 80 milligrams—

417. Hey, how are you guys making out?

418. Yeah, we're getting there.

419. Have you seen Dr. Al-Hashimi?

420. - No. - Can I talk to you for a sec?

421. So I just wanted to let you know that I've been

422. checking out some of your online posts—

423. Look, I was just trying to help

424. get some health messages out there,

425. especially for young people. - I think they're great.

426. Really good.

427. - You do? - Yeah.

428. Yeah, um, keep it up.

429. OK.

430. As long as you follow the HIPAA laws.

431. I do.

432. And wait until you're done charting.

433. Sure.

434. Actually, Dr. Robby—sorry, um, can I ask you a question?

435. Shoot.

436. Um, I—I may be

437. considering emergency psychiatry.

438. Very cool.

439. Think I could do it?

440. I think that you could do

441. anything that you put your mind to, Victoria.

442. OK.

443. Pulse ox is 88.

444. Dr. Abbot?

445. Intubate? - Let's do it.

446. Nazely, what do you suggest for rapid sequence induction?

447. Etomidate and roc.

448. Mm, not quite.

449. 120 of propofol,

450. 60 of succinylcholine.

451. Why is that, Crus?

452. Propofol for the anti-seizure effect,

453. sux to avoid prolonged paralysis

454. so we can check her neuro exam. - Exactly.

455. Pushing the propofol.

456. Once she's flat for intubation,

457. we need to displace the uterus to the left.

458. Nazely, that's you. Big hug, both arms.

459. Get the baby off the vena cava. - Sux is on board.

460. But after she's paralyzed, the seizing stops, right?

461. It might look like that,

462. but an ongoing seizure will still fry the brain.

463. We monitor with EEG.

464. - Is there time for that? - Wait and see.

465. Paralytics kicked in.

466. Let's go. Roll her to her back.

467. Intubate, then EEG

468. to see if her brain is still seizing.

469. I need first pass success.

470. You and me both.

471. Have you seen Dr. Al-Hashimi?

472. No.

473. Have you seen Dr. Al-Hashimi?

474. Al-Hashimi?

475. With how this day's going, she probably quit.

476. Last I saw her, she was in Peds with Baby Jane Doe.

477. Nope, I was just in there.

478. Want me to page her?

479. Uh, no, that's OK.

480. I will find her.

481. Hello.

482. Hey, how did our people do at the deposition?

483. Oh, well, Dr. Ellis is a pit bull.

484. Dr. King is a petunia.

485. They were pretty brutal with her.

486. - She's sensitive. - Very.

487. And I'm afraid it isn't over.

488. They want to call her back.

489. Oh, that's unfortunate.

490. Maybe I should go with you

491. to break that news to her, actually.

492. - Misery loves company. - Um, hey, while I have you,

493. can I pose a hypothetical to you?

494. If a doctor suspects another physician

495. of having a medical condition that could negatively

496. affect the way they would treat a patient,

497. where would disclosing that fall

498. on the HIPAA violation scale?

499. First, do no harm.

500. Dr. King, do you have a second?

501. Mm...

502. Good lung sliding bilaterally.

503. Fetal heart rate borderline at 98.

504. Roll her to the left again. That can help.

505. One, two, three.

506. OK, all set here.

507. EEG monitor's good to go.

508. That was fast.

509. Still seizing while paralyzed.

510. It's nonconvulsive status.

511. What's she had so far?

512. 30 of diazepam, a full load of mag,

513. Keppra, and propofol.

514. Damn. What's your next step?

515. Any ideas?

516. Hmm? Nazely?

517. Dilantin? Valproate?

518. Mm, infusion is too long.

519. So is onset of action.

520. Push 100 of ketamine.

521. That's had results with refractory status.

522. She also has HELLP syndrome— hemoglobin only 7,

523. platelets down to 30. - Two units whole blood?

524. O-neg is going up on the rapid infuser as we speak.

525. Uh, put the AP pads on, just in case.

526. And 10 of Decadron IV push for the inflammatory storm.

527. - Fetal heart rate up to 104. - Hmm.

528. - Little better. - Yeah.

529. She should be upstairs with OB.

530. She will be after we break this seizure.

531. There was a delay in history-taking

532. due to a malfunctioning VRI interpretation device.

533. During this time, there was a normal CBC

534. and comprehensive metabolic panel

535. that came back from the lab.

536. What's wrong with you, Malfeasance?

537. I have to do another deposition.

538. Oh, that sucks.

539. You must have really messed up.

540. Dude, I'm joking.

541. You gotta lighten up.

542. It's all just bullshit.

543. God, you know what? Fuck all this.

544. Do you want to go get a drink?

545. Me?

546. Yes, you.

547. You—you do go out, don't you?

548. Well, I'm usually with Becca.

549. Well, bring her along.

550. Can she drive?

551. No, and she's with her boyfriend.

552. OK, Becca.

553. So it's just you and me.

554. Do you like karaoke?

555. You do karaoke?

556. Well, what I do is more like primal scream therapy.

557. There's nothing like getting wasted

558. and just absolutely wailing

559. to shake off a shit show like today.

560. I could use a fun night.

561. You and me both, sister.

562. There's been no improvement.

563. Still seizing on the EEG.

564. Neurology has been called. - OK. Got it.

565. OB says send her up. They have an OR ready.

566. About time.

567. Baby's been bradying down a bit more.

568. This one looks like it took a turn for the worse.

569. Eclampsia, refractory seizures,

570. HELLP syndrome with anemia and thrombocytopenia.

571. Yeah, about as bad as it gets.

572. V-fib!

573. Chest compressions, Nazely.

574. Charge to 200.

575. Prep the belly.

576. Get a baby warmer.

577. Call the NICU. Start a timer.

578. Charged.

579. Clear.

580. Continue compressions.

581. We'll check a rhythm in a minute.

582. Gown up.

583. Robby, it's you and me.

584. Nazely, what's the four-minute rule?

585. Uh, not sure.

586. Pregnant patient with a viable fetus,

587. you have four minutes after cardiac arrest

588. to save the baby. - And the mom.

589. We don't call it a postmortem C-section anymore.

590. It's a resuscitative hysterotomy

591. to try to save them both.

592. But she doesn't want any medical intervention.

593. That doesn't matter.

594. Mom and baby are both dead if we do nothing.

595. OK, charge to 200.

596. One more rhythm check and then Abbot and I are gonna cut.

597. Ellis, you and Crus on Mom resuscitation.

598. Shen, you and Nazely take the baby.

599. OK, hold compressions.

600. Still V-fib.

601. Clear.

602. No change.

603. Resume compression, amp of epi. - OK, showtime.

604. We need to get this baby out right now.

605. OK, take a break.

606. OK, 10 blade. Good.

607. First incision is from the xiphoid

608. to the pubic symphysis

609. through the skin to the linea alba.

610. Units three and four on the infuser.

611. Second incision goes through the peritoneum,

612. exposing the uterus.

613. Where do you need me?

614. You're with the baby. Nazely's got the bag mask.

615. You're on suction. Stand by for intubation.

616. Bladder retractors.

617. Neonatal monitor and pulse ox ready to go.

618. Ellis, gentle traction.

619. OK, making a small vertical incision

620. through the lower uterus so as not to cut the baby.

621. Mm-hmm.

622. - Got it? - Yep, I got it.

623. - OK. - OK.

624. Using scissors to extend superiorly.

625. Ellis, hand retract the uterus with me.

626. Amniotic fluid looks good.

627. Give me some fundal pressure.

628. Breech position.

629. OK, baby's out.

630. It's a girl. - All right.

631. Milking the cord.

632. Clamping.

633. Cutting.

634. OK, blue and flaccid. Coming to you, Shen.

635. You ready? - Yeah, you got her.

636. I got it, yep.

637. OK.

638. Poor tone, no movement.

639. Keep the blow-by closer.

640. She's really blue.

641. Some blue is normal, but not this much.

642. - Do we need to intubate? - Not yet, no.

643. They usually pink up with stimulation and blow-by.

644. OK, removing the placenta.

645. Sweeping to the left, trying to get it in one piece.

646. - Looks intact. - Yeah.

647. Nicely done.

648. 10 of IV Pitocin to contract the uterus.

649. And lots of massage.

650. Heart rate 76.

651. Less than 100 means we need to bag.

652. Suction first.

653. OK.

654. Hey, Jord, charge to 200.

655. Stand by for the next rhythm check.

656. She grimaced. Good sign.

657. Bagging.

658. Pulse ox 45%.

659. Oh, I've never seen it that low.

660. It's not as bad as it sounds.

661. I'm more worried about the heart rate.

662. McKay, get ready with an IO in case we need epi.

663. OK.

664. Rhythm check. Hold compressions.

665. Still V-fib.

666. OK, shock it. - Clear.

667. Resume compressions.

668. Shen, how's she doing over there?

669. Heart rate's up to 104.

670. Uh, at one minute,

671. she's 0 for color, 2 for heart rate,

672. 1 for reflex, tone, breathing.

673. APGAR of 5.

674. 5 out of 10. Not great.

675. Pulse ox 58%.

676. - Intubation? - Uh, not yet.

677. O2 sat in the 60s is normal at one minute.

678. Her heart rate and pulse ox are trending higher.

679. Let's keep doing what we're doing.

680. A little tincture of time.

681. Hold compressions.

682. Looks like sinus.

683. Can't feel a carotid.

684. No.

685. Heart's barely pumping. It's PEA.

686. Back on compressions.

687. Transfuse two more units.

688. She needs more red cells and platelets.

689. Ongoing blood loss from the uterus.

690. Give me all the lap pads we got, please.

691. Yeah.

692. OK, yeah, thanks.

693. I appreciate it, honey.

694. Oh, gotta go.

695. Whoa, whoa, whoa!

696. Hold up.

697. Is there a problem here?

698. Yeah, you two aren't leaving empty-handed.

699. What?

700. One of you follow me.

701. Rape kits are supposed to be picked up

702. within 72 hours of collecting 'em.

703. This one's been here for over two weeks.

704. That's not on us.

705. Well, it's on somebody.

706. It's not bad enough these poor women

707. go through an assault, plus the indignity

708. of the whole collection process,

709. but nobody from the police department

710. even has the human decency to come get these things?

711. Like nobody there gives a flying fuck?

712. OK, we got it.

713. We'll see that these get put into evidence properly.

714. Thank you.

715. How hard was that?

716. Units five and six are in.

717. Down to a slow ooze here.

718. Hold compressions.

719. Looks like sinus.

720. And I got a weak carotid. - OK.

721. Cycle the BP.

722. Better filling, better squeeze.

723. No seizure activity on the EEG.

724. That's progress. That's progress.

725. We're at five minutes.

726. Uh, heart rate is 132.

727. Uh, pulse ox 79%.

728. Nazely, the APGAR?

729. Um...

730. 1 off for color, 1 off for tone,

731. 1 off for respiration with hypoxia, total of 7.

732. Respiration score is for observed breathing,

733. not pulse ox.

734. Sat of 80 is normal at five minutes.

735. With no crying, she still gets 1 off.

736. Yeah.

737. Ah!

738. She just scored the winning point!

739. APGAR of 8 is pretty normal.

740. Holy shit. What did I miss?

741. Eclampsia with status, HELLP syndrome,

742. cardiac arrest, resuscitative hysterotomy.

743. I was in the OR with a septic twin C-section.

744. Got your text 12 minutes ago.

745. Shit happens fast down here.

746. Resuscitative hysterotomy in 36 seconds.

747. - Impressive. - BP's 102/64.

748. Hemoglobin is up to 9.

749. That'll do.

750. NICU's sending a team down.

751. We can take Mom. You guys are rock stars.

752. We like to be referred to as crawlers of the night.

753. If you're not careful,

754. you're gonna get stuck here all night.

755. Nah, Henny said she'd be here in 30 minutes.

756. How's Mom and baby? - Whew.

757. They're both gonna go upstairs.

758. Good. You leaving now?

759. Yeah, pretty soon.

760. I gotta find Whitaker, I gotta find Al-Hashimi,

761. and I gotta find Langdon before I leave.

762. You missed Langdon. He just checked out.

763. Shit.

764. Can I help you?

765. Uh, yeah, I'm Dr. Langdon from the ED.

766. I was just, uh, checking in on the status

767. of someone we sent up here earlier.

768. Patient's name is, uh, Cohen.

769. Let me check.

770. What was she up here for?

771. Uh, clean out a nasty neck fash.

772. Oh, yeah, she's good.

773. She's in 4202, recovering nicely.

774. Great, great.

775. I mean, she was—she was in not-great shape earlier.

776. It was a good catch.

777. Saved her life, even if we couldn't save her leg.

778. Uh, was it below the knee?

779. Unfortunately, it was above.

780. My cell phone and the building manager's.

781. He can help if there's any emergencies.

782. Yeah, what kind of emergencies?

783. Whatever.

784. And follow up with Duke

785. in a couple days, yeah?

786. Yeah.

787. You, um—you sure about this?

788. I trust you, Whitaker.

789. Great.

790. Any questions?

791. Uh, when are you back, exactly?

792. You know, I'll text you.

793. I'm trying to keep my dates kind of fluid.

794. I think this is your ride.

795. Yeah, uh, yes.

796. I—I promise I'll check in on your house tomorrow.

797. Sounds good.

798. - Hey. - Hey.

799. OK. Hey, Theo.

800. You're up late, huh?

801. What you got there?

802. OK.

803. He's been fussy all day.

804. I think he's got another tooth coming in.

805. Aw, right on, big guy.

806. Are you ready to get funky?

807. Yeah?

808. Hey.

809. Any luck picking an elective?

810. Don't know.

811. Maybe I will go into geriatrics.

812. It's a smart choice.

813. I know that life can be challenging,

814. especially when it doesn't work out

815. the way you expected.

816. OK.

817. I thought I would be married

818. with two kids in college by now.

819. Maybe have some property with a pond,

820. and we could play hockey on it in the wintertime.

821. And yet look at me now.

822. No wife, no kids, no pond.

823. It's never too late.

824. Do you really believe that?

825. Yeah.

826. Only for me, or for you too?

827. OK.

828. I see what you did there.

829. Was that true, or something you just said to make a point?

830. Have you worked things out with your mom?

831. We're not talking.

832. I am sorry that, um, I let it distract me.

833. She was treating me like a child,

834. and I was letting her.

835. Have a good trip.

836. Please be safe.

837. We need you here.

838. Even if you can be a dick sometimes.

839. Good luck.

840. You too.

841. Hey, I didn't think you were still here.

842. I was just talking to the neurologist on call.

843. And?

844. We had a nice chat.

845. She agrees I can work with double coverage.

846. That's not her call to make.

847. You can't do anything critical

848. where a five-second lapse in consciousness

849. could potentially kill a patient.

850. I agree.

851. But 90% of our patients

852. don't require critical procedures.

853. And the ones that do?

854. Will be handled by whomever is working with me.

855. Unless they're also tied up with a critical patient.

856. What if it's a double or triple trauma?

857. - Robby, I can handle it. - No, you can't.

858. And I can't let you.

859. I am fully capable of handling—

860. No, you are not fully capable,

861. and you know it.

862. What do you want from me?

863. I want what's best for this department—

864. patients and staff.

865. Best-case scenario, you get a handle on this,

866. you're seizure-free for six months,

867. you get your driver's license back,

868. you are cleared to work.

869. I am cleared for my driver's license.

870. You shouldn't be driving at all like this.

871. If you were a patient, we would have to report you.

872. I am not your fucking patient.

873. No, but I cannot let you work

874. in my emergency department

875. until you're fully capable of doing so.

876. That is not your fucking call!

877. You're fucking-A right, that's my call!

878. I'm trying to protect you and my patients,

879. and you know I'm right about this.

880. Oh, "my department," "my patients."

881. All you fucking think about is yourself!

882. Do you hear yourself?

883. You didn't rat out Langdon

884. for stealing fucking drugs.

885. No, but I kicked him out of this department

886. until he got the appropriate help that he needs,

887. and the same goes for you.

888. You've got until Monday to let the administration know,

889. or I will.

890. I am finished.

891. Last chart.

892. - You and me both. - Really?

893. Is this a thing? I finished a while ago.

894. I never want to hear that fucking bell again.

895. - Where's Dana? - Not sure.

896. A bunch of day shift just headed to the roof

897. to watch the fireworks.

898. You want me to call her?

899. No, that's OK.

900. Yo.

901. Thanks for your help in there.

902. Almost out? - Yep, just about.

903. Is this where you try to talk me out of going?

904. Me?

905. No, not a chance.

906. Why, are you having second thoughts?

907. - Nope. - No?

908. Nope.

909. Don't have to convince me.

910. I mean, it is a little strange the only place

911. you talked about going is somewhere

912. they used to drive buffalo off a cliff to die.

913. - Here it comes. - I looked it up,

914. and as far as summer vacations go,

915. it's not exactly a holiday hotspot.

916. I mean, what's in the fucking gift shop, man?

917. It's just one place I'm going.

918. As long as it's not the last.

919. Don't be pulling a "Thelma and Louise" out there.

920. I am minutes from taking a three-month vacation.

921. When's the last time you took any time off, Jack?

922. Yeah, but I've dealt with my demons.

923. It's a process.

924. You want to know why I never killed myself?

925. After what I saw, lived through?

926. Losing my leg, losing my wife?

927. Because it comes for all of us, man.

928. You and I know it more than most.

929. We see it every shift,

930. but we can't let ourselves succumb to it.

931. Yes, life can suck.

932. It can be unbearable

933. and—and brutal

934. and ugly and heartbreaking.

935. But it's also beautiful— and hilarious.

936. And that woman today...

937. Her baby, they'd both be in the morgue

938. if you hadn't been here.

939. That's us. That's you and me.

940. That's what we're here for.

941. The most important things I've ever done in my life

942. have been in this hospital.

943. Nothing will ever matter more than what I've done

944. in this hospital, but it is killing me.

945. You know how they say that a part of you dies

946. when you lose someone you love?

947. I'm not convinced that a part of you doesn't die

948. every time you see a fellow human pass.

949. And I've seen so many people die

950. that I feel like it's leaching something from my soul.

951. Go on a cruise, man.

952. Knock off this helmetless motorcycle shit.

953. Yeah, people talk.

954. That's death-wish behavior.

955. I'm tired of being a role model.

956. I'm tired of feeling like you can't get ahead.

957. I'm tired of feeling like I'm drowning every day.

958. I'm tired of all of it.

959. You need to get away for a while,

960. and you need to get some help.

961. You need this place as much as it needs you.

962. Am I fucked up?

963. 100%.

964. But nobody works here as long as you and me

965. and doesn't get screwed up.

966. You—you gotta find somebody

967. to help you dance through the darkness.

968. Did you just make that up?

969. Maybe it's a song lyric.

970. I don't— maybe my therapist said it.

971. I don't know.

972. Some dude just pulled up.

973. Looks like he blew half his face off.

974. How can you not love this place?

975. Look, don't make me look stupid.

976. You come back to us in one piece.

977. I'm still your emergency contact,

978. and I do not want to be contacted.

979. All right, night crawlers,

980. what the hell's going on out here?

981. 25-year-old man—

982. history,

983. no meds, no allergies.

984. More than 2,000 years ago,

985. the Chinese were throwing bamboo into fire

986. to make explosions.

987. They went on to invent gunpowder.

988. And boom! The rest is history.

989. They had chemicals to get the different colors, you know?

990. Sodium gives you yellow, strontium gives you red,

991. and barium is green.

992. Who knew chemistry could be so damn pretty?

993. - Hey. - Hey.

994. - I thought you'd left already. - On my way out.

995. Hey, I'm sorry that I didn't find the time today

996. to have that conversation.

997. Yeah, that's all right.

998. Seems like you didn't really want to.

999. I didn't.

1000. Did you?

1001. Uh...

1002. yeah, actually.

1003. Look, I'm doing the work.

1004. I'm—I've been sober 186 days.

1005. I'm going to meetings. I'm taking the drug tests.

1006. - That's good. - And you're still riding me.

1007. What would have happened if I'd paralyzed that guy?

1008. I don't know.

1009. What would have happened if I hadn't been here today?

1010. You'd still be questioning yourself.

1011. Now you know you can do it. You're welcome.

1012. Oh, so that's— that's how you teach now?

1013. Sometimes.

1014. You know who I saw in rehab?

1015. I saw a bunch of guys just like you.

1016. The only difference is,

1017. they've accepted that they need help.

1018. I think you're afraid to admit that

1019. the mighty Dr. Robinavitch isn't perfect.

1020. Oh, I never claimed to be perfect.

1021. No, but you expect it of yourself,

1022. and it's not realistic, man.

1023. How can any of us live up to your standards

1024. if you can't even do it?

1025. You need help, Robby.

1026. You need help.

1027. Finished?

1028. You don't gotta be honest with me, man.

1029. At least be honest with yourself.

1030. She is due for a new bottle.

1031. I was hoping to get her some formula before I clocked out.

1032. I'll stay with her.

1033. Thanks.

1034. Why are you—will you hit those lights on your way out?

1035. - Yep. - Why are you crying?

1036. Why are you crying, little one?

1037. You're OK. You're safe.

1038. Yeah, you're not alone.

1039. Yeah, you're OK.

1040. Do you need to be swaddled again?

1041. Is that it?

1042. I can do that. Look.

1043. Aww.

1044. I wish somebody would swaddle me.

1045. Yes, I do.

1046. Oh.

1047. You got off to kind of a rough start,

1048. didn't you, little one?

1049. Yeah, you did.

1050. Well, that makes two of us.

1051. I got abandoned too.

1052. When I was eight.

1053. But I got through all of that, and so will you.

1054. I got a good feeling that you're gonna be just fine.

1055. Everything's gonna be just fine.

1056. You got so many wonderful things to see

1057. and so many people to love ahead of you.

1058. So many wonderful things to see,

1059. people to love ahead of you.

1060. Shh.

1061. It's OK. It's gonna be OK.

1062. It's OK.