The Pitt 2x4

1. - The man is in his element. - What's he doing?

2. Age-old ritual, meant to capitalize

3. off the unknown origins

4. of Westbridge's current state of affairs.

5. Whoever guesses the reason they went code black wins the pot.

6. Ah, interesting. We didn't do this at the VA.

7. - You game? - Of course.

8. Now, how's this look to you?

9. My wager is on flooding.

10. They're going to be down for 3 hours,

11. and we're going to get 20 of their patients.

12. Put me down for flooding, 4 hours and 30 patients.

13. Okay, okay, okay.

14. Hey, Dr. Robby, looks like you got some competition.

15. Yes, it would appear that I do.

16. All right, guys and gals, enough fun.

17. We have people to take care of.

18. You want to bring Langdon back from triage

19. for the extra hands?

20. No, I do not. I don't think that's necessary.

21. We're doing just fine without him.

22. You're the boss, boss.

23. Daniel Ortiz, tu licencia en el mostrador.

24. Next.

25. Hi. Uh, the doctor guy told me

26. to put this mineral oil on my eye for 20 minutes.

27. That was 2 hours ago.

28. We're really busy, but we'll get to you.

29. - Oh, my God. Okay, when? - I will check.

30. Listen for your name to be called.

31. - Thanks. - Next.

32. Excuse me.

33. Uh, hi. I heard my brother was brought here.

34. His name is Jackson Davis. - Do you have ID?

35. Yes, yes, um,

36. I am his sister Jada Davis.

37. I'm sorry. I just, uh—

38. my friend told me that he was brought in by campus police.

39. There was some sort of fight that broke out at his school.

40. Is he okay? Is he here? - Don't know, hon.

41. Can you just tell me if he's a patient here?

42. I'll check. Take a seat. And I'll let you know.

43. - Okay. - Next.

44. Is Harlow feeling lightheaded or faint now?

45. It's not as bad as it was before,

46. but my head still hurts.

47. And now my stomach does, too.

48. Well, did she eat before she took her ibuprofen?

49. Ugh, it's not my...

50. Breakfast is my least favorite meal of the day.

51. It's okay to look at me.

52. I don't bite.

53. I'm sorry.

54. Um, we're going to get started with some blood tests.

55. Is that baby from the bathroom going to be okay?

56. She'll be fine.

57. Uh, good news—

58. nose swab came back negative for COVID,

59. influenza, and RSV,

60. but a lot of other viruses can cause a cough.

61. Lucky me.

62. You can take off your mask.

63. Pulse ox is at 91.

64. Your oxygen level is down

65. since we checked you an hour ago,

66. and your temp is up to 102.4.

67. Let's get you some Tylenol.

68. Have you been outside today? It's already stifling.

69. Could be heat-related, but we're going to take you

70. back to the big ER for a full evaluation.

71. Can't you just

72. write me a prescription for some medicine?

73. I'm sure it's just a summer cold.

74. - Got somewhere to be? - Work.

75. I know. It's Saturday.

76. But I don't think I've had a day off since...

77. Well, your holiday weekend starts now.

78. Hey, Javadi.

79. What are you doing for your birthday?

80. - Who told you? - Word gets around.

81. Nothing. I hate celebrating my birthday.

82. You only turn 21 once.

83. It's your birthday?

84. Oh, that makes you a Cancer, right?

85. I didn't peg you for an astrology girlie.

86. Yeah.

87. Been spending too much time around Santos.

88. Yes, you have.

89. I don't know how you guys do it.

90. Live together and work together?

91. It's my cross to bear.

92. It can't be as bad as having to live with your parents.

93. I don't know. I haven't lived at home in years.

94. I kind of miss it. - I can tell.

95. You've been spending a lot of time on that farm.

96. "Farm"?

97. Remember the burned farmer who came in last year?

98. Propane tank exploded, he died in the ICU?

99. Yeah, that was sad.

100. Well, this guy has been playing house

101. with his widow and their baby.

102. Oh, that's messy.

103. No.

104. It's not like that, okay?

105. I've been helping Amy out on the farm

106. after her husband died, and she is a friend.

107. She's just a friend.

108. Sure, just a friend, with farm benefits.

109. What are farm benefits?

110. Oh, use your imagination.

111. You ever see a milking machine?

112. Oh, can we not talk about this, please?

113. We're getting two runs rerouted

114. from Westbridge already— chest pain and belly pain.

115. Robby wants you three out back. - Thank you.

116. Come on.

117. Dr. Santos, making progress on your charting, I hope?

118. Getting there.

119. Deficient charts leave a gap for the providers

120. who give continuity of care and delays hospital billing.

121. Oh, I'd hate to delay billing.

122. Timely documentation is essential.

123. Let's fix this before end of shift.

124. - I'm on it, boss. - Good.

125. You wouldn't want to repeat your R2 year again

126. because of this.

127. Fuck.

128. God, it's humid as shit out here.

129. It is.

130. What's going on at Westbridge?

131. They're closed, so we're covering their paramedic runs

132. until they come back up.

133. As if a holiday weekend wasn't enough.

134. So, Dr. Al-Hashimi...

135. Yes?

136. Do we like her?

137. She seems pretty cool so far.

138. You're trying to gossip about an attending with an attending?

139. Dr. Robby doesn't mind. Do you?

140. Oh, uh, that's a nice bike, by the way.

141. - Thank you. - Yeah.

142. Pamela Perry, 48, abdominal pain

143. with vomiting after eating chilaquiles with fried eggs.

144. BP 108 over 64, pulse 98, good sats.

145. Okay, let's see how she feels with some Zofran

146. and a liter wide open. - Got it.

147. - Yo, Whitaker. - How are you feeling? OK?

148. Not so good.

149. - Who do we have here? - Jean Samba—

150. 54, half an hour of left-sided chest pain.

151. History of hypertension, on lisinopril and Crestor.

152. Some relief with two nitro.

153. Decent vitals, no STEMI on 12-lead.

154. Gave him 324 of chewable aspirin.

155. Okay, we're going to give you a full evaluation, sir.

156. Oh, if I am to die, God willing,

157. I will see His pearly gates.

158. What's the plan?

159. Repeat 12-lead, check a troponin,

160. admit for new onset angina.

161. Evaluate for PE, aortic dissection.

162. - That goes without saying. - Sounds good.

163. I'm a minute behind you.

164. And who do we have here?

165. Vince Cole, 23, fell through the skylight of a florist shop,

166. 10 feet down to a bunch of ferns.

167. Complained of headache, asking repetitive questions,

168. and only responds to pain.

169. Multiple lacs from the glass.

170. BP, 118 over 72, pulse 98, sats, 99 on 5 liters.

171. No meds, no allergies.

172. Hey, Vince, how'd you fall through a skylight?

173. Vince?

174. Were you with him?

175. Yeah, we were parkouring, and he overshot a kong vault.

176. What, like, jumping off of buildings?

177. People still do that?

178. It was almost an Olympic sport.

179. Now we know why it isn't.

180. Pupils are equal and reactive.

181. - What do you got? - A 10-foot fall, altered.

182. - That's a long way down. - 10 feet is the threshold

183. for trauma center activation— 10 feet, 10% mortality.

184. 0%, anything over 0% is a concern.

185. Somebody's annoying, and it's not me.

186. Hey, you said two. You missed one.

187. Sent you backup, didn't I?

188. One, two, three.

189. Okay. Thanks, guys. Good to see you.

190. Get the EFAST.

191. Ogilvie, Joy, GCS, please.

192. Uh, open your eyes, sir.

193. Two for eyes, two for verbal.

194. Uh, good lung sliding bilaterally.

195. Joy, finish GCS.

196. Squeeze my hand.

197. He gets a 4 for motor.

198. Pulse ox 99, heart rate 102, blood pressure 114 over 78.

199. - And EFAST is negative. - Music to my ears.

200. Somebody shooting a documentary here?

201. Whoa, whoa, whoa, you can't film in here.

202. We've got patient-privacy laws.

203. What happened to your hand? - Cut it.

204. Can somebody show Spielberg here out to the waiting room

205. and get her registered at triage, please?

206. He's my creative partner— I have his written consent

207. to film everything for our TikTok page.

208. Put the camera down.

209. We have to drop this video for the Fourth tonight.

210. That literally means nothing to me.

211. Seriously, Sean, can you escort her out, please?

212. Somebody will come and find you once he's stabilized.

213. Thank you.

214. I would have let her stay if she'd asked nicely.

215. What is the, uh, story with surgery?

216. You guys getting any Westbridge transfers yet?

217. Not yet, but I'm sure it's coming.

218. Pan scan, head through pelvis. Let's get him to CT ASAP.

219. Absent gag.

220. We need to intubate before CT.

221. C-can I do it?

222. Uh, I'm keeping a procedure log,

223. and I need more intubations on this rotation.

224. If Dr. McKay wants to teach?

225. Sure.

226. Okay, uh, I need suction.

227. 8-oh tube, etomidate and sux, end tidal CO2.

228. Ambitious.

229. He reminds me of someone I know very well.

230. Can you not?

231. Yeah, sorry.

232. Hot off the press.

233. Okay.

234. No STEMI, doesn't need to go right to the cath lab.

235. And orders are in.

236. Whitaker, try another nitro

237. and let me know when the troponin's back.

238. Yeah. Hey, hey, Jesse?

239. Do you think you could repeat this

240. but with the chest leads on his back?

241. Why?

242. T Waves are kind of high with ST depression anterior.

243. We see ST depression all the time.

244. Yeah, but it could be a posterior MI.

245. All right, run it by the attending.

246. If they agree, we'll do it.

247. Thank you.

248. Uh, Victoria, if his CT's normal, he'll need an LP.

249. Got it.

250. Dr. Al-Hashimi.

251. This is Jada Davis, Jackson's sister.

252. - Oh, thank you. Hi. - Is he okay?

253. And why is he asleep?

254. Well, he was uncooperative when he first arrived

255. and needed to be sedated. - "Uncooperative"?

256. That doesn't make any sense. What happened?

257. We're still trying to piece the story together.

258. He was brought in by a campus security guard

259. who Tased him after he was allegedly...

260. - "Tased him"? - Combative and violent.

261. Wait, what do you mean, Tased him?

262. We've treated his injury, and now we're trying

263. to understand why he was so agitated.

264. Okay, this doesn't sound like my brother.

265. Well, his drug screen came back negative,

266. so now we're taking Jackson to get a CT scan of his brain

267. to look for any abnormalities. - Can I go with him?

268. You can't go into the CT,

269. but you can wait for him to come back.

270. And then we can discuss next steps.

271. Okay.

272. Just did my first ER intubation.

273. - That's great, man. - Such a prick.

274. - You got a second? - What's up?

275. 12-lead on my chest-pain patient shows no STEMI,

276. but the anterior leads might be suspicious for a posterior MI?

277. Uh... agreed.

278. Yeah, I was going to repeat, but with the chest leads

279. on the back. - V7 through V9.

280. Good idea. - Thank you.

281. Hey, Dr. Robby gave the go-ahead for the back leads.

282. Sorry, man, I got a call report

283. on a septic patient going to the ICU.

284. Busy today, huh?

285. Uh, well, it's 10:15.

286. We're actually just getting started.

287. - Oh. - There she is.

288. Dr. Mohan, uh, this is Lorrie Diaz, Orlando's wife.

289. - Thank you, Perlah. - Thank you.

290. - Hi, Mrs. Diaz. - Hi.

291. Let me take you to your husband.

292. Ay, mi amor.

293. I'm sorry you have to be here alone.

294. I missed my first bus transfer and—

295. Anyway...

296. Hey.

297. How'd I get here?

298. You fell at your construction site.

299. A coworker brought you in.

300. He's a lot better but doesn't remember anything.

301. That's common after a concussion or DKA.

302. DKA?

303. It's a serious complication of your husband's diabetes.

304. How serious? Can he go home?

305. We still have to clear the ketones from his bloodstream.

306. He'll need to be on an insulin drip for a while

307. until things get back to normal.

308. Best if he stays in the hospital.

309. It's okay, Mom.

310. Things are headed in the right direction, Mrs. Diaz.

311. He's going to be better. - Mm.

312. Sorry. I got to check his blood sugar.

313. - Oh, do you mind? - Absolutely.

314. So the thing is...

315. we don't have health insurance.

316. So...

317. I don't think that we can afford this.

318. I'll have our case manager, Noelle Hastings, come by.

319. She's an expert in health insurance.

320. She might have some options for you for coverage.

321. Okay. - Thank you.

322. Crap. - What's wrong?

323. Uh, some of the leads aren't sticking here.

324. Can I lay down now? I'm tired.

325. Yeah, as soon as we're done here.

326. Whitaker, Louie's all numb. His tooth is ready for you.

327. That's great.

328. Hey, I'm having some trouble here with adherence.

329. Oh. Of course you are.

330. Uh, try this.

331. Oh, yeah. That makes sense.

332. Uh, you think you could—

333. Do you mind if I paint some sticky stuff on you?

334. Oh.

335. If you must prolong the inevitable, so be it.

336. You'll get to lie down afterwards.

337. No success with the mineral oil.

338. That's what I said.

339. So now what?

340. You can wait one to two weeks

341. for the superglue to break down on its own.

342. I'm hosting a Fourth of July party tonight.

343. You want me to show up like this?

344. The other option is I trim your eyelashes halfway down.

345. That'll lower the strength of the glue holding them together.

346. Let's do that.

347. Lie back, please.

348. I need you to hold your head perfectly still,

349. keep your eye closed.

350. My eye can't open. That's why I'm here.

351. No, I mean, your other eye, too.

352. Okay, here we go.

353. Perfect, Mr. Samba.

354. All good here.

355. Feeling... dizzy.

356. We'll put you down in a second.

357. Holy shit.

358. ST elevation, V7, V8, V9.

359. It's a posterior STEMI. - What's that?

360. It's the worst kind of heart attack.

361. Mr. Samba.

362. Mr. Samba!

363. Hey, I could use a second set of hands here!

364. Pulseless V tach.

365. Start compressions.

366. Charging to 200.

367. Clear.

368. Okay, resume compressions.

369. Code STEMI. It was posterior.

370. Yeah, good call.

371. - You put the defib pads on? - Yeah, just in case.

372. Hold compressions.

373. Normal sinus. - All right.

374. Got a strong pulse. Check the BP.

375. All right, we'll prep him for cath lab.

376. Hey, Mr. Samba, you're going to be okay.

377. No pearly gates today.

378. - Really good pickup, Whitaker. - Thank you.

379. Ah...

380. Has a patient ever flirted with you?

381. Sure. Why?

382. There was this guy this morning—

383. he turned out to be a criminal,

384. but, yeah, it was a nice distraction

385. from the deposition.

386. You still worried about that?

387. Yep. Yeah, counting down the hours.

388. There are five left, if you're wondering.

389. Hi, Miss Ronson.

390. Phylicia, please.

391. Phylicia, I'm Dr. King.

392. This is my colleague Dr. Santos.

393. What brings you in today?

394. I've had this pretty bad cough for a few days now.

395. Do you smoke?

396. Are coughing up anything, any chest pain?

397. No, no, and no.

398. I honestly think I picked it up at work.

399. It was going around. - Oh, where do you work?

400. - I'm in corporate at PNC Bank. - Sit forward, please.

401. It could be an office bug.

402. Or I got it from the gym. I'm there all the time.

403. Do you have anything to ask, Dr. Santos?

404. What?

405. Do you have any questions to ask our patient?

406. Uh, no, I'm good.

407. Okay. What'd you hear?

408. Maybe some crackles at the right base.

409. Okay, well, we're going to need a chest X-ray

410. to check your lungs.

411. Will that take long?

412. Maybe I can still make it to the office.

413. It shouldn't.

414. You can go put the orders in. - Yeah.

415. - How are we doing in here? - Oh, this is thrilling.

416. Definitely worth $200,000 worth of student debt.

417. Ha.

418. Superficial ones get a steri-strip.

419. Full thickness, try Dermabond.

420. How can you tell they need a suture, Joy?

421. If the edges are under significant tension.

422. I didn't realize your name was Joy.

423. I'm going to have to tell my parents how trendy they were.

424. CT head, neck, chest, abdomen, and pelvis,

425. all normal on preliminary read. - Lucky guy.

426. Little bit of oozing.

427. Uh, pressure for two minutes.

428. Lidocaine and epi if that doesn't work.

429. Are the admit orders in for Surgical ICU?

430. Fuck!

431. What?

432. - This. - Ah.

433. - Irrigation saline. - It's just a small cut.

434. It is a work-related blood exposure,

435. which means you're a patient now.

436. - Are you serious? - Needle stick?

437. Piece of glass.

438. - Here you go. - Thanks.

439. No past records on this guy.

440. We don't know HIV or hepatitis status.

441. I'll put the orders in, HIV antibody, Hep B surface,

442. and Hep C.

443. She needs post-exposure medication.

444. Maybe not.

445. For occupational exposure, the rapid HIV test

446. takes an hour or two. - Subcutaneous puncture wound.

447. No risk of joint or tendon involvement.

448. Elevate, pressure, and then a Band-Aid.

449. Give yourself a dose of PEP if you want

450. while you're waiting for results.

451. Start a chart, and I'll find another nurse

452. for your blood draw.

453. Great.

454. Looks like we've got a couple more diverted from Westbridge.

455. Any estimate on their downtime?

456. Not yet.

457. Time to pull Dr. Langdon from triage?

458. No, no. First day back.

459. I want to let him kind of ease into things.

460. Understood. I'll keep an eye on it.

461. Thank you very much.

462. Thinking about changing your bet?

463. I am just weighing my odds.

464. Don't worry. I'll buy you a drink with my winnings.

465. Your brother should be back shortly.

466. There was a little holdup at CT.

467. Um, should I be worried?

468. Let's wait and see what his test results say.

469. This is just, um...

470. this just doesn't make any sense.

471. It doesn't sound like my brother at all.

472. He's the—the friendliest guy I know.

473. He never even gets angry, barely yells.

474. He's never had an episode like this in the past?

475. No, or not that I know of.

476. He's in a great relationship.

477. And he's in law school

478. 'cause he wants to help people.

479. He always tells me that I should, um...

480. follow my dreams,

481. even if it means my parents may disown me.

482. Should I call them?

483. I think that's a good idea.

484. This—this could be pretty serious.

485. Thanks. - Mm-hmm.

486. The new radiologist is a hottie.

487. Okay.

488. Um...

489. his head CT is normal, as are his blood and urine tests.

490. Then—then what's wrong with him?

491. We're not, um, sure yet.

492. There is another test— a-a spinal tap.

493. This could be, um, an infection

494. in the fluid that surrounds the brain—viral encephalitis.

495. Um, it can also cause...

496. altered mental status and confusion.

497. Can you treat it, if it is?

498. Yes.

499. Okay.

500. I'll go find Dr. Al-Hashimi, and—and we'll do it together.

501. - Thank you. - Of course.

502. Just what we thought— it's a fracture of your coccyx.

503. It's your tailbone.

504. Yeah, see, these pieces here

505. should be lined up with that part here.

506. - Do I need surgery? - No.

507. No, no, these heal pretty well, but it'll take about six weeks.

508. "Six weeks"?

509. I have dinner dates every weekend.

510. You can keep your—

511. still keep your dinner plans.

512. Dinner starts at Pino's, the best Italian in town.

513. Mm-hmm.

514. A nightcap at my place usually follows,

515. and then breakfast in bed.

516. Ah, okay.

517. Well, in that case, you might—

518. you might need to take a little break.

519. My greatest joy in life is my social calendar.

520. - Mm. - Hmm?

521. Is there something else you can do?

522. W-well, there— there is a procedure

523. to push the fragments back in place.

524. It could help it heal faster. - Now we're talking.

525. Yeah, but it'll hurt pretty bad but only for a second.

526. I can take it.

527. Okay.

528. Come here. Back in the gown.

529. How's it going over here?

530. Better now.

531. Uh...

532. Oh, the X-ray is back on your foot,

533. and no fracture.

534. So, um, ACE wrap, ice, rest, and elevate,

535. and you can take ibuprofen if you need it.

536. So that's it?

537. Well, if it's—if it's too painful to bear weight,

538. we can give you crutches to use for a day or two.

539. So I won't be seeing you again.

540. Uh...

541. as a patient, no, but...

542. it was nice meeting you, Brian.

543. It was nice meeting you, too, Dr. McKay.

544. You know, I was— I was going to go check out

545. a few of the art galleries in Lawrenceville tonight.

546. Have you been to that one on 40th and Butler?

547. No, I was, um, gonna go by.

548. Maybe around 9:00?

549. Okay.

550. Cool. - Cool.

551. Dude, I resuscitated that parkour guy

552. and—and intubated a STEMI.

553. I think I can handle this.

554. It's best if you watch the first one.

555. How's that tooth feeling?

556. The whole side of my face is numb.

557. That's how we like it.

558. Okay, we've got a...

559. a fluctuant gumline at—

560. Tooth number 23, lateral incisor.

561. - With an extension to an— - Apical abscess.

562. - Right again. - Ah, the kid's smart.

563. Hook up the Yankauer. Get ready to retract the gum.

564. Hey, Louie, this is a temporary fix, okay?

565. You're going to need to get that tooth pulled by a dentist.

566. Hey, you going to find me one?

567. We can have you talk to Dylan.

568. Is Dr. Collins around?

569. Sister always helps me out.

570. Uh, Dr. Collins finished her residency,

571. took up a job in Portland as an attending physician.

572. "Portland"?

573. Yeah, I think that's where she's from.

574. She's adopting a baby.

575. Wanted to be closer to her family.

576. Well, that's a beautiful thing.

577. - We're set. - Okay. Ready?

578. Okay, 3-cc syringe,

579. 20-gauge needle entering at the juiciest part,

580. aiming for the apex.

581. - Send that for culture? - No.

582. Pen V.K. for a few days.

583. Bugs in the mouth are old school.

584. Ah, just like me.

585. Both parents work,

586. but neither of them have health coverage?

587. Orlando and his wife have multiple part-time jobs

588. that don't offer insurance.

589. Can they qualify for Medicaid?

590. Unfortunately, no, because their combined annual income

591. is over the Medicaid threshold for a family of five.

592. So they make too much money?

593. And not enough at the same time.

594. They live over the poverty line,

595. and yet they are still living paycheck to paycheck.

596. I think their best option

597. would be to buy private insurance

598. through the Affordable Care Act.

599. Thank you.

600. My parents don't have insurance?

601. I'm sorry, Ana.

602. How much will it cost to keep my dad in the hospital?

603. I don't know.

604. But the ER visit alone will likely be in the thousands.

605. We will figure something out, okay?

606. Purple top for the CBC.

607. Red top for chemistries and serologies.

608. Okay.

609. Ready? - Uh, yeah.

610. I can be a hard stick, though.

611. Now or never, hon.

612. Okay.

613. One, two...

614. three.

615. - Good blood return. - Oh, thank God.

616. Pop one on.

617. You're supposed to release the tourniquet now.

618. Right. Sorry.

619. Lab won't take it without your initials,

620. time, and date drawn.

621. How you feeling? - Peachy.

622. Hopefully I get to do this several times every day.

623. All set.

624. Keep some pressure here for a minute.

625. Initials, time, and date.

626. Oh.

627. Shit.

628. Environmental to North.

629. Sorry.

630. How is he?

631. He's stable. He's doing great.

632. Doesn't look great.

633. Is there brain damage?

634. The head CT showed no bleeding or skull fracture.

635. It's most likely a bad concussion.

636. It's hard to know when he'll regain consciousness.

637. - Did he break any bones? - We don't think so.

638. He should thank those ferns.

639. Uh, chest and abdomen CT scans

640. also showed no major internal injuries.

641. Mm-hmm.

642. What's that?

643. Whoa, whoa, whoa, whoa, whoa.

644. We need respiratory therapy in here!

645. Okay.

646. One, two, three, over.

647. You got a problem with the vent?

648. No, he's bleeding from the back.

649. Got to prone him to take a look.

650. Back away, Tanya. One, two, three, up.

651. One, two, three, over.

652. Good. - Oh, shit.

653. - Left-flank area. - Careful. Careful, everybody.

654. There might be glass. - That's a lot of blood.

655. 2-centimeter simple laceration.

656. Open a suture kit, 4-0 Prolene.

657. He wasn't bleeding when we flipped him on arrival.

658. No, but when we moved him around for CT,

659. it might have rubbed off a clot.

660. Slow venous oozing.

661. I might need a figure of eight.

662. Yeah, little piece of glass in there.

663. It's just under the skin.

664. - Is it a loose fragment? - Yeah, I can wiggle it around.

665. Here, I'll pull it out. - No, don't—

666. Shit.

667. Uh, that's—it's bigger than I thought it would be.

668. - Shit. - That looks arterial.

669. Can I get some 4-by-4s over here, please?

670. Oh, I'm going to be sick.

671. Put some pressure on this from all sides.

672. Hard and deep, please.

673. I can push it back in. No!

674. No, you've done enough damage.

675. Should I keep pulling it out, then?

676. Absolutely not. The glass was tamponading a vessel.

677. Not anymore. BP's down. Page surgery!

678. - Ah, I was looking for you. - Well, you found me.

679. Um, the X-ray came back on the lady with the cough.

680. Weird infiltrate. Have you seen it yet?

681. No, I've been trying to catch up on my charting.

682. Right here.

683. Yep, stringy right lower lobe.

684. It looks like aspiration pneumonia.

685. Think about it.

686. How do oral and gastric fluids end up in lungs?

687. Um, dysphagia, swallowing disorders.

688. But she's not an old person choking on their food.

689. Right, and there's protracted vomiting.

690. Okay, maybe recent gastroenteritis,

691. food poisoning.

692. Yeah, or...

693. or...

694. An eating disorder.

695. You think she's bulimic?

696. I mean, she's fixated on working out.

697. Check the, uh, enamel behind her front incisors.

698. Um, oh, it's, uh—

699. if it's not in the differential,

700. it won't be in the diagnosis.

701. You know that—

702. Yeah, you know— you know that.

703. Nice job on the tap.

704. Thanks.

705. Hi. You called for a consult on Jackson Davis?

706. Yes, we did.

707. I'll let Victoria present the case.

708. This is Jada, Jackson's sister.

709. This is Dr. Jefferson from psychiatry.

710. "Psychiatry"?

711. Do you think this is a mental-health problem?

712. We thought it best to cover all our bases.

713. We'll know more once I speak with your brother.

714. Okay.

715. Hi, Jackson.

716. Jackson, can you wake up?

717. Jackson. - They said he's sedated.

718. I'll come back a little later.

719. - Oh, that was fast. - Yeah.

720. Next time, maybe wait until the patient wakes up

721. before calling me down.

722. Psychiatrists do best

723. when we can actually talk to our patients.

724. I got a little ahead of myself.

725. Um, will do.

726. Thank you.

727. Sorry.

728. Pressure's up with one unit type specific.

729. What the fuck? He was stable.

730. - Slight change in status. - Okay, get the clamp ready.

731. Who's the genius who pulled that out?

732. I thought it was a loose fragment.

733. Next time, leave the decisions to the adults.

734. Okay, Dr. McKay, ready to go?

735. - Whoa. - Hoo.

736. Looks like an icicle.

737. Christmas in July.

738. Hey, Sophie, can you answer that?

739. Okay, I am injecting the X-stat.

740. - Hello? - What is that?

741. It's a syringe filled

742. with tiny, rapid-expanding hemostatic sponges.

743. Okay, got it. Thanks.

744. Radiology attending says a resident missed something.

745. There's a radiopaque foreign body

746. in the left paralumbar musculature.

747. Not anymore.

748. Sounds like "first week in July" syndrome.

749. Mm-hmm.

750. Okay.

751. That looks pretty dry. - On the surface.

752. Okay, let's turn him back down.

753. Okay, one, two, three, over.

754. One, two, three, flip.

755. One, two, three, down.

756. All right, CT is ready to rescan.

757. Interventional radiology is holding a room.

758. Look at you— so on top of things.

759. Hasta la próxima.

760. How you doing over here?

761. Definitely not great.

762. Right, well, let's get you a ginger ale.

763. So we never, ever remove a deep foreign body in the ER.

764. We always leave that to surgery.

765. It won't happen again.

766. I was just coming to find you.

767. Sure you were.

768. It's almost like you're avoiding me.

769. Me? Never.

770. No, I'm just having one of those busy days,

771. you know, living the dream, saving America's tired,

772. poor, huddled masses yearning to breathe free.

773. - You're a saint. - I tell myself that every day.

774. I heard you had a, uh, motorcycle crash

775. come through about an hour ago. - Yeah.

776. Couldn't save him.

777. And, no, he was not wearing a helmet.

778. Interesting.

779. One motorcycle crash is not going to scare me off my trip.

780. I didn't say it should.

781. I hope he died doing what he loved.

782. That's... optimistic.

783. "Glass half full" kind of guy.

784. I am not on your couch. - I'm aware.

785. Conflict of interest here. - Why? Because we're friends?

786. Ooh, look at you, using the F word.

787. That's growth.

788. I use F words all the time.

789. I guess this therapy must be working.

790. Ah, I got somebody new for you.

791. She takes no shit. You'll love her.

792. I hope so.

793. The last two have not exactly been... my speed.

794. Meaning what, empathetic?

795. Look, sometimes it just takes a little while

796. to, you know, find the right fit.

797. Well, it's going to have to wait,

798. because I'm going on my sabbatical tomorrow.

799. There's always Zoom therapy.

800. Motorcycle trip is zoom therapy.

801. I'll bet somebody set off fireworks in the shitter.

802. How dumb is that?

803. You think people are smart?

804. Yeah.

805. What's up, man?

806. You want to get on the books?

807. Uh, yeah.

808. Yeah, yeah. May—maybe. Yeah.

809. Hey, look here.

810. I only take real money,

811. none of that "I owe you" bullshit.

812. Okay, I have money, okay?

813. My first direct deposit finally hit, so...

814. Nice. Hmm.

815. Put me down for $40...

816. for power outage.

817. Nice.

818. We got a big baller on our hands.

819. - Congrats, Doctor. - Thank you.

820. I like this side of you, man.

821. - Any improvement? - No.

822. What kind of super glue did you use?

823. Does it matter? My eye is still fucking shut.

824. Okay, there's one other thing I can try.

825. No. I'm done. I asked for Dr. J earlier,

826. and I would like to see her now.

827. I haven't been in the hospital for a while.

828. I don't know a Dr. J.

829. She's one of the best doctors in Pittsburgh.

830. Oh, Dr. J.

831. Hmm.

832. - Do what you must, milady. - Mm-hmm.

833. Okay, first, I need to get a good grip for the reduction.

834. Uh-huh.

835. Here we go.

836. Try to relax.

837. Deep breath, with your mouth open.

838. Not how I imagined

839. our first intimate encounter.

840. Okay, got it.

841. Now, on three, okay?

842. One...

843. Ah! Motherfucker.

844. Ho-ho! You said "on three."

845. I—I know.

846. Sorry. It keeps you from tensing up.

847. Okay, I think that worked.

848. How does it feel? - Can I sit up?

849. - Uh-huh. - Oh.

850. Oh.

851. Oh, my God.

852. Oh.

853. That is definitely better.

854. Oh, my God.

855. Great.

856. Can I give you a hug?

857. Mm, maybe—maybe later, okay?

858. Aspiration pneumonia? How does that happen?

859. It's when bacteria from the mouth or stomach

860. get into the breathing tube,

861. uh, when you're choking,

862. if you're eating or vomiting.

863. Oh.

864. Do you ever drink a lot of alcohol,

865. maybe so much that you pass out?

866. No, I'm not a big drinker.

867. Have you had the stomach flu recently, food poisoning?

868. No and no.

869. Do you mind if we take a look inside your mouth?

870. You can lean your head back...

871. and open up wide.

872. What?

873. The enamel on the back of your teeth is worn away.

874. What does that mean?

875. Um, it can happen

876. if someone makes themselves vomit repeatedly.

877. All the stomach acid dissolves the enamel.

878. What does that have to do with having pneumonia?

879. It may have caused it.

880. Can you just give me some medicine?

881. Yeah, we can do that.

882. Dr. J, finally.

883. It is so nice to meet you, Dr. J.

884. This is Willow, your new patient.

885. I'm actually a student doctor.

886. I, uh, watch all of your videos.

887. The one about coping with difficult coworkers

888. was super helpful.

889. I got to watch that.

890. Um, um, so—so what is Willow's health issue?

891. Uh, my eye— it's superglued shut.

892. Halfway trim and mineral oil didn't work?

893. Nope.

894. Then—then I would suggest cutting the full lash down.

895. I concur, Dr. J.

896. As long as you're the one doing it.

897. Oh.

898. Okay, yeah, sure.

899. Um, yeah.

900. Uh, sit back for me.

901. I'll get you to close both your eyes

902. and be as still as possible.

903. Okay.

904. All you, Doc.

905. Thank you, Dr. Langdon.

906. Okay, here we go.

907. How many followers do you have, Dr. J?

908. More than you'd guess, Dr. Langdon.

909. There.

910. You did it.

911. Oh, my God. This looks terrible.

912. I can still put a false lash on it, though, right?

913. How are you feeling, Mr. Diaz?

914. Much better.

915. We need to talk about how your diabetes

916. progressed to this place.

917. This is Student Dr. Kwon.

918. What you say here remains between us.

919. I'm taking a lower dose of insulin than I should be.

920. How much of your prescribed dose are you using at a time?

921. Half.

922. I used to have insurance through work,

923. but I lost that job when the pandemic hit.

924. It was easy to keep up with my medication then.

925. I had a great primary doctor, too.

926. Now I'm kind of on my own.

927. Do you have a glucose monitor?

928. Uh, yes.

929. But I can't afford the test strips every week.

930. They're too expensive.

931. Can we not talk about this in front of my family?

932. - Hi. - Hi.

933. There are my girls.

934. Did you call your brothers? - They're still at soccer.

935. I have good news. I started a GoFundMe for Dad.

936. A what?

937. To help raise money for Dad's medical care

938. since we don't have insurance. - No, no.

939. Take it down, now. - But why?

940. I work hard. I don't need charity.

941. But, Dad, we've already—

942. Ana, you heard me!

943. Take it down.

944. Jesus, Orlando.

945. No necesito eso.

946. Louie, thought I'd sneak back here to check on you.

947. - How we doing in here? - Good.

948. Tooth's feeling much better. - Glad to hear it.

949. Looks like you're stuck with us for the next three hours.

950. We need to monitor your blood pressure.

951. How about a drink while I wait?

952. Water or orange juice?

953. Uh, never mind.

954. So, uh...

955. how are the kids doing?

956. Oh, they're perfect little monsters.

957. Tanner's five now. Penny's three.

958. Oh, ain't that a blessing.

959. It is, but they have zero interest in bedtime.

960. And there's the dog always digging up the yard.

961. How much sun does your lawn get?

962. I don't know. Plenty.

963. Seed it with perennial ryegrass.

964. And you want to lightly water it

965. and put up a temporary fence so the dog can't get back to it.

966. Color me impressed.

967. What can I say? I like grass.

968. No, seriously, how do you— how do you know all that?

969. I was a groundskeeper.

970. I worked with gardens and lawns back in the day.

971. Robby.

972. Got a sec?

973. - Dr. Langdon. - Dr. Al-Hashimi.

974. How's triage looking?

975. Donnie and I have it under control.

976. Good. I want you to wrap up what you're doing out there

977. and join us back here.

978. We're expecting more diverted traffic from Westbridge.

979. Will do.

980. And I just want to say, I think it's great

981. that you're in the Physicians' Health Program.

982. I know it's a big commitment.

983. Uh, yeah, it was hard at the beginning,

984. but, you know, I'm almost done with year one now.

985. Only four more years to go.

986. Penny for your thoughts.

987. Oh, they're way more expensive than that.

988. I'm on a budget. Take it or leave it.

989. My day is not turning out the way that I expected.

990. We had a callout. Langdon was available.

991. I was sort of hoping to be on my sabbatical

992. when he came back.

993. You two were very close.

994. Maybe this is the universe's way

995. of telling you it's time to clear the air.

996. Maybe it is.

997. Maybe it isn't.

998. Okay, so, um, we'll need to keep you for the day

999. for your IV antibiotics and to monitor your oxygen level.

1000. Okay.

1001. What if...

1002. I have been making myself vomit?

1003. Well...

1004. bulimia is treatable.

1005. I was going to stop.

1006. I stopped before.

1007. My family gathers around food.

1008. We eat when we're celebrating. We eat when we're mourning.

1009. We just eat.

1010. But then I got to college,

1011. and it was all about how you looked.

1012. That's a lot of pressure.

1013. I started vomiting.

1014. Everyone said I looked great.

1015. So I went to the gym more.

1016. I didn't need to purge as much.

1017. Last year, I went through a breakup.

1018. It all came back.

1019. You're...

1020. doing long-term damage to your body.

1021. And it doesn't just go away on its own.

1022. It's okay to ask for help.

1023. We can set you up

1024. with our eating-disorder program upstairs.

1025. - It's here in the hospital? - It's an outpatient program.

1026. You'd meet with a therapist

1027. for individual and group therapy once or twice a week.

1028. Would you be open to meeting with a therapist?

1029. I guess.

1030. Do you have any preference for type of therapist—

1031. male, female?

1032. If there's a Black woman, I'd like that.

1033. Yeah, we can arrange that.

1034. Thank you.

1035. That was a good catch.

1036. Black women tend to go underdiagnosed

1037. when it comes to eating disorders.

1038. - Really? - Yeah, unfortunately.

1039. You know, I thought I had an eating disorder in high school,

1040. and so I did a lot of research on the subject.

1041. I didn't—no, I just—

1042. My sister and I were really picky eaters growing up,

1043. you know?

1044. Color and texture.

1045. Vegetables and fish.

1046. Oh, eggs.

1047. Slimy okra, asparagus— ugh, disgusting.

1048. Drove our parents crazy.

1049. Oh, eggs, weird.

1050. It's not that weird.

1051. I got to catch up on my charting.

1052. Ah.

1053. You know, if—if you want to talk, I'm around.

1054. Talk about what?

1055. Being an R2?

1056. Way harder than intern year.

1057. Oh, yeah, um...

1058. yeah, overseeing the med students, the interns,

1059. having no time to do my own charts.

1060. Yeah, just wait until you get into Medical,

1061. Surgical, and Cardiac ICU.

1062. I stands for "intense."

1063. Somehow that seems like an understatement.

1064. Well, it does help you grow your clinical skills,

1065. you know, caring for the sickest patients.

1066. Tell that to these charts.

1067. Um, dictate. Helps you go faster.

1068. Oh, uh, what happened with our patient from Westbridge?

1069. You never grabbed me for his troponin.

1070. Mr. Samba— it was a posterior STEMI.

1071. What? Didn't show on the 12-lead.

1072. Oh, usually doesn't.

1073. And I think most clinicians would have missed it.

1074. But you didn't.

1075. Guess I got lucky.

1076. Whatever, Fuckleberry.

1077. Okay, I'm sorry. Did I do something to bother you?

1078. Nope.

1079. Okay.

1080. - Yo. - What's up?

1081. I got a bounce-back. You remember Debbie Cohen?

1082. Not really. I've seen 16 patients this morning.

1083. The restaurant worker with cellulitis

1084. on the dorsum of the foot? - Yes, yes, she's on Keflex.

1085. I marked the border.

1086. Yeah, I got a hot pack on it, but, uh, you should take a look.

1087. Hi. Dr. Langdon.

1088. I wasn't expecting to see you back so soon.

1089. Meds upset your stomach? - Uh, no.

1090. The pain got worse, and you said to come back

1091. if the redness spread outside the Sharpie line.

1092. Let's take a look.

1093. Ah.

1094. It looks like the infection

1095. isn't responding to the pills I prescribed you,

1096. so we need to get you on some IV antibiotics

1097. and get you back to the ED now.

1098. Uh, I-is it bad?

1099. Not if we can get a handle on it.

1100. - MRSA? - Or maybe worse.