The Pitt 2x9

1. All right, everybody, settle down!

2. Good.

3. Now, Robby has something important to say.

4. I know that this isn't easy.

5. We're going to help you address any challenges

6. that you might be having.

7. If you have any concerns, just raise your hand.

8. - Emma, write all this down. - Dr. Mohan.

9. Medication orders aren't coming up from the pharmacy.

10. Check with the clinical pharmacist

11. to see if it's in the PDS.

12. If it's not, then give the third copy

13. of the order sheet to Dr. Nordt.

14. We're gonna need more people to run it down.

15. We'll work on it. Langdon.

16. I can't find the patient clipboards.

17. Clipboards need to stay here for orders and labs.

18. Wait, so how do we write our notes?

19. Take the T sheet to the bedside, not the whole chart.

20. Same goes for nursing notes.

21. - Princess. - Fax machine is down.

22. Error message E6. - What the hell does that mean?

23. - You can check the manual. - There isn't one.

24. Okay, Perlah,

25. why don't you take your phone out to the base?

26. See if you can get service, find a manual online.

27. What else?

28. Ogilvie, put your hand down. Santos.

29. We've gotten a few CT results back

30. but nothing on plain films.

31. That's probably because they're all sitting

32. on the portable machine not getting to radiology.

33. I'll take care of this. - You be patient.

34. Help each other. Thank you.

35. We need to call in extra help.

36. - At 3:00 p.m. on a holiday? - I know people, buddy.

37. I have a 32-year-old woman with severe abdominal pain.

38. Do we have a bed? - Not at the moment.

39. - I'll take her. - Incoming.

40. Thank you.

41. Santos, Javadi, you're up.

42. Trauma one's open.

43. 12-year-old Jude Augustin—

44. firecracker exploded, nondominant left hand.

45. Good vitals. 25 of fent so far.

46. Any other injuries?

47. No, but seems to have lost two of his fingers.

48. - Did you bring 'em? - Blown to bits.

49. - It really hurts. - I'm sure it does.

50. We'll do something for that.

51. Parents? - Not on scene.

52. Ready?

53. One, two, three.

54. Hey, Jude,

55. do you know your mom or your dad's telephone number?

56. No. But I know my sister's.

57. Okay.

58. - Good breath sounds. - Abdomen nontender.

59. Heart rate 112.

60. Put this around his left forearm.

61. - Is that good? - That is very good.

62. I want to do another 25 of fent before we open this bandage.

63. Can you tell us what happened?

64. - My friends had firecrackers. - 25 fent on board.

65. I lit one, and it went off fast.

66. I-I dropped it, but...

67. We're gonna take your bandage off now, okay?

68. - I don't want to see. - You don't have to.

69. Just look at me.

70. Okay.

71. Cutting.

72. Sorry.

73. You're doing great.

74. That looks like a lot more than a firecracker.

75. More like an M-80 or a cherry bomb.

76. It's really good that you dropped it.

77. You saved the rest of your hand.

78. Digits 4 and 5 avulsed.

79. Distal metacarpals 4 and 5 also gone with exposed bone.

80. Soft-tissue damage on the palmar aspect,

81. less so on dorsal— some burns on wound edges.

82. Jude, can you bend your fingers for me up and down?

83. Really good job. Really good job.

84. - How bad is it? - You lost two fingers.

85. But it seems like the rest are gonna be okay.

86. Oh, no. I fucked up!

87. All right, can we do a wrist block for the pain?

88. I want to do a very detailed motor and sensory exam first.

89. We're gonna continue our exam now, okay, Jude?

90. Okay, thanks.

91. ICU can take her after the next neuro exam.

92. The ICU?

93. It's just so she can be monitored for the rest

94. of the day.

95. 4 millimeters and reactive.

96. Mel.

97. 4 millimeters and reactive. - Yep, got it.

98. I could sort of make out your hand.

99. Can you cover your good eye?

100. How many fingers am I holding up?

101. Three.

102. That's good news.

103. So the medicine worked? She's out of the woods?

104. Um, possibly.

105. It's...

106. Okay, um, cover your eye again.

107. All right, what do you see?

108. - Top line is E. - All right, and the next one?

109. Nothing.

110. Okay, well, that's 20/200.

111. Meaning?

112. Uh, what a healthy eye can see at 200 feet,

113. she can see at 20 feet.

114. - Is that good? - Yeah. It's much better.

115. Um, and it can continue to improve over time.

116. Thank you, Dr. King.

117. Um, I'm gonna take a quick break

118. before my deposition. - Mm-hmm.

119. So I'll let Robby know that I'm off the clock

120. for the time being. - Good luck.

121. Thanks.

122. - Mel. - Hey.

123. You have a visitor in chairs.

124. - What? Who? - Said she's your sister.

125. Becca?

126. Yep. You have heat exhaustion.

127. It usually gets better with Aleve,

128. but today was really bad.

129. - Same pain you had before? - Mm-hmm.

130. - From a cyst? - I think so.

131. I have PCOS.

132. Is the, uh—is the pain always on your left?

133. Today it is.

134. We will check a UA and urine pregnancy test,

135. and I'll give you a shot of Toradol.

136. It's something a little stronger for the pain.

137. I'm not pregnant, I promise.

138. No, we have to. It's hospital policy.

139. You guys still write stuff down on paper?

140. Today we do, yeah.

141. Are you a doctor?

142. I've been waiting hours to be seen.

143. - Quick question— - Oh.

144. - Hey, watch the walker. - This thing is useless.

145. Sorry, I just, um, um— we're really busy.

146. And someone will see you in a second.

147. Becca. - Mel, hi.

148. - Is everything okay? - Yeah, I have a stomachache.

149. Did you see the residential-care nurse?

150. She was out for the Fourth,

151. but I talked to her on the phone.

152. She told me to come here, and Geri brought me.

153. - Thank you. - No problem.

154. I'll wait for you. - Okay.

155. Okay. Come on, this way.

156. Uh, just through here.

157. - Is it always like this? - Yeah, pretty much.

158. Wow. There are a lot of smelly people.

159. Yeah.

160. Are you going to help them all?

161. Yeah, but, um, let's start with you first.

162. Okay.

163. - How's the pain? - I can't feel my hand anymore.

164. Ancef's on board.

165. Okay, we're going to clean out your hand with saline—

166. salt water. - Okay.

167. What's up?

168. Hand versus M-80.

169. Hmm. Surprised we've only seen one of these.

170. The day's still young yet.

171. Lost fourth metacarpal, mid-shaft on the fifth.

172. Bummer.

173. Hello, I'm Dr. Garcia from surgery.

174. - I'm gonna have surgery? - Yes.

175. The first operation is to clean everything up

176. and cover where the skin is missing.

177. But you still have your thumb

178. and your most important fingers.

179. - What'd you give him for pain? - We did regional blocks.

180. Hand surgery always wants to document their own neuro exam.

181. Sensation is intact to light touch and pinprick

182. throughout the digits in the remaining hand.

183. Um, yeah, FDS and FTPs and extensor function

184. was all intact.

185. Need parental consent for surgery.

186. - Yeah, we're working on that. - Dr. Robby?

187. I smell alcohol on his breath.

188. He's in line for the OR.

189. Might be a little bit of a wait.

190. Ortho's still in with Allen Billings—

191. that open shoulder dislocation that came back from Westbridge.

192. He's still in surgery?

193. He waited an hour to be cleared by anesthesia.

194. Is the insurance company

195. gonna cover the cost of the surgery?

196. Yeah, since Westbridge is still down.

197. Well, good, because the delay in care

198. definitely increased the chance of a post-op infection.

199. You got to love it when insurance companies

200. make medical decisions.

201. - Hey. - What's up?

202. Do you still need a rain check

203. for watching fireworks tonight?

204. I thought you were coming over.

205. I made other plans.

206. Okay, cool.

207. I'll try hitting you up tomorrow.

208. We're just keeping it casual, right?

209. For sure.

210. Yeah.

211. Thank you. Yeah, bye.

212. Oh, uh, hey.

213. I just got a hold of the sister of the heavy patient

214. Abbot's taking to Presby.

215. She still lives in Arizona, but she is willing to talk

216. to him when he's back.

217. That's good news.

218. When do you think that might be?

219. Depends on how crazy it is over at Presby.

220. If it's anything like here, who knows?

221. Yeah.

222. Um, is help on the way?

223. Ah, ye of little faith.

224. You got a gumband?

225. Thanks. Keep losing these.

226. Oh, this fucking day.

227. Thought I was gonna get a clean getaway for my trip.

228. God gives His toughest battles

229. to His strongest soldiers.

230. Dana, is there a room open? This is my sister.

231. She's in a lot of pain, and—and we need a bed ASAP.

232. My name is Becca, not "my sister."

233. Sorry, right.

234. Um, Dana, Dr. Robby, this is my—

235. my—Becca.

236. Nice to meet you.

237. You're Dr. Robby? Cool.

238. Central 7 was just cleaned. Anything I can get you, hon?

239. No, thank you.

240. Oh, wait, Becca. Come here.

241. Come this way. We're going right in here.

242. All right, so, um, you're gonna need to get undressed

243. and get into the gown, which should be on the bed.

244. Then we're gonna do an evaluation and take a history.

245. That's a lot of questions,

246. like, like, a lot, a lot of questions, which we'll do.

247. And then a physical exam, of course.

248. Mel, I've been to the doctor's before.

249. Right. Sorry.

250. I just—I-I really want this to be done the right way.

251. Do you need to take that call?

252. Uh, no, it's, um— it's a reminder alarm

253. for this important meeting I have in 15 minutes.

254. Um, do you have to go?

255. Let's just get you taken care of first, all right?

256. So just change into the gown. I'll be behind the curtain.

257. Okay.

258. Your grand prize.

259. All I see is green, baby.

260. Oh. What's up with her?

261. Fax machine has paper jam— so annoying.

262. Hmm.

263. - You want me to try? - No.

264. - Oh, huzzah. - I got it.

265. What's it say? - "Replace toner."

266. We live in hell.

267. - Oh, where can we get that? - 1988.

268. You ever seen one of these? - Honestly, no.

269. How are we gonna get labs and X-rays to the wards?

270. The old-fashioned way, runners.

271. I'll check if they can spare a couple clerks

272. from upstairs.

273. When were you first diagnosed

274. with polycystic ovarian syndrome?

275. Last summer.

276. That's when the symptoms started?

277. No. I've had years of pain, hormonal changes,

278. and an abnormal period.

279. I was finally diagnosed after switching to a gyno

280. who actually listened to me.

281. Yeah, it can take time to make the diagnosis.

282. That sounds like an excuse for lazy doctoring.

283. And it doesn't help that some of you don't listen to women,

284. let alone brown ones.

285. It hasn't been easy.

286. - How's your pain now? - Better.

287. - What was she given? - IM Toradol.

288. Have you had a transvaginal ultrasound before?

289. I've lost count of how many times.

290. Okay, if you want to scoot your bottom down,

291. I'll help you put your feet in the leg rests here.

292. Yep, you got it.

293. Okay, ready to go here?

294. Cold gel and some pressure.

295. Okay.

296. Okay, ectopic is unlikely

297. since the urine pregnancy was negative.

298. I'm hoping it'll be positive one day.

299. - Oh, are you trying? - Not at the moment.

300. I'm getting married in September.

301. - Oh, congratulations. - Okay.

302. A bunch of small cysts— to be expected.

303. But then there's one big one, about 5 centimeters.

304. My gyno's been monitoring her.

305. Mm-hmm.

306. With a little bit of free fluid.

307. Checking blood flow to the ovary.

308. Red is for artery. Blue is for vein.

309. Okay, looks good.

310. Coming out now.

311. - Sorry. - Okay.

312. We will be back when we get your blood-test results.

313. All right, what do you think?

314. She probably had a small fluid leak

315. from the cyst that caused the pain

316. that improved with a nonsteroidal.

317. - And what's your plan? - Discharge with naproxen?

318. Do you think that just might be what her doctors in the past

319. have done?

320. Well, she said she's feeling better.

321. We can free up a bed.

322. Mm, she didn't look good in triage,

323. and her pain was way more severe than previous episodes.

324. I think we observe her for a bit.

325. Okay.

326. Mr. Green, this is Dr. Mohan and student doctor Ogilvie.

327. Uh, what can you tell me about your flank pain?

328. Feels like another kidney stone.

329. You've had them before?

330. I said "another," which means an additional thing

331. of the same type.

332. I teach English at Point Park.

333. Triggering.

334. My dad's a high-school English teacher.

335. Oh.

336. Well, you went into medicine. He must be really proud.

337. You'd have to ask him.

338. Getting back to your pain,

339. it feels like something you've experienced before?

340. Same as always, left kidney.

341. Started about 10:00 p.m. last night.

342. Any fever, blood in the urine?

343. No. Uh, no fever.

344. Urine's a bit darker than normal.

345. Dehydration can lead to stone formation.

346. Lean forward a bit, please.

347. Check for CVA tenderness. - Yeah.

348. All right.

349. Let me know if there's any discomfort.

350. Mm-hmm.

351. Ah! - Sorry.

352. Yeah.

353. We'll order medication and a few tests.

354. Okay.

355. Um, dip urine, Chem Seven,

356. bedside ultrasound to check for hydro,

357. and ketorolac for pain. - Sounds good.

358. Okay.

359. Really putting me to work.

360. It's been a very busy day, Dr. Barker.

361. Call me Nick.

362. - What's all this? - I brought radiology to us.

363. Dr. Barker, Nick, will have wet-read results for us

364. in no time. - Good idea.

365. - Thank you. - "Wet read"?

366. You ever take a photography class?

367. Yeah, in, like, middle school.

368. So, before digital technology, X-ray films

369. were physically developed in a darkroom, in baths,

370. thus wet read.

371. Oh, cool.

372. He's taking up a lot of space.

373. Got an update from Dylan on our abandoned baby.

374. CYF has requested an emergency custody authorization.

375. Once we get a court order, we can place her in foster care.

376. I love photography.

377. - Jesus Christ. - Dr. Robby?

378. Dr. Robby, can I borrow you for a second?

379. Sure. What can I do for you?

380. Well, she said she has a stomachache,

381. but belly pain can mean a lot of different things—

382. - Okay, okay, okay, breathe. - I'm looking for Dr. Mel King.

383. Yes?

384. I'm Morgan Stiles, one of the hospital's attorneys.

385. I'm here to escort you upstairs for your deposition.

386. Right now?

387. Morgan, can I borrow Dr. King for just a moment?

388. Sure.

389. It's gonna be fine.

390. I can't go up now because of Becca.

391. You probably shouldn't be caring for Becca.

392. It's not a good idea to care for family members.

393. It's hard to stay objective.

394. Let's see who's available.

395. Hey, are you free?

396. Is anybody really free?

397. Not an R2.

398. Ah, just the guy we were looking for.

399. - Need something? - Yes.

400. Uh-huh, mm-hmm. - Sure.

401. Dr. King's sister has a bellyache.

402. The case is now yours. - Sure.

403. You can pick up the rest of her patients

404. while she's doing her deposition.

405. How am I supposed to catch up on my outstanding charts

406. with extra patients and the computer system down?

407. The same way that the rest of us do.

408. You can finish your charting when you finish your shift.

409. Fucking fantastic.

410. - Hi, Becca. - Hi.

411. Um, This is Dr. Langdon.

412. He'll be taking care of you.

413. You have really nice hair, Dr. Langdon.

414. Thank you.

415. Mel, would you mind turning off the lights on your way out?

416. Of course.

417. And, um, I'll be back as soon as I'm done.

418. And feel free to call me if anything comes up,

419. because I can come right— - Don't—don't worry.

420. Becca's in good hands. - I know.

421. Okay.

422. Mel says lots of nice things about you.

423. Okay.

424. Um...

425. tell me the reason you're here today.

426. I have a stomachache.

427. Your belly hurts? Where about?

428. - Right, um—right down here. - Okay.

429. Are you experiencing anything else,

430. or is it just the stomachache?

431. It—it stings when I pee.

432. Sometimes when that happens,

433. women feel like they need to urinate all the time.

434. Do you feel that way? - Yes.

435. And what happens when you go?

436. Hardly anything comes out.

437. That's what I thought.

438. Really? How do you know?

439. Well, I've seen a lot of patients

440. with the same symptoms. - So this is normal?

441. Yes, it's totally normal.

442. But we still need to fix it.

443. Okay.

444. Hey.

445. How's it going, Roxy?

446. - A little better. - Yeah?

447. You need more morphine?

448. I've been in pain all this time, my love.

449. Why didn't you tell me?

450. I didn't want you guys to worry.

451. I can't pretend anymore.

452. Mom, it's so hot outside, the ice cream's melting.

453. We, uh...

454. we thought we'd indulge a bit.

455. - Oh, yeah. - Ooh.

456. Looks amazing.

457. So, uh, which flavor should we start with?

458. Salty caramel, Mom's favorite.

459. You'll need lots more napkins.

460. Mmm.

461. Rude.

462. - How's it going in there? - All good.

463. Langdon's great with her.

464. I got seven more films ordered, waiting to be shot,

465. but Dr. Nick here's tying up the machine.

466. Isn't there a USB port on the front of that portable?

467. And can't we just download the films to a workstation

468. and watch them without the Internet?

469. - Yes. - Oh, right. Forgot about that.

470. Is he actually helping, or is he just distracting?

471. Let's download these and start moving on to folks

472. waiting for X-rays. - Great. I'm caught up anyway.

473. I'll be back when the next batch is ready.

474. Dr. Robby, the guardian of your missing-fingers kid

475. in Central 12 has arrived. - Thank you, Olive.

476. Will you ask Dr. Santos to come and meet me, too?

477. - On it. - Who's in South 22?

478. Nobody. Headache was discharged.

479. Tell that to the lady on the bed.

480. What lady?

481. I just tried to put a hematuria patient in there,

482. but, uh, it's occupied. - South 22? You sure?

483. - I'm positive. - That's my patient.

484. Then why isn't she on the board?

485. I— She should be.

486. Olive was bringing her back from triage.

487. I picked her right up.

488. I just assumed she made it to the board.

489. You should've checked. You should've made sure.

490. I-I haven't put anybody on the board.

491. I thought the nurses did that. - We all need to pitch in.

492. There's no rooms at the moment. Put hematuria on the wall.

493. Who's your patient? - Mrs. Burns, with nausea.

494. I've ordered labs and X-rays. - Who are you seeing her with?

495. I still need to present the case.

496. Get busy. Find somebody with MD after their name.

497. Oh, God, kids.

498. Hello, I'm Dr. Robby.

499. This is Dr. Santos.

500. - Chantal. - How do you do?

501. We've been caring for your brother.

502. Are you Jude's legal guardian?

503. Yeah.

504. Our, uh—our parents aren't around.

505. Is he going to be okay? - He got very lucky.

506. He lost the fourth and fifth fingers

507. on his nondominant hand.

508. But if he hadn't dropped the firecracker,

509. it would have been a lot worse.

510. He lost fingers from a firecracker?

511. Will he be able to use his hand?

512. Yes, he still has his three most important fingers,

513. and they are fully functional.

514. He'll need surgery to clean everything up,

515. but it should heal well.

516. What the fuck were you thinking?

517. I'm sorry.

518. Alex asked me to come over.

519. His brother had a stack of fire—

520. You think I wanted to blow my hand off?

521. Then you need to listen to me when I tell you something.

522. You're not my mom.

523. You think I want to be your mom?

524. Chantal, why don't we take a step outside?

525. So I know that this can be very stressful.

526. Yeah, he almost lost his hand being stupid.

527. - He's a really sweet kid. - He used to be.

528. We also found something in his blood work.

529. What?

530. He has a blood alcohol of 0.08.

531. What, he was drunk?

532. Are you fucking kidding me?

533. - Does he drink regularly? - No.

534. I... I don't know. I—

535. The boys at our apartment complex

536. are a really bad influence.

537. I mean, he's only 12.

538. That is what concerns us.

539. A positive blood alcohol

540. immediately triggers a social service consult.

541. They gonna take my brother away from me?

542. It's an evaluation to determine if the injury

543. and the drinking is cause for some kind of intervention.

544. Whoa, whoa, I won't let you separate us.

545. - We are required to— - No!

546. Hmm.

547. 58-year-old woman with nausea,

548. vomited once after eating warm potato salad at a barbecue.

549. Well-hydrated— abdomen's pretty benign,

550. just a little distended with mild tenderness.

551. History of constipation. I give her Zofran.

552. Labs and abdominal series pending.

553. - Okay, let's take a look. - Okay.

554. Hi, Mrs. Burns.

555. This is Dr. Whitaker. How are you feeling?

556. Mrs. Burns?

557. Mrs. Burns, can you open your eyes for me?

558. She was awake and alert last time I saw her.

559. Okay, uh, feels warm, thready pulse.

560. Abdomen's more distended than before.

561. Okay, uh, agonal respirations.

562. She's—she's hardly breathing. - It's kind of rigid.

563. Yeah, yeah, Perlah, we need a crash cart.

564. Can you call respiratory?

565. Pull the bed out for intubation, please.

566. I can give you guys some room.

567. - Okay. - What's up?

568. Hypotensive, acute abdomen. She needs an airway.

569. - I'll find the GlideScope. - No time for that.

570. We've got direct on the crash cart.

571. Whitaker, you're up. - I haven't done many directs.

572. Well, then you need to do more.

573. Induction meds? - 100 ketamine, 80 of raw.

574. Javadi, what's the story?

575. Presented with mild abdominal pain,

576. took a turn for the worse.

577. A-fib 122, BP 98 and systolic.

578. Okay, let's bolus another 500 cc's.

579. - Are we shocking her? - Uh, maybe. After intubation.

580. Check your light. Check your balloon.

581. Javadi, AP pads in case we need to cardiovert.

582. Normal EKG at triage. She wasn't in A-fib.

583. Stress from her condition probably put her there.

584. Good? Let's roll her.

585. Do we have any labs back? - I don't think so.

586. - What else do we need? - Um, blood cultures.

587. Lactate, 2 liters LR, 3.375 pip-tazo.

588. Okay, she's loose.

589. Go ahead, Whitaker. Take a look.

590. Okay.

591. Hi. I'm Dr. Santos. This is student doctor Kwon.

592. How are you doing after the mist?

593. Better than I was an hour ago.

594. Okay, we are going to check your vitals.

595. Temp is 100.2, and heart rate is 96.

596. Okay, down from 101.5 and 120.

597. Very good.

598. You were out in the heat in that costume?

599. Yeah, with about 18,000 of my friends.

600. - Were you at Anthrocon? - Uh-huh.

601. What's that?

602. Pittsburgh's annual furry convention.

603. I go every year.

604. Ever been?

605. - Uh, it's not really my scene. - Mm.

606. Yeah, furries get a bad rap,

607. but there are great people in the community—

608. creative, welcoming, funny.

609. I actually met my girlfriend at last year's convention.

610. Oh, that's cute.

611. She gave me hope after struggling on the dating apps.

612. Nice to hear

613. that meeting people in real life still works.

614. Wouldn't recommend it, especially at work.

615. You should come to Anthrocon this weekend.

616. Doesn't she need a fur suit for that?

617. I think you'd make a good dragon.

618. I'm in.

619. Balloon up.

620. Yep, bag her.

621. Okay.

622. That was harder without video. - We won't always have video.

623. A-fib now at 152.

624. Blood pressure's down to 76 over 44.

625. Okay, Javadi, sync mode. Javadi, sync mode, 200, please.

626. Good end tidal waveform.

627. Good breath sounds bilaterally.

628. Charged for cardioversion.

629. Everyone, clear.

630. - Normal sinus. - Normal radial pulse.

631. Good. Keep the fluids going.

632. Let's see what labs are back on her.

633. Nice.

634. Very nice.

635. - What did you order? - Um, CBC, ER chem panel.

636. - Something should be back. - Fax machine ran out of toner.

637. Check the chart. - There is no chart in slot 22.

638. Check the orders rack.

639. Nothing here either.

640. Where's the chart for Claire Burns?

641. Claire Burns, order slip.

642. Never drawn, never sent off to the lab.

643. That's cause the patient wasn't on the board.

644. Nurses are working zones.

645. If the patient's not on the board, they don't exist.

646. So they didn't shoot her X-ray?

647. X-ray downtime box is empty. That means it was done.

648. Then it's on the portable machine.

649. Last I saw, it was headed north.

650. - Thanks, Dana. - Yep.

651. Hey, Kenny, can you wait up a sec?

652. If you need an X-ray, write the order.

653. Fill out a downtime.

654. Did you shoot a KUB in South 22?

655. No. Maybe another tech did?

656. Okay, can you flick through the films,

657. look for a patient—Burns?

658. Oh, shit.

659. Oh, that is a classic sigmoid volvulus.

660. - Peritoneal signs. - Okay, call the OR.

661. She's going to need surgery ASAP.

662. Urine shows three plus blood.

663. No surprise.

664. BUN and creatinine are normal.

665. No evidence of renal insufficiency.

666. I got a good look at the left kidney—

667. mild hydronephrosis consistent with ureteral column.

668. How was the rest of the ultrasound?

669. Normal. Uh, Pain improved after 15 ketorolac IM.

670. Now you can give another 15 and observe.

671. Hmm.

672. Just need you to cosign my order.

673. Thank you.

674. Something on your mind?

675. Yeah, I-I saw this regular an hour ago.

676. He's in his 60s, fakes an ailment

677. so he can come in to chat every now and then

678. because he's really lonely.

679. You sure he just doesn't have a crush on you?

680. Maybe, but it got me thinking about my mom.

681. She's probably just been lonely.

682. Yeah.

683. You know, I, uh...

684. I haven't really dated since my divorce.

685. Medical school, my kid, residency.

686. And now I'm feeling finally kind of ready.

687. I was waiting until I got back to Jersey

688. to work on finding a relationship,

689. and now that's out the window.

690. Maybe I waited too long.

691. For what?

692. Do you hear that?

693. That painful, lonely silence is the sound of my eggs dying.

694. Ah.

695. So the rash in North 3 has been discharged.

696. The Tasered law student in Central 10

697. has gone up to psych.

698. The eye stroke is now in the ICU.

699. And the tongue laceration in South 15

700. is sobering up before we discharge,

701. which better be soon because we need the room.

702. Okay, I'll grab a med student

703. and get more patients moving out.

704. You're not fazed by any of this chaos?

705. - Hmm. - What a fucking mess.

706. Jesus Christ, we need you.

707. Monica Peters, this is our new attending, Dr. Al-Hashimi.

708. - Welcome. - Thank you.

709. Monica's a retired clerk, best of the best.

710. She was kind enough to come in on a holiday

711. and help get us back into shape.

712. Laid off by the digital revolution,

713. not retired. - Okay.

714. And how's all this digital shit working out for you now?

715. - Not so good. - Exactly.

716. All right, then, who's handling

717. the charts and the orders? - That's us, right here.

718. How long have you been clerks?

719. Uh, just today. We're medical assistants.

720. Then get out of my space

721. and go do something you know how to do.

722. And no personal calls.

723. Red phones are for emergencies only.

724. This is a hospital, for God's sake.

725. I'll call you back.

726. - Got a gumband? - Yeah.

727. Hi. I'm Makedah from admin and records.

728. I have a new badge for a Dr. Whitaker.

729. Yeah. I'll get that to him.

730. Heard you all need extra runners?

731. - Perfect timing. - How fast can you move?

732. - I run marathons. - Great.

733. Grab the blood samples and the bin and get them up to the lab.

734. I want a lab run every 15 minutes.

735. Got it.

736. I work at a shoe store in Oakland.

737. Full-time and you're in school?

738. Yes, and, yes.

739. Allegheny Community.

740. Does Jude go to summer school or camp

741. while you're at, uh, work or school?

742. Can't afford it.

743. Are there any other family members

744. that could help with his care when you're not available?

745. No.

746. Chantal, we want to help you,

747. but we can't help if you won't talk to us.

748. What, you're gonna take Jude away

749. and put him in foster care?

750. I promised my parents that would never happen.

751. Did your parents pass away?

752. Nope.

753. What happened to them?

754. My parents were deported to Haiti nine months ago.

755. They went in for their immigration hearing and were...

756. detained.

757. I was a sophomore at Ithaca.

758. I had to move back home to take care of my brother.

759. I'm sorry.

760. It was either that, or he moved back to Haiti with them.

761. He's never been there.

762. We were both born here.

763. My mom was so excited when I got into college.

764. She worked so hard

765. to save up and pay my tuition.

766. And now all she wants

767. is for my brother to finish high school.

768. Man, being a big sister's a lot easier

769. than being a surrogate mom.

770. Just give us a moment, please,

771. and I'll come grab you when we're done.

772. Do we really need to get family services involved?

773. You wanted to get them involved this morning

774. with your eight-year-old ITP patient.

775. That's different. Abuse trumps neglect.

776. We can't separate her from her brother.

777. It's not right.

778. A lot of what happens to people around here isn't right.

779. McKay, patient's complaining of pain.

780. Uh, yeah.

781. Hey, Amaya. What's going on?

782. Oh, it really fucking hurts again.

783. Hey, Jesse, can you grab Whitaker?

784. When did it get bad? - Two minutes ago. Aah!

785. Giving you some morphine to take the edge off.

786. How severe, 1 to 10? - Ah. 12. It's way worse.

787. Okay.

788. Hey, Amaya, the meds will kick in,

789. and we'll get you back on the foot rest

790. to see what's going on, okay?

791. I had to call her husband in New York to get consent.

792. Okay.

793. Dr. Shamsi will be operating.

794. If she presented with peritoneal signs,

795. why wasn't I called?

796. There was a delayed presentation.

797. The X-ray was shot an hour ago.

798. Why didn't anybody read it?

799. There was confusion with the digital systems down.

800. It wasn't read. We didn't get a report.

801. An hour ago, I could have fixed this in 60 seconds

802. with a rectal tube.

803. Now she needs major surgery.

804. - I'm sorry. - Not good enough, nepo baby.

805. You fucked up.

806. Don't trust anything or anybody else when the system's down.

807. With all the chaos, she just fell through the cracks.

808. She almost died.

809. I could have killed her.

810. - Whitaker. - No—

811. McKay needs you in Central 11.

812. We caught it in time.

813. We won't let it happen again, okay?

814. Oh, uh, Princess is looking for you.

815. Um, she said something about Monica under her breath,

816. but I couldn't make it out. - Okay, I'll be back in a sec.

817. Hey. Hey.

818. You did good with that sexual-assault victim.

819. You were amazing with her.

820. We do what we can to provide the best care

821. to traumatized people in their darkest days.

822. What'd you talk to her about

823. when you took her out on the walk?

824. I, um...

825. told her there might be a time in the future

826. when she changes her mind, wants to press charges.

827. It's better to have the option to do it than not.

828. Smart.

829. Is every day like this?

830. Minus the cyberattacks, yeah.

831. But you're only a few hours away

832. from being done with your first of many.

833. Be proud of that.

834. You're gonna want to be on a soft diet,

835. so, uh, things like, uh, mashed potatoes,

836. soup, mac and cheese are good.

837. I was gonna make

838. your favorite three-bean dip tonight.

839. Bitch, that is so nice.

840. See, I am nice.

841. Could she have that?

842. Uh, yeah. Yeah, yeah, if you eat it with a spoon

843. rather than anything, like, crunchy

844. that could work its way into the laceration.

845. Mm.

846. So she'll need to be spoon-fed?

847. Antibiotics three times a day.

848. Come back here in two days for a wound check.

849. See you then, Doctor.

850. Checking blood flow to the ovary.

851. - Something wrong? - Intermittent torsion.

852. What's that?

853. I'm coming out now.

854. We will slide you back. Thanks.

855. Your ovary is twisting

856. and cutting off the blood supply.

857. That's what's been causing your pain.

858. Ah. You said the blood supply was fine before.

859. Sometimes the ovary can twist randomly.

860. In those cases, the pain can come and go.

861. - Can you fix it? - With surgery.

862. "Surgery"?

863. The ovary needs to be untwisted

864. and tacked down with a stitch so this doesn't happen again.

865. If we can get you upstairs quickly, we can save it.

866. I could lose my ovary?

867. Will I still be able to have a baby?

868. This shouldn't be an issue in the future.

869. Dr. McKay made the right call

870. to keep you in the ER for observation

871. so we could catch it if the pain returned.

872. Thank you.

873. - I'll call GYN. - Yeah.

874. Hey, welcome back. How was the trip?

875. Smooth sailing. Presby's pretty nice.

876. I might have to pick up some day shifts over there.

877. Dr. Abbot's funny.

878. Trust me, his charm wears off.

879. - No, it doesn't. - He's not sedated?

880. I gave him Versed for the CT scan on the ride back,

881. but I figured he'd need to be awake and alert

882. to give consent. - "Consent"?

883. Yep. We're going to get you settled.

884. Why don't you page Garcia to come down?

885. - Dr. Robby. - You got this?

886. - You know I got it. - Yep.

887. All right, Howard.

888. Hey, I want to debrief with you later

889. on your sigmoid volvulus patient.

890. I finished with your fireworks kid's sister.

891. - And? - She's a responsible

892. young woman and a good guardian to Jude.

893. There is no reason to get family services involved today.

894. That's good.

895. Because he's in the hospital for surgery,

896. but they will most likely make a home visit next week

897. to evaluate the safety of their apartment

898. and the care that Chantal can provide,

899. along with her other responsibilities.

900. And then what? They take Jude?

901. In my experience, they'll make the same assessment I did.

902. They don't like to separate siblings.

903. Anything else we can do for 'em?

904. I'll get some resources together for Chantal—

905. summer after-school programs.

906. But there might come a point when he'd be better off

907. with his parents in Haiti.

908. His parents want him to stay here.

909. It's what's best for the child.

910. - Says who? - Dr. Santos.

911. Come on.

912. Welcome back, Mr. Knox. What did we discover?

913. Diverticular abscess that progressed to perforation,

914. now with free air under the diaphragm.

915. In English, please?

916. There's a small hole in the colon

917. that's spilling bacteria into the abdomen.

918. You're likely to develop peritonitis and sepsis.

919. How bad?

920. You need surgery now.

921. You have a 100% chance of death without it.

922. With it?

923. 50% chance.

924. I could die?

925. Yes, but we're very good at what we do.

926. That is what the consent is for.

927. What about my sister?

928. We found her. She'd like to speak with you.

929. We don't have time for that.

930. Any delay increases your mortality risks.

931. I want to talk to my sister first.

932. We're gonna make that happen for you.

933. I'll have them prep an OR, but make it fast, very fast.

934. Yeah. We're on the move again, Howard.

935. Hey.

936. The ice cream party over?

937. Yes.

938. Do you need anything?

939. A time machine.

940. That'd be nice, wouldn't it?

941. I don't even know what hurts more—

942. the cancer or...

943. Knowing I'm never gonna see my sons grow up.

944. It feels like a cruel joke.

945. Why give me children and a husband I adore

946. if you're just gonna take them away from me?

947. For what? Fucking lung cancer.

948. I didn't even smoke.

949. Do you believe in God?

950. I like the concept.

951. I'm sure you've seen a lot of death.

952. I have seen my share.

953. Any advice?

954. I've never died before.

955. Hey, sorry. W-we're outside.

956. There's, um—there's no cell service inside right now,

957. but, um, here he is.

958. Oh, my God.

959. Are you all right?

960. Been better.

961. You look beautiful.

962. Thank you.

963. You're not looking so hot.

964. Thank you for calling back.

965. Of course.

966. I'm sorry that it's been this long.

967. All the stuff with Dad and the drinking, I—

968. I had to do what was best for me and Tommy.

969. How is Tommy?

970. Starting his junior year in high school next month,

971. 16 and already has a girlfriend.

972. Takes after his uncle.

973. Maybe we can make a plan

974. for you to see each other over the holidays.

975. I'd love that.

976. Is the doctor there?

977. Hi, I'm Dr. Abbot.

978. Can you call me when he gets out of surgery?

979. Of course, but right now we need to get him up to the OR.

980. I understand. Thanks.

981. Talk to you soon, Howard.

982. Oh, I forgot to tell him I love him.

983. Oh, wow.

984. Monica?

985. Welcome back.

986. Robinavitch.

987. Two for the lab, three for CT. - I'll take those.

988. They need me upstairs. - On it for CT.

989. You run a tight ship.

990. Well, it's a work in progress.

991. - Is he going up? - Yeah.

992. He's a good guy.

993. Our surgeons will get him through.

994. I like her.

995. More than me?

996. Only time will tell.

997. - Yeah? - Yeah.

998. She has good command of staff and procedures.

999. I think you're leaving your day shift in very capable hands.

1000. I hope so.

1001. All right, I'm out of here, man.

1002. I got to be back in a few hours for my shift.

1003. Well, hey, if I don't see you...

1004. You're really doing this still?

1005. I don't think I can remember the last time

1006. you took three days off in a row.

1007. I've taken a vacation before.

1008. Name the last one.

1009. Point taken.

1010. It's gonna be a lot of time to self-reflect.

1011. You sure you can handle that?

1012. Okay.

1013. You just make sure you come back.

1014. And if it gets dark, you call me.

1015. You listening?

1016. So the ankle's negative for fracture.

1017. Wait, go back to the ankle.

1018. You see the normal mortise?

1019. Yeah, but the tibiofibular clear space looks enlarged,

1020. and the tibiofibular overlap seems reduced.

1021. Maybe a little.

1022. 8 millimeters, 3 millimeters.

1023. Seems like a tear in the syndesmotic ligaments.

1024. Doesn't that need surgical fixation?

1025. They do. I can request an MRI.

1026. Um, have you done a radiology clerkship before?

1027. No, I'm just that good.

1028. I'm good at things, too.

1029. Really great work earlier today, Doctor.

1030. Huh.

1031. Ow, wow.

1032. You can just call me Whitaker. - Not a chance.

1033. You earned that.

1034. I'm proud of you.

1035. We all are.

1036. Thank you.

1037. - Busy day. - Oh, yeah.

1038. So you're a very empathetic soul.

1039. - Yeah, I'd like to think— - I'm not finished yet.

1040. And you want to be there for all your patients.

1041. - Don't you? - Shh.

1042. Sorry.

1043. So this relationship that you're having

1044. with this woman, um, the widow of the burn victim

1045. who died last year. - Amy.

1046. Santos tell you?

1047. I understand you're helping her out.

1048. Yeah, on the farm.

1049. I grew up on one, and Amy's—

1050. Mrs. Miller is getting pressure to sell,

1051. so I'm just helping out.

1052. What about her friends and family?

1053. Yeah, they're around.

1054. Supporting her?

1055. Yeah, I think they try to,

1056. but, mostly, she's just leaning on...

1057. me.

1058. I'm sure she's really grateful

1059. for everything that you do,

1060. but it's important to have boundaries.

1061. Yeah.

1062. Hey, you want to do me a favor?

1063. Yeah?

1064. You want to house-sit for me while I'm gone?

1065. You'd actually be helping me out,

1066. and you could save some money on rent.

1067. Are you being serious?

1068. No smoking, no parties, no pets, no babies,

1069. yours or anybody else's.

1070. - I don't have a baby. - No, but she does.

1071. I was going to ask Abbot, but he does nude yoga at sunrise,

1072. and I don't think some of my elderly neighbors

1073. would survive seeing that.

1074. Yeah. Yeah, t-that would be amazing—

1075. the house-sitting, not seeing Abbot's naked yoga.

1076. If I don't come back, you got a swinging bachelor pad.

1077. Okay.

1078. Come find me before you leave.

1079. I'll give you my keys and the security code.

1080. Okay.

1081. Who's the joker that did this?

1082. Oh.

1083. We need some help out there.

1084. You two, make sure to double-check your work.

1085. Triage could use an extra hand.

1086. Princess, finish up here, then head that way.

1087. Three for CT now. Should I run it over?

1088. No. Keep taking off orders.

1089. CT's gonna get backed up if we wait on these.

1090. I know, but I can't waste a runner on that right now.

1091. Where'd you find a carrier sheet?

1092. Exactly where I filed it away ten years ago.

1093. I thought that thing didn't work.

1094. Can't receive, but it can send.

1095. Stay hydrated, preferably with electrolyte-rich drinks

1096. like coconut water. - I'm not a fan of coconuts.

1097. Okay, Gatorade's also an option.

1098. Just avoid alcohol and caffeine, and I suggest wearing

1099. light, breathable clothing. - Boring.

1100. Come back if your symptoms worsen,

1101. if you develop a headache or confusion.

1102. Okay.

1103. Mm. You sure about that?

1104. Hey, could you turn that up?

1105. Have responded to a deadly waterslide collapse

1106. at a local water park.

1107. Now, we're told there's at least one fatality,

1108. with multiple injuries.

1109. Oh, shit. And they're all coming to us.

1110. Currently being airlifted to the hospital by heli—