- 18 hours ago
- #realitytvdeep
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00:00Oh, shit.
00:28What?
00:28I think I just broke some ribs.
00:30It means you're doing it right.
00:32Third amp of Epi's on board.
00:34Come on.
00:41Call me if there's a resurrection.
00:45Hey, Perla.
00:47Doctor?
00:48Your kids have any pets?
00:50Oh, my house is like a zoo.
00:52You have a dog?
00:53Oh, no dogs, no cats.
00:55I followed my mother's rule.
00:56No pets that can't be buried at sea.
00:59I'm not sure I follow.
01:00You ever try to flush a guinea pig?
01:03Try explaining that to your plumber.
01:06Good to know.
01:13Hey, what's up with your asthma guy?
01:15Responding to albuterol.
01:16Hey, one more nabble discharge on prednisone.
01:18How's it going out in chairs?
01:20That's fine, I guess.
01:20Dr. McKay seems nice.
01:24Cassie?
01:24Oh, yeah, she's great.
01:26She been here long?
01:27A little while.
01:27Why?
01:28I'm just curious.
01:29Do you know what she did before she came here?
01:31What she did?
01:32What do you mean?
01:32Like school?
01:34Oh, like school.
01:35Work.
01:35Um, personal life.
01:39I'm just trying to get to know her better.
01:41Um, yeah, I don't, uh, I don't know.
01:43I don't know that much about her.
01:44She has a son.
01:45I know that.
01:45She's a, she's a pretty private person.
01:49Anything else?
01:50No.
01:50Sorry, I'm good.
01:55Hey, where are we at with opening up some beds?
01:57Our Nepali lady with the crushed foot, Manu, she's still in line for the oar?
02:02Yeah, she got bumped by your Lefort III fracture, Ben Kemper.
02:05He just went up.
02:06Still waiting for him to take the electrocution fasciotomy.
02:09What about our OD in Central 7?
02:11Robbie wants a few more tests.
02:12He's stable and on a vent.
02:14Is he a candidate for organ donation?
02:16Not sure.
02:17Then why is Robbie keeping him here?
02:19I don't know.
02:19Maybe he sees something we don't.
02:21Or maybe he's hoping for something that isn't there.
02:23What's there is an 18-year-old kid named Nick Bradley.
02:26Yeah, is he, though?
02:27I don't mean to be a dick, but...
02:28You just can't help it?
02:29No, as sad as it is, that kid is gone, and if we get him upstairs to ICU,
02:32we're going to use that bed to actually help somebody.
02:34Robbie is helping somebody.
02:36He's helping two people, in fact.
02:38They're in there right now, praying over their dead son.
02:41They just haven't let their hearts accept it yet.
02:43Jesus, 9 o'clock.
02:44You're already bumming me out.
02:46Okay, let's see.
02:47Who's up next at the Deli of Death?
02:49Weak and dizzy?
02:50No, thanks.
02:51Flank pain?
02:52Need a UA first.
02:53And buttock abscess?
02:55Great teaching case for a student.
02:56Don't make me tell Robbie you're cherry-picking.
02:58I'll take, uh, projectile vomiting in North 5 for 200, Alex.
03:03What do you think the chances are it's a demonic possession?
03:06About the same as you go in a whole hour without saying something stupid.
03:09Christ's sakes, go already.
03:11You're like having a kid I never wanted.
03:12How are you feeling?
03:15Any pain, Minu?
03:16What's the pain?
03:17Minu, do you feel pain?
03:19Do you feel pain?
03:20No pain, but I'm thirsty.
03:26Oh.
03:26Nothing to drink before your surgery, but we can get you some lemon swabs.
03:30I'll drink some lemon swabs.
03:33I'll drink some lemon swabs.
03:33I'll drink some water.
03:34I'll drink some water.
03:35I'll drink some water.
03:35I'll drink some water.
03:36I'll drink some water.
03:40Why are you doing it?
03:43Excuse me?
03:45When are you due?
03:48You're still going.
03:50You can always tell.
03:51But I don't.
03:52Congratulations.
03:53Ah, thanks.
03:55how long before we might expect to see some improvement it could be hours it could be days
04:10it could be never i don't expect anything for a little while why don't you guys go get a cup
04:15of coffee in the cafeteria maybe something to eat i don't have a nurse call you if anything
04:18changes while you're out thank you we appreciate that i'm not leaving suit yourself i'm gonna get
04:24a cup of coffee i gotta call sarah and the kids um cafeteria straight down that hallway through
04:28the corridor and to the right thanks and i'm i'm sorry if my sister comes across a little
04:34strident it's okay this isn't easy
04:37the parents of teen overdose lillian john bradley are asking about the tests you told them about
04:47okay i'll be right there what about the rats what about them they've been caught i have no idea
04:53we'll find out i'm not sure that's my job you're in charge of the er the rats are in the er that
04:58makes you in charge of the rats and i have a strict rule about vermin in the workplace good to know
05:03could i get your eyes on a sickle cell crisis in south 21 that way right now
05:11icu's insisting they still don't have rooms available oh shit esme recon for me send our
05:16electrocution victor hand up there until the oars ready please thank you
05:1930 i'd be on board three minutes ago how long has he been going in
05:27uh 10 minutes in here possibly 30 minutes of prior downtown
05:30don't suppose you'd let me try a pair of cardiocentesis
05:33for what it's for practice in case it's tamponade i'm unseen an ultrasound
05:38this is a teaching hospital it's not like a dabble lab what do you call this
05:43do you need a break i'm fine you don't look fine
05:49hold compressions
05:52still no rhythm
05:55okay whitaker i think that's enough
05:59oh it's been four minutes since the last epi one more minute please
06:03help me please help
06:11help me please my friend please help
06:14my friend hey hey where is she my friend she's in my she's in my car she won't wake up
06:18okay okay potato burnie
06:20what's her name jenna
06:28come on jenna wake up for me baby
06:31pupils pinpoint i need narcan
06:37yep hold her head back to body
06:40okay
06:41i'm not responding to narcan we might need to intubate
06:55find a room and open a crash cart
06:57i can't find a carotid pulse
06:59five minutes since the last epi
07:03okay that's it
07:06all compressions
07:08welcome back
07:27she's okay
07:29he took his wife out for dinner last night
07:35for her birthday
07:39okay why doesn't everybody take a minute go check on your other patients we'll meet back here to debrief with kiara
07:44bed four where the hell am i pittsburgh trauma medical center why your friend couldn't wake you i'm right here jenna came to with one spray and narcan
07:54what'd you take jenna what'd you take jenna nothing you had to have taken something to cause this okay no i was just up late studying and i just couldn't fall asleep so you took something to help you sleep we need to know in order to treat you properly okay
08:06do you know what she took no this could be assigned to something really serious and we're gonna have to do a lot of tests that you really don't have to have a xanax
08:13okay i don't think have a xanax
08:14that's not nothing
08:16it's okay
08:17okay
08:18have you taken xanax before
08:20first time
08:22okay
08:22take a deep breath for me
08:26come on man you heard dr robbie let's take a break grab a coffee no i'm fine thank you
08:37did you know him no i didn't did you just met him he's my first patient to die
09:03i'm sorry
09:05are you okay
09:14mm-hmm
09:15yeah
09:15you sure
09:16yeah just i um
09:17i just
09:19remembering the first time
09:20that
09:21on occasion i have an emotional response to death
09:26it's
09:27gotta be kind of tough for a doctor
09:30that time it can be
09:32at least i'm not a pathologist
09:37that was a joke
09:41i
09:41oh
09:42except i have nothing against pathologists
09:45yeah no
09:47okay
09:48you can do read your dentist and you can write me a little
09:51is it pneumonia
09:53possibly
09:54or just changes from basal occlusion of the sickle cells
09:57it's called acute chest syndrome
09:58we're gonna cover you with antibiotics just to be on the safe side
10:01you know we've been through this before
10:03third generation selfless spore and then a macrolide
10:06perfect you're in good hands
10:08can i do a chest tube
10:11which patient
10:12any
10:13i've just never done a chest tube before
10:15are you really asking me to reserve any incoming injury requiring a chest tube for you
10:21not all of them
10:22i'd be more than happy just doing one but hey if you wanted to give me more i'd be fine with that too
10:27but
10:27that's up to you i'm down for anything
10:29confidence and ambition are great attributes
10:32especially when paired with respect and humility
10:36okay what else
10:38what uh what else went well
10:40we checked for reversible causes of cardiac arrest on ultrasound
10:45okay
10:46good
10:46does anybody have anything that they wish had gone differently
10:49in the hall
10:49you should have been on a cardiac monitor
10:51we would have caught the arrest right away
10:53that's true
10:53but there was no indication for monitoring
10:56and we now know that his abdominal pain was not from his gallstones
10:59but from unstable angina due to coronary artery disease
11:02then we should have admitted to cardiology
11:04we did an ekg
11:06we did a troponin
11:07he had a heart score of three
11:08who can tell me what that means
11:10one percent chance of an adverse cardiac event in the next 30 days
11:14standard of care is to discharge without patient follow-up
11:17he was your patient dr whitaker
11:21would you like to say something before we all take a brief moment of silent reflection
11:24um
11:27he liked kentucky bourbon
11:31okay
11:33good me too
11:34anything else
11:35i don't know i just met him
11:37no he seemed nice
11:40he was married
11:42um
11:44that's it that's all i got
11:46i
11:47i spoke with his wife
11:52she's on her way here
11:54if anyone needs to talk about this some more
11:56i'm available
11:57for now let's harness some good thoughts here for
12:01for mr milton
12:02okay
12:14that's it let's go save some lives
12:17hey whitaker
12:21how are you feeling on this
12:26i mean not good
12:29i was just talking to him
12:32now he's dead
12:32it's the hardest way to lose a patient
12:34always hurts
12:35especially when it's your fault
12:37this was not your fault
12:38this was nobody's fault
12:39no doctor on the planet could have caught this
12:41listen it sucks
12:43but today
12:44today was this guy's day
12:46to leave this mortal coil
12:47150 000 people die every day in the world
12:50and you got one of them
12:51but you you learn to live with it
12:53you learn to accept it
12:54as much as your own mortality
12:55and find balance if you can
12:56you found balance
12:58no not even close
13:00but i i you know you keep trying
13:02which is all you can do
13:04you're doing great
13:07whitaker just you know hang in there
13:10yeah thanks
13:11okay
13:12i'm just gonna go
13:14yeah
13:14but you know our our social worker kiara is here
13:16or if you want to talk
13:17okay yeah
13:20okay
13:25you're gonna recover
13:26okay good luck
13:28but wait
13:30what happens now
13:31we monitor her heart and breathing
13:33for the next few hours
13:34to make sure she doesn't need more narcan
13:35that's it
13:37yeah
13:37you should text your friends
13:39i thought you should text your whole college
13:42tell anyone to listen
13:43to not take pills
13:44without a real prescription
13:45unless they want to end up here
13:47seriously
13:49fentanyl is everywhere
13:51it's in everything on the street these days
13:52how long would i monitor her pupils for
13:56yeah you know what i actually have to go to the bathroom
13:57do you care on your own till i get back
13:59absolutely take your time
14:00okay great
14:01thanks
14:01sometimes i come on too strong
14:06excuse me
14:08it's a defense mechanism
14:09against insecurity
14:10you're kidding right
14:12yeah
14:13but i am sorry if i hurt your feelings
14:16i really i want us to get along
14:18i want us to be friends
14:19and if i'm really being honest
14:21i want your mother to write me a kick-ass recommendation letter
14:24you're going into general surgery
14:26i might
14:27i'm keeping my options open
14:30you want me to pimp out my mother for something you might do
14:33okay well when you put it like that it sounds dirty
14:37and a little hot but yes
14:39and full disclosure so we can be friends
14:42friends
14:44you've heard of the concept
14:46buddies
14:47compatriots
14:48confidants
14:49pals
14:49they even made a show about it
14:50yeah
14:51well
14:52come on
14:54don't leave me hanging crash
14:56pound rush it
14:57i can call you that now that we're friends
14:59right
15:00okay
15:04we'll work on that
15:05so for the apnea test
15:09we keep him on 100% oxygen
15:11but the ventilator won't be giving him breaths
15:13for how long
15:14for 10 minutes
15:15we'll monitor his carbon dioxide levels
15:17and if they come back way too high
15:20then we'll know that his brainstem is not telling him to breathe
15:22and that means
15:25that would mean that there's no brain function
15:27at the most fundamental level
15:30princess will monitor him and i will
15:33come back as soon as we know the test results
15:36okay
15:37yeah
15:38okay
15:41i hate this fucking hospital
15:47this is hank
15:48what happened
15:50oh nothing
15:51we were just
15:51framing
15:53and then my buddy joey comes in
15:54he says a guy walks into a bar with a nail in his head
15:57and then he points his fucking nail gun at my head
16:00so what would you do
16:01so i freaked out
16:02and then in the way
16:03and suing melee
16:04he fucking fucking shoots me
16:07melee
16:07yeah you know like a like a scuffle
16:10like a donny brook
16:11what you think because i work construction not a hospital i don't have a fucking vocabulary
16:15tier one trauma now
16:16no sir
16:17whoa definitely intracardiac
16:19i gotta tell you this fucking hurts
16:21let's just try and relax and dial down the f-bombs we have children in here
16:24you want me to stop swearing take the fucking nail out of my heart and please something for the pain
16:29stabilize the nail
16:30hank we need to cut your shirt off
16:32fuck that you cut this shirt you're gonna buy me a new one
16:35you can have your pick out of our lost and found
16:37oh how did this happen
16:39framing nail incident with deep penetration of the left chest
16:42what the fuck does it look like
16:44hank you take medicine every day
16:45okay
16:45uh any allergies to medication
16:47no
16:47can you get me something for the fucking pain already
16:49is this a hospital or a vet clinic
16:51very soon hank
16:52very soon
16:53how did you say that to the beagles too
16:54pulse 120 bp 100 over 65
16:56two milligrams of morphine
16:59liver gsw is in recovery
17:00good as new
17:01whoa that looks intracardiac
17:03oh nailed it
17:04oh you got jokes now
17:05no jokes just pushing your pain meds buddy
17:07small pericardial effusion
17:09but no evidence of tamponade
17:11not yet
17:11somebody talk to me
17:12do i need a priest here
17:13he's tachycardic with borderline bp
17:15he could decompensate
17:16stand by with two units whole blood
17:18Garcia here
17:18sac cardiac case
17:20am i dying here and nobody's telling me
17:22hank
17:23there is blood collecting in the sac around your heart
17:25you need surgery before your heart stops from the pressure around it
17:29just pull the fucking nail out
17:30that would definitely kill you
17:32i want a second opinion
17:34where's my fucking phone
17:35i can uber to presidi and find a real hospital
17:38or i can take him in 10 minutes
17:39and if we intubate him first
17:41the better for all of us
17:43great 120 of sucks
17:44100 of ketamine
17:45dervati you're up for this one
17:47really
17:48now let's go
17:49move
17:50demi EPA five minutes
17:51demi EPA five minutes
17:54i can start the stimmy with mel
17:56sounds good
17:57this place sucks
17:58i will destroy you on yelp
18:00nobody's ever coming to this shithole again
18:03i swear to god
18:04from your mouth to god's ear
18:05kiara
18:07hi i'm dr melissa king
18:09everyone calls me mel
18:10yes
18:11we met
18:12right
18:14um
18:15i wanted to ask you about tyler
18:19the little boy who ate the marijuana gummy
18:21he's been admitted to pediatrics for observation
18:23and his parents
18:24they're upstairs with him
18:26c.y.f. is going to follow up with a home visit just to be safe
18:29but no police were involved
18:31don't worry
18:32no one's taking their child away from them
18:33that's a relief
18:35yeah the parents on the other hand may need couples counseling after this
18:38but i think little tyler's going to be fine
18:40stimmy with me mel
18:42right behind you
18:43dana
18:44what's open
18:45trauma too
18:46all right keep it that way
18:48our target door to balloon time for stimmy's is 51 minutes
18:52ambitious
18:53but doable
18:54as you're about to find out
18:56good view of the glottis
19:02eyes off the screen
19:05now look down the mouth
19:07and insert the tube
19:10around the bend
19:11you stole my med student from triage
19:15how's she doing over here
19:16she's doing pretty good
19:17now look back at the screen
19:19and advance through the cords
19:22good
19:26good job
19:27thanks
19:28pressure's down
19:3272 38
19:33infusion has grown
19:37now with rv collapse
19:39pericardiocentesis
19:41she's got another unit on that infuser
19:43right for thoracotomy
19:43coming through
19:44we should get back to triage
19:46you don't want to stay for this
19:48there are like 30 patients still waiting to be assessed out there
19:50okay
19:52did someone say thoracotomy
19:54it's crashing from tampon on
19:56dr. garcia do you think
19:57trauma surgery gets left sided
19:59thoracotomy's ed gets the right
20:01if we need to extend
20:02glove up girl
20:04your own suction
20:05let's say advance that et tube
20:08to the right main stem please
20:0910 blade
20:0910 blade
20:0910 blade
20:18vets
20:20dr. santos how do we cut through the encostals
20:22uh through the superior rib to avoid the neurovascular bundle
20:26that's correct
20:26finish out a retractor
20:28pull suction
20:33and get rid of this nail before i get poked
20:36on it
20:37nails intact
20:43one piece
20:45shoot forceps
20:46opening the pericardium
20:48this is so fucking cool
20:51dr. santos
20:52you and his patient share a common vocabulary
20:54yeah i swear a lot i know i'm sorry
20:56i say it's a sign of intelligence
20:58i think it shows a lack of self-control
21:01but what the fuck do i know
21:03single puncture wound to the left ventricle
21:05you've got a finger on it
21:06first unit is in
21:09pressure's up
21:09heart is feeling well
21:11throwing our hearts off the mattress and we're out of here
21:14stop the bleed while i sew
21:15stemmy's arrived
21:16you got this
21:17just wrapping him up for our delivery
21:19mr. ed gellin is 52 years young
21:24with a history of hypertension and hyperlipidemia
21:2620 minutes of substernal chest pain
21:2810 out of 10 with dyspnea and diaphoresis
21:31bp is 152 over 95
21:33currently chewing 324 mg of baby aspirin
21:35okay
21:36blood's drawn second ib started
21:38ut stable
21:39seven millimeters
21:40of the best elevation in the anterior lead
21:42these are sometimes called tombstones
21:44open up sir
21:45tombstones
21:45lift the tongue
21:46mr. gellin you're having a very big heart attack right now
21:49the major artery that carries oxygen to your heart is almost totally blocked
21:52that doesn't sound too good
21:53no it's not very good we're gonna send you up to the cath lab
21:56a cardiologist is gonna unblock that with balloon
21:58and leave it open with a stent
21:59but i'm still having a heart attack
22:01if everything goes as planned i'd be like you never had a heart attack
22:03we're gonna put a catheter in this artery right here
22:05we're gonna shave the hair with a clipper
22:06as long as you stop short of a brazilian
22:08it's an option we offer
22:09costs a little bit more
22:11a lot of people's insurance won't cover
22:12don't make me laugh
22:13it hurts
22:14deal
22:14anybody we can call
22:16my wife
22:17already have her number
22:18okay we'll call her
22:19you hang in there
22:20i'll be right back
22:20i think they finished the apnea test on nick
22:28can you check the results
22:29all right not just yet
22:30the blood test needs to go to the lab
22:31takes a few minutes to run the test
22:32i'll come find you in the room as soon as it's done
22:34horizontal mattress in place
22:39with excellent hemostasis
22:41cut here
22:41my sterile towel and away we go
22:46i spoke to cardiothoracic
22:49they can meet you in the o.r
22:50good job
22:51coming through
22:54well done
22:57well done
22:58good luck mr gellen
23:00thank you so much
23:02you're welcome
23:02two saves
23:07totally awesome
23:09i just held a beating human heart in my hands
23:12we should celebrate
23:14we should clean these rooms and bring some more patients back
23:17sounds like a plan
23:18rest for the wicked
23:19coach stemmy was fast
23:21time is myocardium
23:23and our statistics for door to balloon time get reviewed critiqued and published online
23:27door to balloon time
23:28that's the time from when they hit our door to when the angioplasty balloon gets inflated in the cath lab
23:33if we keep it to under 51 minutes we can reverse a heart attack and save a life
23:36i kind of wish mr milton had a stemmy
23:39thank you for letting me go the distance on him
23:42i really thought we'd get him back you know
23:44yeah well you know even though you do everything right you don't always get what you hope for
23:48uh my parents both had sickle cell trait and i was screened as a newborn with the hemoglobin fs pattern
23:57did you take penicillin
23:58mm-hmm until i was five and the vaccines kicked in
24:01she has her entire medical history on her phone
24:04it's extremely long
24:05dr mohan do you have a minute
24:07yep
24:08excuse me
24:09is there a problem over there no her pain's well controlled you understand that's my polite way of asking why are you spending so much time with one patient
24:21you're an r3 as an r3 you should be seeing at least two patients an hour
24:25i have two joyce and mr wallace are good to matter
24:27who's comatose and stable you should have four by now
24:30i have the highest patient satisfaction of anyone
24:33i don't doubt it but we just had this conversation a couple hours ago
24:36i know people call me slow mo
24:37you don't have to confirm or deny it used to hurt my feelings
24:41a lot but i can't help it
24:43i work at the speed i'm comfortable at
24:45because
24:46you're afraid of making a mistake
24:49i'm always afraid of making a mistake aren't you
24:51yeah of course i am but you know what i mean
24:53you make a mistake once and somebody dies
24:55and you feel so badly about it you'll never let it happen
24:57how is that wrong
24:58because you waste time and money on unnecessary tests
25:02you keep sick patients waiting too long
25:05you miss out on cases you could be learning from
25:07you shortchange your own education
25:08i'm not saying this to be a hard ass
25:10i'm saying this because i know you can do this
25:12but you need to do it at a level i also know you're capable of
25:15and what if i'm not
25:16then you should look into a specialty that better suits you
25:19have you thought about psychiatry
25:20i don't want to go into psychiatry i want to be here
25:23being here means no matter how good you are
25:26or how hard you try you're going to make another mistake
25:28and someone else might even die
25:30that's called being an emergency medicine doctor
25:32and if you can't accept that then maybe this isn't the place for you
25:37i can accept that
25:38you sure
25:39yes
25:40okay
25:40good
25:41go save some lives
25:43clear some beds while you're at it
25:46i would fancy a spot of tea at some point
25:52you want some tea darling
25:53i'll get you some tea
25:54oh thank you sweetheart
25:56is dr robbie available
25:58he's with the patient can i help
25:59my father's starting to move
26:01okay i'll let him know
26:02thanks
26:03yeah
26:03is it good or bad
26:06if there's no spontaneous breathing
26:08then carbon dioxide levels rise above 60
26:11so 82
26:12definitely means that nick's brainstem is not triggering him to breathe
26:16well how can you fix that
26:17we can't
26:18i'm sorry
26:19but with rest and time
26:22this is not something that heals on its own
26:24there's got to be something else uh that we can do
26:27nick is our only child
26:28is that test 100 accurate
26:31it is
26:32isn't there anything else
26:34we can do an imaging test called a cerebral perfusion study
26:38then let's do it
26:39but you have to understand that would be the last test what we would do
26:41if it comes back that there's no blood flow to nick's brain
26:45it would confirm beyond a shadow of a doubt
26:49that there's been brain death
26:51which would mean that he's gone
26:55uh then then we wait and see
27:00call nuclear medicine see how soon they can take him
27:05you got it
27:06i'll be back in a few minutes
27:08ah thank you
27:09hey mr spencer and central nine tried to pull out his et tube and his non-soft restraints
27:21no surprise there we need to up the propofol
27:22and the sister of the dead mbc vet in the viewing room just arrived in chairs
27:27can you um uh parker in the family room
27:30please
27:30no problem i'll have perla and princess prep the body as best they can for viewing
27:34any progress in there
27:36no
27:37can you also um give an extra eye on whitaker today
27:41oh i'm already on it i know he lost his first patient
27:44yeah i just don't want to throw him off as a game
27:45you think this kid is gang
27:47i'm not sure yet
27:49i'll give him a chance to find out
27:51copy that
27:51pay for a cake
27:54myrna
27:56what brings you in here today anyway
27:58i murdered my husband
28:00oh
28:01how'd you do it this time
28:02i put him through a meat grinder
28:04best just to grab one and jump back in
28:08yeah right
28:10mr fulton in central 14 just needs a shot on my lantern for his gird
28:16to avoid eating foods with the words flaming hot in their title for at least a few days
28:20okay thanks
28:22central 14
28:24yeah
28:25could i get some milanta for mr fulton in central 14
28:30it'll be a while if you want it fast go check out the employee first aid cabinet
28:35where is that
28:36where is that in the lounge i'll show you how's it going
28:39uh not so great i lost a patient so i heard also heard it wasn't your fault
28:46doesn't make it feel any better
28:47yeah it doesn't i'm sorry unfortunately it comes with a job
28:50if it's any consolation i just got scolded for going too slow
28:54if you're someone talking about a slow-mo that's me
28:56guaranteed you're going faster than me
28:58i like to say it gets easier
29:00some days it does
29:01i'm sure the rest of your shift will be better
29:03shake it first
29:04oh but make sure the lid is
29:05screw down tight
29:08okay
29:10oh god
29:13everyone seems to get along
29:16like family
29:17you see a family i see every man for himself
29:22actually that's not entirely true
29:24there is some family here
29:25jabadi's mom is a surgeon upstairs
29:27really
29:27yeah
29:28oh that must be so nice
29:29are you kidding
29:31i don't know about your mom but i would not want mine working within a hundred miles of me
29:36no way
29:36uh my mother passed
29:38um she uh
29:40she had a very aggressive malignant pheochromocytoma
29:44so
29:45sorry
29:46unfortunately my mother's gonna live forever
29:49no she was definitely dead
29:53like i'm still shaking
29:55no she was like dead like dead dead
29:57i mean i think her heart stopped
29:59i think she was dead
30:02who
30:03who she was
30:04just talking about
30:06oh
30:07in case you didn't realize i use sarcasm and comedy as a shield
30:10or so i've been told
30:12thank you for opening up to me
30:13mel right
30:15yes
30:16well it was nice talking to you mel
30:17it was nice talking to you too
30:19you know i really hope we can be friends
30:21friends
30:22is there anything i can assist you with dr ravi
30:34i think we're best on our own right now thank you
30:36he keeps trying to pull away
30:37we're giving him some more sedation
30:39why is he so agitated
30:41he could have some awareness of the tube in his throat
30:43or that he's in a strange place
30:45or it could be lack of oxygen to his brain
30:48does he need more oxygen
30:49he's on a hundred percent
30:51that's as high as it goes
30:52that is his blood pressure dropping
30:55oh
30:56is that even fixable
30:57normally yes
30:59with iv fluids
31:00but we now know that that will just fill up his lungs
31:02drop his oxygen even more
31:04wasn't there something else we can do
31:06we can place a
31:08long
31:09large ivy catheter in his jugular vein
31:11down into his heart
31:12and administer levophed
31:14which is a very powerful medicine
31:16constrict his arteries
31:17raise his blood pressure
31:18but
31:19that could cause
31:21other organ damage
31:23organ failure
31:23i'm really sorry
31:26but
31:26each new step
31:28is even more invasive
31:29could cause more suffering
31:31with minimal benefit
31:33uh
31:42hi
31:43uh
31:43hello
31:44uh
31:45dr robbie said he'd be back in a few minutes
31:46yeah he's
31:47he's with the patient
31:48but i'll let him know
31:49my son is dead isn't he
31:53i'm not a doctor mr bradley
31:55but
31:56i do believe in god
31:58and i am praying for your boy
31:59with every beat of my heart
32:00and xanax but it was actually bent
32:02thank you
32:04yeah
32:04oh one second
32:06yeah
32:07she was legitimately dead
32:08yeah like a hundred percent
32:09mr bradley
32:10bent
32:12now my dad's
32:15gonna freak out
32:16no i
32:17i know
32:18i know
32:18i just needed to sleep
32:20i thought i was
32:22where did you get the fucking drugs
32:24who are you
32:25did you give them to my son
32:26did you give my son
32:28drugs
32:28mr bradley
32:29you can't come in here
32:30mr bradley please
32:31who is this
32:32tell me the fucking truth
32:33security
32:33did you
32:35drug my son
32:37your son gave me the drugs
32:38asshole
32:39ask him
32:39he's dead
32:40and you are a fucking liar
32:42you killed my son
32:44you killed my fucking son
32:46hey there's no scrubs in here
33:00yeah you have to put your old ones in
33:02before it'll give you a new pair
33:03what
33:04forgive me mr milton
33:22forgive me mr milton
33:27hey you missed the best action of the day
33:35i heard
33:36what happened
33:37father of the brain dead son goes after another patient he thinks gave his son the drugs that killed him
33:42jesus how do you deal with me
33:43jesus how do you deal with that
33:44no fucking idea
33:45it was
33:46oh what happened here
33:48did we have an accident
33:49do you think i'm wearing this by choice
33:51is it number one or number two
33:52i just got some stuff spilled on me
33:55was it a bodily fluid
33:56or was it yours
33:57no and no
33:58oh was it from when you killed that guy
33:59i did not
34:00that guy had a massive mi in his sleep
34:03relax uncle barry i'm just fucking with you
34:05truth is
34:06you're not a real doctor till you've lost at least one patient
34:09you got off easy it wasn't your fault
34:11not all of us can take comfort in saying that
34:14but uh try not to kill anybody else
34:17what am i looking at
34:20mr bill philbin 46
34:22he tripped while walking his dog
34:24he saw a squirrel
34:25and it's my wife's dog
34:27damn thing doesn't even like me
34:29clearly
34:29what is the dog now
34:30hopefully in a kill shelter
34:32come on baby
34:48i'm sorry
35:03i just want to understand how this could happen to our son
35:08i can't stop wondering why nick and not her
35:12i can't help it
35:15i think it would be helpful for you to speak with our
35:18department social worker
35:20would you two be open to that
35:21none of this is fair
35:23no
35:24no it's not
35:26but he's still breathing
35:28the ventilator's breathing for him
35:31brain death is the same as death
35:32what about that last test that we're waiting for
35:35i can almost guarantee it'll say the same
35:37i'm so sorry
35:39i wish i could have done more to save your son
35:43our social worker kiara is here to help you with anything you might need
35:49she's amazing
35:50i'm gonna go find her and have her come see you
35:52go to the dorm
35:56and within a couple minutes
35:58i i never i've never seen anything
36:00get that sorted out
36:04i think so
36:06he and his wife are dealing a lot right now
36:08no shit that's a tough one
36:10yeah do you know where kiara is
36:13not offhand but i can pay drew
36:15no it's okay i'll find her
36:17i gotta hit the restroom anyway
36:18i'll tell her you're looking for if she comes this way
36:20thank you
36:21yep now i gotta pee
36:23kevin
36:24take marnie to pee
36:25ask dana what's open
36:28for morphine and order an x-ray okay
36:31copy
36:31hey
36:33closed injury
36:34forklift versus foot
36:35forklift one
36:36got it
36:36hey um any news on our insult kid david
36:38uh i don't think we've heard from him yet
36:40and i don't know that you should refer to him that way
36:42well
36:42he did have a list of girls names he wanted to hurt
36:45they could be at risk
36:46are the cops looking for him
36:48not sure we're there yet
36:49okay
36:50i trust your judgment
36:51and i'm the last person who wants to involve the police in anything
36:54but you don't want to be wrong about this one
36:57i know
36:57i know
36:58so what's the issue
36:59maybe i don't want to ruin this kid's life
37:02well you don't want him ruining anyone else's life either
37:06look
37:10i've personally been on the wrong side of someone who hates women
37:13it's not a safe place to be
37:16okay
37:17any luck reaching david
37:26not yet
37:27did you try and call him to school
37:28he didn't show up for class
37:30any idea where he might have gone
37:35friends
37:35relatives
37:36we don't have any family and state
37:38and david
37:39he doesn't associate with anyone
37:43teresa
37:47do you think that david would try to hurt any of the girls that are on that list
37:51no
37:53do you remember some of the names on that list
37:55not really
37:58maybe you could try
37:59how's she doing
38:09she's worried sick about her son
38:11what are you going to do
38:13i thought he would come back after mom called him
38:15hey what are the ethics about me reaching out to him
38:18under the guise of a medical emergency with mom
38:19if he's a danger to himself or others
38:22i'd argue you have a professional responsibility to do whatever's necessary
38:26right
38:27okay
38:29hey can you come talk to the parents of the od kit that we brought in earlier
38:3218 year old brain dead from a fentanyl overdose
38:35oh jeez
38:36yeah only child
38:37and i just think that the parents could use a little help processing what they're going through
38:40uh what about donation is he a candidate
38:43the transplant counselor could get him there but i think we're a ways away from calling them in
38:46i'll see what i can do
38:48thank you
38:48they're in central 7 i wouldn't introduce you but i really have to pee
38:51no worries
38:52thank you
38:52what the hell
39:01i just saw one of those rats
39:02and you thought you started an iv
39:04it's not funny you're not the one who's going to have nightmares
39:07i forgot about your phobia with rats
39:10it is not a phobia nobody likes rats
39:13some people keep them as pets
39:14if you are purposely keeping a rat in your house that is not a pet
39:19that is a sign of an underlying mental health problem
39:22okay if it makes you feel any better just think of them as cute little disney mice with a pituitary condition
39:26joke all you want
39:28but if one of those disgusting things bites a patient and we get a case of hantavirus
39:33guess who's going to have to answer for that one chief
39:37weren't they
39:38what was the name of that cop you were talking to earlier
39:40what cop
39:41the good looking one that you were talking to earlier
39:43how would i know
39:44seem like you guys have
39:45stay in your own lane
39:47what
39:48i'm not even asking like that
39:50i really did want to talk to him about something
39:53uh-huh
39:54hey
39:56did the exterminator come yet
39:58yeah right sometimes he can be so cute
40:00and kind of get us to go through facilities
40:01said they'd handle it
40:03what does that mean
40:05it means nothing's gonna happen until next week at the earliest
40:08unless we get a patient in here with a service cat
40:11oh uh don't forget you still have the sister of abbas deceased veteran waiting for you
40:15shit yes yes yes i'll be there i'll be there
40:17yeah go
40:17hey
40:21been looking all over for you
40:22we need a cardiovert unstable afib in north one
40:24okay just give me a sec
40:26this is stolix 90
40:27fuck me
40:2935 year old architects working on a deadline vaping nicotine all night palpitations this morning
40:36afib at 147
40:38mr quinn this is dr robbie
40:40hello sir how you feeling
40:41like crap
40:42when did your palpitations start
40:43a little while ago
40:44we interrogated his smartwatch
40:46his heart rate's only been up for 92 minutes
40:48you understand we need to shock your heart back to normal
40:50is it gonna hurt
40:51you'll be sedated
40:52it's really gonna hurt
40:54mel 75 of propovol slow iv push
40:56how much did you vape last night
40:57uh a couple of pods
40:58you vape every day
40:59i do but not that much
41:01you want to cut back
41:03i try but it's just really fucking hard
41:05how much nicotine is in the pot anybody know
41:08no idea
41:0840 milligrams same as a pack of cigarettes
41:10wow two packs in one night
41:12mel what's the safe window for cardioversion
41:1412 hours
41:15what happens after that
41:16increased risk of the embolic stroke from left atrial blood clot
41:20which he does not have
41:22mr quinn
41:23mr quinn
41:25okay
41:25okay he's out
41:26same cardioversion 200 joules
41:27charged
41:29clear
41:29bingo
41:35sinus rhythm
41:36cycle BP
41:37we'll monitor for a few hours
41:39yeah let's get addiction services on the case too
41:41he's gonna need a daily patch of nicotine gum
41:43for breakthrough cravings
41:44this one's a bitch to kick
41:45hey the uh
41:46sister of david
41:47shit yes
41:48shit yes
41:49go get him tiger
41:51are you mr worcester's sister
42:01fiona
42:02hi fiona
42:03i'm dr rubinovich
42:05everybody calls me dr robbie
42:06have a seat please
42:08i will tell you everything that's happened
42:10you looking for something in particular
42:15anything with a very low potential for mortality
42:19mm-mm
42:20you're not playing that game
42:21only thing i'm playing is let's keep the patients alive
42:24uh-huh
42:24well now we're playing face your fears
42:26that sounds like a terrible game
42:29what up there scares you the most
42:31all of it
42:32pick the worst
42:33uh
42:34south 20
42:3682 year old woman low back pain
42:38i mean that's potential leaking triple a
42:41caudic quina syndrome
42:42spinal epidural abscess
42:44that could go wrong in so many ways
42:45not today amigo
42:46we're gonna work this lady up like a race car
42:48what does that mean
42:49means you're on the pit crew now
42:50come on
42:51you ready to go inside
42:56no not really
42:59i'll be with you
43:01you can decide when you want to leave
43:04you're so cold
43:25i'm sorry
43:27i'm sorry i'm sorry i wasn't here with you
43:31i'm here now
43:34wherever you are
43:38i don't know what the world is without you
43:44i really can't look at this letter
43:59i want you too much for asking you to read it to me
44:01oh i'm sorry that's inappropriate
44:04no not at all not at all
44:05i'd be honored by the request
44:08to the family of raymond or sir
44:19to the family of raymond or sir
44:21my name is dr jack abbott
44:24i am the emergency department physician who treated raymond
44:30i like ray am also a veteran
44:34and though i never met raymond before today
44:38i served with men like him
44:41so i can only imagine what an outstanding person he must have been
44:46i'm sorry i could not save ray's life
44:53we worked on him for several hours but his injuries were too severe
44:58even for someone as tough and battle-tested as raymond
45:03please take some comfort in knowing he did not suffer
45:08you have my heartfelt condolences jack app
45:13thank you
45:19very welcome
45:21again i'm very very sorry for your loss
45:38where do you think you're going myrna
45:49oh
45:50none of your business fruitcake
45:53actually everything that happens in this department is my business
45:57and you know what i put up with a lot around here
46:00i take very good care of you
46:01so you can call me dr rabinovich
46:03you can call me dr robbie
46:05or you can use my first name of michael
46:07but i do not appreciate you calling me fruitcake
46:09oh did i hurt your feelings
46:12cocksucker
46:13that said it has a certain whimsical quality to it
46:17that i could probably learn to live with
46:19whatever you say fruitcake
46:21excuse me doctor
46:22my father's starting to struggle again
46:24okay
46:24did you know those things will kill you?
46:32not that lucky
46:33what the fuck
46:36hey they're stealing our rig
46:39did you leave the keys in it?
46:43always in case somebody needs to move it
46:45yeah you probably shouldn't have done that
46:46why don't you come on inside ziggler we'll look you over
46:48i'm fine fuck that
46:50you leave that shit
46:52what happens
46:54what can you do to make him more comfortable?
47:00we can take the tube out
47:01but he needs that to breathe
47:03if we extubate
47:05we would keep him on oxygen for comfort
47:07it would decrease his sedation
47:10he might regain consciousness
47:12he could recognize you
47:13maybe even speak
47:14well i don't want to do anything to jeopardize him getting better
47:17that's just the point helen
47:19he's never getting better
47:21you don't know that
47:22you don't know that
47:23i do know that
47:24okay he knows that
47:25and dad probably even knows it
47:28it's time to let him go
47:31i'm sorry if you've had your fill of dad but i haven't
47:34and i am not giving up on him
47:36even if it's hurting him
47:40i'm sorry but if there was anything i could do to heal your father i would do it
47:46but the most humane thing that i can do for him
47:49is to allow him a painless peaceful passing
47:52and that requires removing the breathing tube
47:55fuck
47:57how long um will it take once the tube's out
48:01from minutes to hours
48:03but we would ensure that he'd be in no physical discomfort
48:06okay
48:33so
48:35so
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