The Pitt (2025) s02e03 Episode Script
9:00 A.M.
1
2701! Get the fuck out!
Is there a MedicAlert bracelet?
- Did you get an ID on him?
- Student ID.
- Name says Jackson Davis.
- That's a start.
- Jackson, what's going on?
- Title 18!
- Title section 508!
- Javadi, you're with us.
We're gonna take good care
of you, Mr. Davis.
- You're in a safe place.
- You're okay.
- Get off!
- Trauma One.
- Reasonableness! 2709!
- Okay, okay, Jackson.
We're gonna need you to calm down
to get the Taser barbs out of your neck.
- Do you need to jump on that?
- Mm-mm.
Covering calls for Dana.
Stop talking to me.
You can't! Title 2710
- Hard to assess pupils.
- [GRUNTS]
- Hard to assess anything.
- Yeah, yeah.
Wait till after he's sedated.
- 10 of olanzapine.
- No, no.
That'll take 15 minutes to kick in.
Uh, 5 of droperidol puts him down in 5.
No, you can't give it
without knowing his QT.
Two beats of a rhythm strip
before he took off the leads.
No.
You can't be in here. Get out!
That looks good. Go with the droperidol.
Get the fuck out! Get off me!
Do we take the Taser barbs out?
- 2701.
- No.
We got to wait till he calms down first.
Get off me, man. 2901, get out!
Get out! 2710.
Title 18, section 1938.
Mr. Randall, happy 20th anniversary
and a very happy Fourth of July.
But no sex fireworks for you tonight.
Give everything a chance to heal.
Don't worry, I will.
Thanks, Doc. Ow.
We're going right back
through here, okay, ma'am?
Oh, thank you.
Change the dressing twice a day.
Doggy bag of the ointment
and nonstick gauze.
Cool. I know the drill.
Come back if it starts to ache or stink.
Exactly. Good luck. Stay safe.
Oh, shit, it's Daddy, with your daddy.
Lord, what'd they get up to now?
Treatin' and streetin'.
"Pros from Dover."
I'm sorry, Ms. Graham.
I just saw the ASL note in your chart.
This is Lindsey.
We'll bring you back
as soon as possible.
Stay with her.
[INDISTINCT CHATTER]
All right. Who here needs help?
[INDISTINCT CHATTER]
You? You need help?
Oh, no, no, no, ma'am.
I've been on these since 1987.
This one here, he got dizzy, fell down.
Forgot my blood-pressure medication.
I left it back home in Georgia.
And presto.
We're back, Mr. Digby,
with some IV antibiotics.
First we scrub your outsides,
then we clean your insides.
What do you need to document
in his chart?
Uh, time started, time completed,
and any adverse reactions.
What else?
Um, lot number on the antibiotic vial.
Excellent. Mr. Digby.
It's just Digby.
Digby, why'd you wait
so long to come see us?
I don't like going to doctors.
Well, that makes two of us.
We all need help from time to time.
Think maybe we could arrange
for some ongoing care?
I just kind of want
to get patched up, you know?
I do know.
But that's today. What's tomorrow?
Sunday.
Use the system.
That's what it's there for.
Buddy of mine, Dylan,
knows all the angles.
He even works the occasional miracle.
You think maybe
I could have him stop by?
I guess, yeah.
Great.
- How about a sandwich?
- Yeah.
Yes, please.
We always offer.
Two most important things
that they know we're here
and that we'll never stop offering.
Thanks for covering, Princess.
Anytime.
Yo, can I get some help over here?
Yeah. What's going on, man?
The crazy kid in there, screaming.
- All right, have a seat.
- Yeah, that's him.
Still going nuts.
Probably meth fucking animal.
- What's your name, sir?
- You don't understand!
Tony Chinchiolo, campus security.
Yeah, I was at work when this happened,
so I'm gonna need everything documented.
Okay.
All right. Heart rate's 89.
Pulse ox 97.
Scalp lac's tiny
- 5 millimeters.
- Ow.
Should hold together with Dermabond.
Kid threw a fucking chair at me.
Work-related injury gets a full exam.
- Jesse here will take you.
- Oh, no.
I-I'm gonna stay here till the cops come
so I can give my statement
and so I can watch him.
Yeah.
Trust me, you do not want
him getting out of there.
Ow, fuck.
- Did she say anything?
- No more than she said to you.
Nothing going on at home.
Nothing at school.
- And you believe her?
- There's some flags.
Bruising in various stages of healing.
She's a little withdrawn,
doesn't engage much for girls her age.
But she could just be a little shy
or scared of being in here.
Or she's being abused.
That too.
We'll find out more when Dad shows up.
Yep. If he shows up.
I need a hand here!
- [OBJECT SNAPS]
- There's the first barb out.
All right, Javadi, you're up.
[MONITOR BEEPING]
Okay, so you're gonna want to clamp
where the shaft meets the barb.
- Mm-hmm.
- Yep.
Stabilize the skin.
Not so close so as to stick yourself.
I've seen that once or twice.
Uh, pull up at 90 degrees.
Harder. Yep.
Harder.
Oh.
Do we suture those?
Nope, just a Band-Aid.
- Mel, we need orders.
- Right.
I got a rainbow.
Uh, CBC
CMP, UA, blood alcohol, and tox screen.
All of the above.
Cap, if this young man's stable,
can he go to Central 10 pronto?
Double trauma at the back door.
Okay, you heard the boss.
Let's get going.
Today is starting to heat up.
[INDISTINCT CHATTER, TELEPHONE RINGING]
Mark Yee, 32-year-old restrained driver,
auto versus motorcycle.
Altered with normal BP,
satting 99 on 2 liters.
We're at the hospital now, Mark.
What's wrong with him?
Why isn't he talking?
His wife, Nancy, front-seat passenger,
- declined transport.
- I'm fine.
We weren't going all that fast.
The motorcycle ran the light.
I'm Dr. Robby. This is Dr. Al-Hashimi.
- Nice to meet you.
- And this is Nurse Dana.
She's our charge nurse.
We need to look over your husband.
Hello. Let's step over here
for a minute, hon.
Let them get to work, okay?
Antoine, Larry, transfer out here.
T-1 will be open in a sec.
Aye, aye, Cap.
One, two, three.
- [GRUNTS]
- Incoming.
Okay, Joy, you stay with me.
Samira, you stay with Dr. Al-Hashimi.
Open skull fracture.
Tubed him for agonal respirations.
BP 60 palp initially.
Started a liter of NS,
but lost his pulse en route.
Oh, boy, this doesn't look good.
One, two, three.
[GRUNTS] Joy, check his pupils.
Somebody hand me a pair of scissors.
8 millimeters. Nonreactive.
AKA blown pupils, fixed and dilated.
Oh. [GROANS]
Crushed skull with tons
of gray matter extravasation.
At least it was quick.
- No helmet?
- Nope, 'cause he took
the PennDOT Motorcycle Safety Course.
Isn't that what you took, Robby?
Hold compressions.
Yes, but I still wear a helmet.
- Is he a donor?
- Also nope.
That is too bad.
Asystole. I think we are done here.
- What's next door?
- The guy who hit him.
Joy, you're with me.
What about a moment
of reflection? I thought
He'll still be dead when we get back.
Pulse ox 99. BP 108 over 72.
EFAST negative.
Hell of a lot better
than the guy next door.
- How's the airway?
- Good volume.
Good sats. Gag reflex
- [GAGS]
- Present.
- Intubate?
- Maybe.
- Maybe not.
- Mr. Yee?
Joy, sternal rub
on his chest, like this.
Really hard, please.
- Mr. Yee?
- [GROANS]
Spontaneous eye movement.
Responds to pain.
GCS is 10. Borderline for intubation.
No muscle tone flaccid
paralysis in the left arm.
- Same on the right.
- And both legs.
Add towels to both sides of
the collar for more stability.
Let's not make this worse.
Pan scan with 3D
reconstruction of the spine.
He's quadriplegic?
If so, it's a low cervical injury.
- Why is that, Joy?
- Uh
C3, 4, and 5 helps you
breathe to stay alive.
Mr. Montrose
you can't just be wandering
around, talking to patients.
Well, that's that's what I do.
I'm a greeter at Walmart.
I get paid to wander
and to talk to folks.
Well, as a as a personal favor to me,
can you at least stay
in your general vicinity?
I can get you a wheelchair
while we wait for your X-rays,
but it might take a minute.
[CLEARS THROAT] My dear, I cannot sit.
My backside is killing me
from where I fell on it,
which is an embarrassing
admission to make
- to such a lovely woman.
- [CHUCKLES]
Well, thank you for the compliment,
but there's no need to be embarrassed.
You took a very nasty fall.
Well, then may I say that
one look in your beautiful eyes
and I think I'm falling again.
[BOTH LAUGHING]
What a charmer.
Just for that, I'm gonna
get you a foam donut.
It's the eighth wonder of the world.
Pretty great laugh you got there, Doc.
[CHUCKLES]
Oh, God. My witch's cackle?
Got CT results for Mr. Williams.
Ah.
Oh, wow.
Okay.
Okay.
Ah. Right on time.
Just just getting full.
Yeah, I'm ready for number five.
- That's impressive.
- Uh-huh.
Yeah, there's more where that came from.
Although, uh, my intake is running low.
Yeah, well, two more bottles
ought to do it.
Then we'll drain your tooth,
and we'll get you out of here
- before the fireworks tonight.
- Oh.
Okay. Clamped.
Ogilvie, make the change.
- Okay.
- Mm-hmm.
All right. Let her rip.
- Flowing like a river.
- [CHUCKLES]
I love me some fireworks.
Oh, yeah?
Shit, I-I met Mr. Zambelli
Lean forward.
Many times on the field.
Who's Mr. Zambelli?
Son, you don't know fireworks
if you don't know the name Zambelli.
He helped Pittsburgh become
the firework capital of America.
You did know that, didn't you?
- No.
- Ah.
Y'all don't know nothing
about pyrotechnics.
Stick to doctoring.
Yes, will do.
[SIGHS] I'm sure you have
some questions.
I know it's a lot to take in.
It's a tumor.
It's a brain tumor.
Well, it's a mass, about 4 centimeters,
in the frontal lobe.
Is it cancer?
We can't say for sure right now.
It could be many things
uh, infection, inflammation,
a benign cyst.
Is it what made me fall?
Yeah, possibly.
We'd like to keep you here
and treat with dexamethasone,
which is a steroid
to take down the swelling.
- Hmm.
- And then we'll need
a brain biopsy
to know exactly what it is.
What, you're you're gonna
cut open my head?
It's just a small hole.
We'll do a-a CT-guided
stereotactical biopsy
- with a-a blunt, thin needle
- [SIGHS]
Which sounds crazy, but it's
actually pretty amazing.
I mean, most patients
go home the next day.
I don't know.
What do you think I should do?
I think this is a pretty good plan.
- Okay.
- Yeah?
BP 95 over 67.
Seems a little on the low side.
It is.
Have you ever had
low blood pressure in the past?
No, sir. My blood pressure's
always high.
Hold still, sir.
No talking while we do the EKG.
The Hansens all run high,
except for Monty.
- He ran low, but he's dead.
- That's not helpful.
You want to help,
quit playing family pharmacist.
Pooling meds is how
we've always done it.
You put everything in a big pile
in the middle of the table
Well, look where that got us now.
No, I'm gonna jump in here
and echo that sharing meds
which haven't been prescribed to you
is actually a real big no-no.
How we doing on remembering
what your brother might've taken?
We could call back to the house.
Great idea. Okay.
Whatever little round pill
you took, sir,
has caused your heart rate
and blood pressure
to drop so low,
you're at risk of fainting,
falling, or having a serious injury.
Oh.
We need to take him back to the ER
so he can get a liter of fluids,
we can check his blood tests
and monitor his heart rate
and blood pressure
till he recovers.
Pulse ox holding steady at 99.
Good tidal volume.
How you doing there, Mr. Yee?
Scanner can take him now.
I'll check the results from upstairs.
- Why is he so altered?
- Could be concussion.
Maybe a small intracranial hemorrhage.
All will be revealed
by the Donut of Truth.
- Need a portable monitor.
- Joy, stay with him, please.
See if the radiologist
can give us a STAT read.
How is he?
Did I hear someone say he's paralyzed?
There are signs of weakness
in both arms and legs.
But before we can make any prognosis,
we'll need a full-body scan.
Head CT will show us any brain injury.
Neck CT will show us
any spinal-cord injury.
Chest, abdomen, pelvis will
rule out any internal bleeding.
Oh, my God.
The scans should only take
about 15 minutes.
In the meantime, perhaps you'd
let us look you over as well?
I'm fine. The medics checked me.
I just want to stay with my husband.
Well, you can't go into the CT with him,
but you can wait just outside
if you like.
- Excuse me.
- Princess, this is Nancy.
Mrs. Yee is gonna go
with her husband to CT.
Will you show her where to go?
- Sure. Come on in.
- Thank you.
So what's the plan now?
Keep observing me in my natural habitat?
No telling what I might do next.
I think I've got the gist.
How about we each take a lap
and meet here
when Mr. Yee is back from CT?
Splitting up so soon?
You're free to see
other people, Dr. Robinavitch.
I'm looking for cooperation,
not commitment.
[CHUCKLES] [DEVICE WHIRS]
So you bandaged the burn yourself?
Oh, no, no, no, no, no, no, no, no
Ma'am, you're you're making
it difficult for me
to see under this dressing.
- Is that a tablecloth?
- Part of a window curtain.
Cleaner than tablecloth.
I'll wait for the doctor. Thank you.
May I ask how this happened?
For weeks on end, the kids with their
guchnyy firecrackers,
going all day and night.
Oh, i-is this a firecracker burn?
No, sweetie,
this is from the full samovar
I drop on the floor when the sh
the firecrackers started going on again.
I'm sorry. What's a samovar?
It is a big metal urn for coffee or tea.
They can get super-duper hot,
and I was never allowed to touch ours.
Uh, hello, Mrs. Kovalenko.
My name is Dr. Michael Robinavitch.
Everybody calls me Dr. Robby.
- Robinavitch? Jewish?
- You guessed it.
And I see that you are
here today for a burn.
Why don't we take a look?
Oh, not married?
No, I'm not married.
[CHUCKLES] Do you attend synagogue?
Uh, not for a while.
I mean, High Holidays mostly.
Where?
- Ooh.
- [WHIMPERS]
What did you put on this?
- Where?
- On your burn.
- Is this honey?
- Yes, honey.
Where do you go on holy days?
Uh, my grandparents, um
I grew up going to Rodef Shalom.
You?
Tree of Life.
They're rebuilding.
Yes, something new.
Remember, Rebuild, Renew.
That's the slogan.
I'm sorry, did you say "honey"?
You think honey's funny?
Works like a charm.
My father kept bees. I know.
If the honey is medical grade
and the burns are not too bad,
honey actually does have
some antibacterial
and anti-inflammatory properties.
However, these burns
are very deep in some places.
They're going to need debridement.
I'm glad you came in.
That's what I thought.
I was hoping no, but I figured as much.
Not to worry.
We are gonna have you
patched up and home
in time for dinner and fireworks.
No.
No more fireworks.
No.
Okay.
Anyone here treating Kylie Connors?
She's my daughter.
She's nine. I'm Benny Connors.
Mr. Connors, I'm Dr. Santos.
I'm treating Kylie.
Is she okay? Can I see her?
My my girlfriend, Gina,
says she got a cut on her chin?
Yeah, I can take you to her.
She has a small laceration on her chin,
but it was easily repaired
with medical superglue,
- so no stitches necessary.
- Okay.
She chipped a tooth,
but it's a baby tooth,
so it won't need dental work.
All right, well, that's a relief.
Has Kylie had any previous injuries?
Uh, yeah.
She, um she broke
her wrist last year.
She was skateboarding.
Dana, if you could get Dylan
to come to North 1,
- and Ahmad.
- You bet.
Okay, I got it now. One, two, three.
Daddy, you came.
Baby, what's going on, huh?
My tooth broke, and my chin got cut.
Oh, no. [SMOOCHES]
What happened?
She was running up the stairs.
- Gina was chasing me.
- We were playing.
As I was saying, Mr. Connors,
the laceration is pretty minor.
On the stairs?
- It was an accident.
- Perhaps we can
An accident that wouldn't have happened
if you weren't running up the stairs.
Do you understand what I'm saying?
This is the last thing
that I need right now,
is her mother finding out
that she got hurt
- when she's with you.
- It was an accident.
And before you get all high and mighty,
- I've got questions of my own.
- Like what?
Hey, Mr. Connors.
I'm sorry, I meant to be here
when you arrived.
I'm Dylan Easton.
I'm with Social Services.
We have insurance. Thank you.
Perhaps we can step outside
and chat for a second?
I can fill you in on where we are.
Hey, uh, Jesse, do you want
to keep Kylie entertained
- for a few minutes while I
- Absolutely.
Borrow her dad?
We'll just head down to the family room.
It's a little quieter there.
Why do I got to talk to a social worker?
Anytime a child is injured,
we have some standard questions
that we ask parents and caregivers.
Good. That's fine. Great. Ask me here.
Well, we noticed
some bruising on Kylie's body,
some old, some new,
on her back and legs.
- Any idea how she got those?
- Yeah, soccer.
She plays for a club team.
They're, you know, little girls,
but they play like they're
in "The Hunger Games."
Well, I understand that you and Kylie do
a fair amount of roughhousing.
What?
I'm sorry. Are you fucking kidding me?
Where are you going with this?
Are you saying that I hurt my daughter?
Mr. Connors, nobody's saying that
Oh, no, no, no, no, no, no, no, no.
- Gina!
- Mr. Connors
Just just Gina!
Sir, take a breath.
Gina, what did you say to them?
Nothing. I said that you're a great dad.
Okay. What else?
That you guys like to wrestle.
- Jesus Christ.
- What?
They wanted to know where
all her bruises are from.
Who the fuck are you to talk
about me and my daughter?
- Who the fuck am I?
- Yeah, that's what I'm asking.
Who the fuck am I?
Hey, big man, take
one more fucking step
Hey, that's enough.
You need to calm down.
Hey, everybody, back the fuck up!
Stop! Stop! Stop! Stop!
Kylie's platelets are only 9,000.
- What does that mean?
- [SIGHS]
It's it's not what we thought.
It's probably ITP.
What the hell is ITP?
Something we can treat.
- You feel that?
- Mm, no.
Excellent.
This is looking very good.
Ah. Tell Mr. Kovalenko.
[LAUGHTER]
Mrs. Kovalenko?
Yes? Yana, please.
Yana, you mentioned
that you dropped the samovar
when you heard firecrackers.
Yeah.
I was on my way inside
October 27, 2018
to the synagogue
when the shooting started.
There was nothing I could do.
I went in
after the police arrived.
I felt I had to.
I'm better now.
But
[VOICE BREAKING]
New Year's Eve, Fourth of July,
when when kids have their fireworks
and firecrackers, I
There is no clock on how long it takes.
[SCOFFS]
No clock.
You must be joking.
[KNOCK AT DOOR]
- Robby?
- Yep.
- Mark Yee is back from CT.
- Oh, okay.
Um, Perlah, why don't we go
ahead and see if we can put
a nonstick dressing on this?
And I will come back, and we can discuss
aftercare instructions.
Yeah, you got it, boss.
Thank you, Doctor.
[DOOR CLOSES]
[INDISTINCT CHATTER]
Vitals stable. Pulse ox holding at 99.
Okay. Heart and lungs look good.
[CELL PHONE RINGS]
- Dr. Mohan.
- Dr. Robby?
Yeah? [SIGHS]
Please make him be okay.
I can assure you that we
are gonna do absolutely
Everything you can. I know.
God, this is all my fault.
- Mrs. Yee
- Oh, he's been so stressed.
So I planned this weekend away
at Seven Springs,
but he didn't want to go
because of work.
So we fought this whole morning.
And then I
I said awful things.
Those can't be the last words
we say to each other.
Doctor, please.
Good news. CT looks normal.
No bleeding inside the skull.
C-spine, no fractures seen.
- He didn't break his neck?
- Then why is he paralyzed?
You can have spinal injuries
without radiologic abnormalities.
Sometimes it doesn't show up
on CT, only on MRI.
- [CELL PHONE RINGS]
- Dr. Mohan.
Are you sure?
Okay.
Critical potassium level, 1.2.
Wow.
- Okay.
- That's crazy low.
Uh, extremely low potassium
with generalized weakness
and no cervical injury.
We may be looking at
Hypokalemic periodic paralysis.
What is that?
It's a rare condition
where potassium gets shifted
into the cells,
causing profound weakness,
just like paralysis.
- Will he get better?
- Yes.
Back to normal in a few hours.
In a f
Replete slowly. 10 MEQ of KCl
[CRYING] Thank you so much.
Did you hear that, Mark?
Oh, baby, you're gonna get better.
Oh, baby.
All right, DD. Hey, come on now, man.
Oh, how you doing, Duante?
- Fine.
- Great.
If you're fine, you go home.
- Really?
- Yeah.
Mm-mm. Hey, tell them.
Me and my sister were making bracelets,
and I put beads up my nose.
How many?
One on each side.
I got to ask
why'd you stick them up there?
See how many will fit?
To shoot them out like rockets.
Mm.
But I breathed in,
and they went deeper
and now won't come out.
Did you try anything at home?
Yeah, I tried blowing in his mouth,
but just got a little snot on my cheek.
"A" for effort, Dad.
Okay, we need to take a look
with a little flashlight.
- Okay?
- Okay.
This is what I have to look forward to?
This and so much more.
Red bead below the inferior turbinate.
I
got a blue one.
Afrin, benzocaine, Katz extractor?
Yep. Dad, looks like we got
to go up and get them.
- No way he's sitting still.
- Oh, he'll be numbed up.
You don't know this child.
Hey, Duante, you like video games?
Everybody does.
We have a 3D video game.
- Yeah.
- Cool.
[CHUCKLES]
That's KCl and saline
at 10 MEQ per hour.
We avoid dextrose
because the insulin response
drops the K even more.
If it's genetic, why didn't
it happen when he was a kid?
It usually starts after the teen years.
And it can be intermittent.
Sometimes it's triggered
by intense exercise or stress.
We've been married eight years.
We've had fights. He's never collapsed.
If his thyroid gets overactive,
that brings it on later in life.
I ordered TSH, T3, T4.
So now we just wait?
[MONITORS BEEPING RAPIDLY]
Bag him. Starting compressions.
- Charge to 200.
- What is happening?
Low potassium
can harm electrical activity
- in the heart.
- Charged.
- Clear.
- Clear.
Resuming compressions.
- So your little girl was ITP?
- Go figure.
Nothing like a zebra
to kick-start your morning.
Well, it's better than the alternative.
True.
ITP.
So that's, uh, intra
Immune thrombocytopenia.
Used to be called idiopathic
thrombocytopenic purpura.
Know what "idiopathic" means?
That we don't know the exact cause.
It means the patient is pathetic
and the doctor is an idiot.
Just checked on baby Jane Doe.
Looking good. Taking formula well.
We're here to take a statement.
We're looking for a Tony Chinchiolo.
Yo! Right over here, boys!
Well, officers.
Heard you had some trouble
over at the campus library.
Shit. Let me just say
new appreciation
for what you guys do every day.
Frickin' junkie jungle, right?
At the campus library?
Yeah.
Thumb and forefinger make a C.
Bottom three fingers make an E
for jaw lift.
One breath every five seconds.
Come here, try it.
About two minutes since defibrillation.
- Holding compressions.
- Normal sinus.
Carotid. Strong carotid.
Okay, let's try for BP.
Why don't we check after the shock?
2024 ACLS guidelines.
Patients can remain pulseless
for a little bit,
even after successful defib.
He came back with one shock.
That's as good as it gets.
- 104 over 68.
- Good squeeze. Good EF.
Spontaneous respirations.
Okay, let's lift him up.
He's breathing on his own
excellent sign.
Oh, God.
- Can I touch him?
- Of course.
Oh, Mark.
- Hey.
- [GROANS SOFTLY]
Oh, shit.
We need a gurney!
Nancy?
Mrs. Yee?
Weak carotid. Shallow breaths.
Did she vasovagal from stress?
Can't assume that.
Positive seat belt si oh, shit.
Hang two units of O-neg
on the rapid infuser.
Somebody call Garcia. Shit.
We really should have insisted
on examining her.
Okay, I got the head.
Platelets are these
tiny things in the blood
that help it clot.
And thrombocytopenia is fancy
for "low platelets,"
which explains why your skin
bruises so easily.
And what causes it?
It's actually her immune system
that's causing
the destruction of platelets.
Sometimes it's a triggered response
to, uh, an environmental factor
or virus.
And what's the treatment?
What are you giving her?
We'll be treating her
with high-dose steroids
to suppress the immune system
and IV immunoglobulin,
which reduces the destruction
of the platelets in the spleen.
Can I go home?
You're gonna have to stay
in the hospital
for about three days
to make sure
that the treatment is working.
Okay. Okay.
So when can she get
a room in the hospital?
That is an excellent question.
I'm going to see
if I can make that happen
sooner rather than later,
- but it might take a while.
- Okay.
GPS says I should be there
by 11:00.
Do you have any other
questions for me, ma'am?
No. I'm sure I will,
but I'll let you go for now.
Thank you, Benny.
All right.
I'll see you when you get here.
See you soon, baby. I love you.
Bye, Mom. Love you too.
There you are.
And there you are.
Don't try to charm me.
You promised to stay put.
I was going to come right back.
My backside is killing me.
I need to keep moving,
or I get all achy and stiff.
Well, I got you
this foam donut to sit on
- while we wait for your X-rays.
- Hmm.
Dr. Hazel Eyes, it says here
that it's only supposed to take
an hour or two for an X-ray.
Well, the patient passport
holiday edition
would better reflect reality.
It could be double that.
There's no need for reality.
We romantics
prefer la reve, the dream.
We do, do we?
Oui.
La mer qu'on voit danser ♪
Le long des golfes clairs ♪
A des reflets
d'argent, la mer ♪
[LAUGHS] Right.
Des reflets
changeants sous la pluie ♪
Hey, save a dance for me.
Uh, yeah, okay, I will.
- Dr. McKay?
- Yes.
This is Gretchen Williams.
- Actually, it's Lambdin.
- Ah.
You called about my
ex-husband, Michael Williams.
Yeah. Yes, yes. Thank you for coming in.
You were, um, listed
as his emergency contact.
Yeah, I don't know why.
We have been divorced for years.
Is he all right?
He's he's going
through a lot right now.
Would you like to see him?
Uh, okay.
Leo, can you zoom in and please
hold it a little steadier?
Okay.
Okay.
Atorvastatin.
Simvastatin.
Ezetimibe.
Those are all
high-cholesterol medications.
Can you go to the right?
Lisinopril.
Losartan. Propranolol.
Wait, wait, that's it.
Wendy's pile.
Yellowish bottle,
little, round blue pills,
just like I said.
- Propranolol?
- Bingo, little lady.
Okay, yeah, well, this makes
a lot of sense now.
Um, propranolol is a
high-blood-pressure medication.
Those are 20 milligrams each,
and the starting dose is 40 mgs.
How many pills did you take?
No, ma'am. I-I went
just before I came here.
Dad.
Um pill how many pills
did you take?
Oh, uh, I think four, maybe five.
That is a lot. Okay.
Full stomach, mind you.
Well, um, the good news is,
it has a short half-life,
so, um, we're gonna need to keep you
for about four hours to monitor.
But then you'll be able to rejoin
for all the late-afternoon festivities.
- All right.
- Whoo!
- [MONITOR BEEPING RAPIDLY]
- Unit 3 and 4 running in.
BP 84 over 56. Heart rate 112.
Free fluid's much bigger than before.
She's not turning the corner.
OR is holding a room.
I'll let the husband know.
Why did you guys wait
so long to check her?
Good vitals in the field. No distress.
She refused to sign in.
You should have convinced her.
20/20 hindsight. She was stable.
Until she wasn't.
Next time, I'll use
my X-ray vision goggles.
Let's get her upstairs.
Got to do an accu-check
on my DKA patient.
Thanks for the backup.
Anytime.
Now, try and lift your arm, Mark.
I'm trying. Can't do it.
But you are getting stronger,
and your speech is improving.
How did I lose so much potassium?
You didn't lose it.
It got shifted into cells.
When it comes back,
you'll return to normal.
Where's Nancy?
She had an injury to her
spleen right about here
with some internal bleeding.
Oh, God.
She passed out from blood loss.
We were able to transfuse her,
and she's now on her way
to surgery to repair that damage.
This is my fault.
She was trying to [SIGHS]
She booked a trip for us, for me.
I fought her the whole time.
I've been
[SIGHS]
Please don't
oh, my God, please don't let her die.
Please.
I can assure you
that she is in excellent hands.
Is this how it works?
How what works?
You think things are important
that everything's so important.
And then you end up here and see.
Yeah, that is how it works.
No, it's a small hole.
Like the size of a dime, right, Doc?
Mm-hmm. Yeah, even smaller.
It's a minor enough procedure
that most patients go home the next day.
And then?
And then they'll know what it is
and how to treat it.
- Isn't that right?
- Yeah, exactly.
I'm sorry that they called you.
I never updated the form, I guess.
No, no, it's okay. I'm
You know, they called, and I
was just kind of surprised.
[BOTH CHUCKLE]
Well, you didn't have to come.
But I did.
I heard you got married.
Congratulations.
Thank you.
I hope he treats you well.
You deserve to be happy.
[SIGHS]
I'm really sorry you're going
through this, Michael.
Yeah.
Me too.
But you know me I'm a survivor.
Why don't I-I leave you guys
to talk for a few minutes?
I have a patient to check on.
- Sure.
- Yeah.
Mr. Diaz should be improving
after 2 liters.
Blood sugar?
Down from 521 to 436.
That's good, right?
Moving in the right direction.
Were you able to get ahold of your mom?
Yes. She's on her way.
She doesn't have a car.
She takes buses, so it takes longer.
- I'm sorry.
- Don't be.
Current insulin is 0.1 units
per kilo per hour.
Next steps?
Once the glucose is down to 250,
reduce the insulin to
0.05 units per kilo per hour.
Because you can normalize
the blood sugar
before you clear the ketones,
and you don't get hypoglycemia.
But as treatment continues,
you'll have to give IV dextrose
to keep the blood glucose
in between 150 and 200
while the insulin drip
clears the ketones.
Obviously.
I'm sorry, what?
Got it.
Duante, what are you doing
in there, son?
I'm a rabbit,
grabbing all the carrots
before the farmer gets me.
Keep going.
This is a Katz extractor
with a tiny balloon at the end.
What we're gonna do is, we're
gonna slip it past the bead,
inflate the balloon,
try to pull out the bead.
- Is it painful?
- No, he's he's numbed up.
Made it to level three.
And pretty distracted.
Dad's gonna hold your head still, okay?
- Look up.
- Okay.
Now go back, perpendicular,
below the turbinates.
You guys ever hear of John O'Donohue?
- Mm-mm.
- No.
I've been reading him a lot lately.
He's got this book of, um, blessings.
And there's this one about fatherhood.
Really stuck with me. [BEAD CLATTERS]
Voilà. One red bead.
Yeah? How's it go?
The ending goes,
"May you be gentle and loving,
"clear and sure.
"May you trust in the unseen Providence
"that has chosen you to be a family.
"May you stand sure
on your ground and know
"that every grace you need
will unfold before you
like all the mornings of your life."
Hmm. That's good.
I'd add, support your woman
and pack good snacks.
That's beautiful.
And it turns out, there's
no handbook for fatherhood.
So I will take all the wisdom I can.
[BEAD CLATTERS] Blue bead out.
Anything else?
You tell me. I have my own report to do.
Anything I left out?
Labs are back on that kid.
We'll follow up with Mr. Davis.
Yeah, when Mr. Davis
comes off the ceiling.
Jackson Davis
tox screen negative for cocaine,
amphetamines, marijuana,
PCP, benzos, and opioids.
- So no drugs in his system?
- Nope.
Taser barbs on the back
of the victim's neck?
Yep.
Changes things, Tony.
- Hey, Louie.
- [GROANS]
- How we doing?
- Not so good.
I could really use a drink.
I f-feel a-a little empty.
Okay, well, empty is what we want.
And it looks like we are there.
Hey, well, if I can't get
a drink, my tooth.
You you got to do something.
We're gonna get right to that.
Let's hang some IV antibiotics,
3 grams of Unasyn.
Excellent.
He's gonna be right back.
We're gonna numb it up and drain it.
- Ten minutes, tops, okay?
- Oh.
Hey, uh, you said you met Mr. Zambelli,
the fireworks guy, on the field.
What field was that?
Uh, n-no more talking.
You got to fix my tooth.
Yeah, deal.
[GRUNTS]
You're Muslim?
I am.
Thank you.
Oh, for what?
After the shooting, it was the Muslims
that came together for us
in support and
walked with us.
You raised money.
You
paid for all the funerals.
Anyway
thank you. [DOOR OPENS]
Hello. How's it going in here?
Did I miss all the gross stuff?
- Timed it perfectly.
- Excellent.
My job is all about delegation
and time management.
- Oh, not for much longer.
- That is very true.
W-why for not longer?
Because tomorrow I am leaving
to go on sabbatical.
He's leaving us for
three months on a motorcycle.
Motorcycle? You're joking.
- Why would you do this?
- Why? Why?
- Why? Because
- You're middle-aged man.
Don't be stupid.
Don't hold back.
Tell me how you really feel.
Forgive me for being blunt,
Dr. Robinavitch,
but how old are you, huh 50?
- Ish.
- Ish.
50-ish-year-old man on a motorcycle
very sad.
[LAUGHTER]
[INDISTINCT CHATTER]
I, um
I-I-I don't know what to say.
Have you ever heard of ITP?
I never did.
I really appreciate you
bringing her here, okay?
Of course. What do you think I am?
Oh, that's right.
You think I'm some kind of child abuser.
- No, I never said that
- The fuck you didn't.
In front of all those people,
you made it sound like
she might have been getting hurt
while I was watching her,
like it was my fault.
You basically said
the same thing about me.
No, I said that you guys roughhouse
that's all because you do.
You know I would never hurt my daughter.
Actually, I don't.
I've known you six months.
You could be anybody.
Okay, well, I am sorry
for what I said, okay?
I was upset, and I-I was worried.
And I just I said something stupid.
- And I just
- You think?
Will you just fucking let me finish?
You are finished!
We're finished.
Well, happy fucking Fourth of July.
Yeah, happy Independence Day.
[INDISTINCT CHATTER]
Excuse me? [GRUNTS]
Yes? What can I do for you?
Uh, my wife and I were in an accident.
Um, she's in surgery right now.
Would you mind holding
my phone up for me
so I could record a message for her?
Of course I will.
Happy to.
Oh, good, I have the same one.
I know how this works.
Okay.
Ready?
- Go.
- [CLEARS THROAT]
[SIGHS]
Hi, my love.
[CLEARS THROAT] So, uh
I was listening
to this couple argue, uh
and they were yelling.
Both so angry.
And I just wanted you to know, um
that I was wrong.
I was so wrong, and
and I'm sorry about all of it.
Uh
Hey.
- How you doing?
- [SIGHS]
I haven't seen him in, like, four years.
Oh. I can't imagine.
- That must have been
- So crazy.
You know, things were not good
at the end.
He was a really different person.
Huge temper, not like
when we first got married.
I'm so sorry.
Could that mass
have been there for a while
and only recently got worse?
Yes.
Could it be responsible
for how much he changed?
You know, his his moods and tempers?
He was he was getting
into fights with strangers.
It's possible. [SIGHS]
Oh.
Thank you.
Um, unless he's asked you to change it,
would you please leave me as
the emergency contact?
Yeah, absolutely.
[DOOR OPENS]
[SIGHS]
Okay, I'm sending Mrs. Kovalenko home
with burn dressing
but not before she turned my sabbatical
- into a midlife crisis.
- No comment.
- Wound check, two days.
- Got it.
What about Kylie, this little girl?
- She gone up yet?
- Hopefully soon.
Hey, we're starting to clear
some space around here.
- Yep.
- [TELEPHONE RINGING]
PTMC Charge Nurse.
Go ahead, Medic Command.
Is this a drill?
Is this a joke?
It's the Fourth of fucking July.
Got it. Thanks.
- What's up?
- Westbridge has a Code Black
and is closing to internal disaster.
Central's diverting all
their ambulance traffic to us.
- What's the issue?
- Comspec didn't say.
Shit, it could be anything
from a flooding toilet
to a power outage.
- How long?
- Didn't know.
A couple of doctors
probably got the holiday flu,
and they're understaffed.
[CHUCKLES]
How come? How long? How many?
Mm, mm, mm.
Sounds like a betting grid to me.
We are back.
Oh, I should have left last night.
2701! Get the fuck out!
Is there a MedicAlert bracelet?
- Did you get an ID on him?
- Student ID.
- Name says Jackson Davis.
- That's a start.
- Jackson, what's going on?
- Title 18!
- Title section 508!
- Javadi, you're with us.
We're gonna take good care
of you, Mr. Davis.
- You're in a safe place.
- You're okay.
- Get off!
- Trauma One.
- Reasonableness! 2709!
- Okay, okay, Jackson.
We're gonna need you to calm down
to get the Taser barbs out of your neck.
- Do you need to jump on that?
- Mm-mm.
Covering calls for Dana.
Stop talking to me.
You can't! Title 2710
- Hard to assess pupils.
- [GRUNTS]
- Hard to assess anything.
- Yeah, yeah.
Wait till after he's sedated.
- 10 of olanzapine.
- No, no.
That'll take 15 minutes to kick in.
Uh, 5 of droperidol puts him down in 5.
No, you can't give it
without knowing his QT.
Two beats of a rhythm strip
before he took off the leads.
No.
You can't be in here. Get out!
That looks good. Go with the droperidol.
Get the fuck out! Get off me!
Do we take the Taser barbs out?
- 2701.
- No.
We got to wait till he calms down first.
Get off me, man. 2901, get out!
Get out! 2710.
Title 18, section 1938.
Mr. Randall, happy 20th anniversary
and a very happy Fourth of July.
But no sex fireworks for you tonight.
Give everything a chance to heal.
Don't worry, I will.
Thanks, Doc. Ow.
We're going right back
through here, okay, ma'am?
Oh, thank you.
Change the dressing twice a day.
Doggy bag of the ointment
and nonstick gauze.
Cool. I know the drill.
Come back if it starts to ache or stink.
Exactly. Good luck. Stay safe.
Oh, shit, it's Daddy, with your daddy.
Lord, what'd they get up to now?
Treatin' and streetin'.
"Pros from Dover."
I'm sorry, Ms. Graham.
I just saw the ASL note in your chart.
This is Lindsey.
We'll bring you back
as soon as possible.
Stay with her.
[INDISTINCT CHATTER]
All right. Who here needs help?
[INDISTINCT CHATTER]
You? You need help?
Oh, no, no, no, ma'am.
I've been on these since 1987.
This one here, he got dizzy, fell down.
Forgot my blood-pressure medication.
I left it back home in Georgia.
And presto.
We're back, Mr. Digby,
with some IV antibiotics.
First we scrub your outsides,
then we clean your insides.
What do you need to document
in his chart?
Uh, time started, time completed,
and any adverse reactions.
What else?
Um, lot number on the antibiotic vial.
Excellent. Mr. Digby.
It's just Digby.
Digby, why'd you wait
so long to come see us?
I don't like going to doctors.
Well, that makes two of us.
We all need help from time to time.
Think maybe we could arrange
for some ongoing care?
I just kind of want
to get patched up, you know?
I do know.
But that's today. What's tomorrow?
Sunday.
Use the system.
That's what it's there for.
Buddy of mine, Dylan,
knows all the angles.
He even works the occasional miracle.
You think maybe
I could have him stop by?
I guess, yeah.
Great.
- How about a sandwich?
- Yeah.
Yes, please.
We always offer.
Two most important things
that they know we're here
and that we'll never stop offering.
Thanks for covering, Princess.
Anytime.
Yo, can I get some help over here?
Yeah. What's going on, man?
The crazy kid in there, screaming.
- All right, have a seat.
- Yeah, that's him.
Still going nuts.
Probably meth fucking animal.
- What's your name, sir?
- You don't understand!
Tony Chinchiolo, campus security.
Yeah, I was at work when this happened,
so I'm gonna need everything documented.
Okay.
All right. Heart rate's 89.
Pulse ox 97.
Scalp lac's tiny
- 5 millimeters.
- Ow.
Should hold together with Dermabond.
Kid threw a fucking chair at me.
Work-related injury gets a full exam.
- Jesse here will take you.
- Oh, no.
I-I'm gonna stay here till the cops come
so I can give my statement
and so I can watch him.
Yeah.
Trust me, you do not want
him getting out of there.
Ow, fuck.
- Did she say anything?
- No more than she said to you.
Nothing going on at home.
Nothing at school.
- And you believe her?
- There's some flags.
Bruising in various stages of healing.
She's a little withdrawn,
doesn't engage much for girls her age.
But she could just be a little shy
or scared of being in here.
Or she's being abused.
That too.
We'll find out more when Dad shows up.
Yep. If he shows up.
I need a hand here!
- [OBJECT SNAPS]
- There's the first barb out.
All right, Javadi, you're up.
[MONITOR BEEPING]
Okay, so you're gonna want to clamp
where the shaft meets the barb.
- Mm-hmm.
- Yep.
Stabilize the skin.
Not so close so as to stick yourself.
I've seen that once or twice.
Uh, pull up at 90 degrees.
Harder. Yep.
Harder.
Oh.
Do we suture those?
Nope, just a Band-Aid.
- Mel, we need orders.
- Right.
I got a rainbow.
Uh, CBC
CMP, UA, blood alcohol, and tox screen.
All of the above.
Cap, if this young man's stable,
can he go to Central 10 pronto?
Double trauma at the back door.
Okay, you heard the boss.
Let's get going.
Today is starting to heat up.
[INDISTINCT CHATTER, TELEPHONE RINGING]
Mark Yee, 32-year-old restrained driver,
auto versus motorcycle.
Altered with normal BP,
satting 99 on 2 liters.
We're at the hospital now, Mark.
What's wrong with him?
Why isn't he talking?
His wife, Nancy, front-seat passenger,
- declined transport.
- I'm fine.
We weren't going all that fast.
The motorcycle ran the light.
I'm Dr. Robby. This is Dr. Al-Hashimi.
- Nice to meet you.
- And this is Nurse Dana.
She's our charge nurse.
We need to look over your husband.
Hello. Let's step over here
for a minute, hon.
Let them get to work, okay?
Antoine, Larry, transfer out here.
T-1 will be open in a sec.
Aye, aye, Cap.
One, two, three.
- [GRUNTS]
- Incoming.
Okay, Joy, you stay with me.
Samira, you stay with Dr. Al-Hashimi.
Open skull fracture.
Tubed him for agonal respirations.
BP 60 palp initially.
Started a liter of NS,
but lost his pulse en route.
Oh, boy, this doesn't look good.
One, two, three.
[GRUNTS] Joy, check his pupils.
Somebody hand me a pair of scissors.
8 millimeters. Nonreactive.
AKA blown pupils, fixed and dilated.
Oh. [GROANS]
Crushed skull with tons
of gray matter extravasation.
At least it was quick.
- No helmet?
- Nope, 'cause he took
the PennDOT Motorcycle Safety Course.
Isn't that what you took, Robby?
Hold compressions.
Yes, but I still wear a helmet.
- Is he a donor?
- Also nope.
That is too bad.
Asystole. I think we are done here.
- What's next door?
- The guy who hit him.
Joy, you're with me.
What about a moment
of reflection? I thought
He'll still be dead when we get back.
Pulse ox 99. BP 108 over 72.
EFAST negative.
Hell of a lot better
than the guy next door.
- How's the airway?
- Good volume.
Good sats. Gag reflex
- [GAGS]
- Present.
- Intubate?
- Maybe.
- Maybe not.
- Mr. Yee?
Joy, sternal rub
on his chest, like this.
Really hard, please.
- Mr. Yee?
- [GROANS]
Spontaneous eye movement.
Responds to pain.
GCS is 10. Borderline for intubation.
No muscle tone flaccid
paralysis in the left arm.
- Same on the right.
- And both legs.
Add towels to both sides of
the collar for more stability.
Let's not make this worse.
Pan scan with 3D
reconstruction of the spine.
He's quadriplegic?
If so, it's a low cervical injury.
- Why is that, Joy?
- Uh
C3, 4, and 5 helps you
breathe to stay alive.
Mr. Montrose
you can't just be wandering
around, talking to patients.
Well, that's that's what I do.
I'm a greeter at Walmart.
I get paid to wander
and to talk to folks.
Well, as a as a personal favor to me,
can you at least stay
in your general vicinity?
I can get you a wheelchair
while we wait for your X-rays,
but it might take a minute.
[CLEARS THROAT] My dear, I cannot sit.
My backside is killing me
from where I fell on it,
which is an embarrassing
admission to make
- to such a lovely woman.
- [CHUCKLES]
Well, thank you for the compliment,
but there's no need to be embarrassed.
You took a very nasty fall.
Well, then may I say that
one look in your beautiful eyes
and I think I'm falling again.
[BOTH LAUGHING]
What a charmer.
Just for that, I'm gonna
get you a foam donut.
It's the eighth wonder of the world.
Pretty great laugh you got there, Doc.
[CHUCKLES]
Oh, God. My witch's cackle?
Got CT results for Mr. Williams.
Ah.
Oh, wow.
Okay.
Okay.
Ah. Right on time.
Just just getting full.
Yeah, I'm ready for number five.
- That's impressive.
- Uh-huh.
Yeah, there's more where that came from.
Although, uh, my intake is running low.
Yeah, well, two more bottles
ought to do it.
Then we'll drain your tooth,
and we'll get you out of here
- before the fireworks tonight.
- Oh.
Okay. Clamped.
Ogilvie, make the change.
- Okay.
- Mm-hmm.
All right. Let her rip.
- Flowing like a river.
- [CHUCKLES]
I love me some fireworks.
Oh, yeah?
Shit, I-I met Mr. Zambelli
Lean forward.
Many times on the field.
Who's Mr. Zambelli?
Son, you don't know fireworks
if you don't know the name Zambelli.
He helped Pittsburgh become
the firework capital of America.
You did know that, didn't you?
- No.
- Ah.
Y'all don't know nothing
about pyrotechnics.
Stick to doctoring.
Yes, will do.
[SIGHS] I'm sure you have
some questions.
I know it's a lot to take in.
It's a tumor.
It's a brain tumor.
Well, it's a mass, about 4 centimeters,
in the frontal lobe.
Is it cancer?
We can't say for sure right now.
It could be many things
uh, infection, inflammation,
a benign cyst.
Is it what made me fall?
Yeah, possibly.
We'd like to keep you here
and treat with dexamethasone,
which is a steroid
to take down the swelling.
- Hmm.
- And then we'll need
a brain biopsy
to know exactly what it is.
What, you're you're gonna
cut open my head?
It's just a small hole.
We'll do a-a CT-guided
stereotactical biopsy
- with a-a blunt, thin needle
- [SIGHS]
Which sounds crazy, but it's
actually pretty amazing.
I mean, most patients
go home the next day.
I don't know.
What do you think I should do?
I think this is a pretty good plan.
- Okay.
- Yeah?
BP 95 over 67.
Seems a little on the low side.
It is.
Have you ever had
low blood pressure in the past?
No, sir. My blood pressure's
always high.
Hold still, sir.
No talking while we do the EKG.
The Hansens all run high,
except for Monty.
- He ran low, but he's dead.
- That's not helpful.
You want to help,
quit playing family pharmacist.
Pooling meds is how
we've always done it.
You put everything in a big pile
in the middle of the table
Well, look where that got us now.
No, I'm gonna jump in here
and echo that sharing meds
which haven't been prescribed to you
is actually a real big no-no.
How we doing on remembering
what your brother might've taken?
We could call back to the house.
Great idea. Okay.
Whatever little round pill
you took, sir,
has caused your heart rate
and blood pressure
to drop so low,
you're at risk of fainting,
falling, or having a serious injury.
Oh.
We need to take him back to the ER
so he can get a liter of fluids,
we can check his blood tests
and monitor his heart rate
and blood pressure
till he recovers.
Pulse ox holding steady at 99.
Good tidal volume.
How you doing there, Mr. Yee?
Scanner can take him now.
I'll check the results from upstairs.
- Why is he so altered?
- Could be concussion.
Maybe a small intracranial hemorrhage.
All will be revealed
by the Donut of Truth.
- Need a portable monitor.
- Joy, stay with him, please.
See if the radiologist
can give us a STAT read.
How is he?
Did I hear someone say he's paralyzed?
There are signs of weakness
in both arms and legs.
But before we can make any prognosis,
we'll need a full-body scan.
Head CT will show us any brain injury.
Neck CT will show us
any spinal-cord injury.
Chest, abdomen, pelvis will
rule out any internal bleeding.
Oh, my God.
The scans should only take
about 15 minutes.
In the meantime, perhaps you'd
let us look you over as well?
I'm fine. The medics checked me.
I just want to stay with my husband.
Well, you can't go into the CT with him,
but you can wait just outside
if you like.
- Excuse me.
- Princess, this is Nancy.
Mrs. Yee is gonna go
with her husband to CT.
Will you show her where to go?
- Sure. Come on in.
- Thank you.
So what's the plan now?
Keep observing me in my natural habitat?
No telling what I might do next.
I think I've got the gist.
How about we each take a lap
and meet here
when Mr. Yee is back from CT?
Splitting up so soon?
You're free to see
other people, Dr. Robinavitch.
I'm looking for cooperation,
not commitment.
[CHUCKLES] [DEVICE WHIRS]
So you bandaged the burn yourself?
Oh, no, no, no, no, no, no, no, no
Ma'am, you're you're making
it difficult for me
to see under this dressing.
- Is that a tablecloth?
- Part of a window curtain.
Cleaner than tablecloth.
I'll wait for the doctor. Thank you.
May I ask how this happened?
For weeks on end, the kids with their
guchnyy firecrackers,
going all day and night.
Oh, i-is this a firecracker burn?
No, sweetie,
this is from the full samovar
I drop on the floor when the sh
the firecrackers started going on again.
I'm sorry. What's a samovar?
It is a big metal urn for coffee or tea.
They can get super-duper hot,
and I was never allowed to touch ours.
Uh, hello, Mrs. Kovalenko.
My name is Dr. Michael Robinavitch.
Everybody calls me Dr. Robby.
- Robinavitch? Jewish?
- You guessed it.
And I see that you are
here today for a burn.
Why don't we take a look?
Oh, not married?
No, I'm not married.
[CHUCKLES] Do you attend synagogue?
Uh, not for a while.
I mean, High Holidays mostly.
Where?
- Ooh.
- [WHIMPERS]
What did you put on this?
- Where?
- On your burn.
- Is this honey?
- Yes, honey.
Where do you go on holy days?
Uh, my grandparents, um
I grew up going to Rodef Shalom.
You?
Tree of Life.
They're rebuilding.
Yes, something new.
Remember, Rebuild, Renew.
That's the slogan.
I'm sorry, did you say "honey"?
You think honey's funny?
Works like a charm.
My father kept bees. I know.
If the honey is medical grade
and the burns are not too bad,
honey actually does have
some antibacterial
and anti-inflammatory properties.
However, these burns
are very deep in some places.
They're going to need debridement.
I'm glad you came in.
That's what I thought.
I was hoping no, but I figured as much.
Not to worry.
We are gonna have you
patched up and home
in time for dinner and fireworks.
No.
No more fireworks.
No.
Okay.
Anyone here treating Kylie Connors?
She's my daughter.
She's nine. I'm Benny Connors.
Mr. Connors, I'm Dr. Santos.
I'm treating Kylie.
Is she okay? Can I see her?
My my girlfriend, Gina,
says she got a cut on her chin?
Yeah, I can take you to her.
She has a small laceration on her chin,
but it was easily repaired
with medical superglue,
- so no stitches necessary.
- Okay.
She chipped a tooth,
but it's a baby tooth,
so it won't need dental work.
All right, well, that's a relief.
Has Kylie had any previous injuries?
Uh, yeah.
She, um she broke
her wrist last year.
She was skateboarding.
Dana, if you could get Dylan
to come to North 1,
- and Ahmad.
- You bet.
Okay, I got it now. One, two, three.
Daddy, you came.
Baby, what's going on, huh?
My tooth broke, and my chin got cut.
Oh, no. [SMOOCHES]
What happened?
She was running up the stairs.
- Gina was chasing me.
- We were playing.
As I was saying, Mr. Connors,
the laceration is pretty minor.
On the stairs?
- It was an accident.
- Perhaps we can
An accident that wouldn't have happened
if you weren't running up the stairs.
Do you understand what I'm saying?
This is the last thing
that I need right now,
is her mother finding out
that she got hurt
- when she's with you.
- It was an accident.
And before you get all high and mighty,
- I've got questions of my own.
- Like what?
Hey, Mr. Connors.
I'm sorry, I meant to be here
when you arrived.
I'm Dylan Easton.
I'm with Social Services.
We have insurance. Thank you.
Perhaps we can step outside
and chat for a second?
I can fill you in on where we are.
Hey, uh, Jesse, do you want
to keep Kylie entertained
- for a few minutes while I
- Absolutely.
Borrow her dad?
We'll just head down to the family room.
It's a little quieter there.
Why do I got to talk to a social worker?
Anytime a child is injured,
we have some standard questions
that we ask parents and caregivers.
Good. That's fine. Great. Ask me here.
Well, we noticed
some bruising on Kylie's body,
some old, some new,
on her back and legs.
- Any idea how she got those?
- Yeah, soccer.
She plays for a club team.
They're, you know, little girls,
but they play like they're
in "The Hunger Games."
Well, I understand that you and Kylie do
a fair amount of roughhousing.
What?
I'm sorry. Are you fucking kidding me?
Where are you going with this?
Are you saying that I hurt my daughter?
Mr. Connors, nobody's saying that
Oh, no, no, no, no, no, no, no, no.
- Gina!
- Mr. Connors
Just just Gina!
Sir, take a breath.
Gina, what did you say to them?
Nothing. I said that you're a great dad.
Okay. What else?
That you guys like to wrestle.
- Jesus Christ.
- What?
They wanted to know where
all her bruises are from.
Who the fuck are you to talk
about me and my daughter?
- Who the fuck am I?
- Yeah, that's what I'm asking.
Who the fuck am I?
Hey, big man, take
one more fucking step
Hey, that's enough.
You need to calm down.
Hey, everybody, back the fuck up!
Stop! Stop! Stop! Stop!
Kylie's platelets are only 9,000.
- What does that mean?
- [SIGHS]
It's it's not what we thought.
It's probably ITP.
What the hell is ITP?
Something we can treat.
- You feel that?
- Mm, no.
Excellent.
This is looking very good.
Ah. Tell Mr. Kovalenko.
[LAUGHTER]
Mrs. Kovalenko?
Yes? Yana, please.
Yana, you mentioned
that you dropped the samovar
when you heard firecrackers.
Yeah.
I was on my way inside
October 27, 2018
to the synagogue
when the shooting started.
There was nothing I could do.
I went in
after the police arrived.
I felt I had to.
I'm better now.
But
[VOICE BREAKING]
New Year's Eve, Fourth of July,
when when kids have their fireworks
and firecrackers, I
There is no clock on how long it takes.
[SCOFFS]
No clock.
You must be joking.
[KNOCK AT DOOR]
- Robby?
- Yep.
- Mark Yee is back from CT.
- Oh, okay.
Um, Perlah, why don't we go
ahead and see if we can put
a nonstick dressing on this?
And I will come back, and we can discuss
aftercare instructions.
Yeah, you got it, boss.
Thank you, Doctor.
[DOOR CLOSES]
[INDISTINCT CHATTER]
Vitals stable. Pulse ox holding at 99.
Okay. Heart and lungs look good.
[CELL PHONE RINGS]
- Dr. Mohan.
- Dr. Robby?
Yeah? [SIGHS]
Please make him be okay.
I can assure you that we
are gonna do absolutely
Everything you can. I know.
God, this is all my fault.
- Mrs. Yee
- Oh, he's been so stressed.
So I planned this weekend away
at Seven Springs,
but he didn't want to go
because of work.
So we fought this whole morning.
And then I
I said awful things.
Those can't be the last words
we say to each other.
Doctor, please.
Good news. CT looks normal.
No bleeding inside the skull.
C-spine, no fractures seen.
- He didn't break his neck?
- Then why is he paralyzed?
You can have spinal injuries
without radiologic abnormalities.
Sometimes it doesn't show up
on CT, only on MRI.
- [CELL PHONE RINGS]
- Dr. Mohan.
Are you sure?
Okay.
Critical potassium level, 1.2.
Wow.
- Okay.
- That's crazy low.
Uh, extremely low potassium
with generalized weakness
and no cervical injury.
We may be looking at
Hypokalemic periodic paralysis.
What is that?
It's a rare condition
where potassium gets shifted
into the cells,
causing profound weakness,
just like paralysis.
- Will he get better?
- Yes.
Back to normal in a few hours.
In a f
Replete slowly. 10 MEQ of KCl
[CRYING] Thank you so much.
Did you hear that, Mark?
Oh, baby, you're gonna get better.
Oh, baby.
All right, DD. Hey, come on now, man.
Oh, how you doing, Duante?
- Fine.
- Great.
If you're fine, you go home.
- Really?
- Yeah.
Mm-mm. Hey, tell them.
Me and my sister were making bracelets,
and I put beads up my nose.
How many?
One on each side.
I got to ask
why'd you stick them up there?
See how many will fit?
To shoot them out like rockets.
Mm.
But I breathed in,
and they went deeper
and now won't come out.
Did you try anything at home?
Yeah, I tried blowing in his mouth,
but just got a little snot on my cheek.
"A" for effort, Dad.
Okay, we need to take a look
with a little flashlight.
- Okay?
- Okay.
This is what I have to look forward to?
This and so much more.
Red bead below the inferior turbinate.
I
got a blue one.
Afrin, benzocaine, Katz extractor?
Yep. Dad, looks like we got
to go up and get them.
- No way he's sitting still.
- Oh, he'll be numbed up.
You don't know this child.
Hey, Duante, you like video games?
Everybody does.
We have a 3D video game.
- Yeah.
- Cool.
[CHUCKLES]
That's KCl and saline
at 10 MEQ per hour.
We avoid dextrose
because the insulin response
drops the K even more.
If it's genetic, why didn't
it happen when he was a kid?
It usually starts after the teen years.
And it can be intermittent.
Sometimes it's triggered
by intense exercise or stress.
We've been married eight years.
We've had fights. He's never collapsed.
If his thyroid gets overactive,
that brings it on later in life.
I ordered TSH, T3, T4.
So now we just wait?
[MONITORS BEEPING RAPIDLY]
Bag him. Starting compressions.
- Charge to 200.
- What is happening?
Low potassium
can harm electrical activity
- in the heart.
- Charged.
- Clear.
- Clear.
Resuming compressions.
- So your little girl was ITP?
- Go figure.
Nothing like a zebra
to kick-start your morning.
Well, it's better than the alternative.
True.
ITP.
So that's, uh, intra
Immune thrombocytopenia.
Used to be called idiopathic
thrombocytopenic purpura.
Know what "idiopathic" means?
That we don't know the exact cause.
It means the patient is pathetic
and the doctor is an idiot.
Just checked on baby Jane Doe.
Looking good. Taking formula well.
We're here to take a statement.
We're looking for a Tony Chinchiolo.
Yo! Right over here, boys!
Well, officers.
Heard you had some trouble
over at the campus library.
Shit. Let me just say
new appreciation
for what you guys do every day.
Frickin' junkie jungle, right?
At the campus library?
Yeah.
Thumb and forefinger make a C.
Bottom three fingers make an E
for jaw lift.
One breath every five seconds.
Come here, try it.
About two minutes since defibrillation.
- Holding compressions.
- Normal sinus.
Carotid. Strong carotid.
Okay, let's try for BP.
Why don't we check after the shock?
2024 ACLS guidelines.
Patients can remain pulseless
for a little bit,
even after successful defib.
He came back with one shock.
That's as good as it gets.
- 104 over 68.
- Good squeeze. Good EF.
Spontaneous respirations.
Okay, let's lift him up.
He's breathing on his own
excellent sign.
Oh, God.
- Can I touch him?
- Of course.
Oh, Mark.
- Hey.
- [GROANS SOFTLY]
Oh, shit.
We need a gurney!
Nancy?
Mrs. Yee?
Weak carotid. Shallow breaths.
Did she vasovagal from stress?
Can't assume that.
Positive seat belt si oh, shit.
Hang two units of O-neg
on the rapid infuser.
Somebody call Garcia. Shit.
We really should have insisted
on examining her.
Okay, I got the head.
Platelets are these
tiny things in the blood
that help it clot.
And thrombocytopenia is fancy
for "low platelets,"
which explains why your skin
bruises so easily.
And what causes it?
It's actually her immune system
that's causing
the destruction of platelets.
Sometimes it's a triggered response
to, uh, an environmental factor
or virus.
And what's the treatment?
What are you giving her?
We'll be treating her
with high-dose steroids
to suppress the immune system
and IV immunoglobulin,
which reduces the destruction
of the platelets in the spleen.
Can I go home?
You're gonna have to stay
in the hospital
for about three days
to make sure
that the treatment is working.
Okay. Okay.
So when can she get
a room in the hospital?
That is an excellent question.
I'm going to see
if I can make that happen
sooner rather than later,
- but it might take a while.
- Okay.
GPS says I should be there
by 11:00.
Do you have any other
questions for me, ma'am?
No. I'm sure I will,
but I'll let you go for now.
Thank you, Benny.
All right.
I'll see you when you get here.
See you soon, baby. I love you.
Bye, Mom. Love you too.
There you are.
And there you are.
Don't try to charm me.
You promised to stay put.
I was going to come right back.
My backside is killing me.
I need to keep moving,
or I get all achy and stiff.
Well, I got you
this foam donut to sit on
- while we wait for your X-rays.
- Hmm.
Dr. Hazel Eyes, it says here
that it's only supposed to take
an hour or two for an X-ray.
Well, the patient passport
holiday edition
would better reflect reality.
It could be double that.
There's no need for reality.
We romantics
prefer la reve, the dream.
We do, do we?
Oui.
La mer qu'on voit danser ♪
Le long des golfes clairs ♪
A des reflets
d'argent, la mer ♪
[LAUGHS] Right.
Des reflets
changeants sous la pluie ♪
Hey, save a dance for me.
Uh, yeah, okay, I will.
- Dr. McKay?
- Yes.
This is Gretchen Williams.
- Actually, it's Lambdin.
- Ah.
You called about my
ex-husband, Michael Williams.
Yeah. Yes, yes. Thank you for coming in.
You were, um, listed
as his emergency contact.
Yeah, I don't know why.
We have been divorced for years.
Is he all right?
He's he's going
through a lot right now.
Would you like to see him?
Uh, okay.
Leo, can you zoom in and please
hold it a little steadier?
Okay.
Okay.
Atorvastatin.
Simvastatin.
Ezetimibe.
Those are all
high-cholesterol medications.
Can you go to the right?
Lisinopril.
Losartan. Propranolol.
Wait, wait, that's it.
Wendy's pile.
Yellowish bottle,
little, round blue pills,
just like I said.
- Propranolol?
- Bingo, little lady.
Okay, yeah, well, this makes
a lot of sense now.
Um, propranolol is a
high-blood-pressure medication.
Those are 20 milligrams each,
and the starting dose is 40 mgs.
How many pills did you take?
No, ma'am. I-I went
just before I came here.
Dad.
Um pill how many pills
did you take?
Oh, uh, I think four, maybe five.
That is a lot. Okay.
Full stomach, mind you.
Well, um, the good news is,
it has a short half-life,
so, um, we're gonna need to keep you
for about four hours to monitor.
But then you'll be able to rejoin
for all the late-afternoon festivities.
- All right.
- Whoo!
- [MONITOR BEEPING RAPIDLY]
- Unit 3 and 4 running in.
BP 84 over 56. Heart rate 112.
Free fluid's much bigger than before.
She's not turning the corner.
OR is holding a room.
I'll let the husband know.
Why did you guys wait
so long to check her?
Good vitals in the field. No distress.
She refused to sign in.
You should have convinced her.
20/20 hindsight. She was stable.
Until she wasn't.
Next time, I'll use
my X-ray vision goggles.
Let's get her upstairs.
Got to do an accu-check
on my DKA patient.
Thanks for the backup.
Anytime.
Now, try and lift your arm, Mark.
I'm trying. Can't do it.
But you are getting stronger,
and your speech is improving.
How did I lose so much potassium?
You didn't lose it.
It got shifted into cells.
When it comes back,
you'll return to normal.
Where's Nancy?
She had an injury to her
spleen right about here
with some internal bleeding.
Oh, God.
She passed out from blood loss.
We were able to transfuse her,
and she's now on her way
to surgery to repair that damage.
This is my fault.
She was trying to [SIGHS]
She booked a trip for us, for me.
I fought her the whole time.
I've been
[SIGHS]
Please don't
oh, my God, please don't let her die.
Please.
I can assure you
that she is in excellent hands.
Is this how it works?
How what works?
You think things are important
that everything's so important.
And then you end up here and see.
Yeah, that is how it works.
No, it's a small hole.
Like the size of a dime, right, Doc?
Mm-hmm. Yeah, even smaller.
It's a minor enough procedure
that most patients go home the next day.
And then?
And then they'll know what it is
and how to treat it.
- Isn't that right?
- Yeah, exactly.
I'm sorry that they called you.
I never updated the form, I guess.
No, no, it's okay. I'm
You know, they called, and I
was just kind of surprised.
[BOTH CHUCKLE]
Well, you didn't have to come.
But I did.
I heard you got married.
Congratulations.
Thank you.
I hope he treats you well.
You deserve to be happy.
[SIGHS]
I'm really sorry you're going
through this, Michael.
Yeah.
Me too.
But you know me I'm a survivor.
Why don't I-I leave you guys
to talk for a few minutes?
I have a patient to check on.
- Sure.
- Yeah.
Mr. Diaz should be improving
after 2 liters.
Blood sugar?
Down from 521 to 436.
That's good, right?
Moving in the right direction.
Were you able to get ahold of your mom?
Yes. She's on her way.
She doesn't have a car.
She takes buses, so it takes longer.
- I'm sorry.
- Don't be.
Current insulin is 0.1 units
per kilo per hour.
Next steps?
Once the glucose is down to 250,
reduce the insulin to
0.05 units per kilo per hour.
Because you can normalize
the blood sugar
before you clear the ketones,
and you don't get hypoglycemia.
But as treatment continues,
you'll have to give IV dextrose
to keep the blood glucose
in between 150 and 200
while the insulin drip
clears the ketones.
Obviously.
I'm sorry, what?
Got it.
Duante, what are you doing
in there, son?
I'm a rabbit,
grabbing all the carrots
before the farmer gets me.
Keep going.
This is a Katz extractor
with a tiny balloon at the end.
What we're gonna do is, we're
gonna slip it past the bead,
inflate the balloon,
try to pull out the bead.
- Is it painful?
- No, he's he's numbed up.
Made it to level three.
And pretty distracted.
Dad's gonna hold your head still, okay?
- Look up.
- Okay.
Now go back, perpendicular,
below the turbinates.
You guys ever hear of John O'Donohue?
- Mm-mm.
- No.
I've been reading him a lot lately.
He's got this book of, um, blessings.
And there's this one about fatherhood.
Really stuck with me. [BEAD CLATTERS]
Voilà. One red bead.
Yeah? How's it go?
The ending goes,
"May you be gentle and loving,
"clear and sure.
"May you trust in the unseen Providence
"that has chosen you to be a family.
"May you stand sure
on your ground and know
"that every grace you need
will unfold before you
like all the mornings of your life."
Hmm. That's good.
I'd add, support your woman
and pack good snacks.
That's beautiful.
And it turns out, there's
no handbook for fatherhood.
So I will take all the wisdom I can.
[BEAD CLATTERS] Blue bead out.
Anything else?
You tell me. I have my own report to do.
Anything I left out?
Labs are back on that kid.
We'll follow up with Mr. Davis.
Yeah, when Mr. Davis
comes off the ceiling.
Jackson Davis
tox screen negative for cocaine,
amphetamines, marijuana,
PCP, benzos, and opioids.
- So no drugs in his system?
- Nope.
Taser barbs on the back
of the victim's neck?
Yep.
Changes things, Tony.
- Hey, Louie.
- [GROANS]
- How we doing?
- Not so good.
I could really use a drink.
I f-feel a-a little empty.
Okay, well, empty is what we want.
And it looks like we are there.
Hey, well, if I can't get
a drink, my tooth.
You you got to do something.
We're gonna get right to that.
Let's hang some IV antibiotics,
3 grams of Unasyn.
Excellent.
He's gonna be right back.
We're gonna numb it up and drain it.
- Ten minutes, tops, okay?
- Oh.
Hey, uh, you said you met Mr. Zambelli,
the fireworks guy, on the field.
What field was that?
Uh, n-no more talking.
You got to fix my tooth.
Yeah, deal.
[GRUNTS]
You're Muslim?
I am.
Thank you.
Oh, for what?
After the shooting, it was the Muslims
that came together for us
in support and
walked with us.
You raised money.
You
paid for all the funerals.
Anyway
thank you. [DOOR OPENS]
Hello. How's it going in here?
Did I miss all the gross stuff?
- Timed it perfectly.
- Excellent.
My job is all about delegation
and time management.
- Oh, not for much longer.
- That is very true.
W-why for not longer?
Because tomorrow I am leaving
to go on sabbatical.
He's leaving us for
three months on a motorcycle.
Motorcycle? You're joking.
- Why would you do this?
- Why? Why?
- Why? Because
- You're middle-aged man.
Don't be stupid.
Don't hold back.
Tell me how you really feel.
Forgive me for being blunt,
Dr. Robinavitch,
but how old are you, huh 50?
- Ish.
- Ish.
50-ish-year-old man on a motorcycle
very sad.
[LAUGHTER]
[INDISTINCT CHATTER]
I, um
I-I-I don't know what to say.
Have you ever heard of ITP?
I never did.
I really appreciate you
bringing her here, okay?
Of course. What do you think I am?
Oh, that's right.
You think I'm some kind of child abuser.
- No, I never said that
- The fuck you didn't.
In front of all those people,
you made it sound like
she might have been getting hurt
while I was watching her,
like it was my fault.
You basically said
the same thing about me.
No, I said that you guys roughhouse
that's all because you do.
You know I would never hurt my daughter.
Actually, I don't.
I've known you six months.
You could be anybody.
Okay, well, I am sorry
for what I said, okay?
I was upset, and I-I was worried.
And I just I said something stupid.
- And I just
- You think?
Will you just fucking let me finish?
You are finished!
We're finished.
Well, happy fucking Fourth of July.
Yeah, happy Independence Day.
[INDISTINCT CHATTER]
Excuse me? [GRUNTS]
Yes? What can I do for you?
Uh, my wife and I were in an accident.
Um, she's in surgery right now.
Would you mind holding
my phone up for me
so I could record a message for her?
Of course I will.
Happy to.
Oh, good, I have the same one.
I know how this works.
Okay.
Ready?
- Go.
- [CLEARS THROAT]
[SIGHS]
Hi, my love.
[CLEARS THROAT] So, uh
I was listening
to this couple argue, uh
and they were yelling.
Both so angry.
And I just wanted you to know, um
that I was wrong.
I was so wrong, and
and I'm sorry about all of it.
Uh
Hey.
- How you doing?
- [SIGHS]
I haven't seen him in, like, four years.
Oh. I can't imagine.
- That must have been
- So crazy.
You know, things were not good
at the end.
He was a really different person.
Huge temper, not like
when we first got married.
I'm so sorry.
Could that mass
have been there for a while
and only recently got worse?
Yes.
Could it be responsible
for how much he changed?
You know, his his moods and tempers?
He was he was getting
into fights with strangers.
It's possible. [SIGHS]
Oh.
Thank you.
Um, unless he's asked you to change it,
would you please leave me as
the emergency contact?
Yeah, absolutely.
[DOOR OPENS]
[SIGHS]
Okay, I'm sending Mrs. Kovalenko home
with burn dressing
but not before she turned my sabbatical
- into a midlife crisis.
- No comment.
- Wound check, two days.
- Got it.
What about Kylie, this little girl?
- She gone up yet?
- Hopefully soon.
Hey, we're starting to clear
some space around here.
- Yep.
- [TELEPHONE RINGING]
PTMC Charge Nurse.
Go ahead, Medic Command.
Is this a drill?
Is this a joke?
It's the Fourth of fucking July.
Got it. Thanks.
- What's up?
- Westbridge has a Code Black
and is closing to internal disaster.
Central's diverting all
their ambulance traffic to us.
- What's the issue?
- Comspec didn't say.
Shit, it could be anything
from a flooding toilet
to a power outage.
- How long?
- Didn't know.
A couple of doctors
probably got the holiday flu,
and they're understaffed.
[CHUCKLES]
How come? How long? How many?
Mm, mm, mm.
Sounds like a betting grid to me.
We are back.
Oh, I should have left last night.