The Pitt (2025) s02e15 Episode Script
9:00 P.M.
1
Baran, is this you?
It began after a bad case
of viral meningitis
when I was five.
They tried every
anti-seizure medication,
but I still had episodes
every few months or so.
No one's ever noticed before.
They just think I'm thoughtful.
Are you driving?
I couldn't until laser ablation
to my left temporal lobe 12 years ago.
Between that and the Keppra,
I've been seizure-free,
cleared by Neurology to drive
and to work as an attending.
How long, uh, between the seizure
you had today and the last one?
It's been well over a year.
But I had two today.
I don't know why.
It could be sleep deprivation,
new job stress.
I I haven't had to deal
with Peds cases
since Afghanistan.
What are your options now?
Um
up my Keppra or maybe try
one of the newer anti-seizure meds.
But if that doesn't work,
I'm left with two choices
um, a temporal lobectomy,
which could impair my speech,
or get a neuromodulation device,
which can sense and stop the seizures
almost immediately.
You need to disclose this.
I know. I have a plan.
Hey, Robby, Dana's looking for you.
She's in Peds.
Yeah, OK, I'll be right there.
[DOOR CLOSES]
Sounds like you're needed in Peds,
and I have patients to see.
Robby, pregnant woman
with severe headache
on her way in by ambulance.
Find Abbot or a night shift resident.
[INDISTINCT CHATTER]
Need you to turn out your pockets.
OK. Show me your hands.
[SIGHS]
[URINE TRICKLING]
Come here often?
[BABY CRYING]
[CLEARS THROAT]
What's going on?
Oh, sorry false alarm.
We thought she spiked a fever,
but it was the wrong chart
from our analog hell.
You know anybody who might
consider kinship adoption?
Doctors and nurses qualify.
Don't look at me.
Hey, can your staff
keep an eye on Dr. Al-Hashimi
until she leaves?
Why?
Uh, because I think she's tired,
and I don't want her
to make any mistakes.
Oh, great advice.
Maybe you should take it.
Yeah. I'm gonna go get some fresh air.
Grab some for me while you're out there.
Your lungs wouldn't know
what to do with it.
Screw you!
In front of the baby? Nice.
[BABY CRYING]
Yeah.
We are the night crawlers.
We deal with the weirdest
and the wildest because
ALL: We are the weirdest
and the wildest of them all.
That is right, and tonight,
they are really gonna be crawling.
Now go get some!
ALL: Hooah!
[CLAPS]
[CLEARS THROAT]
Sorry to wake you.
I I was thinking.
[YAWNS] Doubt PTX.
You're supposed to be leaving.
I am.
You know, this spirit quest of yours
has a lot of people
up in arms around here.
Everyone's gonna be fine without me,
and it's hardly a spirit quest.
Whatever it is,
it seems you've given people
the impression
you might not be coming back.
Well, who knows what the
future has in store for any of us?
Yeah, saying shit like
that right there isn't helping.
People are worried about you.
Dr. Abbot, the patient in South 21,
Digby, he's missing again.
Sounds like a day shift problem.
Not if he was handed off already.
Best I can do under the circumstances.
Thank you.
Hey, don't leave
before I get back, yeah?
Hell, I feel like I live here now.
Your friend fixing your bike?
Ambulance clipped it
while it was just parked here today.
Jesus Christ.
That's a sign if I've ever seen one.
[SIREN CHIRPS]
Yeah, here's the thing
when people worry about you,
it makes me think that
I should be worried about you,
and I don't like worrying about things.
Ooh. Now you're a shrink?
No, I'm trying to be your friend.
You got you got Dana convinced
that you're gonna hurt yourself.
- Dana's got her own issues.
- That sounds like projection.
Are you seriously trying
to have this fucking
conversation with me right now, man?
I I'm not the one
who spends his free time
getting shot at.
Hooah!
Hey, Dr. Robby,
this is Judith Lastrade
36 weeks pregnant
with two days of headache,
now a 10 out of 10 with blurred vision.
BP 174/120, heart rate 92.
- No relief with fentanyl.
- Judith, I'm Dr. Abbot.
Any weakness in your arms or legs?
No, no. Is this a stroke?
We need to check for everything.
Pitting edema with severe preeclampsia.
Where are you doing your prenatal care?
Nowhere.
It's a wild pregnancy.
I want a free birth.
This 81-year-old nun
presents with red, itchy eyes
with secretions for the past two days.
Patient complains of no URI symptoms,
- no contact with any chemical
- Hey.
Agents, no known exposures
Want half a Monster?
Oh, no, thanks.
I I don't really want to stay awake
any longer than I have to.
Yeah, I hear you.
Did you find your ID badge?
Uh, no.
You any closer to deciding
what's next for you?
Uh, yeah, I'm seriously
considering law school.
What? What are you talking about?
You're gonna be a great doctor.
I mean, no offense, but look
what this place does to you.
Langdon's an addict.
Is a person with
a substance use disorder.
McKay was on house arrest.
Dana's a time bomb.
Santos is one of the angriest people
you are ever going to meet.
Sarcastic, yes. Cynical, definitely.
I don't know if she's, you know
Mel?
Samira has no life.
Abbot's an adrenaline junkie
who gets shot at for fun.
Robby's got, like, PTSD
or something way fucking worse.
OK, well, I I mean,
I'd hate to know
what you think about me.
I don't know, I just
the more time I spend here,
the more I realize the importance
of my mental health.
Mm.
For patients and for us.
And this is
Yeah.
Well, you know,
maybe that's what you should focus on.
- What?
- Mental health.
Clearly, you have
a passion for it, right?
I mean, that's that's great.
I don't know if I'd call it a passion.
I would call it, like, a
Oh, my God.
You might be right.
Oh, you're a genius, Whitaker.
Oh, OK.
[LAUGHS]
CTG is on.
- CTG?
- Cardiotocography.
Measures the baby's heart rate
and checks for contractions.
Fetal heart rate 128.
Normal range, Nazely?
110 to 160.
So the baby's OK?
Right now, yes.
128 is reassuring.
BP's 170/119.
6 grams of magnesium running in.
Your next move, Crus?
20 of labetalol,
IV push over two minutes.
Uh, what's happening?
Uh, you have a condition
called preeclampsia.
And how did it happen?
Uh, nobody really knows, actually.
It affects about 10% of the pregnancies.
High blood pressure, headaches,
protein in the urine,
and swollen ankles.
OK, well, it's a wild pregnancy,
so that means no medical care.
Then why are you here?
[CRYING]
I just need to get rid of this headache.
Well, if we don't lower
your blood pressure
and treat with magnesium,
there can be problems.
Like what?
Seizures, bleeding,
even death, for you and the baby.
[CRYING] Oh, my God.
Robby, your VIP's ready to go.
OK, I'll be right there.
- You good?
- Yeah, I'm good.
I got it. With my eyes closed.
But I won't. Maybe one eye.
[CLICKS TONGUE]
Hey [DOOR CLOSES]
[MACHINES BEEPING]
Hey, Becca. How you feeling?
I'm better. Thanks.
Where are you?
I'm at Adam's house.
Can I call you later?
We're watching a movie.
Oh, sure. I just I thought
you were gonna see the fireworks.
Nope, we decided to watch "Elf" instead.
Ah.
- Of course you did.
- OK.
- I'll call you tomorrow!
- Tomorrow? Wait.
Uh, are are you spending the night?
Um, uh, yes.
His parents invited me.
They they need to ask me that.
Are are you staying here too?
No, they they needed to ask
if it was OK if you stayed.
Why?
Be because, uh, it's polite.
It's the right
it's the right thing to do.
Um, I need to talk to them.
Um, they're not here.
They're at a barbecue.
OK, um, can you have them call me
as soon as they get home?
- Yes.
- Can you promise?
I promise. OK, bye, Mel!
- [PHONE CHIMES]
- Bye. Have fun
Thanks for fixing my bike.
Well, you keep me running,
I'll keep her going.
You know, the Cree don't have
a word for goodbye.
You know a lot of Cree?
[CHUCKLES] A bit.
I got around, man.
I don't doubt it.
Look, I'll come back
for all this other shit
Great.
If you promise to come back
and let me take the Bonnie for a ride.
Uh, I don't know.
I've seen you ride, old man.
Fuck you.
I mean it.
We got a deal?
I'll think about it.
This looks like an ambush.
We got a slight hiccup in chairs.
ICE is back?
No, we got a dead body.
- Somebody died out there?
- Yeah.
Poor devil checked in
at 5:00 this morning.
- He was a DNR.
- [GROANS]
- What was his chief complaint?
- Hemorrhoids
- and constipation.
- No shit.
- Hence the constipation.
- [LAUGHS]
Throw me a slow one, I'm gonna hit it.
Tell the night shift.
I'm saying that's when he died.
We all in agreement on that?
To the grave.
Just like poor Jasper.
You're on fire.
Just getting my second wind.
How's the headache?
Still a 10.
More fentanyl?
- Yep.
- BP's good. Another 50.
Hey, Abbot.
Attending and resident
are stuck in the OR.
Oh, you're the next best thing.
Better, some would say.
Mm.
- What do you got?
- This is Judith.
G1, P0 with no prenatal care.
Preeclampsia with severe hypertension.
Hi, Judith. Nurse Garvin from OB.
Some jelly on the belly.
Gonna take a quick look with ultrasound.
No, no, no.
Ultrasound can harm the baby.
- Not true.
- Not doing the ultrasound
could end up harming you and the baby.
[SIGHS] OK.
Just do it as fast as you can.
Why no prenatal care, Judith?
I wanted a free birth
no doctors, no hospital, no medicine.
Mm. You have a midwife?
A birth doula?
No, I don't need one.
Women have been having
children on their own
for thousands of years.
Yeah, with an infant mortality rate
of 30% for most of those
thousands of years.
- Femur length 7 centimeters.
- 37 weeks.
They'll probably induce.
What? No.
No, no, no, no. Absolutely not.
At 37 weeks,
the cure for preeclampsia
is to deliver the baby.
We need to get you upstairs
so the OB doctors
can induce labor
to save you and your baby.
No. No, no, no, no. Mm-mm.
Yep, that's definitely Jasper.
He was alive and kicking
when my shift ended this morning.
This is definitely a day shift patient.
Now he's not a patient.
He's a DB that we gotta deal with.
[SIGHS]
Is this dude dead?
BOTH: Nope.
All right, Mr. Reed,
time to take you back
and get you checked out, OK?
- He sure looks dead.
- Are you a doctor?
- No, but he
- Has hypernarcolepsy.
- It's no joke.
- Mm-hmm.
- Excuse me.
- [CLEARS THROAT]
Oh, sometimes I hate nights.
- Yep.
- Oof.
[GRUNTS]
[FIREWORKS WHISTLING, POPPING]
Wow.
Crazy how muggy it still is out here.
You, uh you seen Robby?
Uh, not for a bit.
You catch up on your charts
from the beginning of the shift?
Yeah.
What are you still doing here?
Uh, just gonna
You staying for the fireworks?
Yeah.
I was supposed to see them with Becca,
but she is at her boyfriend Adam's
family's house instead.
Your sister seems like
she's, uh, pretty put-together.
Yeah.
Uh, a lot more than I realized.
How was your day?
I've had better.
You?
Yeah.
But then again, I've had a lot worse.
Hell, I did a closed cervical
reduction, like, an hour ago.
Oh, I heard.
That must have been so intense.
My hands are still shaking.
Hey, um, do you think you could teach me
how to do that sometime?
Uh, yeah.
- Yeah?
- Yeah, sure. I mean,
I hope you never have to use it.
I could have paralyzed that guy.
Yeah, but you didn't.
No, I didn't.
Thank you
by the way, for
talking me down earlier.
I'm sorry I snapped.
It's OK.
Dr. Mohan, you ever heard
of kinship fostering?
It's where a nurse or doctor can
- become an emergency foster
- Oh, no.
I don't need any kids.
I need to find a job first.
Candice O'Grady is an 82-year-old female
brought in by her son
for intractable vomiting.
No fever, no chills,
no abdominal pain, no rash.
Beep.
Oh, I've already got one
I can barely keep up with.
What about Sleeping Beauty over here?
She's already babysitting Whitaker.
Well, if you know anyone
who'd like to help us out
with Baby Jane Doe,
have them call the main desk.
Sure thing.
I'd take her myself,
but Benji'd kill me.
BP's 164/114.
Another 40 of labetalol.
Mag bolus is in.
Now infusing 2 grams an hour.
Labs are coming back.
Hemoglobin 7.5, platelets 40.
LFTs are sky high.
- HELLP syndrome.
- Hemolytic anemia,
elevated liver enzymes,
and low platelets.
They're cleaning a room.
We can bring her up in ten minutes.
How you doing, Judith?
I I
- [MACHINE BEEPING]
- Oh, she's seizing.
Oh, shit.
10 of IV diazepam.
Have another 10 ready.
With all the movement,
we can't get a fetal heartbeat.
Putting on 15 liters by mask.
Should we intubate?
Hold intubation.
Let's try to break this.
We don't want to mask seizures
with paralysis
unless we have to.
OK, um
[RAPID BEEPING]
Crus, CTG isn't reading.
- Check with ultrasound.
- On it.
Nazely, what's the diagnosis?
Um, with the seizure,
now it's eclampsia.
- Fetal heart rate is about 90.
- Way too low.
Mom's sats are going down.
Time to tube her?
Set up for it, but wait.
Another 10 of diazepam.
Push 4 grams of Keppra.
[BABY FUSSING]
History of hypertension
presents to the emergency department
with a chief complaint of dizziness
after inadvertently
ingesting 80 milligrams
Hey, how are you guys making out?
Yeah, we're getting there.
Have you seen Dr. Al-Hashimi?
- No.
- Can I talk to you for a sec?
So I just wanted
to let you know that I've been
checking out some
of your online posts
Look, I was just trying to help
get some health messages out there,
- especially for young people.
- I think they're great.
Really good.
- You do?
- Yeah.
Yeah, um, keep it up.
OK.
As long as you follow the HIPAA laws.
I do.
And wait until you're done charting.
[SCOFFS] Sure.
Actually, Dr. Robby sorry,
um, can I ask you a question?
Shoot.
Um, I I may be
considering emergency psychiatry.
Very cool.
Think I could do it?
I think that you could do
anything that you put
your mind to, Victoria.
OK.
Pulse ox is 88.
[RAPID BEEPING]
Dr. Abbot?
- Intubate?
- Let's do it.
Nazely, what do you suggest
for rapid sequence induction?
Etomidate and roc.
Mm, not quite.
120 of propofol,
60 of succinylcholine.
Why is that, Crus?
Propofol for the anti-seizure effect,
sux to avoid prolonged paralysis
- so we can check her neuro exam.
- Exactly.
Pushing the propofol.
Once she's flat for intubation,
we need to displace
the uterus to the left.
Nazely, that's you. Big hug, both arms.
- Get the baby off the vena cava.
- Sux is on board.
But after she's paralyzed,
the seizing stops, right?
It might look like that,
but an ongoing seizure
will still fry the brain.
We monitor with EEG.
- Is there time for that?
- Wait and see.
Paralytics kicked in.
Let's go. Roll her to her back.
Intubate, then EEG
to see if her brain is still seizing.
I need first pass success.
You and me both.
[MACHINERY BEEPING]
[INDISTINCT CHATTER]
[SIGHS] Have you seen Dr. Al-Hashimi?
No.
Have you seen Dr. Al-Hashimi?
Al-Hashimi?
With how this day's going,
she probably quit.
Last I saw her, she was
in Peds with Baby Jane Doe.
Nope, I was just in there.
Want me to page her?
Uh, no, that's OK.
I will find her.
Hello.
Hey, how did our people do
at the deposition?
Oh, well, Dr. Ellis is a pit bull.
Dr. King is a petunia.
They were pretty brutal with her.
- She's sensitive.
- Very.
And I'm afraid it isn't over.
They want to call her back.
Oh, that's unfortunate.
Maybe I should go with you
to break that news to her, actually.
- Misery loves company.
- Um, hey, while I have you,
can I pose a hypothetical to you?
If a doctor suspects another physician
of having a medical condition
that could negatively
affect the way they
would treat a patient,
where would disclosing that fall
on the HIPAA violation scale?
First, do no harm.
Dr. King, do you have a second?
Mm
Good lung sliding bilaterally.
Fetal heart rate borderline at 98.
Roll her to the left again.
That can help.
- One, two, three.
- [GRUNTS]
OK, all set here.
EEG monitor's good to go.
That was fast.
Still seizing while paralyzed.
It's nonconvulsive status.
What's she had so far?
30 of diazepam, a full load of mag,
Keppra, and propofol.
Damn. What's your next step?
Any ideas?
Hmm? Nazely?
Dilantin? Valproate?
Mm, infusion is too long.
So is onset of action.
Push 100 of ketamine.
That's had results
with refractory status.
She also has HELLP syndrome
hemoglobin only 7,
- platelets down to 30.
- Two units whole blood?
O-neg is going up on
the rapid infuser as we speak.
Uh, put the AP pads on, just in case.
And 10 of Decadron IV push
for the inflammatory storm.
- Fetal heart rate up to 104.
- Hmm.
- Little better.
- Yeah.
She should be upstairs with OB.
She will be after we break this seizure.
There was a delay in history-taking
due to a malfunctioning
VRI interpretation device.
During this time, there was a normal CBC
and comprehensive metabolic panel
that came back from the lab.
What's wrong with you, Malfeasance?
I have to do another deposition.
Oh, that sucks.
You must have really messed up.
[CHUCKLES]
Dude, I'm joking.
You gotta lighten up.
It's all just bullshit.
[SIGHS] God, you know what?
Fuck all this.
Do you want to go get a drink?
Me?
Yes, you.
You you do go out, don't you?
Well, I'm usually with Becca.
Well, bring her along.
Can she drive?
No, and she's with her boyfriend.
OK, Becca.
So it's just you and me.
Do you like karaoke?
You do karaoke?
Well, what I do is more like
primal scream therapy.
There's nothing like getting wasted
and just absolutely wailing
to shake off a shit show like today.
I could use a fun night.
You and me both, sister.
There's been no improvement.
Still seizing on the EEG.
- Neurology has been called.
- OK. Got it.
OB says send her up.
They have an OR ready.
About time.
Baby's been bradying down a bit more.
This one looks like
it took a turn for the worse.
Eclampsia, refractory seizures,
HELLP syndrome with anemia
and thrombocytopenia.
Yeah, about as bad as it gets.
- [ALARM BLARING]
- V-fib!
Chest compressions, Nazely.
Charge to 200.
Prep the belly.
Get a baby warmer.
Call the NICU. Start a timer.
Charged.
Clear.
[TENSE MUSIC]
Continue compressions.
We'll check a rhythm in a minute.
Gown up.
Robby, it's you and me.
Nazely, what's the four-minute rule?
Uh, not sure.
Pregnant patient with a viable fetus,
you have four minutes
after cardiac arrest
- to save the baby.
- And the mom.
We don't call it a postmortem
C-section anymore.
It's a resuscitative hysterotomy
to try to save them both.
But she doesn't want
any medical intervention.
That doesn't matter.
Mom and baby are both dead
if we do nothing.
OK, charge to 200.
One more rhythm check and then
Abbot and I are gonna cut.
Ellis, you and Crus
on Mom resuscitation.
Shen, you and Nazely take the baby.
OK, hold compressions.
♪
Still V-fib.
Clear.
- [THUD]
- No change.
- Resume compression, amp of epi.
- OK, showtime.
We need to get this baby out right now.
OK, take a break.
OK, 10 blade. Good.
First incision is from the xiphoid
to the pubic symphysis
through the skin to the linea alba.
Units three and four on the infuser.
Second incision goes
through the peritoneum,
exposing the uterus.
Where do you need me?
You're with the baby.
Nazely's got the bag mask.
You're on suction.
Stand by for intubation.
Bladder retractors.
Neonatal monitor
and pulse ox ready to go.
Ellis, gentle traction.
OK, making a small vertical incision
through the lower uterus
so as not to cut the baby.
Mm-hmm.
- Got it?
- Yep, I got it.
- OK.
- OK.
Using scissors to extend superiorly.
♪
Ellis, hand retract the uterus with me.
Amniotic fluid looks good.
♪
Give me some fundal pressure.
Breech position.
♪
OK, baby's out.
- It's a girl.
- All right.
♪
Milking the cord.
Clamping.
Cutting.
OK, blue and flaccid.
Coming to you, Shen.
- You ready?
- Yeah, you got her.
I got it, yep.
OK.
[RAPID BEEPING]
Poor tone, no movement.
Keep the blow-by closer.
She's really blue.
Some blue is normal, but not this much.
- Do we need to intubate?
- Not yet, no.
They usually pink up
with stimulation and blow-by.
OK, removing the placenta.
Sweeping to the left,
trying to get it in one piece.
♪
- Looks intact.
- Yeah.
Nicely done.
10 of IV Pitocin to contract the uterus.
And lots of massage.
Heart rate 76.
Less than 100 means we need to bag.
Suction first.
OK.
♪
Hey, Jord, charge to 200.
Stand by for the next rhythm check.
She grimaced. Good sign.
Bagging.
Pulse ox 45%.
Oh, I've never seen it that low.
It's not as bad as it sounds.
I'm more worried about the heart rate.
McKay, get ready with an IO
in case we need epi.
OK.
[WHIRRING]
Rhythm check. Hold compressions.
Still V-fib.
- OK, shock it.
- Clear.
[THUD]
Resume compressions.
Shen, how's she doing over there?
Heart rate's up to 104.
Uh, at one minute,
she's 0 for color, 2 for heart rate,
1 for reflex, tone, breathing.
APGAR of 5.
5 out of 10. Not great.
Pulse ox 58%.
- Intubation?
- Uh, not yet.
O2 sat in the 60s is normal
at one minute.
Her heart rate and pulse ox
are trending higher.
Let's keep doing what we're doing.
A little tincture of time.
Hold compressions.
Looks like sinus.
Can't feel a carotid.
No.
Heart's barely pumping. It's PEA.
Back on compressions.
Transfuse two more units.
She needs more red cells and platelets.
Ongoing blood loss from the uterus.
Give me all the lap pads we got, please.
[RAPID BEEPING]
♪
Yeah.
OK, yeah, thanks.
I appreciate it, honey.
Oh, gotta go.
Whoa, whoa, whoa!
Hold up.
Is there a problem here?
Yeah, you two aren't leaving
empty-handed.
What?
One of you follow me.
Rape kits are supposed to be picked up
within 72 hours of collecting 'em.
This one's been here for over two weeks.
That's not on us.
Well, it's on somebody.
It's not bad enough these poor women
go through an assault,
plus the indignity
of the whole collection process,
but nobody from the police department
even has the human decency
to come get these things?
Like nobody there gives a flying fuck?
OK, we got it.
We'll see that these get
put into evidence properly.
Thank you.
How hard was that?
[RAPID BEEPING]
Units five and six are in.
Down to a slow ooze here.
Hold compressions.
[MACHINERY BEEPING]
Looks like sinus.
- And I got a weak carotid.
- OK.
Cycle the BP.
Better filling, better squeeze.
No seizure activity on the EEG.
That's progress. That's progress.
We're at five minutes.
Uh, heart rate is 132.
Uh, pulse ox 79%.
Nazely, the APGAR?
Um
1 off for color, 1 off for tone,
1 off for respiration
with hypoxia, total of 7.
Respiration score is
for observed breathing,
not pulse ox.
Sat of 80 is normal at five minutes.
With no crying, she still gets 1 off.
Yeah.
- [BABY CRYING]
- Ah!
She just scored the winning point!
APGAR of 8 is pretty normal.
Holy shit. What did I miss?
Eclampsia with status, HELLP syndrome,
cardiac arrest,
resuscitative hysterotomy.
I was in the OR
with a septic twin C-section.
Got your text 12 minutes ago.
Shit happens fast down here.
Resuscitative hysterotomy in 36 seconds.
- Impressive.
- BP's 102/64.
Hemoglobin is up to 9.
That'll do.
NICU's sending a team down.
We can take Mom.
You guys are rock stars.
We like to be referred to
as crawlers of the night.
[SIGHS]
If you're not careful,
you're gonna get stuck here all night.
Nah, Henny said she'd
be here in 30 minutes.
- How's Mom and baby?
- Whew.
They're both gonna go upstairs.
Good. You leaving now?
Yeah, pretty soon.
I gotta find Whitaker,
I gotta find Al-Hashimi,
and I gotta find Langdon before I leave.
You missed Langdon. He just checked out.
[SIGHS] Shit.
Can I help you?
Uh, yeah, I'm Dr. Langdon from the ED.
I was just, uh,
checking in on the status
of someone we sent up here earlier.
Patient's name is, uh, Cohen.
Let me check.
What was she up here for?
Uh, clean out a nasty neck fash.
[KEYS CLACKING]
Oh, yeah, she's good.
She's in 4202, recovering nicely.
Great, great.
I mean, she was she was
in not-great shape earlier.
It was a good catch.
Saved her life, even if
we couldn't save her leg.
Uh, was it below the knee?
Unfortunately, it was above.
My cell phone
and the building manager's.
He can help if there's any emergencies.
Yeah, what kind of emergencies?
Whatever.
And follow up with Duke
in a couple days, yeah?
Yeah.
You, um you sure about this?
I trust you, Whitaker.
Great.
Any questions?
Uh, when are you back, exactly?
You know, I'll text you.
I'm trying to keep my dates
kind of fluid.
I think this is your ride.
Yeah, uh, yes.
I I promise I'll check in
on your house tomorrow.
Sounds good.
- Hey.
- Hey.
OK. Hey, Theo.
You're up late, huh?
What you got there? [CHUCKLES]
OK.
He's been fussy all day.
I think he's got
another tooth coming in.
Aw, right on, big guy.
Are you ready to get funky?
- Yeah?
- [CHUCKLES]
Ain't we funkin' now ♪
[THE BROTHERS JOHNSON'S
"AIN'T WE FUNKIN' NOW"]
Ain't we funkin' now ♪
♪
Hey.
Any luck picking an elective?
Don't know. [SIGHS]
Maybe I will go into geriatrics.
It's a smart choice.
I know that life can be challenging,
especially when it doesn't work out
the way you expected.
OK.
I thought I would be married
with two kids in college by now.
Maybe have some property with a pond,
and we could play hockey on it
in the wintertime.
[SIREN WAILING]
And yet look at me now.
No wife, no kids, no pond.
It's never too late.
Do you really believe that?
Yeah.
Only for me, or for you too?
OK. [SIREN CHIRPS]
I see what you did there.
Was that true, or something
you just said to make a point?
[VEHICLE DOOR OPENS]
Have you worked things out
with your mom?
We're not talking.
I am sorry that, um,
I let it distract me.
She was treating me like a child,
and I was letting her.
Have a good trip.
Please be safe.
We need you here.
Even if you can be a dick sometimes.
Good luck.
You too.
[LOUD BANG]
[CAR ALARM BLARING]
Hey, I didn't think you were still here.
I was just talking
to the neurologist on call.
And?
We had a nice chat.
She agrees I can work
with double coverage.
That's not her call to make.
You can't do anything critical
where a five-second lapse
in consciousness
could potentially kill a patient.
I agree.
[SIGHS]
But 90% of our patients
don't require critical procedures.
And the ones that do?
Will be handled by
whomever is working with me.
Unless they're also tied up
with a critical patient.
What if it's a double or triple trauma?
- Robby, I can handle it.
- No, you can't.
And I can't let you.
I am fully capable of handling
No, you are not fully capable,
and you know it.
What do you want from me?
I want what's best
for this department
patients and staff.
Best-case scenario,
you get a handle on this,
you're seizure-free for six months,
you get your driver's license back,
you are cleared to work.
I am cleared for my driver's license.
You shouldn't be driving
at all like this.
If you were a patient,
we would have to report you.
I am not your fucking patient.
No, but I cannot let you work
in my emergency department
until you're fully capable of doing so.
That is not your fucking call!
You're fucking-A right, that's my call!
I'm trying to protect you
and my patients,
and you know I'm right about this.
Oh, "my department," "my patients."
All you fucking think about is yourself!
Do you hear yourself?
You didn't rat out Langdon
for stealing fucking drugs.
No, but I kicked him
out of this department
until he got the appropriate
help that he needs,
and the same goes for you.
You've got until Monday
to let the administration know,
or I will.
[BELL DINGING]
I am finished.
Last chart.
[BELL DINGS]
- You and me both.
- Really?
Is this a thing? I finished a while ago.
[BELL DINGS]
I never want to hear
that fucking bell again.
- Where's Dana?
- Not sure.
A bunch of day shift
just headed to the roof
to watch the fireworks.
You want me to call her?
No, that's OK.
Yo.
Thanks for your help in there.
- Almost out?
- Yep, just about.
Is this where you try
to talk me out of going?
Me?
No, not a chance.
Why, are you having second thoughts?
- Nope.
- No?
Nope.
Don't have to convince me.
I mean, it is a little strange
the only place
you talked about going is somewhere
they used to drive buffalo
off a cliff to die.
- Here it comes.
- I looked it up,
and as far as summer vacations go,
it's not exactly a holiday hotspot.
I mean, what's in
the fucking gift shop, man?
It's just one place I'm going.
As long as it's not the last.
Don't be pulling a "Thelma
and Louise" out there.
I am minutes from taking
a three-month vacation.
When's the last time
you took any time off, Jack?
Yeah, but I've dealt with my demons.
It's a process.
You want to know why
I never killed myself?
After what I saw, lived through?
Losing my leg, losing my wife?
Because it comes for all of us, man.
You and I know it more than most.
We see it every shift,
but we can't let ourselves
succumb to it.
Yes, life can suck.
It can be unbearable
and and brutal
and ugly and heartbreaking.
But it's also beautiful
and hilarious.
And that woman today
Her baby, they'd both be in the morgue
if you hadn't been here.
That's us. That's you and me.
That's what we're here for.
The most important things
I've ever done in my life
have been in this hospital.
Nothing will ever matter more
than what I've done
in this hospital, but it is killing me.
You know how they say
that a part of you dies
when you lose someone you love?
I'm not convinced that
a part of you doesn't die
every time you see a fellow human pass.
And I've seen so many people die
that I feel like it's leaching
something from my soul.
Go on a cruise, man.
Knock off this
helmetless motorcycle shit.
Yeah, people talk.
That's death-wish behavior.
I'm tired of being a role model.
I'm tired of feeling
like you can't get ahead.
I'm tired of feeling
like I'm drowning every day.
I'm tired of all of it.
You need to get away for a while,
and you need to get some help.
You need this place
as much as it needs you.
[BREATHES DEEPLY]
Am I fucked up?
100%.
But nobody works here
as long as you and me
and doesn't get screwed up.
You you gotta find somebody
to help you dance through the darkness.
[BREATHES DEEPLY]
Did you just make that up?
- Maybe it's a song lyric.
- [LAUGHS]
I don't maybe my therapist said it.
I don't know.
[SIGHS]
Some dude just pulled up.
Looks like he blew half his face off.
How can you not love this place?
Look, don't make me look stupid.
You come back to us in one piece.
I'm still your emergency contact,
and I do not want to be contacted.
All right, night crawlers,
what the hell's going on out here?
[INDISTINCT CHATTER]
25-year-old man
[INDISTINCT] history,
no meds, no allergies.
[CONTINUES SPEAKING INDISTINCTLY]
[LOCK CHIRPS]
[ENGINE STARTS]
[CHIMING]
[SOBBING]
More than 2,000 years ago,
the Chinese were throwing
bamboo into fire
to make explosions.
They went on to invent gunpowder.
And boom! The rest is history.
They had chemicals to get
the different colors, you know?
Sodium gives you yellow,
strontium gives you red,
and barium is green.
Who knew chemistry could be
so damn pretty?
[BOOMING]
[CHATTER, LAUGHTER]
[FIREWORKS POPPING]
["AMERICA THE BEAUTIFUL" PLAYING]
♪
- Hey.
- Hey.
- I thought you'd left already.
- On my way out.
Hey, I'm sorry that
I didn't find the time today
to have that conversation.
Yeah, that's all right.
Seems like you didn't really want to.
I didn't. [SIGHS]
Did you?
Uh
yeah, actually.
Look, I'm doing the work.
I'm I've been sober 186 days.
I'm going to meetings.
I'm taking the drug tests.
- That's good.
- And you're still riding me.
What would have happened
if I'd paralyzed that guy?
I don't know.
What would have happened
if I hadn't been here today?
You'd still be questioning yourself.
Now you know you can do it.
You're welcome.
Oh, so that's
that's how you teach now?
Sometimes.
You know who I saw in rehab?
I saw a bunch of guys just like you.
The only difference is,
they've accepted that they need help.
I think you're afraid to admit that
the mighty Dr. Robinavitch
isn't perfect.
Oh, I never claimed to be perfect.
No, but you expect it of yourself,
and it's not realistic, man.
How can any of us live up
to your standards
if you can't even do it?
You need help, Robby.
You need help.
[BABY CRYING]
Finished?
You don't gotta be honest with me, man.
At least be honest with yourself.
[BABY CRYING]
She is due for a new bottle.
I was hoping to get her some
formula before I clocked out.
I'll stay with her.
Thanks.
Why are you will you hit
those lights on your way out?
- Yep.
- Why are you crying?
Why are you crying, little one?
You're OK. You're safe.
Yeah, you're not alone.
[BABY CRYING]
Yeah, you're OK.
Do you need to be swaddled again?
Is that it?
I can do that. Look.
Aww.
I wish somebody would swaddle me.
Yes, I do.
Oh.
[ROSIE CARNEY'S "THOUSAND"]
You got off to kind of a rough start,
didn't you, little one?
Yeah, you did.
She is left stuck on her own ♪
Well, that makes two of us.
Dust grows ♪
[SIGHS]
I got abandoned too.
Can't move, can't grow ♪
When I was eight.
When you've fallen
on your knees ♪
But I got through
all of that, and so will you.
I got a good feeling that
you're gonna be just fine.
Everything's gonna be just fine.
You got so many wonderful things to see
and so many people to love ahead of you.
♪
So many wonderful things to see,
people to love ahead of you.
To show they really care ♪
Love, please surround me ♪
- [BABY FUSSING]
- Shh.
It's OK. It's gonna be OK.
It's OK.
But a thousand more to live ♪
Will it be this way tomorrow ♪
I don't know ♪
But I won't fade ♪
BOTH: I want you to know ♪
That I'm happy for you ♪
I wish nothing but ♪
The best for you both ♪
An older version of me ♪
Is she perverted like me ♪
Would she go down on you
in a theater ♪
Does she speak eloquently ♪
And would she have your baby ♪
I'm sure she'd make
a really excellent mother ♪
'Cause the love that you gave
that we made ♪
Wasn't able to make it enough ♪
For you to be open wide ♪
No ♪
And every time you speak her name ♪
Does she know how you told me ♪
You'd hold me until you died ♪
Till you died,
but you're still alive ♪
And I'm here to remind you ♪
Of the mess that you left ♪
When you went away ♪
It's not fair to deny me ♪
Of the cross I bear
that you gave to me ♪
You, you, you oughta know ♪
[ALANIS MORISSETTE'S
"YOU OUGHTA KNOW" PLAYING]
♪
Baran, is this you?
It began after a bad case
of viral meningitis
when I was five.
They tried every
anti-seizure medication,
but I still had episodes
every few months or so.
No one's ever noticed before.
They just think I'm thoughtful.
Are you driving?
I couldn't until laser ablation
to my left temporal lobe 12 years ago.
Between that and the Keppra,
I've been seizure-free,
cleared by Neurology to drive
and to work as an attending.
How long, uh, between the seizure
you had today and the last one?
It's been well over a year.
But I had two today.
I don't know why.
It could be sleep deprivation,
new job stress.
I I haven't had to deal
with Peds cases
since Afghanistan.
What are your options now?
Um
up my Keppra or maybe try
one of the newer anti-seizure meds.
But if that doesn't work,
I'm left with two choices
um, a temporal lobectomy,
which could impair my speech,
or get a neuromodulation device,
which can sense and stop the seizures
almost immediately.
You need to disclose this.
I know. I have a plan.
Hey, Robby, Dana's looking for you.
She's in Peds.
Yeah, OK, I'll be right there.
[DOOR CLOSES]
Sounds like you're needed in Peds,
and I have patients to see.
Robby, pregnant woman
with severe headache
on her way in by ambulance.
Find Abbot or a night shift resident.
[INDISTINCT CHATTER]
Need you to turn out your pockets.
OK. Show me your hands.
[SIGHS]
[URINE TRICKLING]
Come here often?
[BABY CRYING]
[CLEARS THROAT]
What's going on?
Oh, sorry false alarm.
We thought she spiked a fever,
but it was the wrong chart
from our analog hell.
You know anybody who might
consider kinship adoption?
Doctors and nurses qualify.
Don't look at me.
Hey, can your staff
keep an eye on Dr. Al-Hashimi
until she leaves?
Why?
Uh, because I think she's tired,
and I don't want her
to make any mistakes.
Oh, great advice.
Maybe you should take it.
Yeah. I'm gonna go get some fresh air.
Grab some for me while you're out there.
Your lungs wouldn't know
what to do with it.
Screw you!
In front of the baby? Nice.
[BABY CRYING]
Yeah.
We are the night crawlers.
We deal with the weirdest
and the wildest because
ALL: We are the weirdest
and the wildest of them all.
That is right, and tonight,
they are really gonna be crawling.
Now go get some!
ALL: Hooah!
[CLAPS]
[CLEARS THROAT]
Sorry to wake you.
I I was thinking.
[YAWNS] Doubt PTX.
You're supposed to be leaving.
I am.
You know, this spirit quest of yours
has a lot of people
up in arms around here.
Everyone's gonna be fine without me,
and it's hardly a spirit quest.
Whatever it is,
it seems you've given people
the impression
you might not be coming back.
Well, who knows what the
future has in store for any of us?
Yeah, saying shit like
that right there isn't helping.
People are worried about you.
Dr. Abbot, the patient in South 21,
Digby, he's missing again.
Sounds like a day shift problem.
Not if he was handed off already.
Best I can do under the circumstances.
Thank you.
Hey, don't leave
before I get back, yeah?
Hell, I feel like I live here now.
Your friend fixing your bike?
Ambulance clipped it
while it was just parked here today.
Jesus Christ.
That's a sign if I've ever seen one.
[SIREN CHIRPS]
Yeah, here's the thing
when people worry about you,
it makes me think that
I should be worried about you,
and I don't like worrying about things.
Ooh. Now you're a shrink?
No, I'm trying to be your friend.
You got you got Dana convinced
that you're gonna hurt yourself.
- Dana's got her own issues.
- That sounds like projection.
Are you seriously trying
to have this fucking
conversation with me right now, man?
I I'm not the one
who spends his free time
getting shot at.
Hooah!
Hey, Dr. Robby,
this is Judith Lastrade
36 weeks pregnant
with two days of headache,
now a 10 out of 10 with blurred vision.
BP 174/120, heart rate 92.
- No relief with fentanyl.
- Judith, I'm Dr. Abbot.
Any weakness in your arms or legs?
No, no. Is this a stroke?
We need to check for everything.
Pitting edema with severe preeclampsia.
Where are you doing your prenatal care?
Nowhere.
It's a wild pregnancy.
I want a free birth.
This 81-year-old nun
presents with red, itchy eyes
with secretions for the past two days.
Patient complains of no URI symptoms,
- no contact with any chemical
- Hey.
Agents, no known exposures
Want half a Monster?
Oh, no, thanks.
I I don't really want to stay awake
any longer than I have to.
Yeah, I hear you.
Did you find your ID badge?
Uh, no.
You any closer to deciding
what's next for you?
Uh, yeah, I'm seriously
considering law school.
What? What are you talking about?
You're gonna be a great doctor.
I mean, no offense, but look
what this place does to you.
Langdon's an addict.
Is a person with
a substance use disorder.
McKay was on house arrest.
Dana's a time bomb.
Santos is one of the angriest people
you are ever going to meet.
Sarcastic, yes. Cynical, definitely.
I don't know if she's, you know
Mel?
Samira has no life.
Abbot's an adrenaline junkie
who gets shot at for fun.
Robby's got, like, PTSD
or something way fucking worse.
OK, well, I I mean,
I'd hate to know
what you think about me.
I don't know, I just
the more time I spend here,
the more I realize the importance
of my mental health.
Mm.
For patients and for us.
And this is
Yeah.
Well, you know,
maybe that's what you should focus on.
- What?
- Mental health.
Clearly, you have
a passion for it, right?
I mean, that's that's great.
I don't know if I'd call it a passion.
I would call it, like, a
Oh, my God.
You might be right.
Oh, you're a genius, Whitaker.
Oh, OK.
[LAUGHS]
CTG is on.
- CTG?
- Cardiotocography.
Measures the baby's heart rate
and checks for contractions.
Fetal heart rate 128.
Normal range, Nazely?
110 to 160.
So the baby's OK?
Right now, yes.
128 is reassuring.
BP's 170/119.
6 grams of magnesium running in.
Your next move, Crus?
20 of labetalol,
IV push over two minutes.
Uh, what's happening?
Uh, you have a condition
called preeclampsia.
And how did it happen?
Uh, nobody really knows, actually.
It affects about 10% of the pregnancies.
High blood pressure, headaches,
protein in the urine,
and swollen ankles.
OK, well, it's a wild pregnancy,
so that means no medical care.
Then why are you here?
[CRYING]
I just need to get rid of this headache.
Well, if we don't lower
your blood pressure
and treat with magnesium,
there can be problems.
Like what?
Seizures, bleeding,
even death, for you and the baby.
[CRYING] Oh, my God.
Robby, your VIP's ready to go.
OK, I'll be right there.
- You good?
- Yeah, I'm good.
I got it. With my eyes closed.
But I won't. Maybe one eye.
[CLICKS TONGUE]
Hey [DOOR CLOSES]
[MACHINES BEEPING]
Hey, Becca. How you feeling?
I'm better. Thanks.
Where are you?
I'm at Adam's house.
Can I call you later?
We're watching a movie.
Oh, sure. I just I thought
you were gonna see the fireworks.
Nope, we decided to watch "Elf" instead.
Ah.
- Of course you did.
- OK.
- I'll call you tomorrow!
- Tomorrow? Wait.
Uh, are are you spending the night?
Um, uh, yes.
His parents invited me.
They they need to ask me that.
Are are you staying here too?
No, they they needed to ask
if it was OK if you stayed.
Why?
Be because, uh, it's polite.
It's the right
it's the right thing to do.
Um, I need to talk to them.
Um, they're not here.
They're at a barbecue.
OK, um, can you have them call me
as soon as they get home?
- Yes.
- Can you promise?
I promise. OK, bye, Mel!
- [PHONE CHIMES]
- Bye. Have fun
Thanks for fixing my bike.
Well, you keep me running,
I'll keep her going.
You know, the Cree don't have
a word for goodbye.
You know a lot of Cree?
[CHUCKLES] A bit.
I got around, man.
I don't doubt it.
Look, I'll come back
for all this other shit
Great.
If you promise to come back
and let me take the Bonnie for a ride.
Uh, I don't know.
I've seen you ride, old man.
Fuck you.
I mean it.
We got a deal?
I'll think about it.
This looks like an ambush.
We got a slight hiccup in chairs.
ICE is back?
No, we got a dead body.
- Somebody died out there?
- Yeah.
Poor devil checked in
at 5:00 this morning.
- He was a DNR.
- [GROANS]
- What was his chief complaint?
- Hemorrhoids
- and constipation.
- No shit.
- Hence the constipation.
- [LAUGHS]
Throw me a slow one, I'm gonna hit it.
Tell the night shift.
I'm saying that's when he died.
We all in agreement on that?
To the grave.
Just like poor Jasper.
You're on fire.
Just getting my second wind.
How's the headache?
Still a 10.
More fentanyl?
- Yep.
- BP's good. Another 50.
Hey, Abbot.
Attending and resident
are stuck in the OR.
Oh, you're the next best thing.
Better, some would say.
Mm.
- What do you got?
- This is Judith.
G1, P0 with no prenatal care.
Preeclampsia with severe hypertension.
Hi, Judith. Nurse Garvin from OB.
Some jelly on the belly.
Gonna take a quick look with ultrasound.
No, no, no.
Ultrasound can harm the baby.
- Not true.
- Not doing the ultrasound
could end up harming you and the baby.
[SIGHS] OK.
Just do it as fast as you can.
Why no prenatal care, Judith?
I wanted a free birth
no doctors, no hospital, no medicine.
Mm. You have a midwife?
A birth doula?
No, I don't need one.
Women have been having
children on their own
for thousands of years.
Yeah, with an infant mortality rate
of 30% for most of those
thousands of years.
- Femur length 7 centimeters.
- 37 weeks.
They'll probably induce.
What? No.
No, no, no, no. Absolutely not.
At 37 weeks,
the cure for preeclampsia
is to deliver the baby.
We need to get you upstairs
so the OB doctors
can induce labor
to save you and your baby.
No. No, no, no, no. Mm-mm.
Yep, that's definitely Jasper.
He was alive and kicking
when my shift ended this morning.
This is definitely a day shift patient.
Now he's not a patient.
He's a DB that we gotta deal with.
[SIGHS]
Is this dude dead?
BOTH: Nope.
All right, Mr. Reed,
time to take you back
and get you checked out, OK?
- He sure looks dead.
- Are you a doctor?
- No, but he
- Has hypernarcolepsy.
- It's no joke.
- Mm-hmm.
- Excuse me.
- [CLEARS THROAT]
Oh, sometimes I hate nights.
- Yep.
- Oof.
[GRUNTS]
[FIREWORKS WHISTLING, POPPING]
Wow.
Crazy how muggy it still is out here.
You, uh you seen Robby?
Uh, not for a bit.
You catch up on your charts
from the beginning of the shift?
Yeah.
What are you still doing here?
Uh, just gonna
You staying for the fireworks?
Yeah.
I was supposed to see them with Becca,
but she is at her boyfriend Adam's
family's house instead.
Your sister seems like
she's, uh, pretty put-together.
Yeah.
Uh, a lot more than I realized.
How was your day?
I've had better.
You?
Yeah.
But then again, I've had a lot worse.
Hell, I did a closed cervical
reduction, like, an hour ago.
Oh, I heard.
That must have been so intense.
My hands are still shaking.
Hey, um, do you think you could teach me
how to do that sometime?
Uh, yeah.
- Yeah?
- Yeah, sure. I mean,
I hope you never have to use it.
I could have paralyzed that guy.
Yeah, but you didn't.
No, I didn't.
Thank you
by the way, for
talking me down earlier.
I'm sorry I snapped.
It's OK.
Dr. Mohan, you ever heard
of kinship fostering?
It's where a nurse or doctor can
- become an emergency foster
- Oh, no.
I don't need any kids.
I need to find a job first.
Candice O'Grady is an 82-year-old female
brought in by her son
for intractable vomiting.
No fever, no chills,
no abdominal pain, no rash.
Beep.
Oh, I've already got one
I can barely keep up with.
What about Sleeping Beauty over here?
She's already babysitting Whitaker.
Well, if you know anyone
who'd like to help us out
with Baby Jane Doe,
have them call the main desk.
Sure thing.
I'd take her myself,
but Benji'd kill me.
BP's 164/114.
Another 40 of labetalol.
Mag bolus is in.
Now infusing 2 grams an hour.
Labs are coming back.
Hemoglobin 7.5, platelets 40.
LFTs are sky high.
- HELLP syndrome.
- Hemolytic anemia,
elevated liver enzymes,
and low platelets.
They're cleaning a room.
We can bring her up in ten minutes.
How you doing, Judith?
I I
- [MACHINE BEEPING]
- Oh, she's seizing.
Oh, shit.
10 of IV diazepam.
Have another 10 ready.
With all the movement,
we can't get a fetal heartbeat.
Putting on 15 liters by mask.
Should we intubate?
Hold intubation.
Let's try to break this.
We don't want to mask seizures
with paralysis
unless we have to.
OK, um
[RAPID BEEPING]
Crus, CTG isn't reading.
- Check with ultrasound.
- On it.
Nazely, what's the diagnosis?
Um, with the seizure,
now it's eclampsia.
- Fetal heart rate is about 90.
- Way too low.
Mom's sats are going down.
Time to tube her?
Set up for it, but wait.
Another 10 of diazepam.
Push 4 grams of Keppra.
[BABY FUSSING]
History of hypertension
presents to the emergency department
with a chief complaint of dizziness
after inadvertently
ingesting 80 milligrams
Hey, how are you guys making out?
Yeah, we're getting there.
Have you seen Dr. Al-Hashimi?
- No.
- Can I talk to you for a sec?
So I just wanted
to let you know that I've been
checking out some
of your online posts
Look, I was just trying to help
get some health messages out there,
- especially for young people.
- I think they're great.
Really good.
- You do?
- Yeah.
Yeah, um, keep it up.
OK.
As long as you follow the HIPAA laws.
I do.
And wait until you're done charting.
[SCOFFS] Sure.
Actually, Dr. Robby sorry,
um, can I ask you a question?
Shoot.
Um, I I may be
considering emergency psychiatry.
Very cool.
Think I could do it?
I think that you could do
anything that you put
your mind to, Victoria.
OK.
Pulse ox is 88.
[RAPID BEEPING]
Dr. Abbot?
- Intubate?
- Let's do it.
Nazely, what do you suggest
for rapid sequence induction?
Etomidate and roc.
Mm, not quite.
120 of propofol,
60 of succinylcholine.
Why is that, Crus?
Propofol for the anti-seizure effect,
sux to avoid prolonged paralysis
- so we can check her neuro exam.
- Exactly.
Pushing the propofol.
Once she's flat for intubation,
we need to displace
the uterus to the left.
Nazely, that's you. Big hug, both arms.
- Get the baby off the vena cava.
- Sux is on board.
But after she's paralyzed,
the seizing stops, right?
It might look like that,
but an ongoing seizure
will still fry the brain.
We monitor with EEG.
- Is there time for that?
- Wait and see.
Paralytics kicked in.
Let's go. Roll her to her back.
Intubate, then EEG
to see if her brain is still seizing.
I need first pass success.
You and me both.
[MACHINERY BEEPING]
[INDISTINCT CHATTER]
[SIGHS] Have you seen Dr. Al-Hashimi?
No.
Have you seen Dr. Al-Hashimi?
Al-Hashimi?
With how this day's going,
she probably quit.
Last I saw her, she was
in Peds with Baby Jane Doe.
Nope, I was just in there.
Want me to page her?
Uh, no, that's OK.
I will find her.
Hello.
Hey, how did our people do
at the deposition?
Oh, well, Dr. Ellis is a pit bull.
Dr. King is a petunia.
They were pretty brutal with her.
- She's sensitive.
- Very.
And I'm afraid it isn't over.
They want to call her back.
Oh, that's unfortunate.
Maybe I should go with you
to break that news to her, actually.
- Misery loves company.
- Um, hey, while I have you,
can I pose a hypothetical to you?
If a doctor suspects another physician
of having a medical condition
that could negatively
affect the way they
would treat a patient,
where would disclosing that fall
on the HIPAA violation scale?
First, do no harm.
Dr. King, do you have a second?
Mm
Good lung sliding bilaterally.
Fetal heart rate borderline at 98.
Roll her to the left again.
That can help.
- One, two, three.
- [GRUNTS]
OK, all set here.
EEG monitor's good to go.
That was fast.
Still seizing while paralyzed.
It's nonconvulsive status.
What's she had so far?
30 of diazepam, a full load of mag,
Keppra, and propofol.
Damn. What's your next step?
Any ideas?
Hmm? Nazely?
Dilantin? Valproate?
Mm, infusion is too long.
So is onset of action.
Push 100 of ketamine.
That's had results
with refractory status.
She also has HELLP syndrome
hemoglobin only 7,
- platelets down to 30.
- Two units whole blood?
O-neg is going up on
the rapid infuser as we speak.
Uh, put the AP pads on, just in case.
And 10 of Decadron IV push
for the inflammatory storm.
- Fetal heart rate up to 104.
- Hmm.
- Little better.
- Yeah.
She should be upstairs with OB.
She will be after we break this seizure.
There was a delay in history-taking
due to a malfunctioning
VRI interpretation device.
During this time, there was a normal CBC
and comprehensive metabolic panel
that came back from the lab.
What's wrong with you, Malfeasance?
I have to do another deposition.
Oh, that sucks.
You must have really messed up.
[CHUCKLES]
Dude, I'm joking.
You gotta lighten up.
It's all just bullshit.
[SIGHS] God, you know what?
Fuck all this.
Do you want to go get a drink?
Me?
Yes, you.
You you do go out, don't you?
Well, I'm usually with Becca.
Well, bring her along.
Can she drive?
No, and she's with her boyfriend.
OK, Becca.
So it's just you and me.
Do you like karaoke?
You do karaoke?
Well, what I do is more like
primal scream therapy.
There's nothing like getting wasted
and just absolutely wailing
to shake off a shit show like today.
I could use a fun night.
You and me both, sister.
There's been no improvement.
Still seizing on the EEG.
- Neurology has been called.
- OK. Got it.
OB says send her up.
They have an OR ready.
About time.
Baby's been bradying down a bit more.
This one looks like
it took a turn for the worse.
Eclampsia, refractory seizures,
HELLP syndrome with anemia
and thrombocytopenia.
Yeah, about as bad as it gets.
- [ALARM BLARING]
- V-fib!
Chest compressions, Nazely.
Charge to 200.
Prep the belly.
Get a baby warmer.
Call the NICU. Start a timer.
Charged.
Clear.
[TENSE MUSIC]
Continue compressions.
We'll check a rhythm in a minute.
Gown up.
Robby, it's you and me.
Nazely, what's the four-minute rule?
Uh, not sure.
Pregnant patient with a viable fetus,
you have four minutes
after cardiac arrest
- to save the baby.
- And the mom.
We don't call it a postmortem
C-section anymore.
It's a resuscitative hysterotomy
to try to save them both.
But she doesn't want
any medical intervention.
That doesn't matter.
Mom and baby are both dead
if we do nothing.
OK, charge to 200.
One more rhythm check and then
Abbot and I are gonna cut.
Ellis, you and Crus
on Mom resuscitation.
Shen, you and Nazely take the baby.
OK, hold compressions.
♪
Still V-fib.
Clear.
- [THUD]
- No change.
- Resume compression, amp of epi.
- OK, showtime.
We need to get this baby out right now.
OK, take a break.
OK, 10 blade. Good.
First incision is from the xiphoid
to the pubic symphysis
through the skin to the linea alba.
Units three and four on the infuser.
Second incision goes
through the peritoneum,
exposing the uterus.
Where do you need me?
You're with the baby.
Nazely's got the bag mask.
You're on suction.
Stand by for intubation.
Bladder retractors.
Neonatal monitor
and pulse ox ready to go.
Ellis, gentle traction.
OK, making a small vertical incision
through the lower uterus
so as not to cut the baby.
Mm-hmm.
- Got it?
- Yep, I got it.
- OK.
- OK.
Using scissors to extend superiorly.
♪
Ellis, hand retract the uterus with me.
Amniotic fluid looks good.
♪
Give me some fundal pressure.
Breech position.
♪
OK, baby's out.
- It's a girl.
- All right.
♪
Milking the cord.
Clamping.
Cutting.
OK, blue and flaccid.
Coming to you, Shen.
- You ready?
- Yeah, you got her.
I got it, yep.
OK.
[RAPID BEEPING]
Poor tone, no movement.
Keep the blow-by closer.
She's really blue.
Some blue is normal, but not this much.
- Do we need to intubate?
- Not yet, no.
They usually pink up
with stimulation and blow-by.
OK, removing the placenta.
Sweeping to the left,
trying to get it in one piece.
♪
- Looks intact.
- Yeah.
Nicely done.
10 of IV Pitocin to contract the uterus.
And lots of massage.
Heart rate 76.
Less than 100 means we need to bag.
Suction first.
OK.
♪
Hey, Jord, charge to 200.
Stand by for the next rhythm check.
She grimaced. Good sign.
Bagging.
Pulse ox 45%.
Oh, I've never seen it that low.
It's not as bad as it sounds.
I'm more worried about the heart rate.
McKay, get ready with an IO
in case we need epi.
OK.
[WHIRRING]
Rhythm check. Hold compressions.
Still V-fib.
- OK, shock it.
- Clear.
[THUD]
Resume compressions.
Shen, how's she doing over there?
Heart rate's up to 104.
Uh, at one minute,
she's 0 for color, 2 for heart rate,
1 for reflex, tone, breathing.
APGAR of 5.
5 out of 10. Not great.
Pulse ox 58%.
- Intubation?
- Uh, not yet.
O2 sat in the 60s is normal
at one minute.
Her heart rate and pulse ox
are trending higher.
Let's keep doing what we're doing.
A little tincture of time.
Hold compressions.
Looks like sinus.
Can't feel a carotid.
No.
Heart's barely pumping. It's PEA.
Back on compressions.
Transfuse two more units.
She needs more red cells and platelets.
Ongoing blood loss from the uterus.
Give me all the lap pads we got, please.
[RAPID BEEPING]
♪
Yeah.
OK, yeah, thanks.
I appreciate it, honey.
Oh, gotta go.
Whoa, whoa, whoa!
Hold up.
Is there a problem here?
Yeah, you two aren't leaving
empty-handed.
What?
One of you follow me.
Rape kits are supposed to be picked up
within 72 hours of collecting 'em.
This one's been here for over two weeks.
That's not on us.
Well, it's on somebody.
It's not bad enough these poor women
go through an assault,
plus the indignity
of the whole collection process,
but nobody from the police department
even has the human decency
to come get these things?
Like nobody there gives a flying fuck?
OK, we got it.
We'll see that these get
put into evidence properly.
Thank you.
How hard was that?
[RAPID BEEPING]
Units five and six are in.
Down to a slow ooze here.
Hold compressions.
[MACHINERY BEEPING]
Looks like sinus.
- And I got a weak carotid.
- OK.
Cycle the BP.
Better filling, better squeeze.
No seizure activity on the EEG.
That's progress. That's progress.
We're at five minutes.
Uh, heart rate is 132.
Uh, pulse ox 79%.
Nazely, the APGAR?
Um
1 off for color, 1 off for tone,
1 off for respiration
with hypoxia, total of 7.
Respiration score is
for observed breathing,
not pulse ox.
Sat of 80 is normal at five minutes.
With no crying, she still gets 1 off.
Yeah.
- [BABY CRYING]
- Ah!
She just scored the winning point!
APGAR of 8 is pretty normal.
Holy shit. What did I miss?
Eclampsia with status, HELLP syndrome,
cardiac arrest,
resuscitative hysterotomy.
I was in the OR
with a septic twin C-section.
Got your text 12 minutes ago.
Shit happens fast down here.
Resuscitative hysterotomy in 36 seconds.
- Impressive.
- BP's 102/64.
Hemoglobin is up to 9.
That'll do.
NICU's sending a team down.
We can take Mom.
You guys are rock stars.
We like to be referred to
as crawlers of the night.
[SIGHS]
If you're not careful,
you're gonna get stuck here all night.
Nah, Henny said she'd
be here in 30 minutes.
- How's Mom and baby?
- Whew.
They're both gonna go upstairs.
Good. You leaving now?
Yeah, pretty soon.
I gotta find Whitaker,
I gotta find Al-Hashimi,
and I gotta find Langdon before I leave.
You missed Langdon. He just checked out.
[SIGHS] Shit.
Can I help you?
Uh, yeah, I'm Dr. Langdon from the ED.
I was just, uh,
checking in on the status
of someone we sent up here earlier.
Patient's name is, uh, Cohen.
Let me check.
What was she up here for?
Uh, clean out a nasty neck fash.
[KEYS CLACKING]
Oh, yeah, she's good.
She's in 4202, recovering nicely.
Great, great.
I mean, she was she was
in not-great shape earlier.
It was a good catch.
Saved her life, even if
we couldn't save her leg.
Uh, was it below the knee?
Unfortunately, it was above.
My cell phone
and the building manager's.
He can help if there's any emergencies.
Yeah, what kind of emergencies?
Whatever.
And follow up with Duke
in a couple days, yeah?
Yeah.
You, um you sure about this?
I trust you, Whitaker.
Great.
Any questions?
Uh, when are you back, exactly?
You know, I'll text you.
I'm trying to keep my dates
kind of fluid.
I think this is your ride.
Yeah, uh, yes.
I I promise I'll check in
on your house tomorrow.
Sounds good.
- Hey.
- Hey.
OK. Hey, Theo.
You're up late, huh?
What you got there? [CHUCKLES]
OK.
He's been fussy all day.
I think he's got
another tooth coming in.
Aw, right on, big guy.
Are you ready to get funky?
- Yeah?
- [CHUCKLES]
Ain't we funkin' now ♪
[THE BROTHERS JOHNSON'S
"AIN'T WE FUNKIN' NOW"]
Ain't we funkin' now ♪
♪
Hey.
Any luck picking an elective?
Don't know. [SIGHS]
Maybe I will go into geriatrics.
It's a smart choice.
I know that life can be challenging,
especially when it doesn't work out
the way you expected.
OK.
I thought I would be married
with two kids in college by now.
Maybe have some property with a pond,
and we could play hockey on it
in the wintertime.
[SIREN WAILING]
And yet look at me now.
No wife, no kids, no pond.
It's never too late.
Do you really believe that?
Yeah.
Only for me, or for you too?
OK. [SIREN CHIRPS]
I see what you did there.
Was that true, or something
you just said to make a point?
[VEHICLE DOOR OPENS]
Have you worked things out
with your mom?
We're not talking.
I am sorry that, um,
I let it distract me.
She was treating me like a child,
and I was letting her.
Have a good trip.
Please be safe.
We need you here.
Even if you can be a dick sometimes.
Good luck.
You too.
[LOUD BANG]
[CAR ALARM BLARING]
Hey, I didn't think you were still here.
I was just talking
to the neurologist on call.
And?
We had a nice chat.
She agrees I can work
with double coverage.
That's not her call to make.
You can't do anything critical
where a five-second lapse
in consciousness
could potentially kill a patient.
I agree.
[SIGHS]
But 90% of our patients
don't require critical procedures.
And the ones that do?
Will be handled by
whomever is working with me.
Unless they're also tied up
with a critical patient.
What if it's a double or triple trauma?
- Robby, I can handle it.
- No, you can't.
And I can't let you.
I am fully capable of handling
No, you are not fully capable,
and you know it.
What do you want from me?
I want what's best
for this department
patients and staff.
Best-case scenario,
you get a handle on this,
you're seizure-free for six months,
you get your driver's license back,
you are cleared to work.
I am cleared for my driver's license.
You shouldn't be driving
at all like this.
If you were a patient,
we would have to report you.
I am not your fucking patient.
No, but I cannot let you work
in my emergency department
until you're fully capable of doing so.
That is not your fucking call!
You're fucking-A right, that's my call!
I'm trying to protect you
and my patients,
and you know I'm right about this.
Oh, "my department," "my patients."
All you fucking think about is yourself!
Do you hear yourself?
You didn't rat out Langdon
for stealing fucking drugs.
No, but I kicked him
out of this department
until he got the appropriate
help that he needs,
and the same goes for you.
You've got until Monday
to let the administration know,
or I will.
[BELL DINGING]
I am finished.
Last chart.
[BELL DINGS]
- You and me both.
- Really?
Is this a thing? I finished a while ago.
[BELL DINGS]
I never want to hear
that fucking bell again.
- Where's Dana?
- Not sure.
A bunch of day shift
just headed to the roof
to watch the fireworks.
You want me to call her?
No, that's OK.
Yo.
Thanks for your help in there.
- Almost out?
- Yep, just about.
Is this where you try
to talk me out of going?
Me?
No, not a chance.
Why, are you having second thoughts?
- Nope.
- No?
Nope.
Don't have to convince me.
I mean, it is a little strange
the only place
you talked about going is somewhere
they used to drive buffalo
off a cliff to die.
- Here it comes.
- I looked it up,
and as far as summer vacations go,
it's not exactly a holiday hotspot.
I mean, what's in
the fucking gift shop, man?
It's just one place I'm going.
As long as it's not the last.
Don't be pulling a "Thelma
and Louise" out there.
I am minutes from taking
a three-month vacation.
When's the last time
you took any time off, Jack?
Yeah, but I've dealt with my demons.
It's a process.
You want to know why
I never killed myself?
After what I saw, lived through?
Losing my leg, losing my wife?
Because it comes for all of us, man.
You and I know it more than most.
We see it every shift,
but we can't let ourselves
succumb to it.
Yes, life can suck.
It can be unbearable
and and brutal
and ugly and heartbreaking.
But it's also beautiful
and hilarious.
And that woman today
Her baby, they'd both be in the morgue
if you hadn't been here.
That's us. That's you and me.
That's what we're here for.
The most important things
I've ever done in my life
have been in this hospital.
Nothing will ever matter more
than what I've done
in this hospital, but it is killing me.
You know how they say
that a part of you dies
when you lose someone you love?
I'm not convinced that
a part of you doesn't die
every time you see a fellow human pass.
And I've seen so many people die
that I feel like it's leaching
something from my soul.
Go on a cruise, man.
Knock off this
helmetless motorcycle shit.
Yeah, people talk.
That's death-wish behavior.
I'm tired of being a role model.
I'm tired of feeling
like you can't get ahead.
I'm tired of feeling
like I'm drowning every day.
I'm tired of all of it.
You need to get away for a while,
and you need to get some help.
You need this place
as much as it needs you.
[BREATHES DEEPLY]
Am I fucked up?
100%.
But nobody works here
as long as you and me
and doesn't get screwed up.
You you gotta find somebody
to help you dance through the darkness.
[BREATHES DEEPLY]
Did you just make that up?
- Maybe it's a song lyric.
- [LAUGHS]
I don't maybe my therapist said it.
I don't know.
[SIGHS]
Some dude just pulled up.
Looks like he blew half his face off.
How can you not love this place?
Look, don't make me look stupid.
You come back to us in one piece.
I'm still your emergency contact,
and I do not want to be contacted.
All right, night crawlers,
what the hell's going on out here?
[INDISTINCT CHATTER]
25-year-old man
[INDISTINCT] history,
no meds, no allergies.
[CONTINUES SPEAKING INDISTINCTLY]
[LOCK CHIRPS]
[ENGINE STARTS]
[CHIMING]
[SOBBING]
More than 2,000 years ago,
the Chinese were throwing
bamboo into fire
to make explosions.
They went on to invent gunpowder.
And boom! The rest is history.
They had chemicals to get
the different colors, you know?
Sodium gives you yellow,
strontium gives you red,
and barium is green.
Who knew chemistry could be
so damn pretty?
[BOOMING]
[CHATTER, LAUGHTER]
[FIREWORKS POPPING]
["AMERICA THE BEAUTIFUL" PLAYING]
♪
- Hey.
- Hey.
- I thought you'd left already.
- On my way out.
Hey, I'm sorry that
I didn't find the time today
to have that conversation.
Yeah, that's all right.
Seems like you didn't really want to.
I didn't. [SIGHS]
Did you?
Uh
yeah, actually.
Look, I'm doing the work.
I'm I've been sober 186 days.
I'm going to meetings.
I'm taking the drug tests.
- That's good.
- And you're still riding me.
What would have happened
if I'd paralyzed that guy?
I don't know.
What would have happened
if I hadn't been here today?
You'd still be questioning yourself.
Now you know you can do it.
You're welcome.
Oh, so that's
that's how you teach now?
Sometimes.
You know who I saw in rehab?
I saw a bunch of guys just like you.
The only difference is,
they've accepted that they need help.
I think you're afraid to admit that
the mighty Dr. Robinavitch
isn't perfect.
Oh, I never claimed to be perfect.
No, but you expect it of yourself,
and it's not realistic, man.
How can any of us live up
to your standards
if you can't even do it?
You need help, Robby.
You need help.
[BABY CRYING]
Finished?
You don't gotta be honest with me, man.
At least be honest with yourself.
[BABY CRYING]
She is due for a new bottle.
I was hoping to get her some
formula before I clocked out.
I'll stay with her.
Thanks.
Why are you will you hit
those lights on your way out?
- Yep.
- Why are you crying?
Why are you crying, little one?
You're OK. You're safe.
Yeah, you're not alone.
[BABY CRYING]
Yeah, you're OK.
Do you need to be swaddled again?
Is that it?
I can do that. Look.
Aww.
I wish somebody would swaddle me.
Yes, I do.
Oh.
[ROSIE CARNEY'S "THOUSAND"]
You got off to kind of a rough start,
didn't you, little one?
Yeah, you did.
She is left stuck on her own ♪
Well, that makes two of us.
Dust grows ♪
[SIGHS]
I got abandoned too.
Can't move, can't grow ♪
When I was eight.
When you've fallen
on your knees ♪
But I got through
all of that, and so will you.
I got a good feeling that
you're gonna be just fine.
Everything's gonna be just fine.
You got so many wonderful things to see
and so many people to love ahead of you.
♪
So many wonderful things to see,
people to love ahead of you.
To show they really care ♪
Love, please surround me ♪
- [BABY FUSSING]
- Shh.
It's OK. It's gonna be OK.
It's OK.
But a thousand more to live ♪
Will it be this way tomorrow ♪
I don't know ♪
But I won't fade ♪
BOTH: I want you to know ♪
That I'm happy for you ♪
I wish nothing but ♪
The best for you both ♪
An older version of me ♪
Is she perverted like me ♪
Would she go down on you
in a theater ♪
Does she speak eloquently ♪
And would she have your baby ♪
I'm sure she'd make
a really excellent mother ♪
'Cause the love that you gave
that we made ♪
Wasn't able to make it enough ♪
For you to be open wide ♪
No ♪
And every time you speak her name ♪
Does she know how you told me ♪
You'd hold me until you died ♪
Till you died,
but you're still alive ♪
And I'm here to remind you ♪
Of the mess that you left ♪
When you went away ♪
It's not fair to deny me ♪
Of the cross I bear
that you gave to me ♪
You, you, you oughta know ♪
[ALANIS MORISSETTE'S
"YOU OUGHTA KNOW" PLAYING]
♪