" [indistinct radio chatter] - [woman] Go ahead, Rescue Two [man] I'm here with an approximately 21-year-old male, found pulseless, apneic and unresponsive in the middle of the street." "Patient sustained, uh, two gunshot wounds." "[man 2] What's your ETA?" "[man] Uh, approximately, probably about seven minutes." "[man 2] Seven minutes to our facility Twenty-one-year-old male, multiple gunshot wounds to the left and right chest, is that correct?" "[man] Yes" "[man] All right, get him out!" "Get him out!" "Get him out!" " [man] Get the oxygen." " [indistinct chatter] [man] OK, hold on." "Hold CPR." "Hold CPR." "He's going to cut." "Does he have a pulse?" "[woman] We need suction." "We need suction." "[man] Who has..." "You got it?" "[indistinct, overlapping chatter] [woman] I need a tube!" "Tube!" "We need a tube!" "[man] We need a chest tube over here." "[man] You know, if you're an outsider, this looks like total chaos." "But as a doctor, I see unity in that chaos." "There's a team here, in all of that, coming together to save someone's life." "Uh, chest tube that side." "OK, you two need to let the doctor in to do a chest tube over here." "[man] But I feel like that spirit is not at all involved in this debate" "And I think that this health care crisis is all about teamwork." "The U S Supreme Court has said the Obama health care law is constitutional, and therefore the law of the land." "The individual mandate that requires all Americans buy insurance has deeply divided America." " Not one" " You don't know who I am" " Our freedoms are shrinking." " [indistinct]" "If you can afford health insurance" "Then you should, and if you don't, you should go to jail." "Now, Nancy, I'm telling you this I'm telling you this" "[man] You know, we're in this crisis now." "There's a health care crisis and that's what we're being raised up in, and trained in." "We are the safety net." "We are when somebody needs somebody, needs a doctor, they get sent to the emergency room." "So we're getting trained in this atmosphere, and I don't think our role has really been defined." "And I don't think our voice has been heard yet." "Our generation of ER docs." "And I think it's gonna be important, to kind of put our stamp on it and say what our relationship with patients is going to be, what our relationship with the business of medicine is going to be," "and health care in general." "[man] I remember my dad always encouraging us to look out for the little guy." "If there was that awkward kid in our class in elementary school, you know, he'd want us to be his friend, you know." "And make sure he felt like he wasn't alone, you know?" "I knew that my life had to mean something, you know?" "I had to do something that was of service to the world." "It couldn't just be a job to make money." "[woman] Someone is suffering What are you going to do?" "Being a doctor, I have the capability to relieve them of their suffering." "So that's what I'm going to do." "Regardless if they have money or no money." "Hold still." "Hold still." "And it doesn't get any more complicated than that." "[indistinct chatter]" "[McGarry] When we started this, it seemed so simple." "We were going to be doctors." "We were going to help people." "But what if those ideals can die?" "What if those hopes can fade into the failure of the system?" "If you're a young doctor, you have to ask yourself," ""How do I protect the ideals I came here for?"" "[siren wailing]" "[McGarry] My fourth and final year of med school it's customary to kind of, like, go on extended auditions at a bunch of hospitals because now you've got to choose where you're gonna be for the next few years to train." "At that point, I don't think I had decided," ""Oh, I'm going to be a county hospital doctor, that's for me." I just heard good things and I was curious." "[PA announcement] Juan, if you can pick up, you have a call on line eight." "[indistinct chatter]" "[overlapping chatter]" "[machine beeping] [man] I mean, from day one, oh my God, it was just, initially, I was like, this is kind of crazy." "I don't know if this is... like, is this real?" "Can this...." "Truly, is this really for real?" "[McGarry] I had been in other hospitals, I had been other places." "I'd never seen anything like this before." "Who's the doctors here?" "Who are the nurses?" "Who do I even talk to?" "It's my first day." "Who do I report to?" "And, um, I remember seeing this very calming man." "Turns out, it's the chairman" "This was the chairman at the time, DrEdNewton." "But I don't know this." "I just think it's a doctor" "And I walk up to him" "And, uh, he says, "Oh, you know, you're the new med student."" "I said, yeah." "I'm like, "What is this?" He said, "It's C-Booth." "This is where our specialty was born." "This is where everything happens." "This is where, um, you know, you're really going to learn to be a doctor."" "And I remember thinking, How the hell am I going to hang here?" "[overlapping chatter]" " [man] Needle in the arm." " [man 2] Deep breath." "Thirty on the top." "[man screams] [man] Slide him up." "Slide him up." "Slide him up." " [woman] Slide him up!" " [man screaming] [man] It's a place where physicians and nurses have come over the years and really learned how to deal with a large volume of really sick people, and really develop their craft." "[Cheng] As an emergency physician at LA County hospital, what you're saying is that you are part of this heritage that is basically the birthplace of emergency medicine arguably, in the world." "Definitely in the United States." "So this place was built in 1930 Fast forward, what, 40 years, when they start an emergency department residency." "They just built one, in a room." "There wasn't anything fancy set up." "It wasn't pre-planned." "They just built a room, and people started to see patients." "[man] At the time that I was an intern, the emergency department really wasn't an emergency department." "It was still back in the era where emergency departments were emergency rooms, staffed by anybody with a degree, including psychiatrists, pediatricians, dermatologists;" "handling gunshot wounds to the abdomen, no experience particularly required." "[man] The concept that one doctor, one emergency physician, trained in resuscitation, would really be the best person to resuscitate you is really part of the core idea of the specialty." "And C-Booth is where that idea was born." "[McGarry] By my first week, I was still kind of trying to figure out just what the hell is C-Booth?" "[Mallon] It's hallowed ground." "More people have died on that square footage than in any other location in the United States." "And on a brighter note, more people have been saved in that square footage than in any other square footage in the United States." "[McGarry] Nobody really knew what the C in C-Booth stood for" "Critical booth, central booth, cardiac booth" "But everyone did know it was special." "And maybe it was most special for what it didn't have" "Hardly any technology." "There was no doctor's or nurse quarters" "Maybe not surprisingly, the patients were in the middle, and they were the focus." "C-Booth sees the most critical patients." "So, be that a massive heart attack, be that severe bleeding, be that severe infection, an inability to breathe, any of the devastating illnesses that put you into shock." "[Newton] The sickest patients in this big, big population in this huge city end up in here, in C-Booth, and they keep pouring in, as you can see. [laughs] [man] And it's true that people would come here on tours." "When we would do tours for the residency, people would come in to interview, and they would want to see C-Booth, and they would know what it was" "Let's see C-Booth." "And the invariable response was," ""That's it?" "This is C-Booth?"" "It's a very small area" "But, again, I always tell people, it's what happens here" "It's not the physical space itself." "[overlapping chatter]" "Please step out." "[man] Thank you very much, gentlemen." " [machine beeping]" " All right." "Prepare a sling." "I need..." "I need some breathing." "[man] OK." "Fine." "All right, guys." "I need space." "The stab wound to the chest is here." "OK, no rectal tone." "I need an abdominal pad." "Can you give me an abdominal pad?" "Some more four-by-fours." "[McGarry] I heard this was a very difficult and rigorous place to train." "And, um, you're constantly deciding, is this me?" "Do I fit?" "Can I do this?" "What's the deal?" " Is it in?" " Yeah, it's in." "OK." "This is not..." "this isn't very good." " What happened?" "Did he wake up?" " What happened?" "No, he didn't wake up." "I think the balloon, I think it backed up." "OK, can you take this out now?" "Take it out 'cause he's gagging." " You got that?" " [woman] It's in." "[Mallon] You can't read about that stuff." "You can't learn it in a medical school." "No matter how many times you've read or even done a chest tube under casual circumstances, it's very different from placing a chest tube that needs to be placed in 30 seconds." "All the way in." "All the way in." "All the way in." "All the way in." "All the way in." "Let it out, open." "Good." "Good." "There you go." "It scares the hell out of you, and it makes you have to work hard and there's no excuse." " Give me a good breath." " Bilateral with bagging." "So Jen?" "Can you hold up for a second?" "Can you troubleshoot your, uh, your tube?" "When I rotated here as a medical student," "I saw how the seniors just commanded the place." "[woman] Bag, I need a bag." " Let's go, dude." "Take that off." "Go." "I thought, I want to be that person." "I want to be that calm, and that cool, that collected, that knowledgeable, that confident." "That's what I want." "All right, what are our vital signs here?" "135, OK." "Switch her over to that one, please." "Emergency medicine calls a certain type of person to work there." "To actively choose to leave a very particular lifestyle, and choose something much different," "I think speaks a lot to the history of that person." "Emergency medicine was a second career." "I started doing medical research, and that was fascinating" "But my dad was diagnosed with Alzheimer's at the time, and I didn't know anything about Alzheimer's, actually." "Being in research, I PubMed'd about Alzheimer's and treatment." "And there's lots and lots and lots of articles with numbers and graphs." "But that was frustrating to me, because I didn't want to be one of those researchers, just generating data point after data point after data point" "I wanted to be the interpreter of that data." "And then have the ability to apply it to somebody who needed it." "Like a patient." "[indistinct chatter]" "Going into emergency medicine I like the hands on, that there are procedures that need to be done." "I enjoy the patient interaction" "I liked the investigative process, in terms of trying to figure out what was going on with the patient." "Um, and I like the people." "The people in the emergency room were just different." " I really don't work out that much." " [laughter]" "But I'm really tired right now, so I'd like to stretch." " That's booth 19 right there." " [laughter]" "This is it." "This is Friday night." "Like, I felt strangely at home, even as a med student, getting along with people that have a good sense of humor, that are very relaxed, but take their job seriously." "[McGarry] You always hear of war and troops and the bonds and closeness of an outfit on the battlefield." "And this hospital is very similar." "It seemed like such a family in that way." "I think it was hard not to be attracted to that." "[Mallon] I guess the picture of me smoking in front of the no smoking sign is appropriate." "But it's sort of the one break that is always respected." "If you're having dinner, they'll interrupt you." "But if you're on the ramp having a smoke, you're pretty much left free." "OK." "[McGarry] I met one of the faculty who is a legend in the ER world, and he seemed to represent the place, a little rough around the edges, breaking some rules." "Nobody boxed him in." "And I think he personified the total opposite of a constrained, but regulated medical culture, and I love that about him." "[Mallon] Yes, I get to pee on my property." "You're not putting that in the film." "[McGarry] Billy once told me that emergency medicine was blue-collar work." "No pretension, no attitude." "And it's true." "Most of my classmates had no interest in status." "They found their value in life's moments instead." "My friends used to call me "The Epic Guy"" "because I loved making everything in life huge." "You know, I love running up mountains, because you get to stand on the top at the end and you feel, you know, it's like in Rocky." "You get that same feeling." "That's what life is about, is, you know, making love to a woman and making it seem more than just having sex." "You know?" "It's about... [laughs]" "It's about these moments that are big, that are larger than life." "I feel like emergency medicine is this place where what we're doing is much more important than just pushing paper and making money." "You're there with staff and nurses." "It's a team and you're talking to patients and you're in the thick of it, fighting to save someone's life." "Uh, chest tube, that side." "[overlapping chatter]" "Correction." "We're going to extend the thoracotomy over to the right side." " Watch your knife." " There's a knife." "[overlapping chatter]" "All the way down." " [woman] Thank you." " [man] Yeah." "She'll work on the bottom." "She'll work on the top." "[McGarry] Being a new doctor," "I think optimism overshadows realism." "And it's easy to see why, you know, they fix the wound." "He had blood, but there was no life." "It's this unfair exception to everything we're taught that as a doctor, beyond your values, beyond your science, the system is sometimes bigger than you [overlapping chatter]" "[man] Anything else to do?" "[man 2] I think we can call it." "[man] We're calling it." "Time of death, 11:46." "[machine beeping]" "The first time I saw a patient die was actually in C-Booth, when I was volunteering in the ED, my first month of med school." "And I remember saying," ""This is going to fuck me up, you know." "A patient died."" "I was touching a dead person for the first time that wasn't a cadaver." "[woman] When somebody dies here, I think it's one of the moments that really connects everybody in C-Booth together." "Everybody has that same sorrow, and a feeling of we tried to do everything we could" "But then also, everybody just the team reinvigorating again, and getting ready for the next patient or case to come through the door, and trying to make a difference there." "[indistinct chatter]" "[man] Skateboarding and... [man 2] What's your name?" "[overlapping chatter] [man] When I see my son, that he was basically dying, it was terrible." "That was the worst day of my life." "He's not... his airway." "We got vomitus in the airway." " [man] All right." " I think we should just go." "[man] All right." "[man 2] Let me do a rectal quick, before you push that." "Like that?" "It's a seven and a half, 23 at the teeth." "Let's get a securing device." "[man] Are you Mom?" "Hi, I'm Dr... [man] Thank God everything went right and good for my son." "I just I don't know," "I don't have words to thank the doctors" "It's an unbelievable feeling, now that I know." "And I have my kid back." " Take care of yourself." "I'll see you back." " Thank you." " Pleasure meeting you." " Thanks." " Just relax." " Does this hurt here, on your leg?" "[man] There's nothing that brings people together than struggling for something that's worthwhile." "And what we had to struggle against was an onslaught of patients being brought into this place." "If there was a hallway spot, and there was a nurse and a doctor available, even if they weren't available, they would make the time to take care of someone who is out there sick." "So it was a cohesive team." "[man] All right. [indistinct]" "The magic of C-Booth was that when you got up in the morning to go to work, you knew that that day you were going to get to be the best you could be in life." "That C-Booth was going to force you to rise up to the occasion and save that kid." "Like, there was no shirking from your responsibilities." "You knew that at the end of the day, you had done your best." "How's your belly?" "Your tummy all right?" "[McGarry] I knew at that point that being a doctor anywhere else but here, but this brand of being an ER doctor, was not gonna cut it." "[overlapping chatter] [woman] Jen." "Jen." "You're at County Hospital." "What happened?" "Remember what happened?" " Open your eyes." " Deep breath." "[woman] Pupils are three millimeters bilaterally symmetric and reactive." "[alarm rings]" "[alarm continues]" "I had to do a year of training elsewhere." "That was just the tradition and requirement of this place, that you did your first year residency at another hospital." "And so when I got back, I find that it's..." "Not only is it a new space and a new place, but it's, to me, feels like a new culture." "[man] Which place do you like better?" " The old building." " [man] How come?" "Too much walking in this building." "[PA] Custodian to North 12, please Custodian to North 12" "I think the difference between the old generation of ER docs and our generation of ER docs is they had the excitement of starting a new field, and basically defining it, and creating a completely different area of the hospital" "that they control, and we're a generation that's starting out, and we're totally immersed in protocols, policies, rules, checklists, forms." "The amount of forms that it takes to get a patient registered, taken care of and discharged is upwards of 50 to 60." "[speaking Spanish]" "I just had a patient with the simplest of complaints." "It took me about two minutes to see her." "I saw her standing right here in the hallway." "I don't even need a room for her" "And what turns into a very simple complaint, there's just tons of things I have to do in terms of documentation." "Basically, it took me four times as long to document as it took for me to talk to her and do the exam at the same time" "The amount of crushing regulations on hospitals, whether it's from CMS at the federal level," "CDPH at the state level," "Joint Commission, the hospital regulations, basically they are tying your hands." "With HIPAA, this ER could get fined if we don't log in every time we need to see a patient's piece of data." "[Eng] What we do here is we log in over and over and over again." "I go to the bathroom, I, like, want to log in before I go." "We moved from a hospital that was protected from regulation, because it was impossible." "You couldn't meet the privacy standards because we were in this old, antiquated building where too many people were jammed into too little space." "And so we were actually given waivers." "It has nothing to do with the county, it's more that we moved forward two decades in time, maybe more, from the old facility to here" "In the new building, which is now all up to those standards, the regulations have no welcome home to roost." "I think what's amazing is you guys have been following me for, you know, 30 minutes now, and I've probably spent all of two minutes with a patient." "It didn't seem that long ago that we were watching senior residents in C-Booth, and now, here we are." "This is us, and we're starting our senior year as ER doctors" "I went into medicine being like, this is the last frontier of intellectual, hands-on career." "And that emergency medicine is the epitome of that, and now we get to it, and it's not C-Booth anymore." "And we're at a computer, at a desk, in a chair, pushing paper." "[Kohanteb] That kind of stuff eats away at me a little bit." "Not, like, the fact that you're taking care of these people." "The gratification is still there." "But that stuff is what chips away slowly, and I think that's the biggest difference between now and then." "[man] Part of what we're trying to figure out now is who we are." "What does it mean to be a doctor in these times in America?" "Like, when you're a medical student, it's an ideal." "You watch the TV shows, you do a rotation, you see a couple of bad cases where you see residents be bad-ass and you're like, yeah!" "And it's just sexy." "And you're like, "I'm gonna be a sexy doctor in the ER."" "And you go in, and in the intern year, you're still riding on that high." "You're like, "Whoo!" "I don't know anything!" "I'm not really responsible!" "But whoo!"" "And it's that excitement that carries you through the rest of the year." "Now I'm realizing fourth year, the progression from "Whoo!" excitement to, "Oh, shit," to "I'm responsible,"" " now it's just sobering." " It's heavy." "It's sobering." "Yes." "It's stressful, and sobering." " What's your last rhythm?" " Last rhythm was v-fib." "At the door, we pulled her in." "She's back in v-fib." "I'm not feeling a pulse down here." "Pads, please, right away!" "CPR right away!" "[Kohanteb] A 69-year-old lady They found her without pulses, not breathing, completely unresponsive, and they brought her in here" " Are the paddles attached?" " Clear." "Everybody clear." "Clear?" "Shock." "Continue CPR." " All right, charging." " Keep doing CPR." "[Kohanteb] I was actually leading the code" "You carry the whole burden of responsibility of, like, organizing all the people that are in there, making sure everyone is doing everything appropriately, making sure the gap between thinking and acting is minimal." " We got good pulse." " One amp calcium carb." "Calcium chloride." "One amp bicarb." "All right, hold CPR." "Quick pulse check, rhythm check." "[Kohanteb] A lot of multitasking" "And meanwhile, dealing with the family." "Talking with the family, being their emotional support." " [Kohanteb] Uh-huh." " [man] In these chairs." "OK." "All right." "Just so you know, she's sitting in those chairs." "OK, thank you." "[Eads] You know, people always say in the ER you see patients for a few minutes, then you never see them again, but I think the relationships you develop in those few minutes, where someone's really sick or on the edge of death," "or they actually don't make it, you know, that's the most important interactions that you'll have with your patients or with their families." "Unfortunately, it doesn't look like she's doing that well." "We've been resuscitating her for about 15 minutes now, and she hasn't responded." "Her heart isn't beating." "We're still doing CPR on her right now." "We're giving her all the appropriate medications and treatment." "But it isn't looking that good right now." "[Kohanteb] I have a hard time separating myself from it." "I lost both my grandfathers in, like, the last two years, and every time I see something like that, it still... it still gets me." " [machine beeping] - [indistinct chatter]" "Does anyone else have any objections to calling it?" " [woman] Call it." "Calling it." " OK." "Hold CPR." "Time of death, 12:54." "[woman] I'm gonna go by that big clock..." " [man] Yeah. [indistinct]" " OK." "[Kohanteb] Can we drape her for the family?" "[man] We'll clean her up and get her off this backboard." "I spoke with her briefly, and we have someone from Social Work." "[Kohanteb] When you do lose those patients, like we did today, your patient is then their family, and helping them cope with that moment." "You know, being the one to break that news to them and doing it in a in a compassionate and very human way." "It's my first opportunity having to do that" "And, uh, I don't expect that to ever get easy" "[woman] She is gone." "And I am so sorry." "[woman 2 crying] [woman] You couldn't have done anything different." "[woman 2 sobbing]" "[Eads] You're seeing people usually on what is often the worst day of their life You know?" "I think that's the hardest thing to do in our specialty." "You have a patient in front of you who is in pain, who needs you, who needs you to take a lot of time to take care of them." "But you have to love the patients in your waiting room just as much." "Because they might be even sicker." "[McGarry] This is our, like, electronic representation of the waiting room." "And when you've got 300 people tonight in the waiting room, you have to decide, how are you going to manage this?" "How are you going to see these people?" "And what order?" "And so we've developed a numerical score that many ers adopt, that's based one, two, three, and four." "Four is, you know, I have a cold, I have a broken finger." "Three is I have the flu." "Two is I might have an appendicitis and could die of a ruptured appendicitis." "And one is I'm actually having a heart attack right now and could die at any minute." "And, uh, one of the sobering facts that we find here at County is that we have such a high volume of patients that come to us that level two scores." "So people who could still have life-threatening emergencies are often asked to wait up to 10, 15 hours before they can be seen." "And so, what's really scary to us is that while we're in here seeing patients, you have no idea what's happening to these ESI two score people that are here." "You can see they're not even..." "Here's a ESI two that's been waiting for eight hours, nine hours, ten hours, 12 hours." "[Eads] People are at their limits You're out there for 15 hours and you're sick." "You can't get in to see a doctor." "And the frustration!" "I can't imagine how bad it is You know?" "[Mallon] People come here and leave because they can't wait anymore?" "I think those are pretty high stakes." "[McGarry] I think I have a low tolerance for making people wait." "Because I've been there myself." "I've felt that." " [man] Let's go, Ryan!" "Go, Ryan!" " [cheering]" " [man] Go, Ryan!" " [cheering]" "[McGarry] I went to college on a scholarship for track and cross country." "But by the middle of the academic year," "I went from being one of the top freshmen to exceedingly lower place on the team and then finally being lapped in races." "I think everybody at the time felt this is just kind of a really bad case of freshman..." "freshman burnout." "I just went to my old home pediatrician, who said 'let's get an x-ray.'" "And we just were ready for him to say 'you have a stress fracture.'" ""You know, shoot, we found something."" "And, uh, he started crying in the office, and said, "You can't be in this office another minute." "I need to refer you to an orthopedic oncologist right now."" "And we all looked at each other and said, "What does that mean?"" "And he said, "You don't..." "We don't have time to explain it." "This looks like a really bad cancer to me." "And you need help right this second." "And we're really late." "We're behind the ball."" "I had stage IV lymphoma." "A very rare subtype of lymphoma." "And within hours, I was signed up for, um, chemotherapy and radiation and we knew we were in for a fight." "When I wasn't busy, when my family wasn't busy, when there wasn't something to do to fight the thing, that's when the fear crept in." "And it was always about the clock." "Waiting on news, if the therapy is working." "Waiting on news, is there more disease we didn't know about?" "Is it getting bigger?" "To wait on news that may not come, not in just hours but in days?" "That's torture." "The clock was torture." "And watching that dial go around was torture." "[clock ticking] [indistinct chatter]" "[McGarry] How long have you been here for?" "Since yesterday at 1:30 in the afternoon." " Get out of here!" "Oh, my God!" " Twenty-four hours." "God bless you." "That's a long time." "When I see somebody who has taken four buses to get to the ER, and now they have waited 18 hours, almost all of me is wired to figure out how I can help them right now in the moment." "I'm sorry it was such a long wait." "OK?" "We're doing the best we can." "Uh, I'll see if I can find you a snack in a second." "But let me get this started and we'll go." "You know what I mean?" " But what are you here for?" " For my sciatic nerve," " which is a lot of pain." "I'm passing out." " Yeah." "OK, what are you taking for pain medication right now?" "I ran out of medication." "So right now, you have no pain medication at all?" " I don't, no." " OK." "And I'm-a keep it real." "The pain medication that I was using was Mary Jane." " What is that...?" "Oh." " You know what Mary Jane is?" " No." "Marijuana." "Sorry." "You know, look at me." "Look at me." "I wouldn't know what that is." "Oh, yeah." "Well, it's called Mary Jane." "And I would smoke the weed to ease pain up long enough to get me here." "It's not a private hospital." "It's a county hospital." "It sees low-income, underprivileged people without access to care." "[man] It's funded through a budget that's provided by the County Board of Supervisors." "And it's taxpayer money." "Um..." "I mean, there's a combination." "There's federal funds and there's state funds and there's county money, but, in the end, our budget is set by the County Board of Supervisors." "We are to take care of all comers." "[singing in Spanish]" "[continues singing]" "[continues singing] [woman] Which one is he on your chart?" "[man screaming]" "Robert." "[screaming]" "No, please, don't put me to sleep!" " No, we're not..." " Don't put me to sleep!" "Please!" "I want to talk to my auntie!" "I want to talk to my auntie, please!" "Get her on the phone!" "I want to talk to my auntie!" " What's her number?" " That nurse is gonna kill me!" " Hold on." " Turn the light on." "We just need two people in here." "We're good." "We're good." " We're good, we're good." " [man sobbing]" " No..." " You want to talk to her?" " Yes. [sobs]" " Let's talk to her." "Let's talk to her." "Let's turn that off." "We need to calm down." "Calm down." "[McGarry] The community really relies on us to provide a lot of the psychiatric care because, um, I think there's other hospitals that would find ways to not, you know, effectively not be around for this patient." "One of those things is just geography." "We're here in the place where all these people end up, just because of the area and the poverty around here." "So" "[Kohanteb] There's more of a need at County hospital." "And I think this kind of place attracts a certain kind of person." "[speaking foreign language] [indistinct chatter]" "I was in a car accident when I was 14 with a few really good friends." "I woke up in the ambulance, was taken to the ER and was basically fine and out of there, you know, within hours with just a concussion." "One of my best friends wasn't so lucky." "His name was Tomas." "My friend Tomas, he had, like, a terrible, uh, traumatic brain injury and was in the hospital for months and months and months, and ultimately left in a persistent vegetative state." "I felt I had, like, real survivor's guilt from that." "I think that was the first thing that made me want to be around him, be at his house all the time rather than just being his friend." "So I was there, at his house, helping with his care" "Um, helping with his rehab." "You know, praying for miracles with his family." "It seemed like the one person that dealt with him that didn't seem to care as much as me or his family did were the doctors, you know?" "My friend Tomas" "He was an undocumented immigrant from Mexico." "And his family was uninsured and the care they would get wasn't the best." "And that was, you know, incredibly frustrating, you know, to see someone you love so much cared for so poorly." "Um, and..." "So at first I thought medicine was the last thing I wanted to do." "[Enriquez] I was just on the front of the hospital." "It's a civic cathedral." "You walk up those stairs, and you look up, and that is awe-inspiring." "This huge structure, 2,000 beds at one time." "And carved in stones along these great men of medicine there's the words that the citizens of Los Angeles taxed themselves for ten years to build this structure, so nobody could go without the fruits of science and health for lack of resources." "And that's what this whole structure stands for." "[Newton] Being in LA, where there are so many people that are uninsured and so many people that live in poverty, the emergency department is where they come when they're cold and tired and hungry and sick." "And I think it's kind of replaced what the churches used to be in the Middle Ages." "You know, it's a place where people come for sanctuary." "[Swadron] This place stands distinctly from most of the practice environments where we spend our faculty meetings, generally speaking, talking about patient welfare, patient safety." "This is our mission here." "This is what we do." "That is not what is happening throughout the country at most private institutions." "The private groups, I know my wife is in private practice, is almost 100 percent focused on money." "[woman] I was in horrible pain I have a broken bone" "[McGarry] Where did you go first for medical attention?" "[woman] To Kaiser hospital." "So if you were already seen at a hospital, why are you at this one?" "They kicked me out of Kaiser because I don't have a Kaiser card." "They told me to come here, to have surgery here." "I see." "You already feel..." "[McGarry] So what happened to this patient is totally legal." "Congress passed legislation in 1986 that requires all hospital emergency rooms to treat basically any patient with a life-threatening condition, even if they can't pay." "This sets the stage for a very lopsided safety net on'the other side of the ER." "Because while all of these American hospital emergency rooms will take care of you, if you're well enough to be discharged, getting to your next doctor might be a real problem." "What if you need surgery, a specialist or an expensive medication?" "Now your options are significantly less." "And the public hospitals become the only safety net these people have." "[Kohanteb] I can't imagine a situation where someone would show up in my hospital needing help and me being able to turn'them away." "It does boil me up to think that that happens." "That people that need help are turned away." "And I feel great that I am at a place where I don't ever have to think about that." "That's why everybody's here." "I mean, this is a place where you get to work twice as hard for half price, deal with a lot more difficult day um, but sometimes a lot more gratifying outcome." "We provide service in health care to those that need it most, so the emergency department has become the only access point for many in our country." "How's it going?" "Hey." "So what's going on?" "So we were just trying to figure out why she's breaking out with all these bumps all over her." "She's got them all over her chest, all over her back, on her booty." "And it's just getting worse." "Like, especially the back." "The back has gotten really bad." "[Pomeranz] Emergency doc is the family medicine doc of the modern era in a lot of ways especially at a county hospital." "And, uh, I fell in love with it." "You know, you get to solve all problems." "You know, whether adjusting their diabetes medications or fixing their laceration or saving their life." "[Cheng] You're seeing the effects of your training and benefiting these-- whoever is coming off the streets from the community" "What we do here makes a huge difference in people's lives." " And does he have diabetes?" " Yes." "OK." "And is he taking insulin for diabetes?" "No, he takes pills." "Has a doctor, like, suggested to take insulin, or no?" " [woman] No." "Only the pills." " [McGarry] Never." "Just the pills." "But when he was taking..." "[McGarry] If you want to talk about access, and the non-emergent use of the emergency room and, um, how much can you push that?" "How much can you expect out of that?" "There's just only so much that we can do." "[woman] Do you have a wristband?" "Are you a patient?" "[overlapping chatter]" "[Cheng] So we have a color coding in the emergency system that is supposed to correlate to how busy we are." "Blue is like there's..." "it's Christmas." "They're handing out free hams everywhere." "There's no one else in the emergency room." "And that ranges all the way up to Code Black." "[McGarry] During Code Black, we are so saturated that it feels like, um, the place is gonna blow up at the seams." "We're the front door for everyone here in Los Angeles County." "We take them all in and we see every single one of them." "And that's why we're busy and patients end up waiting 18 hours." "It's not anybody's fault It's just by sheer volume." "You can only do so much." "You only have so much physical space." "You have only so many resources." "You only have so many nurses, you only have so many doctors." "Part of the system:" "the way that it is." "[McGarry] So imagine, you're gonna start a shift and you're walking in." "You pass the waiting room, and it's overflowing." "We're in Code Black." "And there it is in one space, the most real representation of one of our greatest problems." "And you know, you know, you're not gonna be able to fix that problem in a shift." "And it's defeating." "It's a little bit like losing before you've started." "♪ All these faces ♪" "♪ Come in between ♪" "♪ I m so tired ♪" "♪ Playing with my foolish fingers ♪" "♪ Oooh ♪" "♪ Oooh ♪" "Look at this." "We slow..." "Look at this." "20 hours, man." "I walk in, I see Code Black." "That means, holy shit." "Like, this is not a shift to dick around with." "This is a shift where we need to find a way to decompress this, this emergency room." "Let's see what we got in'the beds here, see who's pullable." "[sighs]" "Complete heart block, no." "Four can be pulled." "[Cheng] Dude, I'm an immigrant Asian child." "And, you know, my choices were physician, lawyer, or, you know, like, world class pianist." "And my mom, when I was eight or nine, she bought me this album, "Where There's a Will, There's an A."" "So that was like a play off 'Where there's a will, there's a way'" ""Where there's a will, there's an A."" "And most families would be OK with a B." "It means you're a slightly above average student." "But my dad would say, like, "Hey, I know you're an A student." "I know you're an excel student." "This is unfortunately, unacceptable." "Please pull your pants down." "I'm going to have to spank you."" "And I was like, it made sense to me at the time, like, this is clearly a failure of my ability to achieve my full potential." "But, you know, going along the way, when I said," "'Hey, I'm thinking about medicine,' it was pure positive encouragement" "This is pretty posterior, so you're gonna go... iYou know, if I don't push myself, I don't see as many patients, or I'm slacking off and I know there's a patient to be seen," "but I'm dicking around, looking at my email;" "I don't think my dad's not going to pop out from a corner and frigging spank me, right?" "He's not going to be like, "Holy shit, Danny, I can't believe you just did that." "Pull your pants down in front of all the nurses." No." "But the metaphorical spanking in my mind," "I guess that's what you'd say, is you should create this correlation between your pride, your name and the pride and respect for your name," "You're the senior resident Daniel Cheng in the ER." "'Yeah." "That guy?" "He works really fucking hard.'" "Chest wall stable." "I know, it's going to be weird." "People are going to be grabbing a lot of things, but don't worry." "I just want to take care of you." "You're really sick right now." "What's hurting you right now, your belly?" "Anthony, what's hurting you right now?" "Your back?" "All right." "[Cheng] Here I am as a senior resident, embarking on this year-long kind of mission of pushing myself, pushing my juniors, and really wanting to put a stamp on this place." "Come." "This is your patient in bed one." "Uh, where's, uh, Deb?" "[Cheng] I want to start a couple of these, what are called, fast track chairs, where we can try to cherry pick people from the waiting room that could be a quick disposition up and out of the department." "And we've done this before, it's not something brand-new that I just thought of today." "The charge nurse had her own ideas and her own arguments of why it was maybe not a good idea." "So no one is a fast track." "When they bring back their fast track, they think they're gonna bring back a patient, it'll take a half hour to see them and they'll send them home with an appointment." "And it usually does not work that way." "Example:" "Today, the one he brought back with a headache ended up with a brain tumor." "Neurosurgery consult." "We had to pull patients to give him a room to consult them." " She went upstairs." " I know you're probably seeing this and thinking this wasn't a great fast track example." "They're supposed to be in and out." "But I would disagree." "In the end we plucked out two people that ended up actually being really sick." "[Enriquez] Now those two patients benefited greatly from what he did." "'Cause one of them had a tumor in her brain and that was a great catch." "She could have left if her wait" "She had hours to go." "She could have said," ""Ah, forget this," and delayed her care." "And I understand your logic." "On paper, it looks perfect." "It should work." "There's four nurses just sitting there." "But there's still the ratios." "These people still need notes." "They still need vitals." "We don't have the capacity to do that in the resuscitation hallway." "And that's the whole point, is that we can't change everything here." "And by trying to do our little changes, we just seem to get in more trouble." "[Henderson] We're in a kind of a crisis situation." "We have nurses who are feeling overwhelmed." "Since February, I've lost 15 nurses and replaced none of them." "So in four months," "I've lost 15 of my staff." "[Eads] The lack of staffing is because we can't pay nurses enough." "And it's one of the most challenging places to work on health care." "[Lasovage] So in California, the nursing ratio is one nurse to five patients for low level acuity patients." "And honestly, we compensate for being underfunded and being understaffed and everything and we just make it happen, like, with the fast track." "But ultimately, it could be my license." "They could pull my nursing license and then I don't have a job." "And there's HIPAA violations, nursing violations." " There's a hundred people out there." " It doesn't make it right." "I'm not saying it makes it right, but I'm saying there's nothing different about it out there than in here, but here at least they're getting treated." "Out there, it's 100 people just sitting there." "But in here, they're getting treated and people's licenses are on the line." "You have to..." "I understand because I've been here long enough, from the old hospital to this one, and you see these patients and you want to do more." "You have to realize, there are set rules for reasons." "There are set things for reasons." "And there are set areas for reasons." "[man] We can't pay for patients in the hallway here because it's not acceptable." "Nurses can't go out of ratio anymore because it is not acceptable." "I mean, look at C-Booth Nursing ratios?" "There was no such thing." "The attitude there was this is what we've got, we're gonna get the job done." ""The day of the cowboy,"" "and I put that in quotes, obviously, is gone." "You can't just come in and do whatever you want whenever you want however you want." "There's a lot of oversight." "There's a lot of regulation." "There's a lot of feedback that goes on." "It's a much more regulated environment." "[McGarry] These regulations, and things like nursing ratios, and the whole bureaucracy here, aren't really unique to County." "I mean, this is just an American problem." "You start to wonder if these regulations have to be here at all." "[Mallon] When I look back at the work that was done here," "I'm proud of the work that we did here." "But if you were to ask me was it private or was it dignified?" "The answer to both of those questions would often be no." "[overlapping chatter]" "[man] All right, coming out, guys." "[overlapping chatter]" "[man] To be a five-year-old boy coming out of a car accident or with some other type of injury and having to be next to someone in alcohol withdrawal who's, you know, all over the gurney" "and obviously gonna be pretty frightening for that kid." "That's not fair" "And I don't think it was fair for the families who had to come in and visit someone who is critically ill and see they had to put up with all the chaos that was going on here." "[Enriquez] I had someone whose mother had died and I had to show the body to them, to help them through the healing process." "And I took that poor woman, I stuck her there in booth 17, where we kept the urinals and the bedpans, and there I showed her her mother. [sobs]" "And next door, there was a man saying, "Shit." "Fuck." "Cunt."" "Because he was psychotic." "In the midst of that, I showed her her mother." "[overlapping chatter]" "[man] When we first made the move, I was ecstatic" "We have a much larger, more comfortable, private experience for our patients." "And I thought this is paradise." "This is so much of what our patients have deserved for so long." "And then I remember hearing from some of the faculty and some of the residents, saying, "Oh, God, we've lost something,"  we have lost something." "It changed the intimacy of the experience that we had with the patients." "So it was basically us and the patients." "And you couldn't not talk to them." "You couldn't not interact with them." "You couldn't..." "you were right there." "There was no separating yourself from the patients." "And what you'll find out now, when you go into any emergency department in the country, modern designs have basically separated us from the patients." "[McGarry] When you talk about privacy and logging in and all these things that are supposed to do the right thing, its intentions are great, but really our patients aren't benefiting as much as they would want." "[Pomeranz] HIPAA, checklist, whatever it is, they are trying to guarantee patients' safety." "But in doing so, they are killing the team and killing the relationship." " OK, you keep your head still." "OK?" " OK." "[Pomeranz] There is this sense of teamwork and passion." "It's there." "But I feel like, as soon as it's done, it dissipates into the computers and the charting and just sitting there it becomes this bucket of work, of paperwork, of saving somebody's life, and that kills" "the passion of saving someone's life." "[McGarry] This patient needs a lumbar puncture." "I have to put a needle in her spine and get fluid out of it." "To do that, I have to fill out a form and eight other forms." "And I have to fill them out, and chart." "It's going to take me almost 25 minutes of prep just to get the procedure to happen" "And so it's funny that in that moment, I'm looking for reasons to not do it." "Not because I don't want to take care of the patient, because I just don't want to do the crap." "But that's fucked up, because I should want to take care of her." "I should want to do that LP now." "[McGarry] But that's the system." "That's not just County not the hospital's fault." "This is just the reality now of American health care." "We want privacy." "We want regulation." "We have these ways of auditing doctors and care here." "But really what it does is, in some ways, it prevents care." "[man] A lot of this has nothing to do with the change in space from there to here." "A lot of it has to do with the change in attitude for health" "Um, there is so little tolerance for mistakes." "Uh, there is so little tolerance for the learning curve." "There is so little tolerance for the imperfections that are out there." "A mistake made by a doctor-- a jury awarded a man more than a million dollars" "I m Ryan Saiontz" "If you suspect you were injured as a result of a medical-- [speaking Spanish] [man] OK, so tough things about this." "This is a work-related injury." "So these are usually always workers' comp issues." "Very commonly, they become malpractice issues, which is unfortunate for us." "So your chart will be looked at again so you need to make it look really good." "[Pomeranz] When I'm charting and I'm not charting to take care of the patient," "I'm charting for defense purposes, just all these things add up to be this kind of wall of bureaucracy." "[McGarry] I think it's mind-numbing." "That's honestly what it feels like to me." "As a doctor, the smallest fraction of what I do is to take care of patients." "And I think as we've grown, and we're about to graduate, we're not comfortable with this." "We became doctors to be with our patients." "And our entire system, the whole of it, isn't letting us do that." "What do you guys think?" "You're our resident leaders, as chief." "Are there ways that we can tangibly bring down the wait in the waiting room?" "My view, bringing the patients in toward us." "And not just any patients." "The sickest patients." "So the way it was done in the old hospital, the sickest patients were literally sitting right in front of you, within five feet." "And you always had eyes on." "Right?" "So just take North, 27 to 31." "We have five booths in there." "You scratch every single one of them and you move as many chairs into that same space as possible." "What you guys are saying is, you want to basically move beds, physically move out beds of the ER, put chairs there." "We want to know what the sickest patients that are waiting for a bed look like." "Even though, yes, it's not ideal, they're in chairs, we're getting them all started up." "I like this." "I think it's..." "My biggest problem is seeing the waiting room and having it be totally detached from the ED." "And scrolling through, page after page of our patients, yeah, it's a name." "You're a number." "You're an age." "And you're a belly pain." "And that's it." "So this is something that's going to require a lot of work on the part of the residents." "Because this is adding a large patient burden." "[Pomeranz] This is our fight as residents." "The fourth year and 1350 and C-Booth ran the whole department." "This is a step towards bringing that back." "[Cheng] It's something new" "It's never been done before here in LA County." "We're taking the sickest of the sick people out front" "No longer are they seeing a nurse." "No longer are they seeing what we're call a mid-level provider." "They're seeing a doctor." "They're seeing one of the house staff." "We're gonna make it known that we know that they are there." "We're gonna take care of them." "That's what this place is about." "[McGarry] So we start seeing patients directly from the waiting room." "Doctors talking to patients first, and the paperwork and crap coming last." "And all with a sense of urgency." "We're really hauling ass." "And we realize, oh, my God, this is" "This is just like C-Booth." "And it was amazing Literally, it was incredible." "Just a few weeks into it, the ER wait time actually started to drop." "In the end, this very simple concept had a way of renewing us." "Suddenly, we were practicing medicine for the reasons that we wanted to practice medicine in the first place:" "to serve, to help, to heal, and the attitude went beyond the 20-chair experiment." "And suddenly, in every case we approached in the ER, we felt this sense of adrenaline." "Airway's intact." " Come on in, chest x-ray." " BP's are..." "[McGarry] Adrenaline as a hormone has been shown, when people are in traumatic situations and car wrecks, and suddenly when they feel adrenaline, they only see what matters." "And I think that's sometimes ridiculously absent in all of health care." "We see everything but what matters." "The profit legal consequences legislative, that's not what anybody really cares about when it's time to see a doctor, and when you're a patient." "Squeeze my fingers on this side." "Hold on, hold on, hold on." "OK?" "[Eng] You work so hard to outsmart the system." "But the success of that project is heavily dependent on the well functioning of the other areas of our department." "And all it takes is one thing to kind of topple it all down." "[Henderson] We're 48 total nurses short And yesterday, instead of the 43 I was supposed to have, I got 28." "I can't do business like that." "So I closed East." "I also closed Adult Waiting." "From that, I gained four or five nurses, two nurses assistants, a clerk, and a PFS worker." "Not a big yield, for the impact that it's gonna have on the emergency department, but we have to do something to get the staff where we need it." "It's always multi-factoral." "When you change one thing, you have to anticipate the ripple effect." "It's not even a ripple effect." "It's the tsunami effect on all the other areas." "[indistinct chatter]" "OK, come on back." "[woman calling Hispanic name] [calling name again]" "They told me I got to..." "[indistinct]" "[McGarry] Since we've started the closure of the areas, we've been in Code Black for six days straight." "And even before that, we were in Code Black for up to half the time anyway." "The influx doesn't stop." "And here's what's scary" "It's not gonna go away anytime soon." "These people aren't seen as profitable" "And the system will always find a way to still see them as not profitable." "So on the front line, the feeling is we need help, we need to be overfunded, we need to be overstaffed." "Because we're this critical community resource, and right now we can't even run on all four cylinders." "[indistinct chatter]" "[Eng] It hurts." "Makes you wonder." "You know, I came here to see patients, and to have a whole unit close with no patients in it is..." "It's heartbreaking." "Soul-crushing, actually." "[Henderson] You would expect it if there was a health authority who understood that the problem we're having right now is that we can't get people in fast enough to meet a loss of staff, they'd say, "You know what?" "We have emergency subsection B for that." "Go."" "Instead, I am dealing with the county CEO, whose job it is to run the county." "Not the County hospital, but the county." "The whole thing." "All nine million people." "It's hard to exist with our unique mission, right next to the Department of Fish and Game and Department of Parks and Recreation and the school district and everybody else who is clamoring for the same attention, the same resources, the same money, the same fill in the blank." "[Cheng] We're in a tough fiscal situation right now across the country and the world." "And we are the ground." "We are seeing what's actually happening to the health care system." "I get really frustrated with the debate on health care, you know, at the national level." "The fact that the uninsured diabetic who doesn't get medications because they can't afford them shows up in the ER and has a heart attack." "You pay for their care." "You pay my salary." "You pay that of the nurse." "You pay for the medicines." "And if you had been willing to pay for pennies of insulin a day, or pennies of very cheap, inexpensive medications to manage their condition, you wouldn't be paying for their tens of thousands of dollars of care" "when they get really, really, really sick." "[McGarry] Ultimately, when you see our waiting room, you see people suffering, when you see other human beings in our country suffering, you go, I just don't see how this equates to," "at the end of a day, to business and money." "And I sometimes wish I could share that with anyone who wants to talk about health care." "Before we even debate about Republican or Democrat or Obamacare or not or whatever..." "wherever you stand on that, this notion of, look, at some point, it really is just about doing the right thing for somebody." "[man] A lot of people have no idea what a county hospital is or even what it stands for or what goes on here." "There are many people that have perceptions that county hospitals are all filled with only illegal immigrants." "And they are quite shocked when they come here and find a different reality." "We see a lot of working poor." "We see people willing to wait 15 to 20 hours and not going to work that day because they need to get medical care." "And this is the only place they can get medical care." "We see very rich, affluent people that suffer some type of illness lose their health insurance, and this is now their only access to medical care." "[woman] I mean, I have always had insurance all my life, except just recently when my business imploded." " [man] What was your profession?" " I'm an attorney." "Yeah." "And so my business was embezzled." "And because of the recession, now I've lost everything." "And, uh, here I am." "Now I can't even walk. [laughs]" "I don't know where I'm living, sort of living in my car." "[man] What are you gonna do next?" "Do you know?" "I'm 58." "I don't know." "[McGarry] In these times, it's not hard to believe that what separates us from having everything to losing everything is one pink slip, one bad loan, one unexpected tragedy." "It's an education that my classmates and I didn't count on." "But it's a reality we all have to face." "I'm just a young doctor, but to me, health care seems so broken and the barriers to fix it appear impossible." "I don't know much about politics or the economy, but I think I worry most about our spirit." "In all that divide, it feels empty, lost, abandoned." "Yet there are reminders all around us of what we have been able to achieve together." "My classmates and I are graduating, and as we figure out our roles in all this, we'll always remember a case from C-Booth." "A case that seemed impossible." "A case that we all could have easily given up on." "[man] All right, I got a little story for you." "I want to sort of see how you guys would handle this." "59-year-old male comes into your ER." "You do all of your ACLS stuff." "You're doing minimizing chest compressions." "You're, you know, doing everything you know how to do." "You're organizing well." "Nothing." "[machine beeping]" "Just shred it open." "There's no mess in there." " No." " Here's 20 units of..." " Awesome." "Perfect." " And two milligrams of epi." "[man] You're getting farther on." "He comes back, gets a faint pulse initially and loses it real quickly" "Continue doing your resuscitation." "It's now 30 minutes in." "You say,'man, this is not looking good.'" "All right." "We're charged to 50 joules." "You got that epi?" "Everybody clear?" "You're now at an hour into the code." "And you say, "Listen, this is futile."" "So it turns out that, uh, sometimes crazy things happen." "And some patients survive, and they actually become a big part of your life." "And so, I'd actually like you to meet Ralph, who is this patient." "Ralph, can you come on down?" "[applause]" "[McGarry] I think it's really easy to see a story like this and say that was a miracle." "But for us, watching that case was inspiring for something more." "At one time, a massive community came together despite barriers, despite complications, and simply did what was right." "Now, we're facing those same challenges" "And 80 years from now," "I really hope people look back at this place and say," "The best health care ideals blossomed here." "This is where we cared for each other and that's more important than anything." "[Eads] I'm constantly amazed by my colleagues here at LA County." "They're willing to change things about their institution in the name of taking care of patients and doing a better job for the people that need them." "The doctors of this hospital believe we can do better, that it's not a failed system, you know, that it can be fixed." "And you've got to have people who can believe first before you can actually make it happen." " OK, thank you, guys." " Easy with the change." "Wait a few breaths." "Don't over bag, don't over bag." "Yes, we're gonna get you something else for the pain, OK?" "♪ You crossed this line ♪" "♪ Do you find it hard to sit with me tonight?" "♪" "♪ I've walked these miles but I've walked them straight-lined ♪" "♪ You'll never know what it's like to be ♪" "♪ Fine ♪" "♪ I'm wasting my young years ♪" "♪ It doesn't matter if ♪" "♪ I'm chasing old ideas ♪" "♪ It doesn't matter if ♪" "♪ Maybe ♪" "♪ We are ♪" "♪ We are ♪" "♪ Maybe I'm wasting my young years ♪" "♪ Maybe ♪" "♪ We are ♪" "♪ We are ♪" "♪ Maybe I'm wasting my young ♪" "♪ Years ♪" "♪ Don't you know that it's only fear ♪" "♪ I wouldn't worry ♪" "♪ You have all your life ♪" "♪ I've heard it takes some time to get ♪" "♪ It right ♪" "♪ I'm wasting my young years ♪" "♪ It doesn't matter if ♪" "♪ I'm chasing old ideas ♪" "♪ It doesn't matter if ♪" "♪ Maybe ♪" "♪ We are ♪" "♪ We are ♪" "♪ Maybe I'm wasting my young years ♪" "♪ Maybe ♪" "♪ We are ♪" "♪ We are ♪" "♪ Maybe I'm wasting my young ♪" "♪ Years ♪" "♪ I don't know what you want ♪" "♪ Don't leave me hanging on ♪" "♪ Don't know what you want ♪" "♪ Don't leave me hanging on ♪"