"__" "_" "_" "I'm confused." "Why am I cleaning up the mess from last shift?" "Because, Dr. Savetti, you're a resident, and your mama said so." "Dr. Pineda, tell him what else I say." "If you want to be part of a team..." "No job is too big, no job is too small." "Being an emergency-room physician requires humility." "And like a firefighter cleans his rig, you clean yours." "This is Center Stage." "It demands your respect." "Sorry, Dr. Lorenson, but did you want to lay down?" "No." "Uh, no." "I didn't..." "I don't want to lay down." "Because if you're tired, your mama could read you a bedtime story." "No." "Just there's a lot of blood on these sheets." "You know, the Buddhists, they use manual labor as a way to meditate, to bring them closer to the world they inhabit." "Or, as Mr. Miyagi said, "wax on, wax off."" "Who's Mr. Miyagi?" ""The karate kid"?" "It's from the '80s." "Right, Christa?" "Funny." "Okay, little serious talk before our shift starts." "It's Saturday night, which means we're gonna see some things before the sun comes up." "For you first-year residents especially, remember, the first pulse you check is always your own." "When it gets rough, make sure to breathe." "Remember, oxygen is the first drug we give our patients." "Same for you." "Lean on each other." "That's what siblings are for." "Lean on me." "That's what your mama's for." " Evening, Dr. Rorish." " Evening, mama." "We've got two incoming, five minutes out." "Let's clean it up, glove it up, and go." "Meet me at the bay doors." "You heard your daddy." "Let's go save the people of Los Angeles." "I am making a formal complaint about this." "Are you sure you want to do that, Mario?" "Angus is right." "Last couple years, half the residents didn't make it." "How do you know so much?" "How do you not know this?" "Malaya was here for medical school and her internship." "Be nice." "Dr. Rorish likes her." "Oh." "Then you were here for Dr. Rorish's accident." " Her family." " That's none of our business." "Wait, wait, wait, wait." "What..." "what are you talking about?" "Car accident." "Bad one." "Minivan rolled down an embankment." "Oh, my god." "Whole family." "Plenty of O-neg." "You get any sleep today?" "Yeah." " I know when you're lying." " No, you don't." "You have a tell." "Yeah?" "What's my tell?" "I'm not giving that up." "Then you'll stop doing it, I won't know when you're lying." "You think you're so smart." "You're so dumb." "You're the dumbest person I ever known." "Stop talking." "This isn't gossip." "I'm sorry." "I didn't know you two were besties now." "I'm with Christa." "I don't think we should talk about it." "You four, you're gonna continue to shadow and assist me and Dr. Hudson until that board gets to code black, and then we're freeballing it." "I'll take the first one." "Dr. Lorenson, Dr. Savetti, go with Dr. Hudson." "And you two, you're with me." "All right." "Let's go." "We got it." "All right." "Set her down easy." "What have you got?" "Car versus car, head-on." "27-year-old female, multiple neck lacerations." "One 6-centimeter in zone three, probable arterial source there." "EBL 400 cc." " What's her name?" " Laura halloran." "She's in and out." "Laura, can you hear me?" "I'm Dr. Hudson." "I'm gonna help you." "Coming in now." "Risa, monitor, O2, lac tray with a Yankauer." " Start two liters of N.S. Wide open." " Copy that." "High-speed MVC with a positive PSI, unrestrained." "Significant crepitus throughout the chest and neck." "On my count." "One, and two, three." "Two, three." "Mid-80s on 25 meters, GCS 13." "Please." "I can't die." "What's your name, sir?" "J-J-Jake." "Jake Willis." "Jake, Jake, I need you to calm down for me, okay?" "Please!" "My family, they cannot get by without me." "My wife, Becca, she takes care of my daughter." "She doesn't... she doesn't w..." "He's out." "All right." "Dr. Pineda, intubate, please." "On it." "Ah." "God, I'm surprised he was conscious at all." "Look at this." "Okay, I'll need bilateral chest tube, large bore in case there's blood." " 32 French." " Let's get ready to roll him." " Brisk facial bleeding." " And on my count." " One, two, three, roll." " Glass embedded pretty much everywhere." "Okay." "We're gonna need to roll her off the board." "Carefully, she might have a C-spine injury." "Dr. Lorenson, I need you to hold that neck like it's disconnected." "It might be." "On my count, everybody." "One, two, three." "Easy." "Easy." " You got it?" " Yeah." "Got..." " Whoa, whoa." "Whoa, whoa." " Let's go." "Slowly." "Slowly." "Thank you." "Spine's good." "Okay." "Down we go." "Dr. Savetti, what's your next move?" " Ultrasound the abdomen, see if there's any fluid." " Very good." "Dr. Lorenson, we're gonna find the artery up here and tie it off." "Grab a Kelly, forceps, and some 3-0 prolene." "You know what I asked for?" "Yes or no?" "Yes." "Yes, I just..." " The Kelly." "It's on the tray second from the right." " Yes." "Yes." "I... yes." "Can't hesitate." "Not ever." " Abdomen's clear." "No fluid." " Very good." "Dr. Rorish will need that at the next table." "Suction, please." "Let's clear the field." "And..." "I'm in." "All right." "Okay, bag it up." "Dr. Pineda, hand off to Dr. Leighton." "I need you down here, please." "He's awake." "He's not awake." "Look at his vitals." "It's just a reflex." "We got you, Jake." "You hear me now?" "Stay with us." "Hey, uh, Jesse, let's make sure he's down." "Push another 10 of etomidate, please." "He's not coming up over 80%." "His chest is hardly rising." "All right." "Positive for pericardial fluid." "Plenty of it." "Dr. Leighton, stop." "Put the bag down." "Okay?" "You're decreasing his ICP by hyperventilating him." "Six breaths a minute, that's all he needs." "It's okay." "Just hold it there." "It's okay." "Just slow down." "Uh, we need to get him upstairs." " Jesse, notify the O.R." " Okay." "See that?" "The artery." "The maxillary artery, to be precise." "It branches out from the external carotid." "It's a real bitch." "But in a couple of seconds..." " It's our bitch." " Precisely." "More dependant fluid in the lungs, left worse than right." "He's gonna die on the elevator." "Likely, yes." "I need a thoracotomy tray." "You're gonna open up his chest?" "You got a better idea?" "I could use the assist." "Dr. Savetti, get back here." "You and Dr. Lorenson close." "Who can tell me what we're doing?" "Dr. Pineda?" "A thoracotomy..." "A clamshell, right and left chest open." "That's right." "Why?" "Dr. Leighton?" "Uh, only way to stop the internal bleeding" " is to go in now." " That's right." "Guys, the thoracotomy is the mother of all E.R. procedures." "Only 5% success rate in E.R.s nationwide." "Don't need all the facts, Malaya." "We are the statistical anomaly." "Jesse, I need, uh, six units of O-neg, please," " through the level-one." " Already here." "All right." "Push it through both 18s, please." "All right." "Scalpel." "Okay." "All right." "Jesse." "Okay." "We're gonna spread the ribs now." "Whoa." "Then... then push the lungs aside." "Dr. Leighton, take the other side, please." "10 blade, please." "Okay." "Now, watch Dr. Hudson." "He's about to reveal the pericardium, the sac around the heart." "You've done a lot of these?" "No." "First one." "That's comforting." "Dr. Hudson has done more than most." "He did a surgical residency before he moved to E.R." "Opening the pericardium now." "Now, the... wait, there it is." "There it is." "For those of you who can see, look, see that laceration right there above the proximal aorta?" "Cross clamp, please." "Okay, we're cross-clamping it." "It'll divert the blood above the opening to the brain, which needs perfusion the most right now." "No cardiac activity." "Dr. Leighton, can you inject with intracardiac epinephrine, please?" "Go ahead." "Dr. Pineda, get your hands in here." " Really?" " Yeah, get your hands in." "Put them around the heart really gently, and you're gonna massage it." "Oh, my god." "I feel it." "It's beating now." "It's beating without me." "Okay, you got a rhythm there." "Synced by emmasan" "Lab results for your MVA head injury." " Thanks." " Mm-hmm." "That's odd." " Wait, did she say those are Laura Halloran's labs?" " Yeah." "What's wrong?" "She has a lactate of 4." "Maybe she had too much wine last night." "Or it's an early sign of organ death." "But, uh, question is which organ?" "Excuse me, why is this patient still in Trauma One?" "Evening, Dr. Taylor." "Oh, sorry, I forgot my salutation." "How you doing?" "Now, why hasn't she been admitted yet?" "'Cause, uh, something's bothering me." "Well, something's bothering me, too." "Hemorrhoids." "My ass is on fire." "Do I get a bed in Trauma One for that?" "I can't send the patient upstairs till I know what's wrong." "Well, what is it that Dr. Rorish always says?" "We're the first 10 minutes." "Well, this one is in minute 11." "So let's ship her out." "Hang on." "Something in her isn't getting enough blood." "You heard Taylor." "He's the director of the E.R." "Yeah." "And this is our patient." "Let's, uh, get her to CT." "I want a pan scan..." "Head, neck, chest, ab/pelvis." "You got it." "Mario, you're with me." "Whoa." "That's Brian Wellborn." "Friend of yours?" "Hockey player." "L.A. Rays." "Well, in here, he's just a patient." "26-year-old male was found unconscious at the gym." "He was awake when we arrived, but initially lethargic and confused." "GCS 13, FGS 110." "I wasn't unconscious." "I laid down for a few minutes," "I woke up in a freaking ambulance." "Has this happened to you before?" "Nothing happened to me." "Were you listening?" "I was." "But given how upset you are," "I'm surprised that you even got into the ambulance, unless you weren't completely lucid at the time." "I've been working out like crazy, dieting, getting ready for the new season." "I overdid it." "End of story." "What do you want to do, doctor?" "Take a history, examine him." " Good." " You're not serious." "If your car broke down, you want to look under the hood, right?" "Mr. Wellborn, you're here now." "We can't let you leave until we've at least done a basic exam." "What do you mean you can't let me leave?" "It's the law." "We need to make sure you're not a danger to yourself or to others." "It's routine." "I need to call my team doctor." "I left my phone back in the locker room at the gym." "We'll hook you up with a phone, buddy." "Evaluate and get back to me." "And remember what I said." "Totally." "Go." "You take care of her at the nursing home?" "She's a nice lady, but she is confused and very willful." "You have a nice face." "So do you." " Alzheimer's?" " Dementia." "She have a good heart, but she wanted to go out for the day, like a field trip, and we don't do that." "But she don't take no for an answer, so she swallowed the money." "What do you mean she swallowed the money?" "She took a bunch of coins and swallowed them." "They're inside her right now." "She ate them so she'd get out for the day?" "$3.80." "We do what we got to do, right?" "Right as rain." "Why didn't you just give her a laxative and wait it out?" "Now that she's here, she's here until she passes them." "The rules say we can't discharge any patient with a foreign object inside of them." "But you already knew that, didn't you?" "We have so many patients and not enough staff." "I can't be taking her to the toilet every five minutes." "You think we can?" "Call us when she's ready to get picked up, hmm?" "Mrs. Perez." "Mrs. Perez, please." " Excuse me." " Can I help you?" "I got a call my husband was in, uh, an accident?" "Jake Willis." "Is he okay?" "Let me get his doctor for you." "Oh, god, is he..." "Mrs. Willis, please don't read into anything I say." "I'm not directly familiar with the case." "I simply don't know." "If you'll wait, I'll get Dr. Rorish." "I was at the Edmonton game." "Which one?" "Which one?" "The no-look backhander." "It was unbelievable." "Are we almost done here?" "Open your mouth for me." "What's my mouth got to do with anything?" "I'm a resident, okay?" "I don't check everything out..." "Yeah, fine, you want to look at my mouth?" "Here." "Occupational hazard." "Tongue out." "Ah." "You're right." "You didn't pass out." "Told ya." "Done here?" "You had a seizure." "Whoa, whoa, whoa, whoa." "How'd you come up with seizure, huh?" "Looking in my mouth?" "You believe this guy?" "You bit your tongue." "And it looks like it's happened before." "Am I right?" "So, he's alive?" "He's alive." "Oh, thank god." "I don't know what we would do if anything happened to him." "Would you rather speak privately?" "I can have a nurse come watch your daughter." "We'll..." "No, no, no, no." "Tara needs me around." "She's calm now, but..." "Is Jake gonna be okay?" "The truth is we don't know yet." "But you said you fixed him." "I said we stabilized him." "Unfortunately, now we..." "just... have to wait." "Tara's father left just after she was diagnosed." "He said it wasn't what he signed up for." "Can you believe that?" "I didn't know what to do." "I tried to work, but she needed me." "Honestly, I..." "I didn't know if we would make it." "And that's when I met Jake." "Do you know where he was going tonight?" "He was gonna sign them up to take dance classes together." "I told him he didn't have to do that." "I think I insulted him." "And he said, "no, she's my daughter." "It's what I signed up for."" ""It's what I signed up for."" "I'll let you know when he's out of surgery." "She swallowed them?" "How else would they get there?" "All right, gang." "She leaves when she's empty." "Dr. Leighton, you'll go first." "First for what?" "I gave her a mild laxative about 30 minutes ago." "Eugh." "Looks like the slot machine's ready to start paying off." "Nothing." "Maybe you were right." "I trust your hunches more than mine." "Well, we can all be wrong." "Leanne, do you have a moment?" "Oh, don't look." "Gangrenous toe." "Gangrene is my jam." "Is that so?" "You needed something?" "Sorry." "Yeah, that, uh, female MVC has a lactate of 4." "What are you thinking?" "Organ ischemia?" "Yeah, but the pan scan is negative." "Wouldn't ischemia show up?" "Not necessarily." "Any evidence of abdominal trauma from the accident?" " No." " Huh." "Then what could've caused it?" "Unless..." "It wasn't caused by the accident." "Ohh." "I was on my way here." "You were on your way to the hospital?" "The pain was sudden, and..." "and so intense, I threw up." "Appendix?" "No, I don't think so." " Risa, I need the ultrasound." " Flying in." "You think it's internal bleeding?" "GP won't show up on ultrasound." "Very good." "But no." "We're not looking for blood." "I have a hunch." "Oh, that's interesting." "You... you don't have a right ovary." "No, just... just a left." "Why?" "Is something wrong with it?" "Look." "There should be a rainbow of flashing colors here on the left, coursing through her left ovary." "But there's nothing." "It's just darkness." "Torsion?" "Laura, your ovary is twisted, cutting off the blood flow." "It's called a torsion." "Is it dangerous?" "I need to know when the pain started..." "Exactly when." "Um..." "I was..." "I was moving some... some boxes from my basement." "It was around 9:00." "I came straight from there." "An ovary has about six hours it can survive without oxygen." "That means, if we're lucky, we have about three hours to detorse it, or..." "I'll lose it?" "I'm afraid so, yeah." "Can I ask you what happened to your other ovary?" "They said it was a-a teratoma." "Happened a few years ago." "My late husband and I had been having some fertility problems, and..." "Nobody available right now from O.B." "Laura, we're gonna need to contact your obstetrician, okay?" "Um, I've been going to a clinic in San Francisco." "I fly out once a month." "For fertility?" "You said it was your late husband?" "It is." "It's where we froze Noah's sperm before he got sick." "I can't lose this ovary." "Please." "I would like to see his chart, and please let the E.R. director know" "I'm here and would like to see him." "Who the hell are you?" "Who are you?" "A resident." "So, are you the genius who diagnosed this man with seizures?" "Again, who are you?" "I'm his team doctor." "Oh, I get it." " You get what?" " Seizures mean he can't play." "I didn't have a damn seizure." "Correct." "In fact, I want it stricken from his chart right now." "That's against the law, and a real doctor would know that." "Who do you think you're talking to?" "Brian, settle down." "I'm Jesse Sallander, senior E.R. nurse." " Can I help you?" " Yes." "I'm checking my patient out, but I would like a chart revision first." " Chart revision?" " Yeah, a chart revision." "Hey, man, we're trying to help you." "Help me?" "Oh, you think I need your help?" "Dr. Savetti, you don't want to do this." "Believe me." "Enough." "Savetti, step out, please." " Come on, me?" " Now, son." "Are you the attending?" "I'm Dr. Edward Darius." "I'm..." "Whoever you think you are, you have zero authority in here." "I play racquetball with Ed Harbert, C.E.O. of this hospital." "Did you know only 1% of all males can perform auto-fellatio?" "You, sir, have a serious medical issue, and it does need to be addressed, but this isn't a jail, and we can't keep you here..." "Ah, he's seizing." " He's seizing." " I got him." "Ohh." " Easy." "Easy." " I need a face mask at 25 liters." "2 mgs of Ativan, please." "There it is." "Put it on." "Put it on, please." "Interested in knowing how your patient is doing, the hockey player?" "Sure." "Had a pretty rough seizure, but it's over now, and he's resting." "And Dr. Darius?" "Taylor and Rorish kicked him out." "Glad I'm not the only one that got booted." "You ever see "An Officer and A Gentleman"?" "What?" "The movie "An Officer and A Gentleman"?" "No." "Richard Gere plays this guy named Mayonnaise." "Mayonnaise?" "Yeah, 'cause his last name is Mayo, and he's white." "Now, Mayonnaise joins the Navy to fly jets." "See, he's good at almost everything." "Fastest runner, best fighter, smart, and fearless." "Now, if the movie were just called "An Officer,"" "he'd be just fine." "But it's not." "It's called "An Officer and A Gentleman,"" "which means you have some things to learn." "Like what?" "Humility, patience, kindness, charity." "You know, the big ones." "You saying I'm Mayonnaise?" "Well, you ain't Lou Gossett." "I know the neighborhood you come from, bro." "Only thing that gets through those walls is a bullet, which means the only way out is to become a bullet." "You got out." "And you're here now." "You can't be a bullet anymore, you understand?" "I'm out." "Hey." "Person." "Christa." "Really?" "I'd have thought Susan." "Uh, O.B. called." "There's an open O.R." "That's great." "That's great news." "Hold your water." "There's no available surgeons." "But that doesn't help me." "I'm not here to help you." "Yeah, was in a diabetic coma when he came in." "25 cents." "You got off easy." "It was all nickels." "Cough for me?" "Puede toser, por favor?" "An O.R. opened up." "But there are no available surgeons." "For Laura Halloran." "The torsion?" "How much time do we have?" "Uh, perdo." "No... no English." "We have about 90 minutes till she loses the ovary." "Do you know how long she and her husband wanted to have children together?" "20 years." "How is that possible?" "She's only 27." "They met in the third grade." "Third grade." "Yeah." "Grab a tissue." "I'm not done." "Dr. Hudson, laceration right leg." "Sides east 2." "You think you can handle that one?" "It's a fairy tale, right?" "Until he gets diagnosed with stage IV lymphoma two years ago." " Dislocated shoulder, sides south 1." " Seriously?" "We're in code red." "Buckle up." "He froze his sperm before chemo and radiation." "He died last year, and it's all she has left of him." "Christa, I sympathize, but with no one to perform surgery..." "That's the thing." "You can do it." " Me?" " Yes." "You did a surgical residency." "You must have done an O.B. rotation." "I'm not a surgeon." "I don't have surgical privileges." "Look, I'm sorry." "But there's really nothing we can do for her right now." "You have patients." "Mario." "Dr. Rorish, listen, sorry about before..." " Here." " What's this?" "It's Wellborn's CT results." "Parenchymal hemorrhages?" " Go tell him." " Me?" "Can you be professional?" "Yes, of course." "Thank you." "Don't thank me." "This isn't a gesture." "We're about to be in code black." "He's your patient, your responsibility." "Go do your job." "Mr. Rocksickler." "Stan." "I'm sorry for the wait out there." "It must've been a long night." "Night?" "I've been here for 10 hours." "My back's killing me." "Is there anything you can give me?" "How long have you had the pain?" "On and off the past few months." "Finally got so bad in the last week," "I couldn't take it anymore." "I feel like it's broken or something." "Eh, it sounds like it worsened pretty dramatically." "I'll say." " You work in construction?" " Yeah." "Lot of heavy lifting?" "Oh, yeah." "Sounds like a persistent muscle spasm." "Maybe." "Heart rate 110." "What... what if it's not his back?" "What if it's his heart?" "Dude, that heart rate is barely elevated." "This is not a zebra." "It's a plain old horse." "At best, he gets a few Percocet and maybe a CT of his back." "I don't know." "It seems to be that an event that changes rapidly like he's describing is not a musculoskeletal problem." "If it's not cardiac, maybe it's vascular." "What do you have?" "Patient came in with persistent yet worsening back pain." "He had a long wait..." "10 hours... which didn't help." "To me, it sounds like a muscle spasm, or, at worst, a compression fracture of the spine." "Which is probably common in his line of work." "I think a CT of his back would be the right precaution." "Sounds right." "Get him scanned." "Let me know what comes back." "Dude, you could've told her your theory." " I don't have a theory." " Yes, you do." "But you don't believe me." "Let's get the CT." "Excuse me." "Get the hell out of here." "I want the real doctor." "You've had a series of parenchymal hemorrhages." "You just learn that word?" "They're small bleeds in your brain caused by multiple concussions." "I hit hard." "Well, the blows to your head have created a serious problem." "Darius said he's got medicine." "The medication will mitigate it, yeah." "All right." "So, can I get out of here now?" "You need to know that the medication should stop the seizures, but it won't reverse the damage that's already been done." "The next concussion could kill you." "What?" "What are you saying?" "I'm saying you can never play hockey again." "Not if you want to live." "I'm sorry." "I really am." "They have an open O.R., but they have no surgeons." "We still have an hour to save the ovary." "There's an option." "Dr. Hudson did a surgical residency..." "But he's not a surgeon." "Why is everybody saying no to this?" "We can help her." "One of the hardest parts about this job is prioritizing patient need." "She's ESI-2, non-life threatening." "As long as there's an ESI-1 patient in front of her, she has to wait." "What do you got?" "14-year-old male." "Climbing accident." "At 2:00 A.M.?" "We were doing the annual full moon climb at Scarbo Canyon." "He fell 15 feet." "Face hit the ground hard." "His nose hasn't stopped bleeding." " And who are you?" " His father." "Persistent epistaxis." "EBL is north of 200 cc." "Tried anterior packing, but no luck." " Uh-huh." " He's on Coumadin." "Coumadin." "Sir, why is your son on blood thinners?" "He had blood clots on his retinas when he was 4." " Just roll him." " Okay, hang on." "Ready." "Ready?" "And, one, two, three." "Easy." "Mind the board." "I got it." "Clear." "Jesse, suction, please." "Careful." "We need to tamponade this bleeding." "Flying in." "Come on." "Blood clots on his retinas?" "Is he blind?" "Not totally." "He sees shapes." "He's blind, and you took him climbing?" " Not our business, Dr. Lorenson." " I'm sorry." "Okay." "Jesse, prep some PCC at 50 units per kilogram and send off coags, type and cross stat." "He's gonna be okay, right?" "Uh, his blood isn't clotting because of the thinners." "Uh, I need more nasal packs, please." " Page E.N.T., please." " Paging now." "Let's get six units in the can." "Hey, Jesse, I don't know if I can get this bleeding under control." "Blood bank out of O-neg." "We're waiting on more from county." "Okay." "Blood pressure's tanking." "We're gonna need that blood." "This kid's tank is gonna run dry unless we find a way to..." "Whoa, whoa!" "Whoa, whoa, whoa, whoa." "Get him down." "Get him down." "Get him down." "Okay, get him down." "Get him down." "Get him down." "Watch his head." "Okay, so, even in a significant bleed, "A-B-C" applies." "Airway's always first." "Dr. Lorenson, I want you to clamp open the nares while Jesse suctions inside." "We need to find the source of the bleed, okay?" "If we're lucky, it'll be in his anterior and we'll be able to see it." "But if it's posterior, which I fear it is, then..." "Blood pressure's tanking." "Damn it." "We need that blood." "Unless we find a way to..." "Get me two urinary catheters." " Urinary catheters?" " Two folies." "Now, please." "Okay, we're gonna make a tamponade." " Dr. Lorenson?" " Yeah." "Give me that coffee over there." "Right there." "Right there." "I need any liquid, and I need it now, all right?" "We just need it to inflate the balloon inside the nose." "Sorry." " See how the balloon conforms to the cavity in the nose..." " Mm-hmm." "And packs the bleed." "Blood supply coming up the ramp now." " About time." " Sorry." " Pressure's stabilizing." " Got it." "Got it." "Okay?" "A perfect tamponade." "All right?" "It's gonna work." "Now we give him more PCC and, uh, reverse the anti-coag, and... and we get him upstairs." "Phew!" "What's this for?" "Well, you're up next, kid." "And you better hurry." "She says she's got a turtle sticking its head out." "Excuse me?" "She's got thumbelina in a headlock." "Look, just get moving, blondie, or we're gonna have a mudslide in here." "Just let me know when the anesthesiologist gets here..." "Still touch and go..." "Oh." "Ohh." "Yeah?" "All right." "Oh." "Coming through." "Sign there." "Do you think that I'm a terrible father for taking my blind son climbing?" "I think Harley's lucky to have a father who doesn't have a blind son." "He has a son." "Enjoy every minute." "Trust me." "Okay, just hear me out." "Just hear me out." "I may be personalizing the torsion... fine." "But Dr. Rorish, even if you had just one chance to get back what you lost, anything..." "We are not here to fix the events of our own lives, Christa." "The last thing you want to do in this job is make it about you." "I don't believe a word of that." "Excuse me?" "I lost my son, my husband left me, and you lost... you said..." "No, I didn't say anything." "You don't know a thing about me, Dr. Lorenson." "We're not friends." "I-I'm the director of the residency program, you're a resident." "Fine, but I heard what you said to that kid's father, and you were right." "Hold onto the people we love, because you never know when they're gonna slip away." "What's going on?" "She wants you to do the detorse." "Yeah, she told me." "I'm sorry." "He was the love of her life." "I just want to help her." "Taylor would have to sign off on it." "Wait." "What?" "It would have to be fast." "Can you do it laparoscopically?" "Laparoscope was my jam." "Don't ask Taylor." "It's easier to ask for forgiveness than it is permission." " Thank you." "Thank you." " Go." "Clock is ticking." "You know in high school when they have career day?" "I wasn't there." "I was too busy winning State." "Hell am I supposed to do if I'm not playing hockey?" "You know, there's a woman here who just became a doctor at 40." "Oh, I'm gonna be a doctor now?" "You can do anything you want, you put your mind to it." "Who told you that?" "You did." "After Edmonton, a reporter asked if that goal was dumb luck." "You said it was smart luck." "He asked you what you meant." "You said, "smart luck is when you work your ass off so when the opportunity presents itself, you don't have to pray for dumb luck."" "You can be anything you want to be, man." "Trust me." "I'm living proof." "Guys, your patient in CT's going sideways." "Rocksickler?" "The one with the back problem." "Wait, what do you mean sideways?" "They just said get up there stat." "Find Dr. Rorish." "Oh, no." "Angus, this was your hunch." "You were right." "We don't know that." "Take his pulse in the right hand." "I'll grab the left." "Ow!" "I have a pulse." "I don't." "You know what that means." " It's bounding." " God, you knew it!" " Knew what?" "What's happening?" " We need an attending in here now!" " We have to be sure we're right." " We are right." "Guys, he's already on the scanner." "Run his chest, CTA down to T10." "We have to make sure that we're right." "Malaya, we don't have time for that!" "Somebody tell me what's happening!" "We think you're having an aortic dissection." "The pain in your back is actually being caused by the vertical splitting of your aorta, the main artery in your heart." "Am I gonna die?" "Definitely not." "Oh, god." "Get him out of here." "Get him out of here!" "Malaya, get in here now!" "Get me a paracentesis kit!" "It's the harpoon with the syringe at the end of it." "I know what a paracentesis kit is!" "I just can't believe this is happening." "Believe it." "This is happening." " He's crumping!" " I know!" "What the hell are you doing?" "Elevated white count over 18,000 with a left shift." "Let's, uh, get her into trendelenburg position, please." "Right away, doctor." "This allows gravity to move the bowel up out of the pelvis and lower abdomen." "Uh, Christa, can you hand me the veress needle?" "Okay, Stan." "I'm gonna have to put this needle into your chest to drain the blood that is crushing your heart." "We're gonna monitor it on the ultrasound to make sure we don't penetrate the heart wall." " What can I do?" " Grab a collection tube." "There could be a liter or more of blood in there." " He's unconscious." " Better for him." "Okay, guys, we've got one shot at this or he's dead." "Understood?" "Understood." "All right." "I'm putting the needle in now." "You see what I mean?" "That dark, black ribbon around the heart?" "That's blood, and lots of it." "There's our needle." "See it?" "We're in the tube now." "See that blue color?" "That's the tube not getting enough blood." "Just like a kinked garden hose." "So let's find the spot where it's kinked." "There." "That's it." "Now, with this hand, I'm gonna move the probe up to the tip of the ovary and just flip it over." "Now watch." "The blood should flow into the ovary, and the color will change." "Any second." "There you go." "You want to drive?" "Come here." "Take the wand." "And the camera." "Gently." "Now you're slowly gonna back the camera out." "Okay." "And watch the image." "Why did you ever leave surgery?" "Ah, long story." "Okay, now you're gonna pull it all the way out through the port." "Gentle." "Now just ease the sleeve out." "What's happening?" " Step out." " Did I do that?" "No." "I must've nicked a vessel when I put the sleeve in." "The sleeve kept the pressure on." "Uh, we're gonna have to open her up." "Can we have a surgical tray, please?" "I'm gonna puncture the sac now." "Fingers crossed." "There it is." "I'm in." "Pull back on the syringe." "Hear that sound?" "It's working." "Blood pressure's tanking." "Let's, uh, squeeze some fluids into her." "Starting the incision now." "Wait." "What?" " Urinary catheter." " What are you talking about?" "It's what Dr. Rorish used with that kid with the nose bleed." "She fed the catheter, and she filled it with liquid to put pressure on the artery." "Can we... can do the same thing here?" "I believe we can." "Is there a foley on that cart?" "Okay." "Okay, let's get it in through the port." "Dr. Lorenson..." "You're gonna squeeze the fluids on my mark." "Now, please." "Push the fluids in." "Look at her BP." "It's working." "Yeah." "It worked." "Very well done, doctor." "Very well done." "If you're ready to go home," "I'll call them to come pick you up." "Growing old is a swirling toilet bowl." "Best you can do is cling to the rim." "Am I right?" "Right as rain, kid." "Right as rain." "You got ice cream in this joint?" "I think we can make that happen." "Dr. Rorish?" "It's my fault." "Angus had a feeling that it was an aortic dissection." "Why didn't you act on it?" "I-I wasn't sure." "I-I guess." "Both of you listen to me very closely." "There are certain things you never, ever want to see on a CT scan." "An aortic dissection is one of them." "Why?" "Because if you took the time to take a picture, it means you didn't act fast enough." "Your instinct has to be sharper than your scalpel and faster than any machine." "You ignore those instincts at your peril and theirs." "Did it work?" "Yes." "Things got complicated, but..." "But it worked." "It appears so." "I hope everything works out for you." "Thank you, doctor." "She's gonna be okay." "I know." "Then why are you crying?" "I'm not." "You may be my boss and my teacher, and I may be overstepping, but you and I, we are in the same club." "And this stuff matters to us." "It matters." "You have a patient in real trouble." "Death's door." "You're so panicked that you can no longer tell the difference between instinct and raw fear." "But a voice somewhere deep inside you whispers," ""I can still bring him back." "I've got one more move left."" "Here's a secret." "If you hear that voice, it means you're in the right place, you're in the right job." "You're home." "24 hours ago, we had a patient just like that." "We opened up his heart right here in this room." "He'd like to meet you." "Thank you so much." "Thank you." "Thank you." "Synced by emmasan"