Quotes

7:00 A.M. [1.01]

Dr. Michael "Robby" Robinavitch: Actually, this is the most important person that you're gonna meet today. This is Dana. She's our charge nurse. She is the ringleader of our circus. Do what she says, when she says it. As you can see, our house is always packed, and our department is mostly clogged up with boarders. Those are admitted patients waiting for a room upstairs, sometimes for days. Beds are a very precious commodity around here, so please be quick and efficient with your workups. What else? We treat the sicker patients back here, but please keep your eye on that waiting room. Make sure nobody's gonna die out there. Your senior residents are Dr. Collins and Dr. Langdon. You report to them, and they report to me. Senior residents, you got your sign-outs? Dr. Heather Collins: Yep. Dr. Frank Langdon: Yep. Robby: OK. Let's do this.

7:00 A.M. [1.01]

Dr. Cassie McKay: Patients, they check in for registration here. A nurse eyeballs them, makes sure they're not dying. If not, they're moved to one of two triage rooms for vitals and a quick chair exam where you can order your labs and your X-rays. And then they come back to Waiting room, until a bed opens up. MS3 Victoria Javadi: For how long? McKay: Eight hours, if they're lucky. A lot of times, 12. MS4 Dennis Whitaker: Uh, is it always this busy? McKay: Uh, no. It gets a lot busier.

7:00 A.M. [1.01]

Gloria Underwood: We need to talk about your numbers. Robby: Of people we've saved? Gloria: Metrics. Robby: Our door-to-balloon times beat federal standards. Gloria: I'm talking about Press Ganey scores. Patient satisfaction. Robby: If they're still alive, they should be satisfied. Gloria: Our goal is 36% very satisfied with their care. Your department is at 8%. Do you know how likely patients are to recommend this hospital? Robby: This is an emergency department, not a Taco Bell. Gloria: 11%. Robby: Well, if you want people to be happier, don't make 'em wait for 12 hours. Gloria: There's a nursing shortage across the country. Robby: Most of our patients are boarders who are waiting for a bed upstairs. Gloria: We don't have the beds. Robby: That's bullshit. The beds are up there. You just don't want to hire the staff you need to care for them. Gloria: Like I said, there's a nursing shortage. Robby: Well, if you paid them a living wage, they'd be lining up to work here. Gloria: Our budg

7:00 A.M. [1.01]

Otis Williams: Am I gonna be OK? McKay: Yeah. You just need to take it easy on yourself. Muscle breakdown and myoglobin damaged your kidneys. Otis Williams: Why'd you shock my heart? McKay: When your kidneys don't work, potassium builds up and messes with the electrical activity in your heart. Otis Williams: Can it happen again? McKay: We gave you medicine to lower your potassium, and you'll need dialysis to clear it all out. Otis Williams: Then I'll be OK? McKay: Yeah. You might need a week or two for your kidneys to recover, but yeah. You really need to hydrate like crazy before and after a triathlon. Otis Williams: Trust me, I won't let this happen again. McKay: Good. Be kind to yourself.

7:00 A.M. [1.01]

One of the things we do here is to take a moment of silence when we lose a patient, to respect their humanity. And also to remember that this was somebody's child, or sibling, or parent, or friend.

8:00 A.M. [1.02]

Gloria: Is it true? ... Robinavitch: You have to be more specific. Gloria: Are there rats in the ED? Robinavitch: Apparently, if somebody already snitched! Gloria: Do you know how bad this looks? One more reason to shutter this place. Only the emergency department admits rats. Robinavitch: Emergency department would never admit rats, unless they had the right insurance. Gloria: Did you catch any of them? Robinavitch: One, and I charged him for a full visit. Gloria: I'm glad you think this is funny. Robinavitch: I'm sorry that you don't. Gloria: Did you call an exterminator? Robinavitch: He's waiting on a second opinion. Gloria: [chuckles] You're pushing your luck today. Robinavitch: Don't worry. Last I heard, they were headed for the cafeteria, so they should be dead within the hour. Gloria: OK. Robinavitch: I'll be here all week. Gloria: Or maybe not.

8:00 A.M. [1.02]

Dana: What's wrong with kids these days? Robinavitch: Uh, you mean besides social media and the worldwide pandemic and the environmental crisis? Dana: Yeah, yeah, yeah. Robinavitch: And gun violence? Dana: You're a fucking fountain of hope today, aren't you?

8:00 A.M. [1.02]

Robinavitch: I got to go tell those parents their 18-year-old son is brain-dead. Collins: Want me to come with you? Robinavitch: No, It's OK. Collins: What are you going to say? Robinavitch: I'm going to say that it's likely, but we still need to do an apnea test and a cerebral perfusion study. Collins: There's no cranial nerve activity. Robinavitch: Those people need some hope. Collins: False hope. Robinavitch: Hope is hope. Collins: Is it? What, are we praying for miracles today? Robinavitch: They need time to process before they can accept what's happening. Collins: You ever consider taking that advice? Physician, heal thyself. Robinavitch: Don't you have patients?

8:00 A.M. [1.02]

Robinavitch: Why did you order the EKG? Whitaker: The nurse suggested it to rule out any cardiac issues. Robinavitch: Well, good call on both your parts. Nurses know what they're doing. Never hesitate to listen to them.

8:00 A.M. [1.02]

King: Because your son tested positive for THC, the psychoactive ingredient in cannabis, we're going to have to admit him for overnight observation and monitoring. Amanda Jones: And what about his brain? Is there a chance that much pot is going to do some damage? He's only four. Langdon: The honest answer is we don't know. There haven't been any long-term studies, but the fact that this is a one-time occurrence suggests that there should be no long-term effects. Amanda Jones: But you don't know. So my son could end up with learning disabilities, psychiatric problems, or even autism because of this. King: There's no evidence to suggest any of that. Kiara Alfaro: Hello. I'm Kiara Alfaro. I'm the department social worker. Langdon: Kiara will help you navigate the next steps. Amanda Jones: What steps? King: Well, a case like this requires mandatory reporting to child services and sometimes law enforcement. Amanda Jones: No. Drew Jones: Why why do you have to involve the police? King: It's

9:00 A.M. [1.03]

Robinavitch: Dr. Mohan, do you have a minute? Mohan: Yep. Excuse me. Robinavitch: Is there a problem over there? Mohan: No, her pain is well controlled. Robinavitch: You understand that's my polite way of asking why are you spending so much time with one patient? You're an R3. As an R3, you should be seeing at least two patients an hour. Mohan: I have two, Joyce and Mr. Wallace, our Good Samaritan. Robinavitch: Who's comatose and stable. You should have four by now. Mohan: I have the highest patient satisfaction of anyone. Robinavitch: I don't doubt it, but we just had this conversation a couple of hours ago. Mohan: I know people call me Slow-Mo. You don't have to confirm or deny. It used to hurt my feelings a lot, but I can't help it. I work at the speed I'm comfortable at. Robinavitch: Because you're afraid of making a mistake? Mohan: I'm always afraid of making a mistake. Aren't you? Robinavitch: Yeah, of course I am. But you know what I mean. You make a mistake once, and somebody d

9:00 A.M. [1.03]

Robinavitch: Mr. Gellin, you're having a very big heart attack right now. Major artery that carries oxygen to your heart is almost totally blocked. Mr. Gellin: That doesn't sound too good. Robinavitch: No, it's not very good. We're gonna send you up to the cath lab. A cardiologist is gonna unblock that with a balloon and leave it open with a stent. Mr. Gellin: But I'm still having a heart attack? Robinavitch: If everything goes as planned, it'll be like you never had a heart attack. We're gonna put a catheter in this artery right here. We're gonna shave the hair with a clipper. Mr. Gellin: Long as you stop short of a Brazilian. Robinavitch: It's an option we offer. Costs a little bit more. A lot of people's insurance won't cover it.

9:00 A.M. [1.03]

Robinavitch: How's she doing? Kiara Alfaro: She's worried sick about her son. What are you going to do? Robinavitch: I thought he would come back after mom called him. Hey, what are the ethics about me reaching out to him under the guise of a medical emergency with mom? Kiara Alfaro: If he's a danger to himself or others, I'd argue you have a professional responsibility to do whatever is necessary.

9:00 A.M. [1.03]

Helen Spencer: He keeps trying to pull away. Robinavitch: We're giving him some more sedation. Jereme: Why is he so agitated? Robinavitch: He could have some awareness of the tube in his throat or that he's in a strange place, or it could be lack of oxygen to his brain. Helen Spencer: Does he need more oxygen? Robinavitch: He's on 100%. That's as high as it goes. [vitals monitor beeps loudly] That is his blood pressure dropping. Jereme: Oh, is that even fixable? Robinavitch: Normally, yes, with IV fluids, but we now know that that will just fill up his lungs, drop his oxygen even more. Helen Spencer: Well, isn't there something else we can do? Robinavitch: We can place a long, large IV catheter in his jugular vein down into his heart and administer Levophed, which is a very powerful medicine to constrict his arteries, raise his blood pressure. But that could cause other organ damage, organ failure. I'm really sorry, but each new step is even more invasive, could cause more suffering wi

9:00 A.M. [1.03]

Confidence and ambition are great attributes, especially when paired with respect and humility.

10:00 A.M. [1.04]

Robinavitch: I had a teacher, mentor, who told me about a Hawaiian ritual called Hoʻoponopono, or "the four things that matter most." It's basically just a few key things that we can say when we're saying goodbye to a loved one that can really help at the early stages of loss. Jereme: What are they? Robinavitch: They're gonna sound really simple, but I swear I've seen them work. Jereme: Okay. Robinavitch: I love you. Thank you. I forgive you. Please forgive me.

10:00 A.M. [1.04]

Mohan: Distraction is a terrible strategy. When a patient says, "I'm hurting," we don't respond, "What's your major?" Santos: Oh, I wasn't trying to diminish Mohan: Additionally, "I" statements work better than "you" statements. "I can see how painful this is" acknowledges the reality of the situation and invites further examination. "You need to move on" has the opposite effect. Santos: Understood, but in my personal experience... Mohan: Your personal experience isn't germane here. We bring our education to the job, not our baggage.

10:00 A.M. [1.04]

It's good that your families live close. This becomes a primary relationship now. You're the last witnesses to each other's lives. You hold the memories.

10:00 A.M. [1.04]

Robinavitch: But I've got four days off next week. I think I'm gonna get out of Dodge and head for the hills. Dana: I wish you would. What'd Shakespeare say "Physician, heal thyself"? Robinavitch: What? Have you been talking to Collins? Not Shakespeare. Luke, the disciple, who probably heard it from Paul the Apostle. But what do I know? I'm Jewish. It's not my book. Shakespeare had nothing to do with it, though. Dana: Yeah. Maybe a little time off would be good.

11:00 A.M. [1.05]

Dana: Don't mind Myrna. She's harmless. Whitaker: She's handcuffed! Dana: That's why she's harmless.

11:00 A.M. [1.05]

A little advice, man-to-man: always compliment her outfit, hold her hand in front of your friends, and always wrap it before you tap it.

11:00 A.M. [1.05]

Doug Driscoll: Excuse me. Excuse me. I've been here for over five hours, okay, way longer than that chick. Can you check the list? Driscoll? Doug Driscoll. Javadi: E-everybody is seen as quickly as possible and in order of medical care needed. Doug Driscoll: Unless they die waiting. McKay: Would you look at that, Mr. Driscoll? It's actually time to bring you back. Doug Driscoll: Thank God. McKay: Would you take care of Mr. Driscoll? Javadi: Yeah, absolutely.

11:00 A.M. [1.05]

Donnie Donahue: What can I do you for? Santos: Hypothetical question would you ever go over a resident's head to the attending? Donnie Donahue: Hypothetically, I wouldn't recommend it unless it's a behavioral issue or harassment. And in that case, you can make a confidential report to HR. Santos: What if it's more patient care related? Donnie Donahue: Depends. If it's something minor, leave it alone. If it's something that endangers the patient, then definitely yes. Pick your battles. You don't want to be the intern who cried wolf.

11:00 A.M. [1.05]

Javadi: Has Kiara been here yet? Sherry Davis: No, who's Kiara? Javadi: Oh, she's the hospital social worker. She can help you out with, like, housing and childcare - and food and security Sherry Davis: [to Dr. McKay] You told her? McKay: No, I-I... Javadi: No, no, it's all free. The system works if you use it. You just have to... McKay: Enough! Sherry Davis: I don't need your help. Nice speech. Next time, mind your own business. McKay: You ever heard of impact over intent? Javadi: I would never intentionally embarrass anybody. McKay: But you did. You didn't have a conversation with Sherry or ask her what she needed. Instead, you walked in here and told her what to do. You gotta slow down, take a beat, and listen instead of judging people. Look, maybe I have a better perspective because I've been on both sides, but we gotta try to at least put ourselves in their shoes. Listening and building trust will make us better doctors and better people. Javadi: Um, I'm sorry. McKay: I'm not tell

12:00 P.M. [1.06]

Mohan: Aren't board rounds at 2:00? Robinavitch: These aren't board rounds. I just want to remind you all of a few things, OK? So we do a great job coming up with the right diagnosis and treatment plan for our patients, but there are still some opportunities for improvement. Langdon: Not this bullshit again. Robinavitch: First off, always sit down at the bedside of a stable patient. It will make you a better doctor. Second, if there's a discharge to be done, do it before you pick up a new patient. The patients are very aware of the time that they spend with us, so please don't keep them here any longer than they need to be. McKay: They complain about the wait. Robinavitch: I get it, but for the sake of efficiency and running smoothly on our end and opening up beds and opening up rooms, let's discharge before we start with somebody new, OK? Thank you. Lastly, in your medical records, make sure that your decision-making and your notes reflect not just the diagnosis but all the thought th

12:00 P.M. [1.06]

Robinavitch: [about Dr. Mohan] Hi, how's she doing? Dana: Better. Faster. Robinavitch: Still need ten more of her. Dana: Never thought I'd see the day where you'd wish for more Samiras. Robinavitch: You can blame Gloria for that. If I don't get patient satisfaction scores up around here, they're bringing in an outside management company to run things. Dana: Mother of God. Really?

12:00 P.M. [1.06]

Gloria: Dr. Robinavitch. Robinavitch: Gloria. Gloria: This is Dr. Tracy Morris, regional manager of ECQ America. Robinavitch: The contract management group. Morris: It's a pleasure to meet you. Robinavitch: Likewise. But if you'll excuse me, I'm a little slammed, as per usual. Gloria: We were upstairs with the executive team going over a proposal. Robinavitch: A proposal? Gloria: Mm-hmm. Morris: We're interested in having your emergency department join us. Robinavitch: The 500 or so ERs you have aren't enough? Morris: What can I say? Business is good. Robinavitch: Yeah, for who? Morris: Everyone benefits. Robinavitch: Do they, though? Your contract management's corporate mandate is profits for shareholders above everything else, yes? Gloria: Robby. Robinavitch: Dah-dah-dah. Morris: Your hospital's board was very impressed with ECQ's metrics on patient satisfaction, throughput time, and billing collections. Robinavitch: Does your proposal include the part where you cut the pay for all m

12:00 P.M. [1.06]

Collins: OK, you're gonna pretend you're a pirate with your foot on a keg of rum. Javadi: Are you serious? Collins: Yep. This is the Captain Morgan technique for hip reduction. Javadi: Who's Captain Morgan? Langdon: The guy on the rum bottle? Collins: I'll stabilize the pelvis. Langdon: OK, you're gonna step up here. Javadi: Actually, let me just...sorry. Langdon: Yeah, and you are gonna put your right leg behind his knee. Javadi: Like this? Langdon: Yeah. And you are gonna use your leg as a hinge to put anterior force on his femur. Robinavitch: Physics. Collins: Push down on the lower leg with your left hand. Langdon: You got this. Put your back into it. The hip is a big joint with lots of muscle stabilizing it. Javadi: Yeah! OK. Robinavitch: Whoa! Javadi: Oh, shit... I mean, shoot. Collins: And that is what a hip reduction feels like.

12:00 P.M. [1.06]

Langdon: Neurocysticercosis, a parasite in your brain. Joseph Marino: I thought I just had a migraine, but I have bugs in my head? Langdon: Well, not exactly. You had larva from a pork tapeworm that made multiple cysts, but they're all dead now. Joseph Marino: A worm? In my fucking head? Are you kidding me? Langdon: No, no, you don't have a worm in your head. Joseph Marino: You just said that I have... Langdon: I said you had a worm in your head, but it's dead and long gone. What we're seeing on the CT is scarring around those dead cysts. Joseph Marino: Like dead worm eggs? Langdon: Larvae. Joseph Marino: Is my brain like Swiss cheese? Am I dying? Langdon: No, no, you're not dying. Joseph, you're gonna be OK. The cysts are tiny, and they're calcified over. There'll be no further damage. Joseph Marino: Can you fix it? Langdon: Unfortunately, no. The little calcified spots will stay there. Joseph Marino: So there's gonna be a worm graveyard in my brain forever? Langdon: Yeah, but they're

1:00 P.M. [1.07]

Robinavitch: Patients come in already in distress, and waiting only makes it worse. Gloria: Wait time has nothing to do with this. Robinavitch: Which is why we're seeing hospital workers like Dr. Collins get assaulted. Gloria: Assaulted? Collins: It was a little push. Robinavitch: Which we're gonna take seriously. We risk our lives coming to work here every day. What if that mother had brought a weapon? Gloria: We have metal detectors. Robinavitch: This is what happens when you keep all the hospital admissions stuck down here instead of properly staffing upstairs. I've got four patients waiting on ICU that have been here since before I got here, and it's already 1:00. Gloria: I can see that you're... Robinavitch: We've got four more waiting on psych. One of them's been here for a fucking week. So please, for the love of God, hire more nurses. Gloria: I'll come back later. Robinavitch: That's not gonna help anything.

1:00 P.M. [1.07]

Terrance: I everted my ankle playing table tennis. Langdon: Everted? Terrance: Yes. Langdon: You mind if I take a look? Terrance: Are you an orthopedic surgeon? Langdon: No. I am an emergency medicine specialist. Terrance: Could I talk to an orthopedic surgeon? I'd prefer an expert in that area. Langdon: Well, I'm pretty good at ankle sprains. Terrance: How do you know it's a sprain? Langdon: Well, I'd have to examine you first, but... Terrance: Could it be a Jones fracture or a dancer's fracture? Langdon: Could be. Again, I'd have to look. Why don't I examine you, and that'll tell me. Terrance: Shouldn't you take a complete history on the present illness first? Langdon: It sounds like you're more interested in asking the questions, so... Terrance: You didn't ask me if I felt a pop or a snap. You didn't ask about previous injuries. You didn't ask about weight bearing. Langdon: Why don't I get you some fresh ice?

1:00 P.M. [1.07]

Kristi Wheeler: Where is she? Collins: She's OK. She just needs a minute. Kristi Wheeler: I have given her enough time. She can process this on the car ride home. Collins: Can we talk for a moment? Please. Kristi Wheeler: I know you're trying to help, but this is really between me and my daughter. So if you could just bring her out, we will be on our way. Collins: She's really upset. Kristi Wheeler: She'll get over it. Collins: Weren't you about the same age when you got pregnant with her? Kristi Wheeler: Yes. Collins: So, you know how hard it can be. Kristi Wheeler: It was very hard at the time. But she turned out to be the best thing that has ever happened to me. Collins: And I hope she feels the same way when she's ready. But right now, she's not. For her, the world is ending. If you push her away, she might never come back.

1:00 P.M. [1.07]

King: [turns off the lights and draws the curtain] The, uh, ER can be very noisy. Terrance: I agree. King: So, I heard that you might have sprained your ankle playing table tennis? Terrance: I everted it. King: Yeah? What is your biggest concern today, Terrence? What worries you the most about the pain in your ankle? Terrance: What worries me? Do you mean right now in this moment? King: Right now. Terrance: I'm worried I won't be able to play table tennis if it's a bad injury. There's a tournament in six weeks, and I already registered. It's my first tournament. King: Wow, that's a big deal. Terrance: Yes. The championship is hosted by the South Park Table Tennis Club. Nine players have USATT ratings over 2,000. 1,400 is considered average. 2,000 is a master player. My goal is to get a rating over 2,000. King: Well, let's get you to that tournament, then. So... King: Terrence, would you walk around the room for me, please? I'll be able to tell a lot more about your injury. Terrance: It

1:00 P.M. [1.07]

King: Sometimes this tendon called peroneus brevis can pull off a piece of this bone, the fifth metatarsal. Terrance: That's the dancer's fracture, right? King: Exactly. You most likely have a second-degree ankle sprain. The X-ray will tell us everything. Tech will come get you, and then I'll come back and show you the images. Terrance: Great. King: OK... I'll put the orders in. Langdon: How'd you do that? King: Do what? Langdon: Talk to him. King: I listened? Langdon: Funny. No, you unlocked something. I wasn't getting anywhere with him. King: Oh, my sister is on the spectrum. And the ER can be a very, very overwhelming place for autistic people, so I... I don't know. It just takes a different approach.

2:00 P.M. [1.08]

Willie Alexander: That looks like ST elevation. That could be bad. Langdon: Oh, no. That's just because we're pacing your right ventricle. Willie, I'm impressed. After all these years, you still remember your medical training. Eli Alexander: He couldn't tell you what he had for breakfast. Willie Alexander: [scoffs] It's all right. I remember what's important. Like the Freedom House. Princess: What's that? Willie Alexander: A damn shame. That's your history. Eli Alexander: Dad, they're busy. Willie Alexander: Back in the '60s, no 911, no ambulances. All we had was police paddy wagons that took you to the hospital, if you were lucky. Then this doc from Pitt, Dr. Safar, he got some money and trained us up. Langdon: Well, you must've been a good student. Willie Alexander: Hell no. I was a knucklehead. Smoked a lot of weed, dropped out of high school. But Freedom House trained me up. Saved my life.

2:00 P.M. [1.08]

Willie Alexander: Freedom House took us in and trained us for 300 hours. Robby: They turned out the very first medics in the United States. Willie Alexander: We started IVs, defibrillated, intubated in the field. Eli Alexander: They were the heroes of Hill District. Bunch of young Black dudes saving lives every day. Langdon: Why'd you quit? Willie Alexander: I didn't. The city saw how successful it was and took over the program. Trained new medics. All white. Robby: Everything that Willie and his friends did set the EMS standard for the entire country. Their program created the 911 system. Willie Alexander: It wasn't just us. We had the best teachers. Dr. Safar invented CPR. Dr. Adamson, med student when I arrived. But I'm telling you, boy, that guy could teach like there was no tomorrow. You ever hear him give a lecture? Robby: Many times. Willie Alexander: Every time I saved a patient, it was like he was standing right here, whispering in my ear, telling me what to do. Robby: Me too.

3:00 P.M. [1.09]

Jesus almighty, I can't believe what I'm seein'! Where do you people think you are? This ain't Philly! This is a hospital, for Christ's sakes, what's the matter with you? You call yourselves adults? There are children in here! You should be ashamed of yourselves.

3:00 P.M. [1.09]

Wendy Atwater: An operation? Langdon: Well, you were just shouting a minute ago about infection, and with good reason. While I am sure you are in the clear for rabies and HIV, human mouths are filthy, some more than others. Wendy Atwater: How can you tell if it's bad? Langdon: Good question. Dr. K? King: I'm sorry? Langdon: I am going to inject some sterile saline into your knuckle joint, which you won't feel 'cause of the anesthetic. If it comes spraying back out of the bite wound, we'll know.

3:00 P.M. [1.09]

Langdon: Oh, did you want me to tell the surgeons to go no masks for surgery? Wendy Atwater: What? Langdon: Well, those of us who save lives for a living believe strongly that masks minimize risk when it comes to spreading disease and infection. But I want to respect your beliefs, so what do you think? With or without for surgery? Without? Wendy Atwater: Um…I want with. Langdon: Good call.

3:00 P.M. [1.09]

Doug Driscoll: I know you hear me. You can pretend you don't, but I know you do. This glass might be bulletproof, but it ain't soundproof. Huh? Hello? Can you hear me now? Huh? Hello! Dana: Whoa. Whoa. Whoa, sir. Sir, what is the issue? Doug Driscoll: Oh, same issue. I've been here all day, and you people have done nothing to fucking help me. Javadi: We're still waiting on your second troponin. We can't clear you medically until it comes back. For instance, if it comes back elevated, that could indicate a silent heart attack. And you'd need to be admitted for monitoring in a cardiology consult. Doug Driscoll: That's all I'm asking for. I'm afraid I've had a silent heart attack. I just want someone who knows something about hearts to tell me what's happening to me. You know, unlike most of these losers, I have insurance, good insurance. And I pay my taxes, which pays for them to not have any insurance. Dana: Sir, you've got about five seconds to change your whole attitude before securit

3:00 P.M. [1.09]

Robinavitch: I hear they're gonna start you working on the Middle East peace plan. Not since the Dalai Lama or Gandhi. Dana: They'd be fucking-A right to. You should have seen me. I was inspiring, also terrifying, and a little bit shaming. Robinavitch: Holy Trinity of crowd control.

3:00 P.M. [1.09]

Collins: Yeah, purulent drainage from the cervix. Got the culture. Oof. Looks like we have our source. The positive urine this morning was contaminated. McKay: Maybe. Collins: Definitely. Not-so-clean catch specimen. Robinavitch: This infection's been brewing for a while. McKay: So the car crash was a coincidence. Robinavitch: Not necessarily. She was probably already septic as the disease progressed, dropped her BP, and passed out while driving. McKay: She wasn't hypotensive when she arrived. Robinavitch: Adrenaline rush from the car crash and the sternal fracture raised her BP but not for long. McKay: Oh. No history of fever. Collins: Bet she was taking Tylenol for the pain. Robinavitch: Let's call ICU for an admit. Also want gyn to see her. McKay: She had mild lower abdominal pain and a positive urine dip. No fever, no back pain to indicate pyelonephritis. She was alert, walking, talking. It just seemed like a simple UTI. I saw no reason to have her wait eight hours for a bed for a

3:00 P.M. [1.09]

Dana: Excuse me, sir. You're not allowed back there. Doug Driscoll: Unless, what, I start a fight? Become homeless? Apparently, that's what it takes. Dana: I understand your frustration. I promise you'll be seen as soon as a provider is available. Doug Driscoll: But how can they become available if new people keep cutting the fucking line? Dana: There's no line. We see patients by severity of need. As soon as we have your tests and labs, you will be seen. Doug Driscoll: This place is fucking unbelievable. Runaround after runaround. Hey. What's up, Erik Estrada? Still keeping your eye on me? Mateo Diaz: Always, my friend. Always. [to Dana] Who's Erik Estrada? Dana: Shame on you. CHiPs. Know your television history.

3:00 P.M. [1.09]

Javadi: It's like…my parents took me skiing in Utah for Christmas, and from the moment I got off the plane, I could not catch my breath. No matter how hard I tried, the altitude made me feel, like, awkward and uncoordinated. I couldn't concentrate, I couldn't get my bearings. And I'm a very good skier, but I spent the entire vacation just, like, on my butt, dizzy and panting. Javadi: Mateo is like a human Utah. Dana: [laughs understandingly] Oh honey! I've worked with a few human Utahs. I wish you many, many Utahs in your life.

4:00 P.M. [1.10]

Gloria: [after Dana was attacked by a patient] Did you fill out an incident report? Robinavitch: I don't know, I was more concerned with her having a skull fracture than with your liability. Gloria: How'd a guy from the waiting room get back here without anyone noticing? Robinavitch: Wow, Gloria! What a great question. Our hard-working nurses were just asking me what steps the hospital plans to take to ensure their safety in the future. Maybe you would like to explain to them why you've denied my request for additional security measures three times in the last four months? If nurses don't feel safe, they're not gonna come to work. Gloria: First off, the safety of all our employees is paramount.

4:00 P.M. [1.10]

Princess: [to Gloria] Glad to know the authorities are looking for this psycho, but what are you gonna do to protect the rest of us? Nurse Kim Tate: Violence against health care workers is a national problem. Donnie Donahue: And it's only getting worse. No surprise there's a nursing shortage everywhere.

4:00 P.M. [1.10]

Langdon: An intern has a problem around here, they come to the senior resident, not the attending. Santos: He is my attending, and I wanted his input on a patient. Is that not OK with you? Langdon: Just, um come to me first next time. Got it? Santos: Yep.

4:00 P.M. [1.10]

McKay: Look, do I think he needed to chill out a little bit? Yes. But he's a parent, and this might be his way of coping with the stress of a very frightening situation. Javadi: I'm sorry. I don't know what came over me. McKay: No, I do. You and that baseball kid are two pressure cooker prodigies in a pod. Just as physicians, we gotta learn to keep our emotions in check and not let our personal experiences interfere with our professional responsibilities. Javadi: How long did it take you to learn that? McKay: I'm still learning. And I also learned to never get on your bad side.

4:00 P.M. [1.10]

Robinavitch: So, in this ER, we all need to work together as a single unified entity. And if two people on my team can't work together, it kind of throws the rhythm of the place off. Santos: Understood. Robinavitch: My duty, regardless of personal relationships, is to make sure everybody on my team is doing OK. So are you doing OK? Santos: Uh, it's not a big deal. I can handle it. Robinavitch: Handle what? Santos: Nothing. It it's fine. I... I don't wanna get anyone in trouble. Robinavitch: Hmm. OK, if there is anything that could affect my ER, I need to know about it, and you have a responsibility to tell me.

5:00 P.M. [1.11]

Mohan: Remember how I said you get good at spotting the fakers? Whitaker: Yeah. Mohan: He's exhibiting every sign of opiate withdrawal. Eyes dilated, tearing, skin has piloerection and goosebumps. Hypertension, tachycardia. Agitation, restlessness, perspiration. He's checking every box. Whitaker: Right, but he said he doesn't take drugs and seldom drinks alcohol, so... Mohan: That's exactly what he would want you to believe if he was drug-seeking. Whitaker: Wow. You're good. Mohan: Thanks. I am. Whitaker: So how do we treat him? Mohan: By getting him to admit his opiate usage. Whitaker: Right. How do we do that? Mohan: By being smarter than the patient. Whitaker: Got it. He said he isn't an addict, so why give him an opiate agonist to treat his withdrawal symptoms? Mohan: Because I don't believe him. And I know this will work. Then once he feels better, we can get him to admit to his addiction and treat him long-term.

5:00 P.M. [1.11]

Theresa Saunders: The psychologist spoke to me about becoming a petitioner to place David on an involuntary psychiatric hold. Robinavitch: Yes. Theresa Saunders: But can that be anonymous? Robinavitch: No. To call a 302 in the state of Pennsylvania, the petitioner needs to admit to having witnessed the concerning behavior, and you need a physician and a social worker to sign off, which both Kiara and I can do. Theresa Saunders: What if I'm wrong? Robinavitch: Then you apologize. And we will help you explain that this came from concern for his safety. What if you're right? Theresa Saunders: But if I become a petitioner, what am I doing to my son? Robinavitch: You are trying to get him the help that it sounds like he needs. David lost his father. That would affect anyone. But we are failing young men, because we don't teach them how to express their emotions. We just tell them to man up, and then we let them get their lessons in manhood from toxic podcasts. And these young men then feel

5:00 P.M. [1.11]

Robinavitch: [about drinking] You ever think about quitting? Louie Cloverfield: [chuckles] I'm not a quitter. Robinavitch: Oh, I know you're a happy drunk today. But one day, when your liver fails and believe me, it will fail you won't be so happy. It's not a nice way to go. Louie Cloverfield: I'm digging my own grave. Let me. Robinavitch: I don't have to give you the shovel.

5:00 P.M. [1.11]

Dana: I'm already in a bad mood. Security Guard Ahmad: I'm just getting some air. Dana: [scoffs] Yeah, right. You're a terrible liar. Hope you're better at security. Security Guard Ahmad: Hey, now you're just being mean. Robinavitch: You realize that this is the second person to accuse you of that today. - You starting to see a pattern? Dana: No. But I am starting to see why Gloria's unhappy with your patient-satisfaction scores. Dana: You need something? Or you just here to ruin one of the few things that still brings me a little joy in life? Robinavitch: I sent Collins home. Dana: You don't want to work with anybody today. You must be in a mood. Robinavitch: She's had a rough day. Dana: It's going around. Robinavitch: You should leave, too. Dana: [chuckles] Yeah. You're good. You're not that good. Robinavitch: You do help. You do make a difference. One asshole doesn't get to change that. Dana: I think I'm done. [sighs] Robinavitch: Yeah. I know that one. And I don't blame you. I, uh.

5:00 P.M. [1.11]

Robinavitch: How you feeling, Mr. Pugliesi? Ivan Pugliesi: Oh, so much better. Thank you. You guys think that I could have a little bit more of that medicine, just for the few days that I'm out here? I just want to be able to walk my daughter down the aisle without shitting myself. Robinavitch: The medication we gave you wasn't morphine. It was something called buprenorphine, or BUPE. Ivan Pugliesi: Yeah, no, she said that. I mean, whatever you call it, Doc, it worked great. Robinavitch: It's a medicine specifically targeted to treat opioid withdrawal. That's why it worked. Ivan Pugliesi: Wait, I-I don't I don't understand. Robinavitch: All indicators are that you have been using opioids. That would include pain medication like hydrocodone, oxycodone. Ivan Pugliesi: I told them I don't do drugs. Wow. You lied to me. Mohan: I didn't lie. I said I was giving you a morphine-like drug that got rid of your cravings. Ivan Pugliesi: Well, you know what? This is bullshit. I mean, you know, I c

6:00 P.M. [1.12]

There is an active shooter at PittFest. As the nearest trauma center, we are going to be getting the majority of the victims. We don't know yet how many we are getting, but we are instituting hospital-wide emergency protocols. We need to move every patient out of here. They either go home, they go upstairs, or they go to Family Medicine. Call your loved ones now if you need to. I can guarantee you cell service will soon be overwhelmed. Eat something. Stay hydrated. Use the bathroom while there's time and meet back here for a full briefing in five minutes.

6:00 P.M. [1.12]

Gloria: We're locking down the hospital and setting up a command center in Administration. We'll coordinate logistics, supplies, communication. Dana: How many casualties? Robinavitch: Unclear, but initial reports are not good. Dana: OK. Robinavitch: The night shift is gonna be here soon, but we are gonna need more help, especially from Surgery and Anesthesiology. Gloria: MCI group text and email went out to everyone, including Transport and Environmental Services. Robinavitch: OK, good. [to Dana] Hey, everyone's gonna want to come in to help. Keep enough in reserve. Tell them to come in eight hours later to give us a break. And can you try and reach Jake? Dana: Of course. Robinavitch: Surgery's got to call in the cavalry. We're gonna need all 25 ORs. Gloria: Ahead of you. Four ORs are prepped and staffed, and we're working on getting the rest up and running. Robinavitch: What about disaster supplies? Gloria: On their way. Robinavitch: Every patient in the ER needs to go up. Beds or no

6:00 P.M. [1.12]

Robinavitch: This is how it's going to work. Our ambulance bay is now our Triage. EMS will be overwhelmed. Most will probably arrive by car, several victims per vehicle. For all you newbies that don't know, Dr. Shen is our night shift attending. John, I'm gonna put you on Point Triage. Dr. Shen: Cool. Robinavitch: Triage will decide who goes where depending on their injury. Abbot: Every department will have a designated primary who will oversee their staff. If you need someone, look for the vest. We're all gonna have walkies. We can get you whatever you need. Robinavitch: No patient goes into a room unless it's a trauma bay, and they will have four patients each. We need to keep everybody out in the open so we can keep an eye on everything, OK? Triage is gonna assess and assign every patient to a specific zone with a colored slap band. Patient who comes in with a red slap band goes to the Red Zone, which is the trauma rooms, with overflow out here. These are the most critical patients

6:00 P.M. [1.12]

Dr. Shen: That's a lot of wrist charts. Robinavitch: Let's hope we don't need them all. Were you at the last mass-casualty faculty meeting? Dr. Shen: Oh, no. I was still a resident three months ago. Robinavitch: Right. Wow. Well, one patient at a time, right? The goal is to triage each patient in ten seconds. Dr. Shen: Ten seconds, got it. Robinavitch: Mental status is [w:AVPU|]]. Alert, response to verbal, response to pain, unresponsive. Dr. Shen: Yep. Robinavitch: Next, do they have a pulse? Radial, carotid, or femoral tells you where to send them. That's it. Dr. Shen: OK. Cool. Oh, I heard it might rain today. Robinavitch: John? Dr. Shen: Yeah, man. Robinavitch: Mental status and pulse gives you everything you need. Dr. Shen: Cool. Robinavitch: Unresponsive with no pulses, slap a black and white band on them, send them to the morgue. Responds to pain with a faint groan, weak femoral pulse, no radial? Dr. Shen: Uh, red. Robinavitch: Right. Slap a red band on them, send them back. Awa

6:00 P.M. [1.12]

King: Oh, um, and four of Ancef. Sorry, I forgot the Ancef. Thank you... . Perlah Alawi: Mel! Mel, I need you to reassess, please, now. King: Sylvia? Oh, Sylvia. Her pulse is weak and thready. She's, uh, bleeding out from her liver lac. I need O-neg! Dana: O-neg's gone, honey. Gloria's got more flying in. Incident Command, what's the ETA on our blood? Dana: The patient's gonna have to get by with a liter of saline. King: No, no, she needs blood, not crystalloid. Um, can she go to surgery? Dana: All right, she's next to go, as soon as we get an open OR. King: She's not gonna last that long -- Dr. Robby. Dr. Robby! Dr. Robby, we're out of O-neg, but I'm O-neg. Can I donate? Robinavitch: Gloria's got more blood flying in. King: But I need it now. Robinavitch: What is our blood status? Dana: Just used the last units of O-neg and O-pos. More flying in. Robinavitch: ETA? Dana: Less than 10. King: Some patients are not gonna last that long. And I'm sure there are other O-neg donors that proba

7:00 P.M. [1.13]

Robinavitch: [to his adopted son, about his girlfriend] Leah's injuries were really serious. She stopped breathing. We put a tube down her throat to deliver oxygen. We were able to drain the blood that was collapsing her lungs. We gave her as much blood as we could. We even transfused some of her own blood that was in her chest. But we were unable to get ahead of the massive blood loss. Her heart stopped. You saw me doing CPR. We did everything that we could. Jake Malloy: She's dead?

7:00 P.M. [1.13]

Mohan: What are you doing? Langdon: Giving this guy a chance. He needs a big central line for fast transfusion. Mateo Diaz: You'll kill him if you collapse a lung or hit the carotid. Langdon: I'm not doing an IJ. Unhook that blood line. Bring it up here. This is a supraclavicular subclavian. If you have to go in blind, this is the only safe way to access a giant vein. And hold compressions. A centimeter from the lateral head of the sternocleidomastoid, a centimeter off the clavicle, aiming at the contralateral nipple. I'm in. Okay, resume compressions. And squeeze blood. Mohan: Where'd you learn that? Langdon: "EM: RAP" podcast. We'll be ready for a second unit in under a minute. Boom.

7:00 P.M. [1.13]

Whitaker: What are you doing? Santos: Prepping for REBOA. Whitaker: Are you crazy? Did Abbot approve this? Santos: He said, do what you have to do. Attendings are all tied up. If I can blow up a balloon in the aorta, it'll stop the bleeding. Whitaker: It'll cut off the blood supply to half her body. Santos: I'll only go in a few inches, zone three, below the kidneys, until she gets up to the OR. Glove up, Huckleberry. Whitaker: Okay, you're gonna need an ultrasound, X-ray. Santos: Not today. Whitaker: Have you done this before? Santos: It's a central line. I just need to hit the femoral artery like that. Piece of cake. All right, guidewire, then introducer sheath.

8:00 P.M. [1.14]

Robinavitch: I just wanted to say thank you for earlier when I was, um Whitaker: Oh, your brief moment of silent reflection? Robinavitch: Yeah. You didn't mention that to anybody? Whitaker: No, no. God, no. No. Robinavitch: I don't know what that was. I was just felt like I was drowning.

8:00 P.M. [1.14]

Whitaker: What was that you were reciting? Robinavitch: It's called the Shema prayer. It's a declaration of faith in God. I lived with my grandmother when I was little, and she and I used to recite it every morning. Whitaker: "Even youths grow tired and weary, "and young men stumble and fall. "But those who hold hope in the Lord "will renew their strength and soar on wings like eagles." It's Isaiah 40. I was an undergrad theology major.

8:00 P.M. [1.14]

Okay, nipples to navel is no man's land. If he got shot while exhaling, the bullet possibly passed below the diaphragm.

9:00 P.M. [1.15]

Dr. Walsh: Once I'm through the fascia, you're gonna sweep a finger around the bladder, open up the space of Retzius. Dr. Shen: Named after Anders Retzius, 19th-century Swedish professor of anatomy.

9:00 P.M. [1.15]

Abbot: Deaver retractor. Dr. Walsh: Named for John Blair Deaver, Philadelphia surgeon who revolutionized abdominal surgery in the early 1900s. Abbot: I'm surrounded by med nerds. Dr. Walsh: I went to med school at Penn. I walked by his portrait every day. Dude did, like, 100,000 surgeries.

9:00 P.M. [1.15]

Santos: I know Krav Maga. Whitaker: Cool. I don't know who that is, but he sounds very protective of you. Santos: The chances of this working are diminishing by the second. I'm just fucking with you, Whitaker. You're such a Huckleberry.

7:00 A.M. [2.01]

One of the things we like to do here, when we have the time, is to take a moment of silence when we lose a patient to respect their humanity. He was someone's son, perhaps a father himself, a brother or friend. Oh, make sure your phones are on silent.

8:00 A.M. [2.02]

Al-Hashimi: This should be done in the O.R. Garcia: I am the O.R.!

1:00 P.M. [2.07]

Abbot: [to Robby] Thought you left us already for the open road. Robby: And miss seeing you in uniform? Abbot: You should see me as a flight attendant.

1:00 P.M. [2.07]

Al-Hashimi: SWAT? Really? Abbot: I suck at golf. Al-Hashimi: You spend time in the Middle East? Abbot: More than I would have liked. Al-Hashimi: I worked in Kabul with Médecins Sans Frontières, and in 2020 at the maternity hospital. I met the most incredible, bravest doctors there. Abbot: Dashte Barchi. Tragedy. [sighs] We should grab a beer sometime. Share war stories. Al-Hashimi: I'd like that. [walks out, leaving Abbot and Robby] Abbot: [to Robby] She seems cool.

8:00 P.M. [2.14]

Sir! We are gonna get you more pain meds, but you need to shut your fuckin' mouth.

8:00 P.M. [2.14]

Duke: I can see why you liked restoring this bike. You're a fixer. I fix bikes, but you fix people. That's pretty damn impressive, man. Robby: Some people can't be fixed. Duke: Look, I'm-- I've done plenty of things I'm not proud of. Robby: Yeah, me too. Duke: No, bad things. Hurt people on purpose, hurt myself. And I did my time, but that doesn't wash away the regret. I... wish I'd done things differently. I think about it every day. Robby: You know, they say that it's never too late to change. Duke: Some things can't be changed, like death. Death can't be changed. Robby: Hey, I know the surgery is scary-- Duke: I'm not talking about me. Robby: Yeah, I don't know if I wanna be here anymore. Duke: I don't know how you stand 12 minutes in there, let alone 12 hours, 20 years. Robby: No. That's the only place I can be. I have purpose in there. I can be distracted in there. I don't know that I wanna be…anywhere anymore. Duke: So what's the plan? Robby: Ride. Duke: Toward what? Robby: I don

9:00 P.M. [2.15]

Abbot: We are the Night Crawlers! We deal with the weirdest and the wildest because… Night Shift: We are the weirdest and the wildest of them all! Abbot: That is right, and tonight they are really gonna be crawling. Now go get some! Night Shift: HOOAH!

9:00 P.M. [2.15]

Langdon: You know who I saw in rehab? I saw a bunch of guys just like you. The only difference is, they've accepted that they need help. I think you're afraid to admit the mighty Dr. Robinavitch isn't perfect. Robby: I never claimed to be perfect. Langdon: No, but you expect it of yourself and it's not realistic, man. How can any of us live up to your standards if you can't even do it? You need help, Robby. You need help.

9:00 P.M. [2.15]

Abbot: You want to know why I never killed myself? After what I saw, lived through? Losing my leg, losing...my wife? Because it comes for all of us, man. You and I know it more than most. We see it every shift, but we can't let ourselves succumb to it. Yes, life can suck. It can be unbearable and-and-and brutal and ugly and heartbreaking; but it's also beautiful, and hilarious, and that woman today, her baby? They'd both be in the morgue if you hadn't been here. That's us. That's you and me. That's what we're here for. Robby: The most important things I've ever done in my life have been in this hospital. Nothing will ever matter more than what I've done in this hospital, but it is killing me. You know how they say that a part of you dies when you lose someone you love? I'm not convinced that a part of you doesn't die every time you see a fellow human pass. And I've seen so many people die that I feel like it's leaching something from my soul. Abbot: Go on a cruise, man. Knock off this

9:00 P.M. [2.15]

You got off to kind of a rough start, didn't you, little one? Well, that makes two of us. I got abandoned, too. When I was eight. But I got through all of that, and so will you. I got a good feeling that you're gonna be just fine. Everything's gonna be just fine. You got so many wonderful things to see, and so many people to love ahead of you. So many wonderful things to see, people to love ahead of you.