The Pitt

Huh?

Hey!

Donnie, thank you. I'm sorry.

We'll get another nurse to replace Jesse.

Do we even know where these ICE assholes took him?

No, but the hospital attorneys are all over it.

I know you got child duty... What's going on?

It's a code Hula Hoop, Central 14.

Move, move, move, move, move, move, move, move.

What the hell happened?

He attacked Emma, so I gave him a shot to settle him down.

Are you all right?

Let's see.

- How did he get a bloody nose? - He slipped.

- Can I see? - He had her in a headlock.

- Uh, where's Ogilvy? - Upstairs.

They let him scrub in on that kidney stone turned triple-A.

Oh, great, on the one day med students

might actually be useful in the ED.

Oh, uh, present company excluded.

You're doing great.

Sure.

Hey, uh, can I get a selfie with you?

With me?

Yeah, you're kind of a legend among med students.

Really?

They call you Phantom of the Pitt,

on account of you secretly living

in the hospital for months.

What? It wasn't months.

Still waiting on labs...

X-rays, meds.

PTMC. Go ahead, Medic Command.

Where are all the nurses?

There was a code Hula Hoop in Central 14.

- Oh, no. - What's that?

Hospital worker assault.

- Who? - The new nurse Emma.

- Is she okay? - I don't know.

I think so.

Smoke 'em if you got 'em. This place is going tits up.

Okay, are we all good in here?

Oh, yeah, boss, we got this.

Are you sure you're all right?

- Uh, I think so. - Okay, good. Come.

So what exactly happened?

He grabbed Emma. He threw her up against a wall.

- I ran in and gave him a shot. - Right.

And did he slip before or after the shot?

Before.

Yeah, he had me in a headlock.

I didn't see what happened.

- What did you give him? - 4 milligrams of Versed.

- Who wrote the order? - I had it in my pocket.

I was on my way to waste it when shit went sideways.

What?

Okay, so now he's altered

from alcohol, Versed, and a head trauma.

Now he's gonna need a head CT to rule out

intracranial bleeding and a fracture.

Would you rather it be Emma with a head injury or worse?

Don't worry about it. We got this.

No, there's no we here.

You need to pass this patient off and report him.

Fine. Emma, you're done with this bastard.

- I'll handle him now. - No, no,

this is my emergency department,

and I'm telling you to pass it off.

These are my nurses, and I choose

what cases they work, and if you think for one minute

I'm putting anyone else from my staff at risk

with that asshole, you better give your fucking head a shake.

Come on. Come on.

- MVA coming in. - Okay, I'll be right there.

Thank you.

Did I kill my son?

No, he's not dead.

He's recovering in pediatric ICU.

We'll be back to check on you again shortly, Ms. Azurmendi.

Um, has her husband arrived yet?

Yeah, but he went straight upstairs.

Really?

He may have just wanted to see his child first.

Let's not jump to conclusions.

- Dr. Robby, can I have a word? - Shoot.

In private.

People are gonna start to talk.

- Thank you. - Mm-hmm.

What is this about?

I'm going to recommend this ED have two attendings on shift

at all times moving forward.

This department is clearly too much

for one person to handle.

It's not healthy for you or the patients,

and I'm very concerned

by what I've witnessed today with some of the staff.

What is going on with Langdon and Santos?

I saw them having it out like it was fight night.

Dr. Langdon hasn't even been here for ten months,

and you told me this morning

there was nothing to worry about with Dr. Santos.

There isn't. There isn't. Santos and Langdon have beef

because she's the one who turned him in for taking meds.

I'm sorry, what?

Santos is responsible

for revealing Langdon's benzo addiction.

Was he stealing drugs from this ED?

This ED is the best of the best,

and I would put it up against any emergency department

in the country.

And it is going to be yours to fuck up,

so don't fuck it up.

You're not supposed to smoke out here.

Really?

Seems to be working for me so far.

How old are you, kid?

I'm 21...

On Tuesday.

Jesus, some kind of idiot savant.

We no longer use that term.

It's derogatory.

- You bruise-easy Millennials. - Actually, I'm Gen Z.

Even worse.

I was stripping at Purgatory to put myself through school

when I was your age.

Snowflake.

Hey, Amy?

Yeah, I'm getting off later than I thought.

Um, I'll give you a call when I get a better idea of...

I need help!

- I got to go. - He can't breathe.

I got the airway. You take the pulse.

Yeah.

- Oh, shit. - Oh, my God.

Okay, trying jaw thrust.

- Radial's weak and thready. - What's his name?

My dad... uh, Oliver.

Hey, Oliver, can you open your eyes for me?

Okay, here we go.

Okay, one, two, three.

Drive-in with severe respiratory distress.

Left-sided dialysis shunt, probable renal failure

and fluid overload.

Have respiratory set up BiPAP.

When was his last dialysis?

It was supposed to be yesterday morning.

I'm gonna need a nitro drip ASAP.

- You got this? - Yeah.

Is that the guy who attacked Emma?

Is he going to CT?

Yeah, Ms. Emma here needs an H&P.

Uh, Cassie, can you give Emma here a workup?

Start a chart.

- Victim of assault. - Really?

- I'm fine. - He was choking you.

- He had me by the head mostly. - You're a patient now.

Full examine in South 18, McKay.

She also needs to make a statement to the police.

Is that really necessary?

- Yeah. - Absolutely.

Don't worry. I'll be there with you.

Come on, let's get you a spot.

Well, your guy just bumped my guy for CT.

- Now he's my guy? - Duke's gonna chew me

a new one 'cause he's been sitting here forever,

and I'm never gonna get out of here.

- Tell it to someone who cares. - You know what?

You should care, because if you gave that guy

a serious injury with force inflicted from a sedative

you are not licensed to prescribe...

Anyone else uses force to stop an assault,

they're a hero, but a nurse does it, and we're punished.

You just happened to have a vial of Versed in your pocket?

It was extra from the medics. Good timing, I guess.

When we waste a controlled substance,

we need a witness to sign off.

I was on my way to when I spotted that asshole

attacking a girl.

Anything else, Nancy Drew?

- Where you going? - Taking a pee.

Do I need your permission to do that, too, now?

Fuck! Fuck! Fuck! Fuck!

Should we intubate?

Uh, best to avoid that if possible.

Pressure support and after load reduction

buys us time for dialysis.

BiPAP starting at 10 over 5.

Good hard squeeze, good lung sliding,

- but there's a ton of B lines. - Pulmonary edema.

Which is best treated by what, Dr. Javadi?

- Uh, nitrates. - Dose?

BP 198 over 132.

Pulse 120.

- Pulse ox only 85. - Good BP.

Let's start at 400 mikes per minute for 2 to 5 minutes.

I was asking Dr. Javadi.

Don't you always start low with nitro, then titrate up?

In flash pulmonary edema, we do the opposite.

What he really needs is dialysis to get the fluid off.

- What's his dialysis schedule? - Monday, Wednesday, Friday.