The Pitt

- Robby. - Yep.

Cellulitis on the dorsum of the foot,

now spreading up the leg.

Hello, I'm Dr. Robby.

Mind if I take a look?

How long do you think this is gonna take?

I took an early lunch break.

I don't know that you're gonna

make it back to work today.

Erythema and warmth halfway up her knee.

When did you see her, Donnie?

He didn't. I did.

- When? - About four hours ago.

Gave her a dose of Keflex,

told her to come back if things got worse.

Things have definitely gotten worse.

Dana, what's open?

Trauma Two.

Jesse, can you get her started in Trauma Two

with some vanco and blood cultures, please?

- Got it, boss. - I'm coming with.

Suit yourself.

Santos, you want in on Trauma Two?

Too much charting, too little time.

62-year-old male presents with chief complaint

of left lower back pain.

- Considered the diagnosis... - Hey.

Oh, Jesus Christ.

I'm charting.

Sorry.

Did I do something wrong?

Besides interrupting me? Probably.

Then I apologize.

I know that second year of residency can be stressful,

so if there's anything I can do to help you

like stop talking.

- That's a great idea. - Yeah.

Considered the diagnosis of aortic aneurysm or dissection.

Got a new one for you in 13.

I'm 20 charts behind, and the new attending

is threatening to make me repeat

a year if I can't catch up.

Cry me a river.

Old lady with bad abdominal pain.

Somebody's gotta see her.

Dana, please do me a solid.

Holiday weekend.

Westbridge is down, and our waiting room's on overdrive.

I'm sorry, but your charting's gonna have to wait

until after your shift.

Ogilvie.

Dr. Santos needs you to pick up a new patient in 13.

Y-yes, ma'am. I'm on it.

Chart while you supervise.

Best I can do.

Setting up a GoFundMe, that's what her generation does.

That's how they support each other.

Doctor, tell him.

Your wife's right.

Staying here's gonna cost more than we can afford.

Look, I'm feeling better.

I'll just leave.

Mr. Diaz, even if your blood sugar is back to normal,

we have to continue with the insulin drip

until we clear the ketones from your bloodstream.

Otherwise, you could experience electrolyte disorders,

heart and kidney problems...

Mi amor, your health is what matters.

I'll make you a deal.

You agree to stay on the insulin drip,

and I'll go find our case manager

to discuss cost-cutting options for your stay.

Deal.

And I'm sitting here making sure he doesn't move.

- You should go look for Ana. - Mm-hmm.

I can find her.

BRB.

Hanging vanco.

What's vanco?

A really strong antibiotic to kill skin germs.

- Need a hand? - No. We got this.

I'll just observe.

Pretend I'm not even here.

Let's send off a CBC, blood cultures, and CMP.

And also a lactic acid, CRP, and calcitonin.

Wait, she's not febrile, not tachycardic.

No evidence of SIRS.

- Yet. - What's SIRS?

Systemic inflammatory response syndrome.

Sorry.

An exaggerated defense response.

A what?

Sometimes the human body can have an overreaction

to an infection, so we're gonna monitor you

to make sure that this does not progress.

It's my boss.

Sorry, I have to take this, or he's gonna fire me.

OK.

Hello.

No, I'm still at the hospital.

Being seen right now.

Ow.

No, they just stuck me with a needle.

I don't know.

You wanna talk to them?

They're kind of busy right now.

I know you are.

Second IV's in.

No, I'm not overreacting.

My body's overreacting.

Please... please don't fire me.

I...

This is Dr. Michael Robinavitch.

I am the chief of emergency medicine at PTMC.

If you fire her, she will sue you,

and I will testify on her behalf.

OK.

Don't worry about it. We got you.

Do you know how long Jackson's gonna be asleep?

So there's no exact timeline with the sedatives we gave him,

but he should be awake soon.

Have you spoken to your parents yet?

Yeah, they're on their way back from Columbus.

Maybe you should take some time for yourself

before they arrive.

Yeah, cafeteria's right down the hall.

Decent grilled cheese.

Stay away from the tuna.

Thanks, but I'm not hungry.

You know, I just can't believe that a campus security guard

tased my brother.

Aren't they supposed to be helping students

and protect them, not shoot at them?

You have every right to be upset,

and you should absolutely pursue accountability.

But right now, we are taking care of your brother.

And you should really take care of yourself.

I... I have your number.

I'll text you as soon as Jackson's LP results get back

or if he wakes up.

OK.

OK, thank you.

Of course.

- Oh. - OK.

Hypoactive bowel sounds.

Soft, with moderate tenderness in the left lower quadrant.

Mrs. Randolph, do you take Percocet every day?

- No. - Huh.

And what about your water intake, 'cause...

Pause.

Mrs. Randolph, you said you don't take Percocet every day,

but when was the last time you took some?

Maybe three or four times last week.

Assisted living had a ballroom dance competition,

- and I tweaked my back. - Mm.

Any further questions, Ogilvie?

When was your last bowel movement?

I don't know. Sometime last week.

I've been stopped up for at least five or six days.

Mm-hmm, painkillers can cause constipation.

I know.

That's why they put me on a stool softener,

and then they tried an enema.

- And... and no movements? - Yep.

And then they gave me this horrible drink.

Mag citrate.

Yeah.

Mag citrate.

Made me puke.

All right, what's next, Ogilvie?

Let's get you an X-ray and see how we can help you,

Mrs. Randolph.

- Thank you. - Yeah.

Differential?

Probable stool impaction.

But with her history of cholecystectomy,

it could be small bowel obstruction.

Or worse.

Sigmoid volvulus?

But that's a surgical emergency.

Wouldn't she have tons of pain?

Not always, especially when you're in your 80s.

I am getting concerned.

This is a millimeter past the line.

Or my line was sloppy.

- Any increase in pain? - Oh.

OK, sorry. Let's try four morphine.

White count's only 10,000.

It'd be over 12,000 for SIRS.

There are other criteria.

Still a febrile.

Did you ask about past history of MRSA?

Not specifically, but she's never been hospitalized.

Any evidence of an immunocompromised state?

- No, she's healthy. - Steroid use?

Never.

Maximum heart rate's only 89.

Is that OK?

That's good, very good.

Stay with her.