Code Black (2015) s01e01 Episode Script
Pilot
1 Hello, residents.
Dr.
Rorish will be here shortly.
For now, you got me.
I'm Jesse Sallander.
For the next three years, I'm your mama.
I'm the senior E.
R.
nurse, and I can promise you there's nothing that goes on in this house your mama don't know about.
Try hiding something, your mama will find out.
You think you're smarter than your mama because you got an M.
D.
? Well, you are not.
Your mama knows when you're lying, crying, or dying, and it's not only my job to teach you right from wrong, but to make sure you don't leave here in three years thinking you can do no wrong.
Guys, can we clean this up, please? You resident or attending? First-year resident, like you.
My name's Christa.
Mario.
Where'd you intern? UCLA.
Can't beat the tuition, right? Wouldn't know.
NYU.
I'll be paying off loans till I'm your age.
Thank you.
Thousands of newly minted doctors like yourself apply every year to learn emergency medicine in the civic cathedral, which you are about to enter.
This is why you're here.
The most famous strip of hospital real estate in the nation, where emergency medicine was born, where the secret service reserves a trauma bed for the president of the United States when he is in Los Angeles.
This is Trauma-1, Angels Memorial.
These stalls around the perimeter, which we call the Sides, are for the patients who put off dying for a few minutes.
And then this here, this is for the ones who are trying to die on you right this second.
This, ladies and gentlemen, is Center Stage.
People come here for one reason and one reason only To get one last miracle.
Now, in your mama's house, there is a number-one rule, and in order that you properly obey this number-one rule, ask me all the questions you think are stupid.
Why? Because you're gonna be too afraid to ask daddy.
So better to ask me than to violate the number-one rule, which is that you are not, under any circumstances, allowed to kill a guest in my house.
If he's mama, who's daddy? Somebody's at the door! Homeboy drop-off! Let's move! That's daddy.
Grab some gloves, follow me.
What the hell's a homeboy drop-off? Gangbangers leave their wounded on the sidewalk.
Jesse put up a doorbell.
"Homeboy drop-off"? That sounds racist.
They gave it that name, not us.
Oh, my God.
What the hell? Keep it together! Come on! Got a heavy bleeder up front.
Check the back.
Back's empty.
Gunshot wound to the neck, obliterated carotid.
He's lost half his volume here.
Jesse, we got to get him out of here.
Let's get the gurney underneath him, please.
Go.
All right, you Get over there on the other side and push with both legs.
One, two, three Go! Put him up.
Watch his head.
One more time.
Let's go.
One, two, three, go! All right, you, ride up top.
I can do it.
Get up there.
All right, careful, careful.
Put your finger down where my finger is, right? You feel that little thing wiggling around like a worm trying to get away? Okay, that's the carotid artery.
Your finger is now the only thing keeping that man alive.
Okay, go.
Life is measured here in split seconds.
Hesitate, and people die.
I'm gonna need some suction.
Ella, Ella.
Call a T.
T.
A.
Jesse, call the blood bank.
Tell them I need 6 to 8 units and notify the O.
R.
Copy that.
Off to Level 1, all right.
Got a gunshot wound, male.
One hole.
I don't know if there's more.
N.
V.
P.
Now! R.
S.
I.
Etomidate.
20 milligrams.
Sux 140, please.
Push it on my mark.
Meds are ready.
Push it now, please.
Okay.
Okay, now's a good time to get down.
- Come on, come on.
- Copy that.
Do you want me to get the labs for transfusion type and cross match? No, but you can take over CPR.
But the blood loss is critical.
Look at his pulse, doctor.
This man's heart needs assistance.
Stop compressions so we can intubate.
- You got it? - Yeah.
Who can tell me why this patient cannot be transfused with type and cross-match blood? Anyone? 'Cause it takes an hour.
He doesn't have an hour.
He needs O-neg, which is here now.
Thank you, Jesse.
But six units? That's a lot of blood.
By the time he gets sewn up, he'll have lost that and more.
Hang on.
She's right.
Yeah.
It's gonna take a vascular surgeon an hour to replace that vessel, and he doesn't have an hour.
He doesn't have 10 minutes.
And all that blood's gonna end up on the floor underneath a dead man.
It's Friday night, mama.
We're gonna need that blood.
Yes, we will.
You're not gonna transfuse him? Wait.
You're just gonna kill him? What's going on? I need a vas cath in his "L" subclavian and all the cold saline that I can get.
Leanne? A word? Who can tell me what I'm doing? Cold saline, coming in.
Anyone? I'm replacing all the patient's blood with ice-cold saline.
Why am I doing that? You shouldn't be.
He's already decompensating.
I need assistance, Dr.
Hudson.
I'll take it black with no sugar.
That's a man on that table, Leanne.
You are you ready to speak yet? The theory of cold infusion is that it can create a temporary suspension of animation through hypothermia, buying the patient, in theory, the hour it'll take a surgeon to repair the artery.
Bingo.
So you were right.
We are going to kill him.
We're going to kill him to save him.
All right.
Let it go, let it go.
- You have the cold saline? - Yep.
Stat it.
Suction.
A cold infusion.
It's an experimental procedure.
It doesn't even have I.
R.
B.
approval yet.
Sounds exciting.
You're the director of the E.
R.
, Mark.
Where's your concern? Left it in a bottle of Xanax.
The patient survived, Neal.
Well, this time.
Look, it was a horrible thing that happened to Leanne.
We all felt it.
But in the three years since, she's had more dropouts than any residency director we've ever had.
She's become more dangerous and more reckless.
She's been investigated What four times by the State.
Exonerated four times.
I mean, where are we going with this? She's different.
You know she is.
No, what I know is that while the accident was deeply tragic, all that rage made her better.
You know, more dropouts, yes, but the ones that got through her went on to better jobs at better hospitals.
She makes great docs, Neal.
The board likes her, which means I love her.
You wanted to see me? Uh, yeah.
You put a patient into suspended animation.
How's he doing? Has he, uh, reached hyperspace yet? He's in the O.
R.
, getting his carotid sewn up.
And all of his blood is safely back inside him.
Don't ever challenge me in front of my residents again.
You were performing an unapproved procedure on a patient, Leanne.
Uh, Neal, your old lady here, she's, uh, trying to get up.
Miss? Miss, you can't do that, okay? The patient was in the grave.
And I brought him back.
That's a win in anyone's book.
Not yours.
You know, when I was a resident, you always said they're not scorecards.
They're actual people.
Careful.
I think I know a little bit better than you that kid is an actual person, that he has an actual family who's praying that if their son gets brought in here E.
S.
I.
-1, he'll be treated by a doctor who will do everything humanly possible to save his kid's life, not by a timid one who's more concerned about the rules than he is about the life on the table in front of him.
I see.
They want you, not me.
No.
You're the doctor they want.
I'm the doctor they need.
Fun stuff, but I just got a text that 40 people just checked in while we were having this little menage, so if nobody's taking their clothes off, I need you both back down on the floor now.
Neal, your patient.
You were a little rough on him, huh? We're not their friend, their family, or their shrink.
We're their doctor.
He gets confused.
He's not confused.
He cares about you, about them.
And for that, you have only yourself to blame.
Fall off your board? The rail was sketchy.
I think it's broken.
I can feel bones crunching around in there.
You high right now? Why? You want some? Cute.
Come on.
You're only as good as your wait time out here.
You want to love your patients, fine thank you But you better love the ones out here just as much, because they may need you more.
Angus Leighton.
Malaya Pineda.
Wait.
You're Mike Leighton's brother? He talked about you.
You know him? I was just a med student when he was a resident, but everyone knew Mike.
He's a superstar.
He crapped his bed in summer camp.
He was 12, but it counts.
We separate them into three categories of acuity E.
S.
I.
-1, 2, and 3.
E.
S.
I.
-1 is critical.
Bullet wound, heart attack.
The 2 is rough, but it's not death's door Pneumonia, blood clot.
E.
S.
I.
-3 meh.
The flu, migraine, minor laceration.
Are we gonna be seeing our own patients today? For now, you'll be taking light cases and assisting the attendings unless that board says "code black," in which case, half of L.
A.
is in this room, and then all bets are off.
Doctors.
75-year-old male.
Started speaking gibberish at dinner.
Bay number 4.
He's gonna need tPA.
Dr.
Leighton.
tPA.
I think he needs tPA.
I didn't ask, but I'm sure Dr.
Guthrie will be thrilled.
Follow him and try not to kill anyone.
Dr.
Rorish, I'd really like to observe that case, too.
How nice for you.
Waiting for a formal invitation? Go now.
I'm gonna need you at dispatch.
I got two coming in, one critical.
Dr.
Hudson's on his way down now to meet you.
You and you Follow me.
Jesse, find something for Dr.
Pineda.
Why is she ignoring me? Because you're the only one who went to school here.
It's their first day around her.
You need to relax.
I'm not here to relax.
- I want - I know.
This is your big "I'm a doctor now" moment? Kinda, yeah.
Good, good, 'cause I need a hero.
In fact, I'm holding out for a hero till the end of the night.
And she gotta be fast and she gotta be strong and she gotta be fresh from the fight é¾ Don't get shy now.
I need a hero come on.
Come on.
Let's go find you an attending to annoy.
Someone who Needs a hero! Looking for a hero.
Leanne? Dr.
Hudson.
Say hello to Doctors Savetti and Lorenson.
Neal Hudson.
Congratulations on matching to Angels.
You're learning from the best.
I didn't mean what I said before.
I don't think those things about you.
Yes, you do.
Well, we just have different philosophies.
We didn't always, Leanne.
What you got? 36-year-old male.
Airbag malfunction.
Nonresponsive, head injury, multiple lacs.
Pulse 65, B.
P.
120 over 90.
Ariel multiple lacs to the face, head, and upper body, with glass embedded just about everywhere.
She is highly agitated.
Daddy! Daddy! Hey! Whoa, whoa, whoa.
No, no, no, no, no! Darling, please! Let go of me! - No.
- Is he gonna die? No way.
Do you want it straight or do you want doctor talk? I want it straight.
- What's your name? - Ariel.
Ariel, I'm Dr.
Rorish, and the truth is we don't know why your father's unconscious, and I can't learn anything out here in the dark.
So, with your permission, I want to take him inside, and I promise you I will tell you everything I know as soon as I know it.
- Okay? - Okay.
Okay.
You.
Don't ever lie to a patient again.
She may be young, but she's entitled to the truth.
One, two, three.
And careful.
All right.
And great.
Back down easy now.
There we go.
Pulse is thready.
B.
P.
60 over 30.
All right, I need central lines prepped for pressors, please.
Norepinephrine? Yes, please.
Somebody call X-ray, please.
I'm on it.
Thank you.
What's your evaluation, doctor? Uh, patient unconscious, low B.
P.
, warm extremities.
He's in spinal shock.
No additional examination? It's pretty textbook.
- Pretty textbook, huh? - Yeah.
Okay, what about you, doctor? Textbook? Here you go, needle.
Thank you.
Got it.
Wire.
Wire.
Is he 1-1-1? - Yes.
- Then say so.
Trepidation is a deadly quality in this place.
Let me out.
Life lesson.
When asked if you want to examine your patient some more, it's like being asked if you want a breath mint.
The only answer is "yes.
" Okay, we're in.
What the hell is a 1-1-1? I assumed she was referring to the G.
C.
S.
scale.
6-5-4 is normal brain function.
1-1-1 is the lowest.
He's brain-dead.
That poor kid.
You know, Ariel, I think it's time you called your aunt.
She can't get a flight until tomorrow.
I can't talk to her until I know my dad's okay.
She didn't handle my mom dying very well.
How did you handle it? I was only 8, so Is that lady doctor coming in soon? The one taking care of my dad.
I'll check.
Meantime, here's my cellphone.
You call your aunt.
She'll feel better hearing your voice.
He was confused that I didn't understand him.
Yes.
Called expressive aphasia.
It's word salad.
Sounds right to him, but the words come out all tossed around.
Activate the stroke team, please.
Young squire.
I heard you mention tPA.
Is that what you're thinking? Sides, North 4.
8:55 P.
M.
Yes.
The symptom profile suggests M.
C.
A.
distribution.
I think so, too.
Fingers crossed.
Okay, Mr.
and Mrs.
Cleery, tPA is a kind of miracle drug that has the potential to bust the clot up and reverse the stroke, but only if there's no actual bleeding yet in the brain.
We're gonna need a scan to know for sure.
Doesn't take 12 people to run a scan.
Come on, folks.
It's Friday night.
Let's divide and conquer.
Young squire, would you check in at the nursing station, see where you can be useful? When they're done X-raying him, take him down to Sides and put a cast on him.
Are you good? A cast? That's it? This one.
Oh.
You got it.
Wait.
Where is X-ray? Let's just keep that between us, okay? He's brain-dead.
Oh, God.
And she's all alone till tomorrow.
Has someone called Child and Family Services to come get her? Yeah, but you know how that goes.
It could be hours.
It gets worse.
He's an organ donor.
Transplant team's on the way.
Then we can't wait for CFS.
I have to tell her.
Neal.
Neal.
I should do it.
Why? She's my patient.
I gave her my word.
I don't think it's a good idea.
It won't be pretty.
Are you protecting me or her? He was under my care.
Let's do it together.
Is he awake? Ariel, your father came in with some terrible injuries, most of which we couldn't see at first.
What are you What are you saying? There is no g good way to say this.
I'm sorry.
For what? We couldn't save him.
I-I don't understand.
Your father died, Ariel.
Well, technically Technically, it's a-a brain death.
- So he's not dead? - No, no.
That's What I mean is, machines are keeping his body in a state of What are you saying? I'm trying to explain to you.
No, you're not! What happened to just giving it to me straight? I'm giving it to you straight.
So he's dead, but technically, not really, right? No, I want to go see him.
I want to see him.
I have to see him! Please, sit down.
Please sit.
- Listen.
- No.
Ariel, your father chose to be an organ donor.
That's why we have machines keeping his organs functioning.
You have to understand He's never going to wake up.
He's gone, sweetheart.
I'm terribly sorry.
No.
No.
No.
Ariel.
No.
No, I know.
No, no, no.
You can't have his organs.
I'm his daughter, and I'm saying no.
Well, unfortunately, that's not your decision to make.
It's your father's, and he made it a long time ago.
No, you don't care about my father, and you don't care about me.
You just want to cut him up.
That is not true.
Shut up! Shut up.
Sorry.
I'm I'm so sorry.
Shh.
Got bleeding, I've got bleeding! Transplant team's en route.
I want to tell you how fabulous you look right now.
I do? No.
I want to tell you that, but then it'd be a lie.
You look like you've been strapped to the bow of a ship.
Is that so? Mm-hmm.
No, no.
Don't do that.
You don't need any more laugh lines, believe me.
Me? Have you looked at yourself in the mirror lately? Mm-hmm.
I love you so much, I want to break you in half.
I love you so much, I want to punch your face in.
All right, back to work.
We might hit code black tonight.
You got that, boss.
Well, you qualify for tPA, and we're still inside the window for it to be effective.
What are the complications? Only 7% experience the miracle.
However, the same number experience catastrophic bleeding somewhere else in the body.
We wouldn't know where until it was actually happening, and we might not be able to stop it.
And if we do nothing? What you see now.
And possibly worse.
Hey, Hannah? Who's next? Uh 26 year old Pregnant, U.
R.
I.
, fever.
Parked her in triage.
Sounds like the flu.
Evaluate, then come find me.
- Should I go - Evaluate and find me.
Next.
How do you know so much? Believe me, I don't.
We both went to medical school, we both did an internship.
You pulling second residency? What do you mean? I mean, were you already an M.
D.
and then went back to try a different specialty or something? No.
I was too busy being a wife and a mom.
Wife and a mom? You sure you're ready for this? How old do you think I am? All I'm saying is, there's no tougher place to work in all of E.
R.
medicine than Trauma-1 at Angels Memorial.
This place is hard enough for The young.
For the unattached.
Stop being threatened by me, okay? Is that what you think, that I'm threatened? I think we should examine this patient together.
Maybe we'll both learn something.
Why not? The worst part is the headache.
I live above the boiler room in my building, and the noise just keeps cracking my head open.
Is there anything you can give me for that? You're nine months pregnant.
There's not a whole lot we can do other than give you Tylenol.
I've tried that.
Doesn't work.
Using again? - Excuse me? - Mario.
The scars on the inside of your arm They're old track marks, right? None of your damn business.
Who the hell do you think you are? Just a doctor trying to figure out what's wrong with a patient.
You're a jackass.
I don't have to listen to this.
Take it easy.
Take it easy.
It's okay.
He's leaving.
Can I talk to you for a second? What was that about? She's a seeker.
Heroin withdrawals often mimic flu symptoms.
You don't know that for a fact.
Where's the fever? If it was the flu, would've hit her like a freight train.
You got a lot of experience with drug withdrawals? No.
I'm sorry.
I just don't think that woman is using.
I know a little bit more about this than you do.
It was a long time ago.
I'm not ashamed.
I pulled myself out, and I'm fine now.
What, do you two just not have enough to do? We're having a disagreement about a patient.
Oh, yeah? Which one? The pregnant U.
R.
I.
I think we should run a tox screen, rule out heroin withdrawals.
Huh.
And you? I don't know.
Something's not right.
I don't think it's the flu, I don't think it's heroin.
If I just had a little bit more time, I could Well, you don't have time, and a positive tox screen doesn't change the management of the case.
Even if she has an addiction problem, there is nothing we can do for her in the E.
R.
Recommend a social worker, ship her out.
You make a good point about the fever, but I don't think it's heroin.
Doesn't matter.
You heard what she said.
Doesn't change the management of the case.
Yeah, but we need to know.
We should run a tox screen.
There's no "we" here.
You heard what Rorish said.
She also said trepidation is a deadly quality.
I'm already on her bad side.
There's nothing in this for me.
Except maybe saving a patient's life.
Malaya, whatever you're doing, log out, follow me.
You're gonna love this.
Sounds exciting.
Clearly, you don't speak the native tongue of my people Sarcasm.
Come on.
Hey, come on.
Hold your arm up just like this.
- Angus.
- Yep? Guthrie wants you.
He's with the stroke patient.
Malaya can finish the cast.
Wait.
Guthrie's gonna let him administer the tPA? And I'm gonna do a nurse's job? A nurse's job? I didn't mean it.
You want to be part of a team, Malaya, no job is too big, no job is too small.
Dr.
Leighton, go now, please.
Yep.
Arm up.
Come on.
I won't go, either.
That's ridiculous.
I didn't mean it.
Of course I'm going.
Wait.
What's up with skater boy? He's, uh Just sleeping it off.
Great.
Go.
tPA has a short window.
How soon will we know if it worked? Just takes a few seconds When it works.
Come on, baby.
Show us the magic.
Mr.
Cleery.
I want you to try and speak.
Love you.
Yes.
Abracadabra.
That's why we're here, young squire.
Never forget that.
- Take it easy! Take it easy! - No! No! No! 10-year-old male, breathing labored, possible allergic reaction.
He didn't eat or drink anything out of the ordinary.
Uh, where are you from? Norway.
Uh, Center Stage.
Your son has a collapsed lung.
We're gonna help.
How could you know that? If a Norwegian kid can't breathe, it's a pneumothorax.
It's a genetic predisposition.
Can someone run another I.
V.
for me, please? I'm all out of nurses.
- I got it! - My girl.
Okay, watch his head.
Ready? Back him up, back him up.
What's your son's name? Basti Short for "Sebastian.
" Okay, Basti.
I need you to look at me.
Need a mask.
Step it out.
Step it out.
You're gonna be all right.
We just need to let a little air out of your chest.
You're gonna feel better right away.
It's okay.
Leanne, transplant team just took Ariel's father upstairs.
Understood.
Uh, we're gonna put a tube into Basti's chest to relieve the pressure.
This is very routine.
We can do it right here.
She asked to talk to you.
Me? Why? She connected with you.
No, she didn't.
Uh, nurse.
Angus, you're gonna do the chest tube.
Me? Yes.
What are you doing? I'm looking for my diploma to make sure it's really my name on it.
I'm prepping a tray for you.
You're going to be making an incision.
I need some more local.
Leanne, I can take this case.
Go and talk to her for a minute.
Look, if you want me to be a social worker, You pick the patient who should die in the waiting room.
She's a patient, too, Leanne.
Go and talk to her for a minute.
Look around you, Doctor! We'er about to be in Code Black.
I have eczema, itches like crazy.
You don't care, right? These people here, they don't care about your problems either.
All right, uh, Sebastian, I want you to slow your breathing down, okay? Can you do that? We're going to help you.
What's that kid doing in here? Is he okay? Whose patient is this? Mine.
Hey.
Focus.
Whoa! This kid has a head injury! I need a gurney.
I'm out of gurneys.
Guys, guys, can I get a wheelchair? Come on.
A wheelchair or something.
I got to pull somebody out of here.
I.
V.
tubing.
We are officially in code black.
God help us.
Yeah, exactly.
That's what we need a neurosurgeon.
Yeah, of course we're gonna get a C.
T.
scan, Natalie, as soon as the room frees.
No, I know it is, but I need a neurosurgeon down here right now.
I think it's an internal bleed, Natalie! We're slammed up here! Hold on a second! Listen.
I'm checking.
It's going to take a few minutes.
Wait! Wait, Natalie! C.
T.
scan is ready.
All right, great.
Let's move him.
Jesse.
Simple chest tube, right? Yeah, yeah.
About to start the incision.
Wait.
Wait.
You're gonna move You're leaving? This patient needs an M.
D.
, and we're in code black.
I think you can handle it.
Let's go, let's go.
Let's go, Jesse.
Go, go.
Mama's in the kitchen.
Hey.
Focus.
You can do this.
Out of my way! Come on! See you.
Thanks.
Blood pressure.
Great.
Hurry up.
Stabilized, let me know when he's ready.
Got it.
Tube is in.
Vitals are dropping.
Doesn't make sense.
Hang in there, pal, okay? Why isn't it working? What is happening, please? Might be a bad chest tube.
I'm gonna need another chest tube.
I-it's it's not the tube.
This one's just stuck.
Please do something! He's not breathing! Angus! It's stuck in the fascia of his back.
Get him out of the way! Grab the tube! You need to pull! We need to get the doctor in here! I'm a doctor.
And you are, too.
Listen.
- Listen to my voice, okay? - Okay.
- Do you feel it? - Yes.
- Just stuck in the fatty tissue.
- Okay.
So we just pull gently.
Okay.
Okay.
Ah! Good job, Dr.
Pineda.
Your little boy's gonna be okay.
Good job.
I need a 3 of nylon.
Pick this up.
Someone put up some dressings.
Thank you, thank you.
All right.
Rorish is looking for you.
She canceled the tox screen on your pregger.
Patient left anyway.
Sorry.
Which is showing a hyper dense increased attenuation in an elliptical pattern, which is consistent with an epidural hematoma.
No, do not put me on hold again! Dr.
Rorish, I know you're angry You deliberately ignored direct instructions from your supervising physician.
You said trepidation is a deadly quality.
I thought I was acting in the best interest of my patient.
You don't have patients.
You're a first-year a first-day resident, which means every patient you see is my patient.
If I can't trust you here, I can't have you here.
Goodbye, Christa.
Wait.
What? Go home.
It's over.
Yes, yes, yes, I'm here.
No, well, someone's gonna have to drill a hole, then, because the blood has to go somewhere! She fired me.
Did you tell her I knew? No, Mario, but thanks for the concern.
Look, I'm sorry, but while you were busy picking up preschools, I paid for medical school driving a truck, choking on diesel fumes.
Wait, wait, wait.
Diesel fumes! - Oh, my God! - What? What if it's carbon monoxide? Carbon monoxide poisoning can mimic flu symptoms.
She said she lived above a boiler room, right? Oh, my God, Mario, I could kiss you.
But not really.
Come on, come on, come on, come on, come on, come on.
Let's move, people.
I.
V.
and foley are in.
Truck ran right over his leg, broke in at least four places.
Big mid-femur deformity from the crush.
What's your name, sir? Wayne.
I just can't feel my leg, doc.
Bone's pinching a nerve.
We're gonna help you.
I.
V.
, fluids, 20 milligram morphine, stat.
Flying it.
What's that for? Renovating the suture room.
You're drilling a burr hole? Foot cold.
There's no pulse down here.
We got to get this leg straight.
He's gonna need that gurney.
Got it.
Bring it in.
You can't put a hole in that kid's skull in the E.
R.
, Leanne.
You need a neurosurgeon.
It's an epidural bleed.
He's out cold.
I got to drain it.
- Line him up.
- One, two, three.
Sometimes you just got to be a cowboy, Neal.
Hey, you're gonna need some help if you're gonna yank that.
Mario, get over here.
Okay, Wayne, this is gonna help with the pain.
Phone the cath lab.
Tell them we're on our way.
Dr.
Rorish, you might not be surprised by this, but one of your residents is calling you from the back of an ambulance on the 101 Freeway.
What?! Who? - Blondie.
I got to go.
- Christa? Dr.
Rorish, it's definitely carbon monoxide.
They had to break all the windows.
She's still unconscious.
We're giving her oxygen.
I'm sitting here Christa, deep breath.
Give me vitals.
Pulse faint at 120, B.
P.
60 over palp.
Her patient's crashing.
She's pregnant.
You need to get her back here.
She needs a hyperbaric chamber.
Christa, what's your E.
T.
A.
? Not soon.
You're not gonna like this, Neal, but She has to perform a C-section on the rig.
Sometimes you got to be a cowboy, right? Let's do this.
Wait, Christa's gonna do a C-section? Mario, focus.
I need you up by his shoulders to give me leverage.
I'm gonna try and save his leg.
Christa, listen.
I need you to tell the medic to prepare an emergency surgical kit.
Wait, wait, wait, wait.
I can't do this.
Yes, you can.
You've done an O.
B.
rotation.
You've witnessed plenty of these.
Take a deep breath for me, sir.
Christa, make sure the patient stays unconscious.
Uh, no danger there.
Okay.
Get ortho ready to go.
Our friend Wayne here is gonna need an O.
R.
right after.
After what? Susie, I need you on his pelvis.
Make sure he doesn't slide.
Jesse.
Need you over here for a sec.
Whoa, whoa, whoa, whoa! B.
P.
dropping! Jesse, get back.
I need Jesse back, damn it.
Okay.
You got that? Everybody ready? Ready for what? Hold him.
One, two, three.
Pulse is dropping.
Okay, then we got to move fast.
To still have a chance to save both of them.
Christa, I need you to start with an abdominal incision beginning at the umbilicus and straight down to the pubic symphysis.
- Whoa! - I need a clean up in aisle 3.
You need to cut through all five layers of the abdominal wall, including the peritoneum.
I've got this.
- Get this cleaned up.
- What is that noise? Ignore it.
Vitals? Pressure dropping.
Pulse 30.
It's okay.
Stay focused.
Start your incision now.
Christa, right under the abdominal wall, you're gonna see something shiny.
That's not the uterus.
It's the bladder.
Careful not to nick it.
You're gonna want to reflect it distally, get it out of your way.
Okay, vitals are dropping.
Yeah, I'm almost there.
- Leanne? - Almost there.
Okay.
Pulse is dropping.
Leanne, he's herniating! I know.
Almost.
Uterus is exposed.
- Hang on.
- "Hang on"?! Almost got it.
Is he draining yet? Come on.
Come on.
Almost there.
I got it! Okay, get it in.
Heart rate normalizing.
Pupils Reactive.
All right, Christa, time to make the vertical incision in the uterus.
Watch the lateral vessels.
Oh, God.
Oh! Okay.
Now, this is gonna happen very quickly.
I want you to reach your hand inside as fast as you can, carefully feel for the baby.
When? - Have you made the cut yet? - Yes.
- Now! - Now! All right, I think I can feel it.
Okay.
I got it.
Oh! I got her! She's so beautiful! Oh, I got her.
Oh, my gosh.
Okay, kids, we got one open in O.
R.
Mine's stable.
You should go.
All right, let's move him.
Gurney.
Get him up.
Okay, guys, let's go! Go, go! Move it, move it.
Move aside.
You think Dr.
Rorish ignores you because she doesn't trust you? It's just the opposite.
She knows you're good.
She's testing the rest of us.
And I don't think I'm gonna pass that test.
What are you talking about? You know your stuff, dude.
You just need confidence.
You asked how I got in.
Our dad is on the hospital board.
My brother never told anyone.
He thought people wouldn't take him seriously.
Wouldn't matter anyway.
He was born for this.
I am not like him, though.
Then what are you doing here? I hated psych.
Hated it.
I wanted something more exciting.
I wanted what Mike had.
So when my dad said he could get me in here, I jumped at it.
Big mistake.
Did you know that they opened this place up in 1932? Light bulbs weren't bright enough back then, so they put in all these big windows so they could see what they were doing.
Imagine that.
Hell of a night for you two.
Started off saving a life, ended up almost killing someone.
Two people, actually.
I missed an epidural hematoma.
I missed it, too.
Hm.
Know what that sounds like to me? A typical night in this joint.
You did good.
So did you.
We've got her mom in the hyperbaric chamber, oxygenated her.
She's gonna make it.
Thank God.
Can I ask you something personal? Why are you here? Pardon? Med school, internship, and now the most punishing residency in the country.
Most people do that in their 20s.
What made you decide My son died.
Stage 4 glio.
You learn a lot when your kid gets sick.
So I thought maybe I should make it official.
I got into med school And here I am.
In my experience, tragedy either softens you or hardens you.
For me, it was the former.
For you, I suspect it was the latter.
You spend enough time in group therapy sessions, you start to recognize it.
Who'd you lose? Everyone.
You better go home and get some sleep.
You've got a shift tonight.
I do? Hi, Ariel.
Hi.
And you must be Aunt Linda.
So nice to meet you in person.
Thank you for this.
Mm-hmm.
You ready? I'll wait for you right here.
Thank you.
Hi.
I'm Vanessa.
I'm Ariel.
I like your room.
Thanks.
You can come closer if you want.
It's okay.
Can you hear it? Yeah.
I can hear it.
I hear you, daddy.
I hear you.
You got to be kidding me.
Every ventilator I.
C.
U.
can spare.
Got an apartment fire.
We got 22 in so far.
Burns, smoke inhalation, broken bones, - and a heart attack.
- Got it.
Yeah, we're gonna need a barrel of morphine.
Dr.
Rorish will be here shortly.
For now, you got me.
I'm Jesse Sallander.
For the next three years, I'm your mama.
I'm the senior E.
R.
nurse, and I can promise you there's nothing that goes on in this house your mama don't know about.
Try hiding something, your mama will find out.
You think you're smarter than your mama because you got an M.
D.
? Well, you are not.
Your mama knows when you're lying, crying, or dying, and it's not only my job to teach you right from wrong, but to make sure you don't leave here in three years thinking you can do no wrong.
Guys, can we clean this up, please? You resident or attending? First-year resident, like you.
My name's Christa.
Mario.
Where'd you intern? UCLA.
Can't beat the tuition, right? Wouldn't know.
NYU.
I'll be paying off loans till I'm your age.
Thank you.
Thousands of newly minted doctors like yourself apply every year to learn emergency medicine in the civic cathedral, which you are about to enter.
This is why you're here.
The most famous strip of hospital real estate in the nation, where emergency medicine was born, where the secret service reserves a trauma bed for the president of the United States when he is in Los Angeles.
This is Trauma-1, Angels Memorial.
These stalls around the perimeter, which we call the Sides, are for the patients who put off dying for a few minutes.
And then this here, this is for the ones who are trying to die on you right this second.
This, ladies and gentlemen, is Center Stage.
People come here for one reason and one reason only To get one last miracle.
Now, in your mama's house, there is a number-one rule, and in order that you properly obey this number-one rule, ask me all the questions you think are stupid.
Why? Because you're gonna be too afraid to ask daddy.
So better to ask me than to violate the number-one rule, which is that you are not, under any circumstances, allowed to kill a guest in my house.
If he's mama, who's daddy? Somebody's at the door! Homeboy drop-off! Let's move! That's daddy.
Grab some gloves, follow me.
What the hell's a homeboy drop-off? Gangbangers leave their wounded on the sidewalk.
Jesse put up a doorbell.
"Homeboy drop-off"? That sounds racist.
They gave it that name, not us.
Oh, my God.
What the hell? Keep it together! Come on! Got a heavy bleeder up front.
Check the back.
Back's empty.
Gunshot wound to the neck, obliterated carotid.
He's lost half his volume here.
Jesse, we got to get him out of here.
Let's get the gurney underneath him, please.
Go.
All right, you Get over there on the other side and push with both legs.
One, two, three Go! Put him up.
Watch his head.
One more time.
Let's go.
One, two, three, go! All right, you, ride up top.
I can do it.
Get up there.
All right, careful, careful.
Put your finger down where my finger is, right? You feel that little thing wiggling around like a worm trying to get away? Okay, that's the carotid artery.
Your finger is now the only thing keeping that man alive.
Okay, go.
Life is measured here in split seconds.
Hesitate, and people die.
I'm gonna need some suction.
Ella, Ella.
Call a T.
T.
A.
Jesse, call the blood bank.
Tell them I need 6 to 8 units and notify the O.
R.
Copy that.
Off to Level 1, all right.
Got a gunshot wound, male.
One hole.
I don't know if there's more.
N.
V.
P.
Now! R.
S.
I.
Etomidate.
20 milligrams.
Sux 140, please.
Push it on my mark.
Meds are ready.
Push it now, please.
Okay.
Okay, now's a good time to get down.
- Come on, come on.
- Copy that.
Do you want me to get the labs for transfusion type and cross match? No, but you can take over CPR.
But the blood loss is critical.
Look at his pulse, doctor.
This man's heart needs assistance.
Stop compressions so we can intubate.
- You got it? - Yeah.
Who can tell me why this patient cannot be transfused with type and cross-match blood? Anyone? 'Cause it takes an hour.
He doesn't have an hour.
He needs O-neg, which is here now.
Thank you, Jesse.
But six units? That's a lot of blood.
By the time he gets sewn up, he'll have lost that and more.
Hang on.
She's right.
Yeah.
It's gonna take a vascular surgeon an hour to replace that vessel, and he doesn't have an hour.
He doesn't have 10 minutes.
And all that blood's gonna end up on the floor underneath a dead man.
It's Friday night, mama.
We're gonna need that blood.
Yes, we will.
You're not gonna transfuse him? Wait.
You're just gonna kill him? What's going on? I need a vas cath in his "L" subclavian and all the cold saline that I can get.
Leanne? A word? Who can tell me what I'm doing? Cold saline, coming in.
Anyone? I'm replacing all the patient's blood with ice-cold saline.
Why am I doing that? You shouldn't be.
He's already decompensating.
I need assistance, Dr.
Hudson.
I'll take it black with no sugar.
That's a man on that table, Leanne.
You are you ready to speak yet? The theory of cold infusion is that it can create a temporary suspension of animation through hypothermia, buying the patient, in theory, the hour it'll take a surgeon to repair the artery.
Bingo.
So you were right.
We are going to kill him.
We're going to kill him to save him.
All right.
Let it go, let it go.
- You have the cold saline? - Yep.
Stat it.
Suction.
A cold infusion.
It's an experimental procedure.
It doesn't even have I.
R.
B.
approval yet.
Sounds exciting.
You're the director of the E.
R.
, Mark.
Where's your concern? Left it in a bottle of Xanax.
The patient survived, Neal.
Well, this time.
Look, it was a horrible thing that happened to Leanne.
We all felt it.
But in the three years since, she's had more dropouts than any residency director we've ever had.
She's become more dangerous and more reckless.
She's been investigated What four times by the State.
Exonerated four times.
I mean, where are we going with this? She's different.
You know she is.
No, what I know is that while the accident was deeply tragic, all that rage made her better.
You know, more dropouts, yes, but the ones that got through her went on to better jobs at better hospitals.
She makes great docs, Neal.
The board likes her, which means I love her.
You wanted to see me? Uh, yeah.
You put a patient into suspended animation.
How's he doing? Has he, uh, reached hyperspace yet? He's in the O.
R.
, getting his carotid sewn up.
And all of his blood is safely back inside him.
Don't ever challenge me in front of my residents again.
You were performing an unapproved procedure on a patient, Leanne.
Uh, Neal, your old lady here, she's, uh, trying to get up.
Miss? Miss, you can't do that, okay? The patient was in the grave.
And I brought him back.
That's a win in anyone's book.
Not yours.
You know, when I was a resident, you always said they're not scorecards.
They're actual people.
Careful.
I think I know a little bit better than you that kid is an actual person, that he has an actual family who's praying that if their son gets brought in here E.
S.
I.
-1, he'll be treated by a doctor who will do everything humanly possible to save his kid's life, not by a timid one who's more concerned about the rules than he is about the life on the table in front of him.
I see.
They want you, not me.
No.
You're the doctor they want.
I'm the doctor they need.
Fun stuff, but I just got a text that 40 people just checked in while we were having this little menage, so if nobody's taking their clothes off, I need you both back down on the floor now.
Neal, your patient.
You were a little rough on him, huh? We're not their friend, their family, or their shrink.
We're their doctor.
He gets confused.
He's not confused.
He cares about you, about them.
And for that, you have only yourself to blame.
Fall off your board? The rail was sketchy.
I think it's broken.
I can feel bones crunching around in there.
You high right now? Why? You want some? Cute.
Come on.
You're only as good as your wait time out here.
You want to love your patients, fine thank you But you better love the ones out here just as much, because they may need you more.
Angus Leighton.
Malaya Pineda.
Wait.
You're Mike Leighton's brother? He talked about you.
You know him? I was just a med student when he was a resident, but everyone knew Mike.
He's a superstar.
He crapped his bed in summer camp.
He was 12, but it counts.
We separate them into three categories of acuity E.
S.
I.
-1, 2, and 3.
E.
S.
I.
-1 is critical.
Bullet wound, heart attack.
The 2 is rough, but it's not death's door Pneumonia, blood clot.
E.
S.
I.
-3 meh.
The flu, migraine, minor laceration.
Are we gonna be seeing our own patients today? For now, you'll be taking light cases and assisting the attendings unless that board says "code black," in which case, half of L.
A.
is in this room, and then all bets are off.
Doctors.
75-year-old male.
Started speaking gibberish at dinner.
Bay number 4.
He's gonna need tPA.
Dr.
Leighton.
tPA.
I think he needs tPA.
I didn't ask, but I'm sure Dr.
Guthrie will be thrilled.
Follow him and try not to kill anyone.
Dr.
Rorish, I'd really like to observe that case, too.
How nice for you.
Waiting for a formal invitation? Go now.
I'm gonna need you at dispatch.
I got two coming in, one critical.
Dr.
Hudson's on his way down now to meet you.
You and you Follow me.
Jesse, find something for Dr.
Pineda.
Why is she ignoring me? Because you're the only one who went to school here.
It's their first day around her.
You need to relax.
I'm not here to relax.
- I want - I know.
This is your big "I'm a doctor now" moment? Kinda, yeah.
Good, good, 'cause I need a hero.
In fact, I'm holding out for a hero till the end of the night.
And she gotta be fast and she gotta be strong and she gotta be fresh from the fight é¾ Don't get shy now.
I need a hero come on.
Come on.
Let's go find you an attending to annoy.
Someone who Needs a hero! Looking for a hero.
Leanne? Dr.
Hudson.
Say hello to Doctors Savetti and Lorenson.
Neal Hudson.
Congratulations on matching to Angels.
You're learning from the best.
I didn't mean what I said before.
I don't think those things about you.
Yes, you do.
Well, we just have different philosophies.
We didn't always, Leanne.
What you got? 36-year-old male.
Airbag malfunction.
Nonresponsive, head injury, multiple lacs.
Pulse 65, B.
P.
120 over 90.
Ariel multiple lacs to the face, head, and upper body, with glass embedded just about everywhere.
She is highly agitated.
Daddy! Daddy! Hey! Whoa, whoa, whoa.
No, no, no, no, no! Darling, please! Let go of me! - No.
- Is he gonna die? No way.
Do you want it straight or do you want doctor talk? I want it straight.
- What's your name? - Ariel.
Ariel, I'm Dr.
Rorish, and the truth is we don't know why your father's unconscious, and I can't learn anything out here in the dark.
So, with your permission, I want to take him inside, and I promise you I will tell you everything I know as soon as I know it.
- Okay? - Okay.
Okay.
You.
Don't ever lie to a patient again.
She may be young, but she's entitled to the truth.
One, two, three.
And careful.
All right.
And great.
Back down easy now.
There we go.
Pulse is thready.
B.
P.
60 over 30.
All right, I need central lines prepped for pressors, please.
Norepinephrine? Yes, please.
Somebody call X-ray, please.
I'm on it.
Thank you.
What's your evaluation, doctor? Uh, patient unconscious, low B.
P.
, warm extremities.
He's in spinal shock.
No additional examination? It's pretty textbook.
- Pretty textbook, huh? - Yeah.
Okay, what about you, doctor? Textbook? Here you go, needle.
Thank you.
Got it.
Wire.
Wire.
Is he 1-1-1? - Yes.
- Then say so.
Trepidation is a deadly quality in this place.
Let me out.
Life lesson.
When asked if you want to examine your patient some more, it's like being asked if you want a breath mint.
The only answer is "yes.
" Okay, we're in.
What the hell is a 1-1-1? I assumed she was referring to the G.
C.
S.
scale.
6-5-4 is normal brain function.
1-1-1 is the lowest.
He's brain-dead.
That poor kid.
You know, Ariel, I think it's time you called your aunt.
She can't get a flight until tomorrow.
I can't talk to her until I know my dad's okay.
She didn't handle my mom dying very well.
How did you handle it? I was only 8, so Is that lady doctor coming in soon? The one taking care of my dad.
I'll check.
Meantime, here's my cellphone.
You call your aunt.
She'll feel better hearing your voice.
He was confused that I didn't understand him.
Yes.
Called expressive aphasia.
It's word salad.
Sounds right to him, but the words come out all tossed around.
Activate the stroke team, please.
Young squire.
I heard you mention tPA.
Is that what you're thinking? Sides, North 4.
8:55 P.
M.
Yes.
The symptom profile suggests M.
C.
A.
distribution.
I think so, too.
Fingers crossed.
Okay, Mr.
and Mrs.
Cleery, tPA is a kind of miracle drug that has the potential to bust the clot up and reverse the stroke, but only if there's no actual bleeding yet in the brain.
We're gonna need a scan to know for sure.
Doesn't take 12 people to run a scan.
Come on, folks.
It's Friday night.
Let's divide and conquer.
Young squire, would you check in at the nursing station, see where you can be useful? When they're done X-raying him, take him down to Sides and put a cast on him.
Are you good? A cast? That's it? This one.
Oh.
You got it.
Wait.
Where is X-ray? Let's just keep that between us, okay? He's brain-dead.
Oh, God.
And she's all alone till tomorrow.
Has someone called Child and Family Services to come get her? Yeah, but you know how that goes.
It could be hours.
It gets worse.
He's an organ donor.
Transplant team's on the way.
Then we can't wait for CFS.
I have to tell her.
Neal.
Neal.
I should do it.
Why? She's my patient.
I gave her my word.
I don't think it's a good idea.
It won't be pretty.
Are you protecting me or her? He was under my care.
Let's do it together.
Is he awake? Ariel, your father came in with some terrible injuries, most of which we couldn't see at first.
What are you What are you saying? There is no g good way to say this.
I'm sorry.
For what? We couldn't save him.
I-I don't understand.
Your father died, Ariel.
Well, technically Technically, it's a-a brain death.
- So he's not dead? - No, no.
That's What I mean is, machines are keeping his body in a state of What are you saying? I'm trying to explain to you.
No, you're not! What happened to just giving it to me straight? I'm giving it to you straight.
So he's dead, but technically, not really, right? No, I want to go see him.
I want to see him.
I have to see him! Please, sit down.
Please sit.
- Listen.
- No.
Ariel, your father chose to be an organ donor.
That's why we have machines keeping his organs functioning.
You have to understand He's never going to wake up.
He's gone, sweetheart.
I'm terribly sorry.
No.
No.
No.
Ariel.
No.
No, I know.
No, no, no.
You can't have his organs.
I'm his daughter, and I'm saying no.
Well, unfortunately, that's not your decision to make.
It's your father's, and he made it a long time ago.
No, you don't care about my father, and you don't care about me.
You just want to cut him up.
That is not true.
Shut up! Shut up.
Sorry.
I'm I'm so sorry.
Shh.
Got bleeding, I've got bleeding! Transplant team's en route.
I want to tell you how fabulous you look right now.
I do? No.
I want to tell you that, but then it'd be a lie.
You look like you've been strapped to the bow of a ship.
Is that so? Mm-hmm.
No, no.
Don't do that.
You don't need any more laugh lines, believe me.
Me? Have you looked at yourself in the mirror lately? Mm-hmm.
I love you so much, I want to break you in half.
I love you so much, I want to punch your face in.
All right, back to work.
We might hit code black tonight.
You got that, boss.
Well, you qualify for tPA, and we're still inside the window for it to be effective.
What are the complications? Only 7% experience the miracle.
However, the same number experience catastrophic bleeding somewhere else in the body.
We wouldn't know where until it was actually happening, and we might not be able to stop it.
And if we do nothing? What you see now.
And possibly worse.
Hey, Hannah? Who's next? Uh 26 year old Pregnant, U.
R.
I.
, fever.
Parked her in triage.
Sounds like the flu.
Evaluate, then come find me.
- Should I go - Evaluate and find me.
Next.
How do you know so much? Believe me, I don't.
We both went to medical school, we both did an internship.
You pulling second residency? What do you mean? I mean, were you already an M.
D.
and then went back to try a different specialty or something? No.
I was too busy being a wife and a mom.
Wife and a mom? You sure you're ready for this? How old do you think I am? All I'm saying is, there's no tougher place to work in all of E.
R.
medicine than Trauma-1 at Angels Memorial.
This place is hard enough for The young.
For the unattached.
Stop being threatened by me, okay? Is that what you think, that I'm threatened? I think we should examine this patient together.
Maybe we'll both learn something.
Why not? The worst part is the headache.
I live above the boiler room in my building, and the noise just keeps cracking my head open.
Is there anything you can give me for that? You're nine months pregnant.
There's not a whole lot we can do other than give you Tylenol.
I've tried that.
Doesn't work.
Using again? - Excuse me? - Mario.
The scars on the inside of your arm They're old track marks, right? None of your damn business.
Who the hell do you think you are? Just a doctor trying to figure out what's wrong with a patient.
You're a jackass.
I don't have to listen to this.
Take it easy.
Take it easy.
It's okay.
He's leaving.
Can I talk to you for a second? What was that about? She's a seeker.
Heroin withdrawals often mimic flu symptoms.
You don't know that for a fact.
Where's the fever? If it was the flu, would've hit her like a freight train.
You got a lot of experience with drug withdrawals? No.
I'm sorry.
I just don't think that woman is using.
I know a little bit more about this than you do.
It was a long time ago.
I'm not ashamed.
I pulled myself out, and I'm fine now.
What, do you two just not have enough to do? We're having a disagreement about a patient.
Oh, yeah? Which one? The pregnant U.
R.
I.
I think we should run a tox screen, rule out heroin withdrawals.
Huh.
And you? I don't know.
Something's not right.
I don't think it's the flu, I don't think it's heroin.
If I just had a little bit more time, I could Well, you don't have time, and a positive tox screen doesn't change the management of the case.
Even if she has an addiction problem, there is nothing we can do for her in the E.
R.
Recommend a social worker, ship her out.
You make a good point about the fever, but I don't think it's heroin.
Doesn't matter.
You heard what she said.
Doesn't change the management of the case.
Yeah, but we need to know.
We should run a tox screen.
There's no "we" here.
You heard what Rorish said.
She also said trepidation is a deadly quality.
I'm already on her bad side.
There's nothing in this for me.
Except maybe saving a patient's life.
Malaya, whatever you're doing, log out, follow me.
You're gonna love this.
Sounds exciting.
Clearly, you don't speak the native tongue of my people Sarcasm.
Come on.
Hey, come on.
Hold your arm up just like this.
- Angus.
- Yep? Guthrie wants you.
He's with the stroke patient.
Malaya can finish the cast.
Wait.
Guthrie's gonna let him administer the tPA? And I'm gonna do a nurse's job? A nurse's job? I didn't mean it.
You want to be part of a team, Malaya, no job is too big, no job is too small.
Dr.
Leighton, go now, please.
Yep.
Arm up.
Come on.
I won't go, either.
That's ridiculous.
I didn't mean it.
Of course I'm going.
Wait.
What's up with skater boy? He's, uh Just sleeping it off.
Great.
Go.
tPA has a short window.
How soon will we know if it worked? Just takes a few seconds When it works.
Come on, baby.
Show us the magic.
Mr.
Cleery.
I want you to try and speak.
Love you.
Yes.
Abracadabra.
That's why we're here, young squire.
Never forget that.
- Take it easy! Take it easy! - No! No! No! 10-year-old male, breathing labored, possible allergic reaction.
He didn't eat or drink anything out of the ordinary.
Uh, where are you from? Norway.
Uh, Center Stage.
Your son has a collapsed lung.
We're gonna help.
How could you know that? If a Norwegian kid can't breathe, it's a pneumothorax.
It's a genetic predisposition.
Can someone run another I.
V.
for me, please? I'm all out of nurses.
- I got it! - My girl.
Okay, watch his head.
Ready? Back him up, back him up.
What's your son's name? Basti Short for "Sebastian.
" Okay, Basti.
I need you to look at me.
Need a mask.
Step it out.
Step it out.
You're gonna be all right.
We just need to let a little air out of your chest.
You're gonna feel better right away.
It's okay.
Leanne, transplant team just took Ariel's father upstairs.
Understood.
Uh, we're gonna put a tube into Basti's chest to relieve the pressure.
This is very routine.
We can do it right here.
She asked to talk to you.
Me? Why? She connected with you.
No, she didn't.
Uh, nurse.
Angus, you're gonna do the chest tube.
Me? Yes.
What are you doing? I'm looking for my diploma to make sure it's really my name on it.
I'm prepping a tray for you.
You're going to be making an incision.
I need some more local.
Leanne, I can take this case.
Go and talk to her for a minute.
Look, if you want me to be a social worker, You pick the patient who should die in the waiting room.
She's a patient, too, Leanne.
Go and talk to her for a minute.
Look around you, Doctor! We'er about to be in Code Black.
I have eczema, itches like crazy.
You don't care, right? These people here, they don't care about your problems either.
All right, uh, Sebastian, I want you to slow your breathing down, okay? Can you do that? We're going to help you.
What's that kid doing in here? Is he okay? Whose patient is this? Mine.
Hey.
Focus.
Whoa! This kid has a head injury! I need a gurney.
I'm out of gurneys.
Guys, guys, can I get a wheelchair? Come on.
A wheelchair or something.
I got to pull somebody out of here.
I.
V.
tubing.
We are officially in code black.
God help us.
Yeah, exactly.
That's what we need a neurosurgeon.
Yeah, of course we're gonna get a C.
T.
scan, Natalie, as soon as the room frees.
No, I know it is, but I need a neurosurgeon down here right now.
I think it's an internal bleed, Natalie! We're slammed up here! Hold on a second! Listen.
I'm checking.
It's going to take a few minutes.
Wait! Wait, Natalie! C.
T.
scan is ready.
All right, great.
Let's move him.
Jesse.
Simple chest tube, right? Yeah, yeah.
About to start the incision.
Wait.
Wait.
You're gonna move You're leaving? This patient needs an M.
D.
, and we're in code black.
I think you can handle it.
Let's go, let's go.
Let's go, Jesse.
Go, go.
Mama's in the kitchen.
Hey.
Focus.
You can do this.
Out of my way! Come on! See you.
Thanks.
Blood pressure.
Great.
Hurry up.
Stabilized, let me know when he's ready.
Got it.
Tube is in.
Vitals are dropping.
Doesn't make sense.
Hang in there, pal, okay? Why isn't it working? What is happening, please? Might be a bad chest tube.
I'm gonna need another chest tube.
I-it's it's not the tube.
This one's just stuck.
Please do something! He's not breathing! Angus! It's stuck in the fascia of his back.
Get him out of the way! Grab the tube! You need to pull! We need to get the doctor in here! I'm a doctor.
And you are, too.
Listen.
- Listen to my voice, okay? - Okay.
- Do you feel it? - Yes.
- Just stuck in the fatty tissue.
- Okay.
So we just pull gently.
Okay.
Okay.
Ah! Good job, Dr.
Pineda.
Your little boy's gonna be okay.
Good job.
I need a 3 of nylon.
Pick this up.
Someone put up some dressings.
Thank you, thank you.
All right.
Rorish is looking for you.
She canceled the tox screen on your pregger.
Patient left anyway.
Sorry.
Which is showing a hyper dense increased attenuation in an elliptical pattern, which is consistent with an epidural hematoma.
No, do not put me on hold again! Dr.
Rorish, I know you're angry You deliberately ignored direct instructions from your supervising physician.
You said trepidation is a deadly quality.
I thought I was acting in the best interest of my patient.
You don't have patients.
You're a first-year a first-day resident, which means every patient you see is my patient.
If I can't trust you here, I can't have you here.
Goodbye, Christa.
Wait.
What? Go home.
It's over.
Yes, yes, yes, I'm here.
No, well, someone's gonna have to drill a hole, then, because the blood has to go somewhere! She fired me.
Did you tell her I knew? No, Mario, but thanks for the concern.
Look, I'm sorry, but while you were busy picking up preschools, I paid for medical school driving a truck, choking on diesel fumes.
Wait, wait, wait.
Diesel fumes! - Oh, my God! - What? What if it's carbon monoxide? Carbon monoxide poisoning can mimic flu symptoms.
She said she lived above a boiler room, right? Oh, my God, Mario, I could kiss you.
But not really.
Come on, come on, come on, come on, come on, come on.
Let's move, people.
I.
V.
and foley are in.
Truck ran right over his leg, broke in at least four places.
Big mid-femur deformity from the crush.
What's your name, sir? Wayne.
I just can't feel my leg, doc.
Bone's pinching a nerve.
We're gonna help you.
I.
V.
, fluids, 20 milligram morphine, stat.
Flying it.
What's that for? Renovating the suture room.
You're drilling a burr hole? Foot cold.
There's no pulse down here.
We got to get this leg straight.
He's gonna need that gurney.
Got it.
Bring it in.
You can't put a hole in that kid's skull in the E.
R.
, Leanne.
You need a neurosurgeon.
It's an epidural bleed.
He's out cold.
I got to drain it.
- Line him up.
- One, two, three.
Sometimes you just got to be a cowboy, Neal.
Hey, you're gonna need some help if you're gonna yank that.
Mario, get over here.
Okay, Wayne, this is gonna help with the pain.
Phone the cath lab.
Tell them we're on our way.
Dr.
Rorish, you might not be surprised by this, but one of your residents is calling you from the back of an ambulance on the 101 Freeway.
What?! Who? - Blondie.
I got to go.
- Christa? Dr.
Rorish, it's definitely carbon monoxide.
They had to break all the windows.
She's still unconscious.
We're giving her oxygen.
I'm sitting here Christa, deep breath.
Give me vitals.
Pulse faint at 120, B.
P.
60 over palp.
Her patient's crashing.
She's pregnant.
You need to get her back here.
She needs a hyperbaric chamber.
Christa, what's your E.
T.
A.
? Not soon.
You're not gonna like this, Neal, but She has to perform a C-section on the rig.
Sometimes you got to be a cowboy, right? Let's do this.
Wait, Christa's gonna do a C-section? Mario, focus.
I need you up by his shoulders to give me leverage.
I'm gonna try and save his leg.
Christa, listen.
I need you to tell the medic to prepare an emergency surgical kit.
Wait, wait, wait, wait.
I can't do this.
Yes, you can.
You've done an O.
B.
rotation.
You've witnessed plenty of these.
Take a deep breath for me, sir.
Christa, make sure the patient stays unconscious.
Uh, no danger there.
Okay.
Get ortho ready to go.
Our friend Wayne here is gonna need an O.
R.
right after.
After what? Susie, I need you on his pelvis.
Make sure he doesn't slide.
Jesse.
Need you over here for a sec.
Whoa, whoa, whoa, whoa! B.
P.
dropping! Jesse, get back.
I need Jesse back, damn it.
Okay.
You got that? Everybody ready? Ready for what? Hold him.
One, two, three.
Pulse is dropping.
Okay, then we got to move fast.
To still have a chance to save both of them.
Christa, I need you to start with an abdominal incision beginning at the umbilicus and straight down to the pubic symphysis.
- Whoa! - I need a clean up in aisle 3.
You need to cut through all five layers of the abdominal wall, including the peritoneum.
I've got this.
- Get this cleaned up.
- What is that noise? Ignore it.
Vitals? Pressure dropping.
Pulse 30.
It's okay.
Stay focused.
Start your incision now.
Christa, right under the abdominal wall, you're gonna see something shiny.
That's not the uterus.
It's the bladder.
Careful not to nick it.
You're gonna want to reflect it distally, get it out of your way.
Okay, vitals are dropping.
Yeah, I'm almost there.
- Leanne? - Almost there.
Okay.
Pulse is dropping.
Leanne, he's herniating! I know.
Almost.
Uterus is exposed.
- Hang on.
- "Hang on"?! Almost got it.
Is he draining yet? Come on.
Come on.
Almost there.
I got it! Okay, get it in.
Heart rate normalizing.
Pupils Reactive.
All right, Christa, time to make the vertical incision in the uterus.
Watch the lateral vessels.
Oh, God.
Oh! Okay.
Now, this is gonna happen very quickly.
I want you to reach your hand inside as fast as you can, carefully feel for the baby.
When? - Have you made the cut yet? - Yes.
- Now! - Now! All right, I think I can feel it.
Okay.
I got it.
Oh! I got her! She's so beautiful! Oh, I got her.
Oh, my gosh.
Okay, kids, we got one open in O.
R.
Mine's stable.
You should go.
All right, let's move him.
Gurney.
Get him up.
Okay, guys, let's go! Go, go! Move it, move it.
Move aside.
You think Dr.
Rorish ignores you because she doesn't trust you? It's just the opposite.
She knows you're good.
She's testing the rest of us.
And I don't think I'm gonna pass that test.
What are you talking about? You know your stuff, dude.
You just need confidence.
You asked how I got in.
Our dad is on the hospital board.
My brother never told anyone.
He thought people wouldn't take him seriously.
Wouldn't matter anyway.
He was born for this.
I am not like him, though.
Then what are you doing here? I hated psych.
Hated it.
I wanted something more exciting.
I wanted what Mike had.
So when my dad said he could get me in here, I jumped at it.
Big mistake.
Did you know that they opened this place up in 1932? Light bulbs weren't bright enough back then, so they put in all these big windows so they could see what they were doing.
Imagine that.
Hell of a night for you two.
Started off saving a life, ended up almost killing someone.
Two people, actually.
I missed an epidural hematoma.
I missed it, too.
Hm.
Know what that sounds like to me? A typical night in this joint.
You did good.
So did you.
We've got her mom in the hyperbaric chamber, oxygenated her.
She's gonna make it.
Thank God.
Can I ask you something personal? Why are you here? Pardon? Med school, internship, and now the most punishing residency in the country.
Most people do that in their 20s.
What made you decide My son died.
Stage 4 glio.
You learn a lot when your kid gets sick.
So I thought maybe I should make it official.
I got into med school And here I am.
In my experience, tragedy either softens you or hardens you.
For me, it was the former.
For you, I suspect it was the latter.
You spend enough time in group therapy sessions, you start to recognize it.
Who'd you lose? Everyone.
You better go home and get some sleep.
You've got a shift tonight.
I do? Hi, Ariel.
Hi.
And you must be Aunt Linda.
So nice to meet you in person.
Thank you for this.
Mm-hmm.
You ready? I'll wait for you right here.
Thank you.
Hi.
I'm Vanessa.
I'm Ariel.
I like your room.
Thanks.
You can come closer if you want.
It's okay.
Can you hear it? Yeah.
I can hear it.
I hear you, daddy.
I hear you.
You got to be kidding me.
Every ventilator I.
C.
U.
can spare.
Got an apartment fire.
We got 22 in so far.
Burns, smoke inhalation, broken bones, - and a heart attack.
- Got it.
Yeah, we're gonna need a barrel of morphine.