Robby Robinavitch quotes from The Pitt

Robby

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.

Robinavitch

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.

Robinavitch

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.

Robby

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.

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.

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 budget can't support that.

Robby

[laughs] Here's a dirty little secret. The hospital saves money keeping patients down here in the Pitt. It's way cheaper than staffing upstairs.

Gloria

I have asked you repeatedly to stop referring to the emergency department as the Pitt. It is derogatory and incompatible to the institution's image.

Robby

You know what's incompatible with the institution's image? Me speaking to the media about people who code in our waiting rooms and people who get shitty care in our hallways waiting for an ICU bed for days.

Gloria

I've heard about doctors who have tried that and find themselves out of work.

Robby

Uh-huh.

Gloria

I know today is difficult for you.

Robby

Every day is difficult down here.

Gloria

Boarding is a nationwide problem. Your predecessor, Adamson, sure as hell knew that. Or wasn't that something he taught you?

Robby

Fuck. Wow. Really?

Gloria

Yes, really. Other hospitals are managing this crisis much more effectively. So, you can either step up your game, or you can step aside.

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.

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?

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?

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.

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.

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.

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.

Hello. I'm Kiara Alfaro. I'm the department social worker.

Langdon

Kiara will help you navigate the next steps.

What steps?

King

Well, a case like this requires mandatory reporting to child services and sometimes law enforcement.

No.

Why why do you have to involve the police?

King

It's a controlled substance.

They're not taking my kid away.

They were pot gummies.

No one's suggesting that.

Well, fuck your suggestions! No one is touching my child! In fact, we're leaving.

Langdon

Well no, you can't take your son. He could stop breathing. He could have a seizure.

I will observe him at home.

Amanda, please.

Fuck off, Drew.

Langdon

Get security. If you can't cooperate, I'm going to have to ask you to leave.

Amanda, please. He needs to stay here.

And you need to get a fucking hotel.

Langdon

Your son can't leave the hospital, but I can have you removed.

Don't you dare touch me. Get out! All of you!

Mrs. Jones, I know this is scary and stressful.

Oh, fuck you! Fuck you! This is my son. My son! And nobody is touching him!

Robinavitch

[enters] Whoa, whoa, whoa. What's going on?

How can I help you?

By backing the fuck off!

Mom's worried a CYF investigation.

Amanda, just calm down!

Robinavitch

OK, OK, OK, enough! This is a hospital. This isn't "The Jerry Springer Show." Ma'am, nobody's trying to take your child, so why don't you stay here with him while your husband talks to our social worker outside and straightens all this out?

Well, I don't want him speaking for me and my son.

Robinavitch

Well, it is either you or him. Your son is not leaving, but you can be escorted out and even arrested if you refuse to cooperate. Nobody wants that. So you tell us. What do you want to do?

I'm staying with my son.

Robinavitch

OK, great. You do that. We all on the same page here? Thank you, Olsen. You know where to find me.You OK?

Langdon

Yeah, we got this.

Robinavitch

All good. It's all yours.

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 dies, and you feel so badly about it, you'll never let it happen again

Mohan

How is that wrong?

Robinavitch

Because you waste time and money on unnecessary tests. You keep sick patients waiting too long. You miss out on cases you could be learning from. You shortchange your own education. I'm not saying this to be a hard-ass. I'm saying this because I know you could do this, but you need to do it at a level I also know you're capable of.

Mohan

And what if I'm not?

Robinavitch

Then you should look into a specialty that better suits you. Have you thought about psychiatry?

Mohan

I don't want to go into psychiatry. I want to be here.

Robinavitch

Being here means no matter how good you are or how hard you try, you're gonna make another mistake, and someone else might even die. That's called being an emergency medicine doctor. And if you can't accept that, then maybe this isn't the place for you.

Mohan

I can accept that.

Robinavitch

You sure?

Mohan

Yes.

Robinavitch

OK, good. Go save some lives. Clear some beds while you're at it.

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.

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.

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.

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.

Robinavitch

How's she doing?

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?

If he's a danger to himself or others, I'd argue you have a professional responsibility to do whatever is necessary.

He keeps trying to pull away.

Robinavitch

We're giving him some more sedation.

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.

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.

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.

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 with minimal benefit.