RobinavitchI 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.
Robinavitch
They're gonna sound really simple, but I swear I've seen them work.
Robinavitch
I love you. Thank you. I forgive you. Please forgive me.
Robinavitch
But I've got four days off next week. I think I'm gonna get out of Dodge and head for the hills.
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.
Yeah. Maybe a little time off would be good.
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.
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.
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 that you put into ruling out all the critical illnesses in the differential.
More work? I do enough charting as it is.
The hospital won't admit this, but it's less about charting and more about profit.
Robinavitch
OK? Good. That's it. Goodbye. Go.
Robinavitch
[about Dr. Mohan] Hi, how's she doing?
Robinavitch
Still need ten more of her.
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.
Robinavitch
Gloria.
This is Dr. Tracy Morris, regional manager of ECQ America.
Robinavitch
The contract management group.
MMorris
It's a pleasure to meet you.
Robinavitch
Likewise. But if you'll excuse me, I'm a little slammed, as per usual.
We were upstairs with the executive team going over a proposal.
Robinavitch
A proposal?
MMorris
We're interested in having your emergency department join us.
Robinavitch
The 500 or so ERs you have aren't enough?
MMorris
What can I say? Business is good.
Robinavitch
Yeah, for who?
MMorris
Everyone benefits.
Robinavitch
Do they, though? Your contract management's corporate mandate is profits for shareholders above everything else, yes?
Robinavitch
Dah-dah-dah.
MMorris
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 my doctors?
MMorris
Maybe I can find an incentive for you. How does regional medical director sound? Lighter workload, better benefits, stock options.
Robinavitch
Did you go to business school or medical school?
MMorris
Both. We look forward to your decision.
MMorris
Hopefully we'll get a chance to work together soon, Dr. Robinavitch.
[Dr. Morris leaves]
Robinavitch
I can't believe you're seriously considering this.
Bottom line is, our current numbers aren't good, and theirs are.
Robinavitch
Just because their dashboard is pretty doesn't mean it's good for patients.
If you want to keep this ED, improve metrics. There's a lot of OFI. Opportunities for improvement.
Robinavitch
Well, you could have just said that.
I need you to care about patient-satisfaction scores.
Robinavitch
I would love nothing more. But right now, the average wait time is six hours, and that's before you see a doctor. You need to hire more staff so we can open more inpatient beds. Are you prepared to do that?
I need you to improve scores with the resources we have, or we will explore what ECQ has to offer.
Robinavitch
This is bullshit. You know this is bullshit. And if you don't, then we are all in trouble.
Maybe you need some time off.
OK, you're gonna pretend you're a pirate with your foot on a keg of rum.
Yep. This is the Captain Morgan technique for hip reduction.
[Doctor Robby chuckles]
The guy on the rum bottle?
I'll stabilize the pelvis.
OK, you're gonna step up here.
Actually, let me just...sorry.
Yeah, and you are gonna put your right leg behind his knee.
Yeah. And you are gonna use your leg as a hinge to put anterior force on his femur.
Robinavitch
Physics.
Push down on the lower leg with your left hand.
You got this. Put your back into it. The hip is a big joint with lots of muscle stabilizing it.
Robinavitch
Whoa!
Oh, shit... I mean, shoot.
And that is what a hip reduction feels like.
Robinavitch
Patients come in already in distress, and waiting only makes it worse.
Wait time has nothing to do with this.
Robinavitch
Which is why we're seeing hospital workers like Dr. Collins get assaulted.
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?
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.
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.
Robinavitch
That's not gonna help anything.
[Robby has pulled Mohan, Javadi, and a couple of paramedics to Willie Alexander's room for an impromptu history lesson.]
WAWillie Alexander
Freedom House took us in and trained us for 300 hours.
Robby
They turned out the very first medics in the United States.
WAWillie Alexander
We started IVs, defibrillated, intubated in the field.
EAEli Alexander
They were the heroes of Hill District. Bunch of young Black dudes saving lives every day.
WAWillie 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.
WAWillie 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.
WAWillie 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.
WAWillie Alexander
Yeah. Where is he working now?
Robby
Dr. Adamson died a few years ago, during COVID.
WAWillie Alexander
[clearly saddened] Oh. Hard to believe. He was so young, so full of life. A force of nature.
Robby
Yes, he was.
Robinavitch
I hear they're gonna start you working on the Middle East peace plan. Not since the Dalai Lama or Gandhi.
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.
Yeah, purulent drainage from the cervix. Got the culture. Oof. Looks like we have our source. The positive urine this morning was contaminated.
Definitely. Not-so-clean catch specimen.
Robinavitch
This infection's been brewing for a while.
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.
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.
Bet she was taking Tylenol for the pain.
Robinavitch
Let's call ICU for an admit. Also want gyn to see her.
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 pelvic exam.
McKay. Every postpartum patient needs a pelvic exam to rule out endometritis.
Wait, you're saying that with 20/20 hindsight.
Did you ask about Tylenol or ibuprofen use? Because that can mask a fever.
Did you do a careful abdominal exam?
It was a quick chair exam, and there was only mild tenderness over the bladder.
Perhaps there was something about the patient that made you overlook proper treatment.
Like what, other than the obvious health risk factors?
Her size doesn't inherently make her unhealthy.
Are you saying I was biased against the patient because of her weight?
I raise it as a possibility, not as an accusation.
Wow. I mean, I really don't think that's the case here, but I will look out for it. Yeah.
[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.
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.
First off, the safety of all our employees is paramount.
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.
Robinavitch
My duty, regardless of personal relationships, is to make sure everybody on my team is doing OK. So are you doing OK?
Uh, it's not a big deal. I can handle it.
Robinavitch
Handle what?
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.
TSTheresa Saunders
The psychologist spoke to me about becoming a petitioner to place David on an involuntary psychiatric hold.
Robinavitch
Yes.
TSTheresa 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.
TSTheresa 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?
TSTheresa 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 isolated from themselves and society, and they find community and comfort in all the wrong places. David needs help. We don't want to fail him, too.
Robinavitch
[about drinking] You ever think about quitting?
LCLouie 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.
LCLouie Cloverfield
I'm digging my own grave. Let me.
Robinavitch
I don't have to give you the shovel.
I'm already in a bad mood.
SGSecurity Guard Ahmad
I'm just getting some air.
[scoffs] Yeah, right. You're a terrible liar. Hope you're better at security.
SGSecurity 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?
No. But I am starting to see why Gloria's unhappy with your patient-satisfaction scores.
[Robby laughs]
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.
You don't want to work with anybody today. You must be in a mood.
Robinavitch
She's had a rough day.
Robinavitch
You should leave, too.
[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.
I think I'm done. [sighs]
Robinavitch
Yeah. I know that one. And I don't blame you. I, uh...I-I-I-I don't know. I don't know. Maybe what I want and what the patients need isn't what's best for you anymore.
Robinavitch
I just honestly don't know what I'm going to do without you.
You'll figure it out. You always do. You're a good man, Robinavitch. Don't let this place take that from you.
The Pitt · 77 quotes
