Dr. Frank Langdon quotes from The Pitt

Langdon

A little advice, man-to-man: always compliment her outfit, hold her hand in front of your friends, and always wrap it before you tap it.

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.

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.

Mohan

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.

Langdon

Not this bullshit again.

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.

McKay

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.

Langdon

More work? I do enough charting as it is.

Collins

The hospital won't admit this, but it's less about charting and more about profit.

Robinavitch

OK? Good. That's it. Goodbye. Go.

Collins

OK, you're gonna pretend you're a pirate with your foot on a keg of rum.

Javadi

Are you serious?

Collins

Yep. This is the Captain Morgan technique for hip reduction.

Javadi

Who's Captain Morgan?

Langdon

The guy on the rum bottle?

Collins

I'll stabilize the pelvis.

Langdon

OK, you're gonna step up here.

Javadi

Actually, let me just...sorry.

Langdon

Yeah, and you are gonna put your right leg behind his knee.

Javadi

Like this?

Langdon

Yeah. And you are gonna use your leg as a hinge to put anterior force on his femur.

Robinavitch

Physics.

Collins

Push down on the lower leg with your left hand.

Langdon

You got this. Put your back into it. The hip is a big joint with lots of muscle stabilizing it.

Javadi

Yeah! OK.

Robinavitch

Whoa!

Javadi

Oh, shit... I mean, shoot.

Collins

And that is what a hip reduction feels like.

Langdon

Neurocysticercosis, a parasite in your brain.

I thought I just had a migraine, but I have bugs in my head?

Langdon

Well, not exactly. You had larva from a pork tapeworm that made multiple cysts, but they're all dead now.

A worm? In my fucking head? Are you kidding me?

Langdon

No, no, you don't have a worm in your head.

You just said that I have...

Langdon

I said you had a worm in your head, but it's dead and long gone. What we're seeing on the CT is scarring around those dead cysts.

Like dead worm eggs?

Langdon

Larvae.

Is my brain like Swiss cheese? Am I dying?

Langdon

No, no, you're not dying. Joseph, you're gonna be OK. The cysts are tiny, and they're calcified over. There'll be no further damage.

Can you fix it?

Langdon

Unfortunately, no. The little calcified spots will stay there.

So there's gonna be a worm graveyard in my brain forever?

Langdon

Yeah, but they're resting in peace.

Terrance

I everted my ankle playing table tennis.

Langdon

Everted?

Terrance

Yes.

Langdon

You mind if I take a look?

Terrance

Are you an orthopedic surgeon?

Langdon

No. I am an emergency medicine specialist.

Terrance

Could I talk to an orthopedic surgeon? I'd prefer an expert in that area.

Langdon

Well, I'm pretty good at ankle sprains.

Terrance

How do you know it's a sprain?

Langdon

Well, I'd have to examine you first, but...

Terrance

Could it be a Jones fracture or a dancer's fracture?

Langdon

Could be. Again, I'd have to look. Why don't I examine you, and that'll tell me.

Terrance

Shouldn't you take a complete history on the present illness first?

Langdon

It sounds like you're more interested in asking the questions, so...

Terrance

You didn't ask me if I felt a pop or a snap. You didn't ask about previous injuries. You didn't ask about weight bearing.

Langdon

Why don't I get you some fresh ice?

King

[turns off the lights and draws the curtain] The, uh, ER can be very noisy.

Terrance

I agree.

King

So, I heard that you might have sprained your ankle playing table tennis?

Terrance

I everted it.

King

Yeah? What is your biggest concern today, Terrence? What worries you the most about the pain in your ankle?

Terrance

What worries me? Do you mean right now in this moment?

King

Right now.

Terrance

I'm worried I won't be able to play table tennis if it's a bad injury. There's a tournament in six weeks, and I already registered. It's my first tournament.

King

Wow, that's a big deal.

Terrance

Yes. The championship is hosted by the South Park Table Tennis Club. Nine players have USATT ratings over 2,000. 1,400 is considered average. 2,000 is a master player. My goal is to get a rating over 2,000.

King

Well, let's get you to that tournament, then. So...

King

Terrence, would you walk around the room for me, please? I'll be able to tell a lot more about your injury.

Terrance

It hurts a little.

Langdon

How painful on a scale from 1 to 10? 10 is the worst.

Terrance

The worst? The worst I've ever felt or the worst that a human being can experience?

King

A little pain is a great answer, Terrence. Thank you. Well, based on your walking around, I don't think it's a serious injury.

King

Sometimes this tendon called peroneus brevis can pull off a piece of this bone, the fifth metatarsal.

Terrance

That's the dancer's fracture, right?

King

Exactly. You most likely have a second-degree ankle sprain. The X-ray will tell us everything. Tech will come get you, and then I'll come back and show you the images.

Terrance

Great.

King

OK... I'll put the orders in.

Langdon

How'd you do that?

King

Do what?

Langdon

Talk to him.

King

I listened?

Langdon

Funny. No, you unlocked something. I wasn't getting anywhere with him.

King

Oh, my sister is on the spectrum. And the ER can be a very, very overwhelming place for autistic people, so I... I don't know. It just takes a different approach.

That looks like ST elevation. That could be bad.

Langdon

Oh, no. That's just because we're pacing your right ventricle. Willie, I'm impressed. After all these years, you still remember your medical training.

He couldn't tell you what he had for breakfast.

[scoffs] It's all right. I remember what's important. Like the Freedom House.

What's that?

A damn shame. That's your history.

Dad, they're busy.

Back in the '60s, no 911, no ambulances. All we had was police paddy wagons that took you to the hospital, if you were lucky. Then this doc from Pitt, Dr. Safar, he got some money and trained us up.

Langdon

Well, you must've been a good student.

Hell no. I was a knucklehead. Smoked a lot of weed, dropped out of high school. But Freedom House trained me up. Saved my life.

Freedom House took us in and trained us for 300 hours.

Robby

They turned out the very first medics in the United States.

We started IVs, defibrillated, intubated in the field.

They were the heroes of Hill District. Bunch of young Black dudes saving lives every day.

Langdon

Why'd you quit?

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.

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.

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.

Yeah. Where is he working now?

Robby

Dr. Adamson died a few years ago, during COVID.

[clearly saddened] Oh. Hard to believe. He was so young, so full of life. A force of nature.

Robby

Yes, he was.

An operation?

Langdon

Well, you were just shouting a minute ago about infection, and with good reason. While I am sure you are in the clear for rabies and HIV, human mouths are filthy, some more than others.

How can you tell if it's bad?

Langdon

Good question. Dr. K?

King

I'm sorry?

Langdon

I am going to inject some sterile saline into your knuckle joint, which you won't feel 'cause of the anesthetic. If it comes spraying back out of the bite wound, we'll know.

Langdon

Oh, did you want me to tell the surgeons to go no masks for surgery?

What?

Langdon

Well, those of us who save lives for a living believe strongly that masks minimize risk when it comes to spreading disease and infection. But I want to respect your beliefs, so what do you think? With or without for surgery? Without?

Um…I want with.

Langdon

Good call.

Doug Driscoll

I know you hear me. You can pretend you don't, but I know you do. This glass might be bulletproof, but it ain't soundproof. Huh? Hello? Can you hear me now? Huh? Hello!

Dana

Whoa. Whoa. Whoa, sir. Sir, what is the issue?

Doug Driscoll

Oh, same issue. I've been here all day, and you people have done nothing to fucking help me.

Javadi

We're still waiting on your second troponin. We can't clear you medically until it comes back. For instance, if it comes back elevated, that could indicate a silent heart attack. And you'd need to be admitted for monitoring in a cardiology consult.

Doug Driscoll

That's all I'm asking for. I'm afraid I've had a silent heart attack. I just want someone who knows something about hearts to tell me what's happening to me. You know, unlike most of these losers, I have insurance, good insurance. And I pay my taxes, which pays for them to not have any insurance.

Dana

Sir, you've got about five seconds to change your whole attitude before security and the police get involved.

Doug Driscoll

Fuck it. I'm leaving.

Langdon

Hey. Hey! You are absolutely free to go. But if you do, you will be leaving AMA, against medical advice. This form states that I have advised you to stay and complete your evaluation, but you are choosing to leave, understanding and accepting all risks of heart attack, stroke, disability, and death.

Doug Driscoll

Sounds like a CYA form in case I drop dead on the curb.

Langdon

That's exactly what it is.

Doug Driscoll

I just want to be treated fairly.

Langdon

I assure you that is our intention. We are not back here playing Go Fish.

Dana

We're doing our best to help some very sick people. You will be seen, OK?

Langdon

Robby's gonna love that patient satisfaction score.

Crazy people.

Langdon

An intern has a problem around here, they come to the senior resident, not the attending.

Santos

He is my attending, and I wanted his input on a patient. Is that not OK with you?

Langdon

Just, um come to me first next time. Got it?

Santos

Yep.