Dr. Heather Collins quotes from The Pitt

Collins

Confidence and ambition are great attributes, especially when paired with respect and humility.

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.

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?

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.

Robinavitch

Patients come in already in distress, and waiting only makes it worse.

Gloria

Wait time has nothing to do with this.

Robinavitch

Which is why we're seeing hospital workers like Dr. Collins get assaulted.

Gloria

Assaulted?

Collins

It was a little push.

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?

Gloria

We have metal detectors.

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.

Gloria

I can see that you're...

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.

Gloria

I'll come back later.

Robinavitch

That's not gonna help anything.

Where is she?

Collins

She's OK. She just needs a minute.

I have given her enough time. She can process this on the car ride home.

Collins

Can we talk for a moment? Please.

I know you're trying to help, but this is really between me and my daughter. So if you could just bring her out, we will be on our way.

Collins

She's really upset.

She'll get over it.

Collins

Weren't you about the same age when you got pregnant with her?

Yes.

Collins

So, you know how hard it can be.

It was very hard at the time. But she turned out to be the best thing that has ever happened to me.

Collins

And I hope she feels the same way when she's ready. But right now, she's not. For her, the world is ending. If you push her away, she might never come back.

Collins

Yeah, purulent drainage from the cervix. Got the culture. Oof. Looks like we have our source. The positive urine this morning was contaminated.

McKay

Maybe.

Collins

Definitely. Not-so-clean catch specimen.

Robinavitch

This infection's been brewing for a while.

McKay

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.

McKay

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.

McKay

Oh. No history of fever.

Collins

Bet she was taking Tylenol for the pain.

Robinavitch

Let's call ICU for an admit. Also want gyn to see her.

McKay

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.

Collins

McKay. Every postpartum patient needs a pelvic exam to rule out endometritis.

McKay

Wait, you're saying that with 20/20 hindsight.

Collins

Did you ask about Tylenol or ibuprofen use? Because that can mask a fever.

McKay

There was no fever.

Collins

Did you do a careful abdominal exam?

McKay

It was a quick chair exam, and there was only mild tenderness over the bladder.

Collins

Perhaps there was something about the patient that made you overlook proper treatment.

McKay

Like what, other than the obvious health risk factors?

Collins

Her size doesn't inherently make her unhealthy.

McKay

Are you saying I was biased against the patient because of her weight?

Collins

I raise it as a possibility, not as an accusation.

McKay

Wow. I mean, I really don't think that's the case here, but I will look out for it. Yeah.