KingBecause your son tested positive for THC, the psychoactive ingredient in cannabis, we're going to have to admit him for overnight observation and monitoring.
AJAmanda Jones
And what about his brain? Is there a chance that much pot is going to do some damage? He's only four.
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.
AJAmanda Jones
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.
KAKiara Alfaro
Hello. I'm Kiara Alfaro. I'm the department social worker.
Kiara will help you navigate the next steps.
AJAmanda Jones
What steps?
King
Well, a case like this requires mandatory reporting to child services and sometimes law enforcement.
DJDrew Jones
Why why do you have to involve the police?
King
It's a controlled substance.
AJAmanda Jones
They're not taking my kid away.
DJDrew Jones
They were pot gummies.
KAKiara Alfaro
No one's suggesting that.
AJAmanda Jones
Well, fuck your suggestions! No one is touching my child! In fact, we're leaving.
Well no, you can't take your son. He could stop breathing. He could have a seizure.
AJAmanda Jones
I will observe him at home.
DJDrew Jones
Amanda, please.
AJAmanda Jones
Fuck off, Drew.
Get security. If you can't cooperate, I'm going to have to ask you to leave.
DJDrew Jones
Amanda, please. He needs to stay here.
AJAmanda Jones
And you need to get a fucking hotel.
Your son can't leave the hospital, but I can have you removed.
AJAmanda Jones
Don't you dare touch me. Get out! All of you!
KAKiara Alfaro
Mrs. Jones, I know this is scary and stressful.
AJAmanda Jones
Oh, fuck you! Fuck you! This is my son. My son! And nobody is touching him!
[enters] Whoa, whoa, whoa. What's going on?
SGSecurity Guard Olsen
How can I help you?
AJAmanda Jones
By backing the fuck off!
KAKiara Alfaro
Mom's worried a CYF investigation.
DJDrew Jones
Amanda, just calm down!
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?
AJAmanda Jones
Well, I don't want him speaking for me and my son.
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?
AJAmanda Jones
I'm staying with my son.
OK, great. You do that. We all on the same page here? Thank you, Olsen. You know where to find me.You OK?
All good. It's all yours.
King
[turns off the lights and draws the curtain] The, uh, ER can be very noisy.
King
So, I heard that you might have sprained your ankle playing table tennis?
King
Yeah? What is your biggest concern today, Terrence? What worries you the most about the pain in your ankle?
What worries me? Do you mean right now in this moment?
King
Right now.
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.
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...
[Dr. Langdon enters]
King
Terrence, would you walk around the room for me, please? I'll be able to tell a lot more about your injury.
How painful on a scale from 1 to 10? 10 is the worst.
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.
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.
King
OK... I'll put the orders in.
[Langdon and King leave]
King
Do what?
King
I listened?
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.
WAWendy Atwater
An operation?
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.
WAWendy Atwater
How can you tell if it's bad?
King
I'm sorry?
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.
This is how it's going to work. Our ambulance bay is now our Triage. EMS will be overwhelmed. Most will probably arrive by car, several victims per vehicle. For all you newbies that don't know, Dr. Shen is our night shift attending. John, I'm gonna put you on Point Triage.
Triage will decide who goes where depending on their injury.
Every department will have a designated primary who will oversee their staff. If you need someone, look for the vest. We're all gonna have walkies. We can get you whatever you need.
No patient goes into a room unless it's a trauma bay, and they will have four patients each. We need to keep everybody out in the open so we can keep an eye on everything, OK? Triage is gonna assess and assign every patient to a specific zone with a colored slap band. Patient who comes in with a red slap band goes to the Red Zone, which is the trauma rooms, with overflow out here. These are the most critical patients who will die without immediate attention. Samira, where are you? You are here with Dr. Abbot and me. Jack's gonna run traffic.
We have five minutes to try and stabilize the reds. After that, it's OR, ICU, or morgue.
The south and central common area over there will be the Pink Zone. That is for patients who will die in under an hour without treatment. McKay and Javadi, you are over there, with help from incoming night shift and surgical staff. Yellow Zone is the North Corridor. Those are gonna be mostly extremity wounds good vitals, talking. Mel, you're gonna run point there with Santos and Whitaker.
King
Uh, what if what if there's a-a pulseless extremity?
Oh, if you if you can't feel a pulse, check for Doppler flow with this. It's a mini-ultrasound. Follow the screen prompts.
But a yellow can change to a red if they go south. You got to stay on top of them, even if they seem stable.
King
OK, yeah.
You got this, Dr. King. Green minor lacs and sprains. They go to Family Medicine. Black and white bands are DOA, imminent death. Pedes is now our morgue. Let's hope we don't get too many of these.
We're a MASH unit now. There's no charting, no electronic medical records, no board.
How do we document treatment?
Oh, you'll all get Sharpies, and every patient has a wrist chart to document treatment and procedures. You run out of room, write on the patient's forehead.
Each wrist chart has a unique mass-casualty-incident barcode and patient number. That's how the patients are gonna get identified.
This is no-frills combat-zone medicine. No ultrasound, no X-rays, no CT, no labs. Assess based on mental status and pulse strength. Every critical patient gets an IO, intubation, a unit of blood and chest tube if needed. Everything you need blood, drugs, bandages everything will be in the Behavioral Health rooms. That's our supply depot. Um oh, keep a couple of 11 blades in your pocket. Goal is to resuscitate ASAP so they'll make it upstairs for definitive care.
Trauma surgery and neurosurgery will decide who goes up to the OR immediately and who goes to the ICU for further treatment and evaluation. Communicate. Ask for help if you need it. Trust your attendings. We will get through this together.
King
Oh, um, and four of Ancef. Sorry, I forgot the Ancef. Thank you... .
PAPerlah Alawi
Mel! Mel, I need you to reassess, please, now.
King
Sylvia? Oh, Sylvia. Her pulse is weak and thready. She's, uh, bleeding out from her liver lac. I need O-neg!
O-neg's gone, honey. Gloria's got more flying in. Incident Command, what's the ETA on our blood?
[Incident Command relays it would take eight to ten minutes]
The patient's gonna have to get by with a liter of saline.
King
No, no, she needs blood, not crystalloid. Um, can she go to surgery?
All right, she's next to go, as soon as we get an open OR.
King
She's not gonna last that long -- Dr. Robby. Dr. Robby! Dr. Robby, we're out of O-neg, but I'm O-neg. Can I donate?
Gloria's got more blood flying in.
King
But I need it now.
What is our blood status?
Just used the last units of O-neg and O-pos. More flying in.
King
Some patients are not gonna last that long. And I'm sure there are other O-neg donors that probably work here, so...
It would take hours to screen for HIV and hepatitis.
King
Well, I have neither, and I donate all the time.
[Robby sighs]
King
Please.
Fuck it. If the patient's gonna die before they get to the OR, then the benefits outweigh the risks.
My man. All right, kid, roll up your sleeve I'll meet you in 7. Listen up. Central 7, 8, 9 is now the blood donor center. Anyone who's O-neg or O-pos, we need you to donate now. Hands where I can see them. OK, let's do this.
The Pitt · 77 quotes
