I everted my ankle playing table tennis.
You mind if I take a look?
Are you an orthopedic surgeon?
No. I am an emergency medicine specialist.
Could I talk to an orthopedic surgeon? I'd prefer an expert in that area.
Well, I'm pretty good at ankle sprains.
How do you know it's a sprain?
Well, I'd have to examine you first, but...
Could it be a Jones fracture or a dancer's fracture?
Could be. Again, I'd have to look. Why don't I examine you, and that'll tell me.
Shouldn't you take a complete history on the present illness first?
It sounds like you're more interested in asking the questions, so...
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.
Why don't I get you some fresh ice?
KWKristi Wheeler
Where is she?
She's OK. She just needs a minute.
KWKristi Wheeler
I have given her enough time. She can process this on the car ride home.
Can we talk for a moment? Please.
KWKristi Wheeler
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.
KWKristi Wheeler
She'll get over it.
Weren't you about the same age when you got pregnant with her?
So, you know how hard it can be.
KWKristi Wheeler
It was very hard at the time. But she turned out to be the best thing that has ever happened to me.
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.
[turns off the lights and draws the curtain] The, uh, ER can be very noisy.
So, I heard that you might have sprained your ankle playing table tennis?
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?
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.
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.
Well, let's get you to that tournament, then. So...
[Dr. Langdon enters]
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?
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.
Sometimes this tendon called peroneus brevis can pull off a piece of this bone, the fifth metatarsal.
That's the dancer's fracture, right?
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.
OK... I'll put the orders in.
[Langdon and King leave]
Funny. No, you unlocked something. I wasn't getting anywhere with him.
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.
WAWillie Alexander
That looks like ST elevation. That could be bad.
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.
EAEli Alexander
He couldn't tell you what he had for breakfast.
WAWillie Alexander
[scoffs] It's all right. I remember what's important. Like the Freedom House.
WAWillie Alexander
A damn shame. That's your history.
EAEli Alexander
Dad, they're busy.
WAWillie Alexander
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.
Well, you must've been a good student.
WAWillie Alexander
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.
[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.
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.
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?
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.
WAWillie Alexander
Yeah. Where is he working now?
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.
[Dana breaks up a fight in the waiting room]
Jesus almighty, I can't believe what I'm seein'! Where do you people think you are? This ain't Philly! This is a hospital, for Christ's sakes, what's the matter with you? You call yourselves adults? There are children in here! You should be ashamed of yourselves.
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?
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.
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!
Whoa. Whoa. Whoa, sir. Sir, what is the issue?
Oh, same issue. I've been here all day, and you people have done nothing to fucking help me.
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.
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.
Sir, you've got about five seconds to change your whole attitude before security and the police get involved.
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.
Sounds like a CYA form in case I drop dead on the curb.
That's exactly what it is.
I just want to be treated fairly.
I assure you that is our intention. We are not back here playing Go Fish.
We're doing our best to help some very sick people. You will be seen, OK?
Robby's gonna love that patient satisfaction score.
LPLupe Perez
Crazy people.
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.
This infection's been brewing for a while.
So the car crash was a coincidence.
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.
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.
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.
Excuse me, sir. You're not allowed back there.
Unless, what, I start a fight? Become homeless? Apparently, that's what it takes.
I understand your frustration. I promise you'll be seen as soon as a provider is available.
But how can they become available if new people keep cutting the fucking line?
There's no line. We see patients by severity of need. As soon as we have your tests and labs, you will be seen.
This place is fucking unbelievable. Runaround after runaround. Hey. What's up, Erik Estrada? Still keeping your eye on me?
MDMateo Diaz
Always, my friend. Always. [to Dana] Who's Erik Estrada?
Shame on you. CHiPs. Know your television history.
It's like…my parents took me skiing in Utah for Christmas, and from the moment I got off the plane, I could not catch my breath. No matter how hard I tried, the altitude made me feel, like, awkward and uncoordinated. I couldn't concentrate, I couldn't get my bearings. And I'm a very good skier, but I spent the entire vacation just, like, on my butt, dizzy and panting.
[Dana half-glares at her, nudging her to get to the point]
Mateo is like a human Utah.
[laughs understandingly] Oh honey! I've worked with a few human Utahs. I wish you many, many Utahs in your life.
[after Dana was attacked by a patient] Did you fill out an incident report?
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?
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.
