The Pitt · Season 1
I 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.
What are they?
They're gonna sound really simple, but I swear I've seen them work.
Okay.
I love you. Thank you. I forgive you. Please forgive me.
Distraction is a terrible strategy. When a patient says, "I'm hurting," we don't respond, "What's your major?"
Oh, I wasn't trying to diminish
Additionally, "I" statements work better than "you" statements. "I can see how painful this is" acknowledges the reality of the situation and invites further examination. "You need to move on" has the opposite effect.
Understood, but in my personal experience...
Your personal experience isn't germane here. We bring our education to the job, not our baggage.
It's good that your families live close. This becomes a primary relationship now. You're the last witnesses to each other's lives. You hold the memories.
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"?
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.
Don't mind Myrna. She's harmless.
She's handcuffed!
That's why she's harmless.
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.
Excuse me. Excuse me. I've been here for over five hours, okay, way longer than that chick. Can you check the list? Driscoll? Doug Driscoll.
E-everybody is seen as quickly as possible and in order of medical care needed.
Unless they die waiting.
Would you look at that, Mr. Driscoll? It's actually time to bring you back.
Thank God.
Would you take care of Mr. Driscoll?
Yeah, absolutely.
What can I do you for?
Hypothetical question would you ever go over a resident's head to the attending?
Hypothetically, I wouldn't recommend it unless it's a behavioral issue or harassment. And in that case, you can make a confidential report to HR.
What if it's more patient care related?
Depends. If it's something minor, leave it alone. If it's something that endangers the patient, then definitely yes. Pick your battles. You don't want to be the intern who cried wolf.
Has Kiara been here yet?
No, who's Kiara?
Oh, she's the hospital social worker. She can help you out with, like, housing and childcare - and food and security
[to Dr. McKay] You told her?
No, I-I...
No, no, it's all free. The system works if you use it. You just have to...
Enough!
I don't need your help. Nice speech. Next time, mind your own business.
[McKay pulls Javadi to the hall]
You ever heard of impact over intent?
I would never intentionally embarrass anybody.
But you did. You didn't have a conversation with Sherry or ask her what she needed. Instead, you walked in here and told her what to do. You gotta slow down, take a beat, and listen instead of judging people. Look, maybe I have a better perspective because I've been on both sides, but we gotta try to at least put ourselves in their shoes. Listening and building trust will make us better doctors and better people.
Um, I'm sorry.
I'm not telling you this to reprimand you. I'm trying to teach you to help you.
Aren't board rounds at 2:00?
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.
Not this bullshit again.
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.
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.
OK? Good. That's it. Goodbye. Go.
[about Dr. Mohan] Hi, how's she doing?
Better. Faster.
Still need ten more of her.
Never thought I'd see the day where you'd wish for more Samiras.
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.
Mother of God. Really?
Dr. Robinavitch.
Gloria.
This is Dr. Tracy Morris, regional manager of ECQ America.
The contract management group.
It's a pleasure to meet you.
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.
A proposal?
Mm-hmm.
We're interested in having your emergency department join us.
The 500 or so ERs you have aren't enough?
What can I say? Business is good.
Yeah, for who?
Everyone benefits.
Do they, though? Your contract management's corporate mandate is profits for shareholders above everything else, yes?
Robby.
Dah-dah-dah.
Your hospital's board was very impressed with ECQ's metrics on patient satisfaction, throughput time, and billing collections.
Does your proposal include the part where you cut the pay for all my doctors?
Maybe I can find an incentive for you. How does regional medical director sound? Lighter workload, better benefits, stock options.
Did you go to business school or medical school?
Both. We look forward to your decision.
Of course.
Hopefully we'll get a chance to work together soon, Dr. Robinavitch.
[Dr. Morris leaves]
I can't believe you're seriously considering this.
Bottom line is, our current numbers aren't good, and theirs are.
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.
Well, you could have just said that.
I need you to care about patient-satisfaction scores.
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.
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.
Are you serious?
Yep. This is the Captain Morgan technique for hip reduction.
Who's Captain Morgan?
[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.
Like this?
Yeah. And you are gonna use your leg as a hinge to put anterior force on his femur.
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.
Yeah! OK.
Whoa!
Oh, shit... I mean, shoot.
And that is what a hip reduction feels like.
Neurocysticercosis, a parasite in your brain.
I thought I just had a migraine, but I have bugs in my head?
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?
No, no, you don't have a worm in your head.
You just said that I have...
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?
Larvae.
Is my brain like Swiss cheese? Am I dying?
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?
Unfortunately, no. The little calcified spots will stay there.
So there's gonna be a worm graveyard in my brain forever?
Yeah, but they're resting in peace.
Patients come in already in distress, and waiting only makes it worse.
Wait time has nothing to do with this.
Which is why we're seeing hospital workers like Dr. Collins get assaulted.
Assaulted?
It was a little push.
Which we're gonna take seriously. We risk our lives coming to work here every day. What if that mother had brought a weapon?
We have metal detectors.
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.
I can see that you're...
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.
I'll come back later.
That's not gonna help anything.
These quotes come from Wikiquote's The Pitt pages and are available under the Creative Commons Attribution-ShareAlike License.
